bluuebunny/crossref_metadata_2025 huggingface dataset:
Content validity, face validity and internal consistency of the Slovene version of Caring Factor Survey for care providers, caring for co‐workers and caring of managers
Authors: Vrbnjak Dominika , Pahor Dušica , Nelson John W. , Pajnkihar Majda
Published: June 2016

Background

Caring relationships are important for developing a caring culture. It is important that care provider's relationships with patients, co‐workers and managers are caring relationships. However, in the Slovene language, there is a lack of psychometrically sound instruments to measure these caring relationships.

Aim

To explore the psychometric properties of the Slovenian version of the Caring Factor Survey (CFS) for care providers, the care given by co‐workers and managers as judged by the providers, by evaluating its content validity, face validity and internal consistency.

Methods

In the process of our instrument, we used translation and back translation and validation based on experts' agreement. Content validity was quantified by the content validity index (CVI) and a modified Cohen's kappa index. Face validity was evaluated by ten nurses who reviewed the instruments. In the process of psychometric testing based on survey data, we used a cross‐sectional research design with a convenience sample of 91 caregivers working in internal or surgical wards in two health care institutions. Cronbach's alpha and corrected item–total correlations were used to test internal consistency.

Results

All items in all three versions of the CFS had a CVI score higher than 0.78 and excellent modified Cohen's kappa index, showing excellent content validity. The average content validity indices were 0.990, 0.975 and 0.963. The face validity was good with no major remarks given. Cronbach's alpha was 0.941, 0.962 and 0.970. The item–total correlations reached a criterion of 0.2 < r < 0.3 for all items.

Conclusion

All three versions of the CFS showed an acceptable content validity, face validity and internal consistency; however, due to some methodological shortcomings, results should be interpreted with caution. Further psychometric testing is needed.
Exploring the Rural Eco‐Economy: Beyond Neoliberalism
Authors: Marsden Terry
Published: June 2016

Rural areas become central sites for the development of the post‐carbon transition, yet this is a highly contested and contingent process whereby neo‐liberal models of development and framings compete with the emergence of the alternative circular eco‐economy. The article argues for a grounded conceptual and empirical approach in tracing this overall process of sustainable place‐making. It explores three key highly contested dimensions: reflexive governance, distributed eco‐economies, and re‐financialisation, arguing that such explorations are critical in developing more sustainable rural‐urban functionalities for the necessary post‐ carbon and post‐neoliberal transition.
Spatial distribution and risk assessment of heavy metals in the farmland along mineral product transportation routes in Zhejiang, China
Authors: Yan W. , Liu D. , Peng D. , Mahmood Q. , Chen T. , Wang Y. , Li S. , Chen J.
Published: June 2016

Various metal pollutants transported from certain sources may considerably contaminate the soil environment. It was reported that transportation related metal pollution was closely associated with the distance, the freight volume and traffic emissions. However, the effect of topography on the heavy metal distribution in the soils along transportation routes has received little attention. In the present investigation, arable soils along two selected transportation routes for mineral products were studied to characterize the topographic impacts on their level of metal pollution. Soil samples were collected within a 5‐m radius following ‘S’ sampling procedure using spatial autocorrelation analysis. The descriptive statistics showed that most of the heavy metal (Pb, Zn, Cu and Cd) concentrations exceeded the background value of Zhejiang Province and contents of most metals in Area B, within a plain, were generally higher than in Area A, a valley within a hilly region. LISA maps showed that all heavy metals did not have similar spatial autocorrelation in Area B. The spatial distribution maps in Area A showed that distribution of most of the contaminants Zn, Cu, Cd and Pb had a similar spatial structure and were located along a transportation route. In Area A within valley topography, metal concentrations in soils were found generally to decrease with increasing distance from the road. However, this was not valid for Area B on the plain, where the metals concentrated in the soils could be derived from multiple sources, particularly emissions from nearby local industry.
Probable transfusion‐transmitted Zika virus in Brazil
Authors: Barjas‐Castro Maria L. , Angerami Rodrigo N. , Cunha Mariana S. , Suzuki Akemi , Nogueira Juliana S. , Rocco Iray M. , Maeda Adriana Y. , Vasami Fernanda G.S. , Katz Gizelda , Boin Ilka F.S.F. , Stucchi Raquel S.B. , Resende Mariângela R. , Esposito Danillo L.A. , de Souza Renato P. , da Fonseca Benedito A. , Addas‐Carvalho Marcelo
Published: June 2016

BACKGROUND

Zika virus (ZIKV) is an emerging arthropod‐borne flavivirus transmitted by Aedes mosquitoes. Recent commentaries regarding ZIKV routes of transmission describe a potential transmission by transfusion. Herein, we report a probable case of transfusion‐transmitted ZIKV infection through a platelet transfusion that was detected from postdonation information.

