bluuebunny/crossref_metadata_2025 huggingface dataset:
Getting more from heterogeneous HIV-1 surveillance data in a high immigration country: estimation of incidence and undiagnosed population size using multiple biomarkers
Authors: Giardina Federica , Romero-Severson Ethan O , Axelsson Maria , Svedhem Veronica , Leitner Thomas , Britton Tom , Albert Jan
Published: April 2019

Background

Most HIV infections originate from individuals who are undiagnosed and unaware of their infection. Estimation of this quantity from surveillance data is hard because there is incomplete knowledge about (i) the time between infection and diagnosis (TI) for the general population, and (ii) the time between immigration and diagnosis for foreign-born persons.

Methods

We developed a new statistical method for estimating the incidence of HIV-1 and the number of undiagnosed people living with HIV (PLHIV), based on dynamic modelling of heterogeneous HIV-1 surveillance data. The methods consist of a Bayesian non-linear mixed effects model using multiple biomarkers to estimate TI of HIV-1-positive individuals, and a novel incidence estimator which distinguishes between endogenous and exogenous infections by modelling explicitly the probability that a foreign-born person was infected either before or after immigration. The incidence estimator allows for direct calculation of the number of undiagnosed persons. The new methodology is illustrated combining heterogeneous surveillance data from Sweden between 2003 and 2015.

Results

A leave-one-out cross-validation study showed that the multiple-biomarker model was more accurate than single biomarkers (mean absolute error 1.01 vs ≥1.95). We estimate that 816 [95% credible interval (CI) 775-865] PLHIV were undiagnosed in 2015, representing a proportion of 10.8% (95% CI 10.3-11.4%) of all PLHIV.

Conclusions

The proposed methodology will enhance the utility of standard surveillance data streams and will be useful to monitor progress towards and compliance with the 90–90-90 UNAIDS target.
Postsynaptic Mechanisms Render Syn I/II/III Mice Highly Responsive to Psychostimulants
Authors: Pogorelov Vladimir M , Kao Hung-Teh , Augustine George J , Wetsel William C
Published: April 2019

Background

Synapsins are encoded by SYN I, SYN II, and SYN III, and they regulate neurotransmitter release by maintaining a reserve pool of synaptic vesicles.

Methods

Presynaptic dopamine responses to cocaine were examined by microdialysis, and postsynaptic responses were evaluated to various dopamine receptor agonists in the open field with SynI/SynII/SynIII triple knockout mice.

Results

Triple knockout mice showed enhanced spontaneous locomotion in a novel environment and were hyper-responsive to indirect and direct D1 and D2 dopamine agonists. Triple knockout animals appeared sensitized to cocaine upon first open field exposure; sensitization developed across days in wild-type controls. When mutants were preexposed to a novel environment before injection, cocaine-stimulated locomotion was reduced and behavioral sensitization retarded. Baseline dopamine turnover was enhanced in mutants and novel open field exposure increased their striatal dopamine synthesis rates. As KCl-depolarization stimulated comparable dopamine release in both genotypes, their readily releasable pools appeared indistinguishable. Similarly, cocaine-induced hyperlocomotion was indifferent to blockade of newly synthesized dopamine and depletion of releasable dopamine pools. Extracellular dopamine release was similar in wild-type and triple knockout mice preexposed to the open field and given cocaine or placed immediately into the arena following injection. Since motor effects to novelty and psychostimulants depend upon frontocortical-striatal inputs, we inhibited triple knockout medial frontal cortex with GABA agonists. Locomotion was transiently increased in cocaine-injected mutants, while their supersensitive cocaine response to novelty was lost.

Conclusions

These results reveal presynaptic dopamine release is not indicative of agonist-induced triple knockout hyperlocomotion. Instead, their novelty response occurs primarily through postsynaptic mechanisms and network effects.
Natural killer cells killBurkholderia cepaciacomplex via a contact-dependent and cytolytic mechanism
Authors: Li Shu Shun , Saleh Marwah , Xiang Richard F , Ogbomo Henry , Stack Danuta , Huston Shaunna H , Mody Christopher H
Published: April 2019

Burkholderia cepacia complex (Bcc), which includes B. cenocepacia and B. multivorans, pose a life-threatening risk to patients with cystic fibrosis. Eradication of Bcc is difficult due to the high level of intrinsic resistance to antibiotics, and failure of many innate immune cells to control the infection. Because of the pathogenesis of Bcc infections, we wondered if a novel mechanism of microbial host defense involving direct antibacterial activity by natural killer (NK) cells might play a role in the control of Bcc. We demonstrate that NK cells bound Burkholderia, resulting in Src family kinase activation as measured by protein tyrosine phosphorylation, granule release of effector proteins such as perforin and contact-dependent killing of the bacteria. These studies provide a means by which NK cells could play a role in host defense against Bcc infection.
Prospective evaluation of a rapid antimicrobial susceptibility test (QMAC-dRAST) for selecting optimal targeted antibiotics in positive blood culture
Authors: Kim Jeong-Han , Kim Taek Soo , Jung Hyun gul , Kang Chang Kyung , Jun Kang-Il , Han Sangkwon , Kim Dong Young , Kwon Sunghoon , Song Kyoung-Ho , Choe Pyeong Gyun , Bang Ji Hwan , Kim Eu Suk , Park Sang Won , Kim Hong Bin , Kim Nam Joong , Park Wan Beom , Oh Myoung-don
Published: April 2019

