bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence Assisted Infrastructure Assessment using Mixed Reality Systems
Authors: Karaaslan Enes , Bagci Ulas , Catbas Fikret Necati
Published: July 2019

Conventional methods for visual assessment of civil infrastructures have certain limitations, such as subjectivity of the collected data, long inspection time, and high cost of labor. Although some new technologies (i.e., robotic techniques) that are currently in practice can collect objective, quantified data, the inspector’s own expertise is still critical in many instances because these technologies are not designed to work interactively with a human inspector. This study aims to create a smart, human-centered method that offers significant contributions to infrastructure inspection, maintenance, management practice, and safety for the bridge owners. By developing a smart mixed reality (MR) framework, which can be integrated into a wearable holographic headset device, a bridge inspector, for example, can automatically analyze a certain defect such as a crack that he or she sees on an element, and display its dimension information in real-time along with the condition state. Such systems can potentially decrease the time and cost of infrastructure inspections by accelerating essential tasks of the inspector such as defect measurement, condition assessment, and data processing to management systems. The human-centered artificial intelligence (AI) will help the inspector collect more quantified and objective data while incorporating the inspector’s professional judgment. This study explains in detail the described system and related methodologies of implementing attention guided semisupervised deep learning into MR technology, which interacts with the human inspector during assessment. Thereby, the inspector and the AI will collaborate/communicate for improved visual inspection.
Ascorbic Acid, Thiamine, and Steroids in Septic Shock: Propensity Matched Analysis
Authors: Sadaka Farid , Grady Justin , Organti Nikhil , Donepudi Bhargavi , Korobey Matthew , Tannehill David , O’Brien Jacklyn
Published: July 2019

Introduction:

We aimed to study the use of ascorbic acid, thiamine, and steroids (ATS) in patients with septic shock (SS).

Methods:

Data on 62 patients with SS were collected from Acute Physiologic and Chronic Health Evaluation (APACHE) Outcome database and medical records. The ATS group received full doses of intravenous (IV) ATS (ascorbic acid [1.5 g every 6 hours for 4 days], hydrocortisone [50 mg every 6 hours for 7 days], and thiamine [200 mg every 12 hours for 4 days]). Data included age, gender, APACHE III, acute physiologic score (APS), mechanical ventilation (MV), lactic acid (LA), serum creatinine (Cr), duration of vasopressors (VP, days, median: interquartile ranges [IQR]: [Q1, Q3]), MV-free days (median: IQR [Q1-Q3]), percentage of patients requiring renal replacement therapy (RRT) for acute kidney injury (AKI), and mortality. Propensity analysis was used to match patients on age, gender, MV, APACHE III, APS, LA, and Cr.

Results:

The ATS group had longer duration of VP (4.5: 4.0-6.0 vs 2.0: 1.0-2.0, P = .001), similar RRT for AKI (26% vs 29%, P = .8), similar MV-free days (10.2: 5.0-15.0 vs 10.2: 1.6-18.0, P > .9), lower intensive care unit mortality (9.6% vs 42%, P = .004), and a trend toward lower hospital mortality (29% vs 45%, P = .2) compared to the NO ATS group.

Conclusions:

The use of IV ascorbic acid, thiamine, and hydrocortisone might be beneficial in patients with SS.
Effectiveness of a Kansas City, Jail-Based Intervention to Improve Cervical Health Literacy and Screening, One-Year Post-Intervention
Authors: Emerson Amanda M. , Smith Sharla , Lee Jaehoon , Kelly Patricia J. , Ramaswamy Megha
Published: July 2019

Purpose:

To assess effectiveness, 1-year post-intervention, of a program delivered in jails with women to improve cervical health literacy (CHL) and up-to-date Papanicolaou (Pap) screening.

Design:

Pre-post design to evaluate Pap screening and CHL effects 1 year after our original randomized wait-list control study.

Setting:

Surveys conducted in Kansas City, 2015 to 2017 (baseline in 2014).

Participants:

Adult women (n = 133).

Intervention:

One-week (10-contact-hour), small-group, CHL program.

Measures:

Surveys to assess CHL components and up-to-date Pap screening.

Analysis:

χ2 and t tests, followed by best-subsets logistic regression using sociodemographic and CHL components to fit an optimal model for up-to-date screening 1-year post-intervention.

Results:

73% (133/182) women retained at 1-year. From pre-intervention, 6 of 8 CHL components improved (.01 > P > .001). Up-to-date Pap screenings increased over pre-intervention (72%-82%, P < .05). Best-subset model to predict up-to-date screening included age; public benefits; medical insurance; 5 CHL components (knowledge, benefits, barriers, seriousness, susceptibility).