CASE REPORT

A blood donor made a voluntary telephone report to the blood donor facility 3 days after donation and informed the facility of a febrile illness (fever, malaise, and headaches). Due to the ongoing dengue epidemic, the initial clinical investigation included dengue among other possible diagnoses. The serology and molecular laboratory results excluded dengue infection. However, stored samples from the donation were positive for ZIKV on reverse transcription‐polymerase chain reaction (RT‐PCR) analysis. A retrospective investigation demonstrated that the platelet concentrate, which was part of a pool, had been transfused after a liver transplantation. A physician had evaluated the patient 4 days after surgery. Laboratory investigation showed enzyme‐linked immunosorbent assay results that were negative for dengue immunoglobulin M antibodies; however, the results were positive for hemagglutination inhibition antibodies against flavivirus. ZIKV RT‐PCR and virus isolation analyses in cell cultures from recipient serum were both positive. The sequencing confirmed ZIKV in the donor and patient samples. Ten partial nucleotide sequences from the ZIKV strain that were detected in the donor were aligned and compared with the ZIKV genome detected in the recipient, revealing a 99.8% homology between the two strains.

CONCLUSIONS

This is a case of probable transmission of ZIKV through blood transfusion. The patient had been transfused with the blood product from an infected donor, most likely in the incubation period after ZIKV infection but prior to clinical disease onset. This report emphasizes the importance of postdonation information and recipient investigations during outbreaks of potentially blood‐borne infections.
Two solvent/detergent‐treated plasma products with a different biochemical profile
Authors: Neisser‐Svae A. , Heger A.
Published: June 2016

Background and Objectives

The distribution of US‐produced solvent/detergent (S/D)‐treated plasma (Plas+SD) was discontinued in 2003 due to bleeding and thrombotic events. In this work, we were searching for explanations that might explain these severe side‐effects.

Materials and Methods

The activities of coagulation factors and inhibitors and von Willebrand factor (VWF) multimers were tested in three Plas+SD batches and compared with an S/D‐treated plasma named OctaplasLG. In addition, the Plas+SD process was investigated in downscale studies.

Results

When compared to OctaplasLG, coagulation factors (F)V and FXI were significantly increased in the Plas+SD product, whereas FIX, protein C (PC), protein S (PS) and plasmin inhibitor (PI) were significantly decreased, leading to a haemostatic imbalance in this product. In addition, loss of high molecular weight VWF multimers was observed in the Plas+SD product compared to both OctaplasLG and normal plasma. Downscale studies of the Plas+SD manufacturing steps revealed significant losses of all parameters tested during the S/D‐treatment and removal steps. Except for PS and PI, which remained decreased by 47% and 65%, respectively, these losses were nearly compensated for the other parameters by the subsequent ultrafiltration step performed.

Conclusion

Although both S/D plasma manufacturing processes have the same basic set‐up, differences in single process steps are responsible for the different biochemical profiles. The study performed may contribute to a better understanding of the side‐effects that occurred with the Plas+SD product.
On the Relationship Between Journal Misalignment and Web Deflection in Crankshafts
Authors: Jang J. Y. , Khonsari M. M.
Published: June 2016

To characterize the severity of misaligned journal bearings, two independent parameters are needed: degree of misalignment and misalignment angle. These parameters are routinely used to predict the behavior of steadily loaded bearing. However, in the case of dynamically loaded bearings, the associated measurement of these parameters becomes much more complex. It is shown that the local crankshaft deflection can be obtained from the rigid body motion of the main journal with computed deflection angles. A model is developed which provides a relationship between the web deflection and crankshaft deflection. It enables one to conveniently characterize the severity of misalignment by measuring web deflection.
Hydraulic Design of Inlet Guide Vane and its Full Flow Passage Numerical Simulation on Centrifugal Pump
Authors: Hou Hucan , Zhang Yongxue , Li Zhenlin , Zhou Xin , Wang Zizhe
Published: June 2016

In order to effectively improve hydraulic performance of centrifugal pump on off-conditions, the hydraulic design of inlet guide vane (IGV) was completed by adopting two dimensional theory in-house code based on one kind of IS series of centrifugal pump, which can achieve pre-whirl regulation of centrifugal pump. During design process the trailing edge of vane is assumed as equal velocity moment condition, and the distribution of vane setting angle along meridional streamline is also given as a quartic function firstly, the camber line is then drawn by point-by-point integration method and thickened at both sides along circumferential direction. With local vortex dynamics diagnosis theory, the optimal improvement of vane space shape can be finished by adjusting the design parameters of vane setting angle distribution coefficient ap. The full flow passage numerical simulations of centrifugal pump with IGV device are completed to analyze the influence of pre-whirl regulation on hydraulic performance of centrifugal pump under various pre-whirl angles. The results show that the pre-whirl regulation can improve the hydraulic performance of centrifugal pump on off-conditions. Under the positive pre-whirl regulation conditions, the best efficient point shift to small flow rate zone, and under the negative pre-whirl regulation conditions it moves to large flow rate zone. Compared with the pump without IGV device at the same flow rate condition of 0.8Q (Q the design flow rate), the hydraulic efficiency of centrifugal pump with IGV device improves obviously and reaches up to 1.43%. Meanwhile compared with that installed with the straight vanes designed based on the traditional theory, the inner flow field of centrifugal pump with the designed vanes improves and the overall hydraulic efficiency of centrifugal pump is somewhat increased.
Experimental Performance Evaluation of a Centrifugal Pump With Different Impeller Vane Geometries
Authors: Das Susanta K.
Published: June 2016

