bluuebunny/crossref_metadata_2025 huggingface dataset:
What's the right model for the national blood programme?
Authors: Flanagan P.
Published: June 2016

Every country needs to define a national blood programme that ensures that an appropriate range of blood products is available to treat patients in a timely manner. Internationally, many different models exist for delivery of the programme. The most effective approach for any given country will be determined by a range of factors and may change over time. Government commitment and support is essential to successful implementation.
Governance and clinical transfusion
Authors: Benjamin Richard J.
Published: June 2016

Clinical governance was first introduced in the U.K. in response to catastrophic failures in a healthcare system focused on efficiency and cost containment. Lessons learned regarding management responsibility for patient outcomes can be applied to transfusion medicine. The concept of clinical governance will be explored in the context of the changing transfusion medicine environment. Blood collectors are regulated using current good manufacturing principles (cGMP) that ensure product quality, and the concepts of organizational corporate governance are well established. In contrast, the process of transfusion is considered medical practice. Clinical governance is a system through which organizations are accountable for continuously improving their patient services and safeguarding high standards of patient care by creating an environment in which clinical excellence will flourish. For transfusion, this incorporates ensuring staff have the appropriate training and their performance is audited. Certification in transfusion principles, continuous education and maintenance of skills are required. The clinical effectiveness of transfusion should be monitored, and research focused on ensuring appropriate transfusion indications. Hemovigilance systems focused on adverse outcomes highlight areas for potential improvement but only if data‐based interventions are implemented. An environment is necessary that fosters open reporting and discussion of problems, with formalized corrective action plans leading to continuous clinical quality improvement supported by risk management principles. Clinical governance principles should be applied to transfusion medicine in order to ensure optimum patient outcomes in an environment of limited resources, with responsibility firmly ensconced at the highest level of the organization.
Update on Indications for Red cell transfusion
Authors: Ang A. L.
Published: June 2016

The first successful blood transfusion in human took place in the early 19th century. However, blood transfusion became an established clinical practice only in the 20th century as the need to treat large numbers of war casualties during the First and Second World Wars propelled the improvement in transfusion‐related knowledge and technology, resulting in safer and more effective blood collection and transfusion. The benefits of blood (or red cell) transfusion were first recognized and demonstrated in patients with massive haemorrhage and haemorrhagic shock. In such patients, securing haemostasis remains the most important therapeutic goal. Red cell transfusion also helps to quickly restore arterial oxygen content, and together with other measures such as fluid resuscitation, it helps to restore oxygen delivery to tissues. For patients with non‐haemorrhagic isovolaemic anaemia or non‐massive bleed who are haemodynamically stable, there may be differences in their tolerance of anaemia due to variations in their ability to recruit physiological reserves depending on their age and comorbidities. Therefore, decision to transfuse red cells in these patients should not be based purely on their haemoglobin (Hb), but should also depend on their clinical assessment. As the randomized controlled trial on Transfusion Requirements in Critical Care was first published in the late 1990s, more randomized controlled trials were conducted, showing non‐inferiority of a restrictive transfusion strategy compared to a liberal strategy in most clinical settings despite a significantly lower transfusion requirement. However, a safe Hb threshold for red cell transfusion in high‐risk patients such as those with acute coronary syndrome remains unknown, and larger randomized controlled trials are needed.
Role of a perfusionist in patient blood management
Authors: Tara S. W. , Cheong R. H. E. , Boonkiangwong N.
Published: June 2016

Perfusionists are essential members of the cardiac surgery team. They provide cardiopulmonary support for patients undergoing various cardiac surgeries with the use of the cardiopulmonary bypass (CPB) machine. This takes over the functions of a patient's native heart and lungs. Blood from the patient is drained (typically from the right atrium) into the CPB circuit where it gets oxygenated and then pumped back to the patient's aorta. It is important that the extracorporeal circulation of the CPB meets the oxygen demands of the patient. Central in this oxygen demand–supply relationship between the patient and CPB is blood and its components. Cardiac surgery involves many situations that may necessitate transfusion of blood products. CPB and its circuit components, albeit vital, are one of the major contributors to transfusion. It represents the single largest acute source of exogenous non‐hemic volume infused into a patient at the commencement of CPB. Anticoagulation is also fundamental due to the foreign surfaces of CPB. Systemic cooling of the patient on CPB is another contributor of transfusion. At the National University Hospital, Singapore, measures, both in terms of practices and devices, have been put in place to minimize transfusion. Switching to albumin prime and maintaining mild hypothermia may help reduce prime‐ and hypothermia‐induced coagulopathy. Additionally, devices such as the haemofilter and cell saver can aid in concentrating and recycling patient's own shed blood. Despite each having its own limitations, together, they help to minimize patients receiving homologous blood in the course of their surgery.
Lessons from sheep models of transfusion
Authors: Fung Y. L. , Simonova G. , Tung J.‐P.
Published: June 2016

Background

Animal models have been a valuable tool for research into blood products and outcomes of blood transfusions. Small animal models have been applied extensively and large animal models less frequently. This review describes the experience and details the findings from a recent series of in vivo sheep transfusion models.

