bluuebunny/crossref_metadata_2025 huggingface dataset:
Temperature dependence of dimensionless figure of merit of a thermoelectric module estimated by impedance spectroscopy
Authors: Hasegawa Yasuhiro , Otsuka Mioko
Published: July 2018

Temperature dependence of dimensionless figure of merit zT of a Π-shaped thermoelectric module using bismuth-telluride materials was estimated on the basis of a theory of impedance spectroscopy, which is able to ascertain zT directly using only electrometric measurements from the frequency dependence of the impedance without any calorific measurement. The dependence of the module was measured from 5 mHz to 10 kHz with precise temperature control. From the analysis, the ohmic resistance, the impedance due to the Peltier effect, and the characteristic heat frequency at 300 K were determined under two different boundary conditions (the suspended and fixed conditions of a heat bath). A comparison between these boundary conditions revealed that their difference led to a slight change in the frequency dependence of the measured impedance due to the variation in the heat capacity of the module, and the estimated dimensionless figure of merit was identical for the two boundary conditions (zT ≈ 0.839 at 300 K). The temperature dependence of the dimensionless figure of merit of the module was successfully measured from 20 K to 300 K. The dependence of the thermal conductivity was also estimated with an assumed Seebeck coefficient from the definition of zT. In addition, a new method using only two impedances with repeatability was proposed and demonstrated to estimate the dimensionless figure of merit precisely (zT ≈ 0.845 at 300 K).
Relativistic effects on the energy levels and radiative properties of He-like ions immersed in Debye plasmas
Authors: Chen Zhan-Bin , Ma Kun , Hu Hong-Wei , Wang Kai
Published: July 2018

Systematic investigations are performed for the energy levels and radiative properties for selected He-like C4+, Ne8+, Ar16+, and Kr34+ ions embedded in weakly coupled plasmas. For the conditions in which the Coulomb coupling parameter is small, the standard Debye model is adopted to describe the plasma screening effects. Within the relativistic framework, the modified version of the Flexible Atomic Code computations is carried out by considering a Debye-Hückel potential, in which the plasma screening is taken into account for both the electron-nucleus and electron-electron (e-e) interactions. An independent calculation for various Debye lengths is also presented using the multiconfiguration Dirac-Fock method for comparison purposes. For the nonrelativistic treatment, the analytical solution of the Schrödinger equation with the Debye screened potential is proposed. The variation method is developed with Slater wave function as a trial wave function that contains the variational parameters. An exact analytical expression of relativistic corrections such as the mass-velocity correction, the one/two-body Darwin correction, the spin-spin contact interaction correction, and the orbit-orbit interaction correction is derived. Differences among our three kinds of calculated energy levels and transition properties are analyzed in terms of the nuclear charge and/or the Debye length. Systematic trend is observed for all the properties under study with respect to increased screening. The influence of relativistic effects is also investigated in detail and found to play an important role in these systems. Our results are compared with available results from other theoretical calculations and the experimental values in the literature, and a good agreement is achieved. This work should be useful for astrophysical applications where such plasma environments exist.
Organo-montmorillonites for efficient and rapid water remediation: sequential and simultaneous adsorption of lead and bisphenol A
Authors: Liu Chongmin , Wu Pingxiao , Tran Lytuong , Zhu Nengwu , Dang Zhi
Published: July 2018

Environmental contextNovel materials are increasingly being sought-after to remove metals and organic pollutants from water. We investigated two organo-functionalised montmorillonites for sequential and simultaneous adsorption of lead and bisphenol A. Our findings could lead to new approaches for handling emergency complex pollution events.
AbstractOrgano-montmorillonites (OMts) modified by two different carbon chain lengths of betaine were used to remove the combined pollution (heavy metal and organic pollutant) from a water environment, sequentially and simultaneously. The properties of OMts were measured with X-Ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR) and Thermogravimetry-Differential Scanning Calorimetry (TG-DSC). The independent adsorption of a single pollutant, direct sequential adsorption, indirect sequential adsorption and simultaneous adsorption of bisphenol A (BPA) and lead ion (Pb2+) onto OMts were investigated. Initial concentrations, reaction time, solution pH and the release amount of pre-adsorbed contaminant in the sequential sorption system were also investigated for the adsorption behaviours of Pb2+ and BPA. Two kinetic models and two adsorption isotherms were applied to explain the adsorption process. The adsorptive mechanism of BPA adsorption onto OMts was ascribed to a hydrophobic interaction, while the mechanism for Pb2+ adsorption was attributed to cation exchange, surface adsorption, electrostatic attraction and complexation from the results of specific surface area Brunauer–Emmett–Teller (BET) and X-ray photoelectron spectroscopy (XPS). This study might provide valuable information for the application of novel organoclays to the removal of both heavy metal and organics from water.
The development of the portmanteau verbal morphology in Ecuadorian Siona
Authors: Bruil Martine
Published: July 2018

