bluuebunny/crossref_metadata_2025 huggingface dataset:
Statistical edutainment with confidence
Authors: Pearl Dennis K. , Lesser Lawrence M.
Published: January 2020

The use of cartoons, songs, and quotes can be a useful way to engage students in discussion and learning key concepts about quantifying the uncertainty in statistical estimates.
Industrial research and development and real exchange rate depreciation in a small open economy
Authors: Tabrizy Saleh S.
Published: January 2020

To examine how changes in relative national prices affect innovation input, this paper studies the impact of changes in industry‐specific effective real exchange rates on industrial R&D expenditures in Korea. In particular, it explores the heterogeneous responses of industries with different export intensities. Employing dynamic panel data estimation techniques, the results suggest that among industries with medium levels of export intensity a lagged depreciation in industry‐specific effective real exchange rate leads to a decline in contemporaneous industry‐level R&D expenditures. However, this adverse effect is insignificant for industries that either mostly serve the domestic markets or that are heavily engaged in foreign markets.
Xenotransplantation literature update, November/December 2019
Authors: Thomas Adwin , Hawthorne Wayne J. , Burlak Christopher
Published: January 2020

The ever‐increasing disparity between the lack of organ donors and patients on the transplant waiting list is increasing worldwide. For the past several decades xenotransplantation has led the way to correct this deficit and remains clearly the only feasible option to provide a means to meet the demand for patients in need of an organ transplant. Xenotransplantation’s ability to provide a specifically designed unlimited supply of organs, suited to treat the various needs for transplant organs and cells, has recently been championed by successful pre‐clinical trials that have run long‐term in non‐human primate studies.

In this review we show how these improvements have come about due to long‐term dedicated research and recent advances in biomedical engineering technology, such as genome editing tools including zinc finger nucleases, TALEN, and CRISPER/Cas9 which have paved the way for significant breakthroughs in improving xenograft outcomes through genetic modifications to the donor source pig. Other novel approaches include the development of decellularized porcine tissue, such as corneas which can now be transplanted into patients with the minimal need for immunosuppression or other side effects. Further genetic variants of the porcine genome are also now being optimized to abrogate rejection.

The emergence of new modalities such as; mesenchymal stem cells, donor thymic vascularization, in vivo bioreactors, chemokine and cytokine therapies have come to show improvements in xenograft outcomes. Furthermore, new studies confirm the safety status of using porcine xenografts, verifying that with current technologies and approaches, the issue of PERV transmission is a moot point. These breakthroughs and technological advancements push the reality of xenotransplantation one step closer to the clinic.
Divided Elite and Disordered State
Authors: Nugent David
Published: January 2020

This chapter investigates the changes in the regional social structure that made it impossible for government officials to mobilize the workforce they needed to carry out modernization projects. Key in this regard was the breakdown of the castas. When the Pizarro-Rubio fell from power in 1930, there were no remaining elite coalitions that could take their place. Instead, the castas fragmented into a series of separate families, each having to fend for itself. This resulted in an unprecedented degree of infighting within the apparatus of government. For positions in government were the only way that elite families could maintain an elite station in life. From this point onward the apparatus of government became a terrain of conflict. This in turn undermined any and all efforts to modernize the Chachapoyas region. Those responsible for mobilizing the workforce became involved in bitter struggles with one another.
The Sacropolitics of Labor Conscription
Authors: Nugent David
Published: January 2020

This chapter analyzes the authorities’ mounting difficulties in conscripting the population for public works—a second “routine” activity they had previously undertaken with great success. The chapter shows the delusional nature of government plans, and how delusion was represented as rationality and routine. The chapter also explores officials’ confusion about their inability to carry out the ordinary, everyday task of conscription, and their sense that what had formerly seemed ordinary was anything but that. Chapter Eight also examines the explanations that government officials generated to explain their inability to carry out activities that had formerly been routine—in which their attribute their difficulties to a series of phantom figures that are said to haunt government efforts to rule.
Ecosistema del conocimiento en América Latina: el acceso abierto, métricas, paradojas y contradicciones
Authors: López López Wilson
Published: January 2020

Editorial.
Entre milagros, espíritus y esoterismo: pensamiento mágico y pseudociencia en el Chile globalizado del siglo XXI
Authors: Rodríguez Garcés Carlos René , Valenzuela Orrego Mónica
Published: January 2020

Paralelo a la racionalidad que sustenta la ciencia y la tecnología, persiste un conjunto de creencias infundadas entre la ciudadanía, las que usualmente omiten criterios científicos para dar explicación a fenómenos aparentemente sobrenaturales. Haciendo uso de los datos de la primera Encuesta nacional de percepción social de la ciencia y la tecnología (EPSCYT) aplicada en Chile el año 2016, se exploran descriptivamente mediante prevalencias y razones de probabilidad, algunos fenómenos en los que la gente cree, y se analiza qué tan arraigados están en los diversos segmentos de la población. Entre los resultados, encontramos una alta prevalencia en creencias acerca de la existencia de los milagros (79 %), los espíritus (65 %), la telepatía (60.2 %), la numerología (50.4 %) y los OVNIS (59.9 %). Como discusión, se plantea una paradoja de la modernidad, donde pese a la propagación del conocimiento científico y las tecnologías, algunas creencias en lo sobrenatural se mantienen, esto incluso entre quienes teóricamente serían más escépticos, es decir, quienes han alcanzado educación universitaria, son adultos, se declaran agnósticos y/o partidarios de la tesis de comprobabilidad.
Inteligencia emocional centrada en uno mismo y en el otro: Escala Rotterdam de Inteligencia Emocional (REIS)
Authors: Teruel Pilar , Salavera Carlos , Usán Pablo , Antoñanzas José L.
Published: January 2020