Aims & Method

To discuss: (i) the benefits of sheep as a large animal transfusion model; and (ii) review conclusions from a series of sheep transfusion models.

Results & Discussion

Similarities in size, anatomy and physiology of sheep compared to humans have supported the use of sheep to model a wide range of human diseases, enabled continuous physiological monitoring using standard human techniques, and the collection of multiple and serial samples.

Conclusion

The findings discussed demonstrate that sheep are effective models of the blood donor, donations and of transfusion recipients. Importantly, they also define limitations of ovine models, which need to be considered when designing in vivo sheep models of transfusion.
The problem with hepatitis
Authors: Satake M.
Published: June 2016

Background and Objectives

In the era of NAT, strategies to further eradicate transfusion‐transmitted (TT) HCV and HBV should be clarified. Whether or not to introduce NAT for HEV is a controversial issue.

Materials and Methods

Recent voluntary reports of suspected TT‐HCV were thoroughly evaluated for causal relationship with transfusion. Donor infection status of HBV was assessed for TT‐HBV in relation to the change of screening strategy.

Results

Even after the introduction of NAT, reports for suspected TT‐HCV continued, almost all of which were denied for TT‐HCV. Window period‐related TT‐HBV was mitigated only with the introduction of individual donation NAT, but there still remains the risk due to the donation with very low viral load below NAT sensitivity. Occult HBV infection‐related TT‐HBV was prevented by total rejection of HBcAb‐positive blood. HEV‐viremic donation could amount to several hundred a year in Japan.

Conclusion

The risk of nosocomial HCV infection seems higher than the residual risk of TT‐HCV infection. Individual donation NAT combined with total rejection of HBcAb‐positive donation is the best policy for the eradication of TT‐HBV. Whether or not to screen for HEV should be determined considering viremic donation frequency, HEV transmissibility through transfusion, disease severity, clinical outcome after chronicity, and cost.
Therapeutic apheresis
Authors: Triyono T.
Published: June 2016

Apheresis is a procedure to separate and collect or remove a particular blood component. Apheresis may be used for collecting a therapeutic dose of component, remove the circulating amount of harmful component/substances, or collect a particular blood cell/precursor from a patient for reinfusion. Therapeutic plasma exchange (TPE) is a therapeutic procedure in which the plasma is removed and replaced with a replacement solution. It is used primarily for the removal of pathological immunoglobulin. Red cell exchange is a procedure in which the patient's red cells are removed and replaced with the donor red cells. It is usually used in the case of sickle cell disease to prevent stroke. Mononuclear cell collection is a procedure used primarily to collect peripheral blood haemopoietic progenitor cells (HPC) for autologous or allogeneic transplantation. As the most frequently performed procedures, they will be described in some detail in this article. Therapeutic leucapheresis and thrombocytapheresis are less frequently performed and will be mentioned briefly.
Update on donor recruitment and management in blood service
Authors: Lee C. K.
Published: June 2016

Voluntary non‐remunerated blood donation is the cornerstone of modern blood service which depends largely on community support and participation. Over the years, several efforts have been made on the adequacy of blood donation and blood safety. Although, significant improvement in blood safety profile has been seen, challenges in safety and adequacy still abound in every country. Since blood transfusion will never diminish, a balance between matching the right blood supply and managing the donors’ expectation need serious consideration. Besides, counteracting factors including ageing population/donors, population migration, socio‐economic factors and the increasing stringent donor selection criteria could definitely add to the difficulties. At the same time, the traditional intention for donation – ‘Give Blood Save Lives’ is no longer adequate nowadays, to reflect their expectations. Therefore, transfusion services have been working on ways to refresh and revisit the current donor recruitment and its management. Wide spread use of social media and data analysis in blood donation settings are typical examples which enabled them have a totally different approach in reaching and understanding donor behaviours. While those can either be passively originated from the donors or proactively disseminated from the blood service, they all create a dynamic and interactive culture among donors, blood services and the communities at large. With proper strategies, targeted donors (right age, sex, blood groups or others) are reached, donate blood and return to subsequent donation at their expectation. In summary, some challenges and possible solutions have been discussed to allow blood service operators revisit their needs as well as adapt and revise for their own applications.
Getting the right unit to the right patient – how can we fix the problem
Authors: Ayob Y.
Published: June 2016

Blood transfusion has inherent risks such as transmission of infectious agents and vulnerabilities to transfusion reactions and complications, but there also exists the possibility of hazards associated with process errors and suboptimal care during the transfusion process. The process of blood transfusion is complex, and at every stage of the blood transfusion process, error may occur. These errors are traditionally blamed on humans, but often they are due to preexisting factors, procedures and policies. Investigating the root cause of these errors provide opportunities for corrective actions which should be an ongoing activity. Patient safety should be our ultimate objective. It is necessary to determine the magnitude of these errors, when they occur and why they occur. These errors are preventable and it is important that the causes of these errors are identified and rectified. Many studies and haemovigilance reports have documented errors at all stages of the transfusion process. Initially, these were addressed by education and training programmes, but with limited success. However, system approach views most errors occurring due to poorly designed systems. Essentially, better processes, not greater individual efforts, produce the greatest impact on reducing and preventing error. Adopting this concept will change the way we introduce remedial measure to ensure that the right blood is transfused into the right patient. Substantial gains in efficiency and safety have been made with a variety of technological innovations, and transfusion is now a remarkably safe procedure, but there is still a need to review systems for vulnerabilities.
Pathogen reduction technology – is it time?
Authors: Kwon S.‐Y.
Published: June 2016