Conclusion:

A brief intervention to promote cervical health literacy, delivered with women during a jail detention, can lead to sustained improvements in CHL and prevention practices.
Effect of various enzymatic treatments on the mechanical properties of coir fiber/poly(lactic acid) biocomposites
Authors: Coskun Kubra , Mutlu Aysenur , Dogan Mehmet , Bozacı Ebru
Published: July 2019

The effects of enzymatic treatments on the properties of coir fiber-reinforced poly(lactic acid) (PLA) were not found in the literature. Accordingly, the effects of various enzymatic treatments on the mechanical performance of the coir fiber-reinforced PLA composites were investigated in the current study. Four different enzymes, namely lipase, lactase, pectinase, and cellulase, were used. The mechanical properties of the composites were determined by the tensile, flexural, impact tests, and dynamic mechanical analysis. According to the test results, the use of enzyme treated coir fibers affected the mechanical properties except for the flexural properties with different extents depending upon their type. The tensile strength increased with the treatments of lipase and lactase, while the treatments with pectinase and cellulase had no remarkable effect. The impact strength was improved with enzymatic treatments except for pectinase. All enzymatic treatments improved the elastic modulus below the glass transition temperature. In brief, enzymatic treatments improved the interfacial adhesion between coir fiber and PLA via the waxes and fatty acids removal and/or the increment in surface roughness.
Behind the Rhodes statue: Black competency and the imperial academy
Authors: Shilliam Robbie
Published: July 2019

Recent criticisms of the Rhodes Must Fall (RMF) Oxford campaign have problematized the presence of Black bodies within British higher education by reference to an ideal image of the impartial and discerning academy. In this article, I historically and intellectually contextualize the apprehension, expressed in the debates over RMF Oxford, that an intimate Black presence destabilizes the ethos of higher education. Specifically, I argue that much more than Rhodes’ statue implicates the British academy in the Empire’s southern African interests. I excavate a genealogy of academic debates regarding the effects of an increased proximity of Black presence to empire’s white spaces. These debates were initiated by social anthropologists in the interwar years primarily (albeit not solely) with regards to studies of southern Africa’s urbanizing spaces. What is more, such debates were highly influential to the study of ‘race relations’ in Britain’s postwar era of Commonwealth immigration. Critically, all these debates problematized the cognitive competency of African/Black peoples to inhabit white cultural spaces – including the academy – in ways that were not destabilizing of imperial order. Current campus campaigns such as RMF should not be evaluated against an ideal image of the academy. Rather, they form part of a continued confrontation with the afterlives of academic dispositions that were implicated in the imperial project that Rhodes was integral to.
Inheritance of Neural Substrates for Motivation and Pleasure
Authors: Li Zhi , Wang Yi , Yan Chao , Cheung Eric F. C. , Docherty Anna R. , Sham Pak C. , Gur Raquel E. , Gur Ruben C. , Chan Raymond C. K.
Published: July 2019

Despite advances in the understanding of the reward system and the role of dopamine in recent decades, the heritability of the underlying neural mechanisms is not known. In the present study, we examined the hemodynamic activation of the nucleus accumbens (NAcc), a key hub of the reward system, in 86 healthy monozygotic twins and 88 healthy dizygotic twins during a monetary-incentive-delay task. The participants also completed self-report measures of pleasure. Using voxelwise heritability mapping, we found that activation of the bilateral NAcc during the anticipation of monetary gains had significant heritability ( h2 = .20–.49). Moreover, significant shared genetic covariance was observed between pleasure and NAcc activation during the anticipation of monetary gain. These findings suggest that both NAcc activation and self-reported pleasure may be heritable and that their phenotypic correlation may be partially explained by shared genetic variation.
Cerebral blood flow abnormalities in neuropsychiatric systemic lupus erythematosus
Authors: Jia J , Xie J , Li H , Wei H , Li X , Hu J , Meng D , Zhang Y , Zhang X
Published: July 2019

Objective

To investigate the clinical characteristics, imaging changes and early diagnostic methods of neuropsychiatric systemic lupus erythematosus (NPSLE).

Methods

Thirty-five SLE patients, of which 16 had overt neuropsychiatric symptoms, underwent examination for multiple autoantibodies, including anti-double-stranded DNA (anti-dsDNA) antibody, anti-nucleosome antibody, anti-cardiac-phospholipid antibody (aCL)-IgG, aCL-IgM, anti-β2-glycoprotein I antibody and anti-ribosomal P antibody, and the SLEDAI score of every patient was recorded. All patients further received neuropsychological tests, including the Mini-Mental State Examination, the Self-Rating Anxiety Scale and the Self-Rating Depression Scale. Imaging examination using 3D arterial spin labeling was performed on 3.0 T MRI scanners. After processing the 3D arterial spin labeling image, the cerebral blood flow map was obtained and the cerebral blood flow value was calculated.

Results

The values of anti-dsDNA, anti-nucleosome antibody, aCL-IgG and anti-β2-glycoprotein I antibodies were significantly higher in the NPSLE group than those in the SLE group. The SLEDAI scores of the NPSLE group were significantly higher than those of the SLE group. There were no significant differences between the NPSLE group and the SLE group in the directional ability, memory, attention, numeracy, recall ability or language ability scores on the Mini-Mental State Examination scale. Furthermore, there were no symptoms of anxiety or depression in any of the patients, according to the Self-Rating Anxiety Scale and Self-Rating Depression Scale. In the 35 patients with SLE, decreases in blood perfusion were seen in some areas, and were unilateral and asymmetrically distributed. There was obvious asymmetry between sides in areas including the frontal lobe, temporal lobe, parietal lobe and occipital lobe. The incidence of perfusion decreases in frontal lobe in the NPSLE group was significantly higher than in the SLE group.

