bluuebunny/crossref_metadata_2025 huggingface dataset:
A population-based study of prescribing trends in a potentially vulnerable paediatric population from 1999 to 2012
Authors: Sears Kim , Elms Sherri , Whitehead Marlo , Tranmer Joan E , Edge Dana S , VanDenKerkhof Elizabeth G
Published: August 2019

Objectives

There is a limited understanding of paediatric medication prescribing trends and patterns, thus poorly positioning decision-makers to identify quality and safety concerns related to medication use. The objective of this study was to determine overall medication prescribing trends and patterns among children receiving Ontario Drug Benefits over a thirteen-year period in the province of Ontario, Canada.

Methods

Administrative health databases housed within the Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada, were used to identify outpatient prescriptions dispensed from 1999 to 2012 through a publicly funded programme to children ≤18 years of age. Medications were classified according to the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system. Descriptive statistics were used to summarize prescribing patterns.

Key findings

This study identified 457 037 children who were dispensed a new prescription between 1999 and 2012. About 56% received their first prescription before 6.5 years of age, and 85% of the children in this study were from families who received social assistance. The most commonly prescribed drugs were antiinfectives (56.1%). Prescriptions for several central nervous system agents, including antipsychotics and agents for attention-deficit/hyperactivity disorder, increased across the study period. Changes in prescribing patterns within opioids, hormones and autonomic agents were noted. The results suggest that historically, prescribing trends have shifted with public policy, pharmaceutical marketing and diagnostic patterns, thus identifying them as a possible tool to measure the impact of policydriven practice changes. Anti-infective prescribing increased markedly with the global H1N1 pandemic. Pharmaceutical marketing, formulary decisions and diagnostic trends may affect the prescribing of ADHD medications globally. The prescribing of codeine-containing products and medroxyprogesterone appeared to fluctuate in response to important publications in the medical literature, and the use of epinephrine syringes increased after public policy changes in the province of Ontario. The steady rise in the use of medications whose long-term effects in children are unknown, such as antipsychotics and proton pump inhibitors, identifies areas in need of future research.

Conclusions

This study presents the first overview of Canadian prescribing trends for children, the majority of which are of low socioeconomic status and represent a potentially vulnerable population. Our analysis suggests that future research is required to determine whether prescribing trends could be used as indicators of policy effectiveness, pharmacovigilance and diagnostic trends.
Physical inactivity among parents of children with and without Down syndrome: the National Health Interview Survey
Authors: Diaz K. M.
Published: August 2019

Background

Emerging evidence suggests that parents of children with intellectual disabilities have poorer physical health than parents of typically developing children. However, it is unclear why. The purpose of this study was to examine differences in physical inactivity among a population‐based sample of parents of children with and without Down syndrome.

Methods

Data for this analysis come from 11 waves (2005–2016) of the National Health Interview Survey, a U.S. nationally representative survey. Minutes per week of leisure‐time physical activity were ascertained by self‐report with physical inactivity defined as reporting no leisure‐time physical activity. Parents were classified as (1) parents of typically developing children, (2) parents of children with Down syndrome, (3) parents of children with a developmental disability that had a high functional impact (autism, cerebral palsy, vision impairment or hearing impairment), (4) parents of children with an intellectual or developmental disability, but who did not have Down syndrome or a high‐impact developmental disabilities, and (5) parents of children with other special health care needs.

Results

Parents of children with Down syndrome were more likely to be physically inactive compared with parents of typical children (odds ratio [OR]: 1.51 [95% confidence interval, CI: 1.08, 2.12]) and had the lowest likelihood among all subgroups of parents to children with developmental disabilities or special health care needs. Parents of children with Down syndrome also had a significantly greater likelihood of being physically inactive compared with parents of children with other special health care needs (OR: 1.56 [95% CI: 1.11, 2.19]), with developmental disabilities without high functional impact (OR: 1.58 [95% CI: 1.12, 2.24]) and with developmental disabilities with high functional impact (OR: 1.46 [95% CI: 1.03, 2.08]).

Conclusion

Parents of children with Down syndrome are more likely to be physically inactive compared with parents of typically developing children and parents of children with other developmental disabilities or special health care needs. These findings suggest that parents of children with Down syndrome are a population in urgent need for interventions/programmes that promote physical activity, particularly as child well‐being is linked to caregiver health.
Neuroprotective action of PHD inhibitors is predominantly HIF‐1‐independent
Authors: Vetrovoy Oleg , Rybnikova Elena
Published: August 2019

