bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting the acceptability of isoniazid preventive therapy among healthcare providers in selected HIV clinics in Nairobi County, Kenya: a qualitative study
Authors: Wambiya Elvis Omondi Achach , Atela Martin , Eboreime Ejemai , Ibisomi Latifat
Published: December 2018

Objective

Despite being globally recommended as an effective intervention in tuberculosis (TB) prevention among people living with HIV, isoniazid preventive therapy (IPT) implementation remains suboptimal, especially in sub-Saharan Africa. This study explored the factors influencing the acceptability of IPT among healthcare providers in selected HIV clinics in Nairobi County, Kenya, a high HIV/TB burden country.

Design

A qualitative study was conducted using in-depth interviews with healthcare providers in selected HIV clinics. All conversations were audio recorded, transcribed verbatim and analysed using a thematic approach.

Setting

The study was conducted in the HIV clinics of three purposefully selected public healthcare facilities in Nairobi County, Kenya between February 2017 and April 2017.

Participants

Eighteen purposefully selected healthcare providers (clinicians, nurses, pharmacists and counsellors) working in the HIV clinics participated in the study.

Results

Provider acceptability of IPT was influenced by factors relating to the organisational context, provider training on IPT and their perception on its efficacy, length and clarity of IPT guidelines and standard operation procedures, as well as structural factors (policy, physical and work environment). Inadequate high-level commitment and support for the IPT programme by programme managers and policy-makers were found to be the major barriers to successful IPT implementation in our study context.

Conclusion

This study provides insight into the complexity of factors affecting the IPT implementation in Kenya. Ensuring optimal acceptability of IPT among healthcare providers will require an expanded depth of engagement by policy-makers and IPT programme managers with both providers and patients, as well as on-the-job design specific actions to support providers in implementation. Such high-level commitment and support are consequently essential for quality delivery of the intervention.
Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational study
Authors: Brøgger Helle Algren , Maribo Thomas , Christensen Robin , Schiøttz-Christensen Berit
Published: December 2018

Introduction

Lumbar spinal stenosis is a common cause of low back and leg pain in the elderly and affects both physical activity and quality of life. First-line treatments are non-surgical options but if unsuccessful, surgery is advocated. The literature is not clear as to the outcome of surgery compared with non-surgical treatment, and the optimal time for surgery is not explicit. This observational study is designed to investigate the course of treatment, compare effectiveness of surgical and non-surgical management in patients with lumbar spinal stenosis and identify prognostic factors for outcome in the context of current clinical practice.

Materials and analysis

Prospectively registered data on treatment, outcome and patient characteristics are collected from nationwide registers on health and social issues, a clinical registry of people with chronic back pain and hospital medical records. Primary outcome is change in physical function measured by the Zurich Claudication Questionnaire. Secondary outcomes are changes in symptom severity, pain-related function, health-related quality of life and general self-efficacy. Outcomes are assessed at baseline and 6 and 12 months. Outcomes at 12 months will be compared for patients who undergo surgery for lumbar spinal stenosis and patients managed non-surgically, using different analytical approaches. Prespecified prognostic factors of interest at baseline include treatment allocation, back and leg pain intensity, comorbidity, duration of symptoms, pretreatment function, self-rated health, income, general self-efficacy and MRI-graded severity of central stenosis.

Ethics and dissemination

The study has been evaluated by the Regional Committees on Health Research for Southern Denmark (S-20172000–200) and notified to the Danish Data Protection Agency (18/22336). All participants provide consent. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences according to the Strengthening the Reporting of Observational Studies in Epidemiology and Prognosis Research Strategy statements. Potential sources of bias will be addressed using Risk of Bias in Non-randomised Studies of Interventions.

Trial registration number

NCT03548441; Pre-results.
Preferences for portable ultrasound devices: a discrete choice experiment among abdominal aortic aneurysm surveillance patients and general ultrasound patients in England
Authors: Parsons Caron , Khan Kamran Ahmad , Pink Joshua , Verran Alice , Griffiths Frances , Hutchinson Charles E , Petrou Stavros
Published: December 2018

Objective

To undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA group); and (2) patients being scanned for general abdominal conditions (general group).

