bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing laser beam welding parameters for the assembly of steel SLM parts for the automotive industry
Authors: Fieger Thiemo Valentin , Sattler Maximilian Ferdinand , Witt Gerd
Published: October 2018

Purpose

This paper aims to identify issues with joining selective laser melting (SLM) steels with conventional cold rolled steels through remote laser beam welding.

Design/methodology/approach

A novel approach for substituting conventional cold rolled metal sheets with SLM metal sheets, made of 316L and 18-Ni 300, is presented. The characteristics of the interaction of wrought and SLM materials are described, and joining benchmark parameters are presented and compared to known existing joining results. Finally, the joints are assessed in line with automotive specifications. This research also addresses the importance of joining technologies for the implementation of SLM as a full-fledged manufacturing technology for the automotive industry.

Findings

New parameter ranges for laser beam welding of SLM steels are defined.

Research limitations/implications

This research is limited to the examined steels and the used machines, parameters and equipment.

Practical implications

The presented benchmark parameters are expected to be useful for designers, product developers and machine operators.

Originality/value

Little knowledge is available about the behavior of SLM materials and their suitability for assembly processes. Novel information about SLM steels and their interaction with conventionally produced steel sheets is presented.
Tetrahymena promotes interactive transfer of carbapenemase gene encoded in plasmid between fecal Escherichia coli and environmental Aeromonas caviae
Authors: Matsushita Mizue , Okubo Torahiko , Hasegawa Takaki , Matsuo Junji , Watanabe Takanori , Iwasaki Sumio , Fukumoto Tatsuya , Hayasaka Kasumi , Akizawa Kozi , Shimizu Chikara , Yamaguchi Hiroyuki
Published: October 2018

Tetrahymena can facilitate plasmid transfer among Escherichia coli or from E. coli to Salmonella Enteritidis via vesicle accumulation. In this study, whether ciliates promote the interactive transfer of plasmids encoding blaIMP‐1 between fecal E. coli and environmental Aeromonas caviae was investigated. Both bacteria were mixed with or without ciliates and incubated overnight at 30°C. The frequency of plasmid‐acquired bacteria was estimated by colony counts using an agar plate containing ceftazidim (CAZ) followed by determination of the minimum inhibitory concentration (MIC). Cultures containing ciliates interactively transferred the plasmid between E. coli and Aeromonas with a frequency of 10−4 to 10−5. All plasmid‐acquired bacteria showed a MIC against CAZ of >128 μg/mL and the plasmid transfer was confirmed by PCR amplification of the blaIMP‐1 gene. Fluorescent observation showed that both bacteria accumulated in the same vesicle and that transwell sequestering significantly decreased the transfer frequency. Although ciliates preferentially ingested E. coli rather than A. caviae, both bacteria were co‐localized into the same vesicles of ciliates, indicating that their meeting is associated with the gene transfer. Thus, ciliates interactively promote plasmid transfer between E. coli and A. caviae. The results of this study will facilitate control of the spread of multiple‐antibiotic resistant bacteria.
Measuring competence in systemic practice: development of the ‘Systemic Family Practice – Systemic Competency Scale’ (SPS)
Authors: Butler Catherine , Sheils Elizabeth , Lask Judith , Joscelyne Trish , Pote Helen , Crossley Jon
Published: October 2018

Ensuring that practitioners are competent in the therapies they deliver is important for training, therapeutic outcomes and ethical practice. The development of the Systemic Practice Scale (SPS) is reported – a measure to assess the competence of students as trialed by Children and Young Person’s Improving Access to Psychological Therapies (CYP‐IAPT) training courses. Initial reliability assessment of the SPS with twenty‐eight supervisors of systemic practice evaluating students’ competence using an online recording of a family therapy session is detailed. The SPS was found to be a reliable measure of systemic competence across training settings. Rating variability was noted, with training and benchmarking to improve rating consistency recommended. Further research using the SPS to further establish the reliability and validity of the scale is required.

Practitioner points

SPS represents an important tool, particularly for the supervision and development of more junior staff or students

Initial reliability for use of the SPS as a formative tool has been established. Further benchmarking is required if using the tool in a summative manner
Falling perinatal mortality in twins in the UK: organisational success or chance?
Authors: Kilby MD , Gibson JL , Ville Y
Published: October 2018

In June 2018, Mothers and Babies Reducing Risks through Audits and Confidential Enquiries across the UK (MBRRACE‐UK) published a Perinatal Surveillance report of an audit between 2013–2016. This noted that the stillbirth rate for twins nearly halved between 2014–2016; whereas the stillbirth rate for singletons remained static. There was a statistically significant reduction in the rate of stillbirth in twins over this period from 11.07 (95% CI, 9.78–12.47) to 6.16 (95% CI, 5.20–7.24) per 1000 total births. This commentary discusses these observations, the effects of twin chorionicity, and the potential obstetric and neonatal interventions, as well as public health improvements, that may have influenced these findings.
Relationship Between Oligosaccharides and Glycoconjugates Content in Human Milk and the Development of the Gut Barrier
Authors: Figueroa‐Lozano Susana , de Vos Paul
Published: October 2018