Hypoxia‐inducible factor (HIF‐1) as the primary factor mediating gene‐dependent cellular responses to hypoxia represents an attractive target for the therapeutic interventions. The current Editorial comments on an as yet underestimated facet of HIF‐1–related research. The activity of HIF‐1 is being regulated by the availability of its α‐subunit HIF‐1α, which undergoes quick degradation. The process of degradation is initiated by prolyl 4‐hydroxylase (PHD). PHD is an oxygen‐dependent enzyme and therefore is inactivated in hypoxia, in turn resulting in HIF‐1α stabilization, its dimerization with HIF‐1β subunit thereby producing the transcriptionally active factor. It has been suggested that pharmacological inhibition of PHD activity might give the same results. Indeed, a large body of evidence on beneficial effects of PHD inhibitors has been accumulated in multiple laboratory and clinical trials. In addition to them, a paper by Li and colleagues published in this issue of Journal of Neurochemistry also reports that inhibition of PHD by adaptaquin reduces hypoxic‐ischemic brain injury in a neonatal mouse model. When dissecting the underlying molecular mechanisms, Li and colleagues surprisingly found that the observed effects appear to be independent of HIF‐1. These findings draw attention back to the question about possible HIF‐1 effects independent of PHD inhibitors, which has been raised several years ago but has not received sufficient attention so far, and is being discussed in this Editorial. One of the possible mechanisms might be ascribed to the ferroptosis pathway affected by PHD inhibitors but this question needs further careful studies, as well as clarification of other mechanisms possibly involved. Even if they represent a prospective therapeutic strategy, the lack of current knowledge about endogenous targets of PHD inhibitors, except for PHD, calls for a careful and balanced approach toward their clinical use.

image
What are the most accurate categories for mammal tarsus arrangement? A review with attention to South American Notoungulata and Litopterna
Authors: Lorente Malena
Published: August 2019

Abstract

The arrangement of the tarsus has been used to differentiate afrotherian and laurasiatherian ungulates for more than a century, and it is often present in morphological matrices that include appendicular features. Traditionally, it has two states: (i) an alternating tarsus, where proximal elements are interlocked with central and distal elements positioned like the bricks of a wall; and (ii) a serial tarsus, where elements are not interlocked. Over the years, these states became synonymous with the presence or absence of an astragalocuboid contact. Within the South American order Notoungulata, a third disposition was recognized: the reversed alternating tarsus, associated with a calcaneonavicular contact. This state was considered to be a synapomorphy of ‘advanced’ Toxodontia families (Notohippidae, Leontiniidae and Toxodontidae), but a further inspection of its distribution shows that it occurs throughout Mammalia. Additionally, it overlaps the serial tarsus condition as originally defined, and it probably has no functional or phylogenetic significance. Calcaneonavicular and astragalocuboid contacts are non‐exclusive, and their presence within a species, genus or family is not constant. Serial and alternating imply movements of the articulations of the mid‐tarsus in the transverse axis, while reverse alternating refers to a small calcaneonavicular contact that sometimes occurs in a serial condition or to a significant displacement of the tarsal articulations in a different (proximodistal) axis. The proximodistal arrangement of the joints could be functionally significant. Two new states are observed and defined: (i) ‘flipped serial’, present in Macropodidae, in which the calcaneocuboid articulation is medially displaced and significantly larger than the astragalonavicular contact, but the relationships between proximal and central elements are one to one; and (ii) ‘distal cuboid’, an extreme proximodistal displacement of the astragalonavicular joint. Serial and alternating, as originally defined (i.e. without any reference to which bone contacts which), seem to be the best states for classifying tarsal arrangement though as the disposition of distal or central bones in relationship to proximal bones.
Inflammation and angiogenesis in the corpus luteum
Authors: Lu Enhang , Li Chunjie , Wang Jing , Zhang Chunping
Published: August 2019

Angiogenesis is a very important process that helps establish and maintain the normal structure and function of the corpus luteum (CL). Early luteal development can be considered a kind of physiological injury with an inflammatory response; therefore, the inflammatory response may play an important role in the luteal angiogenesis. The inflammatory response is companied by activated leukocytes and their mediators. For luteal tissue, numerous activated leukocytes such as macrophages, neutrophils and eosinophils are present in the early luteal phase and are widely involved in neovascularization. The objective of this review is to describe the role of the inflammatory factors in the angiogenesis and to discuss their mechanism. Knowledge of action and mechanism of these inflammatory factors on angiogenic activity will be beneficial for the understanding of luteal function.
How do career adaptability and proactive career behaviours interrelate over time? An inter‐ and intraindividual investigation
Authors: Spurk Daniel , Volmer Judith , Orth Maximilian , Göritz Anja S.
Published: August 2019

Using and extending career construction theory (CCT), this study disentangled parallel and attenuating relationships between career adaptability and proactive career behaviours on both the interindividual and intraindividual levels. Using a large heterogeneous sample of working adults, univariate and bivariate latent growth curve analyses were conducted (three measurement points, 9‐month time span). On the one hand, career adaptability and proactive career behaviours showed positive relations of initial interindividual levels. Furthermore, intraindividual changes in career adaptability and proactive career behaviours were positively related, pointing towards a parallel development. On the other hand, as predicted, the initial level of career adaptability was negatively related to the slope of developmental trajectories of proactive career behaviours. In other words, because the average growth rate for proactive career behaviours was negative, this means that individuals with higher initial career adaptability showed stronger decreases in proactive career behaviours. Finally, only the intraindividual developments of career adaptability, but not of proactive career behaviours, positively predicted higher levels of career satisfaction. These findings point towards diverse developmental relationships between career adaptability and proactive career behaviours. Results are discussed against the background of CCT and successful career development.