Subject marking in the Western Tukanoan language Ecuadorian Siona is part of a complex system of portmanteau morphology that also marks tense and clause type. This system shows a remarkable number of regularities that hint that it might be possible to tease apart these functions. Synchronically, it is problematic to posit distinct markers for each of the three relevant linguistic categories, but diachronically, it is likely that these categories were expressed by distinct markers. This article reconstructs the pathway of the formal merger of these three linguistic categories, comparing the expression of Ecuadorian Siona’s system to the expression of these categories in other Tukanoan languages.
French negative concord and discord
Authors: Déprez Viviane , Yeaton Jeremy
Published: July 2018

Evidence that DN readings arise in solid NC languages more than previously thought (Déprez et al. 2015) underscore the importance of investigating the factors governing their emergence to deepen our understanding of Negative Concord. This paper examines the roles of context and prosody in disambiguating simple French transitive sentences with two NCIs (personne, rien) experimentally. French speakers were recorded reading target sentences with NCIs in NC or DN eliciting contexts followed by a verification statement judged as T/F and analyzed as context-matching or not. Context-matching targets were extracted using Praat and analyzed using ProsodyPro (Xu 2013). Sentence contour, average pitch and F0 peak value on NCIs were compared across conditions. Our results provide solid evidence that in French, context influence interpretation and NC and DN interpretations are prosodically distinguished.
Dimensions of variation
Authors: Di Caro Vincenzo Nicolò , Giusti Giuliana
Published: July 2018

This paper provides an overview of the different dimensions of variation found in the Inflected Construction (IC) (cf. Cardinaletti and Giusti 2001, 2003) arising with motion verbs in most Sicilian dialects. It does so by discussing data from the dialect of Delia (Caltanissetta) at face value with the dialect of Marsala (Trapani). The micro-variation emerging from the discussion challenges Cruschina’s (2013) morphomic account; while it is easily captured by Cardinaletti and Giusti’s (to appear) hypothesis that a semi-functional V1 fills a remerged functional head (t-T, c-C). Merger in t or c is not only restricted to lexically specified forms of V1 but, in given feature combinations, also to lexically specified forms of V2 in T or C.
Parametric comparison and dialect variation
Authors: Guardiano Cristina , Michelioudakis Dimitris , Cordoni Guido , Irimia Monica Alexandrina , Radkevich Nina , Sitaridou Ioanna
Published: July 2018

This paper applies the Parametric Comparison Method (PCM) to the description of syntactic variation in the nominal domain in a representative subset of Romance dialects of Southern Italy. We observe that, in order to perform successfully at the level of micro-comparison, the method must be supplemented by parameters specifically targeting this level of resolution. We sketch some such (micro-)parameters, investigate their interaction with the observed surface patterns, and show that their distribution broadly matches the received wisdom about the dialectal structure of Italo-Romance.
Stressed enclitics are not weak pronouns
Authors: Pescarini Diego
Published: July 2018

The paper compares a morphophonological and a syntactic approach to stress shift and enclisis/proclisis asymmetries. The former analysis envisages the co-occurrence of multiple allomorphs with the same featural content, which are distributed in accordance with phonological rules. The latter analysis, by contrast, is based on the hypothesis that alternations are due to the co-occurrence of items belonging to different functional classes. I argue that the syntactic analyses put forth so far are not superior to previous morphophonological accounts. I acknowledge that the synchronic distribution of allomorphs does not result from productive phonological rules. Nonetheless, this is not per se a valid argument in favor of syntactic, class-based accounts, which must be advanced in compliance with Occam’s razor.
Bifunctional properties and characterization of a novel sialidase with esterase activity from Bifidobacterium bifidum
Authors: Ashida Hisashi , Tanigawa Kana , Kiyohara Masashi , Katoh Toshihiko , Katayama Takane , Yamamoto Kenji
Published: July 2018

Sialidases catalyze the removal of terminal sialic acid from various complex carbohydrates. In the gastrointestinal tract, sialic acid is commonly found in the sugar chain of mucin, and many enteric commensals use mucin as a nutrient source. We previously identified two different sialidase genes in Bifidobacterium bifidum, and one was cloned and expressed as an extracellular protein designated as exo-α-sialidase SiaBb2. The other exo-α-sialidase gene (siabb1) from the same bifidobacterium encodes an extracellular protein (SiaBb1) consisting of 1795 amino acids with a molecular mass of 189 kDa. SiaBb1 possesses a catalytic domain that classifies this enzyme as a glycoside hydrolase family 33 member. SiaBb1 preferentially hydrolyzes α2,3-linked sialic acid over α2,6-linked sialic acid from sialoglycan, which is the same as SiaBb2. However, SiaBb1 has an SGNH hydrolase domain with sialate-O-acetylesterase activity and an N-terminal signal sequence and C-terminal transmembrane region. SiaBb1 is the first bifunctional sialidase identified with esterase activity.