Centrifugal pumps vane geometry plays an important role in pump’s overall performance. Thus, to know the impeller vane geometry effects on the performance of a centrifugal pump are essential from pump’s design point of view. In this study, an experimental investigation is carried out to judge the impeller vane geometry effects on the performance of a centrifugal pump. The performance of three different impeller vane geometries is evaluated in this investigation. To acquire pump performance and characteristics curves, inlet and outlet valves were manually adjusted and the pump’s rpm were varied remotely through computer control. The pressure data were obtained via installed flow rotameter for different flow rates with constant pump speed – 1800 rpm. Experimental data were used to calculate different physical parameters, such as the pump head, water horsepower — the power added to the fluid, power input to the pump–brake horse power, and pump efficiency for each of impeller vane geometries. The pump’s performance curves and the system curves were then plotted for each of the vane geometries. The results show that the pump performance as well as efficiency varies significantly for each of the impeller vane geometries. The results help to understand how to determine appropriate operating conditions and design parameters for different impeller vane geometries for obtaining optimized pump performance.
4D‐CT scans reveal reduced magnitude of respiratory liver motion achieved by different abdominal compression plate positions in patients with intrahepatic tumors undergoing helical tomotherapy
Authors: Hu Yong , Zhou Yong‐Kang , Chen Yi‐Xing , Shi Shi‐Ming , Zeng Zhao‐Chong
Published: June 2016

Purpose:

While abdominal compression (AC) can be used to reduce respiratory liver motion in patients receiving helical tomotherapy for hepatocellular carcinoma, the nature and extent of this effect is not well described. The purpose of this study was to evaluate the changes in magnitude of three‐dimensional liver motion with abdominal compression using four‐dimensional (4D) computed tomography (CT) images of several plate positions.

Methods:

From January 2012 to October 2015, 72 patients with intrahepatic carcinoma and divided into four groups underwent 4D‐CT scans to assess respiratory liver motion. Of the 72 patients, 19 underwent abdominal compression of the cephalic area between the subxiphoid and umbilicus (group A), 16 underwent abdominal compression of the caudal region between the subxiphoid area and the umbilicus (group B), 11 patients underwent abdominal compression of the caudal umbilicus (group C), and 26 patients remained free breathing (group D). 4D‐CT images were sorted into ten‐image series, according to the respiratory phase from the end inspiration to the end expiration, and then transferred to treatment planning software. All liver contours were drawn by a single physician and confirmed by a second physician. Liver relative coordinates were automatically generated to calculate the liver respiratory motion in different axial directions to compile the 10 ten contours into a single composite image. Differences in respiratory liver motion were assessed with a one‐way analysis of variance test of significance.

Results:

The average respiratory liver motion in the Y axial direction was 4.53 ± 1.16, 7.56 ± 1.30, 9.95 ± 2.32, and 9.53 ± 2.62 mm in groups A, B, C, and D, respectively, with a significant change among the four groups (p < 0.001). Abdominal compression was most effective in group A (compression plate on the subxiphoid area), with liver displacement being 2.53 ± 0.93, 4.53 ± 1.16, and 2.14 ± 0.92 mm on the X‐, Y‐, and Z‐axes, respectively. There was no significant difference in respiratory liver motion between group C (displacement: 3.23 ± 1.47, 9.95 ± 2.32, and 2.92 ± 1.10 mm on the X‐, Y‐, and Z‐axes, respectively) and group D (displacement: 3.35 ± 1.55, 9.53 ± 2.62, and 3.35 ± 1.73 mm on the X‐, Y‐, and Z‐axes, respectively). Abdominal compression was least effective in group C (compression on caudal umbilicus), with liver motion in this group similar to that of free‐breathing patients (group D).

Conclusions:

4D‐CT scans revealed significant liver motion control via abdominal compression of the subxiphoid area; however, this control of liver motion was not observed with compression of the caudal umbilicus. The authors, therefore, recommend compression of the subxiphoid area in patients undergoing external radiotherapy for intrahepatic carcinoma.
Prospective treatment plan‐specific action limits for real‐time intrafractional monitoring in surface image guided radiosurgery
Authors: Yock Adam D. , Pawlicki Todd , Kim Gwe‐Ya
Published: June 2016

Purpose:

In surface image guided radiosurgery, action limits are created to determine at what point intrafractional motion exhibited by the patient is large enough to warrant intervention. Action limit values remain constant across patients despite the fact that patient motion affects the target coverage of brain metastases differently depending on the planning technique and other treatment plan‐specific factors. The purpose of this work was twofold. The first purpose was to characterize the sensitivity of single‐met per iso and multimet per iso treatment plans to uncorrected patient motion. The second purpose was to describe a method to prospectively determine treatment plan‐specific action limits considering this sensitivity.

