bluuebunny/crossref_metadata_2025 huggingface dataset:
From Hitler’s Sweater to Dinosaur Fossils: An Essentialist Outlook on Authenticity
Authors: van Gerven Dylan J. J. , Land-Zandstra Anne M. , Damsma Welmoet
Published: July 2019

Over the past two decades, the concept of authenticity has been the subject of considerable disagreement and debate. Although there have been attempts at reconciling various existing approaches, the literature is still short on a definition that is both practical and precise. This article proposes to make significant headway to that effect by suggesting that authenticity can be accounted for by an underlying psychological phenomenon known as essentialism. In making our case, we first provide an overview of present-day objectivist and constructivist positions and point out their shortcomings, after which we introduce an essentialist account of authenticity. We then argue essentialism has profound benefits over contemporary views and might be the best overarching framework we have, if we intend to reach consensus on the meaning of authenticity.
Malnutrition increases the 30-day complication and re-operation rates in hip fracture patients treated with total hip arthroplasty
Authors: Newman Jared M , Sodhi Nipun , Khlopas Anton , Piuzzi Nicolas S , Yakubek George A , Sultan Assem A , Klika Alison K , Higuera Carlos A , Mont Michael A
Published: July 2019

Introduction:

This study sought to determine the effect that malnutrition, defined as hypoalbuminemia, has on hip fracture patients treated with total hip arthroplasty (THA). Specifically, we evaluated: (1) demographics and perioperative data; (2) postoperative complications; and (3) re-operation rates.

Methods:

The National Surgical Quality Improvement Program database was utilised to identify hip fracture patients who underwent THA from 2008 to 2015. Propensity scores were calculated for the likelihood of having a preoperative albumin measurement. Hip fracture patients who underwent THA and had preoperative hypoalbuminemia (<3.5 g/dL) ( n = 569) were compared to those who had normal albumin levels (⩾3.5 g/dL) ( n = 1098) in terms of demographics and perioperative data. Regression models were adjusted for age, sex, modified Charlson/Deyo scores, and propensity scores to evaluate complication and re-operation rates.

Results:

Compared to controls, hypoalbuminemia patients were older (p = 0.006), more likely male ( p = 0.024), had higher Charlson/Deyo scores ( p = 0.0001), more likely smokers ( p < 0.0001), more likely functionally dependent ( p < 0.0001), had ASA scores ⩾3 ( p < 0.0001) and had longer LOS ( p < 0.0001). Compared to controls, hypoalbuminemia patients had 80% higher risk for any complication (OR = 1.80; 95% CI, 1.43–2.26), 113% higher risk for major complications (OR = 2.13; 95% CI, 1.31–3.48), and 79% higher risk for minor complications (OR = 1.79; 95% CI, 1.42–2.26), and 97% increased risk for re-operation (OR = 1.97; 95% CI, 1.20–3.23).

Conclusions:

The findings in the present study indicate the need to develop better pre- and postoperative medical and nutritional care for malnourished hip fracture patients who undergo THA in order to potentially mitigate their increased risk.
Tracing Septic Pollution Sources Using Synthetic DNA Tracers: Proof of Concept
Authors: Georgakakos Christine B , Richards Paul L , Walter M Todd
Published: July 2019

Contamination from septic systems is one of the most difficult sources of nonpoint source (NPS) pollution to quantify. Quantification is difficult in part because locating malfunctioning septic systems within a watershed is challenging. This study used synthetic-DNA-based tracers to track flows from 2 septic systems. Sample DNA was quantified using quantitative polymerase chain reaction (qPCR). This technology could be especially useful for simultaneously assessing multiple septic systems because there are essentially infinite unique combinations of DNA bases such that unique tracers could be engineered for each septic system. Two studies were conducted: the first, to determine whether the tracers move through septic systems (experiment 1), and the second, to determine whether the tracers were detectable at watershed scales (experiment 2). In both cases, clear, although complex, breakthrough curves were detected. Experiment 1 revealed possible preferential flow paths that might not have been otherwise obvious, indicative of short circuiting systems. This proof of concept suggests that these tracers could be applied to watersheds suspected of experiencing NPS septic system pollution.
A High Creatine Kinase Concentration Might Be a Sign of McArdle Disease in Patient With Type 1 Diabetes
Authors: Ugur Kader , Aydogan Yakup , Akgun Abdurrahman , Aydin Suleyman
Published: July 2019

Type 1 diabetes (the pancreas producing little or no insulin) is usually diagnosed in children and young adults and was previously known as juvenile diabetes. McArdle disease is a common metabolic defect caused by an inherited deficit of myophosphorylase. These 2 diseases might have some clinical heterogeneity. Here, we discuss a McArdle disease case where insulin-dependent diabetes overshadows its early diagnosis. In this case, an insulin-dependent 22-year-old female patient with diabetes mellitus had been on diabetes treatment for 15 years. Although her blood glucose was regulated, her anamnesis showed that muscle weakness, fatigue, cramps or myalgia never healed. Based on her anamnesis, the patient was asked to take a nonischemic forearm exercise test, which revealed significant elevation in levels of creatine kinase (5968-7906 U/L), but no increase was found in lactate concentration, but a slight increase in ammonia concentration (not statistically significant) at the end of the test made us consider McArdle disease. A genetic test was done to confirm this possibility. A homozygous c.2128_2130delTTC/p.Phe710del mutation was detected in the examination of exons of the PYGM gene, which confirmed the diagnosis of McArdle disease in our patient. According to the data, this is a rare case of McArdle disease with type 1 diabetes. During treatment for diabetes, if the above-mentioned symptoms are present in a patient, and especially if the patient’s creatine kinase concentration is high, muscle diseases should be suspected. Therefore, we suggest that this case report will provide new insight to clinicians on metabolic defects in this disease and increase the patient comfort. In such cases, an early diagnosis should reduce health costs.
Disarmament is the New War, Gold is the New Opium, and Ecohealth is the Historic Victim
Authors: Villar David , Schaeffer David J
Published: July 2019