Abbreviations: GalNAc: N-acetyl-D-galactosamine; Fuc: L-fucose; Gal: D-galactose
On Fathers and
feuilletonistes
: Creativity and Paternity in Balzac’s
La Muse du département
Authors: Bielecki Emma
Published: July 2018

The iconography of Balzac often presents him as paradigmatic of a model of phallic creativity, his theory and practice of the novel seen as exemplifying the patriarchal idea of the author as father. This article demonstrates that this view of Balzac needs to be revised through an examination of his 1843 novel,
La Muse du département
, which combines a story of adultery with a jaundiced depiction of literary labour and creative exhaustion, exploring what becomes of the idea of the author as father in a society with a weakened paternal order. Through examining the metaphoric link the novel establishes between the narrative of adultery and the representation of literary creation, the article develops a meta-poetic reading of the relationship between biological and literary paternity, analysing how the formal characteristics of the novel refract anxieties about the erosion of paternal authority in July Monarchy France.
Longitudinal Associations Between Loneliness and Cognitive Ability in the Lothian Birth Cohort 1936
Authors: Okely Judith A , Deary Ian J
Published: July 2018

Objectives

Loneliness is associated with poorer cognitive function in old age; however, the direction of this association is unknown. We tested for reciprocal associations between loneliness and the cognitive ability domains of processing speed, visuospatial ability, verbal memory, and crystallized ability.

Method

We used three triennial waves of longitudinal data from the Lothian Birth Cohort Study 1936, and tested for cross-lagged associations between loneliness and cognitive abilities using cross-lagged panel models.

Results

Better processing speed, visuospatial ability, or crystallized ability at age 73, was associated with less positive changes in loneliness between ages 73 and 76; however, these associations were not replicated between ages 76 and 79. Loneliness at ages 73 and 76 did not predict subsequent changes in cognitive abilities.

Discussion

Our findings indicate an association between cognitive ability and loneliness, such that individuals with lower cognitive abilities at age 73 may be at a slightly higher risk of becoming lonely. However, we did not find support for the hypothesis that loneliness causes a decline in cognitive health.
University-based physical literacy programming for children: Canadian community stakeholders’ recommendations
Authors: Yi Kyoung June , Cameron Erin , Patey Matthew , Loucks-Atkinson Angela , Loeffler T A , McGowan Erin , Sullivan Anne-Marie , Borduas Christopher , Buote Richard
Published: July 2018

‘Physical literacy’ (PL) education—that is, teaching foundational skills, attitudes, behaviors and knowledge about lifelong involvements in physical activities, is an important aspect for health promotion among children. Universities have been playing a critical role by teaching future PL professionals. Additionally, various universities have offered university-based PL programming for neighborhood children as a way of public health promotion service and community engagement. However, this additional role of universities and the ways of promoting the quality of this type of health promotion service programming have not been investigated in the current research literature. Therefore, the purpose of this study was to identify the practicable strategies to enhance the quality of university-based PL programming for children from the perspectives of community stakeholders. Overall, 24 community stakeholders who held professional positions that are related to PL education participated in a 90-min focus group interview. This grounded theory study identified that university-based PL programming for children should be (i) inclusive, (ii) collaborative, (iii) welcoming and (iv) responsive. Practical suggestions and recommendations were also provided. This study has provided empirical knowledge to prioritize aspects for the future actions in planning and implementing university-based PL programming for children and informed for further cross-cultural comparisons amongst the perspectives of participants, university service providers and community stakeholders. The knowledge acquired from this research will also be translated to university service providers who operate similar type of health promotion service programming to the public.
Folate Receptor Overexpression in Human and Canine Meningiomas—Immunohistochemistry and Case Report of Intraoperative Molecular Imaging
Authors: Pierce John T , Cho Steve S , Nag Shayoni , Zeh Ryan , Jeon Jun , Holt David , Durham Amy , Nasrallah MacLean P , Singhal Sunil , Lee John Y K
Published: July 2018

BACKGROUND

Meningiomas are well-encapsulated benign brain tumors and surgical resection is often curative. Nevertheless, this is not always possible due to the difficulty of identifying residual disease intraoperatively. We hypothesized that meningiomas overexpress folate receptor alpha (FRα), allowing intraoperative molecular imaging by targeting FRα with a near-infrared (NIR) dye.

OBJECTIVE

To determine FRα expression in both human and canine meningioma cohorts to prepare for future clinical studies. Present a case study of a meningioma resection with intraoperative NIR fluorescence imaging.

METHODS

Tissue samples of 27 human meningioma specimens and 7 canine meningioma specimens were immunohistochemically stained for FRα along with normal dura, skeletal muscle, and kidney tissue. We then enrolled a patient with a pituitary adenoma and tuberculum sella meningioma in a clinical trial in which the patient received an infusion of folate-linked, NIR fluorescent dye prior to surgery.

RESULTS

In the cohort of human meningiomas, 9 WHO grade I, 12 grade II, and 6 grade III tumors were identified. Eighty-nine percent of WHO grade I, 67% of grade II, and 50% of grade III tumors overexpressed FRα. In the 7 canine meningioma samples, 100% stained positively for FRα. Both human and canine normal dura from autopsy samples demonstrated no evidence of FRα overexpression. In the case study, the meningioma demonstrated a high NIR signal-to-background-ratio of 4.0 and demonstrated strong FRα immunohistochemistry staining.