Objectives

MALDI-TOF MS has been successfully used for empirical antibiotic selection. However, limited data are available regarding the usefulness of MALDI-TOF MS in common resistant organisms compared with rapid antimicrobial susceptibility testing (AST). We prospectively evaluated the usefulness of rapid AST, compared with MALDI-TOF MS, for optimal antibiotic selection by infectious disease (ID) physicians in patients with bacteraemia including polymicrobial infection.

Methods

Three hundred and fifty-nine patients with positive blood culture were included for analysis. ID physicians prospectively decided on antibiotic regimens with consensus at each timepoint of receiving results of Gram stain, MALDI-TOF MS and rapid AST, the last of which was performed using QMAC-dRAST.

Results

ID physicians with MALDI-TOF MS results chose optimal targeted antibiotics in 255 (71.0%) cases, with appropriate antibiotic selection in 303 (84.4%) cases. The proportion of optimal targeted antibiotic selection and appropriate antibiotic selection was significantly lower for resistant strains than for susceptible strains [62.5% versus 79.2% (P < 0.001) and 68.2% versus 100% (P < 0.001), respectively]. QMAC-dRAST results led to optimal antibiotic treatment in 95 (91.3%) of the 104 cases receiving non-optimal targeted antibiotics. Optimal targeted treatments based on QMAC-dRAST results were possible in 322 (98.2%) of the 328 cases with monobacterial infection and in 345 (96.1%) of the 359 cases with monobacterial and polymicrobial infection.

Conclusions

MALDI-TOF MS has a high chance of failure in guiding ID physicians to optimal antibiotics, especially against resistant organisms. With increasingly common resistant organisms, rapid AST is needed to identify optimal targeted antibiotics early in bacteraemia.
Embedding research recruitment in a community resource e-prescribing system: lessons from an implementation study on Chicago’s South Side
Authors: Feldmeth Gillian , Naureckas Edward T , Solway Julian , Lindau Stacy Tessler
Published: April 2019

Objective

The study sought to implement and assess the CommunityRx e-prescribing system to recruit research participants from a predominantly non-Hispanic Black community on Chicago’s South Side.

Materials and Methods

CommunityRx integrates with electronic medical record systems to generate a personalized list of health-promoting community resources (HealtheRx). Between December 2015 and December 2016, HealtheRxs distributed at outpatient visits to adults with asthma or chronic obstructive pulmonary disease also incentivized participation in a pulmonary research registry. Usual practices for registry recruitment continued in parallel.

Results

Focus groups established acceptability and appropriateness among the target population. Pulmonary research registry recruitment information was included on 13 437 HealtheRxs. Forty-one (90% non-Hispanic Black) patients responded with willingness to participate and 9 (8 non-Hispanic Black) returned a signed consent required to enroll. Usual recruitment practices enrolled 4 registrants (1 non-Hispanic Black).

Discussion

Automating research recruitment using a community e-prescribing system is feasible.

Conclusions

Implementation of an electronic medical record–integrated, community resource referral tool promotes enrollment of eligible underrepresented research participants; however, enrollment was low.
Outcomes of Pectoralis Major Tears in Active Duty US Military Personnel: A Comparison of Surgical Repairs Performed in the Forward Deployed Setting to Those Performed in the Continental United States
Authors: Shakir Irshad , Davis William , Choate W Stephen , Antosh Ivan J , Parada Stephen , Salazar Dane H
Published: April 2019

Introduction

The purpose of our study is to compare pectoralis major tears in active duty military personal repaired surgically in the forward deployed setting to those performed in the Continental United States.

Materials and Methods

Retrospective comparison of all pectoralis major tendon repairs performed at Madigan Army Medical Center from 2000 to 2007 to a forward deployed series treated by two deployed United States Air Force orthopedic surgeons at one expeditionary medical treatment facility over a 4-month deployment cycle from December 2013 through March 2014.

Results

Fourteen patients from the CONUS group and eight patients from deployed group were compared; they had a mean age of 32 years (21–52) all with pectoralis major ruptures that underwent operative fixation. Nineteen of the 22 patients (86%) sustained their injuries during bench press. The average bench press weight was similar with 271.8 lbs in the CONUS group and 273.1 lbs in the deployed group. There were 9 complete tears and 5 partial tears in the CONUS cohort whereas 7 complete tears and 1 partial tear in the deployed cohort, with all tears in both groups occurring at the insertion of the humerus. All 22 patients in both cohorts denied the use of anabolic steroids. The average DASH score at final follow-up was 12.74 in the CONUS group and 36.44 in the deployed group. The CONUS group reported that 7 out of 8 immediate repair patients and 4 out of 6 delayed repair patients returned to functional work level within 6 months with the 2 patients in the delayed repair group taking longer than 9 months to return to work. The deployed members reported return to functional work level at an average of 6.5 months. Both cohorts had early return to weight lifting at 6 and 7 months, respectively. The CONUS group reported a 39% bench press weight reduction and 34% pushup maximum reduction whereas the deployed cohort reported a 20% and 8% reduction respectively.

