bluuebunny/crossref_metadata_2025 huggingface dataset:
A 3D musculoskeletal model of the western lowland gorilla hind limb: moment arms and torque of the hip, knee and ankle
Authors: Goh Colleen , Blanchard Mary L. , Crompton Robin H. , Gunther Michael M. , Macaulay Sophie , Bates Karl T.
Published: July 2017

Three‐dimensional musculoskeletal models have become increasingly common for investigating muscle moment arms in studies of vertebrate locomotion. In this study we present the first musculoskeletal model of a western lowland gorilla hind limb. Moment arms of individual muscles around the hip, knee and ankle were compared with previously published data derived from the experimental tendon travel method. Considerable differences were found which we attribute to the different methodologies in this specific case. In this instance, we argue that our 3D model provides more accurate and reliable moment arm data than previously published data on the gorilla because our model incorporates more detailed consideration of the 3D geometry of muscles and the geometric constraints that exist on their lines‐of‐action about limb joints. Our new data have led us to revaluate the previous conclusion that muscle moment arms in the gorilla hind limb are optimised for locomotion with crouched or flexed limb postures. Furthermore, we found that bipedalism and terrestrial quadrupedalism coincided more regularly with higher moment arms and torque around the hip, knee and ankle than did vertical climbing. This indicates that the ability of a gorilla to walk bipedally is not restricted by musculoskeletal adaptations for quadrupedalism and vertical climbing, at least in terms of moment arms and torque about hind limb joints.
A forgotten history, a marginalized community: Biographical narratives of Ethiopian Jews, former activists in underground organizations during the civil war in Ethiopia, 1974–1991
Authors: Ratner David
Published: July 2017

Despite a proliferation of studies concerning Ethiopian Jews (formerly known as “Beta Israel”) and their lives while still in Ethiopia, a topic that has not been studied enough is their lives during the turbulent period of the 1974 revolution and the civil war that followed (ending 1991). According to most existing (Israeli) literature, this group was completely cut off from these events, or at most passively affected by them.

The present study, based on 17 in‐depth interviews with Ethiopian‐born Israelis, shows that some members of the community were indeed deeply involved in these historical events, as political activists and/or military rebels in one of two major political parties: the TPLF and the EPRP. After a short historical introduction, the study discusses the central themes that emerged from the interviews: (1) the interviewees' deep identification with universal and contemporary ideology, (2) their deep solidarity with Ethiopia and with the organizations they belonged to, (3) abandonment of revolutionary ideology and politics after arrival in Israel.

The central argument in the concluding part is that this chapter in the community's history was forgotten because it did not accord with the Ethiopian Jews' intended role as reinforcement of the official Zionist narrative of the negation of exile. This oblivion meant that the community was constructed in the Israeli public imagination as pre‐modern, detached from modern ideologies and characterized by a very limited worldview.
Role of FDG‐PET/MRI, FDG‐PET/CT, and Dynamic Susceptibility Contrast Perfusion MRI in Differentiating Radiation Necrosis from Tumor Recurrence in Glioblastomas
Authors: Hojjati Mojgan , Badve Chaitra , Garg Vasant , Tatsuoka Curtis , Rogers Lisa , Sloan Andrew , Faulhaber Peter , Ros Pablo R. , Wolansky Leo J.
Published: July 2017

BACKGROUND AND PURPOSE

To compare the utility of quantitative PET/MRI, dynamic susceptibility contrast (DSC) perfusion MRI (pMRI), and PET/CT in differentiating radiation necrosis (RN) from tumor recurrence (TR) in patients with treated glioblastoma multiforme (GBM).

METHODS

The study included 24 patients with GBM treated with surgery, radiotherapy, and temozolomide who presented with progression on imaging follow‐up. All patients underwent PET/MRI and pMRI during a single examination. Additionally, 19 of 24 patients underwent PET/CT on the same day. Diagnosis was established by pathology in 17 of 24 and by clinical/radiologic consensus in 7 of 24. For the quantitative PET/MRI and PET/CT analysis, a region of interest (ROI) was drawn around each lesion and within the contralateral white matter. Lesion to contralateral white matter ratios for relative maximum, mean, and median were calculated. For pMRI, lesion ROI was drawn on the cerebral blood volume (CBV) maps and histogram metrics were calculated. Diagnostic performance for each metric was assessed using receiver operating characteristic curve analysis and area under curve (AUC) was calculated.

RESULTS

In 24 patients, 28 lesions were identified. For PET/MRI, relative mean ≥ 1.31 resulted in AUC of .94 with both sensitivity and negative predictive values (NPVs) of 100%. For pMRI, CBV max ≥3.32 yielded an AUC of .94 with both sensitivity and NPV measuring 100%. The joint model utilizing r‐mean (PET/MRI) and CBV mode (pMRI) resulted in AUC of 1.0.