The intestinal immune barrier is considered to be the gatekeeper of the human body and rapidly develops directly after birth. Many pre‐ and postnatal factors influence the development of the gut‐barrier, which is composed of the microbiota, the mucus, the epithelial layer and the mucosal immune system. Even minor disturbances during barrier development can have consequences for health far into adulthood. Here we critically discuss the current knowledge on which pre‐ and postnatal factors influence development, maturation, and maintenance of the gut immune barrier. Human milk has a unique composition and is the gold standard for adequate development of the intestinal immune barrier. Not only the influence of human milk oligosaccharides (HMOs) but also that of glycoproteins (HMGPs) is reviewed. We discuss the influence of maternal genetic factors, such as the secretor and Lewis phenotypes on breast milk fucosylation and sialylation of HMOs and HMGPs. This diversity in HMOs and HMPGs influences microbiota composition and also the development of the immune barrier. Cow milk‐derived infant formula is often being used as an alternative for human breast milk. The consequences of this for proper development of the intestinal immune barrier and, in particular, the differences in the type of oligosaccharides and glycosylation patterns (sialic and fucose composition) between cow and human milk are critically discussed. Current and prospective strategies to promote proper gut‐immune maturation are proposed. These might include more personalized infant formulas when breast milk is not an option.
A Comparison of Thresholding Methods for Forensic Reconstruction Studies Using Fluorescent Powder Proxies for Trace Materials
Authors: Levin Emma A. , Morgan Ruth M. , Griffin Lewis D. , Jones Vivienne J.
Published: October 2018

Image segmentation is a fundamental precursor to quantitative image analysis. At present, no standardised methodology exists for segmenting images of fluorescent proxies for trace evidence. Experiments evaluated (i) whether manual segmentation is reproducible within and between examiners (with three participants repeatedly tracing three images) (ii) whether manually defining a threshold level offers accurate and reproducible results (with 20 examiners segmenting 10 images), and (iii) whether a global thresholding algorithm might perform with similar accuracy, while offering improved reproducibility and efficiency (16 algorithms tested). Statistically significant differences were seen between examiners’ traced outputs. Manually thresholding produced good accuracy on average (within ±1% of the expected values), but poor reproducibility (with multiple outliers). Three algorithms (Yen, MaxEntropy, and RenyiEntropy) offered similar accuracy, with improved reproducibility and efficiency. Together, these findings suggest that appropriate algorithms could perform thresholding tasks as part of a robust workflow for reconstruction studies employing fluorescent proxies for trace evidence.
Clinical significance of anti‐DNA/N‐methyl‐D‐aspartate receptor 2 antibodies in de novo and post‐steroid cases with neuropsychiatric systemic lupus erythematosus
Authors: Fujieda Yuichiro , Mader Simone , Jeganathan Venkatesh , Arinuma Yoshiyuki , Shimizu Yuka , Kato Masaru , Oku Kenji , Minami Akiko , Shimizu Chikara , Yasuda Shinsuke , Atsumi Tatsuya
Published: October 2018

Background

Anti‐DNA/N‐methyl‐D‐aspartate receptor 2 (NR2) antibodies (anti‐DNA/NR2 antibodies) are a subset of anti‐DNA autoantibodies that cross‐react with the extracellular domain of the GluN2A/GluN2B subunits of NR2. These antibodies induce apoptosis of hippocampus neurons and psychiatric disorder in mice and humans. Neuropsychiatric system lupus erythematosus (NPSLE) can develop after initiation of corticosteroids (post‐steroid neuropsychiatric manifestation: PSNP) or before treatment (de novo NPSLE); however, pathophysiological differences between these subtypes remain unclear. The objective of this study was to clarify the prevalence of anti‐DNA/NR2 antibodies in patients with NPSLE.

Methods

This study involved a cohort of patients with NPSLE admitted to our hospital. NPSLE patients were classified into two groups, de novo NPSLE and PSNP‐SLE. Serum anti‐DNA antibodies and anti‐DNA/NR2 antibodies were measured by enzyme‐linked immunosorbent assays.

Results

Serum samples were obtained from 24 patients with de novo NPSLE, 25 with PSNP‐SLE and 76 healthy controls (HC). The level of anti‐DNA/NR2 antibodies in patients with de novo NPSLE and PSNP‐SLE were also higher than those in HC. Positive correlation between anti‐DNA antibodies and anti‐DNA/NR2 antibodies were found in PSNP‐SLE, but was not significant in de novo NPSLE.

Conclusion

The levels of anti‐DNA/NR2 antibodies in PSNP‐SLE were similar to those in de novo NPSLE. Anti‐DNA/NR2 antibodies in PSNP‐SLE were suggested as a dominant subset of anti‐DNA antibodies, indicating that anti‐DNA/NR2 antibodies may be a predictive factor in PSNP‐SLE.
Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross‐sectional study
Authors: Hulst Abraham H. , Polderman Jorinde A. W. , Kooij Fabian O. , Vittali Dave , Lirk Philipp , Hollmann Markus W. , DeVries J. Hans , Preckel Benedikt , Hermanides Jeroen
Published: October 2018

Background

Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control.

Methods

We performed a retrospective cross‐sectional study, of all DM patients undergoing surgery between May 2013 and November 2015 in a Dutch university hospital. We compared DM1 with DM2 patients, treated according to the same perioperative glucose protocol. Our primary outcome was the incidence of hyperglycaemia (glucose ≥10 mmol/L). Secondary outcomes were short‐term glycaemic control (glucose before surgery and peak glucose perioperatively), long‐term glycaemic control (HbA1c in 90 days before and after surgery) and the incidence of hypoglycaemia (glucose <4 mmol/L).

