bluuebunny/crossref_metadata_2025 huggingface dataset:
Corrosion protection of Cu by atomic layer deposition
Authors: Cremers Véronique , Rampelberg Geert , Baert Kitty , Abrahami Shoshan , Claes Nathalie , de Oliveira Thais Milagres , Terryn Herman , Bals Sara , Dendooven Jolien , Detavernier Christophe
Published: September 2019

Atomic layer deposition (ALD) is a vapor phase technique that is able to deposit uniform, conformal thin films with an excellent thickness control at the atomic scale. 18 nm thick Al2O3 and TiO2 coatings were deposited conformaly and pinhole-free onto micrometer-sized Cu powder, using trimethylaluminum and tetrakis(dimethylamido)titanium(IV), respectively, as a precursor and de-ionized water as a reactant. The capability of the ALD coating to protect the Cu powder against corrosion was investigated. Therefore, the stability of the coatings was studied in solutions with different pH in the range of 0–14, and in situ raman spectroscopy was used to detect the emergence of corrosion products of Cu as an indication that the protective coating starts to fail. Both ALD coatings provide good protection at standard pH values in the range of 5–7. In general, the TiO2 coating shows a better barrier protection against corrosion than the Al2O3 coating. However, for the most extreme pH conditions, pH 0 and pH 14, the TiO2 coating starts also to degrade.
Body Composition Analysis: The Physics of Measuring What We Are Made Of
Authors: Mylott Elliot , Kutschera Elynne , Widenhorn Ralf
Published: September 2019

Physics instruction for aspiring health care professionals, medical researchers, and biologists often fails to capture the interest of students. This is despite the many ways physics is used in research, diagnostics, and treatment. Universities are revising the introductory physics courses to be more relevant to pre-health students. Part of this process involves incorporating biomedically relevant material into both lecture and laboratory sessions in an authentic way with the physics content.
Uniform Circular Motion of a Spaceship and Its Relation to Free Fall
Authors: Alameh Adel
Published: September 2019

The sensation of weightlessness is common to an astronaut in a spaceship orbiting Earth and to a person aboard a freely falling elevator. This paper presents a detailed treatment of this commonality by showing that a spaceship orbiting Earth is in permanent free fall toward the planet, appropriate for use in the introductory classroom.
A new ‘Blob’ menaces Pacific ecosystems
Authors: Cornwall Warren
Published: September 2019

Scientists see signs of a damaging marine heat wave and prepare to respond.
Technology Feature | When robots sleep, do they dream of algorithms?
Authors: Dove Alan
Published: September 2019

Biomarkers for neurological diseases used to be few and far between, but better technology is making it easier for researchers to track brain health by measuring molecules. This means less invasive testing, earlier diagnosis, faster drug development, and—hopefully—more effective treatments.
Global trends in antimicrobial resistance in animals in low- and middle-income countries
Authors: Van Boeckel Thomas P. , Pires João , Silvester Reshma , Zhao Cheng , Song Julia , Criscuolo Nicola G. , Gilbert Marius , Bonhoeffer Sebastian , Laxminarayan Ramanan
Published: September 2019

Livestock antibiotic resistance

Most antibiotic use is for livestock, and it is growing with the increase in global demand for meat. It is unclear what the increase in demand for antibiotics means for the occurrence of drug resistance in animals and risk to humans. Van Boeckel
et al.
describe the global burden of antimicrobial resistance in animals on the basis of systematic reviews over the past 20 years (see the Perspective by Moore). There is a clear increase in the number of resistant bacterial strains occurring in chickens and pigs. The current study provides a much-needed baseline model for low- and middle-income countries and provides a “one health” perspective to which future data can be added.

Science
, this issue p.
eaaw1944
; see also p.
1251
An atomic-scale view of cyclocarbon synthesis
Authors: Maier Sabine
Published: September 2019

Combining organic synthesis with microscopy addresses long-standing bottlenecks in cyclocarbon production
John Robert Schrieffer (1931–2019)
Authors: Scalapino Douglas , Kivelson Steven Allan
Published: September 2019

Codiscoverer of the theory of superconductivity
Prostaglandin E2in a preterm infant with coarctation of the aorta
Authors: Khodaghalian Bernadette , Subhedar Nimish V , Chikermane Ashish
Published: September 2019

Prostaglandins are widely used in aortic coarctation to maintain ductal patency and preserve systemic perfusion until surgical intervention can be performed. Although the short-term use of prostaglandins to ameliorate aortic narrowing in neonates with a closed ductus has been reported, it has not been described as a longer term therapy in extremely preterm neonates. A 27-week gestation baby weighing 560 g presented at 40 days of age with coarctation and a closed ductus arteriosus. He was successfully treated with a 7-week course of prostaglandin E2therapy because surgical intervention was not deemed feasible in view of his size. Treatment resulted in a relaxation of the aortic constriction and improvement in aortic blood flow velocity profile, highlighting the value of long-term prostaglandin therapy in this population and supporting the hypothesis that the presence of ductal tissue contributes to the development of juxtaductal aortic constriction in some extremely preterm infants.
Secondary pulmonary alveolar proteinosis during corticosteroid therapy for organising pneumonia associated with myelodysplastic syndrome
Authors: Inoue Daiki , Marumo Satoshi , Ishii Haruyuki , Fukui Motonari
Published: September 2019