CONCLUSION

Our study demonstrates that quantitative PET/MRI parameters in combination with DSC pMRI provide the best diagnostic utility in distinguishing RN from TR in treated GBMs.
Melatonin inhibits nucleus pulposus (NP) cell proliferation and extracellular matrix (ECM) remodeling via the melatonin membrane receptors mediated PI3K‐Akt pathway
Authors: Li Zheng , Li Xingye , Chen Chong , Chan Matthew T. V. , Wu William Ka Kei , Shen Jianxiong
Published: July 2017

Pinealectomy in vertebrates accelerated intervertebral disk degeneration (IDD). However, the potential mechanisms, particularly melatonin's role, are still to be clarified. In this study, for first time, melatonin membrane receptors of MT1 and MT2 were found to be present in the human intervertebral disk tissues and nucleus pulposus (NP) cells, respectively. Melatonin treatment significantly inhibited NP cell proliferation in dose‐dependent manner. Accordingly, melatonin down‐regulated gene expression of cyclin D1, PCNA, matrix metallopeptidase‐3, and matrix metallopeptidase‐9 and upregulated gene expression of collagen type II alpha 1 chain and aggrecan in NP cells. These effects of melatonin were blocked by luzindole, a nonspecific melatonin membrane receptor antagonist. Signaling pathway analysis indicated that in the intervertebral disk tissues and NP cells, melatonin acted on MT1/2 and subsequently reduced phosphorylation of phosphoinositide 3‐kinase p85 regulatory subunit, phosphoinositide‐dependent kinase‐1, and Akt. The results indicate that melatonin is a crucial regulator of NP cell function and plays a vital role in prevention of IDD.
Static cerebrovascular pressure autoregulation remains intact during deep hypothermia
Authors: Goswami Dheeraj , McLeod Katherine , Leonard Samantha , Kibler Kathleen , Easley Ronald Blaine , Fraser Charles D. , Andropoulos Dean , Brady Ken
Published: July 2017

Background

Clinical studies measuring cerebral blood flow in infants during deep hypothermia have demonstrated diminished cerebrovascular pressure autoregulation. The coexistence of hypotension in these cohorts confounds the conclusion that deep hypothermia impairs cerebrovascular pressure autoregulation.

Aim

We sought to compare the lower limit of autoregulation and the static rate of autoregulation between normothermic and hypothermic piglets.

Methods

Twenty anesthetized neonatal piglets (5‐7 days old; 10 normothermic and 10 hypothermic to 20°C) had continuous measurements of cortical red cell flux using laser Doppler flowmetry, while hemorrhagic hypotension was induced without cardiopulmonary bypass. Lower limit of autoregulation was determined for each subject using piecewise regression and SRoR was determined above and below each lower limit of autoregulation as (%change cerebrovascular resistance/%change cerebral perfusion pressure).

Results

The estimated difference in lower limit of autoregulation was 1.4 mm Hg (lower in the hypothermic piglets; 95% C.I. −10 to 14 mm Hg; P=0.6). The median lower limit of autoregulation in the normothermic group was 39 mm Hg [IQR 38‐51] vs 35 mm Hg [31‐50] in the hypothermic group. Intact steady‐state pressure autoregulation was defined as static rate of autoregulation >0.5 and was demonstrated in all normothermic subjects (static rate of autoregulation=0.72 [0.65‐0.87]) and in 9/10 of the hypothermic subjects (static rate of autoregulation=0.65 [0.52‐0.87]). This difference in static rate of autoregulation of 0.06 (95% C.I. −0.3 to 0.1) was not significant (P=0.4).

Conclusion

Intact steady‐state cerebrovascular pressure autoregulation is demonstrated in a swine model of profound hypothermia. Lower limit of autoregulation and static rate of autoregulation were similar in hypothermic and normothermic subjects.
Cardiometabolic risks vary by weight status in pediatric kidney and liver transplant recipients: A cross‐sectional, single‐center study in the USA
Authors: He S. , Le N. A. , Frediani J. K. , Winterberg P. D. , Jin R. , Liverman R. , Hernandez A. , Cleeton R. L. , Vos M. B.
Published: July 2017

There is an increasing need to understand long‐term metabolic changes and resultant comorbidities because life expectancy is increasing after pediatric kidney and liver transplants. We evaluated differences in classic and novel cardiometabolic biomarkers among obese and normal weight adolescent transplant recipients. We enrolled a total of 80 adolescent (mean±SD, 14.8 years ±3.0) transplant recipients (63 kidney, 17 liver) with mean duration from transplantation of 6.0 (±4.1) years. Among kidney transplant recipients, overweight and obese individuals had higher leptin (16.7 vs 7.5 μg/mL, P<.001), lower HDL (1.1 vs 1.3 mmol/L, P=.02), higher free fatty acid (0.6 vs 0.5 mmol/L, P=.03), higher apoB‐to‐apoA1 ratio (0.8 vs 0.6, P=.03), and higher glucose (5.8 vs 4.3 mmol/L, P=.03) concentrations compared to normal weight individuals. Regardless of obesity status, over half of all participants (57.5%) were considered at high cardiometabolic risk using consensus guidelines, and this was more pronounced for kidney transplant recipients (61.9%). Post‐transplantation adolescents have increased cardiometabolic risk characterized by traditional risk factors of obesity and diabetes. The presence of obesity significantly worsens biomarkers of cardiometabolic risk. Future studies should explore whether treatment of obesity can improve the health and long‐term outcomes for children undergoing solid organ transplant.
Temperature responses of photosynthetic capacity parameters were not affected by foliar nitrogen content in mature Pinus sylvestris
Authors: Tarvainen Lasse , Lutz Martina , Räntfors Mats , Näsholm Torgny , Wallin Göran
Published: July 2017

