bluuebunny/crossref_metadata_2025 huggingface dataset:
A tale of two eras: Phytoplankton composition influenced by oceanic paleochemistry
Authors: Giordano Mario , Olivieri Camilla , Ratti Simona , Norici Alessandra , Raven John A. , Knoll Andrew H.
Published: May 2018

We report the results of simple experiments which support the hypothesis that changes in ocean chemistry beginning in the Mesozoic Era resulted in an increase in the nutritional quality per mole of C and per cell of planktonic algal biomass compared to earlier phytoplankton. We cultured a cyanobacterium, a diatom, a dinoflagellate, and a green alga in media mimicking aspects of the chemistry of Palaeozoic and Mesozoic‐Cenozoic oceans. Substantial differences emerged in the quality of algal biomass between the Palaeozoic and Mesozoic‐Cenozoic growth regimes; these differences were strongly affected by interspecific interactions (i.e., the co‐existence of different species alters responses to the chemistry of the medium). The change was in the direction of a Mesozoic‐Cenozoic biomass enriched in protein per mole C, although cells contained less carbon overall. This would lead to a lower C:N ratio. On the assumption that Mesozoic‐Cenozoic grazers’ assimilation of total C was similar to that of their earlier counterparts, their diet would be stoichiometrically closer to their C:N requirement. This, along with an increase in mean cell size among continental shelf phytoplankton, could have helped to facilitate observed evolutionary changes in the Mesozoic marine fauna. In turn, increased grazing pressure would have operated as a selective force for the radiation of phytoplankton clades better equipped with antigrazing capabilities (sensu lato), as found widely in phytoplankton with biomineralization. Our results emphasize potential links between changing seawater chemistry, increased predation pressure and the rise to ecological dominance of chlorophyll a+c algae in Mesozoic oceans. The experiments also suggest a potential role for ocean chemistry in changes of marine trophic structure from the Palaeozoic to the later Mesozoic Era.
Successional change in species composition alters climate sensitivity of grassland productivity
Authors: Shi Zheng , Lin Yang , Wilcox Kevin R. , Souza Lara , Jiang Lifen , Jiang Jiang , Jung Chang Gyo , Xu Xia , Yuan Mengting , Guo Xue , Wu Liyou , Zhou Jizhong , Luo Yiqi
Published: May 2018

Succession theory predicts altered sensitivity of ecosystem functions to disturbance (i.e., climate change) due to the temporal shift in plant community composition. However, empirical evidence in global change experiments is lacking to support this prediction. Here, we present findings from an 8‐year long‐term global change experiment with warming and altered precipitation manipulation (double and halved amount). First, we observed a temporal shift in species composition over 8 years, resulting in a transition from an annual C3‐dominant plant community to a perennial C4‐dominant plant community. This successional transition was independent of any experimental treatments. During the successional transition, the response of aboveground net primary productivity (ANPP) to precipitation addition magnified from neutral to +45.3%, while the response to halved precipitation attenuated substantially from −17.6% to neutral. However, warming did not affect ANPP in either state. The findings further reveal that the time‐dependent climate sensitivity may be regulated by successional change in species composition, highlighting the importance of vegetation dynamics in regulating the response of ecosystem productivity to precipitation change.
Competitive Location and Pricing on Networks
Authors: Serra Daniel , ReVelle Charles
Published: May 2018

In this paper we consider a location and pricing model for a retail firm that wants to enter a spatial market tvhere a competitor firm is already operating as a monopoly with several outlets. The entering firm seeks to determine the optimal uniform mill price and its servers' locations that maximize profits given the reaction in price of the competitor firm to its entrance. A tabu search procedure is presented to solve the model together with computational experience and an example.
An Evaluation of Domain Decomposition Strategies for Parallel Spatial Interpolation of Surfaces
Authors: Cramer Barton E. , Armstrong Marc P.
Published: May 2018

The objective of this paper is to investigate static and dynamic methods for spatially subdividing the work required to interpolate a gridded surface into a set of subtasks that are allocated to separate processors for execution in parallel. A description of the parallel implementation and testing procedures is preceded by a review of the serial version of the particular neighborhood‐based, inverse‐distance‐weighted interpolation (Clarke) algorithm chosen for interpolation. The effects on serial program execution time of data distribution (dispersed or clutered ) are documented, and these results are used to inform a partial parallelization process. Next, six problem decomposition and task scheduling strategies are evaluated on a shared memory multiprocessor. The choice of problem decomposition and task scheduling combination is shown to exercise a significant role in determining parallel program performance, with a medium‐grained, dynamically scheduled approach showing the best adaptability to variable spatial workload and uneven processor power.
Optimization in an Error Backpropagation Neural Network Environment with a Performance Test on a Spectral Pattern Classification Problem
Authors: Fischer Manfred M. , Staufer Petra
Published: May 2018