Conclusion

Neurological lesions in SLE patients can be detected by arterial spin labeling. Cerebral blood flow abnormalities may be helpful for the early diagnosis of neurological lesions in NPSLE.
Research on operating parameters of T-groove cylindrical gas film seal based on computational fluid dynamics
Authors: Sun Junfeng , Liu Meihong , Xu Zhen , Liao Taohong
Published: July 2019

Cylindrical gas film sealing technology is a new type of dry gas sealing technology. Compared with the face gas film sealing technology, the cylindrical gas film seal presents a strong floating property, which can reduce the vibration and thermal deformation of the rotor system. In this article, the effect of operating parameters such as speed, pressure difference and viscosity on the T-groove gas cylindrical film seal performance are studied in detail by the method of control variable in computational fluid dynamics software, and pressure distribution, gas film stiffness, leakage, leakage stiffness ratio and hydrodynamic force are analysed. Results show that with the increase of the rotational speed, static pressure, hydrodynamic force and film stiffness increase, but leakage decreases first and then increases. Furthermore, the results indicate that with the increase of pressure difference, the static pressure, leakage and hydrodynamic force increase. In addition, the simulations show that when the viscosity increases, the maximum pressure and film stiffness increase, but the leakage decreases. This indicates that as the rotational speed increases, the hydrodynamic effect and the amount of gas overflow in the axial direction increase, resulting in an increase of leakage. Lastly, the results also show that when the pressure difference increases, both the radial and axial gas flow rates increase, resulting in an increase in both the film stiffness and the leakage. With the increase of viscosity, the viscous shear force and fluid hydrodynamic force increase, resulting in the increase of the gas film stiffness. This study can provide a theoretical basis in industrial applications for setting the operating parameters and serving as a reference.
Patients’ Perception Towards Branded and Generic Medicines in an Emerging Economy: A Scale Development and Validation Study
Authors: Alam Md. Moddassir , Mittal Arun , Chawla Deepak
Published: July 2019

The study intends to develop and validate a scale to gauge the perception of patients towards branded and generic medicines in an emerging economy like India. Items were generated through literature review and exploratory semi-structured interview with patients and physicians. In the way of establishing generic medicines in the market, patients’ acceptability is very much essential. However, with the advent of information age, the patients are now becoming more conscious and aware regarding the generic medicines, and there is an improvement in the acceptability of generic medicines. Hence, the measurement of their perception towards generic medicines becomes an important issue for various stakeholders of the medical world—physicians, government, pharmaceutical companies and chemists. However, no studies regarding the measurement of perception towards the branded and generic have been conducted to develop and validate measurement scale. The present study is an attempt towards fulfilling this gap. A total of 361 valid responses were obtained using purposive sampling. Exploratory factor analysis (EFA) was carried out through principal component analysis (PCA) followed by confirmatory factor analysis (CFA) to establish the validity of the proposed measurement model. The five factors extracted from EFA were named as quality (Cronbach’s alpha: 0.887), trust (Cronbach’s alpha: 0.919), sustained effectiveness (Cronbach’s alpha: 0.832), reputation (Cronbach’s alpha: 0.881) and psychological benefits (Cronbach’s alpha: 0.737). The obtained factors were found reliable and valid for measuring perception of the patients towards generic and branded medicines in emerging market settings. Convergent and discriminant validity of the scale was also established.
Analysis of bimorph piezoelectric beam energy harvesters using superconvergent element
Authors: Hajheidari Peyman , Stiharu Ion , Bhat Rama
Published: July 2019

Cantilever-based piezoelectric energy harvesters have been utilized as structures to extract mechanical energy from the ambient mechanical vibrations and transfer it into the electrical output. In this article, the performance of bimorph piezoelectric beam energy harvesters is investigated. The cantilever beam is modeled by using both Timoshenko and Euler–Bernoulli beam theories. The equations are discretized using the conventional finite element method and superconvergent element. Besides the high rate of convergence, easy switching between the above beam theories is enabled by such type of element. The current model is presented for a Timoshenko beam model, but it could as well be used for a Euler–Bernoulli beam model. In addition, voltage, current, and power frequency response functions for different ranges of load resistance varying from the short-circuit to open-circuit conditions are determined to reach the maximum values. Effects of the slenderness ratio and the required beam model based on the geometric properties of the piezoelectric energy harvesters are discussed in the final part of this study. The results show that only for smaller values of the slenderness ratio (below 5), it is necessary to model the beam using the Timoshenko assumptions; otherwise both beam theories provide approximately the same responses.
Broadband power generation of piezoelectric vibration energy harvester with magnetic coupling
Authors: Jiang Junxiang , Liu Shaogang , Zhao Dan , Feng Lifeng
Published: July 2019

In this work, a magnetic coupling 2-degree-of-freedom bistable piezoelectric energy harvester was designed and developed. The device consisted of a primary beam with a magnet attached to the tip and a parasitic beam. The magnets between the primary beam and the pedestal generated nonlinear repulsive force. By controlling the distance between two magnets, the system could oscillate between two stable equilibrium points which allowed the device to exhibit broadband characteristics. Theoretical and experimental investigations of this energy harvester were presented over a range of excitation frequencies. Lumped-parameter nonlinear equations of the bistable Duffing oscillator with magnetic coupling were introduced to describe the broadband voltage response. Compared with the theoretical results, at an excitation acceleration of 3 m/s2, it is experimentally verified that the proposed device achieved the operation frequency bandwidth adding up to 8 Hz at around the first and second resonance regions which was about 2.7 times higher than conventional 2-degree-of-freedom linear harvester one. In addition, energy harvesting efficiency could be improved by increasing the frequency bandwidth. The results of this work can be applied to optimize the design of piezoelectric energy harvester and harvest low-frequency vibration energy in the environment to supply power for sensor network nodes.
Creating and Sharing Sound in the Music Classroom
Authors: Dunbar Laura
Published: July 2019