Practitioner Points

Organizational and individual career management should account for diverse interdependencies of career adaptability and proactive career behaviour developments.

Career counselling that fosters career adaptability goes along with proactive career behaviour enhancement, and vice versa, within the same clients.

Higher levels of initial career adaptability accelerate the decrease in proactive career behaviours within the same persons.

Career adaptability should be increased within clients and employees because this increase predicts higher levels of career satisfaction.
The Limiting Distribution of a Non‐Stationary Integer Valued GARCH(1,1) Process
Authors: Michel Jon
Published: August 2019

We consider the integer valued GARCH(1,1) process defined by the two equation system and λn + 1 = ω + αYn + βλn. When α + β < 1 this process has a stationary solution and properties are well understood. In this note we find the limiting distribution of λn and Yn for the case of α + β = 1.
Pigmented primary epithelial tumor of the sella: A report of an intriguing case
Authors: Varshney Konil , Epari Sridhar , Sahay Ayushi , Gupta Tejpal , Shetty Prakash , Moiyadi Aliasgar
Published: August 2019

This is a report of an uncommon primary pigmented papillary epithelial tumor of the sella in a 38‐year‐old man, who presented with clinicoradiological features of pituitary adenoma. Histologically, the tumor showed features reminiscent of choroid plexus papilloma, that is, conspicuous papillary epithelial morphology with presence of intacytoplasmic melanin and no mitotic activity. Immunohistochemically, the tumor was positive for pancytokeratin (AE1/AE3), S‐100 protein and CD56, while it was negative for glial fibrillary acid protein, thyroid transcription factor‐1, epithelial membrane antigen, other cytokeratins and pituitary hormones. These findings were not typical of any WHO‐defined entity and is thus best regarded as a pigmented papillary epithelial tumor of sella of uncertain histogenesis. The present case is a valuable addition to the spectrum of primary pigmented papillary epithelial tumors originating at an unusual location.
Validity and reliability of the Karitane Parenting Confidence Scale among Japanese mothers
Authors: Usui Yuriko , Haruna Megumi , Shimpuku Yoko
Published: August 2019

The Karitane Parenting Confidence Scale is a valid and reliable measure used to assess perceived parental self‐efficacy, which is a critical component in facilitating adaptation to parenthood. In the current study, we translated the original version of the scale, developed in Australia, into Japanese and examined the validity and reliability of the translation, including its factor structure. A Web‐based survey was administered to 316 mothers of children aged 0–12 months between May and June 2016. The results revealed that the Japanese version had a two factor structure: “self‐efficacy for infant care” and “self‐efficacy for parental role”. The concurrent/convergent validity of the Japanese version was examined with an acceptable Cronbach's alpha coefficient for each subscale. The present findings indicate that the Japanese version of the Karitane Parenting Confidence Scale is a valid and reliable measure to assess parenting self‐efficacy among Japanese mothers of infants. The results suggest further assessment of parental self‐efficacy by using each subscale. Additionally, future studies should replicate the factor structures across varied or large populations.
Resilience, not frailty: A qualitative study of the perceptions of older adults towards “frailty”
Authors: Pan Edmund , Bloomfield Katherine , Boyd Michal
Published: August 2019

Background

Despite increasing importance placed upon the identification of frailty among the older population, scholarship is limited around the perception of older adults towards the term. This qualitative study aimed to investigate the perceptions of older adults in a New Zealand setting towards the term “frail”.

Methods

Twelve participants identified as frail based on unrelated comprehensive geriatric assessment were approached and interviewed in their own homes. Interviews were transcribed ad verbatim and analysed by general inductive approach.

Results

There was a diverse conceptualisation of frailty among the participants, across physical, cognitive and social dimensions, which differed from professional definitions of frailty. Participants maintained a neutral stance towards the concept of frailty and, however, reject its application to themselves. They also highlight the importance of independence and resilience in the staving off of frailty and the maintenance of quality of life.

Conclusion

This study suggests health professionals should shift focus on clinical encounters with the older patient, away from the deficits of frailty and towards independence, resilience and autonomy.

Implications for practice

Frail older adults often reject the term frailty when used about themselves, therefore using this term in communication with older adults may have negative consequences.
Recurrent reversible neurologic deficits during hemodialysis
Authors: Parmar Malvinder S.
Published: August 2019

Acute neurologic complications in patients receiving dialysis may be secondary to either underlying comorbid diseases, or to the dialysis procedure itself. An incident hemodialysis patient suffered recurrent consecutive episodes of transient ischemic attacks (TIA) that occurred only during hemodialysis and resolved upon discontinuation of the procedure. Eventual work‐up demonstrated an almost complete occlusion of left internal carotid artery. It is likely that the decrease in cerebral blood flow that occurs during hemodialysis, in conjunction with the severely stenotic internal carotid artery, explained the patient's symptoms. The stenotic lesion was deemed inoperable. The patient was transferred to peritoneal dialysis and had no further TIA events.
Blood donor component‐recipient linkages: is there fire where there is smoke?
Authors: Roubinian Nareg H , Kanias Tamir
Published: August 2019

See article on page 2537–2543, in this issue
Changing the deferral for men who have sex with men – an improved model to estimate HIV residual risk
Authors: Davison Katy L. , Gregoire Yves , Germain Marc , Custer Brian , O’Brien Sheila F. , Steele Whitney R. , Pillonel Josiane , Seed Clive R. ,   On behalf of the Surveillance, Risk Assessment, Policy Sub‐Group of the ISBT Transfusion Transmitted Diseases Working Party
Published: August 2019

Background and Objectives

Eight published studies modelled the impact of changing from a lifetime to time‐limited deferral for men who have sex with men (MSM); each predicted greater risk impact than has been observed. This study uses these previous efforts to develop an ‘optimized’ model to inform future changes to MSM deferrals.