Myelodysplastic syndrome (MDS) is frequently complicated by pulmonary disease. Here, we describe secondary pulmonary alveolar proteinosis (sPAP) that developed during corticosteroid therapy for organising pneumonia (OP) associated with MDS. A 75-year-old woman with MDS complained of cough for 2 weeks. Chest CT showed bilateral patchy consolidations with reversed halo sign. Bronchoalveolar lavage (BAL) examination showed remarkably increased cell density with an increased lymphocyte proportion. Abnormal radiological findings improved rapidly on administration of systemic corticosteroid under the diagnosis of OP; however, they relapsed a few weeks later. Transbronchial lung biopsy showed periodic acid-Schiff stain-positive amorphous materials. Autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF) in serum and BAL fluid (BALF) were both negative, while GM-CSF level in BALF was elevated. The patient was diagnosed with sPAP. When chest radiological findings show exacerbation during corticosteroid therapy for OP in a patient with MDS, physicians should consider sPAP complication as a differential diagnosis.
Skin nodules in a young patient with HIV/AIDS
Authors: Hashmi Hamza , Alexander Jonathan Struan
Published: September 2019

AIDS-related Kaposi sarcoma (KS) is a malignancy seen in patients with HIV/AIDS that results from unrestrained human herpesvirus 8 infection. It can have an atypical presentation and an aggressive clinical course in patients with uncontrolled HIV infection. We present an interesting case of AIDS-related KS with an atypical initial presentation with skin nodules and debilitating lymphoedema. Patient was successfully managed with supportive measures, antiretroviral therapy and systemic chemotherapy.
A catastrophic antiphospholipid syndrome complicated with heparin-induced thrombocytopaenia, successfully managed with double filtration plasmapheresis, steroids and a direct thrombin inhibitor
Authors: Prouvot Julien , Aglaé Cédric , Daniel Laurent , Moranne Olivier
Published: September 2019

A middle-aged woman with history of antiphospholipid syndrome, admitted to our hospital for lethargy and persistent chest pain, developed during hospitalisation intracerebral transverse sinus and sigmoid vein thromboses, retinal thromboses, acute renal failure and cardiac involvement associated with thrombocytopaenia. Diagnosis of catastrophic antiphospholipid syndrome was made and treated with IV steroids, heparin infusion and double filtration plasmapheresis (DFPP) without fresh frozen plasma. Heparin-induced thrombocytopaenia was second diagnosed because of persistent severe thrombocytopaenia after 2 weeks of treatment associated with positive conversion of antibodies against platelet factor 4, and a positive functional assay. The clinical course was complicated by cerebellar haematomas that appeared a few days after the last session of DFPP. Heparin-induced thrombocytopaenia was managed by administration of argatroban, a direct thrombin inhibitor with an increase in platelet count. Neurologically, the patient recovered completely and was discharged on vitamin K antagonist treatment and regular dialysis.
Rupture along with fibrin clot occluding the middle port of the triple lumen catheter: an uncommon complication of central venous catheterisation
Authors: Burman Saurav , Kumar Niraj , Goyal Keshav , Bindra Ashish
Published: September 2019

Central venous catheter (CVC) insertion is a commonly done procedure but associated with some potential complications. In our case, intraoperatively we placed a CVC into the right subclavian vein of the patient for a neurosurgical procedure. Subsequently, in the neurosurgical intensive care unit, on checking the patency of the CVC, only the distal and proximal lumens were working and no backflow of blood was detected from the middle port. A chest X-ray and ultrasound were done immediately, which did not reveal why the middle port was blocked. Later CVC was removed, and on examination of the catheter, we noted an intraluminal fibrin clot and a partial tear near the opening of the middle port. This is an uncommon complication of a CVC insertion that is catheter tear along with fibrin clot occluding the middle port of the CVC, which was detected in time and managed successfully.
Florid papillomatosis of the nipple
Authors: Dinesh Baithma Jothi , Hayati Firdaus , Azizan Nornazirah , Abdul Rashid Nor Faezan
Published: September 2019

Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare breast tumour, affecting middle-aged group population. A 46-year-old woman presented to us with a cauliflower-like FP of the right nipple with no blood stained discharge or breast lump. FP can be mistaken clinically for Paget’s disease and occasionally misinterpreted as invasive ductal or intraductal carcinoma. Extensive intervention, correct diagnosis and prompt treatment are essential. Any breast pathology requires triple assessment including FP of the nipple. Once the diagnosis of ductal carcinoma is excluded, simple complete excision can be undertaken. This is to ensure complete obliteration of disease recurrence and preservation of cosmetic result. We discuss the pathology and psychosocial aspects of FP.
A framework for improved one health governance and policy making for antimicrobial use
Authors: Moran Dominic
Published: September 2019