With the application of stringent donor selection criteria and screening tests, the risk of the so‐called traditional transfusion‐transmitted infections has dramatically decreased. However, breakthrough cases are still being reported. Known pathogens that are not screened for and emerging pathogens represent a constant threat. Moreover, bacterial contamination remains the major infectious risk in blood transfusion. Pathogen reduction (PR) technology represents a proactive approach to our blood safety paradigm.PRtechnology for platelets and plasma has been approved in Europe for more than 10 years. AlthoughPRefficacy against non‐enveloped viruses and spore forming bacteria is less satisfactory, these technologies show a robustPRcapability for a broad spectrum of pathogens. According to current data, transfusion reactions after transfusion of treated platelets are comparable to that of non‐treated platelets and transfusion of treated platelets does not increase bleeding. SincePRtechnologies target nucleic acids, they inactivate leucocytes, thereby preventing non‐infectious risks like transfusion‐associated graft‐versus‐host disease and febrile non‐haemolytic transfusion reactions. Despite the multiple risks averted through pathogen reduction, the cost to implement these technologies remains a major issue. On the other hand, pathogen reduction could be an alternative to bacterial screening and gamma irradiation. Furthermore, cessation of some of the current screening items and modification of some donor exclusion criteria might be possible, especially whenPRtechnology for red blood cells or whole blood becomes available. Therefore, if we consider all correlated efforts involved to make blood transfusion safe, the introduction of thePRtechnology might prove to be beneficial.
Laparoscopic placement and urodynamic effects of an artificial urethral sphincter in cadaveric dogs
Authors: Luckring Emilee J. , Ham Kathleen , Adin Christopher A. , McLoughlin Mary A. , Stull Jason W.
Published: June 2016

Objective

To describe a laparoscopic approach for placement of a percutaneously controlled artificial urethral sphincter (AUS) in female cadaver dogs and compare the change in urethral pressure and lumen diameter after filling the device.

Study Design

Experimental study.

Animals

Canine female cadavers (n = 10).

Methods

A laparoscopic technique was used to implant the AUS in 10 cadaver dogs. Maximum urethral closure pressure (MUCP), cystourethral leak point pressure (CLPP), and urethral luminal area were measured at 0, 25, 50, and 75% cuff inflation. Necropsy was performed after urethral pressure profilometry and cystoscopy data collection to assess for trauma caused by the procedure.

Results

Laparoscopic implantation was performed successfully in all 10 cadavers with no evidence of inadvertent trauma. Median MUCP at 0% AUS fill (48.9 cmH2O) was significantly lower than 75% fill (243.5 cmH2O). Median CLPP at 0% fill (5.0 cmH2O) was significantly lower than 75% fill (23.2 cmH2O). Significant differences were also found comparing urodynamic values 25 to 50%, 25 to 75%, and 50 to 75%. Cystoscopic evaluation revealed progressive decreases in urethral lumen area and significant differences between the urethral luminal area values as the AUS cuff was inflated.

Conclusion

Laparoscopic placement of an AUS can be performed successfully in cadaver dogs, improved urethral pressure profile parameters, and visibly occluded the urethral lumen. Further studies of laparoscopic placement in clinical cases affected by urethral sphincter mechanism incompetence are warranted.
Role of Cl−–HCO3− exchanger AE3 in intracellular pH homeostasis in cultured murine hippocampal neurons, and in crosstalk to adjacent astrocytes
Authors: Salameh Ahlam I. , Hübner Christian A. , Boron Walter F.
Published: June 2016

Key points

A polymorphism of human AE3 is associated with idiopathic generalized epilepsy. Knockout of AE3 in mice lowers the threshold for triggering epileptic seizures. The explanations for these effects are elusive.

Comparisons of cells from wild‐type vs. AE3–/– mice show that AE3 (present in hippocampal neurons, not astrocytes; mediates HCO3– efflux) enhances intracellular pH (pHi) recovery (decrease) from alkali loads in neurons and, surprisingly, adjacent astrocytes.

During metabolic acidosis (MAc), AE3 speeds initial acidification, but limits the extent of pHi decrease in neurons and astrocytes.

AE3 speeds re‐alkalization after removal of MAc in neurons and astrocytes, and speeds neuronal pHi recovery from an ammonium prepulse‐induced acid load.

We propose that neuronal AE3 indirectly increases acid extrusion in (a) neurons via Cl– loading, and (b) astrocytes by somehow enhancing NBCe1 (major acid extruder). The latter would enhance depolarization‐induced alkalinization of astrocytes, and extracellular acidification, and thereby reduce susceptibility to epileptic seizures.