Materials and Methods

HIV residual risk was calculated using observed HIV incidence/prevalence prior to the change in MSM deferral, then with the additional MSM expected under a 12‐month deferral for five compliance scenarios, and finally using data observed after implementation of the deferral. Monte Carlo simulation calculated 95% confidence intervals (CI).

Results

The architecture of reviewed models was sound, and two were selected for combination into the optimized model. HIV risk estimated by this in the UK under MSM lifetime deferral was 0·102 (95% CI: 0·050–0·172) per million. The model predicted from a 27·8% decrease to a 47·6% increase depending upon compliance pre‐implementation of the 12‐month deferral. A decrease of 0·9% was observed post‐implementation. For Canada, HIV risk under a 5‐year deferral was 0·050 (95% CI: 0·00003–0·122) per million. Pre‐implementation of the 12‐month deferral, the model predicted from 30·2% decrease to 10‐fold increase. A decrease of 47·0% was observed after implementation.

Conclusion

The optimized model predicted HIV risk under 12‐month MSM deferral in UK and Canada would remain low, and this was confirmed post‐implementation. While the model is adaptable to other deferral scenarios, improved data quality would improve precision, particularly estimates of incidence in individuals likely to donate.
The effect of tibial plateau leveling osteotomy on patellofemoral kinematics in dogs: An in vivo study
Authors: Zann Geoffrey J. , Kim Stanley E. , Tinga Selena , Pozzi Antonio , Banks Scott A.
Published: August 2019

Objective

To quantitatively evaluate patellofemoral (PF) kinematics during walking in dogs with cranial cruciate ligament (CrCL) deficiency treated by tibial plateau leveling osteotomy (TPLO).

Study design

Longitudinal observational study.

Animals

Dogs with unilateral CrCL deficiency treated by TPLO (n = 10).

Methods

Horizontal beam fluoroscopic images of the stifles during treadmill walking were acquired 6 months after TPLO. Computed tomography was performed, and digitized bone models of both femurs and patellae were created. These digital models were superimposed over the fluoroscopic images with shape‐matching software, and sagittal plane PF kinematics for TPLO‐treated and normal contralateral stifles were calculated. Patellofemoral kinematics were described according to phase of gait cycle as well as relative to femorotibial flexion angle.

Results

In TPLO‐treated stifles, there was an approximately 1‐mm increase in cranial displacement of the patella (P < .05) compared with the normal stifle at equivalent femorotibial flexion angles between 120° and 140° and predominately during the stance phase. Proximal‐distal translation and patellar flexion angle were mostly unaffected by TPLO when they were assessed according to either equivalent phase of gait cycle or femorotibial flexion angles.

Conclusion

In vivo PF kinematics in TPLO‐treated stifles were subtly different from normal, characterized by slight cranial shifting of the patella relative to the trochlear groove.

Clinical significance

The clinical significance of these results remains unknown. These results may provide further understanding into extensor mechanism abnormalities associated with TPLO.
West Nile virus outbreak in captive and wild raptors, Czech Republic, 2018
Authors: Hubálek Zdenek , Tomešek Martin , Kosina Marcel , Šikutová Silvie , Straková Petra , Rudolf Ivo
Published: August 2019

West Nile virus lineage 2 (WNV‐2) was detected in the brain of 17 goshawks (Accipiter gentilis) that succumbed to neuroinvasive disease in the Czech Republic during 2018: twelve birds were captive and five wild. Furthermore, two wild sparrowhawks (Accipiter nisus) and three other captive birds of prey (golden eagle Aquila chrysaetos, hybrid saker falcon Falco cherrug × F. rusticolus and Harris's hawk Parabuteo unicinctus) also died due to WNV encephalitis. The 2018 outbreak in Czech raptors clearly reflects a new epidemiological situation and indicates an increasing risk of both raptor and human infection with WNV‐2 in the country.
Subsurface Damage Detection on Ground Silicon Wafers Using Polarized Laser Scattering
Authors: Yin Jingfei , Bai Qian , Zhang Bi
Published: August 2019