Conclusions

When comparing deployed to CONUS results, we demonstrated that surgical repairs at one permanent US military in-theater tertiary referral medical center were as successful as repairs performed at one CONUS US Army academic tertiary referral medical center. Although in-theater surgical repair was technically feasible and clinically successful, we believe the lengthy convalescence, stringent post-operative restrictions, demanding environment and impact on operational readiness should preclude deployed surgical repairs from becoming standard practice.
The Development of an Emergency Medicine Resident Research Program in the United States Military
Authors: Oliver Joshua J , Ross Justin M , Davis W Tyler , NG Patrick C , Long Brit , Weymouth Wells L , Summers Shane M , April Michael D
Published: April 2019

Introduction

The Accreditation Council for Graduate Medical Education stipulates that residents should participate in scholarly activity. As of 2019 that verbiage will be changed to, “Residents must participate in scholarship.” However, scholarly activity is not clearly defined. We set out to define our graduation research requirement in a measurable way and structure a research curriculum that better prepared residents to conduct scholarly activity.

Materials and Methods

This study compares resident scholarly output in several categories before and after the initiation of a revised research curriculum and graduation requirement. Scholarly activity was measured by comparing the production of Pubmed Indexed (PMID) publications, online publications, and conference presentations of two Emergency Medicine Residency classes. The intervention class was represented by the class of 2018 which exposed 16 residents to the new curriculum and graduation requirement for the full three years of their residency. The comparison class was represented by the class of 2015 which exposed 16 residents to the old curriculum and old graduation requirement. The old graduation requirement and curriculum were undefined. The new requirement involved two options, participate in original research starting from the process of question formulation and carried through manuscript drafting or publishing at first author PMID of any kind. The new curriculum involved monthly journal clubs, two annual deep dives, and an 8-day Intern Research Course modeled after the Emergency Medicine Basic Research Skills workshop sponsored by the American College of Emergency Physicians. In addition to the new curriculum, several new leadership positions were created at both the staff and resident level that solely focused on the promotion of scholarly activity. In addition to creating a culture within the department that encouraged scholarship, these overlapping leadership positions also helped create continuity in a program that could easily be hampered by frequent staff turnover due to new military assignments and military deployments.

Results

Resident scholarly activity in the form of PMIDs increased from 4 to 22. The production of online publications was 0 and 12, respectively. There were 2 and 11 conference presentations, respectively.

Conclusion

Resident scholarly activity increased following the institution of a new research curriculum and graduation requirement.
An Editorial Review of Mobile Health: Implications for the US Military Health System
Authors: Selig Daniel J , Collins Jeannette , Church Tyler L , Zeman Joseph
Published: April 2019

Introduction

The United States Military Health System provides healthcare to a diverse patient population throughout the world. There are three distinct challenges that the Military Health System faces. (1) Providers have varying degrees of clinical training expertise and may be called upon to practice outside their usual scope of care. (2) There is geographic isolation of patients and providers with limited resources while stationed overseas. (3) Patients are at higher risk of breaks in continuity of care because of permanent change of duty stations, deployments, and retirement.

Materials and Methods

In this article we review the history of mobile health in both the civilian and military sectors, and how mobile health may be used to address the challenges unique to the United States Military Health System.

Results

There are many good initiatives in military mobile health, however they are decentralized and different across the services and military treatment facilities. We describe some military specific success stories with improving patient access to care and disease specific mobile health applications implemented.

Conclusions

Mobile health is a powerful platform which can help deliver standardized care in missions around the world and improve access to care for patients at military treatment facilities in the United States. The United States Military Health System would benefit greatly from creating universal mobile health applications to assist providers in patient access to care, military mission readiness, and disease specific modules. Future resources should be dedicated to the development of a mobile health application pool that is universally implemented across services to improve quality of care delivered at home and in theater by military providers.
Factors Affecting Performance on an Army Urban Operation Casualty Evacuation for Male and Female Soldiers
Authors: Chassé Etienne , Tingelstad Hans Christian , Needham-Beck Sarah C , Reilly Tara
Published: April 2019

Introduction

This study was conducted to determine what physical and physiological characteristics contribute to the performance of an urban operation casualty evacuation (UO) and its predictive test, FORCE combat (FC) and describe the metabolic demand of the UO in female soldiers.

Methods

Seventeen military members (9 M and 8 F) completed a loaded walking maximal aerobic test, the UO and FC. Heart rate reserve (HRR) and completion time were used as efficiency/performance measures. Oxygen consumption (VO2) was directly measured for UO on five female participants with a portable indirect calorimetry system, and analyzed using descriptive statistics. Stepwise multiple regression analysis was used to determine the contribution of the non-modifiable (age, sex, height) and modifiable characteristics (lean body mass to dead mass ratio (LBM:DM), VO2max corrected for load (L.VO2max), peak force (PF) measured on an isometric mid-thigh pull (IMTP) and medicine ball chest throw distance (Dist) on to the performance of each exercise.