El objetivo de este estudio fue la adaptación y validación al español de la Escala de Inteligencia Emocional de Rotterdam (REIS) (Pekaar, Bakker, van der Linden, & Born, 2018) (N = 384, edad = 29.32 años). Se realizaron dos estudios: 1) la traducción de la escala REIS al español y se evaluó su consistencia interna, estructura factorial y validez convergente; y 2) el análisis factorial confirmatorio del cuestionario. Se obtuvieron cuatro factores: evaluación emocional centrada en sí mismo, evaluación de emociones centrada en otros, regulación de la emoción centrada en uno mismo y regulación de las emociones enfocadas en los otros. El análisis factorial exploratorio mostró claramente que los factores de la escala REIS presentan una varianza acumulada del 56.07 %, que mostraron ser capaces de explicar la variación única de inteligencia emocional. Por su parte, el análisis factorial confirmatorio verificó la adecuación del modelo, con una estructura sustentable compuesta por los cuatro factores identificados y 28 ítems. El REIS es un instrumento fácil de comprender y rápido de completar, por lo que se considera útil para la evaluación de la inteligencia emocional en población española.
Motivos de práctica como predictor de la actividad física en maestros y la satisfacción con la vida
Authors: Gutiérrez Caballero Juana María , Blázquez Manzano Alberto , Feu Sebastián
Published: January 2020

El objetivo de esta investigación es analizar la relación entre la intención de práctica de actividad física, la actividad actual, la motivación y satisfacción vital de maestros españoles. A través de un diseño descriptivo, predictivo y transversal, se administró un cuestionario con diversos instrumentos a una muestra de 649 docentes en activo. Inicialmente, se realizó un análisis de las propiedades psicométricas de las escalas a través de un análisis factorial confirmatorio y de fiabilidades de los factores, encontrando unos índices de ajuste adecuados. Seguidamente, se realizó un análisis correlacional y una regresión lineal múltiple por el método de pasos sucesivos. Las correlaciones más altas se dieron entre los motivos de diversión, competencia, fitness y la actividad física actual y futura (p < 0.05). Los resultados muestran que los motivos de práctica: diversión, competencia y fitness tienen capacidad para predecir la actividad física realizada en la actualidad (R2 = 0.32; p < 0.001); mientras que todos los motivos de práctica de actividad física, excepto los sociales, predicen la intención de ser físicamente activos en el futuro (R2 = 0.59; p < 0.001). Finalmente, se encontró una tendencia de que la práctica de actividad física con motivo de diversión predice significativamente la satisfacción con la vida.
Pseudo-Rigid-Body Dynamic Models for Design of Compliant Members
Authors: Vedant  , Allison James T.
Published: January 2020

Movement in compliant mechanisms is achieved, at least in part, via deformable flexible members, rather than using articulating joints. These flexible members are traditionally modeled using finite element analysis (FEA)-based models. In this article, an alternative strategy for modeling compliant cantilever beams is developed with the objectives of reducing computational expense and providing accuracy with respect to design optimization solutions. The method involves approximating the response of a flexible beam with an n-link/m-joint pseudo-rigid-body dynamic model (PRBDM). Traditionally, static pseudo-rigid-body models (PRBMs) have shown an approximation of compliant elements using two or three revolute joints (2R/3R-PRBM). In this study, a more general nR-PRBDM model is developed. The first n resonant frequencies of the PRBDM are matched to exact or FEA solutions to approximate the response of the compliant system and compared with existing PRBMs. PRBDMs can be used for co-design studies of flexible structural members and are capable of modeling large deflections of compliant elements. We demonstrate PRBDMs that show dynamically accurate response for a random geometry cantilever beam by matching the steady-state and frequency response, with dynamical response accuracies up to 10% using a 5R-PRBDM.
Numerical Study of a Single-Point Mooring Gravity Fish Cage With Different Deformation-Suppression Methods
Authors: Cheng Hui , Aarsæther Karl Gunnar , Li Lin , Ong Muk Chen
Published: January 2020