Methods:

In their surface image guided radiosurgery technique, patient positioning is achieved with a thermoplastic mask that does not cover the patient's face. The patient's exposed face is imaged by a stereoscopic photogrammetry system. It is then compared to a reference surface and monitored throughout treatment. Seventy‐two brain metastases (representing 29 patients) were used for this study. Twenty‐five mets were treated individually (“single‐met per iso plans”), and 47 were treated in a plan simultaneously with at least one other met (“multimet per iso plans”). For each met, the proportion of the gross tumor volume that remained within the 100% prescription isodose line was estimated under the influence of combinations of translations and rotations (0.0–3.0 mm and 0.0°–3.0°, respectively). The target volume and the prescription dose–volume were considered concentric spheres that each encompassed a volume determined from the treatment plan. Plan‐specific contour plots and DVHs were created to illustrate the sensitivity of a specific lesion to uncorrected patient motion.

Results:

Both single‐met per iso and multimet per iso plans exhibited compromised target coverage under translations and rotations, though multimet per iso plans were considerably more sensitive to these transformations (2.3% and 39.8%, respectively). Plan‐specific contour plots and DVHs were used to illustrate how size, distance from isocenter, and planning technique affect a particular met's sensitivity to motion.

Conclusions:

Stereotactic radiosurgery treatment plans that treat multiple brain metastases using a common isocenter are particularly susceptible to compromised target coverage as a result of uncorrected patient motion. The use of such a planning technique along with other treatment plan‐specific factors should influence patient motion management. A graphical representation of the effect of translations and rotations on any particular plan can be generated to inform clinicians of the appropriate action limit when monitoring intrafractional motion.
Celebrating the centenary of the Schwarzschild solutions
Authors: Grøn Øyvind
Published: June 2016

This article is a celebration of the centenary of Schwarzschild's presentations of his external and internal solutions describing spacetime outside and inside an incompressible, spherically symmetric body. I give a review of these solutions and how they have been interpreted physically.
Quantitative wave-particle duality
Authors: Qureshi Tabish
Published: June 2016

The complementary wave and particle character of quantum objects (or quantons) was pointed out by Niels Bohr. This wave-particle duality, in the context of the two-slit experiment, is here described not just as two extreme cases of wave and particle characteristics, but in terms of quantitative measures of these characteristics, known to follow a duality relation. A very simple and intuitive derivation of a closely related duality relation is presented, which should be understandable to the introductory student.
Electromagnetic field energy revisited
Authors: Hilborn Robert C.
Published: June 2016

Electromagnetic field energy is often invoked in introductory physics courses as a mechanism for describing energy exchanges among charged objects. In this paper, we examine field energy in two relatively simple scenarios: a charged particle in a locally uniform electric field and a charged particle moving with a uniform velocity. In both cases, detailed calculations of field energies unveil several surprises about where field energy is located and how it changes when the charge is moving. We argue that these complexities indicate that potential (configuration) energy is a more useful concept than field energy for introductory physics courses.
Correlates of Leisure Time Physical Inactivity in a Scandinavian Population: A Basis for Interventions
Authors: Bonn Stephanie E. , Alfredsson Lars , Saevarsdottir Saedis , Schelin Maria E.C.
Published: June 2016

Background:

Effective interventions are needed to increase physical activity in the general population. To target interventions, we need knowledge of insufficiently active groups in society. This study aims to identify demographic and health-related correlates of leisure-time physical inactivity in a general Scandinavian population.

Methods:

Study participants comprised 5734 control subjects, age 18 to 70 years, from 2 ongoing Swedish case-control studies. Participants self-reported their leisure-time physical activity level. The odds of being physically inactive were calculated using logistic regression.

Results:

A total of 42% of participants were classified as physically inactive during leisure time. A lower prevalence of inactivity was associated with middle age, higher education, having previous experience of sports participation, following a low glycemic index/Mediterranean diet and having a light physical workload. A high prevalence of inactivity was associated with greater age, high body mass index, smoking, never drinking alcohol, having children, having a weak social network or lower levels of emotional support, and a low vegetable intake.

Conclusions:

Several factors were associated with leisure-time physical inactivity. Directing interventions to target groups defined by specific factors associated with physical inactivity could be an efficient way to increase activity and improve health in the general population.
The Attributable Proportion of Specific Leisure-Time Physical Activities to Total Leisure Activity Volume Among US Adults, National Health and Nutrition Examination Survey 1999–2006
Authors: Watson Kathleen Bachtel , Dai Shifan , Paul Prabasaj , Carlson Susan A. , Carroll Dianna D. , Fulton Janet
Published: June 2016

Background:

Previous studies have examined participation in specific leisure-time physical activities (PA) among US adults. The purpose of this study was to identify specific activities that contribute substantially to total volume of leisure-time PA in US adults.