There is a need to develop an evaluation framework to identify intervention priorities to reduce antimicrobial use (AMU) across clinical, agricultural and environmental settings. Antimicrobial resistance (AMR) can be conceptualised and therefore potentially managed in the same way as an environmental pollution problem. That is, over-use of antimicrobial medicines as inputs to human and animal health leads to unintended leakage of resistance genes that further combine with natural or intrinsic resistance in the environment. The diffuse nature of this leakage means that the private use decision is typically neither cognisant, nor made responsible for the wider social cost, which is the depletion of wider antibiotic effectiveness, a common pool resource or public good. To address this so-called market failure, some authors have suggested a potential to learn from similar management challenges encountered in the sphere of global climate change, specifically, capping use of medically important drugs analogous to limits set on greenhouse gas emissions. Drawing on experience of the economics of greenhouse gas mitigation, this paper explores a potential framework to develop AMU budgets based on a systematic comparative appraisal of the technical, economic, behavioural and policy feasibility of AMU reduction interventions across the One Health domains. The suggested framework responds to a call for global efforts to develop multi-dimensional metrics and a transparent focus to motivate research and policy, and ultimately to inform national and global AMR governance.
The NICE-GUT trial protocol: a randomised, placebo controlled trial of oral nitazoxanide for the empiric treatment of acute gastroenteritis among Australian Aboriginal children
Authors: Waddington Claire S , McLeod Charlie , Morris Peter , Bowen Asha , Naunton Mark , Carapetis Jonathan , Grimwood Keith , Robins-Browne Roy , Kirkwood Carl D , Baird Robert , Green David , Andrews Ross , Fearon Deborah , Francis Joshua , Marsh Julie A , Snelling Thomas
Published: September 2019

Introduction

Diarrhoeal disease is the second leading cause of death in children under 5 years globally, killing 525 000 annually. Australian Aboriginal and Torres Strait Islander (hereafter Aboriginal) children suffer a high burden of disease. Randomised trials in other populations suggest nitazoxanide accelerates recovery for children withGiardia, amoebiasis,Cryptosporidium, Rotavirus and Norovirusgastroenteritis, as well as in cases where no enteropathogens are found.

Methods and analysis

This double blind, 1:1 randomised, placebo controlled trial is investigating the impact of oral nitazoxanide on acute gastroenteritis in hospitalised Australian Aboriginal children aged 3 months to <5 years. Dosing is based on age-based dosing. The primary endpoint is the time to resolution of ‘significant illness’ defined as the time from randomisation to the time of clinical assessment as medically ready for discharge, or to the time of actual discharge from hospital, whichever occurs first. Secondary endpoints include duration of hospitalisation, symptom severity during the period of significant illness and following treatment, duration of rehydration and drug safety. Patients will be followed for medically significant events for 60 days. Analysis is based on Bayesian inference. Subgroup analysis will occur by pathogen type (bacteria, virus or parasite), rotavirus vaccination status, age and illness severity.

Ethics and dissemination

Ethics approval has been granted by the Central Australian Human Research Ethics Committee (HREC-14–221) and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC2014-2172). Study investigators will ensure that the trial is conducted in accordance with the principles of the Declaration of Helsinki. Individual participant consent will be obtained. Results will be disseminated via peer-reviewed publication.

Trial registration number

ACTRN12614000381684.
Clinical and non-clinical variables associated with preventive and curative dental service utilisation: a cross-sectional study among adolescents and young adults in Central Mexico
Authors: Medina-Solís Carlo Eduardo , García-Cortés José Obed , Robles-Minaya José Luis , Casanova-Rosado Juan Fernando , Mariel-Cárdenas Jairo , Ruiz-Rodríguez María del Socorro , Navarrete-Hernández José de Jesús , Ávila-Burgos Leticia , Maupomé Gerardo
Published: September 2019

Objective

The present study aimed to identify preventive and curative dental health service utilisation (DHSU) in the context of associated clinical and non-clinical factors among adolescents and young adults in Mexico.

Design

Cross-sectional study.

Setting

Applicants to a public university in Mexico.

Participants

Participants were 638 adolescents and young adults aged 16–25 randomly selected from university applicants.

Interventions

Data were collected using a self-administered questionnaire filled out by the students. For assessment of dental caries experience, we used the index of decayed, missing and filled teeth.

Primary outcome

The dependent variable was DHSU in the previous 12 months, coded as 0=non-use, 1=use of curative services and 2=use of preventive services.

Results

The mean age was 18.76±1.76 years, and 49.2% were women. The prevalence of DHSU was 40.9% (95% CI 37.1 to 44.8) for curative services and 22.9% (95% CI 19.7 to 26.3) for preventive services. The variables associated with curative services were age, sex, mother’s education, dental pain in the previous 12 months, caries experience, use of self-care devices and oral health knowledge. For preventive services, the variables associated were mother’s education, dental pain in the previous 12 months, caries experience, use of self-care devices and self-perception of oral health.