CONCLUSION

This study directly demonstrates FRα overexpression in both human and canine meningiomas. We also demonstrate superb intraoperative imaging of a meningioma using a FRα-targeting dye.
Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs: Case Neurosurgery
Authors: Reponen Elina , Tuominen Hanna , Korja Miikka
Published: July 2018

BACKGROUND

Multiple nationwide outcome registries are utilized for quality benchmarking between institutions and individual surgeons.

OBJECTIVE

To evaluate whether nationwide quality of care programs in the United Kingdom and United States can measure differences in neurosurgical quality.

METHODS

This prospective observational study comprised 418 consecutive adult patients undergoing elective craniotomy at Helsinki University Hospital between December 7, 2011 and December 31, 2012.We recorded outcome event rates and categorized them according to British Neurosurgical National Audit Programme (NNAP), American National Surgical Quality Improvement Program (NSQIP), and American National Neurosurgery Quality and Outcomes Database (N2QOD) to assess the applicability of these programs for quality benchmarking and estimated sample sizes required for reliable quality comparisons.

RESULTS

The rate of in-hospital major and minor morbidity was 18.7% and 38.0%, respectively, and 30-d mortality rate was 2.4%. The NSQIP criteria identified 96.2% of major but only 38.4% of minor complications. N2QOD performed better, but almost one-fourth (23.2%) of all patients with adverse outcomes, mostly minor, went unnoticed. For NNAP, a sample size of over 4200 patients per surgeon is required to detect a 50.0% increase in mortality rates between surgeons. The sample size required for reliable comparisons between the rates of complications exceeds 600 patients per center per year.

CONCLUSION

The implemented benchmarking programs in the United Kingdom and United States fail to identify a considerable number of complications in a high-volume center. Health care policy makers should be cautious as outcome comparisons between most centers and individual surgeons are questionable if based on the programs.
A Review of the Global Burden, New Diagnostics, and Current Therapeutics for Amebiasis
Authors: Shirley Debbie-Ann T , Farr Laura , Watanabe Koji , Moonah Shannon
Published: July 2018

Amebiasis, due to the pathogenic parasite Entamoeba histolytica, is a leading cause of diarrhea globally. Largely an infection of impoverished communities in developing countries, amebiasis has emerged as an important infection among returning travelers, immigrants, and men who have sex with men residing in developed countries. Severe cases can be associated with high case fatality. Polymerase chain reaction–based diagnosis is increasingly available but remains underutilized. Nitroimidazoles are currently recommended for treatment, but new drug development to treat parasitic agents is a high priority. Amebiasis should be considered before corticosteroid therapy to decrease complications. There is no effective vaccine, so prevention focuses on sanitation and access to clean water. Further understanding of parasite biology and pathogenesis will advance future targeted therapeutic and preventative strategies.
Complement Factor H Levels Associate With Plasmodium falciparum Malaria Susceptibility and Severity
Authors: van Beek Anna E , Sarr Isatou , Correa Simon , Nwakanma Davis , Brouwer Mieke C , Wouters Diana , Secka Fatou , Anderson Suzanne T B , Conway David J , Walther Michael , Levin Michael , Kuijpers Taco W , Cunnington Aubrey J
Published: July 2018

Background

Plasmodium falciparum may evade complement-mediated host defense by hijacking complement Factor H (FH), a negative regulator of the alternative complement pathway. Plasma levels of FH vary between individuals and may therefore influence malaria susceptibility and severity.

Methods

We measured convalescent FH plasma levels in 149 Gambian children who had recovered from uncomplicated or severe P. falciparum malaria and in 173 healthy control children. We compared FH plasma levels between children with malaria and healthy controls, and between children with severe (n = 82) and uncomplicated malaria (n = 67). We determined associations between FH plasma levels and laboratory features of severity and used multivariate analyses to examine associations with FH when accounting for other determinants of severity.

Results

FH plasma levels differed significantly between controls, uncomplicated malaria cases, and severe malaria cases (mean [95% confidence interval], 257 [250 to 264], 288 [268 to 309], and 328 [313 to 344] µg/mL, respectively; analysis of variance P < .0001). FH plasma levels correlated with severity biomarkers, including lactate, parasitemia, and parasite density, but did not correlate with levels of PfHRP2, which represent the total body parasite load. Associations with severity and lactate remained significant when adjusting for age and parasite load.

Conclusions

Natural variation in FH plasma levels is associated with malaria susceptibility and severity. A prospective study will be needed to strengthen evidence for causation, but our findings suggest that interfering with FH binding by P. falciparum might be useful for malaria prevention or treatment.
Prevalence and Transmission Dynamics of HIV-1 Transmitted Drug Resistance in a Southeastern Cohort
Authors: Levintow Sara N , Okeke Nwora Lance , Hué Stephane , Mkumba Laura , Virkud Arti , Napravnik Sonia , Sebastian Joseph , Miller William C , Eron Joseph J , Dennis Ann M
Published: July 2018

Background

Transmitted drug resistance (TDR) compromises clinical management and outcomes. Transmitted drug resistance surveillance and identification of growing transmission clusters are needed in the Southeast, the epicenter of the US HIV epidemic. Our study investigated prevalence and transmission dynamics in North Carolina.