A silicon wafer is important for the electronic and computer industries. However, subsurface damage (SSD), which is detrimental to the performance and lifetime of a silicon chip, is easily induced in a silicon wafer during a grinding process since silicon is typically a hard and brittle material. Therefore, it is necessary to detect and remove SSD in the subsequent processes. In this study, a polarized laser scattering (PLS) system is installed to detect the SSD in a ground wafer. It is found that not only the subsurface crack but also the residual stress leads to depolarization of an incident light. The effects of residual stress on depolarization are studied. The residual stress results in the photoelasticity, which causes the depolarization of the incident light in the PLS system. The depolarization caused by the residual stress is determined by the directions and the difference of the principal stresses. When the polarization direction of the incident light is aligned with one of the principal stresses, the effects of the residual stress can be minimized; therefore, the subsurface crack can be quantitatively estimated by PLS.
Mathematical Model of a Vertical Six-Axis Cartesian Computer Numerical Control Machine for Producing Face-Milled and Face-Hobbed Bevel Gears
Authors: Hsu Ruei-Hung , Shih Yi-Pei , Fong Zhang-Hua , Huang Chin-Lung , Chen Szu-Hung , Chen Shih-Sheng , Lee Yi-Hui , Chen Kuan-Hung , Hsu Tzu-Ping , Chen Wei-Jen
Published: August 2019

Prior to the development of sophisticated computer numerical control (CNC), both face milling (FM) and face hobbing (FH), the two most popular technologies for bevel gear production, required cradle-type machines with diverse and complicated mechanisms. In the last two decades, however, the gear industry has replaced these traditional machines with six-axis CNC bevel gear cutting machines that have superior efficiency and accuracy. One such machine is a vertical six-axis machine with a vertical spindle arrangement, which offers two industrially proven advantages: compact design and maximum machine stiffness. The technical details of this machine, however, remain undisclosed; so, this paper proposes a mathematical model that uses inverse kinematics to derive the vertical machine's nonlinear six-axis coordinates from those of a traditional machine. The model also reduces manufacturing errors by applying an effective flank correction method based on a sensitivity analysis of how slight variations in the individual machine setting coefficients affect tooth geometry. We prove the model's efficacy by first using the proposed equations to derive the nonlinear coordinates for pinion and gear production and then conducting several cutting experiments on the gear and its correction. Although the numerical illustration used for this verification is based only on FM bevel gears produced by an SGDH cutting system, the model is, in fact, applicable in the production of both FM and FH bevel gears.
Electromagnetic Nondestructive Testing Model and Surface Magnetic Field Analysis for Circumferential Cracks on Metal Rod
Authors: Jiang Feng , Liu Shulin , Xin Shaojie , Zhang Hongli
Published: August 2019

In this paper, an analytical model for a metal rod with a coating layer is proposed to evaluate circumferential crack from the signals of the surface magnetic field. In the proposed model, magnetic vector equations for four regions of space were built, and series expressions of the magnetic field were proposed by the truncated region eigenfunction method. The calculation results can show the three-dimensional distribution of axial and radial magnetic induction intensities on the surface of a metal rod clearly. In addition, the analytical model is verified by using comsol finite element simulation, which also demonstrates that induced eddy currents on the inner surface of the metal rod with cracks appear to be propelled toward the inner layer of the metal rod and the presence of a circumferential crack directly causes a decrease in the induced eddy current on the inner surface of the rod. The results calculated from the analytical model indicated that the model is capable of providing an accurate variation in the magnetic field due to circumferential cracks at different depths. The analytical results showed that the radial magnetic induction intensity increases by 0.16 × 10−3 T, while the axial magnetic induction intensity decreases by 0.3 × 10−3 T as the crack depth increases from 0 to 3 mm.
Regulatory Mechanisms of the LuxS/AI-2 System and Bacterial Resistance
Authors: Wang Yang , Liu Baobao , Grenier Daniel , Yi Li
Published: August 2019

The quorum-sensing (QS) system is an intercellular cell-cell communication mechanism that controls the expression of genes involved in a variety of cellular processes and that plays critical roles in the adaption and survival of bacteria in their environment. The LuxS/AI-2 QS system, which uses AI-2 (autoinducer-2) as a signal molecule, has been identified in both Gram-negative and Gram-positive bacteria.
The Copy Number of the
spoVA
2mob
Operon Determines Pressure Resistance of
Bacillus
Endospores
Authors: Li Zhen , Schottroff Felix , Simpson David J. , Gänzle Michael G.
Published: August 2019

Bacillus
spp. are considered pressure-resistant microorganisms, but the resistance mechanisms remain unknown. The
spoVA
2mob
operon is a mobile genetic element, and it can transfer to pathogenic or spoilage organisms by horizontal gene transfer. Results in this study indicate that multiple copies of the
spoVA
2mob
operon mediate high-pressure resistance of
Bacillus
endospores, and it might contribute to the identification of the source of pressure-resistant pathogens and spoilage organisms that may contaminate the food supply. The droplet digital PCR (ddPCR) system is well suited for analysis in some human diseases due to its high efficiency and capability to provide high precision; however, no relevant studies in food microbiology have been reported so far. This study demonstrates a novel application of ddPCR in food microbiology.
Architecture and Assembly of Periplasmic Flagellum
Authors: Chang Yunjie , Liu Jun
Published: August 2019