Conclusions

While differences emerged by type of service, a number of variables (sociodemographic and socioeconomic characteristics as well as dental factors) remained in the final model. Greater oral health needs and socioeconomic inequalities remained as predictors of both types of DHSU. Given the differences revealed by our study, oral health policies should refer those seeking dental care for oral diseases to preventive services, and promote the use of such services among the poorer and less educated population groups.
Low back pain in emergency ambulance workers in tertiary hospitals in China and its risk factors among ambulance nurses: a cross-sectional study
Authors: Zhang Qiong , Dong Hongyun , Zhu Chunji , Liu Guangzeng
Published: September 2019

Objective

Low back pain (LBP) could cause serious consequences and has been shown to be prevalent among emergency ambulance workers. Studies on the prevalence of and risk factors for LBP among emergency ambulance workers are scarce in China. The study aimed to determine the prevalence of LBP among ambulance workers, including doctors, nurses and drivers, and to explore the risk factors for ambulance nurses’ chronic LBP (lasting for at least 3 months).

Design

Cross-sectional study.

Setting

Emergency ambulance systems from 38 tertiary hospitals in Shandong, China were selected by random cluster sampling.

Participants

A total of 1560 ambulance workers completed the study.

Outcome measures

A paper-based questionnaire that included the Nordic Musculoskeletal Questionnaire, which evaluated LBP, the Dutch Musculoskeletal Questionnaire, which assessed ergonomic factors, and the Job Content Questionnaire, which assessed stress, was used. Multivariate logistic regression analysis was conducted to quantify the association of potential risk factors with chronic LBP among ambulance nurses.

Results

The 1 year prevalence of LBP lasting for at least 24 hours, 7 days and 3 months was 86.1%, 50.6% and 21.1%, respectively, among 498 ambulance nurses; 70.5%, 36.4% and 15.8% among 519 doctors; and 57.5%, 23.8% and 12.3% among 543 drivers. The factors contributing to chronic LBP among ambulance nurses were the frequent bending of the trunk, heavy or awkward lifting, shift work, low job satisfaction, high psychological fatigue, high psychological job demand, low job control, low supervisor support, older age, female sex and obesity.

Conclusions

LBP was more prevalent among ambulance nurses than among ambulance doctors and drivers. Many factors, especially psychosocial and ergonomic factors, contributed to ambulance nurses’ chronic LBP. Comprehensive measures might be needed to control LBP.
Early childhood vaccination and subsequent mortality or morbidity: are observational studies hampered by residual confounding? A Danish register-based cohort study
Authors: Jensen Andreas , Andersen Per Kragh , Stensballe Lone Graff
Published: September 2019

Objectives

To estimate the association between childhood vaccination and subsequent morbidity and mortality by adjusting for environmental and host factors. Further, to examine the degree of residual confounding in such observational studies.

Design

Register-based cohort study including 1 122 929 Danish children.

Participants

All children born in Denmark in the period 1999–2016 who survived until 16 months of age without prior migration followed from 16 months until the first of the following: event of interest, migration, 5 years of age or 31 December 2016.

Main outcome measures

Adjusted HRs (aHRs) and absolute risks were calculated for the three outcomes: mortality, hospitalisation for infection and asthma using register data on deaths, specific hospital contacts and dispensed prescribed medication. The exposure was the combination of the routine vaccines against diphteria–tetanus–pertussis–polio–Haemophilus influenzaetype b and measles–mumps–rubella (DTP and MMR in short) administered in early childhood. Hospitalisation due to accidents was analysed as a negative control outcome to examine residual confounding.

Results

Children with 3DTP+MMR had a lower hazard of mortality than the reference group with 3DTP, adjusted HR (aHR)=0.45 (95% CI: 0.35 to 0.57), whereas the children with 1 or 2 DTP had higher hazards of dying, aHR=1.55 (95% CI: 1.14 to 2.13) and aHR=1.96 (95% CI: 1.34 to 2.89). The vaccination group 3DTP+MMR was associated with a reduced hazard of asthma aHR=0.94 (95% CI: 0.92 to 0.96). Also, the vaccination group 3DTP+MMR was associated with a reduced hazard of hospitalisation due to accidents, aHR=0.83 (0.80 to 0.85) compared with the reference group with 3 DTP.

Conclusions

The results suggested a beneficial impact of MMR on under-five mortality but did not support the hypothesis that DTP is detrimental, since the group of children with fewer DTP vaccinations experienced increased mortality. The results of the study may to some degree be prone to residual confounding since an unexpected association between MMR vaccination and hospitalisation for accidents was observed.
A protocol for a systematic review of process evaluations of interventions investigating sedentary behaviour in adults
Authors: Corepal Rekesh , Hall Jessica Faye , English Coralie , Farrin Amanda , Fitzsimons Claire F , Forster Anne , Lawton Rebecca , Mead Gillian , Clarke David
Published: September 2019

Introduction

Sedentary behaviour is defined as any waking behaviour characterised by low energy expenditure ≤1.5 metabolic equivalents while in a sitting, lying or reclining posture. The expanding evidence base suggests that sedentary behaviour may have a detrimental effect on health, well-being and is associated with an increased risk of all-cause mortality. We aim to review process evaluations of randomised controlled trials (RCTs) which included a measure of sedentary behaviour in adults in order to develop an understanding of intervention content, mechanisms of impact, implementation and delivery approaches and contexts, in which interventions were reported to be effective or effective. A secondary aim is to summarise participants, family and staff experiences of such interventions.