Results

LBM:DM and PF were the only factors included in the stepwise regression model for UO, predicting 70% of UO performance (p < 0.01). For FC, L.VO2max only was included in the stepwise regression model predicting 54% of FC performance (p < 0.01). Sex, age and height were not included in the regression model. The average metabolic cost of UO was 21.4 mL of O2*kg−1*min−1 in female soldiers while wearing PPE.

Conclusion

This study showed that modifiable factors such as body composition, PF on IMTP and L.VO2max are key contributors to performance on UO and FC performance.
Scopolamine Toxicity in an Elderly Patient
Authors: Knuf Kayla M , Spaulding Francis M , Stevens Gregory J
Published: April 2019

We present a case of a 66-year-old female who was to undergo a scheduled operation and placed on our institution’s ERAS (Enhanced Recovery After Surgery) protocol. The intraoperative course was unremarkable. The patient developed delayed emergence in the Post-Anesthesia Care Unit. On physical exam, the patient was noted to have a transdermal scopolamine patch adjacent to an area of skin breakdown. She also displayed signs of central anti-cholinergic toxicity including mydriasis and tachycardia. Following removal of the scopolamine patch and administration of physostigmine, her mental status returned to baseline. This interesting case highlights the importance of considering patient specific factors such as age when implementing ERAS protocols perioperatively. It also demonstrates the risks associated with scopolamine and the importance of risk/benefit analysis prior to administration.
MyDGR: a server for identification and characterization of diversity-generating retroelements
Authors: Sharifi Fatemeh , Ye Yuzhen
Published: April 2019

MyDGR is a web server providing integrated prediction and visualization of Diversity-Generating Retroelements (DGR) systems in query nucleotide sequences. It is built upon an enhanced version of DGRscan, a tool we previously developed for identification of DGR systems. DGR systems are remarkable genetic elements that use error-prone reverse transcriptases to generate vast sequence variants in specific target genes, which have been shown to benefit their hosts (bacteria, archaea or phages). As the first web server for annotation of DGR systems, myDGR is freely available on the web at http://omics.informatics.indiana.edu/myDGR with all major browsers supported. MyDGR accepts query nucleotide sequences in FASTA format, and outputs all the important features of a predicted DGR system, including a reverse transcriptase, a template repeat and one (or more) variable repeats and their alignment featuring A-to-N (N can be C, T or G) substitutions, and VR-containing target gene(s). In addition to providing the results as text files for download, myDGR generates a visual summary of the results for users to explore the predicted DGR systems. Users can also directly access pre-calculated, putative DGR systems identified in currently available reference bacterial genomes and a few other collections of sequences (including human microbiomes).
Effects of Current and Enhanced Tobacco Corrective Messages on Smokers’ Intention to Quit Smoking and Intention to Purchase Cigarettes
Authors: Lee Stella J , Sanders-Jackson Ashley , Tan Andy S L
Published: April 2019

Introduction

A federal court has ordered tobacco companies to issue corrective messages to address tobacco-related misperceptions. This study examined the effects of viewing current versus two enhanced versions of tobacco corrective messages on smokers’ intention to quit smoking and intention to purchase cigarettes.

Methods

US adult smokers (N = 803) were randomly assigned to view (1) two current tobacco corrective messages (Current), (2) two corrective messages that include an industry deception statement (Industry Deception), or (3) two corrective messages with an industry deception statement and testimonials of people harmed by smoking (Industry Deception + Testimonial). Outcomes were pretest–posttest change in intentions to quit smoking and posttest intention to purchase cigarette measures.

Results

Intention to quit smoking increased significantly after viewing the Current corrective messages versus baseline. In addition, viewing the Industry Deception + Testimonial messages increased intention to quit smoking compared with the Current corrective condition and the Industry Deception condition. Hispanic smokers had increased intention to quit smoking and decreased intention to purchase cigarettes to a greater degree than non-Hispanic smokers in response to Industry Deception + Testimonial messages. There was no significant difference in intention to purchase cigarettes across conditions.

Conclusions

Enhancing the current corrective statements by including an industry deception statement and testimonials may strengthen effects and contribute to remedying the effects of tobacco misinformation.