Design

A discrete choice experiment (DCE) questionnaire was administered to patients attending US appointments. Analysis of questionnaire responses used conditional logit models and included validity checks.

Setting

West Midlands, England.

Participants

524 patients (223 in the AAA group and 301 in the general group) were recruited from the US outpatient department at University Hospital Coventry and Warwickshire.

Outcome measures

Coefficients for attributes in relation to their reference levels.

Results

The AAA group preferred to have their US performed in hospital while the general group had a preference for portable US at general practice surgeries. All patients had a strong preference for scanning by specialists, devices with a lower risk of underdiagnosis and receiving their results at the appointment where the scan takes place. The general group had a strong preference for the person performing the scan to know their medical history.

Conclusions

Patients being scanned for general abdominal conditions prefer to be scanned in a general practice by practitioners who know their medical history. Patients undergoing surveillance of AAA size prefer to be scanned in a hospital setting. Both groups would prefer to be informed of the scan results as soon as possible. Further research is required to explore the clinical scenarios in which targeted scanning by community practitioners would be of benefit to patients.
Novel adaptations of mindfulness in the UK Armed Forces during peacetime
Authors: Bowen Ceri
Published: December 2018

Mindfulness approaches to promoting resilience and mental fitness within the UK Armed Forces have very recently emerged against a backdrop of studies from abroad, leading to a plethora of initiatives. These studies have used biological and cognitive markers of sustained attention and the human stress response, before and after training, in the period prior to deployment and made assertions of effectiveness on this basis. Progress has similarly been made in applying versions of mindfulness meditation to veteran patient groups with several difficult-to-treat conditions, to combat high dropout from services when little patient choice is offered. In short, a case has been made for offering mindfulness interventions as a further treatment option in combination with other approaches to maximise engagement with mental health services. Meanwhile, within the mindfulness literature more and more focus has been placed on ways to improve treatment fidelity and enhance teacher competency, and investment in teacher training is seen as essential for successful outcomes in any controlled trial.
Flow diversion covering the M1 origin as a last resort
Authors: Lin Li-Mei , Bender Matthew T , Colby Geoffrey P , Jiang Bowen , Campos Jessica K , Zarrin David A , Young Robert W C , Xu Risheng , Caplan Justin M , Huang Judy , Tamargo Rafael J , Coon Alexander L
Published: December 2018

Introduction

Internal carotid artery termination (ICAT) and proximal A1 aneurysms can be challenging for open surgical clipping or endovascular coiling. Treatment with flow diversion covering the middle cerebral artery (MCA), an end vessel supplying a terminal circulation, has not been reported.

Methods

A prospective, Institutional Review Board-approved database was analysed for patients with pipeline embolisation device (PED) placement from the anterior cerebral artery (ACA) to the ICA during cerebral aneurysm treatment.

Results

Nine cases were identified, including five proximal A1, three posterior communicating artery and one ICAT aneurysm locations. Average aneurysm size was 8.3 mm (range 3–17), with 67% saccular and 78% right-sided. Primary indication for treatment was significant dome irregularity (44%), recurrence or enlargement (33%), underlying collagen vascular disorder (11%) and traumatic pseudoaneurysm (11%). Preservation of the ipsilateral ACA (with PED placed in A1) was performed when the anterior communicating artery (67%) or contralateral A1 (33%) were absent on angiography. Adjunctive coiling was done in four cases (44%). There was one major stroke leading to mortality (11%) and one minor stroke (11%). Clinical follow-up was 27 months on average. Follow-up digital subtraction angiography (average interval 15 months) showed complete aneurysm obliteration (88%) or dome occlusion with entry remnant (12%). The jailed MCA showed minimal or mild delay (primarily anterograde flow) in 75% of cases and significant delay (reliance primarily on ACA and external carotid artery collaterals) in 25%.