Compared with the multipoint mooring fish cage, the single-point mooring (SPM) fish cage can spread out the fish wastes and uneaten feeds in a larger area, and it can also prevent the local environment from being overwhelmed. Thus, it has attracted much attention recently. In this research, different deformation-suppression methods are applied to the SPM system with a typical Norwegian fish cage aiming to increase the cultivation volume under the action of current and/or wave loads. A well-validated software, fhsim, is used to conduct the full-scale numerical study. The effects of the three deformation-suppression methods, i.e., (i) adding the lower bridles, (ii) adding the frontal rigid frame and (iii) adding the trawl doors, are analyzed under pure current and combined wave–current conditions. The results indicate that all the three deformation-suppression methods can improve the cultivation volume at least by 32% compared to the original SPM fish cage when the current velocity is larger than 0.5 m/s. In addition, moving the conjunction point close to the bottom ring can bring a positive effect on the cultivation volume maintaining with an only small increment in the tension force. This study can provide practical advice and useful guides for the SPM fish cage design.
Artificial Intelligence Based Gas Turbine Compressor Wash: A Predictive Approach
Authors: M. Raghavan Shaiju , Palatel Arun , Simon Jayaraj
Published: January 2020

Deep penetration of renewable energy generation has led to increased periods of operation of industrial gas turbines under part load conditions. The performance fault diagnosis of gas turbine module components such as compressor, turbine, and the combustion chamber is a difficult task for such non-design operating conditions. Hence operational data-based performance health monitoring system is a requirement of gas turbine owners or users. The system must be capable to identify the degradation of gas turbine components, having substantial impact on the performance of the module in any possible operating condition. On time identification of degraded components will reduce the cost of operation, ensure service availability and obtain maximum performance from the turbine. This paper illustrates the application of advanced machine learning techniques to the performance analysis, fault diagnosis and prediction of future performance of gas turbine compressor. Compressor fouling is a primary cause of gas turbine performance deterioration, which accounts for 70% to 85% of the performance loss. The first section of the paper focuses on the residual generation of critical parameters of the compressor. The residual of the critical parameters can be calculated by comparing compressor model output with actual plant parameters. The trained artificial neural network (ANN) classifier uses residual of critical parameters to identify the fast rate of compressor fouling in the early stage. Statistical analysis can estimate the future performance of the compressor from the residual of critical parameters. The predicted values of compressor performance are useful for the planning of offline compressor wash, which in turn improve performance, reliability, and availability of gas turbine module. The residuals can also measure the effectiveness of compressor wash and assess the performance after machine overhauling.
Experimental Investigation of Flow Blurring Atomizer at Near Field Using Particle Image Velocimetry
Authors: Murugan Raju , Sellan Dhanalakshmi , Kolhe Pankaj S.
Published: January 2020

Two-fluid flow blurring atomization is characterized by the backflow recirculation of the air phase in the liquid pipe by bifurcation of the liquid and airflow. Most of the primary spray process is completed in the injector due to the penetration of air into the liquid tube. Thus, the majority of the liquid ligaments are converted into a fine spray at the outlet of the nozzle. Experiments were performed with two different air to liquid ratios (0.6 and 1) by mass, where water is considered as the liquid and airflow was kept constant (0.2 g/s). To change the ALR, the liquid flow rate was changed. Particle image velocimetry (PIV) diagnostic technique provides the full-field velocity of the spray droplets (discrete phase). It may be noted that sprays are self-seeded and PIV measurements reflect the droplet velocities instead of air velocity. To understand the effect of the spatial resolution of PIV on spray droplet velocity; experiments were conducted at three different spatial resolutions (11.8, 16.4 and 23.22 μm/pixel) for each ALR. As the ALR is increased, the mass of the liquid in the spray decreases, resulting in finer atomization and velocity of the spray droplets. This means that finer droplets are generated for the same mass of air at a lower liquid flow rate as compared to higher liquid flow rate. Note that Reynolds stresses provide an indication of the turbulent breakup of the droplet and larger magnitudes observed for higher ALR indicate finer atomization.
Combination of B-mode and color Doppler mode using mutual information including canonical correlation analysis for breast cancer diagnosis
Authors: Yampaca Tongjai , Chongstitvatana Prabhas
Published: January 2020

Aim: This study proposes the combination of B-mode and color Doppler mode using Mutual Information including Canonical Correlation Analysis (MI-CCA) to improve breast cancer diagnosis.Materials and methods: The dataset consisted of 53 benign lesions and 202 malignant lesions including B-mode, and color Doppler mode. Convolutional Neuron Networks (CNNs) was applied to automatically extract the features from breast ultrasound images. Then, MI-CCA was performed to fuse with maximized correlation. Finally, the classification model was built via the support vector machine technique to distinguish breast tumors. Diagnosis performances of single modes, combination modes, and other fusion strategies were compared.Results: The single B-mode obtained 90.92% accuracy, while the color Doppler mode obtained 97.16% accuracy. The MI-CCA fusion reveals a significant improvement with 98.80% accuracy. The results indicated that the fusion of two modes tended to offer a more accurate diagnosis than the single mode. In addition, the unsupervised-PCA was high (AUC 0.91, 95% CI [0.90, 0.91]) and no significant difference was observed with the unsupervised-CCA (AUC 0.90, 95% CI [0.84, 0.90]). The supervised-PCA was the lowest (AUC 0.93, 95% CI [0.91, 0.93] and no significant difference was observed with the supervised-CCA (AUC 0.95, 95% CI [0.91, 0.94]). The proposed MI-CCA was the highest performance (AUC 0.99, 95% CI [0.93, 0.99]). These results indicated that the supervised strategies tended to give a more accurate diagnosis than unsupervised strategies.Conclusion: By using the combination of ultrasound modes, this approach achieves high performance compared with the single mode and other fusion strategies. Our methodology may be a beneficial tool for the early detection and diagnosis of breast cancer
Using electrochemistry-total internal reflection imaging ellipsometry to monitor biochemical oxygen demand with polyaniline modified electrode
Authors: Shen Jia , Liu Wei , Niu Yu , Li Meng , Jin Gang
Published: January 2020