Implications

Previous research has found that draft or proposed versions of tobacco industry corrective messages are effective in correcting beliefs and knowledge. However, studies have not examined how the current court-ordered corrective messages could change intention to quit smoking and intention to purchase cigarettes nor whether enhanced messages could perform better. Study findings suggest that the current corrective messages can increase smokers’ intention to quit smoking beyond their baseline intention. More importantly, enhancing corrective messages by including an industry deception statement and testimonial was found to be more effective than current corrective messages. Findings can inform future iterations of tobacco correctives and strategies to reverse the effects of tobacco misinformation.
tRNA Wobble Modification Affects Leaf Cell Development in Arabidopsis thaliana
Authors: Nakai Yumi , Horiguchi Gorou , Iwabuchi Kosei , Harada Akiko , Nakai Masato , Hara-Nishimura Ikuko , Yano Takato
Published: April 2019

The tRNA modification at the wobble position of Lys, Glu and Gln (wobbleU* modification) is responsible for the fine-tuning of protein translation efficiency and translation rate. This modification influences organism function in accordance with growth and environmental changes. However, the effects of wobbleU* modification at the cellular, tissue, or individual level have not yet been elucidated. In this study, we show that sulfur modification of wobbleU* of the tRNAs affects leaf development in Arabidopsis thaliana. The sulfur modification was impaired in the two wobbleU*-modification mutants: the URM1-like protein-defective mutant and the Elongator complex-defective mutants. Analyses of the mutant phenotypes revealed that the deficiency in the wobbleU* modification increased the airspaces in the leaves and the leaf size without affecting the number and the area of palisade mesophyll cells. On the other hand, both mutants exhibited increased number of leaf epidermal pavement cells but with reduced cell size. The deficiency in the wobbleU* modification also delayed the initiation of the endoreduplication processes of mesophyll cells. The phenotype of ASYMMETRIC LEAVES2-defective mutant was enhanced in the Elongator-defective mutants, while it was unchanged in the URM1-like protein-defective mutant. Collectively, the findings of this study suggest that the tRNA wobbleU* modification plays an important role in leaf morphogenesis by balancing the development between epidermal and mesophyll tissues.
Transcription Is Just the Beginning of Gene Expression Regulation: The Functional Significance of RNA-Binding Proteins to Post-transcriptional Processes in Plants
Authors: Prall Wil , Sharma Bishwas , Gregory Brian D
Published: April 2019

Plants have developed sophisticated mechanisms to compensate and respond to ever-changing environmental conditions. Research focus in this area has recently shifted towards understanding the post-transcriptional mechanisms that contribute to RNA transcript maturation, abundance and function as key regulatory steps in allowing plants to properly react and adapt to these never-ending shifts in their environments. At the center of these regulatory mechanisms are RNA-binding proteins (RBPs), the functional mediators of all post-transcriptional processes. In plants, RBPs are becoming increasingly appreciated as the critical modulators of core cellular processes during development and in response to environmental stimuli. With the majority of research on RBPs and their functions historically in prokaryotic and mammalian systems, it has more recently been unveiled that plants have expanded families of conserved and novel RBPs compared with their eukaryotic counterparts. To better understand the scope of RBPs in plants, we present past and current literature detailing specific roles of RBPs during stress response, development and other fundamental transition periods. In this review, we highlight examples of complex regulation coordinated by RBPs with a focus on the diverse mechanisms of plant RBPs and the unique processes they regulate. Additionally, we discuss the importance for additional research into understanding global interactions of RBPs on a systems and network-scale, with genome mining and annotation providing valuable insight for potential uses in improving crop plants in order to maintain high-level production in this era of global climate change.
Searching for a Match: Structure, Function and Application of Sequence-Specific RNA-Binding Proteins
Authors: Dedow Lauren K , Bailey-Serres Julia
Published: April 2019

Plants encode over 1800 RNA-binding proteins (RBPs) that modulate a myriad of steps in gene regulation from chromatin organization to translation, yet only a small number of these proteins and their target transcripts have been functionally characterized. Two classes of eukaryotic RBPs, pentatricopeptide repeat (PPR) and pumilio/fem-3 binding factors (PUF), recognize and bind to specific sequential RNA sequences through protein–RNA interactions. These modular proteins possess helical structural units containing key residues with high affinity for specific nucleotides, whose sequential order determines binding to a specific target RNA sequence. PPR proteins are nucleus-encoded, but largely regulate post-transcriptional gene regulation within plastids and mitochondria, including splicing, translation and RNA editing. Plant PUFs are involved in gene regulatory processes within the cell nucleus and cytoplasm. The modular structures of PPRs and PUFs that determine sequence specificity has facilitated identification of their RNA targets and biological functions. The protein-based RNA-targeting of PPRs and PUFs contrasts to the prokaryotic cluster regularly interspaced short palindromic repeats (CRISPR)-associated proteins (Cas) that target RNAs in prokaryotes. Together the PPR, PUF and CRISPR-Cas systems provide varied opportunities for RNA-targeted engineering applications.
CAN SCATTER CORRECTION SOFTWARE REPLACE A GRID IN DR PELVIC EXAMINATIONS?
Authors: Precht Helle , Mørup Svea Deppe , Tingberg Anders , Outzen Claus Bjørn , Kusk Kirsten Weber , Nielsen Rita Møller , Midtgård Marie , Winther Martin Brændegaard , Waaler Dag , Kusk Martin Weber
Published: April 2019