In Colombia, the convergence of drug trafficking, illegal armed groups, and gold production and trade threatens peace and stability in the post-FARC (Revolutionary Armed Forces of Colombia) era, as had the narcotics trade previously. Armed groups and criminal organizations have increased and consolidated their influence over illegal mining and may be diverting US$5 billion from Colombia’s annual economy. As of 2014, 46% of the total area (78 939 ha) exploited for alluvial gold was in the Afro-Colombian Pacific States, in which unregulated mining was the main driver of deforestation. The informal job market represents 49% of the workforce and absent other economic alternatives, this workforce of ex-guerrillas, organized crime groups and corrupt officials will sustain the black markets that permeate gold mining. Human health consequences of unregulated gold mining are largely unrecognized, but include the spread of malaria and other insect-borne diseases, and we suggest diseases such as babesiosis.
Demographic Determinants of Influenza Vaccination and Infection, Brazos County, Texas, 2017
Authors: Akpalu Yao , Karaye Ibraheem , Anderson Julie , Mgbere Osaro , Horney Jennifer A
Published: July 2019

Background:

Seasonal influenza constitutes an enormous public health burden. The 2017-2018 influenza season was the most severe since the 2009 novel Influenza A (H1N1) pandemic. The State of Texas, like other states, experienced unusually high and persistent influenza activity.

Methods:

Data on confirmed cases of influenza and influenza-like illness (ILI) in Brazos County during December 2017 were collected by the Brazos County Health Department (BCHD) from medical records. Records of vaccine administered between January 1 and December 31, 2017 were collected from vaccination providers. The total number of influenza cases for 2017 was compiled from regular weekly influenza counts reported to BCHD by healthcare providers.

Results:

A total of 1651 cases of laboratory-confirmed influenza were reported in Brazos County residents in December 2017, 10 times more than that reported in December 2016. The highest rates of infection were in 2 ZIP codes where vaccination rates were also high. A total of 16 027 influenza vaccinations were given to individuals reporting a residential address in Brazos County in 2017. Vaccination coverage was lowest among adults aged 18 to 49, whereas those aged 65 or older and Hispanics were most likely to be hospitalized.

Discussion:

Overall, vaccination coverage in Brazos County, Texas is low, less than half of the Healthy People 2020 target. The development of health education materials and an increased use of social media, local television and radio, and communication methods that can reach parents, younger adults, and Hispanic residents are needed.
Quantitative analysis of dribble volumes and rates using three-dimensional reconstruction of X-ray and diffused back-illumination images of diesel sprays
Authors: Sechenyh Vitaliy , Duke Daniel J , Swantek Andrew B , Matusik Katarzyna E , Kastengren Alan L , Powell Christopher F , Viera Alberto , Payri Raul , Crua Cyril
Published: July 2019

Post-injection fuel dribble is known to lead to incomplete atomisation and combustion due to the release of slow-moving, and often surface-bound, liquid fuel after the end of injection. This can have a negative effect on engine emissions, performance and injector durability. To better quantify this phenomenon, we developed an image-processing approach to measure the volume of ligaments produced during the end of injection. We applied our processing approach to an Engine Combustion Network ‘Spray B’ 3-hole injector, using datasets from 220 injections generated by different research groups, to decouple the effect of gas temperature and pressure on the fuel dribble process. High-speed X-ray phase-contrast images obtained at room temperature conditions (297 K) at the Advanced Photon Source at Argonne National Laboratory, together with diffused back-illumination images captured at a wide range of temperature conditions (293–900 K) by CMT Motores Térmicos were analysed and compared quantitatively. We found a good agreement between image sets obtained by Argonne National Laboratory and CMT Motores Térmicos using different imaging techniques. The maximum dribble volume within the field of view of the imaging system and the mean rate of fuel dribble were considered as characteristic parameters of the fuel dribble process. Analysis showed that the absolute mean dribble rate increases with temperature when injection pressure is higher than 1000 bar and slightly decreases at high injection pressures (>500 bar) when temperature is close to 293 K. Larger maximum volumes of the fuel dribble were observed at lower gas temperatures (∼473 K) and low gas pressures (<30 bar), with a slight dependence on injection pressure.
Mode and Interviewer Effects in Egocentric Network Research
Authors: Fischer Claude S. , Bayham Lindsay
Published: July 2019