Methods and analysis

Ten electronic databases and reference lists from previous similar reviews will be searched. Eligible studies will be process evaluations of RCTs that measure sedentary behaviour as a primary or secondary outcome in adults. As this review will contribute to a programme to develop a community-based intervention to reduce sedentary behaviour in stroke survivors, interventions delivered in schools, colleges, universities or workplaces will be excluded. Two reviewers will perform study selection, data extraction and quality assessment. Disagreements between reviewers will be resolved by a third reviewer. Process evaluation data to be extracted include the aims and methods used in the process evaluation; implementation data; mechanisms of impact; contextual factors; participant, family and staff experiences of the interventions. A narrative approach will be used to synthesise and report qualitative and quantitative data. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis guidance.

Ethics and dissemination

Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO registration number

CRD42018087403.
Accuracy of endoscopic staging and targeted biopsies for routine gastric intestinal metaplasia and gastric atrophy evaluation study protocol of a prospective, cohort study: the estimate study
Authors: Nieuwenburg Stella A V , Waddingham William W , Graham David , Rodriguez-Justo Manuel , Biermann Katharina , Kuipers Ernst J , Banks Matthew , Jansen Marnix , Spaander Manon C W
Published: September 2019

Introduction

Patients with chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are at risk of developing gastric adenocarcinoma. Their diagnosis and management currently rely on histopathological guidance after random endoscopic biopsy sampling (Sydney biopsy strategy). This approach has significant flaws such as under-diagnosis, poor reproducibility and poor correlation between endoscopy and histology. This prospective, international multicentre study aims to establish whether endoscopy-led risk stratification accurately and reproducibly predicts CAG and IM extent and disease stage.

Methods and analysis

Patients with CAG and/or IM on standard white light endoscopy (WLE) will be prospectively identified and invited to undergo a second endoscopy performed by an expert endoscopist using enhanced endoscopic imaging techniques with virtual chromoendoscopy. Extent of CAG/IM will be endoscopically staged with enhanced imaging and compared with standard WLE. Histopathological risk stratification through targeted biopsies will be compared with endoscopic disease staging and to random biopsy staging on WLE as a reference. At least 234 patients are required to show a 10 % difference in sensitivity and accuracy between enhanced imaging endoscopy-led staging and the current biopsy-led staging protocol of gastric atrophy with a power (beta) of 80 % and a 0.05 probability of a type I error (alpha).

Ethics and dissemination

The study was approved by the respective Institutional Review Boards (Netherlands: MEC-2018-078; UK: 19/LO/0089). The findings will be published in peer-reviewed journals and presented at scientific meetings.

Trial registration number

NTR7661; Pre-results.
Quantifying disruption of workflow by phone calls to the neuroradiology reading room
Authors: Sabat Shyam , Kalapos Paul , Slonimsky Einat
Published: September 2019

Introduction

The purpose of this study was to understand the source and the reason for the phone calls to our neuroradiology suit and to quantify the size of the problem in terms of duration of individual and aggregated calls.

Materials and methods

Observation of the neuroradiology reading room for the entire duration of the working hours over three non-consecutive days was performed, and included telephone calls start time, end time and calls duration for incoming telephone calls. After each phone call the recipients were queried on the details of the phone call; the origin of the call, the reason for the call and the response.

Results

The average total number of minutes (min) spent on the phone each day was 64 min per working day with a total of 39 phone calls per day and 4.4 per hour on average. The trainees answered 71% of the phone calls with additional intervention by attending in 13% of phone calls. The most common source of phone calls was from either the MRI/CT technicians (48%), followed by providers (20%) and returning pages (18%).

Conclusion

Cumulative time spent on the phone by neuroradiologists in the reading room ended up in more than an hour per working day, while trainees were taking the majority of phone calls. Most phone calls originated from technicians, hence, requiring specific solutions to mitigate this kind of interruption.
Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease
Authors: Sundh Josefin , Bornefalk Hans , Sköld Carl Magnus , Janson Christer , Blomberg Anders , Sandberg Jacob , Bornefalk-Hermansson Anna , Igelström Helena , Ekström Magnus
Published: September 2019

Introduction

Breathlessness is the cardinal symptom in both cardiac and respiratory diseases, and includes multiple dimensions. The multidimensional instrument Dyspnoea-12 has been developed to assess both physical and affective components of breathlessness. This study aimed to perform a clinical validation of the Swedish version of Dyspnoea-12 in outpatients with cardiorespiratory disease.

Methods

Stable outpatients with cardiorespiratory disease and self-reported breathlessness in daily life were recruited from five Swedish centres. Assessments of Dyspnoea-12 were performed at baseline, after 30–90 min and after 2 weeks. Factor structure was tested using confirmatory factor analysis and internal consistency using Cronbach’s alpha. Test–retest reliability was analysed using intraclass correlation coefficients (ICCs). Concurrent validity at baseline was evaluated by examining correlations with lung function and several instruments for the assessment of symptoms and health status.