The purpose was to examine if scatter correction software could replace a grid while maintaining image quality and reducing radiation dose for pelvic DR examinations. Grid images was produced with 70 kV and 16mAs. Anthropomorphic- and Contrast Detail RADiography (CDRAD) non-grid images were produced with 60 kV, 80 kV and 90 kV combined with five different mAs and scatter correction software. The anthropomorphic images were analyzed by absolute Visual Grading Analysis (VGA). The CDRAD images were analyzed using the CDRAD analysis software. The results showed a total of 54.6% non-grid images were evaluated as unsuitable for diagnostic use by the VGA. The CDRAD grid images showed that the IQF_inv values were significantly different (p = 0.0001) when compared to every group of non-grid images. Hereby, the conclusion stated that the scatter correction software did not compensate for the loss in image quality due to scattered radiation at the exposure levels included in a pelvic examination.
Towards regional responsible research and innovation? Integrating RRI and RIS3 in European innovation policy
Authors: Fitjar Rune Dahl , Benneworth Paul , Asheim Bjørn Terje
Published: April 2019

This article develops a model for a regional responsible research and innovation (RRI) policy, integrating existing European Union policies on RRI, and on research and innovation strategies for smart specialisation (RIS3). RRI and RIS3 are central concepts in the EU’s innovation policy agenda, but there are tensions between the two approaches. The place-based approach inherent in RIS3 is missing from RRI, which has a fuzzy concept of geographical scale and is vulnerable to mismatches between the scale of innovations and of the associated governance networks involved in the innovation process. Meanwhile, the multitude of visions, values and stakeholder perceptions embodied in the RRI concept is countered by the more optimistic and unitary imagining of a regional future in RIS3. We highlight that Europe’s innovation challenges can only be resolved by leveraging the strengths of both types of innovation policy.
Quantitative electroencephalography measures in rapid eye movement and nonrapid eye movement sleep are associated with apnea–hypopnea index and nocturnal hypoxemia in men
Authors: Appleton Sarah L , Vakulin Andrew , D’Rozario Angela , Vincent Andrew D , Teare Alison , Martin Sean A , Wittert Gary A , McEvoy R Doug , Catcheside Peter G , Adams Robert J
Published: April 2019

Study Objectives

Quantitative electroencephalography (EEG) measures of sleep may identify vulnerability to obstructive sleep apnea (OSA) sequelae, however, small clinical studies of sleep microarchitecture in OSA show inconsistent alterations. We examined relationships between quantitative EEG measures during rapid eye movement (REM) and non-REM (NREM) sleep and OSA severity among a large population-based sample of men while accounting for insomnia.

Methods

All-night EEG (F4-M1) recordings from full in-home polysomnography (Embletta X100) in 664 men with no prior OSA diagnosis (age ≥ 40) were processed following exclusion of artifacts. Power spectral analysis included non-REM and REM sleep computed absolute EEG power for delta, theta, alpha, sigma, and beta frequency ranges, total power (0.5–32 Hz) and EEG slowing ratio.

Results

Apnea–hypopnea index (AHI) ≥10/h was present in 51.2% (severe OSA [AHI ≥ 30/h] 11.6%). In mixed effects regressions, AHI was positively associated with EEG slowing ratio and EEG power across all frequency bands in REM sleep (all p < 0.05); and with beta power during NREM sleep (p = 0.06). Similar associations were observed with oxygen desaturation index (3%). Percentage total sleep time with oxygen saturation <90% was only significantly associated with increased delta, theta, and alpha EEG power in REM sleep. No associations with subjective sleepiness were observed.

Conclusions

In a large sample of community-dwelling men, OSA was significantly associated with increased EEG power and EEG slowing predominantly in REM sleep, independent of insomnia. Further study is required to assess if REM EEG slowing related to nocturnal hypoxemia is more sensitive than standard PSG indices or sleepiness in predicting cognitive decline.
Autologous Platelet-Rich Plasma and Fibrin Glue Decrease Pain Following Excision and Primary Closure of Pilonidal Sinus
Authors: Alamdari Daryoush Hamidi , Motie Mohamad Reza , Kamalahmadi Nasim , Aliakbarian Mohsen
Published: April 2019

BACKGROUND:

Pilonidal sinus is one of the most complicated chronic wounds common in younger adults. This disabling condition affects the natal clefts of the buttocks and often requires surgery.

OBJECTIVE:

To investigate the effect of autologous platelet-rich plasma and fibrin glue (PRP-FG) on pain reduction and the healing process of pilonidal sinus after excisional surgery with primary closure.

METHODS:

This randomized clinical trial study included 40 patients with pilonidal sinus admitted to a surgical ward. Patients were randomly divided into two groups: the control group, who underwent wide excision of the sinus with primary closure, and the case group, who had wide excision of the sinus with primary closure along with injection of autologous PRP-FG into the wound. For 6 months, patients were followed up for their severity of pain, wound healing process, the time it took them to get back to normal activities, infection, and other complications.

RESULTS:

In the first and second week after surgery, the severity of pain in the case group was reduced significantly in comparison with the control group. Healing time decreased but not significantly. There was no significant difference in infection and recurrence between the two groups.

CONCLUSIONS:

The addition of PRP-FG has the potential to reduce pain significantly in primary closure of pilonidal sinus.
Use of Silver-Containing Hydrofiber and Chlorhexidine-Impregnated Tulle Gras Dressings for Second-Degree Burns
Authors: Pamuk Cebeci Sevil , Acaroğlu Rengin
Published: April 2019

OBJECTIVE:

This study evaluated the use of silver-containing hydrofiber and chlorhexidine-impregnated tulle gras dressings for second-degree burns.