A key weakness in current Earth System Models is the representation of thermal acclimation of photosynthesis in response to changes in growth temperatures. Previous studies in boreal and temperate ecosystems have shown leaf‐scale photosynthetic capacity parameters, the maximum rates of carboxylation (Vcmax) and electron transport (Jmax), to be positively correlated with foliar nitrogen (N) content at a given reference temperature. It is also known that Vcmax and Jmax exhibit temperature optima that are affected by various environmental factors and, further, that N partitioning among the foliar photosynthetic pools is affected by N availability. However, despite the strong recent anthropogenic influence on atmospheric temperatures and N deposition to forests, little is known about the role of foliar N contents in controlling the photosynthetic temperature responses. In this study, we investigated the temperature dependencies of Vcmax and Jmax in 1‐year‐old needles of mature boreal Pinus sylvestris (Scots pine) trees growing under low and high N availabilities in northern Sweden. We found that needle N status did not significantly affect the temperature responses of Vcmax or Jmax when the responses were fitted to a peaked function. If such N insensitivity is a common tree trait it will simplify the interpretation of the results from gradient and multi‐species studies, which commonly use sites with differing N availabilities, on temperature acclimation of photosynthetic capacity. Moreover, it will simplify modeling efforts aimed at understanding future carbon uptake by precluding the need to adjust the shape of the temperature response curves to variation in N availability.
Groundwater Citizenship and Water Supply Awareness: Investigating Water‐Related Infrastructure and Well Ownership
Authors: Ternes Brock
Published: July 2017

Due to increased demands for irrigation water, the availability of groundwater has been a growing problem in Kansas, where the future of the High Plains aquifer is in jeopardy. This article investigates the environmental stewardship of Kansas well owners, a key social group whose protection of water supplies is pivotal to prolonging groundwater formations. My guiding research question is: Does owning a well lead to a distinct form of citizenship? To answer this, I constructed one of the only data sets of well owners used in sociology by surveying 864 well owners and non–well owners throughout Kansas. My findings reveal that well owners are more aware of the state's water supplies than the general population, they express environmental motivations to conserve water, they deliberately conserve water more often than non–well owners, and well ownership is significantly correlated with highly ranking water security as a challenge facing Kansas. Furthermore, a majority of well owners check their well depth and test for water contamination, routines that connect them to their water supply. This suggests that well owners exhibit “groundwater citizenship” and can be conceptualized as aquifer stewards.
Mucosal‐associated Invariant Cells are Deficient in Systemic Sclerosis
Authors: Mekinian A. , Mahevas T. , Mohty M. , Jachiet V. , Rivière S. , Fain O. , Gaugler B.
Published: July 2017

Systemic sclerosis (SSc) is an autoimmune disease, characterized by fibrosis of the skin and other organs, vascular impairment and deficient immune responses. Mucosal‐associated invariant T cells (MAIT) have been involved in various inflammatory and autoimmune diseases. The aims of this study were to determine the frequencies of MAIT cells in the blood of patients with systemic sclerosis (SSc) and to compare their distribution in different types of SSc. Blood samples from patients with SSc and healthy controls were examined by flow cytometer to analyse the frequencies of MAIT and γδ T cells. We demonstrate that in SSc the frequencies and absolute numbers of MAIT and γδ T cells are significantly reduced in comparison with healthy controls. MAIT and γδ T cells did not correlate with C‐reactive protein, BNP, pulmonary involvement or median skin fibrosis scale, steroid amount or disease duration. In addition, MAIT and γδ T cells decrease did not stratify with gender, interstitial lung disease or active digital ulcers. Functional studies are necessary to determine the signification of MAIT cells decrease in systemic sclerosis.
Error rate of automated calculation for wound surface area using a digital photography
Authors: Yang S. , Park J. , Lee H. , Lee J. B. , Lee B. U. , Oh B. H.
Published: July 2017

Background

Although measuring would size using digital photography is a quick and simple method to evaluate the skin wound, the possible compatibility of it has not been fully validated.

Purpose

To investigate the error rate of our newly developed wound surface area calculation using digital photography.

Methods

Using a smartphone and a digital single lens reflex (DSLR) camera, four photographs of various sized wounds (diameter: 0.5‐3.5 cm) were taken from the facial skin model in company with color patches. The quantitative values of wound areas were automatically calculated. The relative error (RE) of this method with regard to wound sizes and types of camera was analyzed.

Results

RE of individual calculated area was from 0.0329% (DSLR, diameter 1.0 cm) to 23.7166% (smartphone, diameter 2.0 cm). In spite of the correction of lens curvature, smartphone has significantly higher error rate than DSLR camera (3.9431±2.9772 vs 8.1303±4.8236). However, in cases of wound diameter below than 3 cm, REs of average values of four photographs were below than 5%. In addition, there was no difference in the average value of wound area taken by smartphone and DSLR camera in those cases.