SoundCloud and SoundTrap have both been mentioned in conversations with colleagues recently, and it is time for me to investigate these platforms personally. This article will describe both platforms and discuss how they can be used to enhance the music classroom.
Immunotherapy-induced severe neutropenia with neurotoxicity: A case of a 75-year-old woman with ulcerative colitis diagnosed with melanoma
Authors: Patel Rima , Pai Lori
Published: July 2019

Introduction

Immune checkpoint inhibitors have transformed the field of oncology moving immuno-oncology to the forefront of cancer treatment. However, immune checkpoint inhibitors can result in serious immune-related adverse events. Hematologic toxicities are rare with incidence of neutropenia from nivolumab less than 1%.

Case report

We present a case of refractory neutropenia in a 75-year-old woman with ulcerative colitis on adjuvant nivolumab for stage III melanoma.

Management and outcome

The patient's neutropenia did not improve with high-dose intravenous steroids, filgrastim, mycophenolate mofetil, or intravenous immunoglobulin. She also developed significant neurological symptoms from nivolumab. She was transitioned to comfort measures given her persistent symptoms and poor functional status.

Discussion

Though hematologic malignancies of immune checkpoint inhibitors are rare, they should be considered after other diagnoses are excluded. We discuss the serious immune-related adverse effects of immune checkpoint inhibitors in a patient with an underlying autoimmune disease and general treatment approaches.
A comparison of a community-based dementia support programme and nursing home-based day care: Effects on carer needs, emotional burden and quality of life
Authors: van Haeften-van Dijk A Marijke , Meiland Franka J , Hattink Bart JJ , Bakker Ton JEM , Dröes Rose-Marie
Published: July 2019

Objectives

Within an implementation study, we investigated the effectiveness of a combined community-based day care programme for persons with dementia and their carers versus traditional psychogeriatric nursing home-based day care. The effects on needs, sense of competence, burden and quality of life of the family carers were studied.

Methods

A pretest–posttest control group design among family carers of people with dementia who joined community-based day care centres ( n = 67) or nursing home-based day care centres ( n = 64).

Results

After six months, family carers using community-based day care more often expressed an unmet need for support regarding psychological distress than carers utilising nursing home-based day care. No effect of community-based day care on sense of competence was found. However, carers with a low sense of competence at baseline using community-based compared to nursing home-based day care became less emotionally burdened by behaviour and mood problems of their relative. Conclusion and discussion: Overall, no added value of community-based day care on needs, sense of competence, burden and quality of life was found. Increased unmet needs on psychological distress may have been caused by the increased awareness of carers participating in the carer programme of community-based day care regarding their own unmet support needs. For carers with a low sense of competence, community-based day care proves to decrease the impact of behaviour and mood problems of their relative. A larger controlled follow-up study is recommended to understand the long-term effects of community-based day care over nursing home-based day care.
Validation of the Ohio Youth Assessment System Dispositional Tool (OYAS-DIS): An Examination of Race and Gender Differences
Authors: Campbell Christina A. , D’Amato Christopher , Papp Jordan
Published: July 2019

The Ohio Youth Assessment System-Disposition Tool (OYAS-DIS) is a juvenile risk assessment that is used in numerous states and jurisdictions to assess criminogenic risk of juvenile offenders. Still, there is little published research on the predictive validity of the tool. The purpose of the current study was to examine the predictive validity of OYAS-DIS, with a specific focus on understanding prediction of recidivism across racial and gender subgroups. The sample consisted of 4,383 youth that received a court petition in a single large Midwestern county juvenile court. The findings indicated that the OYAS-DIS was a statistically significant predictor of recidivism across all racial and gender subgroups. However, there was statistically significant variation in predictive validity across subgroups. For instance, the tool was a statistically significantly better predictor of recidivism for White males as compared to Black male youth. There was also statistically significant variation in the predictive validity of certain domains (e.g., juvenile justice history) on the OYAS-DIS across racial and gender subgroups. Implications of research favor the use of the OYAS-DIS to predict recidivism for adjudicated juveniles.
Fuzzy-logic-based data-differentiated service supported routing protocol for emergency communication networks in underground mines
Authors: Jiang Haifeng , Han Guangzhi , Wang He , Li Xinping , Zhang Guopeng
Published: July 2019