Periplasmic flagella are complex nanomachines responsible for distinctive morphology and motility of spirochetes. Although bacterial flagella have been extensively studied for several decades in the model systems
Escherichia coli
and
Salmonella enterica
, our understanding of periplasmic flagella in many disease-causing spirochetes remains incomplete. Recent advances, including molecular genetics, biochemistry, structural biology, and cryo-electron tomography, have greatly increased our understanding of structure and function of periplasmic flagella. In this chapter, we summarize some of the recent findings that provide new insights into the structure, assembly, and function of periplasmic flagella.
On plate tectonics and ocean temperatures
Authors: Vérard Christian , Veizer Ján
Published: August 2019

Plate tectonics, the principal vehicle for dissipation of planetary energy, is believed to buffer the δ18O of seawater at its near-modern value of 0‰ SMOW (Standard Mean Ocean Water) because the hot and cold cells of hydrothermal circulation at oceanic ridges cancel each other. The persistence of plate tectonics over eons apparently favors attribution of the well-documented oxygen isotope secular trends for carbonates (cherts, phosphates) to progressively warmer oceans, from 40–70 °C in the early Paleozoic to 60–100 °C in the Archean. We argue that these oceanic hydrothermal systems are dominated by low-temperature (<350 °C) cells that deplete the percolating water in 18O. Seawater δ18O is therefore a proxy for, rather than being buffered by, the intensity of plate tectonics. Detrending the Phanerozoic carbonate δ18Oc secular trend for its “tectonic” component yields a stationary time series that, interpreted as a proxy for Phanerozoic climate, indicates low-latitude shallow ocean temperatures oscillating between 10 and 30 °C around a baseline of 17 °C, attributes comparable to modern temperature values.
Fifteen-minute consultation: Managing a child with a new-onset squint
Authors: Hopkins Abigail , Simmons Ian
Published: August 2019

Objective

To provide a systematic approach to the child with a new squint.

Method

Review of the current available literature.

Conclusion

Squint is a common presentation in the paediatric population. Although the parents’ primary concern may be cosmetic, a new squint in childhood may be the first sign of a serious or life-threatening ocular or neurological pathology. Thorough assessment and timely referral are essential.
Determining a reliably visible and inexpensive surface fiducial marker for use in MRI: a research study in a busy Australian Radiology Department
Authors: Izatt Maree T , Lees Deborah , Mills Susan , Grant Caroline A , Little J Paige
Published: August 2019

Objectives

Single-use commercial surface fiducial markers are used in clinical imaging for a variety of applications. The current study sought to find a new, reliably visible, easily sourced and inexpensive fiducial marker alternative for use with MRI.

Design

Five commonly requested MRI sequences were determined (three-dimensional (3D) T1-weighted, T1 coronal, 3D T2-weighted, T2 fat suppressed, proton density), to examine the visibility of 18 items (including a commercial fiducial marker).

Setting

Clinical 3T MRI scanner in an Australian Tertiary Hospital and an Australian University Biomedical Engineering research group.

Interventions

18 marker alternatives were scanned using five common MRI sequences. Images were reformatted to obtain both an image through the mid-height of each marker and a maximum intensity z-projection image over the volume of the marker. Variations in marker intensity were profiled across each visible marker and a visibility rating defined.

Main outcome measures

Outcome measures were based on quantitative assessment of a clear intensity contrast ratio between the marker and the adjacent tissue and a qualitative assessment of visibility via a 3-point scale.

Results

The fish oil capsule, vitamin D capsule, paint ball pellet, soy sauce sushi tube and commercial markers were typically visible to a high quality on all the imaging sequences and demonstrated a clear differential in intensity contrast against the adjacent tissue. Other common items, such as plasticine ‘play doh’ and a soft ‘Jelly baby’ sweet, were surprise candidates, demonstrating high-quality visibility and intensity contrast for the 3D T1-weighted sequence.

Conclusions

Depending on the basis for referral and MRI sequence chosen, four alternative fiducial markers were determined to be inexpensive, easily sourced and consistently visible. Of these, the vitamin D capsule provided an excellent balance between availability, size, cost, usability and quality of the visualised marker for all the commonly used MRI sequences analysed.
Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis
Authors: Fernandes Ricardo M , Wingert Aireen , Vandermeer Ben , Featherstone Robin , Ali Samina , Plint Amy C , Stang Antonia S , Rowe Brian H , Johnson David W , Allain Dominic , Klassen Terry P , Hartling Lisa
Published: August 2019

Objective

Adverse events (AEs) associated with short-term corticosteroid use for respiratory conditions in young children.

Design

Systematic review of primary studies.

Data sources

Medline, Cochrane CENTRAL, Embase and regulatory agencies were searched September 2014; search was updated in 2017.

Eligibility criteria

Children <6 years with acute respiratory condition, given inhaled (high-dose) or systemic corticosteroids up to 14 days.

Data extraction and synthesis

One reviewer extracted with another reviewer verifying data. Study selection and methodological quality (McHarm scale) involved duplicate independent reviews. We extracted AEs reported by study authors and used a categorisation model by organ systems. Meta-analyses used Peto ORs (pORs) and DerSimonian Laird inverse variance method utilising Mantel-Haenszel Q statistic, with 95% CI. Subgroup analyses were conducted for respiratory condition and dose.