Conclusions

Covering the MCA with a flow diverting stent should be reserved for select rare cases. Strict attention to blood pressure augmentation during the periprocedural period is necessary to minimise potential ischaemic compromise.
Calculation of energy levels and electric dipole (E1) transition parameters for magnesium-like bismuth
Authors: Konan Gülay Günday
Published: December 2018

Energy levels and electric dipole (E1) transition parameters such as wavelengths, transition probabilities (rates), weighted oscillator strengths, and line strengths for the levels of 3l3[Formula: see text] (l, [Formula: see text] = 0, 1, 2) in magnesium-like bismuth (Bi LXXII, Bi71+, Z = 83) are calculated using the AUTOSTRUCTURE code, which uses non-relativistic or kappa-averaged relativistic wave functions and the full Breit interaction in Pauli approximation. The results are compared with the available literature values and a good agreement is achieved. There are no available experimental data for Bi71+. Therefore, these theoretical calculations provide useful data for future experiments.
THE PERCEPTION OF CREATIVITY THROUGH MULTICULTURAL EXPERIENCE — RESULTS FROM AN EMPIRICAL ANALYSIS
Authors: WIMSCHNEIDER CHRISTINE , BREM ALEXANDER
Published: December 2018

This research is an approach to connect creativity and multicultural experiences (MCEs): we give insights into how and what type of MCE influences people’s perceptive abilities such as creativity. We offer one of the first empirical examinations that links the perception of creativity concept to strategy of acculturation. This study addresses an often-mentioned research gap by examining laypersons’ ability to perceive different levels of creativity. For this, a sample of 195 participants from 26 countries with and without MCE was researched. Findings indicate that attitudes as well as personal and professional goals apparently influence people’s creativity perception. The acculturation strategy integration seems to be a determining factor in this respect. As MCE has become a firm part of many people’s CV, the present paper adds to an omnipresent phenomenon in today’s society, which is worth studying.
Exponential sums involving q-digital functions
Authors: Aloui Karam
Published: December 2018

We estimate the exponential sum [Formula: see text], where [Formula: see text] is a real number and [Formula: see text] are digital functions; in the spirit of the works of Kim and Berend–Kolesnik. A similar estimate along short intervals is also provided.
Synthesis of disodium phosphonate functionalized graphene oxide as an efficient heterogeneous nanocatalyst for mercaptan removal from the gas stream
Authors: Mirzaeian Masoumeh M. , Rashidi Ali Morad , Zare Masud
Published: December 2018

Mercaptans are commonly present in natural gas. Their high corrosiveness make them the most undesirable sulfur compounds, so they should be removed because of harmful effects on the environment. Disodium phosphonate functionalized graphene oxide (GO-P(Na)2) nanocatalyst was synthesized and adsorption of mercaptan on nanocatalyst was studied in this work. The nanocatalyst was characterized using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM) and Raman spectroscopy analysis. The experiments were carried out in a fixed-bed reactor and the effect of temperature and Gas Hour Space Velocity (GHSV) parameters on mercaptan removal under nanocatalyst were investigated, demonstrating that increasing the temperature and decreasing the GHSV improves the rate of the reaction. Moreover, the kinetic parameters relevant to catalytic reaction for mercaptan removal under nanocatalyst were reported. The experimental results displayed that the maximum of mercaptan removal was obtained under GO-P(Na)2nanocatalyst at the temperature of 100∘C and GHSV of 1000[Formula: see text]h[Formula: see text]. The concentration of output mercaptan under nanocatalyst reduced from 16,800[Formula: see text]ppm to less than 25[Formula: see text]ppm.
Controllable synthesis of 3D Urchin-like V2O5as high-stability for Lithium-ion battery cathodes
Authors: Wang Qinggang , Huang Jianfeng , Pan Limin , Liu Yijun , Li Jiayin , Huang Lingyan
Published: December 2018