Methods:

Proportion of total volume of leisure-time PA moderate-equivalent minutes attributable to 9 specific types of activities was estimated using self-reported data from 21,685 adult participants (≥ 18 years) in the National Health and Nutrition Examination Survey 1999–2006.

Results:

Overall, walking (28%), sports (22%), and dancing (9%) contributed most to PA volume. Attributable proportion was higher among men than women for sports (30% vs. 11%) and higher among women than men for walking (36% vs. 23%), dancing (16% vs. 4%), and conditioning exercises (10% vs. 5%). The proportion was lower for walking, but higher for sports, among active adults than those insufficiently active and increased with age for walking. Compared with other racial/ethnic groups, the proportion was lower for sports among non-Hispanic white men and for dancing among non-Hispanic white women.

Conclusions:

Walking, sports, and dance account for the most activity time among US adults overall, yet some demographic variations exist. Strategies for PA promotion should be tailored to differences across population subgroups.
Structural Study of MPN387, an Essential Protein for Gliding Motility of a Human-Pathogenic Bacterium, Mycoplasma pneumoniae
Authors: Kawakita Yoshito , Kinoshita Miki , Furukawa Yukio , Tulum Isil , Tahara Yuhei O. , Katayama Eisaku , Namba Keiichi , Miyata Makoto
Published: June 2016

Mycoplasma pneumoniae
is a human pathogen that glides on host cell surfaces with repeated catch and release of sialylated oligosaccharides. At a pole, this organism forms a protrusion called the attachment organelle, which is composed of surface structures, including P1 adhesin and the internal core structure. The core structure can be divided into three parts, the terminal button, paired plates, and bowl complex, aligned in that order from the front end of the protrusion. To elucidate the gliding mechanism, we focused on MPN387, a component protein of the bowl complex which is essential for gliding but dispensable for cytadherence. The predicted amino acid sequence showed that the protein features a coiled-coil region spanning residue 72 to residue 290 of the total of 358 amino acids in the protein. Recombinant MPN387 proteins were isolated with and without an enhanced yellow fluorescent protein (EYFP) fusion tag and analyzed by gel filtration chromatography, circular dichroism spectroscopy, analytical ultracentrifugation, partial proteolysis, and rotary-shadowing electron microscopy. The results showed that MPN387 is a dumbbell-shaped homodimer that is about 42.7 nm in length and 9.1 nm in diameter and includes a 24.5-nm-long central parallel coiled-coil part. The molecular image was superimposed onto the electron micrograph based on the localizing position mapped by fluorescent protein tagging. A proposed role of this protein in the gliding mechanism is discussed.

IMPORTANCE
Human mycoplasma pneumonia is caused by a pathogenic bacterium,
Mycoplasma pneumoniae
. This tiny, 2-μm-long bacterium is suggested to infect humans by gliding on the surface of the trachea through binding to sialylated oligosaccharides. The mechanism underlying mycoplasma “gliding motility” is not related to any other well-studied motility systems, such as bacterial flagella and eukaryotic motor proteins. Here, we isolated and analyzed the structure of a key protein which is directly involved in the gliding mechanism.
EspC, an Autotransporter Protein Secreted by Enteropathogenic Escherichia coli, Causes Apoptosis and Necrosis through Caspase and Calpain Activation, Including Direct Procaspase-3 Cleavage
Authors: Serapio-Palacios Antonio , Navarro-Garcia Fernando
Published: June 2016

Enteropathogenic
Escherichia coli
(EPEC) has the ability to antagonize host apoptosis during infection through promotion and inhibition of effectors injected by the type III secretion system (T3SS), but the total number of these effectors and the overall functional relationships between these effectors during infection are poorly understood. EspC produced by EPEC cleaves fodrin, paxillin, and focal adhesion kinase (FAK), which are also cleaved by caspases and calpains during apoptosis. Here we show the role of EspC in cell death induced by EPEC. EspC is involved in EPEC-mediated cell death and induces both apoptosis and necrosis in epithelial cells. EspC induces apoptosis through the mitochondrial apoptotic pathway by provoking (i) a decrease in the expression levels of antiapoptotic protein Bcl-2, (ii) translocation of the proapoptotic protein Bax from cytosol to mitochondria, (iii) cytochrome
c
release from mitochondria to the cytoplasm, (iv) loss of mitochondrial membrane potential, (v) caspase-9 activation, (vi) cleavage of procaspase-3 and (vii) an increase in caspase-3 activity, (viii) PARP proteolysis, and (ix) nuclear fragmentation and an increase in the sub-G
1
population. Interestingly, EspC-induced apoptosis was triggered through a dual mechanism involving both independent and dependent functions of its EspC serine protease motif, the direct cleavage of procaspase-3 being dependent on this motif. This is the first report showing a shortcut for induction of apoptosis by the catalytic activity of an EPEC protein. Furthermore, this atypical intrinsic apoptosis appeared to induce necrosis through the activation of calpain and through the increase of intracellular calcium induced by EspC. Our data indicate that EspC plays a relevant role in cell death induced by EPEC.