Surveys of egocentric networks are especially vulnerable to methods effects. This study combines a true experiment—random assignment of respondents to receive essentially identical questions from either an in-person interviewer or an online survey—with audio recordings of the in-person interviews. We asked over 850 respondents from a general population several different name-eliciting questions. Face-to-face interviews yielded more cooperation and higher-quality data but fewer names than did the web surveys. Exploring several explanations, we determine that interviewer differences account for the mode difference: Interviewers who consistently prompted respondents elicited as many alters as did the web survey and substantially more than did less active interviewers. Although both methods effects substantially influenced the volume of alters listed, they did not substantially modify associations of other variables with volume.
RANKL Gene Polymorphism as a Potential Biomarker to Identify Acute Charcot Foot Among Indian Population With Type 2 Diabetes: A Preliminary Report
Authors: SaiPrathiba A. , Senthil G. , Juttada Udyama , Selvaraj Bamila , Kumpatla Satyavani , Viswanathan Vijay
Published: July 2019

Studies addressing the link between gene polymorphism and Charcot neuropathic osteoarthopathy (CN) have been limited to analyse osteoprotegerin gene. Aim is to understand the association of RANKL gene variants on the susceptibility of diabetic neuropathy and CN and to measure the serum levels of sRANKL among Indian population with type 2 diabetes. 77 subjects (48 males: 29 females) were recruited and divided into 3 groups. Group 1 Control: normal glucose tolerance (NGT). Group 2: Type 2 diabetes mellitus and neuropathy (DPN). Group 3: Established type 2 diabetes mellitus, DPN, and CN. Subjects were genotyped for RANKL SNP 693 C/G and 643 C/T using polymerase chain reaction-restriction fragment length polymorphism. sRANKL levels were measured using ELISA (enzyme-linked immunosorbent assay). The serum levels of sRANKL were significantly different between the 3 groups. In RANKL -643 C/T the frequency of “CT” genotype and the minor allele “T” was greater among the DPN and CN group compared with the NGT. Further statistical analysis found a significant difference in genotypic frequencies between DPN and NGT subjects with CT genotype. In RANK L -693 C/G the frequency of homozygote mutant “GG” and the minor allele “G” was greater among the DPN and CN group compared with the NGT. Significant differences in genomic frequencies were observed among “GG” genotype. RANKL -643 C/T was significantly associated with DPN alone while -693 C/G was significantly associated with both DPN and CN. Thus, the study suggests RANKL polymorphism might be considered as an independent risk factor for the development of CN.
Predictive Value of Slow and Fast EEG Oscillations for Methylphenidate Response in ADHD
Authors: Sari Gokten Emel , Tulay Emine Elif , Beser Birsu , Elagoz Yuksel Mine , Arikan Kemal , Tarhan Nevzat , Metin Baris
Published: July 2019

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder and is characterized by symptoms of inattention and/or hyperactivity and impulsivity. In the current study, we obtained quantitative EEG (QEEG) recordings of 51 children aged between 6 and 12 years before the initiation of methylphenidate treatment. The relationship between changes in the scores of ADHD symptoms and initial QEEG features (power/power ratios values) were assessed. In addition, the children were classified as responder and nonresponder according to the ratio of their response to the medication (>25% improvement after medication). Logistic regression analyses were performed to analyze the accuracy of QEEG features for predicting responders. The findings indicate that patients with increased delta power at F8, theta power at Fz, F4, C3, Cz, T5, and gamma power at T6 and decreased beta powers at F8 and P3 showed more improvement in ADHD hyperactivity symptoms. In addition, increased delta/beta power ratio at F8 and theta/beta power ratio at F8, F3, Fz, F4, C3, Cz, P3, and T5 showed negative correlations with Conners’ score difference of hyperactivity as well. This means, those with greater theta/beta and delta/beta powers showed more improvement in hyperactivity following medication. Theta power at Cz and T5 and theta/beta power ratios at C3, Cz, and T5 have significantly classified responders and nonresponders according to the logistic binary regression analysis. The results show that slow and fast oscillations may have predictive value for treatment response in ADHD. Future studies should seek for more sensitive biomarkers.
Transcranial Direct Current Stimulation for Treatment-Resistant Major Depression: A Double-Blind Randomized Sham-Controlled Trial
Authors: Sharafi Elham , Taghva Arsia , Arbabi Mohammad , Dadarkhah Afsaneh , Ghaderi Jamshid
Published: July 2019

In the current study, we tried to evaluate the effect of transcranial direct current stimulation (tDCS) on treatment-resistant major depression. We carried out a double-blind randomized sham-controlled trial was conducted in University Hospitals. Individuals with less than 50% decrease in the intensity of depression after 8 weeks of treatment with selective serotonin reuptake inhibitors were recruited. Thirty patients (16 women) with a mean (SD) age of 47.2 (12.0) years were randomly allocated to 2 groups. For the active group we administered 2-mA stimulation 20 minutes for each session, with 30 seconds ramp-up from 0 and 30 seconds ramp-down. For the sham group we administered 30 seconds ramp-up to 2 mA, 10 seconds stimulation, 30 seconds ramp-down, and 20 minutes no current. The anode was fixed on the center of F3, and the cathode on F4, over the dorsolateral prefrontal cortex. We assessed the Hamilton Depression Rating Scale at the baseline (mean difference = 1.0, P = .630), at the last session of tDCS, and at 1-month postintervention. There were statistically significant differences in the mean Hamilton scores after the intervention, and 1 month later in favor of active group; P < .001, and P = .003, respectively. Mixed analysis of variance showed a significant difference in the mean scores for active group P = .010 and pattern of change during the study P < .001 in favor of active intervention. We concluded that tDCS is an efficient therapy for patients with resistant major depression, and the benefits would remain at least for 1 month.
A robotic shared control teleoperation method based on learning from demonstrations
Authors: Xi Bao , Wang Shuo , Ye Xuemei , Cai Yinghao , Lu Tao , Wang Rui
Published: July 2019