Biochemical oxygen demand (BOD) is an important indicator for characterizing organic pollution in water. So various BOD sensors have been developed for BOD detection. BOD sensors based on a Clark electrode have the problem of signal drift. To overcome this problem, a combined electrochemical and total internal reflection imaging ellipsometry sensor has been proposed. To improve the sensitivity, polyaniline (PAn) and PAn incorporated with Fe(III) meso-tetra (4-sulfonatophenyl) porphyrin (FeTSPP) have been introduced on the working electrode. The results show that the combination system is effective for BOD detection with PAn. By incorporating FeTSPP, the optical and electrochemical responses of a PAn modified gold chip to BOD are improved significantly. Finally, the relationship between the optical and electrochemical signals is investigated by establishing a glass/Au/PAn-based film/liquid model. The analysis reveals that both signals represent the ratio change of the oxidized state of PAn in a similar way.
Gaussian effective medium theory of dielectric properties of inhomogeneous systems
Authors: Chrzanowska Agnieszka , Babiarz Sebastian
Published: January 2020

Inhomogeneous systems, where optical properties change continually, can be analyzed in the ellipsometrical modeling software of Woollam by the use of option GRADED LAYERS, where a main layer is divided into several sublayers, and optical properties of these sublayers lead to effective properties. From a mathematical point of view, this modeling involves evaluations of appropriate integrals, which are assessed so far by only view data points. Precise assessment of integrals by the simplest trapezoidal rule would require, however, hundreds of data points. In this presentation, the authors show a theoretical approach which can improve such modeling in which still several points are needed but the integration outcome is much more precise. The approach uses a well known formula for a chain of capacitors and the principles of Gaussian integration leading to the model of the Gaussian effective medium approximation. As an example, an ultrathin layer of liquid crystal has been used with inhomogeneity induced by the walls. The properties of the order parameter tensor are obtained here from the Onsager theory. The connection of the order parameter tensor with the dielectric tensor components with the rule of chain capacitors allows for obtaining effective dielectric constants for the whole sample of the inhomogeneous layer. Changes in the values of such effective dielectric constants induced by the existence of the walls with respect to uniform bulk values for examined liquid crystal are shown to be so strong that they almost canceled anisotropy. Such a result can be a good motivation for further considering this model for future applications. The proposed effective medium model has been applied then to thin films of the poly vinylo carbazol polymer for which ellipsometric measurements and modeling provide effective values of the optical properties. The agreement between the experimental results and the outcome of the effective medium theory Gaussian effective medium approximation is found to be very satisfactory. Application of this method to porous materials has been also discussed. The method is general and can be applied to any system with inhomogeneous and continually changing optical properties. The proposition how to improve the option Graded Layer in completeease software of Woollam has been also given.
Highly uniform silicon field emitter arrays fabricated using a trilevel resist process
Authors: Karaulac Nedeljko , Rughoobur Girish , Akinwande Akintunde I.
Published: January 2020

The authors report silicon field emitter arrays (FEAs) that were fabricated using a trilevel resist process and are highly uniform. The authors explored the current sensitivity of FEAs to tip radius variation using different tip radius distributions and show that reducing the tip radius dispersion is an effective alternative to increasing the resistance of a current limiter for achieving uniform emission current. In order to reduce the tip radius dispersion, the authors use a trilevel resist process to increase the uniformity of the array of dots used as the etching mask for forming the silicon tips. SEM images show that they were able to reduce the standard deviation of the dot diameter by 60% using a trilevel resist process instead of a single layer resist process. Device characterization showed that the FEAs have a very narrow range of slopes, bFN, extracted from the Fowler–Nordheim plot, indicating that the field emitters within the FEA are highly uniform.
Lychnopholide in Poly(
d
,
l
-Lactide)-
Block
-Polyethylene Glycol Nanocapsules Cures Infection with a Drug-Resistant
Trypanosoma cruzi
Strain at Acute and Chronic Phases
Authors: Branquinho Renata Tupinambá , de Mello Carlos Geraldo Campos , Oliveira Maykon Tavares , Reis Levi Eduardo Soares , Vieira Paula Mello de Abreu , Saúde-Guimarães Dênia Antunes , Mosqueira Vanessa Carla Furtado , de Lana Marta
Published: January 2020

Chagas disease remains neglected, and current chemotherapeutics present severe limitations. Lychnopholide (LYC) at low doses loaded in polymeric poly(
d
,
l
-lactide)-
block
-polyethylene glycol (PLA-PEG) nanocapsules (LYC-PLA-PEG-NC) exhibits anti-
Trypanosoma cruzi
efficacy in mice infected with a partially drug-resistant strain. This study reports the efficacy of LYC-PLA-PEG-NC at higher doses in mice infected with a
T. cruzi
strain resistant to benznidazole (BZ) and nifurtimox (NF) treated at both the acute phase (AP) and the chronic phase (CP) of infection by the oral route.
Gastrointestinal Coinfection Promotes Chlamydial Pathogenicity in the Genital Tract
Authors: Tian Qi , Zhou Zengzi , Wang Luying , Abu-Khdeir Al-Mutassim Hani , Huo Zhi , Sun Xin , Zhang Nu , Schenken Robert , Wang Yufeng , Xue Min , Zhong Guangming
Published: January 2020