Hybrid wireless mesh networks are suitable to construct emergency communication networks after disasters in underground mines. The routing decision in emergency scene is more difficult to give an accurate mathematical description due to the constraints of various data types, different data transmission requirements, and multi-parameters. Based on the fuzzy decision theory, this article has proposed a fuzzy-logic-based data-differentiated service supported routing protocol. Through the use of the adaptive fuzzy decision system, fuzzy-logic-based data-differentiated service supported routing protocol can provide data-differentiated services and make optimized routing decisions to satisfy the transmission requirements of different data types. In addition, a path soft handoff strategy has been proposed to maintain continuous data transmission when the path quality deteriorates. Based on NS2, we set three transmission scenarios (transmitting emergency data, regular data, or mixed data) to test the performances of fuzzy-logic-based data-differentiated service supported routing protocol, ad hoc on-demand distance vector, FUZZY-ad hoc on-demand distance vector, and multi-criteria routing metric. The results show that the fuzzy-logic-based data-differentiated service supported routing protocol has a higher delivery ratio and lower end-to-end delay when transmitting emergency data. When transmitting regular data, fuzzy-logic-based data-differentiated service supported routing protocol has achieved higher throughput and longer network lifetime than that of similar algorithms.
Reasoning strategy modulates gender differences in performance on a spatial rotation task
Authors: Markovits Henry
Published: July 2019

The dual-strategy model of reasoning has proposed that individual differences in reasoning can be understood as due to two general ways of processing information: an analytic, counterexample strategy that examines information for explicit potential counterexamples and an intuitive, statistical strategy that uses associative access to generate a likelihood estimate of putative conclusions. Previous studies have examined this model in the context of basic conditional reasoning tasks. However, the distinctions that underlie the dual-strategy model can be seen as a basic description of more general differences in information processing. A recent study examining interactions between gender and strategy use in processing of negative emotions found that gender differences were modulated by strategy, with the general advantage of females concentrated within statistical reasoners. Two studies were performed to extend this analysis to performance on a mental rotation task for which there also exist clear gender differences. The initial study presented rotation tasks with unlimited time. Results show that males perform better on more difficult rotation tasks than females, with the difference concentrated among statistical reasoners. The second study replicated this using a restricted time (4 s) to make each judgement and showed an increase in the effect of both gender and strategy. This provides additional evidence that the dual-strategy model captures an important individual difference in the general way that information is processed.
The main contributor to the upswing of survival in locally advanced colorectal cancer: an analysis of the SEER database
Authors: Li Yuqiang , Zhao Lilan , Güngör Cenap , Tan Fengbo , Zhou Zhongyi , Li Chenglong , Song Xiangping , Wang Dan , Pei Qian , Liu Wenxue
Published: July 2019

Background:

There is no conclusion about the most important contributor to the upswing of locally advanced colorectal cancer (LACRC) survival.

Methods:

Data from the Surveillance, Epidemiology, and End Results (SEER) database was extracted to identify colorectal adenocarcinoma cancer patients at stage II and III diagnosed in the two periods 1989–1990 and 2009–2010. The statistical methods included Pearson’s chi-squared test, log-rank test, Cox regression model and propensity score matching.

Results:

The Cox regression model showed that hazard ratio (HR) of non-surgery dropped from 11.529 to 3.469 in right colon cancer (RCC), 5.214 to 2.652 in left colon cancer (LCC) and 3.275 to 3.269 in rectal cancer (RC) from 1989–1990 to 2009–2010. The 95% confidence intervals (CIs) for surgical resection in 2009–2010 were narrower than those in 1989–1990. HR became greater in LACRC without chemotherapy (from 1.337 to 1.779 in RCC, 1.269 to 2.017 in LCC, 1.317 to 1.811 in RC). There was no overlapping about the 95% CI of chemotherapy between the two groups. The progress of surgery was not linked to the improvement of overall survival (OS) of RCC ( p = 0.303) and RC ( p = 0.660). Chemotherapy had a significant association with OS of all colorectal cancer (CRC) patients ( p = 0.017 in RCC; p = 0.006 in LCC; p = 0.001 in RC).

Conclusions:

Advancements in chemotherapy regimen were the main contributor to the upswing of CRC survival. The improvements in surgery had a limited effect on improvements in CRC survival.
Describing Normative Foot Temperatures in Patients With Diabetes-Related Peripheral Neuropathy
Authors: Schmidt Brian M. , Allison Sara , Wrobel James S.
Published: July 2019

Background:

Prior research shows increased foot temperatures are predictive of diabetes-related foot complications. Our aim was to describe normative skin foot temperatures for individuals with diabetic peripheral neuropathy to better inform new technologies. We also explored for potential risk factors which correlate with changes in foot temperatures.

Methods:

We conducted a retrospective chart review of adult patients >18 years of age with diabetes mellitus and clinically diagnosed diabetic peripheral neuropathy with pedal digital thermometry performed between 2009 and 2018. A total of 58 patients met these criteria. Univariate modeling was based on covariates that may affect foot temperature including age, peripheral arterial disease, toe pressure, seasonality of measurement, smoking pack-years, caffeine use, insulin use, and calcium channel blocker use.

Results:

In patients with diabetic peripheral neuropathy, mean toe temperatures of 27.67°C (6.300°C), forefoot of 28.58°C (5.36°C), midfoot of 29.21°C (3.81°C), and rearfoot of 29.88°C(3.83°C) were demonstrated. A modest negative correlation between seasonality and toe and metatarsal temperatures ( r = −0.38, P < .05; r = −0.43 P < .01, respectively) was demonstrated. Midfoot temperatures were modestly and positively correlated to the presence of small fiber symptoms ( r = 0.33, P = .03). Positive modest correlation with rearfoot temperatures and amount of pack-year history ( r = 0.30, P = .03) was seen.