Conclusion

For the follow‐up of small skin defect (diameter: <3 cm), our newly developed automated wound area calculation method is able to be applied to the plenty of photographs, and the average values of them are a relatively useful index of wound healing with acceptable error rate.
The full‐length sequence of HLA‐B*59:01:01:01 confirmed by cloning and sequencing
Authors: Li Z. , Zou H.‐Y. , Zhou D.
Published: July 2017

The full‐length sequence of HLA‐B*59:01:01:01.
Identification of the HLA‐DQB1*06:123 allele in an unrelated stem cell donor from the Saudi Registry
Authors: Fakhoury H. A. , Alzahrani M. , Alaskar A. S. , Hajeer A. H.
Published: July 2017

HLA‐DQB1*06:123 differs from HLA‐DQB1*06:29 by six nucleotide substitutions resulting in five amino acid changes.
Continuous assessment in a new Testament survey course: Empirically informed reflections on an Australian trial
Authors: Hussey Ian
Published: July 2017

This article reports on a practitioner action research project focused on developing, trialing, and reflecting upon a continuous and formative‐assessment plan for a foundational New Testament survey course. Three pedagogical convictions are discussed and drive the design of the assessment. Seven to nine assessment items (depending on level of study) based on course learning outcomes and informed by Bloom's taxonomy of learning, were developed and implemented. Students provided feedback on the assessment through an anonymous online survey. The results demonstrate that students preferred continuous assessment to an exam and major essay, and that they better achieved the course learning outcomes. In conclusion, this style of assessment is effective in driving and assessing student learning and so provides a basis for further action reflection.
Conversation: The challenges of teaching in a “nano department”
Authors: Wagoner Bryan , Gummer Natalie , Rein Nathan , Thompson Curtis L. , Czander Giovanna , Peterfeso Jill , Pryor Adam
Published: July 2017

A panel at the 2016 American Academy of Religion conference staged, taped, transcribed, and edited this conversation about the challenges and opportunities of teaching in a “nano department” – an undergraduate religion or religious studies department (or combined religion and philosophy department) with only one, two, or three faculty members. Two things quickly become evident: one is the impossibility of coverage of the full religious studies curriculum, and the other is the necessity for collaboration with other departments. Neither of these is unique to nano departments, but there exists an intimacy between students and faculty in small departments, a necessary freedom to rethink the place of the study of religion in the liberal arts curriculum, and a disruptive value in what can be critiqued and contributed from a marginalized position. Arguably, nano departments are the canaries in the academic coal mine, charting the future of the humanities that cannot be discerned from the vantage point of Research‐1 contexts.
Decolonising geographical knowledges
Authors: Radcliffe Sarah A
Published: July 2017

This piece provides an overview of decolonising approaches for geographers unfamiliar with the field, first by examining some of the ways in which decolonial scholarship seeks to build on – and go beyond – postcolonialism. Developing these points, it turns to discuss what it means to think about decolonising geography at this particular political, institutional and historical conjuncture, examining the urgencies and challenges associated in this moment particularly for British geography. The introductory intervention then moves to examine how the remaining intervention pieces understand and address the theme of decolonial scholarship and geography.
Decolonial theory in a time of the re‐colonisation of UK research
Authors: Noxolo Patricia
Published: July 2017

This piece holds onto the foundation of the material conditions of the experience of Indigenous people out of which decolonial theory springs, first by exploring decolonial theory as it re‐shapes practice globally, and second by recognising how radical power risks becoming harnessed and domesticated in Western academic spaces. Finally, it suggests that the Global Challenges Research Fund is not fertile ground for truly decolonising geographical knowledge in the UK.
Quantification of nasal airflow resistance in English bulldogs using computed tomography and computational fluid dynamics
Authors: Hostnik Eric T. , Scansen Brian A. , Zielinski Rachel , Ghadiali Samir N.
Published: July 2017

Stenotic nares, edematous intranasal turbinates, mucosal swelling, and an elongated, thickened soft palate are common sources of airflow resistance for dogs with brachycephalic airway syndrome. Surgery has focused on enlarging the nasal apertures and reducing tissue of the soft palate. However, objective measures of surgical efficacy are lacking. Twenty‐one English bulldogs without previous surgery were recruited for this prospective, pilot study. Computed tomography was performed using conscious sedation and without endotracheal intubation using a 128 multidetector computed tomography scanner. Raw multidetector computed tomography data were rendered to create a three‐dimensional surface mesh model by automatic segmentation of the air‐filled nasal passage from the nares to the caudal soft palate. Three‐dimensional surface models were used to construct computational fluid dynamics models of nasal airflow resistance from the nares to the caudal aspect of the soft palate. The computational fluid dynamics models were used to simulate airflow in each dog and airway resistance varied widely with a median 36.46 (Pa/mm)/(l/s) and an interquartile range of 19.84 to 90.74 (Pa/mm)/(/s). In 19/21 dogs, the rostral third of the nasal passage exhibited a larger airflow resistance than the caudal and middle regions of the nasal passage. In addition, computational fluid dynamics data indicated that overall measures of airflow resistance may significantly underestimate the maximum local resistance. We conclude that computational fluid dynamics models derived from nasal multidetector computed tomography can quantify airway resistance in brachycephalic dogs. This methodology represents a novel approach to noninvasively quantify airflow resistance and may have utility for objectively studying effects of surgical interventions in canine brachycephalic airway syndrome.
Diversity in root traits of sorghum genotypes in response to Striga hermonthica infestation
Authors: Abate M , Hussien T , Bayu W , Reda F
Published: July 2017