Sexually transmitted
Chlamydia
, which can cause fibrotic pathology in women’s genital tracts, is also frequently detected in the gastrointestinal tract. However, the medical significance of the gastrointestinal
Chlamydia
remains unclear. A murine
Chlamydia
readily spreads from the mouse genital tract to the gastrointestinal tract while inducing oviduct fibrotic blockage or hydrosalpinx. We previously proposed a two-hit model in which the mouse gastrointestinal
Chlamydia
might induce the second hit to promote genital tract pathology, and we are now providing experimental evidence for testing the hypothesis.
Extracellular Electron Transfer: Respiratory or Nutrient Homeostasis?
Authors: Jeuken Lars J. C. , Hards Kiel , Nakatani Yoshio
Published: January 2020

Exoelectrogens are able to transfer electrons extracellularly, enabling them to respire on insoluble terminal electron acceptors. Extensively studied exoelectrogens, such as
Geobacter sulfurreducens
and
Shewanella oneidensis
, are Gram negative. More recently, it has been reported that Gram-positive bacteria, such as
Listeria monocytogenes
and
Enterococcus faecalis
, also exhibit the ability to transfer electrons extracellularly, although it is still unclear whether this has a function in respiration or in redox control of the environment, for instance, by reducing ferric iron for iron uptake.
Reduced
In Vitro
Susceptibility of Streptococcus pyogenes to β-Lactam Antibiotics Associated with Mutations in the
pbp2x
Gene Is Geographically Widespread
Authors: Musser James M. , Beres Stephen B. , Zhu Luchang , Olsen Randall J. , Vuopio Jaana , Hyyryläinen Hanne-Leena , Gröndahl-Yli-Hannuksela Kirsi , Kristinsson Karl G. , Darenberg Jessica , Henriques-Normark Birgitta , Hoffmann Steen , Caugant Dominque A. , Smith Andrew J. , Lindsay Diane S. J. , Boragine David M. , Palzkill Timothy
Published: January 2020

Recently, two related
Streptococcus pyogenes
strains with reduced susceptibility to ampicillin, amoxicillin, and cefotaxime, antibiotics commonly used to treat
S. pyogenes
infections, were reported. The two strains had the same nonsynonymous (amino acid-substituting) mutation in the
pbp2x
gene, encoding penicillin-binding protein 2X (PBP2X). This concerning report led us to investigate our library of 7,025 genome sequences of type
emm1
,
emm28
, and
emm89
S. pyogenes
clinical strains recovered from intercontinental sources for mutations in
pbp2x
.
Analysis of a Candida auris Outbreak Provides New Insights into an Emerging Pathogen
Authors: Wickes Brian L.
Published: January 2020

Candida auris
is an emerging human fungal pathogen that is being increasingly linked to outbreaks. It is concerning to health care workers because of its high mortality rate, due primarily to its antifungal resistance. Among the tools being developed to study this yeast are large cohorts of regional isolates, which can be useful for studying epidemiology, antifungal susceptibility patterns, and diagnostic methods. In this issue of the
Journal of Clinical Microbiology
, Y.
Plasmodium falciparum Resistance to a Lead Benzoxaborole Due to Blocked Compound Activation and Altered Ubiquitination or Sumoylation
Authors: Sindhe Kirthana M. V. , Wu Wesley , Legac Jenny , Zhang Yong-Kang , Easom Eric E. , Cooper Roland A. , Plattner Jacob J. , Freund Yvonne R. , DeRisi Joseph L. , Rosenthal Philip J.
Published: January 2020

Benzoxaboroles are under study as potential new drugs to treat malaria. One benzoxaborole, AN13762, has potent activity and promising features, but its mechanisms of action and resistance are unknown. To gain insights into these mechanisms, we cultured malaria parasites with nonlethal concentrations of AN13762 and generated parasites with varied levels of resistance. Parasites with low-level resistance had mutations in PfPARE, which processes AN13762 into an active metabolite; PfPARE mutations prevented this processing. Parasites with high-level resistance had mutations in any of a number of enzymes, mostly those involved in stress responses. Parasites selected for AN13762 resistance were not resistant to other antimalarials, suggesting novel mechanisms of action and resistance for AN13762, a valuable feature for a new class of antimalarial drugs.
Connexin-Dependent Transfer of cGAMP to Phagocytes Modulates Antiviral Responses
Authors: Pépin Geneviève , De Nardo Dominic , Rootes Christina L. , Ullah Tomalika R. , Al-Asmari Sumaiah S. , Balka Katherine R. , Li Hong-Mei , Quinn Kylie M. , Moghaddas Fiona , Chappaz Stephane , Kile Benjamin T. , Morand Eric F. , Masters Seth L. , Stewart Cameron R. , Williams Bryan R. G. , Gantier Michael P.
Published: January 2020