In teleoperation, the operator is often required to command the motion of the remote robot and monitor its behavior. However, such an interaction demands a heavy workload from a human operator when facing with complex tasks and dynamic environments. In this article, we propose a shared control method to assist the operator in the manipulation tasks to reduce the workload and improve the efficiency. We adopt a task-parameterized hidden semi-Markov model to learn a manipulation skill from several human demonstrations. We utilize the learned model to predict the manipulation target given the current observed robotic motion trajectory and subsequently estimate the desired robotic motion given the current input of the operator. The estimated robotic motion is then utilized to correct the input of the operator to provide manipulation assistance. In addition, a set of virtual reality devices are used to capture the operator’s motion and display the vision feedback from the remote site. We evaluate our approach through two manipulation tasks with a dual-arm robot. The experimental results show the effectiveness of the proposed method.
5-Carbohydrazide and 5-carbonylazide of pyrazolo[3,4-b]pyridines as reactive intermediates in the synthesis of various heterocyclic derivatives
Authors: Aly Ashraf A , El-Emary Talaat I , Mourad Aboul-Fetouh E , Khallaf Alyan Zainab , Bräse Stefan , Nieger Martin
Published: July 2019

5-Carbohydrazides and 5-carbonylazides of pyrazolo[3,4- b]pyridines are used to synthesize new heterocyclic derivatives. Some unexpected behaviors are observed in the reactions of the above two species. The structures of the obtained compounds are proved by spectroscopic studies together with elemental and X-ray structure analyses.
Characterization and Quantitation of Polyphenolic Compounds in Senna macranthera var pudibunda From the Northeast of Brazil
Authors: Maia Irvila Ricarte de O. , Trevisan Maria Teresa Salles , Silva Maria Goretti de V. , Breuer Andrea , Owen Robert W.
Published: July 2019

Until recently, there was a lack of information on the phytochemical composition of the taxon Senna. Recent reports show that Senna splendida, Senna gardneri, and Senna georcica are characterized by profiles dominated by flavonoids, naphthapyrones, and stilbenes. Here, we studied the phytochemical composition of Senna macranthera var pudibunda (Benth) Irwin & Barneby for comparison. A total of 26 polyphenolic compounds were identified in methanol extracts of various botanical parts of Senna macranthera var pudibunda (Benth.) Irwin & Barneby. The higher concentration (on a dry weight basis) of polyphenolic compounds was detected in the leaves (48.55 g/kg), bark (21.26 g/kg), and roots (17.08 g/kg), whereas a lower concentration of polyphenolic compounds was detected in the fruits (6.67 g/kg). The polyphenolic profiles of the various botanical parts were dominated by flavan-3-ols and flavan-3-ol dimers. The bark and roots contained only these components (100%), whereas flavonoids were also identified as minor components in the leaves (15.7%) and the fruits (5.6%), respectively. The flavan-3-ol conjugates comprised the well-known procyanidins, along with the rarely reported afzelechin, giobourtinidol and procassinidin dimers.
Carotenoid Composition of Cionosicyos macranthus Fruit
Authors: Murillo Enrique , Watts Moises , Reyna Gabriel , Giuffrida Daniele , Durant-Archibold Armando A.
Published: July 2019

A complete determination of the carotenoid composition of the edible aril and mesocarp of Cionosicyos macranthus fruit is reported for the first time. The carotenoids present in the fruit were identified and quantified using high-purity carotenoid standards. The fruit contained several rare carotenoids like zeaxanthin, β-cryptoxanthin, and cryptocapsin epoxides. Various keto-κ end-ring carotenoids, derivatives of their corresponding epoxides, ie cryptocapsin, capsanthin, capsanthin 5,6-epoxide, and capsoneoxanthin, were also identified. The total carotenoid contents for the aril and mesocarp were 226.0 μg/g and 83.4 µg/g, respectively. β-Cryptoxanthin was the most abundant carotenoid in both edible parts (58.3 μg/g in the aril and 29.5 μg/g in the mesocarp). Cryptocapsin was the primary keto-κ end-ring carotenoid both in the aril (41.6 μg/g) and in the mesocarp (13.2 μg/g). The fruit provitamin A activity was also determined. Considering the high β-cryptoxanthin and cryptocapsin contents, C. macranthus can be considered a good source of provitamin A carotenoids.
Chemical Composition of the Essential Oils From Twigs, Leaves, and Cones of Thuja plicata and Its Cultivar Varieties “Fastigiata”, “Kornik,” and “Zebrina”
Authors: Lis Anna , Swaczyna Agata , Krajewska Agnieszka , Mellor Karolina
Published: July 2019