Methods

We analyzed surveillance drug resistance mutations (SDRMs) using partial pol sequences from patients presenting to 2 large HIV outpatient clinics from 1997 to 2014. Transmitted drug resistance prevalence was defined as ≥1 SDRMs among antiretroviral therapy (ART)–naïve patients. Binomial regression was used to characterize prevalence by calendar year, drug class, and demographic and clinical factors. We assessed the transmission networks of patients with TDR with maximum likelihood trees and Bayesian methods including background pol sequences (n = 15 246).

Results

Among 1658 patients with pretherapy resistance testing, ≥1 SDRMs was identified in 199 patients, with an aggregate TDR prevalence of 12% (95% confidence interval, 10% to 14%) increasing over time (P = .02). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs; 8%) was common, followed by nucleoside reverse transcriptase inhibitors (4%) and protease inhibitors (2%). Factors associated with TDR were being a man reporting sex with men, white race, young age, higher CD4 cell count, and being a member of a transmission cluster. Transmitted drug resistance was identified in 106 clusters ranging from 2 to 26 members. Cluster resistance was primarily NNRTI and dominated by ART-naïve patients or those with unknown ART initiation.

Conclusions

Moderate TDR prevalence persists in North Carolina, predominantly driven by NNRTI resistance. Most TDR cases were identified in transmission clusters, signifying multiple local transmission networks and TDR circulation among ART-naïve persons. Transmitted drug resistance surveillance can detect transmission networks and identify patients for enhanced services to promote early treatment.
Asymmetric expansion of the Fe ejecta in Kepler’s supernova remnant
Authors: Kasuga Tomoaki , Sato Toshiki , Mori Koji , Yamaguchi Hiroya , Bamba Aya
Published: July 2018

The ejecta kinematics of supernova remnants (SNRs) is one of the crucial clues to understanding the explosion mechanism of type Ia supernovae (SNe). In particular, the kinematic asymmetry of iron-peak elements provides the key to understanding the physical processes taking place in the core of the exploding white dwarfs (WDs), although it has been poorly understood by observations. In this paper, we show for the first time the asymmetric expansion structure in the line-of-sight direction of Fe ejecta in Kepler’s SNR revealed by spectral and imaging analysis using the Chandra archival data. We found that the Kα line centroid energy and line width is relatively lower (<6.4 keV) and narrower (∼80 eV) around the center of the remnant, which implies that the majority of the Fe ejecta in the central region is redshifted. At the outer regions, we identify bright blueshifted structures as have been ejected as high-velocity dense clumps. Taking into account the broad population of the Fe charge states, we estimate the redshifted velocity of ∼2000 km s−1 and the blueshifted velocity of ∼3000 km s−1 for each velocity structure. We also present the possibility that a portion of the Fe ejecta near the center are interacting with the dense circumstellar medium (CSM) on the near side of the remnant. For the origin of the asymmetric motion of the Fe ejecta, we suggest three scenarios; (1) the asymmetric distribution of the CSM, (2) the “shadow” in Fe cast by the companion star, and (3) the asymmetric explosion.
In Silico Analyses of Rice Thionin Genes and the Antimicrobial Activity of OsTHION15 Against Phytopathogens
Authors: Boonpa Krissana , Tantong Suparuk , Weerawanich Kamonwan , Panpetch Pawinee , Pringsulaka Onanong , Roytrakul Sittiruk , Sirikantaramas Supaart
Published: July 2018

Thionins are a family of antimicrobial peptides. We performed in silico expression analyses of the 44 rice (Oryza sativa) thionins (OsTHIONs). Modulated expression levels of OsTHIONs under different treatments suggest their involvement in many processes, including biotic, abiotic, and nutritional stress responses, and in hormone signaling. OsTHION15 (LOC_Os06g32600) was selected for further characterization based on several in silico analyses. OsTHION15 in O. sativa subsp. indica ‘KDML 105’ was expressed in all of the tissues and organs examined, including germinating seed, leaves, and roots of seedlings and mature plants, and inflorescences. To investigate the antimicrobial activity of OsTHION15, we produced a recombinant peptide in Escherichia coli Rosetta-gami (DE3). The recombinant OsTHION15 exhibited inhibitory activities toward rice-pathogenic bacteria such as Xanthomonas oryzae pv. oryzae and Pectobacterium carotovorum pv. atroseptica, with minimum inhibitory concentrations of 112.6 and 14.1 µg ml−1, respectively. A significant hyphal growth inhibition was also observed toward Fusarium oxysporum f. sp. cubense and Helminthosporium oryzae. In addition, we demonstrated the in planta antibacterial activity of this peptide in Nicotiana benthamiana against X. campestris pv. glycines. These activities suggest the possible application of OsTHION15 in plant disease control.
The emotional burden of diabetes
Authors: Giese Karla K.
Published: July 2018