Recent studies suggest that extracellular cGAMP can be taken up by macrophages to engage STING through several mechanisms. Our work demonstrates that connexin-dependent communication between epithelial cells and macrophages plays a significant role in the amplification of antiviral responses mediated by cGAMP and suggests that pharmacological strategies aimed at modulating connexins may have therapeutic applications to control antiviral responses in humans.
Horizontally Acquired Quorum-Sensing Regulators Recruited by the PhoP Regulatory Network Expand the Host Adaptation Repertoire in the Phytopathogen
Pectobacterium brasiliense
Authors: Bellieny-Rabelo Daniel , Nkomo Ntombikayise Precious , Shyntum Divine Yufetar , Moleleki Lucy Novungayo
Published: January 2020

In this study, we examine the impact of transcriptional network rearrangements driven by horizontal gene acquisition in PhoP and SlyA regulons using as a case study a phytopathosystem comprised of potato tubers and the soft-rot pathogen
Pectobacterium brasiliense
1692 (Pb1692).
Prophylactic hydrocortisone in extremely preterm infants and brain MRI abnormality
Authors: Alison Marianne , Tilea Bogdana , Toumazi Artemis , Biran Valérie , Mohamed Damir , Alberti Corinne , Bourmaud Aurélie , Baud Olivier
Published: January 2020

Objective

To determine whether early low-dose hydrocortisone treatment in extremely preterm infants is associated with brain damage assessed by MRI at term equivalent of age (TEA).

Patients and outcomes

This is a predefined secondary analysis of brain abnormalities, observed by MRI at TEA, of patients randomly assigned to receive either placebo or hydrocortisone in the PREMILOC trial. Outcomes were based on brain abnormalities graded according to Kidokoro scores.

Results

Among 412 survivors at TEA, 300 MRIs were performed and 295 were suitable for analysis. Kidokoro scoring was completed for 119/148 and 110/147 MRIs in the hydrocortisone and placebo groups, respectively. The distribution of the Kidokoro white matter (WM) subscore and other subscores was not significantly different between the two groups. There was, however, a significant association between a higher overall Kidokoro score and hydrocortisone treatment (5.84 (SD 3.51) for hydrocortisone and 4.98 (SD 2.52) for placebo; mean difference, 0.86; 95% CI 0.06 to 1.66; p=0.04). However, hydrocortisone was not statistically associated with moderate-to-severe brain lesions (Kidokoro overall score ≥6) in a multivariate logistic regression model accounting for potential confounding variables (adjusted OR (95% CI) 1.27 (0.75 to 2.14), p=0.38). Bronchopulmonary dysplasia at 36 weeks postmenstrual age significantly predicted both WM damage (adjusted OR (95% CI) 2.70 (1.03 to 7.14), p=0.04) and global brain damage (adjusted OR (95% CI) 2.18 (1.19 to 3.99), p=0.01).

Conclusions

Early hydrocortisone exposure in extremely preterm infants is not statistically associated with either WM brain damage or overall moderate-to-severe brain lesions when adjusted for other neonatal variables.

Trial registration number

EudraCT number 2007-002041-20,NCT00623740
Pneumocystis jiroveciipneumonitis: cause of acute hypercalcaemia in chronic haemodialysis patient
Authors: Garo Florian , Aglae Cedric , Ahmadpoor Pedram , Moranne Olivier
Published: January 2020

A 76-year-old renal transplant patient due to autosomal dominant polycystic kidney disease who resumed chronic haemodialysis was admitted to our hospital for confusion and lassitude. He was afebrile and physical examination revealed diffuse bilateral rales with decreased respiratory sounds in lower right lung. Laboratory data showed hypercalcaemia (total calcium 3.92 mmol/L (normal range 2.2–2.6 mmol/L), ionised calcium 1.87 mmol/L (1.15–1.35 mmol/L)), low intact parathyroid hormone (iPTH) 15 ng/L, (15–65 ng/L) and high 1,25(OH)2D3 128.9 pg/mL, (15.2–90.1 pg/mL). Chest CT-scan revealed bilateral apical lung lesions after 15 days of antibiotics. Bronchoalveolar sample was PCR positive forPneumocystis jirovecii. He was treated with an extra session of haemodialysis with 1.25 mmol/L dialysate calcium concentration, oral trimethoprim-sulfamethoxazole was started and oral corticosteroid dose increased to 1 mg/kg for 1 week. Hypercalcaemia decreased progressively after initiation of these treatments. We concluded a case of hypercalcaemia secondary toP. jiroveciiinfection.
Management of a trichobezoar caused by consumption of artificial hair extensions
Authors: Smith Ria Emma , Rait Jaideep Singh , Said Amira , Dighe Shwetal
Published: January 2020