The anion exchanger AE3, expressed in hippocampal (HC) neurons but not astrocytes, contributes to intracellular pH (pHi) regulation by facilitating the exchange of extracellular Cl– for intracellular HCO3–. The human AE3 polymorphism A867D is associated with idiopathic generalized epilepsy. Moreover, AE3 knockout (AE3–/–) mice are more susceptible to epileptic seizure. The mechanism of these effects has been unclear because the starting pHi in AE3–/– and wild‐type neurons is indistinguishable. The purpose of the present study was to use AE3–/– mice to investigate the role of AE3 in pHi homeostasis in HC neurons, co‐cultured with astrocytes. We find that the presence of AE3 increases the acidification rate constant during pHi recovery from intracellular alkaline loads imposed by reducing [CO2]. The presence of AE3 also speeds intracellular acidification during the early phase of metabolic acidosis (MAc), not just in neurons but, surprisingly, in adjacent astrocytes. Additionally, AE3 contributes to braking the decrease in pHi later during MAc in both neurons and astrocytes. Paradoxically, AE3 enhances intracellular re‐alkalization after MAc removal in neurons and astrocytes, and pHi recovery from an ammonium prepulse‐induced acid load in neurons. The effects of AE3 knockout on astrocytic pHi homeostasis in MAc‐related assays require the presence of neurons, and are consistent with the hypothesis that the AE3 knockout reduces functional expression of astrocytic NBCe1. These findings suggest a new type of neuron–astrocyte communication, based on the expression of AE3 in neurons, which could explain how AE3 reduces seizure susceptibility.
The ER structural protein Rtn4A stabilizes and enhances signaling through the receptor tyrosine kinase ErbB3
Authors: Hatakeyama Jason , Wald Jessica H. , Rafidi Hanine , Cuevas Antonio , Sweeney Colleen , Carraway Kermit L.
Published: June 2016

ER remodeling may enhance growth factor signaling to increase cell survival.
Tumor microenvironment on the move and the Aselli connection
Authors: Rodvold Jeffrey J. , Zanetti Maurizio
Published: June 2016

The innate immune response mediates signals that remodel the tumor microenvironment and promotes lymphangiogenesis.
Paper of note in
Science Translational Medicine
Authors: Ferrarelli Leslie K.
Published: June 2016

This week’s article shows a way to prevent learning impairments caused by anesthesia.
You are what your great grandmother ate
Authors: Brown J. Mark
Published: June 2016

Maternal dietary habits impact mitochondrial function in the next generation.
Losing inhibitions: Expect the unexpected
Authors: Gill Saar
Published: June 2016

Careful examination of the role of programmed death ligand-1 (PD-L1) on T cells reveals surprising results.
An old drug auditions for a new leading role
Authors: Martin Ian
Published: June 2016

An FDA-approved drug for multiple sclerosis, dimethyl fumarate, prevents the death of dopaminergic neurons in a mouse model of Parkinson’s disease.
Partial Diversity Generates Effector Immunity Specificity of the Bac41-Like Bacteriocins of Enterococcus faecalis Clinical Strains
Authors: Kurushima Jun , Ike Yasuyoshi , Tomita Haruyoshi
Published: June 2016

Bacteriocin 41 (Bac41) is the plasmid-encoded bacteriocin produced by the opportunistic pathogen
Enterococcus faecalis
. Its genetic determinant consists of

bacL
1

(effector),

bacL
2

(regulator),
bacA
(effector), and
bacI
(immunity). The secreted effectors BacL
1
and BacA coordinate to induce the lytic cell death of
E. faecalis
. Meanwhile, the immunity factor BacI provides self-resistance to the Bac41 producer,
E. faecalis
, against the action of BacL
1
and BacA. In this study, we demonstrated that more than half of the 327 clinical strains of
E. faecalis
screened had functional Bac41 genes. Analysis of the genetic structure of the Bac41 genes in the DNA sequences of the
E. faecalis
strains revealed that the Bac41-like genes consist of a relatively conserved region and a variable region located downstream from
bacA
. Based on similarities in the variable region, the Bac41-like genes could be classified into type I, type IIa, and type IIb. Interestingly, the distinct Bac41 types had specific immunity factors for self-resistance, BacI1 or BacI2, and did not show cross-immunity to the other type of effector. We also demonstrated experimentally that the specificity of the immunity was determined by the combination of the C-terminal region of BacA and the presence of the unique BacI1 or BacI2 factor. These observations suggested that Bac41-like bacteriocin genes are extensively disseminated among
E. faecalis
strains in the clinical environment and can be grouped into at least three types. It was also indicated that the partial diversity results in specificity of self-resistance which may offer these strains a competitive advantage.