This paper attempts to develop a mathematically rigid framework for minimizing the cross‐entropy function in an error backpropagating framework. In doing so, we derive the backpropagation formulae for evaluating the partial derivatives in a computationally efficient way. Various techniques of optimizing the multiple‐class cross‐entropy error function to train single hidden layer neural network classifiers with softmax output transfer functions are investigated on a real‐world multispectral pixel‐by‐pixel classification problem that is of fundamental importance in remote sensing. These techniques include epoch‐based and batch versions of backpropagation of gradient descent, PR‐conjugate gradient, and BPGS quasi‐Newton errors. The method of choice depends upon the nature of the learning task and whether one wants to optimize learning for speed or classification performance. It was found that, comparatively considered, gradient descent error backpropagation provided the best and most stable out‐of‐sample performance results across batch and epoch‐based modes of operation. If the goal is to maximize learning speed and a sacrifice in classification accuracy is acceptable, then PR‐conjugate gradient error backpropagation tends to be superior. If the training set is very large, stochastic epoch‐based versions of local optimizers should be chosen utilizing a larger rather than a smaller epoch size to avoid unacceptable instabilities in the classification results.
Emerging therapies for haemophilia ‐ Global perspective
Authors: Mahlangu J. , Cerquiera M. , Srivastava A.
Published: May 2018

The therapeutic options for people with haemophilia (PWH) have rapidly evolved in the last 5 years. Moving on from conventional plasma‐derived and recombinant clotting factor concentrates (CFC), there now are extended half‐life CFCs (~1.8× for FVIII and ~4.5× for FIX) to as well as several novel haemostasis agents administered subcutaneously (weekly to monthly) such as bispecific antibody which brings together FIXa with FX like FVIII, a liver‐targeted siRNA against antithrombin which can reduce its levels enough to allow significant haemostasis and an antibody against tissue factor pathway inhibitor which then also enhances haemostasis. Successful gene therapy for both haemophilia A and haemophilia B has been demonstrated by gene transfer using adeno‐associated virus vectors. Sustained clinically significant elevation (>5%) to normal factor levels has been demonstrated. Some of these products have already obtained market authorization whilst others are at various stages of development. The choices of products for the treatment of haemophilia have never been better. Whilst the immediate superiority of all these products providing better haemostasis and convenience than conventional CFCs, their exact position in the clinical algorithm will need to be defined based on the long‐term safety and efficacy data. However, most of these products are likely to remain out of reach of >70% of PWH in the world. The biggest challenge will be to find and establish mechanisms for wider access to these transformational haemostasis products for all PWH around the world.
The invasion of Bromus erectus alters species diversity of vascular plants and leafhoppers in calcareous grasslands
Authors: Poniatowski Dominik , Hertenstein Florian , Raude Nadja , Gottbehüt Kathrin , Nickel Herbert , Fartmann Thomas
Published: May 2018

The most common mechanism of biological invasions is an increase in competition, which usually results in the loss of biodiversity. The invasion of Bromus erectus (Syn. Bromopsis erecta) in calcareous grasslands of western and central Europe is well‐documented. Although, it is largely unknown to what extent this development affects biodiversity.

In this study, we analysed the effects of B. erectus invasion on vascular plant and leafhopper assemblages of calcareous grasslands. At each of the 15 randomly selected sites, we compared one plot with stands of Bromus (presence) and one without (absence) (paired sampling design).

The invasion of B. erectus affected vegetation structure as well as vascular plant and leafhopper assemblages. Despite similar abiotic site characteristics, Bromus plots had a higher turf height, vegetation density, and litter cover. Additionally, we recorded a much lower species richness in Bromus plots than in absence plots in all analysed groups of vascular plants. A similar pattern was found for leafhoppers. Absence plots exhibited a higher species richness of habitat and diet specialists than Bromus plots. The overall abundance of all leafhopper species was highest in presence plots, whereas that of diet specialists peaked in absence plots.

We conclude that the ongoing invasion of B. erectus will lead to a strong structural homogenisation with negative effects on plant and insect diversity. One possible management tool might be a goal‐driven rough grazing with sheep – especially in spring when B. erectus is much more palatable than in summer and autumn.
Bi‐cooperative network games: A link‐based allocation rule
Authors: Borkotokey Surajit , Gogoi Loyimee , Mukherjee Diganta
Published: May 2018

We study the notion of a bi‐cooperative network game and obtain a link‐based allocation rule for the corresponding class. Unlike classical network games where players have single motive of forming (or not forming) a network, a player under a bi‐cooperative set up has two more variations: all her links attribute exclusively to her positive or negative contributions, or few links are positive while few others are negative. We extend the position value, an important link‐based allocation rule in classical network games, and show that it is the only rule for all the three variations of a bi‐cooperative network game.
Neuroimmunology and neuroinflammation in autoimmune, neurodegenerative and psychiatric disease
Authors: Altmann Daniel M.
Published: May 2018

An ever‐increasing collection of neurological human diseases are becoming appreciated as encompassing a strong immunological component in pathogenesis or regulation. This derives to a large extent from genome‐wide association studies that have highlighted association with immune system genes, including those in the HLA and KIR regions. Along with the genomic findings have come insights from immune phenotyping and assays for autoimmunity. This is a group of disease processes that includes Parkinson's disease, Alzheimer's, stroke, narcolepsy, schizophrenia and psychosis. In most cases, these are diseases in which we assume that differential regulation of central nervous system inflammation may impact symptoms and severity. The specific roles played by the immune response in these disease processes is largely uncharted and will require considerable investigation.
The AI Spring of 2018
Authors: Olhede Sofia , Wolfe Patrick
Published: May 2018

As nations race for dominance in the field of artificial intelligence, Sofia Olhede and Patrick Wolfe consider the implications for statistics and statisticians
Perspectives on Water Resources among Anishinaabe and Non‐Native Residents of the Great Lakes Region
Authors: Kozich Andrew T. , Halvorsen Kathleen E. , Mayer Alex S.
Published: May 2018