Trichobezoars are rare, but most commonly found in young women with trichophagia and trichotillomania. Complications can include iron deficiency anaemia and gastric erosion or, rarely, perforation. A 19-year-old woman presented with epigastric pain, vomiting and lethargy. Initial investigations revealed a palpable abdominal fullness on examination and iron deficiency anaemia. Oesophagogastroduodenoscopy found a large trichobezoar associated with gastric erosions, polyps and an ulcer. Subsequently, the patient reported previous consumption of artificial hair extensions, which ceased 5 years previously. Attempts to remove the trichobezoar by endoscopy were ineffective and in line with current literature, laparotomy was successful. This case describes a rare cause of trichobezoar and emphasises the importance of appropriate initial investigations and definitive management.
Are the poorest poor being left behind? Estimating global inequalities in reproductive, maternal, newborn and child health
Authors: Barros Aluisio J D , Wehrmeister Fernando C , Ferreira Leonardo Zanini , Vidaletti Luis Paulo , Hosseinpoor Ahmad Reza , Victora Cesar G
Published: January 2020

Introduction

Wealth-related inequalities in reproductive, maternal, neonatal and child health have been widely studied by dividing the population into quintiles. We present a comprehensive analysis of wealth inequalities for the composite coverage index (CCI) using national health surveys carried out since 2010, using wealth deciles and absolute income estimates as stratification variables, and show how these new approaches expand on traditional equity analyses.

Methods

83 low-income and middle-income countries were studied. The CCI is a combined measure of coverage with eight key reproductive, maternal, newborn and child health interventions. It was disaggregated by wealth deciles for visual inspection of inequalities, and the slope index of inequality (SII) was estimated. The correlation between coverage in the extreme deciles and SII was assessed. Finally, we used multilevel models to examine how the CCI varies according to the estimated absolute income for each wealth quintile in the surveys.

Results

The analyses of coverage by wealth deciles and by absolute income show that inequality is mostly driven by coverage among the poor, which is much more variable than coverage among the rich across countries. Regardless of national coverage, in 61 of the countries, the wealthiest decile achieved 70% or higher CCI coverage. Well-performing countries were particularly effective in achieving high coverage among the poor. In contrast, underperforming countries failed to reach the poorest, despite reaching the better-off.

Conclusion

There are huge inequalities between the richest and the poorest women and children in most countries. These inequalities are strongly driven by low coverage among the poorest given the wealthiest groups achieve high coverage irrespective of where they live, overcoming any barriers that are an impediment to others. Countries that ‘punched above their weight’ in coverage, given their level of absolute wealth, were those that best managed to reach their poorest women and children.
Closing the inequality gaps in reproductive, maternal, newborn and child health coverage: slow and fast progressors
Authors: Amouzou Agbessi , Jiwani Safia S , da Silva Inácio Crochemore Mohnsam , Carvajal-Aguirre Liliana , Maïga Abdoulaye , Vaz Lara M E
Published: January 2020

Introduction

Universal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will require an understanding of national progress and how socioeconomic and demographic subgroups of women and children are being reached by health interventions.

Methods

We accessed coverage databases produced by the International Centre for Equity in Health, which were based on reanalysis of Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Reproductive and Health Surveys. We limited the data to 58 countries with at least two surveys since 2008. We fitted multilevel linear regressions of coverage of RMNCH, divided into four main components—reproductive health, maternal health, child immunisation and child illness treatment—to estimate the average annual percentage point change (AAPPC) in coverage for the period 2008–2017 across these countries and for subgroups defined by maternal age, education, place of residence and wealth quintiles. We also assessed change in the pace of coverage progress between the periods 2000–2008 and 2008–2017.

Results

Progress in RMNCH coverage has been modest over the past decade, with statistically significant AAPPC observed only for maternal health (1.25, 95% CI 0.90 to 1.61) and reproductive health (0.83, 95% CI 0.47 to 1.19). AAPPC was not statistically significant for child immunisation and illness treatment. Progress, however, varied largely across countries, with fast or slow progressors spread throughout the low-income and middle-income groups. For reproductive and maternal health, low-income and lower middle-income countries appear to have progressed faster than upper middle-income countries. For these two components, faster progress was also observed in older women and in traditionally less well-off groups such as non-educated women, those living in rural areas or belonging to the poorest or middle wealth quintiles than among groups that are well off. The latter groups however continue to maintain substantially higher coverage levels over the former. No acceleration in RMNCH coverage was observed when the periods 2000–2008 and 2008–2017 were compared.

Conclusion

At the dawn of the SDGs, progress in coverage in RMNCH remains insufficient at the national level and across equity dimensions to accelerate towards UHC by 2030. Greater attention must be paid to child immunisation to sustain the past gains and to child illness treatment to substantially raise its coverage across all groups.
The Pre-BRA (pre-pectoral Breast Reconstruction EvAluation) feasibility study: protocol for a mixed-methods IDEAL 2a/2b prospective cohort study to determine the safety and effectiveness of prepectoral implant-based breast reconstruction
Authors: Harvey Kate Louise , Mills Nicola , White Paul , Holcombe Christopher , Potter Shelley
Published: January 2020

Introduction

Implant-based breast reconstruction is the most commonly performed reconstructive technique worldwide. Subpectoral reconstruction with mesh is the current standard of care but new prepectoral techniques have recently been introduced. Prepectoral breast reconstruction (PPBR) may improve outcomes for patients but robust evaluation is required. Randomised clinical trials (RCTs) are ideally needed but the short-term safety of PPBR is yet to be established; the technique and its indications are evolving and it has yet to be adopted by a sufficient number of surgeons for an RCT to be feasible.