IMPORTANCE
Bacteriocins are antibacterial effectors produced by bacteria. In general, a bacteriocin-coding gene is accompanied by a cognate immunity gene that confers self-resistance on the bacteriocin-producing bacterium itself. We demonstrated that one of the bacteriocins, Bac41, is disseminated among
E. faecalis
clinical strains and the Bac41 subtypes with partial diversity. The Bac41-like bacteriocins were found to be classified into type I, type IIa, and type IIb by variation of the cognate immunity factors. The antibacterial activity of the respective effectors was specifically inhibited by the immunity factor from the same type of Bac41 but not the other types. This specificity of effector-immunity pairs suggests that bacteriocin genes might have evolved to change the immunity specificity to acquire an advantage in interbacterial competition.
Plasmid Dynamics in KPC-Positive Klebsiella pneumoniae during Long-Term Patient Colonization
Authors: Conlan Sean , Park Morgan , Deming Clayton , Thomas Pamela J. , Young Alice C. , Coleman Holly , Sison Christina ,   NISC Comparative Sequencing Program, Weingarten Rebecca A. , Lau Anna F. , Dekker John P. , Palmore Tara N. , Frank Karen M. , Segre Julia A.
Published: June 2016

Carbapenem-resistant
Klebsiella pneumoniae
strains are formidable hospital pathogens that pose a serious threat to patients around the globe due to a rising incidence in health care facilities, high mortality rates associated with infection, and potential to spread antibiotic resistance to other bacterial species, such as
Escherichia coli
. Over 6 months in 2011, 17 patients at the National Institutes of Health (NIH) Clinical Center became colonized with a highly virulent, transmissible carbapenem-resistant strain of
K. pneumoniae
. Our real-time genomic sequencing tracked patient-to-patient routes of transmission and informed epidemiologists’ actions to monitor and control this outbreak. Two of these patients remained colonized with carbapenemase-producing organisms for at least 2 to 4 years, providing the opportunity to undertake a focused genomic study of long-term colonization with antibiotic-resistant bacteria. Whole-genome sequencing studies shed light on the underlying complex microbial colonization, including mixed or evolving bacterial populations and gain or loss of plasmids. Isolates from NIH patient 15 showed complex plasmid rearrangements, leaving the chromosome and the
bla
KPC
-carrying plasmid intact but rearranging the two other plasmids of this outbreak strain. NIH patient 16 has shown continuous colonization with
bla
KPC
-positive organisms across multiple time points spanning 2011 to 2015. Genomic studies defined a complex pattern of succession and plasmid transmission across two different
K. pneumoniae
sequence types and an
E. coli
isolate. These findings demonstrate the utility of genomic methods for understanding strain succession, genome plasticity, and long-term carriage of antibiotic-resistant organisms.

IMPORTANCE
In 2011, the NIH Clinical Center had a nosocomial outbreak involving 19 patients who became colonized or infected with
bla
KPC
-positive
Klebsiella pneumoniae
. Patients who have intestinal colonization with
bla
KPC
-positive
K. pneumoniae
are at risk for developing infections that are difficult or nearly impossible to treat with existing antibiotic options. Two of those patients remained colonized with
bla
KPC
-positive
Klebsiella pneumoniae
for over a year, leading to the initiation of a detailed genomic analysis exploring mixed colonization, plasmid recombination, and plasmid diversification. Whole-genome sequence analysis identified a variety of changes, both subtle and large, in the
bla
KPC
-positive organisms. Long-term colonization of patients with
bla
KPC
-positive
Klebsiella pneumoniae
creates new opportunities for horizontal gene transfer of plasmids encoding antibiotic resistance genes and poses complications for the delivery of health care.
Association of physical activity with cognition, metacognition and academic performance in children and adolescents: a protocol for systematic review and meta-analysis
Authors: Álvarez-Bueno Celia , Pesce Caterina , Cavero-Redondo Iván , Sánchez-López Mairena , Pardo-Guijarro María Jesús , Martínez-Vizcaíno Vicente
Published: June 2016

Introduction

Schools provide a relevant context for improving children's and adolescents’ physical and mental health by increasing physical activity during school hours and/or beyond. The interest in the relationship between physical activity programmes and cognition during development has recently increased, with evidence suggesting a positive association. We present a protocol of systematic reviews and meta-analysis of intervention studies that, by determining the effects of chronic physical exercise on children's and adolescents’ cognitive and metacognitive functions, cognitive life skills, academic behaviours and achievement, aims to ensure procedural objectivity and transparency, and maximise the extraction of relevant information to inform policy development.

Methods

This protocol is guided by Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. Databases to be utilised for a thorough selection of the pertinent literature are MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, PsycINFO and ERIC. Selection is proposed to encompass an international and a national publication level, with inclusion of experimental studies written in English or in Spanish, respectively. Also, relevant references included in the selected studies will be considered suitable for review as supplemental sources.

We present an integrated approach to the methodological quality assessment of the selected studies, including the Jadad Scale for the assessment of the quality of randomised controlled trials and the Quality Assessment Tool for Quantitative Studies for pre–post studies and non-randomised controlled trials. The pre–post interventions mean differences will be the primary indicator of the intervention outcome.

Statistical analysis

A subgroup analysis is proposed based on cognitive functions and their neural correlates, metacognitive functions and cognitive life skills, academic achievement areas and academic behaviours.