IMPORTANCE
EspC, an autotransporter protein with serine protease activity, has cytotoxic effects on epithelial cells during EPEC infection. EspC causes cytotoxicity by cleaving fodrin, a cytoskeletal actin-associated protein, and focal adhesion proteins (i.e., FAK); interestingly, these proteins are also cleaved during apoptosis and necrosis. Here we show that EspC is able to cause cell death, which is characterized by apoptosis: by dissecting the apoptotic pathway and considering that EspC is translocated by an injectisome, we found that EspC induces the mitochondrial apoptotic pathway. Remarkably, EspC activates this pathway by two distinct mechanisms—either by using or not using its serine protease motif. Thus, we show for the first time that this serine protease motif is able to cleave procaspase-3, thereby reaching the terminal stages of caspase cascade activation leading to apoptosis. Furthermore, this overlapped apoptosis appears to potentiate cell death through necrosis, where EspC induces calpain activation and increases intracellular calcium.
Defying Muller’s Ratchet: Ancient Heritable Endobacteria Escape Extinction through Retention of Recombination and Genome Plasticity
Authors: Naito Mizue , Pawlowska Teresa E.
Published: June 2016

Heritable endobacteria, which are transmitted from one host generation to the next, are subjected to evolutionary forces that are different from those experienced by free-living bacteria. In particular, they suffer consequences of Muller’s ratchet, a mechanism that leads to extinction of small asexual populations due to fixation of slightly deleterious mutations combined with the random loss of the most-fit genotypes, which cannot be recreated without recombination. Mycoplasma-related endobacteria (MRE) are heritable symbionts of fungi from two ancient lineages,
Glomeromycota
(arbuscular mycorrhizal fungi) and
Mucoromycotina
. Previous studies revealed that MRE maintain unusually diverse populations inside their hosts and may have been associated with fungi already in the early Paleozoic. Here we show that MRE are vulnerable to genomic degeneration and propose that they defy Muller’s ratchet thanks to retention of recombination and genome plasticity. We suggest that other endobacteria may be capable of raising similar defenses against Muller’s ratchet.
Relapsing CD8+ encephalitis—looking for a solution
Authors: Salam Sharfaraz , Mihalova Tatiana , Ustianowski Andrew , McKee David , Siripurapu Rekha
Published: June 2016

CD8+ encephalitis (CD8+E) is an emerging and incompletely understood HIV-associated neurological syndrome, typically presenting as a steroid-responsive subacute encephalopathy with prominent white matter changes in patients with apparently well-controlled HIV infection. Some cases can be associated with the phenomenon of ‘viral escape’ (disproportionate replication within the cerebrospinal fluid), but the most important pathophysiology of CD8+E is thought to involve an attack on HIV-infected CD4+ lymphocytes by autoreactive CD8+ cells. We report a case of CD8+E where the initial positive response to steroid treatment was followed by several relapses on withdrawal. This led to the use of mycophenolate mofetil (MMF) as a long-term steroid-sparing agent, which is the first time this approach has been reported in the literature. The patient has now been on treatment with MMF for 10 months and it has been possible to taper the steroids down to a minimal maintenance dose without further relapse.
Straddling interatrial embolus: a rare clinical dilemma
Authors: Guella Elhosseyn , Mitchell Louis James , Sobolewska Jolanta , Khan Kamal
Published: June 2016

We present the case of a middle-aged man who was admitted with progressive shortness of breath and haemodynamic instability. He was diagnosed as having unprovoked bilateral central pulmonary emboli. Thrombolysis with alteplase was provided. Subsequently, an echocardiogram was performed which showed a thrombus straddling the interatrial septum. This was managed conservatively with enoxaparin anticoagulation. A repeat echocardiogram 2 days later showed complete resolution of the thrombus without clinical systemic arterial thromboembolic sequelae such as stroke, myocardial ischaemia or acute limb ischaemia.
Laryngeal leishmaniasis in a patient taking inhaled corticosteroids
Authors: Roberts Rachel Margaret , Mukherjee Jayanta , Phillips David
Published: June 2016

We present a case of a man in his late 60s, who had spent 3–4 months of the year in rural Spain, presenting with intermittent hoarseness of voice. He had a background of asthma and bronchiectasis, and was taking inhaled corticosteroids. His dysphonia was initially managed as bronchiectasis with little improvement. Bronchoscopy revealed a cystic lesion on his left vocal fold, and tissue biopsy revealedLeishmaniaamastigotes. This confirmed a diagnosis of laryngeal leishmaniasis. We propose that this is likely secondary to his inhaled corticosteroid therapy. The infection was treated with a 30-day course of miltefosine, and at most recent follow-up the patient was deemed free from leishmanial infection.
Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication
Authors: Vardy J , Keliher T , Fisher J , Ritchie F , Bell C , Chekroud M , Clarey F , Blackwood L , Barry L , Paton E , Clark A , Connelly R
Published: June 2016

Objectives

Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption.