Results

We included 2259 patients with DM, 216 (10%) of which had DM1. The calculated incidences in our population were 7 out of 1000 patients with DM1 and 69 out of 1000 patients with DM2. Compared to those with DM2, patients with DM1 were younger, had a lower BMI, a higher glucose concentration before surgery, and a higher perioperative peak glucose concentration (11.0 [8.2‐14.7] vs 9.4 [7.7‐11.7], P < 0.001). The incidence of the primary endpoint, perioperative hyperglycaemia, was significantly higher in DM1 compared to DM2 patients (63% vs 43%, P < 0.001). Hypoglycaemia occurred more often in the DM1 population (7.1% vs 1.3%, P < 0.001).

Conclusion

Providing similar perioperative treatment to patients with DM1 and DM2 is associated with poorer short‐term and long‐term glycaemic control in DM1 throughout the perioperative period as well as an increased risk of hypoglycaemia.
ICD‐11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire
Authors: Vallières F. , Ceannt R. , Daccache F. , Abou Daher R. , Sleiman J. , Gilmore B. , Byrne S. , Shevlin M. , Murphy J. , Hyland P.
Published: October 2018

Objective

Support for ICD‐11 post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing; however, few studies include refugees or examine the clinical utility of PTSD/CPTSD classifications. This study sought to provide the first evaluations of (i) the factor structure of ICD‐11 PTSD/CPTSD amongst refugees in the Middle East; and (ii) the clinical utility of the International Trauma Questionnaire (ITQ) to identify PTSD/CPTSD in a humanitarian context.

Method

Participants were 112 treatment‐seeking Syrian refugees living in Lebanon. Factorial validity was assessed using confirmatory factor analysis (CFA) based on responses to the ITQ. Clinical utility of the ITQ was assessed through semi‐structured interviews with six Lebanese psychotherapists.

Results

Complex PTSD (36.1%) was more common than PTSD (25.2%), and no sex or age differences were observed at the prevalence or symptomatic levels. CFA results supported a two‐factor higher‐order model consistent with ICD‐11 PTSD/CPTSD. Qualitative findings indicated that the ITQ is generally positively regarded, with some limitations and suggested modifications noted.

Conclusion

This is the first study to support the ICD‐11 PTSD/CPTSD amongst refugees in the Middle East and the clinical utility of the ITQ in a humanitarian context. Findings support the growing evidence for the cross‐cultural applicability of ICD‐11 PTSD/CPTSD.
Immature stages of Blepharotes (Diptera: Asilidae), one of the world's largest assassin flies: multi‐function mandibles and soil‐drilling pupal spines and spurs
Authors: Ferguson David J , Li Xuankun , Yeates David K
Published: October 2018

Assassin or robber flies belong to the family Asilidae, one of the most diverse fly families, with over 7400 described species worldwide. Adults are predators on mostly smaller insects which they catch on the wing; larvae are predators on soft bodied arthropods in the soil or rotting wood, usually beetle (Coleoptera) larvae, often curl or white grubs (Scarabaeidae). Predation by larval and adult Asilidae puts downward pressure on populations of their prey above and below ground. Because asilid larvae are cryptic, the immature stages of few species have been described, thus hampering our ability to identify larvae. We describe and illustrate the late instar larva and pupa of one of Australia's largest and most impressive asilid species, Blepharotes splendidissimus (Wiedemann) (Asilinae: Apocleini). Taxonomically useful variation in asilid larvae so far described occurs in the head and its appendages. We have examined the fine detail of the larval head capsule and mouthparts using scanning electron microscopy (SEM) for the first time in Asilidae. The larva and pupa of B. splendidissimus are similar to other Asilidae but larger and more robust. The larva has a broad maxillae and long narrow mandibular hooks with an acute tip armed with a row of recurved spines. Our SEM studies detail the grooves on the inner surface of the mandible that form a feeding channel when the mandibles are appressed. Thus, the mandibular hooks are the insect equivalent of a Swiss army knife, with at least four functions: to pierce the prey, hold the prey, inject venom and extract nutrients from the prey. Asilid pupae have a well‐developed armature on the head, thorax and abdominal tergites, for drilling up out of the soil on adult eclosion. The pupa has distinct anterior and posterior antennal spinous processes and anterior and posterior mesothoracic spinous processes, and the tip of the abdomen has large, dorsally curved dorsal posterolateral processes and very small ventral posterolateral spinous processes. All the dorsal armature on the pupal abdominal segments are articulated spurs, rather than a mixture of fixed spines and spurs, as found in many asilid pupae.
Evolution of MHC class II SLA‐DRB1 locus in the Croatian wild boar (Sus scrofa) implies duplication and weak signals of positive selection
Authors: Arbanasić H. , Konjević D. , Vranković L. , Bujanić M. , Stipoljev S. , Balažin M. , Šprem N. , Škorić D. , Galov A.
Published: October 2018