Striga hermonthica is a major biotic constraint to agriculture in the lowland areas of Ethiopia where sorghum is a major stable crop. A pot and a field experiment were conducted in 2011 during the rainy season using 10 sorghum genotypes. Each experiment had infested and non‐infested conditions as the main plots and the 10 genotypes as subplots. The aim of this study was to examine the response of root traits of the sorghum genotypes to S. hermonthica infested conditions and to investigate relationships among S. hermonthica, root and growth traits of sorghum genotypes. Sorghum genotypes were categorized in to three groups, that is, low, moderate and high S. hermonthica count groups. Each group showed a differential response to root traits. Low S. hermonthica count groups had significantly lower root length, root length density, root to shoot ratio and root dry weight compared with susceptible groups. In contrast to low S. hermonthica count groups, moderate S. hermonthica count groups had higher root length, root length density, root to shoot ratio and root dry weight. Highly significant and strong relations were observed among root traits of sorghum, indicating that any of the root traits can be used as indicators for resistance. The result indicates different reactions in root traits in the upper soil layer may be useful for genetic improvement of S. hermonthica resistance and tolerance breeding in sorghum.
Condition for minimal harmonic oscillator action
Authors: Moriconi M.
Published: July 2017

We provide an elementary proof that the action for the physical trajectory of the one-dimensional harmonic oscillator is guaranteed to be a minimum if and only if τ<π/ω, where τ is the elapsed time and ω is the oscillator's natural frequency.
Concepts first: A course with improved educational outcomes and parity for underrepresented minority groups
Authors: Webb D. J.
Published: July 2017

Two active learning physics courses were taught and compared. The “concepts first” course was organized to teach only concepts in the first part of the class, the ultimate goal being to increase students' problem-solving abilities much later in the class. The other course was taught in the same quarter by the same instructor using the same curricular materials, but covered material in the standard (chapter-by-chapter) order. After accounting for incoming student characteristics, students from the concepts-first course scored significantly better in two outcome measures: their grade on the final exam and the grade received in their subsequent physics course. Moreover, in the concepts-first class course, students from groups underrepresented in physics had final exam scores and class grades that were indistinguishable from other students. Finally, students who took at least one concepts-first course in introductory physics were found to have significantly higher rates of graduation with a STEM major than students from this cohort who did not.
Deletion of
sigB
Causes Increased Sensitivity to
para
-Aminosalicylic Acid and Sulfamethoxazole in Mycobacterium tuberculosis
Authors: Yang Shan-Shan , Hu Yang-Bo , Wang Xu-De , Gao Yun-Rong , Li Kun , Zhang Xian-En , Chen Shi-Yun , Zhang Tian-Yu , Gu Jing , Deng Jiao-Yu
Published: July 2017

Although the
de novo
folate biosynthesis pathway has been well studied in bacteria, little is known about its regulation. In the present study, the
sigB
gene in
Mycobacterium tuberculosis
was deleted. Subsequent drug susceptibility tests revealed that the
M. tuberculosis
Δ
sigB
strain was more sensitive to
para
-aminosalicylic acid (PAS) and sulfamethoxazole. Comparative transcriptional analysis was performed, and downregulation of
pabB
was observed in the Δ
sigB
strain, which was further verified by a quantitative reverse transcription-PCR and Western blot assay. Then, the production levels of
para
-aminobenzoic acid (
p
ABA) were compared between the
sigB
deletion mutant and wild-type strain, and the results showed that
sigB
deletion resulted in decreased production of
p
ABA. In addition, SigB was able to recognize the promoter of
pabB in vitro
. Furthermore, we found that deleting
pabC
also caused increased susceptibility to PAS. Taken together, our data revealed that, in
M. tuberculosis
,
sigB
affects susceptibility to antifolates through multiple ways, primarily by regulating the expression of
pabB
. To our knowledge, this is the first report showing that SigB modulates
p
ABA biosynthesis and thus affecting susceptibility to antifolates, which broadens our understanding of the regulation of bacterial folate metabolism and mechanisms of susceptibility to antifolates.
Tandem Amplification of the Staphylococcal Cassette Chromosome
mec
Element Can Drive High-Level Methicillin Resistance in Methicillin-Resistant Staphylococcus aureus
Authors: Gallagher Laura A. , Coughlan Simone , Black Nikki S. , Lalor Pierce , Waters Elaine M. , Wee Bryan , Watson Mick , Downing Tim , Fitzgerald J. Ross , Fleming Gerard T. A. , O'Gara James P.
Published: July 2017