Setting

ED of a UK tertiary referral hospital.

Participants

All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%).

Primary outcome measures

Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician.

Secondary outcome measures

Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria.

Results

1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003).

Conclusions

Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD.
Prevalence of musculoskeletal pain of the neck, upper extremities and lower back among dental practitioners working in Riyadh, Saudi Arabia: a cross-sectional study
Authors: Al-Mohrej Omar A , AlShaalan Nouf S , Al-Bani Waad M , Masuadi Emad M , Almodaimegh Hind S
Published: June 2016

Objectives

Studies have shown that dentists have a higher incidence of work-related musculoskeletal (MSK) pain than those in other occupations. The risk factors contributing to MSK pain among Saudi dentists has not been fully studied so this study aims to estimate the prevalence of MSK pain and investigate its associated risk factors among dentists in Saudi Arabia.

Setting and participants

A cross-sectional survey was carried out in the capital city Riyadh, Saudi Arabia, using random cluster sampling. 224 surveys were distributed among dentists with a 91.1% response rate (101 women and 103 men).

Outcomes

The prevalence of MSK pain and its associated risk factors were investigated.

Results

184 (90.2%) respondents reported having MSK pain. Lower back pain was the most commonly reported MSK pain (68.1%). Gender and age were reported to be predictors for at least one type of MSK pain. Older age was associated with lower back pain (OR 1.23; 95% CI 1.00 to 1.50) and women had double the risk of shoulder pain (OR 2.52; 95% CI 1.12 to 5.68). In addition, lower back pain was related to the time the dentist spent with patients (OR 0.28; 95% CI 0.14 to 0.54), while shoulder pain (OR 1.03; 95% CI 1.00 to 1.06) and lower back pain (OR 1.06; 95% CI 1.03 to 1.10) were significantly related to years of experience.

Conclusions

MSK pain is common among older and female Saudi dentists. Research on the impact of exercise and the ergonomics of the workplace on the intensity of MSK pain and the timing of its onset is required.
Cross-sectional study of ethnic differences in physical fitness among children of South Asian, black African–Caribbean and white European origin: the Child Heart and Health Study in England (CHASE)
Authors: Nightingale C M , Donin A S , Kerry S R , Owen C G , Rudnicka A R , Brage S , Westgate K L , Ekelund U , Cook D G , Whincup P H
Published: June 2016

Objective

Little is known about levels of physical fitness in children from different ethnic groups in the UK. We therefore studied physical fitness in UK children (aged 9–10 years) of South Asian, black African–Caribbean and white European origin.

Design

Cross-sectional study.

Setting

Primary schools in the UK.

Participants

1625 children (aged 9–10 years) of South Asian, black African–Caribbean and white European origin in the UK studied between 2006 and 2007.

Outcome measures

A step test assessed submaximal physical fitness from which estimated VO2 maxwas derived. Ethnic differences in estimated VO2 maxwere estimated using multilevel linear regression allowing for clustering at school level and adjusting for age, sex and month as fixed effects.

Results

The study response rate was 63%. In adjusted analyses, boys had higher levels of estimated VO2 maxthan girls (mean difference 3.06 mL O2/min/kg, 95% CI 2.66 to 3.47, p<0.0001). Levels of estimated VO2 maxwere lower in South Asians than those in white Europeans (mean difference −0.79 mL O2/min/kg, 95% CI −1.41 to −0.18, p=0.01); levels of estimated VO2 maxin black African–Caribbeans were higher than those in white Europeans (mean difference 0.60 mL O2/min/kg, 95% CI 0.02 to 1.17, p=0.04); these patterns were similar in boys and girls. The lower estimated VO2 maxin South Asians, compared to white Europeans, was consistent among Indian, Pakistani and Bangladeshi children and was attenuated by 78% after adjustment for objectively measured physical activity (average daily steps).

Conclusions

South Asian children have lower levels of physical fitness than white Europeans and black African–Caribbeans in the UK. This ethnic difference in physical fitness is at least partly explained by ethnic differences in physical activity.
Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention
Authors: Langer Thorsten , Martinez William , Browning David M , Varrin Pamela , Sarnoff Lee Barbara , Bell Sigall K
Published: June 2016

Background

Despite growing interest in engaging patients and families (P/F) in patient safety education, little is known about how P/F can best contribute. We assessed the feasibility and acceptability of a patient–teacher medical error disclosure and prevention training model.

Methods

We developed an educational intervention bringing together interprofessional clinicians with P/F from hospital advisory councils to discuss error disclosure and prevention. Patient focus groups and orientation sessions informed curriculum and assessment design. A pre-post survey with qualitative and quantitative questions was used to assess P/F and clinician experiences and attitudes about collaborative safety education including participant hopes, fears, perceived value of learning experience and challenges. Responses to open-ended questions were coded according to principles of content analysis.