Climate change and human population growth could reduce household water availability in the historically water‐rich Great Lakes region. It is critical to understand human‐water relationships in advance of policy actions that could result from reduced water supplies. Research on household water conservation typically occurs in a reactionary nature, in settings that are already water‐stressed. Furthermore, few studies involve Native American perspectives on this important topic. We used semi‐structured interviews to assess residents' perspectives of Great Lakes water resources and views on household conservation, involving distinct samples of Native American and non‐Native residents. Although interviewees deeply value the region's water resources, few practice household conservation or plan to do so in the future. Few perceive others in the region as conserving water. Beliefs about water‐related problems are focused more on water quality than supply. Native American interviewees expressed deeper spiritual values toward water than non‐Native interviewees. Findings can help inform policy and outreach strategies and provide a rich foundation for follow‐up quantitative research testing the Theory of Planned Behavior's ability to explain household conservation intentions in the Great Lakes region.
Navajo Nation Snowpack Variability from 1985‐2014 and Implications for Water Resources Management
Authors: Tsinnajinnie Lani M. , Gutzler David S. , John Jason
Published: May 2018

In the arid Southwest, snowpack in mountains plays an essential role in supplying surface water resources. Water managers from the Navajo Nation monitor snowpack at nine snow survey stations located in the Chuska Mountains and Defiance Plateau in northern Arizona and New Mexico. We characterize these snowpack data for the period 1985‐2014 and evaluate the efficacy of snowpack data collection efforts. Peak snow water equivalent occurs in early to mid‐March depending on elevation. Variability in snowpack levels correlates highly among all sites (r > 0.64), but higher elevation sites in the Chuska Mountains correlate more strongly with one another compared to lower elevation sites and vice versa. Northern sites also correlate well with each other. A principal component analysis is used to create a weighted average time series of year‐to‐year peak snowpack variability. The first principal component showed no trend in increasing or decreasing Navajo Nation snowpack. Results from this research will provide the Navajo Nation Department of Water Resources information to help determine if any snow survey sites in the Chuska Mountains are redundant and can be discontinued to save time and money, while still providing snowpack information needed by the Navajo Nation. This summary of snowpack patterns, variability, and trends in the Chuska Mountains and Defiance Plateau will help the Navajo Nation to understand how snowpack and water resources respond to climate change and climate variability.
Grain‐size–dependent dielectric properties in nanograin ferroelectrics
Authors: Cai Ziming , Wang Xiaohui , Hong Wei , Luo Bingcheng , Zhao Qiancheng , Li Longtu
Published: May 2018

A series of ferroelectric ceramic models with grain and grain‐boundary structures of different sizes are established via Voronoi tessellations. A phase‐field model is introduced to study the dielectric breakdown strength of these ferroelectric ceramics. Afterward, the relation between the electric displacement and electric field and the hysteresis loop are calculated using a finite element method based on a classical and modified hyperbolic tangent model. The results indicate that as the grain size decreases, the dielectric strength is enhanced, but the dielectric permittivity is reduced. The discharge energy density and energy storage efficiency of these ferroelectric ceramics extracted from the as‐calculated hysteresis both increase along with a decrease in their grain size at their breakdown points. However, under the same applied electric field, the ferroelectric ceramic with a smaller grain size possesses a lower discharge energy density but a higher energy storage efficiency. The results suggest that ferroelectric ceramics with smaller grain sizes possess advantages for applications in energy storage devices.
Amorphous zirconia at high pressure
Authors: Durandurdu Murat
Published: May 2018

We show, by means of ab initio calculations, that amorphous zirconia progressively transforms to a high‐density amorphous phase with the application of pressure. The average coordination number of Zr and O atoms under pressure rises gradually to 8 and 4, respectively. The main building unit of the dense noncrystalline state is the eightfold‐coordinated Zr atoms (62.5%). When the coordinated modification of Zr atoms in the zirconia crystal at high pressure and temperature conditions is considered, it can be perceived that amorphous zirconia follows a transformation mechanism similar to the one observed at high temperature but different than the one detected at high pressure. The dense disordered phase is indeed found to be locally comparable with the high‐temperature tetragonal crystal. Upon decompression, some high‐pressure arrangements are persevered in the model and a transformation into another amorphous state whose structure is intermediate between uncompressed and dense amorphous phases is observed in the simulations. The high‐pressure amorphous structures are found to be semiconductors with a band gap smaller than that of the original model.
Economic values and selection index in different Angus‐Nellore cross‐bred production systems
Authors: Fernandes G.M. , Savegnago R.P. , El Faro L. , Mosaquatro Roso V. , de Paz C.C.P.
Published: May 2018