Patients with diabetes are sometimes overwhelmed with the burden of self-care associated with the disease. Although it may seem appropriate to diagnose patients experiencing such emotional burdens with depression, the literature over the past 20 years has matured the concept of diabetes distress, which may more accurately describe the phenomenon.
Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery
Authors: Wu Zhi-Fu , Lee Meei-Shyuan , Wong Chih-Shung , Lu Chueng-He , Huang Yuan-Shiou , Lin Kuen-Tze , Lou Yu-Sheng , Lin Chin , Chang Yue-Cune , Lai Hou-Chuan
Published: July 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery.

Methods

A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor–node–metastasis staging and postoperative metastasis.

Results

A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor–node–metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor–node–metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings.

Conclusions

Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor–node–metastasis stage.
Use of Dipeptidyl Peptidase-4 Inhibitors and New-onset Rheumatoid Arthritis in Patients with Type 2 Diabetes
Authors: Douros Antonios , Abrahami Devin , Yin Hui , Yu Oriana Hoi Yun , Renoux Christel , Hudson Marie , Azoulay Laurent
Published: July 2018

Background:

Case reports have suggested a link between dipeptidyl peptidase-4 (DPP-4) inhibitors, antidiabetic drugs used as second- to third-line treatments, and incidence of rheumatoid arthritis. Because the DPP-4 enzyme is involved in several immunologic processes and possibly in the pathophysiology of rheumatoid arthritis, further research is warranted. This population-based study aimed to determine whether use of DPP-4 inhibitors is associated with incidence of rheumatoid arthritis.

Methods:

Using the United Kingdom Clinical Practice Research Datalink, we conducted a cohort study among 144,603 patients with type 2 diabetes initiating antidiabetic drugs between 2007 and 2016. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for incident rheumatoid arthritis using time-dependent Cox proportional hazards models, comparing use of DPP-4 inhibitors with use of other antidiabetic drugs. We imposed a 6-month exposure lag period for latency and diagnostic delays. Secondary analyses included assessment of the duration–response relation and comparison with other second-line antidiabetic drugs, among others.

Results:

During 567,169 person-years of follow-up, 464 patients were newly diagnosed with rheumatoid arthritis (crude incidence rate: 82 per 100,000/year). Compared with use of other antidiabetic drugs, use of DPP-4 inhibitors was not associated with an increased risk of rheumatoid arthritis (82 vs. 79 per 100,000/year; HR = 1.0; 95% CI = 0.8, 1.3), with no evidence of duration–response relation. The results did not change after using second-line antidiabetic drugs as the comparator group.

Conclusions:

In this large population-based study, use of DPP-4 inhibitors was not associated with an increased risk of incident rheumatoid arthritis.
DISAPPEARING CHOROIDAL MELANOMA ON OPTOS: THE NOSE ARTIFACT
Authors: Onishi Spencer M. , Crabtree Gordon S. , Marks Steven J. , Wilson Thomas , Shields Carol L.
Published: July 2018

Purpose:

To illustrate a potentially concerning artifact on Optos wide-angle imaging.

Methods:

Case report.

Results:

A healthy 11-year-old girl, with no medical history, was found to have a lightly pigmented superotemporal choroidal tumor, suspicious for melanoma, which was detected on Optos wide-angle imaging by her optometrist. On referral to the retinal specialist, the mass was not visible on funduscopy. B-scan ultrasonography depicted flat retina and no visible mass. Review of the Optos image revealed that the pseudomelanoma represented the patient's nose.

Conclusion:

Optos wide-angle imaging provides broad retinal imaging; however, artifacts from patient positioning can lead to the nose artifact.
Validation of the Korean Version of the MacNew Heart Disease Health-Related Quality of Life Questionnaire
Authors: KANG Kyoungrim , GHOLIZADEH Leila , INGLIS Sally C. , HAN Hae-Ra
Published: July 2018

Background:

Health-related quality of life (HRQoL) is an important concept in patients with cardiac diseases, including myocardial infarction (MI). Disease-specific tools offer valuable insights into the impact of a disease on various aspects of a patient’s life.

Purpose:

The aim of this study was to assess the psychometric properties of the Korean version of the MacNew Heart Disease HRQoL Questionnaire (Korean MacNew).

Methods:

One hundred thirty-six patients who had experienced MI about 3 months earlier were recruited from two tertiary hospitalsin South Korea. The internal consistency and various types of validity of the Korean MacNew were assessed. Exploratory factor analysis with varimax rotation was performed to identify a better structure for this instrument.