METHODS:

This randomized clinical study consisted of 60 patients with second-degree burns. Data were collected using a Patient Identification Form, Wound Assessment Form, and Pain Assessment Scale. Following dressing application, wounds were assessed on days 7, 15, and 22. Study procedures were continued until full epithelialization occurred.

RESULTS:

After the seventh day of follow-up, significant improvement was noted in the experimental group in terms of wound exudate, wound debridement, pain intensity, and analgesic agent administration. After the 15th day of follow-up, there was a significant decrease in epithelialization time in the experimental group. Exudate control was better in patients whose burns were treated with silver-containing hydrofiber dressings, and they needed less debridement and fewer analgesics because of infrequent dressing changes. Lower pain scores were reported, the burn area reduced more quickly, and faster epithelialization and wound healing were achieved.

CONCLUSIONS:

The authors conclude that silver-containing hydrofiber dressings are an effective wound care material that improve the wound healing process. More studies comparing it and other wound care materials could improve the quality of healthcare for patients with burns.
Student Experience of Self-Care in an Online Master of Science in Nursing Course
Authors: Brown Cynthia J. , Bar Bonnie
Published: April 2019

The purpose of this qualitative study was to discover students’ experience of self-care in an online master of science in nursing course. The course included caring groups, organized small groups to provide support. The analysis of the personal reflective summaries of 37 students revealed two main themes and five subthemes. Two overarching themes illuminated “Finding Our Inner Selves” and “A Lasting Journey and Not a Destination.” The students valued a focus on self-care, goal setting, and support from family, friends, and caring groups. Many mentioned that self-care is an ongoing work in progress.
Empirical Grouping of Pain Zones in Fibromyalgia
Authors: Vallejo Miguel A. , Rivera Javier , Vallejo-Slocker Laura
Published: April 2019

Objectives:

Widespread pain is important for the diagnosis of fibromyalgia (FM). For this purpose, the sum of pain regions obtained from a topographical distribution has been used to compute a Widespread Pain Index (WPI), but there is no empirical basis for choosing the regions. The aim of this study was to find an empirical distribution of the pain regions.

Materials and Methods:

We evaluated 228 female patients with FM. They completed the Fibromyalgia Survey Questionnaire, Fibromyalgia Impact Questionnaire (FIQ), Combined Index of Severity in Fibromyalgia (ICAF), and Short Form-36 Health Survey. The pain regions of the WPI were grouped by the topographical distribution (WPIR) and compared with a new empirical distribution (WPIE) obtained through exploratory factor analysis. A decision- tree analysis was conducted to identify the optimal algorithm for selecting pain regions related to the severity of FM.

Results:

The WPIE has a normal distribution compared with the WPIR. It also shows higher correlations with FM severity. From the factor analysis, 4 factors explain 48.5% of the variance. Two factors (emotional and physical) can conform to the decision-tree analysis using the dependent variables FIQ and ICAF. These factors are very congruent with the cutoff points previously proposed for FIQ and ICAF. The emotional factor is the first in the decision-tree.

Discussion:

WPIE has a normal distribution and shows better predictive qualities than WPIR. The emotional factor is conceptualized as emotional because of the relative importance of the right hemisphere in negative emotions and pain. The physical factor could be responsible for the decreased ability to coordinate left-right stepping.
Femoral derotation osteotomy in children with cerebral palsy using the pediatric proximal femoral nail
Authors: Sarikaya İlker A. , Erdal Ozan A. , Şeker Ali , Görgün Bariş , İnan Muharrem
Published: April 2019

We designed a pediatric proximal femoral nail (PPFN) to overcome fixation method-related complications when performing femoral derotation osteotomy in cerebral palsy patients. Preliminary results of cerebral palsy patients who underwent femoral derotation osteotomy fixed using PPFN to treat in-toeing were evaluated. Sixteen patients with a mean age of 10 years were included. Mean follow-up duration was 36 months. There was no significant difference in the follow-up neck-shaft angle and articulotrochanteric distance values (P = 0.2 and 0.3). PPFN provides stable fixation, early weight-bearing, reduces soft-tissue disruption while limiting the complications due to fixation technique.
A Survey of Nurses' Need for Care Robots in Children's Hospitals
Authors: Jin Meiling , Kim Jeongeun
Published: April 2019

The purpose of this study was to investigate nurses' need for care robots in children's hospitals and to help develop care robots that can be used by combining robot-care, game-care, and edu-care. This study employed a mixed-methods design; 198 nurses were recruited for quantitative research and 12 for qualitative research. The findings were as follows. Robot-care: Participants had an overwhelming preference for robots made of plastic or steel that could easily be washed and sterilized. Game-care: Among nursing procedures, vital sign measurements were the most common actions that could be implemented using game elements. Edu-care: The educational content that participants felt should be presented to child patients and caregivers through care robots included information about hospitalization, discharge, infection control, falls, and pressure ulcer prevention. Qualitative data divided the role of care robots into five subcategories associated with children and one subcategory associated with guardians. The findings of this study are meaningful in that it clarified the needs of nurses in the development of care robots for use in children's hospitals.
Parathyroid Hormone and Cardiac Electrophysiology: A Review
Authors: Palmeri Nicholas Osborn , Walker Marcella Donovan
Published: April 2019