Bioeconomic models were developed to calculate economic values (EV) for economically important traits in beef cattle, to evaluate the impact of these traits on production profitability, to assess possible market changes with a payment system and to develop economic selection indexes for Angus cattle for two production systems. Two beef cattle production systems were simulated as follows: a cow‐calf cycle (CC) and a complete cycle (CoC). Following selection, positive changes in the EV were observed. In the CC, each 1.0% increment in weaning weight (WW), weaning rate (WR) and pregnancy rate (PR) resulted in increases in US$ 1.30, US$ 3.68 and US$ 3.55 per cow/year in profit, respectively. In the CoC, EV of US$ 1.01, US$ 1.79, US$ 1.19, US$ 1.34, US$ 6.84 and US$ 7.86 per cow/year were obtained for WW, year weight, yearling weight, final weight, WR and PR, respectively. The payment system for carcass quality showed that the scenario considering that 100% of the animals displayed uniform carcasses exhibited the highest EV and was considered optimal. Considering the sensitivity analysis, the price paid per animal was the factor that most affected the EV in both systems. The selection indexes obtained may be used in similar production systems, and the use of EV and selection indexes are important tools for any production system with positive change in profit after selection.
CRISPR/Cas9‐mediated gene knockout for DNA methyltransferase Dnmt3a in CHO cells displays enhanced transgenic expression and long‐term stability
Authors: Jia Yan‐Long , Guo Xiao , Lu Jiang‐Tao , Wang Xiao‐Yin , Qiu Le‐Le , Wang Tian‐Yun
Published: May 2018

CHO cells are the preferred host for the production of complex pharmaceutical proteins in the biopharmaceutical industry, and genome engineering of CHO cells would benefit product yield and stability. Here, we demonstrated the efficacy of a Dnmt3a‐deficient CHO cell line created by CRISPR/Cas9 genome editing technology through gene disruptions in Dnmt3a, which encode the proteins involved in DNA methyltransferases. The transgenes, which were driven by the 2 commonly used CMV and EF1α promoters, were evaluated for their expression level and stability. The methylation levels of CpG sites in the promoter regions and the global DNA were compared in the transfected cells. The Dnmt3a‐deficent CHO cell line based on Dnmt3a KO displayed an enhanced long‐term stability of transgene expression under the control of the CMV promoter in transfected cells in over 60 passages. Under the CMV promoter, the Dnmt3a‐deficent cell line with a high transgene expression displayed a low methylation rate in the promoter region and global DNA. Under the EF1α promoter, the Dnmt3a‐deficient and normal cell lines with low transgene expression exhibited high DNA methylation rates. These findings provide insight into cell line modification and design for improved recombinant protein production in CHO and other mammalian cells.
NEDD4‐induced degradative ubiquitination of phosphatidylinositol 4‐phosphate 5‐kinase α and its implication in breast cancer cell proliferation
Authors: Tran Mai Hoang , Seo Eunjeong , Min Soohong , Nguyen Quynh‐Anh T. , Choi Juyong , Lee Uk‐Jin , Hong Soon‐Sun , Kang Hyuk , Mansukhani Alka , Jou Ilo , Lee Sang Yoon
Published: May 2018

Phosphatidylinositol 4‐phosphate 5‐kinase (PIP5K) family members generate phosphatidylinositol 4,5‐bisphosphate (PIP2), a critical lipid regulator of diverse physiological processes. The PIP5K‐dependent PIP2 generation can also act upstream of the oncogenic phosphatidylinositol 3‐kinase (PI3K)/Akt pathway. Many studies have demonstrated various mechanisms of spatiotemporal regulation of PIP5K catalytic activity. However, there are few studies on regulation of PIP5K protein stability. Here, we examined potential regulation of PIP5Kα, a PIP5K isoform, via ubiquitin‐proteasome system, and its implication for breast cancer. Our results showed that the ubiquitin ligase NEDD4 (neural precursor cell expressed, developmentally down‐regulated gene 4) mediated ubiquitination and proteasomal degradation of PIP5Kα, consequently reducing plasma membrane PIP2 level. NEDD4 interacted with the C‐terminal region and ubiquitinated the N‐terminal lysine 88 in PIP5Kα. In addition, PIP5Kα gene disruption inhibited epidermal growth factor (EGF)‐induced Akt activation and caused significant proliferation defect in breast cancer cells. Notably, PIP5Kα K88R mutant that was resistant to NEDD4‐mediated ubiquitination and degradation showed more potentiating effects on Akt activation by EGF and cell proliferation than wild‐type PIP5Kα. Collectively, these results suggest that PIP5Kα is a novel degradative substrate of NEDD4 and that the PIP5Kα‐dependent PIP2 pool contributing to breast cancer cell proliferation through PI3K/Akt activation is negatively controlled by NEDD4.
Patient education strategies in cataract surgery: A systematic review
Authors: Choi Ariel R. , Greenberg Paul B.
Published: May 2018

Objective

To systematically review the comparative effectiveness of patient education strategies in cataract surgery.

Methods

A comprehensive literature search of five electronic databases was conducted for randomized controlled trials (RCTs) studying the efficacy of educational interventions for cataract surgery patients. Peer‐reviewed articles published in English were considered for inclusion without restriction limits on publication date. General study characteristics, measurement methodologies, and outcome measures were narratively synthesized. Quality appraisal was conducted using the Oxford quality rating system (for individual studies) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines (for bodies of evidence).

Results

Sixteen RCTs were compiled for qualitative review. We identified 21 distinct patient outcomes, four (19%) with a multi‐study evidence base: knowledge of cataracts/cataract surgery, knowledge of postoperative care, proficiency in postoperative care, and anxiety. Targeted interventions significantly increased educational efficacy in 11 (69%) studies, but there were consistent improvements only for patient understanding of cataracts/cataract surgery and postoperative care. Quality of evidence was poor for all outcomes examined in multiple studies, as well as for deciding to undergo cataract surgery (measured in one study). Cross‐study examination revealed appreciable clinical and methodological heterogeneity.