Trial registration number

PROSPERO CRD42015029913
‘Delayed discharges and boarders’: a 2-year study of the relationship between patients experiencing delayed discharges from an acute hospital and boarding of admitted patients in a crowded ED
Authors: Mustafa Farah , Gilligan Peadar , Obu Deborah , O'Kelly Patrick , O'Hea Eimear , Lloyd Catherine , Kelada Sherif , Heffernan Attracta , Houlihan Patricia
Published: June 2016

Objective

Many believe that hospital crowding manifesting in the ED with the boarding of admitted patients is a result of significant numbers of acute hospital beds being occupied by patients awaiting discharge to nursing homes, step-down facilities or home with or without additional support. This observational study was performed to establish the actual relationship between boarders in the ED and patients experiencing delayed discharge.

Methods

Data relating to the number of patients in the ED and their points in their patient pathway were entered into a logbook on a daily basis by the most senior doctor on duty. 630 days of observations of patients boarded in the ED were compared with the number of inpatients with delayed discharges, obtained from the hospital information system, to see if large numbers of inpatients with delayed discharges are associated with crowding in the ED.

Results

Two years of data showed an annual ED census of more than 47 000, with a daily mean ED admission rate of 29.85 patients and a daily mean ED boarding figure of 29 patients. A mean of 15.4% of the 823 hospital beds was occupied by patients with delayed discharges, and the hospital ran at, or near, full capacity (99%–105%) all the time. Results obtained highlighted a statistically significant relationship between delayed discharges in the hospital and ED crowding as a result of boarders (p value<0.001, with a regression coefficient of 0.16, 95% CI 0.12 to 0.20). The study also showed that the number of boarders was related to the number of ED admissions in the preceding 24 hours (p=0.036, with a regression coefficient of 0.14, 95% CI 0.05 to 0.28).

Conclusions

Delayed hospital discharges significantly contribute to crowding in the ED. Healthcare systems should target timely discharge of inpatients experiencing delayed discharge in an urgent and efficient manner to improve timely access to acute hospital beds for patients requiring emergency admission.
A pictorial review of imaging in paediatric stroke
Authors: Johns Christopher , Kolla S , Hart A , Sinha S , Batty R , Connolly D J A
Published: June 2016

Stroke is recognised as an important disease in adults. Paediatric stroke is less understood, yet still an important cause of morbidity and mortality, with an incidence of 5 per 100 000 children and is one of the top 10 leading causes of death in children. In adults the vast majority of strokes are ischaemic, whereas in children haemorrhage makes up half the cases. The incidence of neonatal stroke is much higher, at up to 45 per 100 000 population; however, the underlying causes are less understood. This paper acts as a guide to the different causes of stroke with the key differences on imaging discussed.
Linker histones: novel insights into structure-specific recognition of the nucleosome
Authors: Cutter Amber R. , Hayes Jeffrey J.
Published: June 2016

Linker histones (H1s) are a primary component of metazoan chromatin, fulfilling numerous functions, both in vitro and in vivo, including stabilizing the wrapping of DNA around the nucleosome, promoting folding and assembly of higher order chromatin structures, influencing nucleosome spacing on DNA, and regulating specific gene expression. However, many molecular details of how H1 binds to nucleosomes and recognizes unique structural features on the nucleosome surface remain undefined. Numerous, confounding studies are complicated not only by experimental limitations, but the use of different linker histone isoforms and nucleosome constructions. This review summarizes the decades of research that has resulted in several models of H1 association with nucleosomes, with a focus on recent advances that suggest multiple modes of H1 interaction in chromatin, while highlighting the remaining questions.
Characterization ofKlebsiellasp. strain S1: a bacterial producer of secoisolariciresinol through biotransformation
Authors: Zhou Yu-Jie , Zhu Songling , Yang Dong-Hui , Zhao Dan-Dan , Li Jia-Jing , Liu Shu-Lin
Published: June 2016

Secoisolariciresinol (SECO) is a lignan of potential therapeutic value for diseases such as cancer, but its use has been limited by the lack of ideal production methods, even though its precursors are abundant in plants, such as flaxseeds. Here, we report the characterization of a bacterial strain, S1, isolated from the human intestinal flora, which could produce secoisolariciresinol by biotransformation of precursors in defatted flaxseeds. This bacterium was a Gram-negative and facultatively anaerobic straight rod without capsules. Biochemical assays showed that it was negative for production of oxidase, lysine decarboxylase, ornithine decarboxylase, arginine dihydrolase, and β-glucolase. The G + C content of genomic DNA was 57.37 mol%. Phylogenetic analysis by 16S rRNA and rpoB gene sequences demonstrated S1’s close relatedness to Klebsiella. No homologues were found for wzb or wzc (capsular genes), which may explain why Klebsiella sp. strain S1 does not have the capsule and was isolated from a healthy human individual. Based on the percentages of homologous genes with identical nucleotide sequences between the bacteria in comparison, we found that clear-cut genetic boundaries had been formed between S1 and any other Klebsiella strains compared, dividing them into distinct phylogenetic lineages. This work demonstrates that the intestinal Klebsiella, well known as important opportunistic pathogens prevalent in potentially fatal nosocomial infections, may contain lineages that are particularly beneficial to the human health.
Massive gauge-flation
Authors: Nieto Carlos M. , Rodríguez Yeinzon
Published: June 2016