The wild boar is an ancestor of the domestic pig and an important game species with the widest geographical range of all ungulates. Although a large amount of data are available on major histocompatibility complex (MHC) variability in domestic pigs, only a few studies have been performed on wild boars. Due to their crucial role in appropriate immune responses and extreme polymorphism, MHC genes represent some of the best candidates for studying the processes of adaptive evolution. Here, we present the results on the variability and evolution of the entire MHC class II SLA‐DRB1 locus exon 2 in 133 wild boars from Croatia. Using direct sequencing and cloning methods, we identified 20 SLA‐DRB1 alleles, including eight new variants, with notable divergence. In some individuals, we documented functional locus duplication, and SLA‐DRB1*04:10 was identified as the allele involved in the duplication. The expression of a duplicated locus was confirmed by cloning and sequencing cDNA‐derived amplicons. Based on individual genotypes, we were able to assume that alleles SLA‐DRB1*04:10 and SLA‐DRB1*06:07 are linked as an allelic combination that co‐evolves as a two‐locus haplotype. Our investigation of evolutionary processes at the SLA‐DRB1 locus confirmed the role of intralocus recombination in generating allelic variability, whereas tests of positive selection based on the dN/dS (non‐synonymous/synonymous substitution rate ratio) test revealed atypically weak and ambiguous signals.
Additive Manufacturing of 3D Biomodels as Adjuvant in Intracranial Aneurysm Clipping
Authors: Leal André , Souza Mauren , Nohama Percy
Published: October 2018

One of the main difficulties in intracranial aneurysms (IA) surgery refers to the choice of the appropriate clip(s) to be implanted. Although the imaging exams currently available ensure visualization of IA's morphology, they do not bring an accurate reference positioning for the surgeon in executing the surgery procedure nor efficiently contribute to planning the surgery. Unfortunately, for IA's largely inaccessible regions, there is not an efficient method of treatment planning. Therefore, we propose a novel method that allows the generation of a 3D biomodel of the IA region under investigation using additive manufacturing technology (AM). Thus, a physical copy of the IA is produced and offers the surgeon a full view of the anatomy of that region of the brain. The aim of this study is the creation of a flexible 3D physical model (elastomer) through the AM technique, in order to allow the clip selection prior to the surgery. DICOM angio‐CT images from eight patients who underwent IA surgery were transformed into STL format and then built on a 3D printer. Preoperative surgical clip selection was performed and then compared with those used in surgery. At the end of the study, all 3D IA biomodels were reproduced for microsurgical clipping selection and it was possible to predict the metal clip to be used in the surgery. In addition, the proposed methodology helps to clarify the surgical anatomy and to avoid excessive manipulation of the intracranial arteries and prolonged surgical time. The major advantage of this technology is that the surgeon can closely study complex cerebrovascular anatomy from any perspective using realistic 3D biomodels, which can be handheld, allowing simulation of intraoperative situations and anticipation of surgical challenges.
Ultrasonic sensor concept to fit a ventricular assist device cannula evaluated using geometrically accurate heart phantoms
Authors: Dual Seraina Anne , Zimmermann Jan Michael , Neuenschwander Jürg , Cohrs Nicholas Heinrich , Solowjowa Natalia , Stark Wendelin Jan , Meboldt Mirko , Schmid Daners Marianne
Published: October 2018

Future left ventricular assist devices (LVADs) are expected to respond to the physiologic need of patients; however, they still lack reliable pressure or volume sensors for feedback control. In the clinic, echocardiography systems are routinely used to measure left ventricular (LV) volume. Until now, echocardiography in this form was never integrated in LVADs due to its computational complexity. The aim of this study was to demonstrate the applicability of a simplified ultrasonic sensor to fit an LVAD cannula and to show the achievable accuracy in vitro. Our approach requires only two ultrasonic transducers because we estimated the LV volume with the LV end‐diastolic diameter commonly used in clinical assessments. In order to optimize the accuracy, we assessed the optimal design parameters considering over 50 orientations of the two ultrasonic transducers. A test bench was equipped with five talcum‐infused silicone heart phantoms, in which the intra‐ventricular surface replicated papillary muscles and trabeculae carnae. The end‐diastolic LV filling volumes of the five heart phantoms ranged from 180 to 480 mL. This reference volume was altered by ±40 mL with a syringe pump. Based on the calibrated measurements acquired by the two ultrasonic transducers, the LV volume was estimated well. However, the accuracies obtained are strongly dependent on the choice of the design parameters. Orientations toward the septum perform better, as they interfere less with the papillary muscles. The optimized design is valid for all hearts. Considering this, the Bland‐Altman analysis reports the LV volume accuracy as a bias of ±10% and limits of agreement of 0%–40% in all but the smallest heart. The simplicity of traditional echocardiography systems was reduced by two orders of magnitude in technical complexity, while achieving a comparable accuracy to 2D echocardiography requiring a calibration of absolute volume only. Hence, our approach exploits the established benefits of echocardiography and makes them applicable as an LV volume sensor for LVADs.
Durable left ventricular assist device implantation in extremely obese heart failure patients
Authors: Lee Andy Y. , Tecson Kristen M. , Lima Brian , Shaikh Asad F. , Collier Justin , Still Sasha , Baxter Ronald , DiMaio John M. , Felius Joost , Carey Sandra A. , Gonzalez‐Stawinski Gonzalo V. , Nauret Richard , Wong Marcus , Hall Shelley A. , Joseph Susan M.
Published: October 2018