A facile technique was used to prepare self-assembled 3D urchin-like V2O5under solvothermal condition. The 3D urchin-like V2O5could provide high Li[Formula: see text] capacity with excellent rate performance, presenting a high reversible discharge capacity of 271.6[Formula: see text]mAh[Formula: see text]g[Formula: see text], at 0.1[Formula: see text]C. At current density of 1[Formula: see text]C, it shows a high reversible capacities of 209[Formula: see text]mAh[Formula: see text]g[Formula: see text] with capactity retention of 91.8% (191[Formula: see text]mAh[Formula: see text]g[Formula: see text]) after 380 cycles. Even at 2[Formula: see text]C and 5[Formula: see text]C, the capacity displays 172.4 and 129.24[Formula: see text]mAh[Formula: see text]g[Formula: see text]. The above enhanced performance is caused from greatly enhanced charge transportation, which closely relates to the structural stability and more channels for Li[Formula: see text] transfer of the unique 3D urchin-like V2O5.
Paleozoic plays of NW Europe: an introduction
Authors: Monaghan A. A. , Underhill J. R. , Marshall J. E. A. , Hewett A. J.
Published: December 2018

Despite successful production from Carboniferous and Permian reservoirs in the Southern North Sea and onshore Netherlands and Germany, Paleozoic hydrocarbon plays across parts of NW Europe remain relatively under-explored onshore and offshore. This volume brings together new and previously unpublished knowledge about the Paleozoic plays of NW Europe. Improvements in seismic data quality and availability tied to previously unpublished well datasets form the basis for improved understanding of local to regional structural interpretations, depositional environments and basin history. New interpretations move significantly away from generalized basin development models, with improved definition of structural traps and source rock basins feeding to better constrained, locally variable burial, uplift, maturation and migration models. Particularly notable are the significant mapped extents and thickness of Paleozoic source, reservoir and seal rocks. Areas previously dismissed as regional highs and platforms are dissected by Paleozoic basins with evidence for mature source rocks into basin centres. Numerous potential Paleozoic plays or play elements result within thick organic-rich and variably mature successions. Outside or below existing Jurassic and Southern North Sea to onshore Netherlands and German Permian-Carboniferous plays, Paleozoic plays in frontier areas offer significant additional exploration opportunities.
Eocene–Recent drainage evolution of the Colorado River and its precursor: an integrated provenance perspective from SW California
Authors: Nicholson Uisdean , Carter Andrew , Robinson Paula , Macdonald David I. M.
Published: December 2018

The Colorado River in the SW of the USA is one of Earth's few continental-scale rivers with an active margin delta. Deformation along this transform margin, as well as associated intra-plate strain, has resulted in significant changes in sediment routing from the continental interior and post-depositional translation of older deltaic units. The oldest candidate deposits, fluvial sandstones of the Eocene Sespe Group, are now exposed in the Santa Monica Mountains, 300 km to the north of the Colorado River. Heavy mineral data from this basin indicate that sediment was sourced by a large river system, with some affinity to the early Pliocene Colorado River, but was unlikely to have been integrated across the Colorado Plateau. Sedimentological and mineralogical evidence from the earliest (
c.
5.3 Ma) unequivocal Colorado River-derived sediments in the Salton Trough provide evidence for a rapid transition from locally derived sedimentation. Lack of evidence for a precursor phase of suspended-load sediment suggests that drainage capture took place in a proximal position, favouring a ‘top-down’ process of lake spillover. Following drainage integration, significant changes in heavy mineral assemblages of fluvio-deltaic sediments, particularly evident from apatite–tourmaline and garnet–zircon indices, as well as U–Pb ages of detrital zircons, document the integration of the fluvial system to its present form and progressive incision of the Colorado Plateau from the Miocene to the present.
The Church-Turing thesis
Authors: Copeland B. Jack , Shagrir Oron
Published: December 2018

In its original form, the Church-Turing thesis concerned computation as Alan Turing and Alonzo Church used the term in 1936---
human
computation.
Proof Complexity Meets Algebra
Authors: Atserias Albert , Ochremiak Joanna
Published: December 2018