The essential oils from different parts of Thuja plicata and its cultivar varieties “Fastigiata”, “Kornik,” and “Zebrina” were analyzed by gas chromatography (GC) and GC/mass spectrometry. More than 80 compounds were identified. The oils from leaves, twigs with leaves, and twigs without leaves contained mainly α-thujone (52.1%-59.2%), fenchone (10.0%-11.3%), and beyerene (3.7%-9.5%), whereas in the cone oil there were α-thujone (35.6%), sabinene (24.0%), and α-pinene (8.3%). The main constituents of the oils from twigs with leaves of “Fastigiata,” “Zebrina,” and “Kornik” cultivars were α-thujone (76.2%, 72.5%, and 67.4%, respectively) and β-thujone (7.6%, 6.2%, and 4.9%, respectively). The oils from cultivars contained more thujones and less fenchone and diterpenes in comparison with T. plicata oil.
iPads or computer labs? A technical communication classroom study
Authors: Watkins Robert , Smith Diantha , McBeth Mark
Published: July 2019

For some schools, using iPads instead of computer labs can be a cost- and space-saving endeavour. We decided to test students’ attitudes toward tablet functions and confidence in classroom objectives in three technical communication courses by administering a pre- and post-test. Two classes used iPads and one did not (the control). We analysed the data and triangulated it with classroom observations. We found that attitudes toward tablets did not change but confidences did, particularly in document design. We analyse the reasons for this and look at potential takeaways on a pedagogical level before addressing if these results can guide administrators contemplating purchasing tablets for the classroom. The study looks at current research in tablet pedagogy, discusses our classroom and study methodology, analyses the results, triangulates student responses with our observations and implicates conclusions while looking to future research angles.
Dialoguing with the silent researcher: Rethinking the role of the transcriptionist in qualitative research
Authors: Hurst Heather , McCallum Kathryn , Tilles Sara
Published: July 2019

Even though transcription is a mainstay of qualitative research, transcription itself is rarely present in discussions of data collection or analysis. A meager body of literature exists that considers transcription as theory, but such literature tends to focus on the transcriptionist’s choices. We have few empirical studies on transcription and the role of the transcriptionist. Drawing on frameworks of literacy as a sociocultural process and post-structural feminism, we investigate two cases that demonstrate how the transcriptionist can assume a generative role in research projects. Our data reveal how the transcriptionist shared interpretations, helped make methodological decisions, and was a reader who knew the full body of data. We argue for a reframing of our collective understanding of the transcriptionist and consider the benefits of, limitations to, and ethical issues in involving transcriptionists explicitly as co-researchers.
Narcotic Use and Resiliency Scores Do Not Predict Changes in Sleep Quality 6 Months After Arthroscopic Rotator Cuff Repair
Authors: Glogovac Georgina , Schumaier Adam P. , Kennedy Mark E. , Schramm Violet T. , Wells Julius , Hasselfeld Kimberly A. , Grawe Brian M.
Published: July 2019

Background:

Patients with rotator cuff disease commonly complain of difficulty sleeping. Arthroscopic repair has been associated with improved sleep quality in many patients with rotator cuff tears; however, some individuals continue to suffer from sleep disturbance postoperatively.

Purpose:

To determine whether changes in sleep quality following rotator cuff repair are predicted by a patient’s narcotic use or ability to cope with stress (resilience).

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 48 patients undergoing arthroscopic rotator cuff repair were prospectively enrolled and completed the Connor-Davidson Resilience Scale (CD-RISC) preoperatively. The Pittsburgh Sleep Quality Index (PSQI) was administered preoperatively and at multiple intervals postoperatively for 6 months. Narcotic utilization was determined via a legal prescriber database. Pre- and postoperative sleep scores were compared using paired t tests and the McNemar test. Linear regression was used to determine whether narcotic use or CD-RISC score predicted changes in sleep quality.

Results:

An increased number of patients experienced good sleep at 6 months postoperatively ( P < .01). Mean ± SD nocturnal pain frequency improved from 2.5 ± 1.0 at baseline to 0.9 ± 1.1 at 6 months. CD-RISC score had a positive predictive value on changes in PSQI score ( R 2 = 0.09, P = .028) and nocturnal pain frequency ( R 2 = 0.08, P = .041) at 2 weeks. Narcotic use did not significantly predict changes in PSQI score or nocturnal pain frequency ( P > .05).

Conclusion:

Most patients with rotator cuff disease will experience improvement in sleep quality following arthroscopic repair. Patients demonstrated notable improvements in nocturnal pain frequency as soon as 6 weeks following surgery. CD-RISC resiliency scores had a significant positive predictive value on changes in sleep quality and nocturnal pain frequency at 2 weeks. Narcotic use was not associated with change in sleep quality.
Development, Implementation, and Evaluation of a Physician-Targeted Inpatient Glycemic Management Curriculum
Authors: Mathioudakis Nestoras , Bashura Holly , Boyér LaPricia , Langan Susan , Padmanaban Bama S , Fayzullin Shamil , Sokolinsky Sam , Hill Golden Sherita
Published: July 2019

Objective:

Diabetes is prevalent among hospitalized patients and there are multiple challenges to attaining glycemic control in the hospital setting. We sought to develop an inpatient glycemic management curriculum with stakeholder input and to evaluate the effectiveness of this educational program on glycemic control in hospitalized patients.