Hospital-associated methicillin-resistant
Staphylococcus aureus
(MRSA) strains typically express high-level, homogeneous (HoR) β-lactam resistance, whereas community-associated MRSA (CA-MRSA) more commonly express low-level heterogeneous (HeR) resistance. Expression of the HoR phenotype typically requires both increased expression of the
mecA
gene, carried on the staphylococcal cassette chromosome
mec
element (SCC
mec
), and additional mutational event(s) elsewhere on the chromosome. Here the oxacillin concentration in a chemostat culture of the CA-MRSA strain USA300 was increased from 8 μg/ml to 130 μg/ml over 13 days to isolate highly oxacillin-resistant derivatives. A stable, small-colony variant, designated HoR34, which had become established in the chemostat culture was found to have acquired mutations in
gdpP
,
clpX
,
guaA
, and
camS
. Closer inspection of the genome sequence data further revealed that reads covering SCC
mec
were ∼10 times overrepresented compared to other parts of the chromosome. Quantitative PCR (qPCR) confirmed >10-fold-higher levels of
mecA
DNA on the HoR34 chromosome, and MinION genome sequencing verified the presence of 10 tandem repeats of the SCC
mec
element. qPCR further demonstrated that subculture of HoR34 in various concentrations of oxacillin (0 to 100 μg/ml) was accompanied by accordion-like contraction and amplification of the SCC
mec
element. Although slower growing than strain USA300, HoR34 outcompeted the parent strain in the presence of subinhibitory oxacillin. These data identify tandem amplification of the SCC
mec
element as a new mechanism of high-level methicillin resistance in MRSA, which may provide a competitive advantage for MRSA under antibiotic selection.
Modeling the Kinetics of the Permeation of Antibacterial Agents into Growing Bacteria and Its Interplay with Efflux
Authors: Nichols Wright W.
Published: July 2017

A mathematical model of the passive permeation of a novel solute into bacteria that explicitly accounts for intracellular dilution through growth was developed. A bacterial cell envelope permeability coefficient of approximately >10−8cm2· s−1is predicted to ensure passive permeation into rapidly replicating bacterial cells. The relative importance of the permeability coefficients of the cytoplasmic and outer membranes of Gram-negative bacteria in determining the overall envelope permeability coefficient was analyzed quantitatively. A mathematical description of the balance between passive influx and active efflux was also developed and shows that bacterial expansion through growth can usually be neglected for compounds likely to be prepared in antibacterial drug discovery programs and the balance between passive inward permeation and active outwardly directed efflux predominates. A new parameter, efflux efficiency (η, where η is equal tok/P, in whichkis the rate coefficient for the efflux pump andPis the permeability coefficient for the membrane across which the pump acts), is introduced, and the consequences for the efficiency of efflux pumping by a single pump, two pumps in parallel across either the cytoplasmic or the outer membrane, and two pumps in series, one across the cytoplasmic membrane and one across the outer membrane of Gram-negative bacteria, are explored. The results, showing additive efficiency for two pumps acting across a single membrane and multiplicative efficiency for two pumps acting in series across the cytoplasmic and outer membranes, can be quantitatively related to the ratios between MICs measured against pump-sufficient and pump deletion strains and agree with those of previous experimental and theoretical studies.
A case of progressive orthopnoea and shoulder pain secondary to bilateral diaphragmatic paralysis
Authors: Herbert Anna , Khan Waseem Asrar , Madi Salem
Published: July 2017

A 45-year-old man with a raised body mass index presented with an acute history of right lower chest pain and increasing breathlessness. C reactive protein, D dimer and cardiac echocardiography were negative, with mild bibasal atelectasis the only positive reported finding from erect chest X-ray and CT pulmonary angiogram. He was discharged with antibiotics for a chest infection. He remained severely breathless and was referred to the sleep-related breathing disorders clinic. He described shoulder pain, daytime tiredness and sleeping upright due to a Ã¢â‚¬ËœsuffocatingÃ¢â‚¬â„¢ sensation. The video demonstrates the clinical findings. The CT topogram confirmed bilateral diaphragmatic paralysis. Spirometry demonstrated an 80% reduction in forced vital capacity in the supine position, when compared with erect. Consultation with a neurologist yielded the diagnosis of neuralgic amyotrophy, leading to bilateral diaphragmatic paralysis. The respiratory symptoms have been controlled with night-time non-invasive ventilation, allowing him to sleep supine.
Catastrophic cervical spinal injury in an amateur college wrestler
Authors: Narayana Kurup Jayakrishnan Kelamangalathu , Jampani Ravitheja , Mohanty Simanchal P
Published: July 2017

A young amateur wrestler presented with a burst fracture of the seventh cervical vertebra with complete paraplegia. He was treated with surgery for spine stabilisation and was actively rehabilitated. Adolescents and teenagers are indulging in high-contact sports like wrestling, without proper training and technical know-how, which can lead to severe injuries and possibly, permanent handicap or death. Trainers, assistants and institutions should be well equipped to diagnose and provide initial care of people with a spinal injury to prevent a partial injury from progressing to complete injury. Athletes, coaches and the public should be aware of methods of first aid and how to transport a patient with a cervical spine injury. Authorities should take steps to improve infrastructures in training institutions and ambulance services. Specialised spinal centres should be established throughout the country for management and rehabilitation of patients with paraplegia.
Myocardial infarction masquerading as myocarditis in a patient with factor V Leiden: unmasked with MR
Authors: Walsh Jason Leo , Harris Benjamin Howell Lole , Gharzuddine Walid , Isma'eel Hussain
Published: July 2017

We present a case of a 21-year-old man presenting with sharp left-sided chest pain. A CT pulmonary angiogram was negative, ECG was unremarkable and a mild troponin rise was observed. Myocarditis was suspected as the most likely diagnosis, particularly in view of the patient’s previous diagnosis of myocarditis 3 years prior. A cardiac MRI was indicative of an acute mid-anterior myocardial infarction (MI) and an old inferior MI with an associated aneurysm. A subsequent angiogram revealed a subtotal occlusion in the second diagonal artery, likely precipitated by homozygous factor V Leiden.