Results:

The internal consistency of the Korean MacNew was established with Cronbach’s alpha coefficients ranging from .88 to .93. Face validity and construct validity (both discriminant and concurrent) of the Korean MacNew were established. Strong positive correlations were found between the total Korean MacNew and the single-item global QoL scale (r = .73, p < .001). As expected, the total Korean MacNew also had strong negative correlations with the Depression Anxiety and Stress Scale 21 (r = −.81, p < .001) and the single-item fatigue scale (r = −.51, p < .001). The outcomes of exploratory factor analysis showed a better result with the five-factor structure in the Korean MacNew.

Conclusions:

The Korean MacNew showed consistently acceptable psychometric properties of reliability and validity in patients with MI. Therefore, this instrument may be recommended for assessing the HRQoL of patients with MI in Korea. However, caution should be taken in using the subscale scores.
Liver Biopsy Can Be Safely Performed in Pediatric Acute Liver Failure to Aid in Diagnosis and Management
Authors: Chapin Catherine A. , Mohammad Saeed , Bass Lee M. , Taylor Sarah A. , Kelly Susan , Alonso Estella M.
Published: July 2018

Objectives:

Liver biopsy can be a valuable tool to help determine the etiology of pediatric acute liver failure (PALF), but is often not performed due to safety concerns. The primary aim was to describe the incidence of major complications after liver biopsy performed in the setting of PALF.

Methods:

Medical records from 2006 to 2016 were reviewed. Patients age 0 to 17 years, who met criteria for PALF, and had a liver biopsy performed while their international normalized ratio (INR) was ≥1.5 were included.

Results:

A total of 26 cases of liver biopsy in the setting of PALF were identified. The majority (n = 22, 85%) of patients had primary liver disease. Most biopsies (n = 17, 65%) were performed by the transjugular route, with 5 (19%) performed percutaneously under ultrasound guidance and 4 (15%) during a surgical procedure. Median INR before biopsy was 2.1 (IQR = 1.73–2.9). Blood products were given before or during the procedure in 23 (88%) cases. One patient (3.8%) had a major complication of biopsy‐associated bleeding requiring a blood transfusion. An additional 3 patients had a hemoglobin decrease of 2.1 to 2.9 g/dL post‐biopsy that was attributed to the procedure but no interventions were necessary. Biopsy results contributed to establishing a diagnosis in 62% (n = 16) of cases, and influenced treatment decisions in 9 of those cases.

Conclusions:

Liver biopsy is safe in the majority of patients with PALF and associated with infrequent major complications. Clinicians should consider performing liver biopsy in this setting, especially when the transjugular approach is feasible, since findings may guide diagnosis and therapy.
Congenital Neutropenia Patient With Hypomorphic Biallelic CSF3R Mutation Responding to GCSF
Authors: Yilmaz Karapinar Deniz , Akinci Burcu , Şahin Yaşar Akkiz , Hekimci Özdemir Hamiyet , Önder Siviş Zuhal , Onay Hüseyin , Özkinay Ferda
Published: July 2018

Congenital neutropenia (CN) is a rare disorder, and the most common gene responsible for CN isELANE. Furthermore, the mutations ofHAX1,G6PC3, andJAGN1genes may cause CN. These patients generally find great benefit from subcutaneous administration of Granulocyte Colony Stimulating Factor (GCSF). In recent years, Biallelic Colony Stimulating Factor 3 Receptor (CSF3R) mutations have been described as an underlying defect of CN in several children. In contrast to the previous group, the patients who have aCSF3Rmutation do not respond to GCSF treatment. Here, we present a CN patient with hypomorphic biallelicCSF3Rmutation responding to GCSF.
Handover of Patients From Prehospital Emergency Services to Emergency Departments
Authors: Sanjuan-Quiles Ángela , Hernández-Ramón María del Pilar , Juliá-Sanchis Rocío , García-Aracil Noelia , Castejón-de la Encina Mª Elena , Perpiñá-Galvañ Juana
Published: July 2018

Background:

During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions.

Purpose:

To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover.

Methods:

A qualitative research method was used.

Results:

Nurses identified the need to standardize the patient transfer process by a written record to support the verbal handover and to transmit patient information adequately, in a timely manner, and in a space free of interruptions, in order to increase patient safety.

Conclusions:

An organized method does not exist. The quality of handovers could be enhanced by improvements in communication and standardizing the process.
Sickle Cell Disease
Authors: Benenson Irina , Porter Sallie
Published: July 2018

Sickle cell disease (SCD) is a group of inherited disorders caused by a mutation of the hemoglobin gene, resulting in the formation of abnormal, sickle-shaped red blood cells. It is a lifelong condition characterized by anemia, vaso-occlusion, and decreased blood flow to vital tissues. Sickle cell disease affects every major organ and significantly reduces life expectancy of the affected individuals. Patients with SCD are at an increased risk for developing musculoskeletal complications that decrease quality of life and contribute to the significant burden of the disease. Understanding these complications, as well as the genetics, pathophysiology, and epidemiology of SCD, will assist orthopaedic nurses in providing evidence-informed care.
Pilsicainide Poisoning
Authors: Fukasawa Maki , Ninomiya Kenji , Kawakami Yuka , Fuke Chiaki , Miyazaki Tetsuji
Published: July 2018