Methods:

Using the Six-Step Approach of Kern to Curriculum Development for Medical Education, we developed and implemented an educational curriculum for inpatient glycemic management targeted to internal medicine residents and hospitalists. We surveyed physicians (n = 73) and conducted focus group sessions (n = 18 physicians) to solicit input regarding educational deficits and desired format of the educational intervention. Based on feedback from the surveys and focus groups, we developed educational goals and objectives and a case-based curriculum, which was delivered over a 1-year period via in-person teaching sessions by 2 experienced diabetes physicians at 3 hospitals. Rates of hypoglycemia and hyperglycemia were evaluated among at-risk patient days using an interrupted time-series design.

Results:

We developed a mnemonic-based (SIGNAL) curriculum consisting of 10 modules, which covers key concepts of inpatient glycemic management and provides an approach to daily glycemic management: S = steroids, I = insulin, G = glucose, N = nutritional status, A = added dextrose, and L = labs. Following implementation of the curriculum, there was no difference in the rates of hyperglycemia in insulin-treated patients following the intervention; however, there was an increase in the rates of hypoglycemia defined as blood glucose (BG) ⩽ 70 mg/dL (5.6% vs 3.0%, P < .001) and clinically significant hypoglycemia defined as BG < 54 mg/dL (1.9% vs 0.8%, P = .01). There was poor penetration of the curriculum, with 60%, 20%, and 90% of the learning modules being delivered at the three participating hospitals, respectively.

Conclusions:

In this pilot study, a physician-targeted educational curriculum was not associated with improved glycemic control. Adapting the intervention to increase penetration and integrating the curriculum into existing clinical decision support tools may improve the effectiveness of the educational program on glycemic outcomes.
Ancestral Fluoxetine Exposure Sensitizes Zebrafish to Venlafaxine-Induced Reductions in Cortisol and Spawning
Authors: Vera-Chang Marilyn N , Moon Thomas W , Trudeau Vance L
Published: July 2019

Owing to the prevalence of depression during childbearing, mothers can be prescribed multiple antidepressants; however, little is known about the risk and consequences to the offspring or subsequent generations. Fluoxetine (FLX) is usually the first-line of pharmacological treatment for affective disorders in pregnant women, with venlafaxine (VEN) used as secondary treatment. Given that FLX and VEN readily cross the placenta, a fetus from a treated pregnant woman is potentially at risk of the endocrine disruptive effects of these chemicals. Pharmaceutical agents, including FLX and VEN, reach aquatic ecosystems through sewage release; thus, fish could also be inadvertently affected. We report the results from a 6-day FLX exposure during early zebrafish development to an environmentally relevant level (0.54 µg/L in water) and a concentration detected in the cord blood of FLX-treated pregnant women (54 µg/L in water). The FLX exposure reduced the stress response (arithmetic difference between the stress-induced and unstressed whole-body cortisol levels) in the adult female and male zebrafish, an effect that persisted for four generations. To model the possibility of a second antidepressant exposure, filial generation 4 was exposed to VEN (5 µg/L). We found that FLX exposure sensitized these descendants to VEN. VEN treatment further suppressed cortisol production in females and decreased spawning rates in adult pairs. This is an important demonstration that in an animal model, a brief ancestral exposure of great-great-grandparents to the selective serotonin reuptake inhibitor FLX will shape the physiological responses of future generations to the serotonin and norepinephrine reuptake inhibitor VEN.
Treatment of Children With GH in the United States and Europe: Long-Term Follow-Up From NordiNet® IOS and ANSWER Program
Authors: Sävendahl Lars , Polak Michel , Backeljauw Philippe , Blair Jo , Miller Bradley S , Rohrer Tilman R , Pietropoli Alberto , Ostrow Vlady , Ross Judith
Published: July 2019

Context

Understanding real-world prescribing of GH may help improve treatment of eligible patients.

Objective

Overall: to assess real-world effectiveness and safety of GH (Norditropin). This analysis: to compare clinical characteristics of GH-treated children in the United States and Europe.

Design

The American Norditropin Studies: Web-Enabled Research Program (ANSWER; 2002 to 2016, United States) and the NordiNet International Outcome Study (NordiNet IOS; 2006 to 2016, Europe) were multicenter longitudinal observational cohort studies.

Setting

Data were recorded in 207 (United States) and 469 (Europe) clinics.

Participants

Patients with GH deficiency, Turner syndrome, Noonan syndrome, idiopathic short stature, Prader–Willi syndrome, or born small for gestational age, who commenced GH treatment aged <1 year.

Intervention

GH was prescribed by treating physicians according to local practice.

Main Outcomes Measures

Baseline data and drug doses were recorded. Data on effectiveness and safety were collected.

Results

ANSWER had 19,847 patients in the full analysis set (FAS; patients with birthdate information and one or more GH prescription) and 12,660 in the effectiveness analysis set (EAS; GH-naive patients with valid baseline information). NordiNet IOS had 17,711 (FAS) and 11,967 (EAS). Boys accounted for 69% (ANSWER) and 57% (NordiNet IOS). Treatment start occurred later than optimal to improve growth. The proportion of boys treated was generally larger, children were older at treatment start, and GH doses were higher in the United States vs Europe. No new safety signals of concern were noted.