Conclusions

Targeted interventions fostered patients’ understanding of cataract surgery and postoperative care. Additional high‐quality studies are needed to determine appropriate educational strategies that improve other clinical, performance, and humanistic outcomes.
Inconsistency prevents the valuable synergism of explanatory and pragmatic trails
Authors: Correia Luis C. L. , Correia Vitor C. A. , Souza Thiago M. B. , Cerqueira Antonio Maurício S , Alexandre Felipe K. B. , Garcia Guilherme , Ferreira Felipe R. M. , Lopes Fernanda O. A.
Published: May 2018

Objective

To assess review articles on pragmatic trials in order to describe how authors define the aim of this type of study, how comprehensive methodological topics are covered, and which topics are most valued by authors.

Methods

Review articles were selected from Medline Database, based on the expression “pragmatic trial” in the titles. Five trained medical students evaluated the articles, based on a list of 15 self‐explanatory methodological topics. Each article was evaluated regarding topics covered. Baseline statements on the aim of pragmatic trials were derived.

Results

Among 22 articles identified, there was general agreement that the aim of a pragmatic trial is to evaluate if the intervention works under real‐world conditions. The mean number of methodological topics addressed by each article was 7.6 ± 3.1. Only one article covered all 15 topics, three articles (14%) responded to at least 75% of topics and 13 articles (59%) mentioned at least 50% of the topics. The relative frequency each of the 15 topics was cited by articles had a mean of 50% ± 25%. No topic was addressed by all articles, only three (20%) were addressed by more than 75% of articles.

Conclusions

There is agreement on the different aims of explanatory and pragmatic trials. But there is a large variation on methodological topics used to define a pragmatic trial, which led to inconsistency in defining the typical methodology of a pragmatic trial.
From wholes to fragments to wholes—what gets lost in translation?
Authors: Kirkengen Anna Luise
Published: May 2018

The highly demanding and, in a certain sense, unique, working conditions of general practitioners (GPs) are characterized by two phenomena: First, they involve an increasing familiarity with individual patients over time, which promotes a deepening of insight. Second, they enable the GP to encounter all kinds of health problems, which in turn facilitates pattern recognition, at both individual and group levels, particularly the kind of patterns currently termed “multimorbidity.” Whereas the term “comorbidity” is used to denote states of bad health in which 1 disease is considered to predate and evoke other ailments or diseases, the term multimorbidity is applied when finding several presumably separate diseases in a person who suffers from them either sequentially or simultaneously. Encounters with patients whose suffering fits the biomedical concept and terminology of multimorbidity are among the most common which GPs face, presenting them with some of their most demanding tasks. The term multimorbidity needs to be examined, however. As it alludes to a multiplicity of diseases, it rests on an assumption of separateness of states of bad health that might not be well founded. An adequate determination of what to deem a “separate” state of bad health would require that the biomedical concept of causation be scrutinized.
New microwave ablation system for unresectable liver tumors that forms large, spherical ablation zones
Authors: Imajo Kento , Tomeno Wataru , Kanezaki Mineo , Honda Yasushi , Kessoku Takaomi , Ogawa Yuji , Yoshida Keisuke , Yoneda Masato , Kirikoshi Hiroyuki , Ono Masafumi , Kaneta Tomohiro , Inoue Tomio , Teratani Takuma , Saito Satoru , Nakajima Atsushi
Published: May 2018

Background and Aim

The aim of this study was to assess the efficacy of a new microwave ablation (MWA) system, the Emprint Ablation System, for the ablation of unresectable large liver tumors (≥ 30 mm).

Methods

Twenty‐one hepatic tumors (mean diameter, 34.7 mm) from 21 patients who underwent percutaneous MWA were included in this cross‐sectional study. A volume analyzer based on computed tomography imaging was used for all patients within the month before and month after the procedure to evaluate the shape and volume of ablation zones. In addition, computed tomography imaging was performed again 3 months after the procedure to evaluate the presence of residual tumors and local recurrence.

Results

Mean ablation time was 11.3 min, and mean overall procedure time was 33.4 min. An ablated adrenal gland‐induced Takotsubo (stress) cardiomyopathy occurred immediately after MWA as a major complication in one patient. Roundness index A, B, and C presented a mean value of 0.94, 0.94, and 1.01, respectively (all values near 1 is a perfect sphere), indicating that a spherical ablation zone was achieved. The mean ablation volume was larger than the volume of tumors (24.5 vs 41.7 cm3). Residual tumors were confirmed in only 4.8% of tumors after a single ablation session. There was no local recurrence.

Conclusions

In our experience, the new MWA system provides an effective treatment option for unresectable large liver tumors. However, to ablate the liver tumors safely, it is necessary to consider the surrounding organs, such as the adrenal glands.
Comparison of retrievable stents and permanent stents for Budd–Chiari syndrome due to obstructive inferior vena cava
Authors: Bi Yonghua , Chen Hongmei , Ding Pengxu , Ren Jianzhuang , Han Xinwei
Published: May 2018

Background and Aim

The aim of this study is to compare long‐term outcomes of retrievable stents (RSs) and permanent stents (PSs) for Budd–Chiari syndrome (BCS) due to long‐segment obstructive inferior vena cava (IVC).