The Pre-BRA study aims to determine the feasibility of using mixed-methods within an IDEAL 2a/2b (IDEAL, Idea-Development-Exploration-Assessment-Long-term) study to explore the short-term safety of PPBR and determine when the technique is sufficiently stable for evaluation in a pragmatic RCT.

Methods and analysis

Pre-BRA is an IDEAL stage 2a/2b prospective multicentre cohort study with embedded qualitative research.

Consecutive patients electing to undergo immediate PPBR at participating centres will be invited to participate. Demographic, operative, oncology and complication data will be collected and patient-reported outcomes will be assessed at baseline, 3 and 18 months postoperatively. The primary safety endpoint will be implant loss at 3 months.

Surgeons performing PPBR will be asked to complete questionnaires regarding their practice and report any modifications made to the procedure or learning arising from complications via free-text response fields on electronic case-report forms. Semistructured will explore surgeons’ experiences in detail to identify emerging best practice. This will be fed back to participating surgeons to promote shared learning.

The Pre-BRA study will aim to recruit 341 patients from 30 to 40 UK centres over a 12-month period. Recruitment will commence Spring 2019.

Ethics and dissemination

The study has full ethical approval from OXFORD-B South Central Committee Ref:19/SC/0129. Results will be presented at national and international meetings and published in peer-reviewed journals.

Trial registration number

ISRCTN11898000; Pre-results.
Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety
Authors: Isbell Linda M , Tager Julia , Beals Kendall , Liu Guanyu
Published: January 2020

Background

Emergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers’ reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care.

Methods

Ninety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data).

Results

Providers generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care.

Conclusions

Positive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions.
An exceptional metaplastic lobular breast carcinoma diagnosed through exome sequencing
Authors: Bergeron Anthony , Desmoulins Isabelle , Beltjens Francoise , Causeret Sylvain , Charon-Barra Celine , Martin Etienne , Richard Corentin , Boidot Romain , Arnould Laurent
Published: January 2020

Metaplastic breast carcinoma is a rare subtype of breast cancer. This subtype is mostly found in association with poorly differentiated ductal breast carcinomas and rarely with other breast carcinoma types. We report the case of a 69-year-old woman with an exceptional invasive lobular breast carcinoma associated with metaplastic squamous cell bone metastasis occurring 2 years after the initial breast cancer diagnosis. Whole-exome sequencing and subsequent immunohistochemistry of the lesions were used to link the squamous cell bone metastasis of unknown origin to the primary breast carcinoma initially diagnosed. Searching for primary carcinoma when metastatic lesions of unknown origin occur can be complex. Current molecular biology techniques may help pathologists in associating metastasis with the primary carcinoma by identifying shared specific gene mutations, even when different morphological and immunohistochemical profiles are observed between the tumours.
Diagnostic value of bone marrow core biopsy patterns in lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia and description of its mutational profiles by targeted NGS
Authors: Garcia-Reyero Julia , Martinez Magunacelaya Nerea , Gonzalez de Villambrosia Sonia , Gomez Mediavilla Angela , Urquieta Lam Marcela , Insunza Andres , Tonda Raul , Beltran Sergi , Gut Marta , Gonzalez Ainara , Montes-Moreno Santiago
Published: January 2020

Aims

The aim of this study was to describe the characteristics of the bone marrow infiltration found in a series of clinically defined lymphoplasmacytic lymphoma (LPL)/Waldenström macroglobulinaemia (WM) and IgM-monoclonal gammopathy of undetermined significance (MGUS) and to perform a targeted next-generation sequencing (NGS) for the identification of additional somatic mutations toMYD88p.L265P in LPL/WM.

Methods

We have reviewed a series of 35 bone marrow biopsies from 28 patients with a clinical diagnosis of LPL/WM (24 cases) or MGUS (4 cases). Bone marrow infiltration characteristics by morphology, immunohistochemistry, flow cytometry (FCM), allele-specific real-time PCR for the detection ofMYD88p.L265P mutation, targeted exonic amplicon-based NGS of 35 lymphoma-related genes and direct sequencing were analysed.

Results

Our findings show that bone marrow trephine biopsy evaluation is superior to FCM in the identification of significant lymphoid infiltrates. A combined paratrabecular and interstitial infiltration pattern is the most common feature in LPL/WM while a patchy interstitial pattern characterises IgM-MGUS cases.MYD88p.L265P mutation was found by allele-specific-PCR in 92% of the LPL cases (22 out of 24) and 25% of IgM-MGUS cases (1 out of 4 cases). In addition toMYD88p.L265P somatic mutations inCXCR4,KMT2D,PRDM1/Blimp1,MYCandID3were found by NGS and direct sequencing in 4 cases.

Conclusions

In conclusion, bone marrow core biopsy evaluation is critical in the identification of unequivocal bone marrow infiltration by LPL/WM. In addition toMYD88p.L265P, somatic mutations inCXCR4,KMT2D,PRDM1/Blimp1,MYCandID3can appear in a fraction of LPL/WM.