Results

Eighty-five studies (11 505 children) were included; 68 were randomised trials. Methodological quality was poor overall due to lack of assessment and inadequate reporting of AEs. Meta-analysis (six studies; n=1373) found fewer cases of vomiting comparing oral dexamethasone with prednisone (pOR 0.29, 95% CI 0.17 to 0.48; I2=0%). The mean difference in change-from-baseline height after one year between inhaled corticosteroid and placebo was 0.10 cm (two studies, n=268; 95% CI −0.47 to 0.67). Results from five studies with heterogeneous interventions, comparators and measurements were not pooled; one study found a smaller mean change in height z-score with recurrent high-dose inhaled fluticasone over one year. No significant differences were found comparing systemic or inhaled corticosteroid with placebo, or between corticosteroids, for other AEs; CIs around estimates were often wide, due to small samples and few events.

Conclusions

Evidence suggests that short-term high-dose inhaled or systemic corticosteroids use is not associated with an increase in AEs across organ systems. Uncertainties remain, particularly for recurrent use and growth outcomes, due to low study quality, poor reporting and imprecision.
Implementation and spread of a simple and effective way to improve the accuracy of medicines reconciliation on discharge: a hospital-based quality improvement project and success story
Authors: Botros Shady , Dunn John
Published: August 2019

Background

Changes are often made to medications at times of transitions in care. Inadequate reconciliation during admission, transfer and discharge causes medication errors and increases risks of patient harm. Despite well-established multidisciplinary medicines reconciliation (MR) processes at hospital admission, our MR process at discharge; however, was poor. The main errors included failure to recommence withheld medicines and lack of documentation explaining changes made to medications on discharge. Our objective was to develop an intervention that supports prescribers to follow a simple standardised MR process at discharge to reduce these errors.

Methods

Working closely as a multidisciplinary team, we used improvement methodologies to design and test a process that reliably directs prescribers in surgery to use the inpatient prescribing chart as well as the MR on admission form as sources to create accurate discharge prescriptions. The project was segmented into testing, implementation, spread and sustainability.

Results

The tested intervention helped the accuracy of discharge prescriptions steadily and quickly improve from 45% to 96% in the pilot ward. Following the successful implementation and sustainability in two separate pilot wards, the intervention was spread to the remaining eight wards producing a similar improvement.

Conclusions

To improve patient safety, it is crucial to ensure that information about medicines is effectively communicated when care is transferred between teams. Although this can be challenging, we’ve shown that it can be done effectively and reliably if this responsibility is equally shared by healthcare professionals from all disciplines while being supported by safe systems that make it easy to do the right thing. Successfully implementing a standardised multidisciplinary MR process at discharge can also reduce the reliance on pharmacists therefore freeing them to undertake other clinical roles.
Risk-adjusted survival in liver transplant patients assessed and managed by a non-transplanting centre: South West Liver Unit experience
Authors: Norton Benjamin Charles , Srivastava Ankur , Ramos Katie , Vine Louisa , Taylor Rhiannon , Aluvihare Varuna , Heaton Nigel , Cramp Matthew E
Published: August 2019

Background

Liver transplant services remain a scarce resource not reflective of geography or burden of liver disease within the UK. To address geographical concerns in the South West (SW), a devolved network model of care for liver transplantation was established in 2004 between the SW Liver Unit (SWLU) at Derriford Hospital, Plymouth and King’s College Hospital, London. The SWLU has evolved to deliver both pre-transplant and post-transplant care for patients across the SW Peninsula. We determined whether risk-adjusted survival in patients assessed and managed at the SWLU compared with existing UK transplant centres.

Design

Retrospective analysis of records at National Health Service Blood and Transplant (NHSBT) for patients ≥18 years listed or undergoing first liver only deceased donor transplantation from 1 January 2006 to 31 December 2017. Data collected and used were in accordance with standard NHSBT outcome measures.

Results

We identified 8492 patients registered for first liver only transplant and 6140 patients who subsequently underwent transplantation. Of these, 215 patients listed and 172 patients transplanted were registered at the SWLU. The 1-year, 5-year and 10-year risk-adjusted post-listing survival for patients registered at the SWLU were 86%, 75% and 67%, respectively, with 1-year and 5-year risk-adjusted post-transplant survival 94.9% and 84.4%, respectively.