Conclusions

In most indications, more boys than girls were treated, and treatment started late. Earlier diagnosis of GH-related disorders is needed. The data support a favorable benefit–risk profile of GH therapy in children.
Hypothyroidism and Its Association With Sleep Apnea Among Adults in the United States: NHANES 2007–2008
Authors: Thavaraputta Subhanudh , Dennis Jeff A , Laoveeravat Passisd , Nugent Kenneth , Rivas Ana M
Published: July 2019

Context

The association between hypothyroidism and sleep apnea (SA) has been studied, but results are conflicting and based mostly on small studies.

Objective

To determine whether there is a positive association between hypothyroidism and SA in the US population.

Design

Cross-sectional study.

Setting

US National Health and Nutrition Examination Survey, 2007–2008.

Participants

We included all subjects ≥18 years old who met inclusion criteria. Participants not on antithyroid medication with a TSH >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorized as hypothyroid. Participants not on thyroid hormone replacement or antithyroid medication who had a TSH ≥0.34 and ≤5.6 mIU/L were categorized as euthyroid. The diagnosis of SA was based on participants’ response when asked whether they had been diagnosed with SA by their doctors.

Main Outcome Measures

Multivariate logistic regression analyses were performed to determine the association between hypothyroidism and SA.

Results

A total of 5515 adults were included for data analysis. The prevalence of hypothyroidism and hyperthyroidism was calculated at 9.47% and 1.19%, respectively. Multivariate logistic regression analysis adjusted for demographics, health care access, body mass index, socioeconomic factors, alcohol use, smoking, and other comorbidities demonstrated a significant association between hypothyroidism and SA (OR = 1.88, 95% CI, 1.24 to 2.84, P < 0.01).

Conclusion

Hypothyroidism is associated with SA after adjustment for potential confounding variables.
Appetite Control Is Improved by Acute Increases in Energy Turnover at Different Levels of Energy Balance
Authors: Hägele Franziska A , Büsing Franziska , Nas Alessa , Hasler Mario , Müller Manfred J , Blundell John E , Bosy-Westphal Anja
Published: July 2019

Background

Weight control is hypothesized to be improved when physical activity and energy intake are both high [high energy turnover (ET)].

Objective

The impact of three levels of ET on short-term appetite control is therefore investigated at fixed levels of energy balance.

Design

In a randomized crossover trial, 16 healthy adults (25.1 ± 3.9 y of age; body mass index, 24.0 ± 3.2 kg/m2) spent three daylong protocols for four times in a metabolic chamber. Four conditions of energy balance (ad libitum energy intake, zero energy balance, −25% caloric restriction, and +25% overfeeding) were each performed at three levels of ET (PAL 1.3 low, 1.6 medium, and 1.8 high ET; by walking on a treadmill). Levels of appetite hormones ghrelin, GLP-1, and insulin (total area under the curve) were measured during 14 hours. Subjective appetite ratings were assessed by visual analog scales.

Results

Compared with high ET, low ET led to decreased GLP-1 (at all energy balance conditions: P < 0.001) and increased ghrelin concentrations (caloric restriction and overfeeding: P < 0.001), which was consistent with higher feelings of hunger (zero energy balance: P < 0.001) and desire to eat (all energy balance conditions: P < 0.05) and a positive energy balance during ad libitum intake (+17.5%; P < 0.001).

Conclusion

Appetite is regulated more effectively at a high level of ET, whereas overeating and consequently weight gain are likely to occur at low levels of ET. In contrast to the prevailing concept of body weight control, the positive impact of physical activity is independent from burning up more calories and is explained by improved appetite sensations.
Cardiometabolic Risk Profile Among Young Adult Females With a History of Premature Adrenarche
Authors: Liimatta Jani , Utriainen Pauliina , Laitinen Tomi , Voutilainen Raimo , Jääskeläinen Jarmo
Published: July 2019

Context

Premature adrenarche (PA) is associated with childhood overweight and hyperinsulinemia; the long-term cardiometabolic outcome is unknown.

Objective

To study cardiometabolic profile in adult women with previous PA.

Design and participants

Thirty women with PA and 41 control subjects were followed from prepuberty to young adulthood.

Main outcome measures

Prevalence of the metabolic syndrome (MetS) and clinical and biochemical cardiovascular risk factors.

Results

There were no differences in the prevalence of MetS or in any parameters indicating dyslipidemia, hypertension, hepatosteatosis, atherosclerosis, or low-grade inflammation between the study groups. However, prevalence of insulin resistance (IR; P = 0.014) and acanthosis nigricans (P = 0.010) was higher in the PA group. Neither fasting glucose nor insulin concentrations differed between the study groups, but HbA1c [adjusted for body mass index (BMI) P = 0.011] and Homeostatic Model Assessment of Insulin Resistance (P = 0.044; BMI-adjusted P = nonsignificant) were higher in the PA group. Although BMI and fat percentage were comparable between the study groups, the PA group had higher central fat mass than the control group. In the whole study population, MetS and IR were associated with greater adult fat mass, but no prepubertal factors predicting later IR were found.