Left ventricular assist devices (LVADs) have improved clinical outcomes and quality of life for those with end‐stage heart failure. However, the costs and risks associated with these devices necessitate appropriate patient selection. LVAD candidates are becoming increasingly more obese and there are conflicting reports regarding obesity’s effect on outcomes. Hence, we sought to evaluate the impact of extreme obesity on clinical outcomes after LVAD placement. Consecutive LVAD implantation patients at our center from June 2008 to May 2016 were studied retrospectively. We compared patients with a body mass index (BMI) ≥40 kg/m2 (extremely obese) to those with BMI < 40 kg/m2 with respect to patient characteristics and surgical outcomes, including survival. 252 patients were included in this analysis, 30 (11.9%) of whom met the definition of extreme obesity. We found that patients with extreme obesity were significantly younger (47[33, 57] vs. 60[52, 67] years, P < 0.001) with fewer prior sternotomies (16.7% vs. 36.0%, P = 0.04). They had higher rates of pump thrombosis (30% vs. 9.0%, P = 0.003) and stage 2/3 acute kidney injury (46.7% vs. 27.0%, P = 0.003), but there were no differences in 30‐day or 1‐year survival, even after adjusting for age and clinical factors. Extreme obesity does not appear to place LVAD implantation patients at a higher risk for mortality compared to those who are not extremely obese; however, extreme obesity was associated with an increased risk of pump thrombosis, suggesting that these patients may require additional care to reduce the need for urgent device exchange.
Replicon typing of plasmids in environmental Achromobacter sp. producing quinolone‐resistant determinants
Authors: Furlan João Pedro Rueda , Sanchez Danilo Garcia , Gallo Inara Fernanda Lage , Stehling Eliana Guedes
Published: October 2018

This study aimed to investigate the antimicrobial resistance profile to quinolones, the presence of quinolone‐resistant determinants and the plasmid replicon typing in environmental Achromobacter sp. isolated from Brazil. Soil and water samples were used for bacterial isolation. The antimicrobial susceptibility testing was performed by minimum inhibitory concentration method. The detection of mutations in the quinolone resistance‐determining regions (QRDR) genes, the presence of plasmid‐mediated quinolone resistance (PMQR) genes, and plasmid replicons were performed by PCR. A total of 16 isolates was obtained from different cultures, cities, and states of Brazil. All isolates were non‐susceptible to ciprofloxacin, norfloxacin, and levofloxacin. Some mutations in QRDR genes were found, including Gln‐83‐Leu and Asp‐87‐Asn in the gyrA and Gln‐80‐Ile and Asp‐84‐Ala in the parC. Different PMQR genes were detected, such as qnrA, qnrB, qnrS, oqxA, and oqxB. Three different plasmid families were detected, being most presented the ColE‐like, followed by IncFIB and IncA/C. The presence of different PMQR genes and plasmids in the isolates of the present study shows that environmental bacteria can act as reservoir of important genes of resistance to fluoroquinolones, which is of great concern, due to the potential of horizontal dissemination of these genes. Besides that, there are no studies reporting these results in Achromobacter sp. isolates.
Generational conflict and provisions for the elderly in Hong Kong: The relevance of position‐based interest and values
Authors: Chan Raymond K. H. , Wang Lih‐Rong
Published: October 2018

Respect for the elderly and hence the associated rights support a generational contract. Nevertheless, the case of the recent debate on the universal retirement scheme in Hong Kong has raised concerns about its strength. We identify relevant items from the sixth wave of the World Values Survey to explore the orientations of different generations toward others. The analysis shows differences between younger and older generations. Regression analyses show that values are not significant in explaining the differences, but various positions, including sex, marital status, and education, and perceptions of the elderly are relevant. Such differences across generations might weaken the generational contract and potentially engender conflicts as shown in the recent debate about the retirement scheme. We suggest short‐ and long‐term interest calculations, informed by their positions, play a more significant role in policy discussions and decisions, rather than simply appealing to values.
Genetic approaches to metabolic bone diseases
Authors: Hannan Fadil M. , Newey Paul J. , Whyte Michael P. , Thakker Rajesh V.
Published: October 2018

Metabolic bone diseases comprise a diverse group of disorders characterized by alterations in skeletal homeostasis, and are often associated with abnormal circulating concentrations of calcium, phosphate or vitamin D metabolites. These diseases commonly have a genetic basis and represent either a monogenic disorder due to a germline or somatic single gene mutation, or an oligogenic or polygenic disorder that involves variants in more than one gene. Germline single gene mutations causing Mendelian diseases typically have a high penetrance, whereas the genetic variations causing oligogenic or polygenic disorders are each associated with smaller effects with additional contributions from environmental factors. Recognition of familial monogenic disorders is of clinical importance to facilitate timely investigations and management of the patient and any affected relatives. The diagnosis of monogenic metabolic bone disease requires careful clinical evaluation of the large diversity of symptoms and signs associated with these disorders. Thus, the clinician must pursue a systematic approach beginning with a detailed history and physical examination, followed by appropriate laboratory and skeletal imaging evaluations. Finally, the clinician must understand the increasing number and complexity of molecular genetic tests available to ensure their appropriate use and interpretation.
Conceptual and Technical Aspects of Psychoanalytic Enactment: A Systematic Review
Authors: Severo Charlie Trelles , Laskoski Pricilla Braga , Teche Stefania Pigatto , Bassols Ana Margareth , Saldanha Raquel Forgiarini , Wellausen Rafael Stella , Rodrigues Wageck Aline André , Costa Camila Piva Da , Rebouças Diego Barreto , Padoan Carolina Stopinski , Barros Alcina Juliana Soares , Nunes Maria Lucia Tiellet , Eizirik Cláudio Laks
Published: October 2018