This case illustrates the value of MRI in differentiating acute MI from myocarditis when clinical suspicion is low, as in this young patient with atypical chest pain. Further, it demonstrates the value of MRI in detecting previous MIs and reinforces the importance of searching for precipitants of MI in young patients.
Intestinal microbiota is altered in patients with colon cancer and modified by probiotic intervention
Authors: Hibberd Ashley A , Lyra Anna , Ouwehand Arthur C , Rolny Peter , Lindegren Helena , Cedgård Lennart , Wettergren Yvonne
Published: July 2017

Objective

The colonic microbiota is altered in patients with colorectal cancer (CRC). We investigated the microbiota composition of patients with colon cancer compared with controls devoid of neoplastic or inflammatory disease and the potential to modify the colonic microbiota with probiotics.

Design

Biopsy samples were obtained from the normal mucosa and tumour during colonoscopy from 15 patients with colon cancer. Subsequent patient-matched samples were taken at surgery from the tumour and nearby mucosa from the patients with cancer, eight of whom had received two daily tablets totalling 1.4×1010CFUsBifidobacterium lactisBl-04 and 7×109CFUsLactobacillus acidophilusNCFM. Faecal samples were obtained after colonoscopy prior to starting the intervention and at surgery. In addition, 21 mucosal biopsies from non-cancer controls were obtained during colonoscopy followed by later faecal samples. The colonic and faecal microbiota was assessed by 16S rRNA gene amplicon sequencing.

Results

The tumour microbiota was characterised by increased microbial diversity and enrichment of several taxa includingFusobacterium,SelenomonasandPeptostreptococcuscompared with the control microbiota. Patients with colon cancer that received probiotics had an increased abundance of butyrate-producing bacteria, especiallyFaecalibacteriumandClostridialesspp in the tumour, non-tumour mucosa and faecal microbiota. CRC-associated genera such asFusobacteriumandPeptostreptococcustended to be reduced in the faecal microbiota of patients that received probiotics.

Conclusions

Patients with colon cancer harbour a distinct microbiota signature in the tumour tissue and nearby mucosa, which was altered with probiotic intervention. Our results show promise for potential therapeutic benefits in CRC by manipulation of the microbiota.

Trial registration number

NCT03072641; Results.
Clinical and genetic profile of patients with seronegative coeliac disease: the natural history and response to gluten-free diet
Authors: Dore Maria Pina , Pes Giovanni Mario , Dettori Ivana , Villanacci Vincenzo , Manca Alessandra , Realdi Giuseppe
Published: July 2017

Objectives

Patients with clinical, genetic and histological features of coeliac disease (CD), but negative for serological markers, pose a significant clinical problem. The aim of this study was to outline a specific profile, and to evaluate the natural history and response to gluten-free diet (GFD) of patients with seronegative CD.

Methods

patients with duodenal mucosa damage Marsh I, II and III stages, HLA DQ2/DQ8 haplotype and clinical features suggestive of CD, but negative for CD serology, were defined as seronegative CD patients. Other common causes of duodenal mucosa damage were excluded. HLA–DR and DQ genotype/haplotype between all Marsh stages of patients with seronegative and seropositive CD were compared. Clinical features, laboratory testing and histological findings were evaluated after a GFD and a gluten rechallenge. A long follow-up period was available.

Results

48 patients fulfilled diagnostic criteria over a 4-year period. Clinical phenotype and HLA−DR and DQ frequencies between patients with seronegative and seropositive CD was similar. However, Marsh I stage was more prevalent in seronegative patients (42% vs 22%; p<0.05). After a 1-year GFD trial, clinical symptoms, histological features and laboratory testing improved in 40 patients and worsened in those who underwent a 6-months gluten challenge. Five patients with seronegative CD (25%) experienced the occurrence of autoimmune diseases during a median follow-up of 133 months (range 72–192).