Conclusion:

Normative foot temperatures in neuropathic patients were found to be inversely associated with seasonality at the toe and metatarsal level. Smoking and pack-year history demonstrate modest correlation previously unseen in temperature analyses and warrant further exploration. Normative temperatures in neuropathic patients can better inform new technologies for the prevention of diabetic foot ulcer and Charcot neuroarthropathy.
Use, effectiveness and tolerability of budesonide‐MMX in ulcerative colitis: A real‐life experience
Authors: Maconi Giovanni , Mezzina Nicolò , Landi Stefano , Grillo Simone , Bezzio Cristina , Bosani Matteo , Pastorelli Luca , Dell'Era Alessandra , Chibbar Richa , Carmagnola Stefania , Molteni Paola , Cassinotti Andrea , Massari Alessandro , Ardizzone Sandro
Published: July 2019

Background

Budesonide‐MMX has an established role in the management of relapsing mild‐to‐moderate ulcerative colitis. Data regarding effectiveness and tolerability in real‐life clinical practice are limited.

Aim

The aim of this study was to assess the use of budesonide‐MMX in ulcerative colitis, as well as short‐term effectiveness and tolerability in real‐life practice.

Methods

We conducted a retrospective study of adult patients with mild‐to‐moderate ulcerative colitis treated with budesonide‐MMX at four tertiary inflammatory bowel disease centres in Italy from June 2016 to February 2018. Demographic and clinical features of patients, the use of budesonide‐MMX, disease course and concomitant therapy were recorded. The primary outcome assessed was clinical remission at 2 months.

Results

A total of 82 patients with active mild‐to‐moderate ulcerative colitis were included in the study with a mean age of 45.9 years and a median partial Mayo Score of 4 (interquartile range 3–5). A total of 41 patients were male. Overall, 36 had extensive colitis, 38 left‐sided colitis and eight proctitis. Treatments at the time of inclusion included 10 patients receiving biologic therapy, seven azathioprine and 54 mesalazine or salazopyrin. The main reasons for the addition of budesonide‐MMX were clinical relapse (47.5%) or inadequate response to current therapy (39.0%). In total, 50% of patients achieved clinical remission, whereas 9.8% had clinical improvement. No response was noted in 40.2% of subjects. Using multivariate binary logistic regression, a moderate degree of activity was the main independent predictor of non‐response. Eight significant adverse effects were reported in six patients with three discontinuing treatment.

Conclusion

In real‐life clinical practice, budesonide‐MMX is commonly used in combination with other therapies, both for acute disease flares and for partial response to therapy.
A multicentre prospective cohort study assessing the effectiveness of budesonide MMX® (Cortiment®MMX®) for active, mild‐to‐moderate ulcerative colitis
Authors: Danese Silvio , Hart Ailsa , Dignass Axel , Fiorino Gionata , Louis Edouard , Bonovas Stefanos , D'Haens Geert , Dotan Iris , Rogler Gerhard , Paridaens Kristine , Peyrin-Biroulet Laurent
Published: July 2019

Background

Cortiment®MMX® (budesonide MMX®) is currently approved for the induction of remission in mild‐to‐moderate ulcerative colitis (UC) patients when 5‐ASA treatment is not sufficient. Data in real‐life settings are lacking.

Methods

This was a multicentre observational prospective cohort study conducted in Europe and Canada. Effectiveness, safety, and tolerability of Cortiment®MMX® in a real‐life setting of patients treated for mild‐to‐moderate UC was investigated. Patients were prescribed Cortiment®MMX® in accordance with the Summary of the Product Characteristics (SmPC).

The primary endpoint was the clinical benefit of Cortiment® MMX® in routine practice (improvement ≥ 3 points in the clinical sub‐scores of the Ulcerative Colitis Disease Activity Index, UCDAI).

Results

Data from 326 patients with mild‐to‐moderate UC were analysed for the primary endpoint. Clinical benefit was achieved in 60.1% (196/326) of patients at the end of Cortiment®MMX® treatment. Clinical remission (UCDAI clinical sub‐score ≤ 1), full symptoms resolution (rectal bleeding (RB) = 0 and stool frequency (SF) = 0) and symptoms resolution (RB = 0 + SF ≤ 1) at the end of the Cortiment®MMX® treatment were achieved in 51.8%, 45.1% and 63.2% of patients, respectively. The median time to symptoms resolution was 30 days (range 29.0–36.0 days). Fifty patients (14.3%) had to discontinue Cortiment®MMX® due to adverse events; 17.5% of patients (n = 61) reported at least one adverse event related to the study drug.

Conclusions

This was the first time that a large cohort study was conducted with Cortiment®MMX® in a real‐life setting. It demonstrated that Cortiment®MMX® is effective, safe and well tolerated in about 60% of UC patients.
The utility of preoperative and intraoperative cultures for guiding urosepsis empirical treatment
Authors: Wood Brielle , Habashy David , Mayne Darren J , Dhar Ankur , Purvis Claire , Skyring Timothy
Published: July 2019

Objective:

Endoscopic upper urinary tract instrumentation is a common urological procedure; often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation.

Methods:

Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis.

Results:

The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases.