Gauge-flation model at zeroth-order in cosmological perturbation theory offers an interesting scenario for realizing inflation within a particle physics context, allowing us to investigate interesting possible connections between inflation and the subsequent evolution of the Universe. Difficulties, however, arise at the perturbative level, thus motivating a modification of the original model. In order to agree with the latest Planck observations, we modify the model such that the new dynamics can produce a relation between the spectral index n[Formula: see text] and the tensor-to-scalar ratio r allowed by the data. By including an identical mass term for each of the fields of the system, we find interesting dynamics leading to slow-roll inflation of the right length. The presence of the mass term has the potential to modify the n[Formula: see text] versus r relation so as to agree with the data. As a first step, we study the model at zeroth-order in cosmological perturbation theory, finding the conditions required for slow-roll inflation and the number of e-foldings of inflation. Numerical solutions are used to explore the impact of the mass term. We conclude that the massive version of gauge-flation offers a viable inflationary model.
The realizations of Lie algebra gl(∞) and tau functions in homotopy category
Authors: Wang Na
Published: June 2016

In this paper, we realize the Lie algebra [Formula: see text] in one homotopy category, and we find that tau functions can be obtained from complexes in this homotopy category by taking Grothendieck group. We start with the realization of Fermions in a homotopy category over a Heisenberg category which is constructed by Khovanov.
Ab initio study of interaction between 3d adatoms on the vicinal Cu(111) surface
Authors: Syromyatnikov A. G. , Kabanov N. S. , Saletsky A. M. , Klavsyuk A. L.
Published: June 2016

Density functional theory is used to resolve the adatom-step and adatom–adatom interactions on vicinal Cu(111) surface. We demonstrated that the interactions between 3d adatoms appreciably depend on the distance from a surface step. Our calculations show that the magnitude of the repulsive barrier related to the surface step is larger for 3d adatoms located at the upper surface terrace than for adatoms located at the lower surface terrace.
Optimal Synchronization of a Memristive Chaotic Circuit
Authors: Kountchou Michaux , Louodop Patrick , Bowong Samuel , Fotsin Hilaire , Kurths Jurgen
Published: June 2016

This paper deals with the problem of optimal synchronization of two identical memristive chaotic systems. We first study some basic dynamical properties and behaviors of a memristor oscillator with a simple topology. An electronic circuit (analog simulator) is proposed to investigate the dynamical behavior of the system. An optimal synchronization strategy based on the controllability functions method with a mixed cost functional is investigated. A finite horizon is explicitly computed such that the chaos synchronization is achieved at an established time. Numerical simulations are presented to verify the effectiveness of the proposed synchronization strategy. Pspice analog circuit implementation of the complete master-slave-controller systems is also presented to show the feasibility of the proposed scheme.
Emulating “Chaos + Chaos = Order” in Chen’s Circuit of Fractional Order by Parameter Switching
Authors: Tang Wallace K. S. , Danca Marius-F.
Published: June 2016

In this paper, the effect of the parameter switching (PS) algorithm in a fractional order chaotic circuit is investigated both in simulation and experiment. The Chen system of fractional order is focused and realized in an electronic circuit. By designing a switching circuit, the PS algorithm is implemented and it is the first time, the paradoxical “Chaos [Formula: see text] Chaos [Formula: see text] Order” is presented in an electronic circuit. Both the simulation and experimental results confirm that the obtained attractor under switching approximates the attractor of the time-averaged model. Some important design issues for the circuitry realization of the PS scheme are pointed out. Finally, our work confirms the practical usage of PS algorithm in potential applications such as attractor synthesis and chaos control.
Bifurcation in Disease Dynamics with Latent Period of Infection and Media Awareness
Authors: Singh Harkaran , Dhar Joydip , Bhatti Harbax Singh
Published: June 2016

In the present study, an SIS epidemic model with a latent period of infection and media awareness as control strategy is proposed. The asymptotic stability of the model is studied for both disease-free equilibrium and endemic equilibrium states with respect to the basic reproduction number [Formula: see text]. It is observed that the coefficient of media awareness [Formula: see text] does not affect [Formula: see text], but significantly affects the level of endemic equilibrium. Further, the specific conditions for the existence of Hopf bifurcation have been obtained for the endemic equilibrium state. We also performed the sensitivity analysis of the basic reproduction number and state variables at endemic steady state with respect to the model parameter and identified the respective sensitive parameters. Numerical simulations have been presented in support of our analytic findings.
Construction of a Class of Four-Dimensional Piecewise Affine Systems with Homoclinic Orbits
Authors: Wu Tiantian , Yang Xiao-Song
Published: June 2016