Results

In total, 182 patients were included: with the mean age of 69 years and 53% women. The main causes of breathlessness were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%) and idiopathic pulmonary fibrosis (19%). Factor analysis confirmed the expected underlying two-component structure with two subdomains. The Dyspnoea-12 total score, physical subdomain score and affective subdomain scores showed high internal consistency (Cronbach’s alpha 0.94, 0.84 and 0.80, respectively) and acceptable reliability after 2 weeks (ICC total scores 0.81, 0.79 and 0.73). Dyspnoea-12 showed concurrent validity with the instruments modified Medical Research Council scale, COPD Assessment Test, European Quality of Life-Five Dimensions-Five levels, the Functional Assessment of Chronic Illness Therapy-Fatigue, the Hospital Anxiety and Depression Scale, and with forced expiratory volume in 1 s in percentage of predicted value. The results were consistent across different cardiorespiratory conditions.

Conclusion

The Dyspnoea-12 is a valid instrument for multidimensional assessment of breathlessness in Swedish patients with cardiorespiratory diseases.
Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer
Authors: Vaccaro Lisa , Butow Phyllis N , Lee Deborah , Johnson Stephanie B , Bell Melanie , Clayton Josephine , Detering Karen Margaret , Tattersall Martin
Published: September 2019

Objectives

Assessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention.

Methods

We developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial.

Results

Fidelity tocontentwas high: mean=9.38/11 but lower for thequalityof general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity tocontentwas associated with the trial primary outcome of family caregiver report of patient wishes being discussed and met.

Conclusions

Fidelity to content, but not quality, of the ACP intervention is strong. Communication skills training is critical for ACP interventionists. Adherence was higher with older patients and religious carers, factors that may influence acceptance of death and readiness to undertake ACP, making the discussion easier.

Trial registration number

ACTRN12613001288718.
Equity as the fourth ‘E’ in the ‘3 E’s’ approach to injury prevention
Authors: Giles Audrey , Bauer Michelle E E , Jull Janet
Published: September 2019

The education, engineering and enforcement (3 E’s) approach to injury prevention is grounded in assumptions that it is effective for everyone; however, evidence demonstrates that it fails to consider opportunities for all populations to experience safe and injury-free lives. In this way, the 3 E’s approach does not support health equity in the injury prevention field. In this brief report, we argue that a fourth E, equity, must also be used with the 3 E’s approach to injury prevention.
Predicting the outcome of a comatose patient at the bedside
Authors: Wijdicks Eelco F M
Published: September 2019

The call to the bedside and the prognostication of a comatose patient—telling family members what to expect—commonly falls to neurologists. The assessment is often confounded by the treatment paradigms of modern intensive care (ie, drugs, drug interactions and targeted temperature management). Patients may be too unstable to leave the intensive care unit for neuroimaging; thus, repeated clinical examinations are decisive. Despite diverse causes, certain principles do apply: (1) Many patients can improve, although with significant abnormalities; (2) Neuroimaging and electrodiagnostic tests can help but are rarely definitive; (3) Secondary involvement of the upper brainstem marks a tipping point with much lower probability for an independent outcome; (4) We rarely predict mortality or diagnose brain death; usually the major concern is anticipated neurological deficits; and (5) Prior comorbidity and permanent organ dysfunction are critical factors in making decisions about de-escalation or escalation of care. This review provides a practical approach to evaluating outcome of a comatose patient. Prognostication is difficult, and we should only attempt it when the diagnosis is confirmed and appropriate (often aggressive) medical or surgical treatment has been tried.
Comparative analysis of isoform-specific and non-selective histone deacetylase inhibitors in attenuating the intestinal damage after hemorrhagic shock
Authors: Bhatti Umar F , Williams Aaron M , Kathawate Ranganath G , Chang Panpan , Zhou Jing , Biesterveld Ben E , Wu Zhenyu , Dahl Julia , Liu Baoling , Li Yongqing , Alam Hasan B
Published: September 2019

Background

Isoform-specific histone deacetylase inhibitors (HDACIs) MC1568 and ACY1083 are comparable to the non-selective HDACI valproic acid (VPA) in improving survival in rodents undergoing lethal hemorrhage. However, the organ-specific properties of isoform-specific HDACIs have not been fully evaluated. Also, whether they can act synergistically is not known. We hypothesized that isoform-specific HDACIs are superior to VPA in attenuating intestinal injury and act synergistically when coadministered.

Methods

Sprague Dawley rats were hemorrhaged (40% of total blood volume) and randomized to receive (n=4 per group) (1) MC1568 (5 mg/kg), (2) ACY1083 (30 mg/kg), (3) MC1568+ACY1083 (combination: 5 mg/kg + 30 mg/kg, respectively), (4) VPA (250 mg/kg), or (5) normal saline (NS; vehicle; 250 μL). Animals were observed for 3 hours, after which blood samples were collected and samples of the ileum were harvested. Expression of interleukin 1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and cytokine-induced neutrophil chemoattractant 1 (CINC-1) was assessed in the tissues using enzyme-linked immunosorbent assay. Intestinal cleaved caspase 3 (c-caspase 3) levels were assessed as a marker of apoptosis, and histologic sections of the ileum were examined for signs of bowel injury. Levels of IL-1β and TNF-α were also measured in the serum as global markers of inflammation.