We describe an autopsy case of fatal poisoning due to accidental overdose of pilsicainide, which is a Vaughan Williams class IC antiarrhythmic drug (a pure sodium channel blocker). A man in his 50s was found dead in his home at approximately noon. He had ischemic heart disease and insomnia, and had previously demonstrated improper prescription drug adherence. The autopsy revealed old coronary artery bypass grafting and mild fibrosis of myocardium, but no acute myocardial infarction was found in microscopic examination. Toxicological analysis also identified a high blood concentration of pilsicainide (femoral vein blood, 14.9 μg/mL), more than 15 times higher than reported therapeutic levels. The blood concentrations of other drugs were at therapeutic levels, and no alcohol was detected. We concluded that the cause of death was pilsicainide poisoning, based on the results of the autopsy and the toxicological examination. This is the first autopsy report of fatal poisoning due to pilsicainide as a single agent.
Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic: The Oregon Health Authority's Opioid Initiative
Authors: Hedberg Katrina , Bui Lisa T. , Livingston Catherine , Shields Lisa M. , Van Otterloo Joshua
Published: July 2018

Context:

Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state.

Program:

The Opioid Initiative, launched in 2015, focuses on integrating efforts to improve patient care and safety, and population health, by increasing access to nonopioid pain treatment, supporting medication-assisted treatment and naloxone access for people taking opioids, decreasing opioid prescribing, and using data to inform policies and interventions.

Implementation:

Four OHA projects highlight the integration: (1) a Medicaid Coordinated Care Organization Performance Improvement Project focused on decreasing risky opioid prescribing; (2) Health Evidence Review Commission guidelines that set coverage standards for opioid and nonopioid back pain treatments for Medicaid recipients; (3) statewide opioid prescribing guidelines; and (4) an opioid data dashboard. Each project involves a partnership between governmental public health, public and private health care systems, and external stakeholders.

Progress:

From 2015 to 2017, the number of Oregonians on 90 or more Morphine Equivalent Doses (MEDs) decreased by 37%, from 11.1 per 1000 residents quarterly to 7.0 per 1000 residents quarterly. Prescription opioid overdose deaths decreased 20% from 4.5 per 100 000 in 2015 to 3.6 per 100 000 in 2016. Within the Medicaid population, the percentage of clients on 120 or more MEDs for 30 consecutive days decreased 27%, from 2.3% in December 2015 to 1.6% in September 2017.

Discussion:

Oregon's integrated approach to address the opioid crisis spans public health and health care systems, engages key stakeholders, and uses data and evidence to inform policies. The progress to date is promising and may assist other states seeking to identify effective strategies to decrease opioid prescribing, misuse, and overdose.
A case of hepato-biliary infection secondary to cryptosporidium in a patient on tacrolimus
Authors: Gupta Sajal , Johnson Alison , Meyrick Simon , Davies Angharad P. , Chalmers R.
Published: July 2018

Introduction. Cryptosporidium infection is known to cause hepato-biliary involvement, mainly in association with T-cell immune deficiency. Hepato-biliary involvement in association with milder immunosuppression is less well described. We describe the first case, to our knowledge, of Cryptosporidium hominis hepato-biliary infection associated with tacrolimus in a patient with nephrotic syndrome.

Case presentation. A 14 year old girl who had been on tacrolimus for nephrotic syndrome presented with diarrhea due to C. hominis. Nineteen days after her initial presentation she attended hospital with abdominal pain and deranged liver function tests. An ultrasound scan showed a thickened gall bladder. Her symptoms settled and her liver function tests returned to normal after treatment with nitazoxanide.

Conclusion. Cryptosporidium should be considered in the differential diagnosis of both diarrhea and hepato-biliary symptoms and abnormal liver function tests, even in the presence of relatively mild immunosuppression. Nitazoxanide was an effective treatment in this case.
Naturally occurring polymorphisms in the virulence regulator Rsp modulate Staphylococcus aureus survival in blood and antibiotic susceptibility
Authors: Krishna Aishwarya , Holden Matthew T. G. , Peacock Sharon J. , Edwards Andrew M. , Wigneshweraraj Sivaramesh
Published: July 2018

Nasal colonization by the pathogen Staphylococcus aureus is a risk factor for subsequent infection. Loss of function mutations in the gene encoding the virulence regulator Rsp are associated with the transition of S. aureus from a colonizing isolate to one that causes bacteraemia. Here, we report the identification of several novel activity-altering mutations in rsp detected in clinical isolates, including for the first time, mutations that enhance agr operon activity. We assessed how these mutations affected infection-relevant phenotypes and found loss and enhancement of function mutations to have contrasting effects on S. aureus survival in blood and antibiotic susceptibility. These findings add to the growing body of evidence that suggests S. aureus ‘trades off’ virulence for the acquisition of traits that benefit survival in the host, and indicates that infection severity and treatment options can be significantly affected by mutations in the virulence regulator rsp.