Methods

Between July 2000 and August 2016, 42 patients with BCS due to long‐segment obstructive IVC were treated with RSs, and 41 patients were treated with PSs. The RSs were removed eventually after thrombus disappeared. Patients were subsequently followed up by color Doppler sonography or computed tomography scanning.

Results

All RS placements were successful, and 37 RSs were retrieved 8 to 29 days later. Forty‐two stents were implanted in PS group. One failure retrieval of RSs occurred, and two failures of cannulations were found in PS group. Two deaths may be procedure related and died from acute pulmonary thromboembolism perioperatively. One patient developed acute cerebral infarction and recovered after treatment. In PS group, minor complications were found in three patients. The length of IVC lesion segment and length and thickness of IVC thrombus decreased significantly, and diameter of retrocaval IVC and diaphragm IVC increased significantly in both groups. During follow‐up, three patients died from liver failure in RS group, and two patients died in PS group. RS group showed a significantly higher primary patency rate than PS group. Cumulative 1‐, 3‐, and 5‐year secondary patency rates were 95.2%, 89.6%, and 89.6% in RS group and 100%, 96.6%, and 96.6% in PS group (P = 0.7109).

Conclusions

Retrievable stents are effective for BCS because of long‐segment obstructive IVC, with a higher primary patency rate.
Factors influencing nurses’ knowledge acquisition of diabetes care and its management: A qualitative study
Authors: Alotaibi Abdulellah , Gholizadeh Leila , Al‐Ganmi Ali Hussein Alek , Perry Lin
Published: May 2018

Aim

To identify and explore the factors nurses perceive as influencing their knowledge acquisition in relation to diabetes care and its management in Saudi Arabia.

Background

Diabetes continues to pose major healthcare challenges despite advances in diabetes management. Nurses have a crucial role in diabetes care, but diabetes knowledge deficits deter effective collaboration with other healthcare providers in educating patients about diabetes self‐management.

Design

An exploratory descriptive qualitative design.

Method

This qualitative study recruited 16 nurses from different specialty areas at a tertiary hospital in Saudi Arabia. Data were obtained through semistructured interviews and analysed using thematic analysis.

Results

Three main themes emerged: (a) diabetes care and education, (b) barriers affecting nurses’ acquisition of diabetes knowledge and (c) factors to support nurses’ acquisition of diabetes knowledge.

Conclusion

To pursue the goal of continued improvement in diabetes management in the challenging settings of acute care, there is a need to develop good practice in diabetes care among nursing professionals. Understanding of the complexity of factors that influence nurses’ knowledge acquisition in relation to diabetes care and its management provides clinical nurses and nursing managers with directions for future education, policy development and research.

Relevance to clinical practice

A range of suggestions are proposed to support the development of nursing education and practice in diabetes, including organisational and individual‐level strategies to offer and enable access to education programmes to maintain up‐to‐date knowledge and skills in diabetes and effective communication for optimal diabetes self‐management.
Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta‐analysis
Authors: Bueno C. H. , Pereira D. D. , Pattussi M. P. , Grossi P. K. , Grossi M. L.
Published: May 2018

The objective of this study was to systematically evaluate gender differences in the prevalence of TMD. A systematic review was performed in PubMed, EMBASE, Web of Science and LILACS in duplicate by two independent reviewers. The inclusion criteria were cross‐sectional studies that reported the prevalence of TMD for men and women and that used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I group diagnostic criteria:(group I = muscle disorders; group II = disc displacements; group III = arthralgias/arthritis/arthrosis).To be eligible for inclusion, studies must include adult individuals (>18 years) from a non‐clinical population (ie without pre‐diagnosis of TMD); in other words, from population‐based studies. There were no restrictions on the year and language of publication. The quality of the articles was assessed by an adapted version of the Newcastle‐Ottawa Scale(NOS), and the publication bias was assessed by a funnel plot graph. Data were quantitatively analysed by meta‐analysis using odds ratio (OR) as the measure effect. The electronic search retrieved a total of 6104 articles, of which 112 articles were selected for full‐text reading according to the eligibility criteria. By means of manual search, one study was retrieved. Five articles were selected for meta‐analysis with a combined sample of 2518 subjects. Women had higher prevalence of TMD in all RDC/TMD diagnostic groups. The meta‐analysis yielded the following results: (a) OR = 2.24 for global TMD (groups I, II and III combined), (b) OR = 2.09 for group I, (c) OR = 1.6 for group II and (d) OR = 2.08 for group III. The importance of gender in the development of TMD has been demonstrated, with a two times greater risk of women to develop it as compared to men.
Frontier Kantianism: Autonomy and Authority in Ralph Waldo Emerson and Joseph Smith
Authors: Davis Ryan W.
Published: May 2018

Ralph Waldo Emerson is often seen as the early American prophet of autonomy. This essay suggests a perhaps surprising fellow traveler in this prophetic call: Joseph Smith. Smith opposed religious creeds for the same reason that Emerson denounced them, namely that creeds represent a threat to the autonomy of a person's beliefs. Smith and Emerson also forward similar defenses of individual autonomy in action. Furthermore, they encounter a shared problem: how can autonomy be possible in a society where other individuals hold some kind of authority? I propose that each thinker resolves this tension through an insight with a Kantian echo. A suitably qualified version of authority can sometimes count as an expression of, rather than hindrance to, autonomy. I describe the overlap in Emerson and Smith as a “frontier” version of Kantianism. They favor determining one's own beliefs and actions in a way that looks forward to an open future of possibility.
Point‐of‐care lung ultrasound in paediatric critical and emergency care
Authors: Dominguez Anna , Gaspar Heloisa A , Preto Marcela , Ejzenberg Fernanda E
Published: May 2018