Results

Treatments with MC1568, ACY1083, MC1568+ACY1083, and VPA were associated with decreased IL-1β levels in the intestine and serum compared with NS. IL-1β and TNF-α levels were significantly lower in the ACY1083 group compared with the VPA group. CINC-1 levels were significantly lower in the isoform-specific HDACI groups compared with the NS; however, no significant differences were seen with VPA. All treatment groups had a lower expression of intestinal c-caspase 3 compared with NS. Furthermore, MC1568 and ACY1083 groups had lower apoptosis compared with the VPA group. Bowel injury scores were significantly lower in the isoform-specific HDACI groups compared with the NS group; however, the attenuation in the VPA-treated animals did not reach statistical significance.

Discussion

Isoform-specific HDACIs provide superior intestinal protection compared with VPA in a rodent model of hemorrhagic shock.

Level of evidence

Preclinical study.
Giant cell sarcoma managed with forelimb amputation in a harbour seal (Phoca vitulina geronimensis)
Authors: Martony Molly , St Leger Judy , Erlacher‐Reid Claire , Nollens Hendrik , Schmitt Todd
Published: September 2019

A 22‐year‐old harbour seal (Phoca vitulina geronimensis) presented with a subcutaneous mass on the right dorsal carpus. The mass measured 5 cm by 2 cm and was firmly attached to the underlying tissues. Cytology from fine‐needle aspiration was consistent with a soft tissue sarcoma. Surgical resection was attempted, however complete excision was prohibited by extensive local invasion. Histopathology results confirmed a moderately cellular, infiltrative, non‐encapsulated giant cell sarcoma. Subsequent surgical amputation of the forelimb was performed successfully, with the animal making a full recovery. No radiographic evidence of reoccurrence was identified three years following the surgical procedure. This is the first described case of forelimb amputation in a pinniped. When complete tumour resection is unattainable, forelimb amputation may serve as an alternative or adjunct to medical management of neoplasia in phocids.
Successful resection of an osteoma in a great horned owl (Bubo virginianus) with subsequent lack of regional feather regrowth
Authors: Barbosa Lorraine , Tom Duane , Han Sushan
Published: September 2019

A free‐living adult great horned owl (Bubo virginianus) was presented to a wildlife rehabilitation centre in Southern California with a firm, pedunculated mass arising from the caudal‐dorsal border of the left ulna. Two secondary covert feathers were incorporated into the mass and multiple secondary flight and covert feathers adjacent to the mass were broken. Radiographs revealed a calcified mass with no cortical involvement. The mass was surgically removed. Histopathology was consistent with a diagnosis of osteoma. Despite tumour removal, the owl sustained a significant flight impairment resulting from lack of regional feather regrowth. Waiting for a natural moult to take place would likely require 9–12 months. An attempt was made at inducing moult by manually pulling feathers but was not successful. As the rehabilitation facility was space limited and the bird was behaviourally a poor candidate for long‐term rehabilitation, humane euthanasia was elected.
Relationships between dietary and cow factors with the fecal phosphorus contents of dairy cows in Manitoba
Authors: Senaratne V. , Plaizier J.C.
Published: September 2019

A survey was carried out on 19 dairy farms in Manitoba that varied in size, diet composition, housing, and feeding strategy to identify factors that affect the phosphorus (P) content of feces. On each farm, 10 early, 10 mid, and 10 late lactation cows were included. Multiple regression analysis showed that high dietary P concentrations and free-stall instead of tie-stall housing were mostly associated with high P contents of feces. Hence, a closer matching of the requirements and supply of P of dairy cows enhances the utilization of dietary P on these farms.
Enhancing unsupervised video-based vehicle tracking and modeling for traffic data collection
Authors: Zaki Mohamed H. , Sayed Tarek , Billeh Moataz
Published: September 2019

Video-based traffic analysis is a leading technology for streamlining transportation data collection. With traffic records from video cameras, unsupervised automated video analysis can detect various vehicle measures such as vehicle spatial coordinates and subsequently lane positions, speed, and other dynamic measures without the need of any physical interconnections to the road infrastructure. This paper contributes to the unsupervised automated video analysis by addressing two main shortcomings of the approach. The first objective is to alleviate tracking problems of over-segmentation and over-grouping by integrating region-based detection with feature-based tracking. This information, when combined with spatiotemporal constraints of grouping, can reduce the effects of these problems. This fusion approach offers a superior decision procedure for grouping objects and discriminating between trajectories of objects. The second objective is to model three-dimensional bounding boxes for the vehicles, leading to a better estimate of their geometry and consequently accurate measures of their position and travel information. This improvement leads to more precise measurement of traffic parameters such as average speed, gap time, and headway. The paper describes the various steps of the proposed improvements. It evaluates the effectiveness of the refinement process on data collected from traffic cameras in three different locations in Canada and validates the results with ground truth data. It illustrates the effectiveness of the improved unsupervised automated video analysis with a case study on 10 h of traffic data collection such as volume and headway measurements.
A Parametrized Analysis of Algorithms on Hierarchical Graphs
Authors: Faran Rachel , Kupferman Orna
Published: September 2019