Ongoing studies in psychoanalysis have been broad and progressive, and have dealt with a number of different phenomena. Many thus foster the identification of intersubjective aspects that characterize therapeutic relationships today, including enactments. The concept of enactment first appeared in the literature in the mid‐1980s and was defined as a manifestation where, in the analytic situation, both analyst and patient unconsciously ‘play out’ psychic conflicts that must be worked out therapeutically. Resulting from unconscious forces activated mutually by the members of a therapeutic dyad, enactments are characterized by transferential and countertransferential dynamics. They are based on the mechanism of projective identification, which is interpersonal and intersubjective. In preparing the present systematic review, PUBMED, PsycINFO and LILACS databases were consulted, a process that generated a total of 59 articles. This paper gives an account of articles published on enactment, including authors, journals, year, type of study and diagnoses, as well as the gender and age bracket of patients mentioned in the literature investigated. We specifically describe how the authors of the respective articles understand and identify the concept of enactment and how they deal with this phenomenon in their clinical work.
Psychoanalytic Psychotherapy for Hikikomori Young Adults and Adolescents
Authors: Ranieri Fiorenzo
Published: October 2018

A hikikomori is a child, an adolescent or a young adult who voluntarily retreats into his own home for long periods, not showing evident signs of psychological distress or overt mental disorder. This phenomenon was first described in Japan, but several research studies show that it is spreading in many countries around the world. The author hypothesizes that the decision to become a hikikomori is made by the person in an attempt to find a solution to difficulties in relationships with himself and with others. The choice of reclusion rapidly becomes a trap: in this condition the individual is imprisoned in complex functions of the mind which curb and restrict independence and personal autonomy. This is owing to the fact that, with the withdrawal, a pathological personality organization, formed during the years of early infancy, gradually takes control of the internal world, pushing towards anti‐developmental mental states and behaviours. The paper continues with some reflections on individual treatment with psychoanalytic psychotherapy of adolescents and young adults in a state of acute social withdrawal. The reference model used is John Steiner's notion of ‘psychic retreat’. A description of a four‐year treatment completes the paper, allowing for further clinical reflections.
Experts vs super‐experts: differences in automated performance metrics and clinical outcomes for robot‐assisted radical prostatectomy
Authors: Hung Andrew J. , Oh Paul J. , Chen Jian , Ghodoussipour Saum , Lane Christianne , Jarc Anthony , Gill Inderbir S.
Published: October 2018

Objectives

To evaluate automated performance metrics (APMs) and clinical data of experts and super‐experts for four cardinal steps of robot‐assisted radical prostatectomy (RARP): bladder neck dissection; pedicle dissection; prostate apex dissection; and vesico‐urethral anastomosis.

Subjects and Methods

We captured APMs (motion tracking and system events data) and synchronized surgical video during RARP. APMs were compared between two experience levels: experts (100–750 cases) and super‐experts (2100–3500 cases). Clinical outcomes (peri‐operative, oncological and functional) were then compared between the two groups. APMs and outcomes were analysed for 125 RARPs using multi‐level mixed‐effect modelling.

Results

For the four cardinal steps selected, super‐experts showed differences in select APMs compared with experts (P < 0.05). Despite similar PSA and Gleason scores, super‐experts outperformed experts clinically with regard to peri‐operative outcomes, with a greater lymph node yield of 22.6 vs 14.9 nodes, respectively (P < 0.01), less blood loss (125 vs 130 mL, respectively; P < 0.01), and fewer readmissions at 30 days (1% vs 13%, respectively; P = 0.02). A similar but nonsignificant trend was seen for oncological and functional outcomes, with super‐experts having a lower rate of biochemical recurrence compared with experts (5% vs 15%, respectively; P = 0.13) and a higher continence rate at 3 months (36% vs 18%, respectively; P = 0.14).

Conclusion

We found that experts and super‐experts differed significantly in select APMs for the four cardinal steps of RARP, indicating that surgeons do continue to improve in performance even after achieving expertise. We hope ultimately to identify associations between APMs and clinical outcomes to tailor interventions to surgeons and optimize patient outcomes.
Is extracorporeal shockwave lithotripsy a risk factor for the development of diabetes mellitus? A population‐based study
Authors: Ordon Michael , Welk Blayne , Ghiculete Daniela , Lee Jason Y. , Pace Kenneth T.
Published: October 2018

Objective

To determine if patients treated with extracorporeal shockwave lithotripsy (ESWL) are at a greater risk of developing diabetes mellitus (DM) than those treated with ureteroscopy (URS).

Patients and Methods

A retrospective population‐based cohort study was performed of all ESWL and URS stone treatments done in Ontario between January 1994 and March 2014, utilising linked encoded healthcare databases. The primary outcome was the development of DM >90 days after treatment. The Kaplan–Meier method was used for unadjusted survival analysis and multivariable analysis with Cox proportional hazards regression was used to assess the risk of DM between the ESWL and URS groups whilst controlling for age, gender, region of residence, income quintile, year of treatment, and comorbidity index. A sensitivity analysis with a subset of ESWL patients treated for left renal or proximal ureteric stones was completed.

Results

We identified 106 963 patients who underwent ESWL or URS over the study period with a median follow‐up of 6.6 years (ESWL 8.5 years, URS 5.6 years). Unadjusted survival analysis showed an increased risk of developing DM in the ESWL group compared to the URS group (P < 0.001); however, multivariable analysis showed no increased risk of DM in the ESWL cohort (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.91–1.02; P = 0.25). Similarly, sensitivity analysis showed no increased risk of DM in the left renal/proximal ureteric stone ESWL cohort compared to the URS cohort (HR 1.04, 95% CI 0.96–1.13; P = 0.35).