Conclusions

Risk-adjusted post-listing 1-year, 5-year and 10-year survival outcomes and risk-adjusted 1-year and 5-year post-transplant survival outcomes at the SWLU are good and comparable with the seven UK transplant centres. These outcomes provide assurance that care delivered by our regional programme is equivalent to well-established liver transplant programmes.
Resveratrol prevents palmitic-acid-induced cardiomyocyte contractile impairment
Authors: Lieben Louis Xavier , Raj Pema , Meikle Zach , Yu Liping , Susser Shannel E. , MacInnis Shayla , Duhamel Todd A. , Wigle Jeffrey T. , Netticadan Thomas
Published: August 2019

Long-chain saturated fatty acids, especially palmitic acid (PA), contribute to cardiomyocyte lipotoxicity. This study tests the effects of PA on adult rat cardiomyocyte contractile function and proteins associated with calcium regulating cardiomyocyte contraction and relaxation. Adult rat cardiomyocytes were pretreated with resveratrol (Resv) and then treated with PA. For the reversal study, cardiomyocytes were incubated with PA prior to treatment with Resv. Cardiomyocyte contractility, ratio of rod- to round-shaped cardiomyocytes, and Hoechst staining were used to measure functional and morphological changes in cardiomyocytes. Protein expression of sarco-endoplasmic reticulum ATPase 2a (SERCA2a), native phospholamban (PLB) and phosphorylated PLB (pPLB ser16 and pPLB thr17), and troponin I (TnI) and phosphorylated TnI (pTnI) were measured. SERCA2a activity was also measured. Our results show that PA (200 μM) decreased the rate of cardiomyocyte relaxation, reduced the number of rod-shaped cardiomyocytes, and increased the number of cells with condensed nuclei; pre-treating cardiomyocytes with Resv significantly prevented these changes. Post-treatment with Resv did not reverse morphological changes induced by PA. Protein expression levels of SERCA2a, PLB, pPLBs, TnI, and pTnI were unchanged by PA or Resv. SERCA2a activity assay showed that Vmaxand Iono ratio were increased with PA and pre-treatment with Resv prevented this increase. In conclusion, our results show that Resv protect cardiomyocytes from contractile dysfunction induced by PA.
Reachability Analysis of Neural Masses and Seizure Control Based on Combination Convolutional Neural Network
Authors: Ma Zhen
Published: August 2019

Epileptic seizures arise from synchronous firing of multiple spatially separated neural masses; therefore, many synchrony measures are used for seizure detection and characterization. However, synchrony measures reflect only the overall interaction strength among populations of neurons but cannot reveal the coupling strengths among individual populations, which is more important for seizure control. The concepts of reachability and reachable cluster were proposed to denote the coupling strengths of a set of neural masses. Here, we describe a seizure control method based on coupling strengths using combination convolutional neural network (CCNN) modeling. The neurophysiologically based neural mass model (NMM), which can bridge signal processing and neurophysiology, was used to simulate the proposed controller. Although the adjacency matrix and reachability matrix could not be identified perfectly, the vast majority of adjacency values were identified, reaching 95.64% using the CCNN with an optimal threshold. For cases of discrete and continuous coupling strengths, the proposed controller maintained the average reachable cluster strengths at about 0.1, indicating effective seizure control.
Social Genesis in Computing Education
Authors: Tenenberg Josh , Chinn Donald
Published: August 2019

It is common to think of learning as the acquisition of knowledge by an individual learner. Starting a century ago, Lev Vygotsky developed a different perspective on learning, initiating a tradition of educational research whose momentum and influence continue to grow. One of Vygotsky's key principles is the
general genetic law of cultural development
that states that whatever skilled cognition that individuals carry out within their own minds is preceded by homologous activity carried out by a social group of which this individual was a part. In linking the individual and society through this law, learning is not simply a matter of the acquisition of domain knowledge. Rather, it is a cyclic process by which a social group, in its functioning through joint activity, leads to individuals taking into themselves (i.e.,
internalizing
) the social forms of activity. In this article, our goal is to explicate Vygotsky's genetic law and demonstrate its utility for yielding novel insight into computing education. We provide an extended illustration of the use of Vygotsky's law in examining a teacher and students in a university setting write code together during a class session. What our analysis reveals is that the teacher and students together enact a sequential, rule-based, and dialogical process of problem decomposition and code writing far different from the plan and schema-based models for programming that have emerged from prior research focused on the individual student and their cognitive strategies and structures. We provide commentary on implications of the genetic law for both research and practice in computing education.
Integrating Ethics within Machine Learning Courses
Authors: Saltz Jeffrey , Skirpan Michael , Fiesler Casey , Gorelick Micha , Yeh Tom , Heckman Robert , Dewar Neil , Beard Nathan
Published: August 2019

This article establishes and addresses opportunities for ethics integration into Machine-learning (ML) courses. Following a survey of the history of computing ethics and the current need for ethical consideration within ML, we consider the current state of ML ethics education via an exploratory analysis of course syllabi in computing programs. The results reveal that though ethics is part of the overall educational landscape in these programs, it is not frequently a part of core technical ML courses. To help address this gap, we offer a preliminary framework, developed via a systematic literature review, of relevant ethics questions that should be addressed within an ML project. A pilot study with 85 students confirms that this framework helped them identify and articulate key ethical considerations within their ML projects. Building from this work, we also provide three example ML course modules that bring ethical thinking directly into learning core ML content. Collectively, this research demonstrates: (1) the need for ethics to be taught as integrated within ML coursework, (2) a structured set of questions useful for identifying and addressing potential issues within an ML project, and (3) novel course models that provide examples for how to practically teach ML ethics without sacrificing core course content. An additional by-product of this research is the collection and integration of recent publications in the emerging field of ML ethics education.