Hierarchical graphs are used in order to describe systems with a sequential composition of sub-systems. A hierarchical graph consists of a vector of subgraphs. Vertices in a subgraph may “call” other subgraphs. The reuse of subgraphs, possibly in a nested way, causes hierarchical graphs to be exponentially more succinct than equivalent flat graphs. Early research on hierarchical graphs and the computational price of their succinctness suggests that there is no strong correlation between the complexity of problems when applied to flat graphs and their complexity in the hierarchical setting. That is, the complexity in the hierarchical setting is higher, but all “jumps” in complexity up to an exponential one are exhibited, including no jumps in some problems.

We continue the study of the complexity of algorithms for hierarchical graphs, with the following contributions: (1) In many applications, the subgraphs have a small, often a constant, number of exit vertices, namely vertices from which control returns to the calling subgraph. We offer a parameterized analysis of the complexity and point to problems where the complexity becomes lower when the number of exit vertices is bounded by a constant. (2) We describe a general methodology for algorithms on hierarchical graphs. The methodology is based on an iterative compression of subgraphs in a way that maintains the solution to the problems and results in subgraphs whose size depends only on the number of exit vertices, and (3) we handle labeled hierarchical graphs, where edges are labeled by letters from some alphabet, and the problems refer to the languages of the graphs.
Self-Attraction Removal from Oritatami Systems
Authors: Han Yo-Sub , Kim Hwee , Rogers Trent A. , Seki Shinnosuke
Published: September 2019

RNA cotranscriptional folding refers to the phenomenon in which an RNA transcript folds upon itself while being synthesized out of a gene by an RNA polymerase. Oritatami is a computational model of this phenomenon, which lets its sequence of beads (abstract molecules) taken from a finite alphabet [Formula: see text] fold cotranscriptionally via interactions between beads according to its rule set. In this paper, we study the problem of removing self-attractions, which lets a bead interact with another bead of the same kind, from a given oritatami system without changing its behavior. Self-attraction is one of the major challenges in the construction of intrinsic oritatami systems, which can simulate even the dynamics of all the oritatami systems.
One-Time Nondeterministic Computations
Authors: Holzer Markus , Kutrib Martin
Published: September 2019

We introduce the concept of one-time nondeterminism as a new kind of limited nondeterminism for finite state machines and pushdown automata. Roughly speaking, one-time nondeterminism means that at the outset the computation is nondeterministic, but whenever it performs a guess, this guess is fixed for the rest of the computation. We characterize the computational power of one-time nondeterministic finite automata (OTNFAs) and one-time nondeterministic pushdown devices. Moreover, we study the descriptional complexity of these machines. For instance, we show that for an [Formula: see text]-state OTNFA with a sole nondeterministic state, that is nondeterministic for only one input symbol, [Formula: see text] states are sufficient and necessary in the worst case for an equivalent deterministic finite automaton. In case of pushdown automata, the conversion of a nondeterministic to a one-time nondeterministic as well as the conversion of a one-time nondeterministic to a deterministic one turn out to be non-recursive, that is, the trade-offs in size cannot be bounded by any recursive function.
Branching Measures and Nearly Acyclic NFAs
Authors: Keeler Casey , Salomaa Kai
Published: September 2019

To get a more comprehensive understanding of the amount of branching in computations of a nondeterministic finite automaton (NFA), we introduce and study the string path width and depth path width measures. For a given NFA, the string path width on a string [Formula: see text] counts the number of all complete computations on [Formula: see text], and the depth path width on an integer [Formula: see text] counts the number of complete computations on all strings of length [Formula: see text]. We give an algorithm to decide the finiteness of the depth path width of an NFA. Deciding finiteness of string path width can be reduced to the corresponding question on ambiguity.

An NFA is nearly acyclic if any computation can pass through at most one cycle. The class of nearly acyclic NFAs consists of exactly all NFAs with finite depth path width. Using this characterization we show that the finite depth path width of an [Formula: see text]-state NFA over a [Formula: see text]-letter alphabet is at most [Formula: see text] and that this bound is tight. The nearly acyclic NFAs recognize exactly the class of constant density regular languages.
State Complexity of Suffix Distance
Authors: Ng Timothy , Rappaport David , Salomaa Kai
Published: September 2019

The neighbourhood of a regular language with respect to the prefix, suffix and subword distance is always regular and a tight bound for the state complexity of prefix distance neighbourhoods is known. We give upper bounds for the state complexity of the neighbourhood of radius [Formula: see text] of an [Formula: see text]-state deterministic finite automaton language with respect to the suffix distance and the subword distance, respectively. For restricted values of [Formula: see text] and [Formula: see text] we give a matching lower bound for the state complexity of suffix distance neighbourhoods.