Conclusions

Our population‐based cohort study demonstrated no increased risk of DM in patients undergoing ESWL compared to URS.
Our Homes: An inclusive study about what moving house is like for people with intellectual disabilities in Ireland
Authors: Salmon Nancy , Garcia Iriarte Edurne , Donohoe Brian , Murray Laura , Singleton Greg , Barrett Mary , Dillon Marie
Published: October 2018

Accessible Summary

The Inclusive Research Network (IRN) is a group of researchers who do projects that matter to people with intellectual disabilities in Ireland.

This paper is about a project we did to learn what it is like for people with intellectual disabilities in Ireland to move from one house to another.

We talked to 35 people who moved house.

Some people chose where to move but others had no choice.

Feeling safe made them happier in their new home.

One third of the people we spoke to had no choice about where they live and who they live with.

Having these choices is their right under the United Nations Convention on the Rights of Persons with Disabilities.

People with intellectual disabilities need supporters who listen and respect them.

Background

Supporting people with intellectual disabilities to live well in communities they choose is deinstitutionalisation's central aim and endorsed by the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (UN, 2006). This study focused on the experiences of people with intellectual disabilities in Ireland when moving home using an inclusive research approach.

Method

This inclusive research project employed a qualitative approach. Participants included 19 men and 16 women (total n = 35) with ages ranging from 22 to 77 years. Structured interviews attended to the experience of moving home and the supports accessed during and after the transition to community living.

Results

Thematic analysis yielded four themes: “expressing choice” in the moving process; “feeling connected or isolated when moving”; “accessing supports during and after the move”; and finally, participants' reflections on “experiencing vulnerability and feeling safe” while resettling.

Conclusions

This is the first study about people with intellectual disabilities moving home to be collaboratively designed and completed by an inclusive research team. Although much is understood about the long‐term benefits of engaging in meaningful choices about housing and supports, concerns remain about the extent to which the will and preferences of people with intellectual disabilities in Ireland are respected when moving home.
Nitric oxide in the gastrointestinal tract: opportunities for drug development
Authors: Wallace John L
Published: October 2018

Nitric oxide (NO) plays important roles in gastrointestinal mucosal defence, as well as in the pathogenesis of several gastrointestinal diseases (e.g. irritable bowel syndrome and inflammatory bowel disease). The potent cytoprotective effects of NO have been demonstrated in a range of animal models. However, in some disease states, inhibition of NO synthesis is beneficial. Several attempts have been made to develop drugs for ulcerative and/or inflammatory disorders of the gastrointestinal tract, with varying degrees of success. Covalently linking a NO‐releasing group to non‐steroidal anti‐inflammatory drugs or to drugs used in the treatment of inflammatory bowel disease and irritable bowel syndrome has shown some benefit, although no drug of this type has yet been fully developed.

Linked Articles

This article is part of a themed section on Nitric Oxide 20 Years from the 1998 Nobel Prize. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.2/issuetoc
Who you know in the PMO: Lobbying the Prime Minister's Office in Canada
Authors: Boucher Maxime
Published: October 2018

This article examines the relationship between lobbying organizations, the Prime Minister’s Office (PMO), and other central agencies of the Canadian government. First, an overall examination of the Canadian lobbying registry shows that the PMO is one of the most lobbied institutions of the executive branch. Second, a statistical model evaluates the effect of organizational (such as the interest type and policy sector) and other strategic factors on the volume of communication between lobbying organizations and the PMO. This inquiry concludes that strategic choices related to the amount of lobbying activities and the scope of lobbying campaigns have the most consistent impact on the access to top‐level policymakers. In the end, the results support the claim that lobbying should be understood as a social, self‐reinforcing process unfolding over the medium‐ and long‐term.
Prevention: Necessary But Insufficient? A 2‐Year Follow‐Up of an Effective First‐Grade Mathematics Intervention
Authors: Bailey Drew H. , Fuchs Lynn S. , Gilbert Jennifer K. , Geary David C. , Fuchs Douglas
Published: October 2018

We present first‐grade, second‐grade, and third‐grade impacts for a first‐grade intervention targeting the conceptual and procedural bases that support arithmetic. At‐risk students (average age at pretest = 6.5) were randomly assigned to three conditions: a control group (n = 224) and two variants of the intervention (same conceptual instruction but different forms of practice: speeded [n = 211] vs. nonspeeded [n = 204]). Impacts on all first‐grade content outcomes were significant and positive, but no follow‐up impacts were significant. Many intervention children achieved average mathematics achievement at the end of third grade, and prior math and reading assessment performance predicted which students will require sustained intervention. Finally, projecting impacts 2 years later based on nonexperimental estimates of effects of first‐grade math skills overestimates long‐term intervention effects.
Paediatric‐onset and adult‐onset Graves' disease share multiple genetic risk factors
Authors: Kuś Aleksander , Radziszewski Mikołaj , Glina Aleksandra , Szymański Konrad , Jurecka‐Lubieniecka Beata , Pawlak‐Adamska Edyta , Kula Dorota , Wawrusiewicz‐Kurylonek Natalia , Kuś Joanna , Miśkiewicz Piotr , Płoski Rafał , Bolanowski Marek , Daroszewski Jacek , Jarząb Barbara , Bossowski Artur , Bednarczuk Tomasz
Published: October 2018

Background

Graves' disease (GD) is an autoimmune thyroid disease (AITD) with a peak incidence between 30 and 50 years of age. Although children and adolescents may also develop the disease, the genetic background of paediatric‐onset GD (POGD) remains largely unknown. Here, we looked for similarities and differences in the genetic risk factors for POGD and adult‐onset GD (AOGD) as well as for variants associated with age of GD onset.