Conclusion

PA does not seem to be associated with MetS, dyslipidemia, hypertension, atherosclerosis, or low-grade inflammation in young adult women. However, some women with PA may be at an increased risk of unfavorable glucose metabolism, which is associated with increased central adiposity at adult age rather than determined by prepubertal factors.
Matrix-assisted ionisation in vacuum mass spectrometry and imaging on a modified quadrupole-quadrupole-time-of-flight mass spectrometer
Authors: Harding Alex , Hough James , Curtis Charlotte , Kinsman Daniel , Clench Malcolm
Published: July 2019

Matrix-Assisted Ionisation in Vacuum (MAIV) is a new ionisation technique which ionises non-volatile compounds producing electrospray ionisation-like spectra. Its simple, matrix-assisted laser desorption/ionisation-like sample preparation allows for rapid analysis, with no requirement for external energy in the form of a laser or high voltage to produce ions. Ionisation occurs when the matrix (often 3-nitrobenzonitrile) is exposed to sub-ambient pressure. Here, the first use of this revolutionary new ionisation technique to image biological samples is reported. A commercial quadrupole-quadrupole-time-of-flight mass spectrometer was modified to incorporate control of the ion source pressure and a reduced sampling cone orifice diameter. In initial experiments, optimisation of source pressure and matrix composition was carried out to increase the longevity of ion formation. It was noted during these experiments that ion production was only observed when the sample was directly under the sampling cone. Optimisation of sample extraction into the MAIV matrix by the addition of 5% chloroform enabled MAIV mass spectrometry imaging of lipids in rat brain sections to be carried out in raster imaging mode. Modification of the size and position of the sampling cone improved the selectivity obtainable in these images. Although the quality of these initial images is relatively poor, work is underway to improve the spatial resolution by further modification of the ion source and progress is reported.
Solution Focused brief therapy In post-stroke Aphasia (SOFIA Trial): protocol for a feasibility randomised controlled trial
Authors: Northcott Sarah , Simpson Alan , Thomas Shirley A. , Hirani Shashivadan P. , Flood Chris , Hilari Katerina
Published: July 2019

Background: Around a quarter of people post stroke will experience aphasia, a language disability. Having aphasia places someone at risk of becoming depressed and isolated. There is limited evidence for effective interventions to enhance psychological well-being for this client group. A potential intervention is Solution Focused Brief Therapy (SFBT), which supports a person to build meaningful, achievable change through focusing on a person’s skills and resources rather than their deficits. The SOFIA Trial aims to explore the acceptability of SFBT to people with varying presentations of aphasia, including severe aphasia, and to assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness.

Methods: The trial is a single-blind, randomised, wait-list controlled feasibility trial with nested qualitative research and pilot economic evaluation comparing SFBT plus usual care to usual care alone. The study will recruit 32 participants with aphasia who are ≥6 months post stroke. All participants will be assessed on psychosocial outcome measures at baseline, three, and six months post randomisation by assessors blinded to treatment allocation. Participants will be randomly assigned to intervention group (start intervention immediately post randomisation) or wait-list group (start intervention six months post randomisation). Wait-list group will additionally be assessed nine months post randomisation. The intervention consists of up to six SFBT sessions delivered over three months by speech and language therapists. Participants and therapists will also take part in in-depth interviews exploring their experiences of the study. The pilot economic evaluation will use the EQ-5D-5L measure and an adapted Client Service Receipt Inventory. People with aphasia have been involved in designing and monitoring the trial.

Discussion: Given the high levels of depression and isolation, there is a need to investigate effective interventions that enhance the psychological wellbeing of people with aphasia.

Trial registration: ClinicalTrials.gov NCT03245060 10/08/2017.
Graphic Algorithms for Constructing a Quadric, Given Nine Points
Authors: Короткий Виктор , Korotkiy Viktor
Published: July 2019

The fundamental issue of constructing a nine-point quadric was frequently discussed by mathematicians in the 19th century. They failed to find a simple linear geometric dependence that would join ten points of a quadric (similar to Pascal's theorem, which joins six points of a conic section). Nevertheless, they found different algorithms for a geometrically accurate construction (using straightedge and compass or even using straightedge alone) of any number of points of a quadric that passes through nine given points. While the algorithms are quite complex, they can be implemented only with the help of computer graphics. The paper proposes a simplified computer-based realization of J.H. Engel’s well-known algorithm, which makes it possible to define the ninepoint quadric metric. The proposed graphics algorithm can be considered an alternative to the algebraic solution of the stated problem. The article discusses two well-known graphical algorithms for constructing a quadric (the Rohn — Papperitz algorithm and the J.H. Engel algorithm) and proposes a simplified version of the J.H. algorithm. For its constructive implementation using computer graphics. All algorithms allow you to determine the set of points and the set of flat sections of the surface of the second order, given by nine points. The Rohn — Papperitz algorithm, based on the spatial configuration of Desargues, is best suited for its implementation on an axonometric drawing using 3D computer graphics. Algorithm J.H. Engel allows you to solve a problem on the plane. The proposed simplified constructive version of the algorithm J.H. Engel is supplemented with an algorithm for constructing the principal axes and symmetry planes of a quadric, given by nine points. The construction cannot be performed with a compass and a ruler, since this task reduces to finding the intersection points of two second-order curves with one known general point (third degree task). For its constructive solution, a computer program is used that performs the drawing of a second order curve defined by an arbitrarily specified set of five points and tangents (both real and imaginary). The proposed graphic algorithm can be considered as an alternative to the algebraic solution of the problem.