Conclusions:

To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b
Presenting qualitative comparative analysis: Notation, tabular layout, and visualization
Authors: Rubinson Claude
Published: July 2019

This article reviews approaches to presenting qualitative comparative analysis and set-theoretic research, with an emphasis on graphic presentation. Although visualization is an important aspect of presenting empirical research, techniques for visualizing qualitative comparative analysis remains underdeveloped. This article reviews existing and emerging standards of presenting qualitative comparative analysis and introduces a number of new ones. Techniques are presented for visualizing calibrated data, truth tables, and consistency/coverage solutions, with particular attention given to strategies for presenting superset/subset relationships.
Elevated Core Temperature in Florida Fernery Workers: Results of a Pilot Study
Authors: Mac Valerie Vi Thien , Tovar-Aguilar Jose Antonio , Elon Lisa , Hertzberg Vicki , Economos Eugenia , McCauley Linda A.
Published: July 2019

With expected increases in extreme weather, there may be a greater risk of injury from extreme heat in outdoor worker populations. To plan for future adaptation measures, studies are needed that can characterize workers’ physiologic responses to heat in outdoor settings such as agriculture. The objective of this study was to characterize occupational heat exposure, key vulnerability factors (e.g., gender, energy expenditure), and physiologic heat stress response in a sample of fernery workers. Forty-three fernery workers over 86 workdays were examined regarding heat-related illness (HRI) during the summer months of 2012 and 2013. The key outcome measure was whether a participant’s body core temperature (Tc) reached or exceeded 38.0°C (100.4ºF; Tc38). Participants’ Tc exceeded 38.0°C on 49 (57%) of the workdays, with 30 of 40 participants reaching or exceeding Tc38 on at least one workday. Adjusting for sex, there was a 12% increase in the odds of Tc38 for every 100 kilocalories of energy expended (OR: 1.12; 95% Confidence Interval [CI]: [1.03, 1.21]). Adjusting for energy expenditure, females had 5 times greater odds of Tc38 compared with males (OR: 5.38; 95% CI: [1.03, 18.30]). These findings provide evidence of elevated Tc in Florida fernery workers, indicating an increased risk of occupational HRI, and the need for policy and interventions to address this health risk.
Treatment of a sacral fracture associated with an intrasacral meningocele: A case report
Authors: Akahane Mika , Sawaguchi Takeshi , Sakagoshi Daigo , Goshima Kenichi , Shigemoto Kenji , Hatsuchi Yu
Published: July 2019

We report a case of sacral fracture complicated by an intrasacral meningocele in a 37-year-old male. The patient had a left sacral fracture with bilateral fractures of the superior and inferior pubic rami. The sacrum was fixed with a posterior plate and both superior pubic rami were fixed with an intramedullary screw. However, computed tomography myelogram and magnetic resonance imaging showed the intrasacral meningocele with the leakage of the cerebrospinal fluid into the buttocks and developed delayed union. Reoperation utilizing a strong anterior and posterior internal fixation combined with posterior bone grafting was undertaken and bone union was obtained.
Targeting WDR5: A WINning Anti-Cancer Strategy?
Authors: Aho Erin R , Weissmiller April M , Fesik Stephen W , Tansey William P
Published: July 2019

WDR5 is a component of multiple epigenetic regulatory complexes, including the mixed lineage leukemia (MLL)/SET complexes that deposit histone H3 lysine 4 methylation. Inhibitors of an arginine-binding cavity in WDR5, known as the WDR5-interaction (WIN) site, have been proposed to selectively kill MLL-rearranged malignancies via an epigenetic mechanism. We discovered potent WIN site inhibitors and found that they kill MLL cancer cells not through changes in histone methylation, but by displacing WDR5 from chromatin at protein synthesis genes, choking the translational capacity of these cells, and inducing death via a nucleolar stress response. The mechanism of action of WIN site inhibitors reveals new aspects of WDR5 function and forecasts broad therapeutic utility as anti-cancer agents.
Assessment of TCR signal strength of antigen-specific memory CD8+ T cells in human blood
Authors: Wu Hanchih , Witzl Ashley , Ueno Hideki
Published: July 2019

Assessment of the quality and the breadth of antigen (Ag)-specific memory T cells in human samples is of paramount importance to elucidate the pathogenesis and to develop new treatments in various diseases. T-cell receptor (TCR) signal strength, primarily controlled by TCR affinity, affects many fundamental aspects of T-cell biology; however, no current assays for detection of Ag-specific CD8+ T cells can assess their TCR signal strength in human samples. Here, we provide evidence that interferon regulatory factor 4 (IRF4), a transcription factor rapidly upregulated in correlation with TCR signal strength, permits the assessment of the TCR signal strength of Ag-specific CD8+ T cells in human peripheral blood mononuclear cells (PBMCs). Coexpression of IRF4 and CD137 sensitively detected peptide-specific CD8+ T cells with extremely low background in PBMCs stimulated for 18 hours with MHC class I peptides. Our assay revealed that human memory CD8+ T cells with high-affinity TCRs have an intrinsic ability to highly express CD25. Furthermore, HIV-specific CD8+ T cells in chronic HIV+ subjects were found to display primarily low-affinity TCRs with low CD25 expression capacity. Impairment in the functions of HIV-specific CD8+ T cells might be associated with their suboptimal TCR signals, as well as impaired responsiveness to interleukin-2.
IL-1 receptor blockade skews inflammation towards Th2 in a mouse model of systemic sclerosis
Authors: Birnhuber Anna , Crnkovic Slaven , Biasin Valentina , Marsh Leigh M. , Odler Balazs , Sahu-Osen Anita , Stacher-Priehse Elvira , Brcic Luka , Schneider Frank , Cikes Nada , Ghanim Bahil , Klepetko Walter , Graninger Winfried , Allanore Yannick , Eferl Robert , Olschewski Andrea , Olschewski Horst , Kwapiszewska Grazyna
Published: July 2019