Calcium has long been known to be essential to cardiac electrical activity. Parathyroid hormone (PTH) is the main regulator of serum calcium and is central to calcium homeostasis. Although there are significant data linking parathyroid disease states with changes in cardiac electrophysiology, most data have focused on how PTH modulates serum calcium to produce these effects. Close scrutiny of early literature demonstrates that the relationship between PTH and electrocardiographic changes is not straightforward, and numerous studies have linked PTH to arrhythmia. Basic science research has demonstrated that there is a basis for a direct role of PTH on cardiac electrophysiology outside of its effect on serum calcium. Later studies in secondary hyperparathyroidism indicate that PTH disturbances could have important implications for broad categories of patients with cardiovascular disease. The current review summarizes the existing literature on PTH and electrophysiology based on clinical and basic science studies of various parathyroid states, providing directions for future study.
Sudden Cardiac Death in Brugada Syndrome
Authors: Kabra Nitin , Gupta Rahul , Aronow Wilbert S. , Frishman William H.
Published: April 2019

The Brugada syndrome is an inherited channelopathy that alters the main transmembrane ion currents that constitute the cardiac action potential. These changes not only modify the resting electrocardiogram but also predispose patients to develop malignant ventricular tachyarrhythmias that can lead to syncope, cardiac arrest, and sudden cardiac death. This syndrome is responsible for nearly 20% of all sudden cardiac deaths in patients with structurally normal hearts and up to 12% of all sudden cardiac deaths. Brugada syndrome is diagnosed by its characteristic electrocardiogram consisting of a coved-type ST-segment elevation of at least 2 mm followed by a negative T wave in either one of the right precordial leads. These changes can be observed spontaneously or after administration of a sodium channel blocker. While our understanding of this disease has increased tremendously since its first description in 1992, the primary therapeutic option remains implantation of an implantable cardioverter-defibrillator to avoid sudden cardiac death. Therefore, tremendous effort is being made to effectively risk stratify patients to determine who would benefit from implantable cardioverter-defibrillator implantation.
Development and Validation of a Sensitive UHPLC-MS/MS–Based Method for the Analysis of Folylpolyglutamate Synthetase Enzymatic Activity in Peripheral Blood Mononuclear Cells: Application in Rheumatoid Arthritis and Leukemia Patients
Authors: Muller Ittai B. , Lin Marry , Struys Eduard A. , Heydari Paniz , Hebing Renske C. F. , Nurmohamed Mike T. , van der Laken Conny , Lems Willem F. , Cloos Jacqueline , Jansen Gerrit , de Jonge Robert
Published: April 2019

Background:

Folylpolyglutamate synthetase (FPGS) is a crucial enzyme in both cellular folate homeostasis and the intracellular retention of folate analogue drugs such as methotrexate (MTX), which is commonly used for the treatment of (pediatric) leukemia and the anchor drug in rheumatoid arthritis (RA) treatment. To date, assessment of FPGS catalytic activity relies on assays using radioactive substrates that are labor-intensive and require relatively large numbers of cells. Here, we describe a nonradioactive, ultra–high-performance liquid chromatography–tandem mass spectrometer (UHPLC-MS/MS)–based method allowing for sensitive and accurate measurements of FPGS activity in low cell numbers (ie, 1–2 × 106) of biological specimens, including leukemic blast cells of acute lymphoblastic leukemia patients and peripheral blood mononuclear cells of patients with RA.

Methods:

The UHPLC-MS/MS assay was validated with 2 CCRF-CEM human leukemia cells, one proficient and one deficient in FPGS activity. Linearity of time and protein input were tested by measuring FPGS activity at 30–180 minutes of incubation time and 10–300 mcg protein extract. In addition, FPGS enzyme kinetic parameters were assessed.

Results:

The FPGS enzymatic assay showed a linear relation between FPGS activity and protein input (R2 ≥ 0.989) as well as incubation time (R2 ≥ 0.996). Moreover, the UHPLC-MS/MS method also allowed for evaluation of FPGS enzyme kinetic parameters revealing Km values for the substrates MTX and L-glutamic acid of 64 µmol/L and 2.2 mmol/L, respectively. The mean FPGS activity of acute lymphoblastic leukemia blast cells (n = 4) was 3-fold higher than that of CCRF-CEM cells and 44-fold and 88-fold higher than that of peripheral blood mononuclear cells from MTX-naive (n = 9) and MTX-treated RA patients (n = 6), respectively.

Conclusions:

Collectively, given its sensitivity with low cell numbers and avoidance of radioactive substrates, UHPLC-MS/MS–based analysis of FPGS activity may be eligible for routine therapeutic drug monitoring of MTX in RA and leukemia for therapy (non)response evaluations.