Results

P/F and clinicians hoped to learn about each other's perspectives, communication skills and patient empowerment strategies. Before the intervention, both groups worried about power dynamics dampening effective interaction. Clinicians worried that P/F would learn about their fallibility, while P/F were concerned about clinicians’ jargon and defensive posturing. Following workshops, clinicians valued patients’ direct feedback, communication strategies for error disclosure and a ‘real’ learning experience. P/F appreciated clinicians’ accountability, and insights into how medical errors affect clinicians. Half of participants found nothing challenging, the remainder clinicians cited emotions and enormity of ‘culture change’, while P/F commented on medical jargon and desire for more time. Patients and clinicians found the experience valuable. Recommendations about how to develop a patient–teacher programme in patient safety are provided.

Conclusions

An educational paradigm that includes patients as teachers and collaborative learners with clinicians in patient safety is feasible, valued by clinicians and P/F and promising for P/F-centred medical error disclosure and prevention training.
Temperature measurement in the adult emergency department: oral, tympanic membrane and temporal artery temperatures versus rectal temperature
Authors: Bijur Polly E , Shah Purvi D , Esses David
Published: June 2016

Objective

The objective was to compare agreement between three non-invasive measures of temperature and rectal temperatures and to estimate the sensitivity and specificity of these measures to detect a rectal temperature of 38°C or higher.

Methods

We conducted a study of the diagnostic accuracy of oral, tympanic membrane (TM) and temporal artery (TA) thermometry to measure fever in an urban emergency department (ED). Data were collected from adult patients who received rectal temperature measurement. Bland-Altman analysis was performed; sensitivity, specificity and 95% CIs were calculated.

Results

987 patients were enrolled. 36% of the TM and TA readings differed by 0.5°C or more from rectal temperatures, 50% of oral temperatures. TM measures were most precise—the SD of the difference from rectal was 0.4°C TM, and 0.6°C for oral and TA (p<0.001). The sensitivities of a 38°C cutpoint on oral, TM and TA measures to detect a rectal temperature of 38°C or higher were: 37.0%, 68.3% and 71.1%, respectively (oral vs TM and TA p<0.001). The corresponding specificities were 99.4%, 98.2% and 92.3% (oral, TM and TA) with oral specificity significantly higher than the other two methods (p<0.01). TM and TA cutpoints of 37.5°C provided greater than 90% sensitivity to detect fever with specificity of 90% and 72%, respectively.

Conclusions

None of the non-invasive methods met benchmarks for diagnostic accuracy using the criterion of 38°C to detect rectal temperature of 38°C. A TM cutpoint of 37.5°C provides maximum diagnostic accuracy of the three non-invasive measures.
Flume investigation of the influence of rigid barrier deflector angle on dry granular overflow mechanisms
Authors: Choi C.E. , Ng C.W.W. , Goodwin G.R. , Liu L.H.D. , Cheung W.W.
Published: June 2016

Mass-wasting processes are often intercepted using rigid barriers, which are sometimes equipped with deflectors to prevent overspilling. Despite the engineering value of deflectors, they are currently only installed using empirical and prescriptive approaches because flow interaction mechanisms are not well understood. A 5 m flume was used to study dry granular flow deposition and overflow processes with and without deflectors of varying angles. The deflector angle was varied as 0°, 30°, 45°, and 60° with respect to the horizontal plane. For the geometric and material parameters adopted in this study, experimental results reveal that deflector angles greater than 45° develop steep ramp-like deadzones that result in effective energy dissipation as approaching flow impacts the deflector, whereas deflectors less than 45° rapidly develop shallow ramp-like deadzones, which promote high-energy overflow. Deflectors of at least 45° are required to develop upward overflow launch angles, whilst deflectors of 30° or less result in downward overflow launch angles. Upward launch angles indicate that a steep deadzone develops and effectively dissipates flow energy. An orthogonal deflector increases launch lengths by 40% compared to a bare rigid barrier.
The fate of marine-derived nutrients: tracing δ13C and δ15N through oligotrophic freshwater and linked riparian ecosystems following salmon carcass analog additions
Authors: Richardson David P. , Kohler Andre E. , Hailemichael Million , Finney Bruce P.
Published: June 2016

The oligotrophic condition of salmon-bearing catchments in the Columbia River Basin is a potential limiting factor for the recovery of Pacific salmon (Oncorhynchus spp.). To address this issue, nutrient supplementation programs attempt to mitigate for reduced marine-derived nutrients (MDN). We examined the assimilation of MDN in the biota of tributaries of the Salmon River Basin, Idaho, USA, following the addition of salmon carcass analogs (SCA). We measured carbon (C) and nitrogen (N) stable isotopes from biofilm, macroinvertebrate, salmonid fish, and riparian vegetation samples and found significant15N enrichment and substantial assimilation of SCA material in all aquatic trophic levels and in riparian vegetation. Our results suggest that SCA are incorporated primarily through indirect pathways and provide a source of MDN to multiple trophic levels in freshwater and linked riparian ecosystems.