The interleukin (IL)-1 family of cytokines is strongly associated with systemic sclerosis (SSc) and pulmonary involvement, but the molecular mechanisms are poorly understood. The aim of this study was to assess the role of IL-1α and IL-1β in pulmonary vascular and interstitial remodelling in a mouse model of SSc.

IL-1α and IL-1β were localised in lungs of SSc patients and in the fos-related antigen-2 (Fra-2) transgenic (TG) mouse model of SSc. Lung function, haemodynamic parameters and pulmonary inflammation were measured in Fra-2 TG mice with or without 8 weeks of treatment with the IL-1 receptor antagonist anakinra (25 mg·kg−1·day−1). Direct effects of IL-1 on pulmonary arterial smooth muscle cells (PASMCs) and parenchymal fibroblasts were investigatedin vitro.

Fra-2 TG mice exhibited increased collagen deposition in the lung, restrictive lung function and enhanced muscularisation of the vasculature with concomitant pulmonary hypertension reminiscent of the changes in SSc patients. Immunoreactivity of IL-1α and IL-1β was increased in Fra-2 TG mice and in patients with SSc. IL-1 stimulation reduced collagen expression in PASMCs and parenchymal fibroblastsviadistinct signalling pathways. Blocking IL-1 signalling in Fra-2 TG worsened pulmonary fibrosis and restriction, enhanced T-helper cell type 2 (Th2) inflammation, and increased the number of pro-fibrotic, alternatively activated macrophages.

Our data suggest that blocking IL-1 signalling as currently investigated in several clinical studies might aggravate pulmonary fibrosis in specific patient subsets due to Th2 skewing of immune responses and formation of alternatively activated pro-fibrogenic macrophages.
FGF signaling patterns cell fate at the interface between tendon and bone
Authors: Roberts Ryan R. , Bobzin Lauren , Teng Camilla S. , Pal Deepanwita , Tuzon Creighton T. , Schweitzer Ronen , Merrill Amy E.
Published: July 2019

Tendon and bone are attached by a transitional connective tissue that is morphologically graded from tendinous to osseous and develops from bipotent progenitors that co-express scleraxis (Scx) and Sox9 (Scx+/Sox9+). Scx+/Sox9+ progenitors have the potential to differentiate into either tenocytes or chondrocytes, yet the developmental mechanism that spatially resolves their bipotency at the tendon-bone interface during embryogenesis remains unknown. Here, we demonstrate that development of Scx+/Sox9+ progenitors within the mammalian lower jaw requires FGF signaling. We find that loss of Fgfr2 in the mouse tendon-bone interface reduces Scx expression in Scx+/Sox9+ progenitors and induces their biased differentiation into Sox9+ chondrocytes. This expansion of Sox9+ chondrocytes, which is concomitant with decreased Notch2-Dll1 signaling, prevents formation of a mixed population of chondrocytes and tenocytes, and instead results in ectopic endochondral bone at tendon-bone attachment units. Our work shows that FGF signaling directs zonal patterning at the boundary between tendon and bone by regulating cell fate decisions through a mechanism that employs Notch signaling.
Nkx2-5 defines a subpopulation of pacemaker cells and is essential for the physiological function of the sinoatrial node in mice
Authors: Li Hua , Li Dainan , Wang Yuzhi , Huang Zhen , Xu Jue , Yang Tianfang , Wang Linyan , Tang Qinghuang , Cai Chen-Leng , Huang Hai , Zhang Yanding , Chen YiPing
Published: July 2019

The sinoatrial node (SAN), the primary cardiac pacemaker, consists of a head domain and a junction/tail domain that exhibit different functional properties. However, the underlying molecular mechanism defining these two pacemaker domains remains elusive. Nkx2-5 is a key transcription factor essential for the formation of the working myocardium, but it was generally thought to be detrimental to SAN development. However, Nkx2-5 is expressed in the developing SAN junction, suggesting a role for Nkx2-5 in SAN junction development and function. In this study, we present unambiguous evidence that SAN junction cells exhibit unique action potential configurations intermediate to those manifested by the SAN head and the surrounding atrial cells, suggesting a specific role for the junction cells in impulse generation and in SAN-atrial exit conduction. Single-cell RNA-seq analyses support this concept. Although Nkx2-5 inactivation in the SAN junction did not cause a malformed SAN at birth, the mutant mice manifested sinus node dysfunction. Thus, Nkx2-5 defines a population of pacemaker cells in the transitional zone. Despite Nkx2-5 being dispensable for SAN morphogenesis during embryogenesis, its deletion hampers atrial activation by the pacemaker.