Materials and methods

A total of 1267 GD patients and 1054 healthy controls were included in the study. Allele frequencies of 40 established and suggested GD/AITD genetic risk variants (39 SNPs and HLA‐DRB1*03) were compared between POGD (N = 179), AOGD (N = 1088) and healthy controls. Subsequently, multiple linear regression was used to explore the relationship between age of GD onset and genotype for each locus.

Results

We identified six POGD risk loci, all of them were also strongly associated with AOGD. Although for some of the analysed variants, including HCP5 (rs3094228), PRICKLE1 (rs4768412) and SCGB3A2 (rs1368408), allele frequencies differed nominally between POGD and AOGD patients, these differences were not significant after applying multiple testing correction (Pcor = 0.05/40 = 1.25 × 10−3). Regression analysis showed that patients with higher number of HCP5 risk alleles tend to have a significantly earlier onset of GD (P = 6.9 × 10−5).

Conclusions

The results of our study revealed that POGD and AOGD share multiple common genetic risk variants. Moreover, we demonstrated for the first time that HCP5 polymorphism is associated with an earlier age of GD onset in a dose‐dependent manner.
Clinical practice update on testosterone therapy for male hypogonadism: Contrasting perspectives to optimize care
Authors: Yeap Bu B. , Wu Frederick C.W.
Published: October 2018

US Endocrine Society (ES) published a clinical practice guideline on testosterone therapy in men with hypogonadism, and Endocrine Society of Australia (ESA) a position statement on management of male hypogonadism. Both emphasize the importance of diagnosing men who are androgen deficient due to organic (classical or pathological) hypogonadism arising from disorders of the hypothalamus, pituitary or testes, who assuredly benefit from testosterone therapy. Both recognize that men with an intact gonadal axis may have low testosterone concentrations, for instance older men or men with obesity or other medical comorbidities. ES guidelines classify such symptomatic men as having organic (advanced age) or functional (obesity, medical comorbidities) hypogonadism, giving an option for testosterone therapy as a shared decision between clinicians and individual patients. ESA did not recommend testosterone therapy in these men. ES offers a reference range for total testosterone established in young men, while ESA cites age‐standardized reference ranges. ES recommends using free testosterone as well as total testosterone to identify men with hypogonadism in conditions where sex hormone‐binding globulin (SHBG) is altered, or when total testosterone is borderline. ESA recommends confirmatory biochemical testing with total testosterone, recognizing that this may be lower than expected if SHBG concentrations are low. Both emphasize the importance of identifying pre‐existing prostate and cardiovascular disease prior to initiating testosterone therapy, with ES providing specific recommendations for PSA measurement, deferring testosterone therapy after major cardiovascular events and indications for pituitary imaging. These contrasting approaches highlight gaps in the evidence base where individualized patient management is required.
Glucocorticoid activation by 11β‐hydroxysteroid dehydrogenase enzymes in relation to inflammation and glycaemic control in chronic kidney disease: A cross‐sectional study
Authors: Sagmeister Michael S. , Taylor Angela E. , Fenton Anthony , Wall Nadezhda A. , Chanouzas Dimitrios , Nightingale Peter G. , Ferro Charles J. , Arlt Wiebke , Cockwell Paul , Hardy Rowan S. , Harper Lorraine
Published: October 2018

Objective

Patients with chronic kidney disease (CKD) have dysregulated cortisol metabolism secondary to changes in 11β‐hydroxysteroid dehydrogenase (11β‐HSD) enzymes. The determinants of this and its clinical implications are poorly defined.

Methods

We performed a cross‐sectional study to characterize shifts in cortisol metabolism in relation to renal function, inflammation and glycaemic control. Systemic activation of cortisol by 11β‐HSD was measured as the metabolite ratio (tetrahydrocortisol [THF]+5α‐tetrahydrocortisol [5αTHF])/tetrahydrocortisone (THE) in urine.

Results

The cohort included 342 participants with a median age of 63 years, median estimated glomerular filtration rate (eGFR) of 28 mL/min/1.73 m2 and median urine albumin‐creatinine ratio of 35.5 mg/mmol. (THF+5αTHF)/THE correlated negatively with eGFR (Spearman's ρ = −0.116, P = 0.032) and positively with C‐reactive protein (ρ = 0.208, P < 0.001). In multivariable analysis, C‐reactive protein remained a significant independent predictor of (THF+5αTHF)/THE, but eGFR did not. Elevated (THF+5αTHF)/THE was associated with HbA1c (ρ = 0.144, P = 0.008) and diabetes mellitus (odds ratio for high vs low tertile of (THF+5αTHF)/THE 2.57, 95% confidence interval 1.47‐4.47). Associations with diabetes mellitus and with HbA1c among the diabetic subgroup were independent of eGFR, C‐reactive protein, age, sex and ethnicity.

Conclusions

In summary, glucocorticoid activation by 11β‐HSD in our cohort comprising a spectrum of renal function was associated with inflammation and impaired glucose control.