Ultrasound techniques have been developed since the past century and are becoming more useful in different areas of medical knowledge. More recently, lung ultrasound gained importance throughout artefacts analysis to help clinical evaluation at bedside and became subject of interest in the paediatric intensive care and emergency department settings for both procedural and diagnostic purposes. The normal pattern of lung ultrasound is defined by the presence of lung sliding associated with A‐lines whereas B‐lines may be representative of pathologic findings. This review focuses on some of the most common pulmonary conditions, their respective sonographic features and clinical implications in the emergency department and paediatric intensive care unit.
Poly(ethylene carbonate)-containing polylactic acid microparticles with rifampicin improve drug delivery to macrophages
Authors: Priemel Petra A , Wang Yingya , Bohr Adam , Water Jorrit J , Yang Mingshi , Mørck Nielsen Hanne
Published: May 2018

Objective

Pulmonary delivery of antibiotics will decrease the required dose for efficient treatment of lung infections and reduce systemic side effects of the drug. The objective was to evaluate the applicability of poly(ethylene carbonate) (PEC) for the preparation of inhalable, antibiotic-containing particles.

Methods

Rifampicin (RF)-loaded microparticles were prepared by electrospraying a carrier matrix of polylactic acid (PLA) with 0%, 5% and 10% PEC.

Key findings

Prepared particles had an aerodynamic diameter between 4 and 5 μm. Within 60 min, PEC-containing particles released 35–45% of RF, whereas PLA particles released only 15% of RF. Irrespective of particle composition, uptake of RF by macrophages was improved to 40–60% when formulated in microparticles compared to 0.4% for RF in solution, and intracellular localisation of particles was confirmed using confocal microscopy. Effect on macrophage and alveolar cell viability was similar for all particles whereas the minimal inhibitory concentrations against Pseudomonas aeruginosa and Escherichia coli for RF-containing PEC particles were twofold lower than for PLA particles, explained by the faster release of RF from PEC-containing particles.

Conclusions

The inclusion of PEC in PLA microparticles increased the release of RF and the inhibitory effect against two bacteria species while displaying physical particle properties similar to PLA particles.
Anti‐inflammatory character of Phelligridin D modulates periodontal regeneration in lipopolysaccharide‐induced human periodontal ligament cells
Authors: Kim J.‐E. , Takanche J.‐S. , Yun B.‐S. , Yi H.‐K.
Published: May 2018

Background and Objective

Phelligridin D is a hispidin analogue from the mushroom Phellinus baumii that is widely used as a food source in East Asia. This study tested phelligridin D for the anti‐inflammatory effect and mechanism in lipopolysaccharide (LPS)‐induced human periodontal ligament cells (HPDLCs). The objective of this study was to clarify whether the anti‐inflammatory function of phelligridin D affects periodontal regeneration for supporting the HPDLCs of teeth.

Material and Methods

Primary HPDLCs were isolated from healthy teeth and then cultured. The anti‐inflammatory function, mechanism and differentiation molecules were verified with reactive oxygen species generation and western blot analysis in LPS‐induced HPDLCs.

Results

HPDLCs showed increased inflammatory molecules (intracellular adhesion molecule‐1 and vascular cell adhesion molecule‐1) and decreased osteogenic proteins (bone morphogenetic protein‐7, Osterix and runt‐related transcription factor 2) by LPS treatment. Phelligridin D decreased inflammatory molecules and increased osteogenic molecules via downregulation of the extracellular signal‐regulated kinase and c‐jun N‐terminal kinases pathway among the mitogen‐activated protein kinase, followed by blocking of nuclear factor kappa‐B translocation from cytosol to nucleus. In addition, phelligridin D showed antioxidant properties by reducing reactive oxygen species activity. Finally, the anti‐inflammatory and antioxidant function of phelligridin D promoted the periodontal differentiation of HPDLCs.

Conclusion

These results suggest that phelligridin D supports teeth on the alveolar bone against outside stress, and may be used as an anti‐inflammatory compound for the prevention of periodontitis or periodontal regenerative related disease.
Real‐world effectiveness of elbasvir/grazoprevir In HCV‐infected patients in the US veterans affairs healthcare system
Authors: Kramer J. R. , Puenpatom A. , Erickson K. F. , Cao Y. , Smith D. , El‐Serag H. B. , Kanwal F.
Published: May 2018