Based on mathematical analysis, this paper provides a methodology to ensure the existence of homoclinic orbits in a class of four-dimensional piecewise affine systems. In addition, an example is provided to illustrate the effectiveness of the method.
Logical Gates Implemented by Solitons at the Junctions Between One-Dimensional Lattices
Authors: Siccardi Stefano , Adamatzky Andrew
Published: June 2016

We study propagation of solitons on one-dimensional lattices of nodes with Morse interaction between the neighboring nodes. In numerical integration, we demonstrate that solitons colliding at junctions of two lattices can implement and, or and not Boolean logic gates. The gates are determined by the geometry of the junctions and phase difference of the colliding solitons. We evaluate the feasibility of casing gates in the design of nor gate.
A Class of Integer Order and Fractional Order Hyperchaotic Systems via the Chen System
Authors: Xu Fei
Published: June 2016

In this article, we investigate the generation of a class of hyperchaotic systems via the Chen chaotic system using both integer order and fractional order differential equation systems. Based on the Chen chaotic system, we designed a system with four nonlinear ordinary differential equations. For different parameter sets, the trajectory of the system may diverge or display a hyperchaotic attractor with double wings. By linearizing the ordinary differential equation system with divergent trajectory and designing proper switching controls, we obtain a chaotic attractor. Similar phenomenon has also been observed in linearizing the hyperchaotic system. The corresponding fractional order systems are also considered. Our investigation indicates that, switching control can be applied to either linearized chaotic or nonchaotic differential equation systems to create chaotic attractor.
Free Vibration Analysis of Rotating Mindlin Plates with Variable Thickness
Authors: Fang J. S. , Zhou D.
Published: June 2016

The modal analysis of rotating cantilevered rectangular Mindlin plates with variable thickness is studied. The Ritz method is used to derive the governing eigenfrequency equation by minimizing the energy functional of the plate. The admissible functions are taken as a product of the Chebyshev polynomials multiplied by the boundary functions, which enable the displacements and rotational angles to satisfy the geometric boundary conditions of the plate. The Chebyshev polynomials guarantee the numerical robustness, while the Ritz approach provides the upper bound of the exact frequencies. The effectiveness of the present method is confirmed through the convergence and comparison studies. The effects of the dimensionless rotational speed, taper ratio, aspect ratio and thickness ratio on modal characteristics are investigated in detail. The frequency loci veering phenomenon along with the corresponding mode shape switching is exhibited and discussed.
Graphical Representation of Separatrices of Attraction Basins in Two and Three-Dimensional Dynamical Systems
Authors: Cavoretto Roberto , De Rossi Alessandra , Perracchione Emma , Venturino Ezio
Published: June 2016

In this paper we consider the problem of reconstructing separatrices in dynamical systems. In particular, here we aim at partitioning the domain approximating the boundaries of the basins of attraction of different stable equilibria. We start from the 2D case sketched in Cavoretto et al. [2011] and the approximation scheme presented in [Cavoretto et al. (2011); Cavoretto et al. (2015)], and then we extend the reconstruction scheme of separatrices in the cases of three-dimensional models with two and three stable equilibria. For this purpose we construct computational algorithms and procedures for the detection and the refinement of points located on the separatrix manifolds that partition the phase space. The use of the so-called Radial Basis Function (RBF) Partition of Unity (PU) method is used to reconstruct the separatrices.
Semantics Out of Context
Authors: Gabbay Murdoch J.
Published: June 2016

Call a semantics for a language with variablesabsolutewhen variables map to fixed entities in the denotation. That is, a semantics is absolute when the denotation of a variableais a copy of itself in the denotation.

We give a trio of lattice-based, sets-based, and algebraic absolute semantics to first-order logic. Possibly open predicates are directly interpreted as lattice elements/sets/algebra elements, subject to suitable interpretations of the connectives and quantifiers. In particular, universal quantification ∀a.φ is interpreted using a new notion of“fresh-finite”limit Λ#a⟦Φ⟧ and using a novel dual to substitution.

The interest in this semantics is partly in the nontrivial and beautiful technical details, which also offer certain advantages over existing semantics. Also, the fact that such semantics exist at all suggests a new way of looking at variables and the foundations of logic and computation, which may be well suited to the demands of modern computer science.
Report on the Eighth Workshop on Exploiting Semantic Annotations in Information Retrieval (ESAIR '15)
Authors: Balog Krisztian , Dalton Jeffrey , Doucet Antoine , Ibrahim Yusra
Published: June 2016

The amount of structured content published on the Web has been growing rapidly, making it possible to address increasingly complex information access tasks. Recent years have witnessed the emergence of large scale human-curated knowledge bases as well as a growing array of techniques that identify or extract information automatically from unstructured and semi-structured sources. The ESAIR workshop series aims to advance the general research agenda on the problem of creating and exploiting semantic annotations. The eighth edition of ESAIR took place at CIKM 2015 in Melbourne, Australia, on the 23rd of October. Having a special focus on applications, we dedicated an "annotations in action" track to demonstrations that showcase innovative prototype systems, in addition to the regular research and position paper contributions. The workshop also featured invited talks from leaders in the field. This report presents an overview of the event and its major outcomes.