We analyze how the standard reductions between constraint satisfaction problems affect their proof complexity. We show that, for the most studied propositional, algebraic, and semialgebraic proof systems, the classical constructions of pp-interpretability, homomorphic equivalence, and addition of constants to a core preserve the proof complexity of the CSP. As a result, for those proof systems, the classes of constraint languages for which small unsatisfiability certificates exist can be characterized algebraically. We illustrate our results by a gap theorem saying that a constraint language either has resolution refutations of constant width or does not have bounded-depth Frege refutations of subexponential size. The former holds exactly for the widely studied class of constraint languages of bounded width. This class is also known to coincide with the class of languages with refutations of sublinear degree in Sums of Squares and Polynomial Calculus over the real field, for which we provide alternative proofs. We then ask for the existence of a natural proof system with good behavior with respect to reductions and simultaneously small-size refutations beyond bounded width. We give an example of such a proof system by showing that bounded-degree Lovász-Schrijver satisfies both requirements. Finally, building on the known lower bounds, we demonstrate the applicability of the method of reducibilities and construct new explicit hard instances of the graph three-coloring problem for all studied proof systems.
Blending Human and Artificial Intelligence to Support Autistic Children’s Social Communication Skills
Authors: Porayska-Pomsta Kaśka , Alcorn Alyssa M. , Avramides Katerina , Beale Sandra , Bernardini Sara , Foster Mary Ellen , Frauenberger Christopher , Good Judith , Guldberg Karen , Keay-Bright Wendy , Kossyvaki Lila , Lemon Oliver , Mademtzi Marilena , Menzies Rachel , Pain Helen , Rajendran Gnanathusharan , Waller Annalu , Wass Sam , Smith Tim J.
Published: December 2018

This article examines the educational efficacy of a learning environment in which children diagnosed with Autism Spectrum Conditions (ASC) engage in social interactions with an artificially intelligent (AI) virtual agent and where a human practitioner acts in support of the interactions. A multi-site intervention study in schools across the UK was conducted with 29 children with ASC and learning difficulties, aged 4--14 years old. For reasons related to data completeness and amount of exposure to the AI environment, data for 15 children was included in the analysis. The analysis revealed a significant increase in the proportion of social responses made by ASC children to human practitioners. The number of initiations made to human practitioners and to the virtual agent by the ASC children also increased numerically over the course of the sessions. However, due to large individual differences within the ASC group, this did not reach significance. Although no evidence of transfer to the real-world post-test was shown, anecdotal evidence of classroom transfer was reported. The work presented in this article offers an important contribution to the growing body of research in the context of AI technology design and use for autism intervention in real school contexts. Specifically, the work highlights key methodological challenges and opportunities in this area by leveraging interdisciplinary insights in a way that (i) bridges between educational interventions and intelligent technology design practices, (ii) considers the design of technology as well as the design of its use (context and procedures) on par with one another, and (iii) includes design contributions from different stakeholders, including children with and without ASC diagnosis, educational practitioners, and researchers.
Generalized Eilenberg Theorem
Authors: Adámek Jiří , Milius Stefan , Myers Robert S.R. , Urbat Henning
Published: December 2018

For finite automata as coalgebras in a category
C
, we study languages they accept and varieties of such languages. This generalizes Eilenberg’s concept of a variety of languages, which corresponds to choosing as
C
the category of Boolean algebras. Eilenberg established a bijective correspondence between pseudovarieties of monoids and varieties of regular languages. In our generalization, we work with a pair
C
/
D
of locally finite varieties of algebras that are predual, i.e., dualize on the level of finite algebras, and we prove that pseudovarieties of
D
-monoids bijectively correspond to varieties of regular languages in
C
. As one instance, Eilenberg’s result is recovered by choosing
D
= sets and
C
= Boolean algebras. Another instance, Pin’s result on pseudovarieties of ordered monoids, is covered by taking
D
= posets and
C
= distributive lattices. By choosing as
C
amp;equals;
D
the self-predual category of join-semilattices, we obtain Polák’s result on pseudovarieties of idempotent semirings. Similarly, using the self-preduality of vector spaces over a finite field
K
, our result covers that of Reutenauer on pseudovarieties of
K
-algebras. Several new variants of Eilenberg’s theorem arise by taking other predualities, e.g., between the categories of non-unital Boolean rings and of pointed sets. In each of these cases, we also prove a local variant of the bijection, where a fixed alphabet is assumed and one considers local varieties of regular languages over that alphabet in the category
C
.
Interval vs. Point Temporal Logic Model Checking
Authors: Bozzelli Laura , Molinari Alberto , Montanari Angelo , Peron Adriano , Sala Pietro
Published: December 2018

In recent years, model checking with interval temporal logics is emerging as a viable alternative to model checking with standard point-based temporal logics, such as LTL, CTL, CTL*, and the like. The behavior of the system is modeled by means of (finite) Kripke structures, as usual. However, while temporal logics which are interpreted “point-wise” describe how the system evolves state-by-state, and predicate properties of system states, those which are interpreted “interval-wise” express properties of computation stretches, spanning a sequence of states. A proposition letter is assumed to hold over a computation stretch (interval) if and only if it holds over each component state (homogeneity assumption). A natural question arises: is there any advantage in replacing points by intervals as the primary temporal entities, or is it just a matter of taste?