Conclusions

Patients with seronegative CD did not display a specific profile. They benefitted from GFD as patients with seropositive CD. Waiting for more sensitive serological markers, the diagnosis of seronegative CD remains a diagnosis of exclusion.
Protocol for a prospective observational study to improve prehospital notification of injured patients presenting to trauma centres in India
Authors: Mitra Biswadev , Mathew Joseph , Gupta Amit , Cameron Peter , O'Reilly Gerard , Soni Kapil Dev , Kaushik Gaurav , Howard Teresa , Fahey Madonna , Stephenson Michael , Kumar Vineet , Vyas Sharad , Dharap Satish , Patel Pankaj , Thakor Advait , Sharma Naveen , Walker Tony , Misra Mahesh Chandra , Gruen Russell , Fitzgerald Mark
Published: July 2017

Introduction

Prehospital notification of injured patients enables prompt and timely care in hospital through adequate preparation of trauma teams, space, equipment and consumables necessary for resuscitation, and may improve outcomes. In India, anecdotal reports suggest that prehospital notification, in those few places where it occurs, is unstructured and not linked to a well-defined hospital response. The aim of this manuscript is to describe, in detail, a study protocol for the evaluation of a formalised approach to prehospital notification.

Methods and analysis

This is a longitudinal prospective cohort study of injured patients being transported by ambulance to major trauma centres in India. In the preintervention phase, prospective data on patients will be collected on prehospital assessment, notification, inhospital assessment, management and outcomes and recorded in a new tailored multihospital trauma registry. All injured patients arriving by ambulance and allocated to a red or yellow priority category will be eligible for inclusion. The intervention will be a prehospital notification application to be used by ambulance clinicians to notify emergency departments of the impending arrival of a patient. The proportion of eligible patients arriving to hospital after notification will be the primary outcome measure. Secondary outcomes evaluated will be availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray and inhospital mortality.

Progress

Ethical approval has been obtained from the All India Institute of Medical Sciences, New Delhi and site-specific approval granted by relevant trauma services. The trial has also been registered with the Monash University Human Research and Ethics Committee; Project number: CF16/1814 – 2016000929. Results will be fed back to prehospital and hospital clinicians via a series of reports and presentations. These will be used to facilitate discussions about service redesign and implementation. It is expected that evidence for improved outcomes will enable widespread adoption of this intervention among centres in all settings with less established tools for prehospital assessment and notification.

Trial registration number

NCT02877342; Pre-results.
Imbuing medical professionalism in relation to safety: a study protocol for a mixed-methods intervention focused on trialling an embedded learning approach that centres on the use of a custom designed board game
Authors: Ward Marie , McAuliffe Eilish , Ní Shé Éidín , Duffy Ann , Geary Una , Cunningham Una , Holland Catherine , McDonald Nick , Egan Karen , Korpos Christian
Published: July 2017

Introduction

Healthcare organisations have a responsibility for ensuring that the governance of workplace settings creates a culture that supports good professional practice. Encouraging such a culture needs to start from an understanding of the factors that make it difficult for health professionals to raise issues of concern in relation to patient safety. The focus of this study is to determine whether a customised education intervention, developed as part of the study, with interns and senior house officers (SHOs) can imbue a culture of medical professionalism in relation to patient safety and support junior doctors to raise issues of concern, while shaping a culture of responsiveness and learning.

Methods and analysis

We will use quantitative and qualitative methods to collect data. The sample size will be approximately 200 interns and SHOs across the two hospital sites. Two surveys will be included with one measuring leadership inclusiveness and psychological safety and a second capturing information on safety concerns that participants may have witnessed in their places of work. The PlayDecide embedded learning intervention will be developed with key stakeholders. This will be trialled in the middle stage of data collection for both interns and SHOs. A detailed content analysis will be conducted on the surveys to assess any changes in reporting following the PlayDecide intervention. This will be compared with the incident reporting levels and the results of the preintervention and postintervention leadership inclusiveness and psychological safety survey. Statistical analysis will be conducted using SPSS. Differences will be considered statistically significant at p<0.05. Semistructured interviews using a critical incident technique will be used for the ongoing analysis and evaluation of the project. These will be transcribed, de-identified and coded into themes.

Ethics and dissemination

The study has been granted ethics approval from University College Dublin (Ref. LS-15–19-Ward-McAuliffe: Imbuing Medical Professionalism in Relation to Safety). The study results will be disseminated through peer-reviewed publications.
Can nurse teachers manage student incivility by guided democracy? A grounded theory study
Authors: Rad Mostafa , Karimi Moonaghi Hossein , Ildarabadi Eshagh
Published: July 2017

Introduction

Managing incivility in academic settings is among the basic concerns and challenges of most educational systems, including nursing education. Incivility management cannot be considered devoid of disruptive behaviors. However, incivility management is a complexphenomenon upon which few studies are conducted.

Objectives

The present study aims at discovering teachers and students’ experiences regarding incivility and developing an approach to manage nursing students’ incivility.

Design

The present study was conducted based on the qualitative research design of the grounded theory methodology.

Settings

This study was conducted at schools of nursing in academic settings in Iran.

Participants

Study participants in the present study includenurse teachers (N=20) and nursing students (N=9).

Method

In-depth semi-structured interviews were conducted using theoretical and purposive sampling. Constant comparative analysis was used for data analysis.

Results

The results include four main categories; (1) deterioration of learning; (2) dominant individual and organisational culture; (3) guided democracy; and (4) movement toward professionalism. Guided democracy is recognised as the main basic psychosocial process for incivility management.

Conclusions

Incivility management is pursued to help learners develop professional performance. As indicated by the results of the present study, guided democracy is an effective strategy for incivility management in nursing education.