Elbasvir/grazoprevir (EBR/GZR) is an all‐oral direct‐acting antiviral agent (DAA) with high sustained virologic response (SVR) in clinical trials. This study's primary objective was to evaluate effectiveness of EBR/GZR among HCV‐infected patients in a real‐world clinical setting. We conducted a nationwide retrospective observational cohort study of HCV‐infected patients in the US Department of Veterans Affairs (VA) using the VA Corporate Data Warehouse. The study population included patients with positive HCV RNA who initiated EBR/GZR from February 1 to August 1, 2016. We calculated the 95% confidence interval for binomial proportions for SVR overall and by demographic subgroups. Clinical and demographic characteristics were also evaluated. We included 2436 patients in the study cohort. Most were male (96.5%), African American (57.5%), with mean age of 63.5 (SD = 5.9) and 95.4% infected with genotype (GT) 1 [GT1a (34.7%), GT1b (58.6%)]. Other comorbidities included diabetes (53.2%), depression (57.2%) and HIV (3.0%). More than 50% had history of drug or alcohol abuse (53.9% and 60.5%, respectively). 33.2% of the cohort had cirrhosis. A total of 95.6% (2,328/2,436; 95% CI: 94.7%‐96.4%) achieved SVR. The SVR rates by subgroups were: male, 95.5% (2245/2350); female, 96.5% (83/86); GT1a, 93.4%, GT1b, 96.6%, GT4, 96.9%, African American, 95.9% (1,342/1,400); treatment‐experienced, 96.3% (310/322); cirrhosis, 95.6% (732/766); stage 4‐5 CKD, 96.3% (392/407); and HIV, 98.6% (73/74). SVR rates were high overall and across patient subgroups regardless of gender, race/ethnicity, cirrhosis, renal impairment or HIV. This study provided important data regarding the effectiveness of EBR/GZR in a large clinical setting.
Comparison of effectiveness and discontinuation of interferon‐free therapy for hepatitis C in prison inmates and noninmates
Authors: Marco A. , Roget M. , Cervantes M. , Forné M. , Planella R. , Miquel M. , Ortiz J. , Navarro M. , Gallego C. , Vergara M. ,   In and Out of Prison Study Group
Published: May 2018

Chronic hepatitis C treatment with direct acting antiviral (DAA) therapy during incarceration is an attractive option, due to its short duration and to the possibility of directly observed treatment or supervision. The aim of this study is to compare the effectiveness and rates of discontinuation of DAA treatment in prisoners and nonprisoners. We studied all patients treated in the 10 prisons of Catalonia and at 3 public hospitals in the Barcelona area between 1 January 2015 and 30 April 2016. We analysed sustained viral response (SVR) and rates of discontinuation through intention‐to‐treat and modified‐intention‐to‐treat analyses, the latter excluding discontinuations due to release from prison. One hundred and eighty‐eight inmates and 862 noninmates were included. Prisoners were significantly younger than nonprisoners, with higher proportions of men, drug users, HIV infection, genotypes 1a and 3 and more treatment with psychiatric drugs. Overall, 98.4% of patients completed treatment. The discontinuation rate was low, but higher in inmates (3.7% vs 1.2% noninmates; P = .003) and in community patients >65 years old (2.8% vs 1.2% in under 65 seconds; P = .008). Among the inmates, 7 (42.8%) discontinuations were due to release. SVR was 93.1% in inmates vs 96.5% in noninmates (P = .08) by intention‐to‐treat and 95.1% vs 96.5% (P = .37) by modified intention‐to‐treat. Virologic failure rates were similar (3.8% vs 3% in noninmates; P = .60). SVR, virologic failure and discontinuation rates were similar in inmates and noninmates. Currently, prisons are considered a priority for the implementation of DAA. Improved coordination between penitentiary and community health systems would help to ensure therapeutic continuity in released prisoners.
Safety and efficacy of vesatolimod (GS‐9620) in patients with chronic hepatitis B who are not currently on antiviral treatment
Authors: Agarwal K. , Ahn S. H. , Elkhashab M. , Lau A. H. , Gaggar A. , Bulusu A. , Tian X. , Cathcart A. L. , Woo J. , Subramanian G. M. , Andreone P. , Kim H. J. , Chuang W. L. , Nguyen M. H.
Published: May 2018

Vesatolimod is an oral agonist of toll‐like receptor 7 designed to minimize systemic exposure and side effects. We assessed the safety and efficacy of vesatolimod in viremic chronic hepatitis B (CHB) patients not currently on oral antiviral treatment (OAV) in a phase 2, multicentre, double‐blind, randomized, placebo‐controlled study. A total of 192 patients stratified by HBeAg status and alanine aminotransferase level were randomized 2:2:2:1 to receive oral vesatolimod (1‐, 2‐ or 4‐mg) or placebo once weekly for 12 weeks; tenofovir disoproxil fumarate (300‐mg daily) was administered daily for 48 weeks. Efficacy was assessed by quantitative serum HBsAg decline at Week 24 from baseline. In addition to safety assessments, changes in whole‐blood interferon‐stimulated gene (ISG) transcripts and serum cytokines were explored. Most patients were male (64.1%) and HBeAg‐negative (60.9%) at baseline. Among vesatolimod‐treated patients, most (60.4%‐69.1%) experienced ≥1 treatment‐emergent adverse event; the majority were mild or moderate in severity. No clinically meaningful differences in HBsAg changes from baseline were observed between treatment groups. No patients experienced HBsAg loss, while 3 patients experienced HBeAg loss and hepatitis B e‐antibody seroconversion at week 48. HBV DNA suppression rates were similar across all treatment arms at Week 24. ISG15 induction was dose‐dependent and did not correlate with HBsAg changes. A small proportion of patients exhibited dose‐dependent interferon‐α induction that correlated with grade of influenza‐like adverse events. Overall, vesatolimod is safe and well tolerated in CHB patients. Although consistent dose‐dependent pharmacodynamic induction of ISGs was demonstrated, it did not result in clinically significant HBsAg decline.