In this article, we study the expressiveness of Halpern and Shoham’s interval temporal logic (HS) in model checking, in comparison with those of LTL, CTL, and CTL*. To this end, we consider three semantic variants of HS: the state-based one, introduced by Montanari et al. in [30, 34], that allows time to branch both in the past and in the future, the computation-tree-based one, that allows time to branch in the future only, and the trace-based variant, that disallows time to branch. These variants are compared among themselves and to the aforementioned standard logics, getting a complete picture. In particular, we show that HS with trace-based semantics is equivalent to LTL (but at least exponentially more succinct), HS with computation-tree-based semantics is equivalent to finitary CTL*, and HS with state-based semantics is incomparable with all of them (LTL, CTL, and CTL*).
A perpetual switching system in pulmonary capillaries
Authors: Wagner Wiltz W. , Jaryszak Eric M. , Peterson Amanda J. , Doerschuk Claire M. , Bohlen H. Glenn , King Judy A. C. , Tanner Judith A. , Crockett Edward S. , Glenny Robb W. , Presson Robert G.
Published: December 2018

Of the 300 billion capillaries in the human lung, a small fraction meet normal oxygen requirements at rest, with the remainder forming a large reserve. The maximum oxygen demands of the acute stress response require that the reserve capillaries are rapidly recruited. To remain primed for emergencies, the normal cardiac output must be parceled throughout the capillary bed to maintain low opening pressures. The flow-distributing system requires complex switching. Because the pulmonary microcirculation contains contractile machinery, one hypothesis posits an active switching system. The opposing hypothesis is based on passive switching that requires no regulation. Both hypotheses were tested ex vivo in canine lung lobes. The lobes were perfused first with autologous blood, and capillary switching patterns were recorded by videomicroscopy. Next, the vasculature of the lobes was saline flushed, fixed by glutaraldehyde perfusion, flushed again, and then reperfused with the original, unfixed blood. Flow patterns through the same capillaries were recorded again. The 16-min-long videos were divided into 4-s increments. Each capillary segment was recorded as being perfused if at least one red blood cell crossed the entire segment. Otherwise it was recorded as unperfused. These binary measurements were made manually for each segment during every 4 s throughout the 16-min recordings of the fresh and fixed capillaries (>60,000 measurements). Unexpectedly, the switching patterns did not change after fixation. We conclude that the pulmonary capillaries can remain primed for emergencies without requiring regulation: no detectors, no feedback loops, and no effectors—a rare system in biology.

NEW & NOTEWORTHY The fluctuating flow patterns of red blood cells within the pulmonary capillary networks have been assumed to be actively controlled within the pulmonary microcirculation. Here we show that the capillary flow switching patterns in the same network are the same whether the lungs are fresh or fixed. This unexpected observation can be successfully explained by a new model of pulmonary capillary flow based on chaos theory and fractal mathematics.
Exercise intensity affects acute neurotrophic and neurophysiological responses poststroke
Authors: Boyne Pierce , Meyrose Colleen , Westover Jennifer , Whitesel Dustyn , Hatter Kristal , Reisman Darcy S. , Cunningham David , Carl Daniel , Jansen Connor , Khoury Jane C. , Gerson Myron , Kissela Brett , Dunning Kari
Published: December 2018

Aerobic exercise may acutely prime the brain to be more responsive to rehabilitation, thus facilitating neurologic recovery from conditions like stroke. This aerobic priming effect could occur through multiple mechanisms, including upregulation of circulating brain-derived neurotrophic factor (BDNF), increased corticospinal excitability, and decreased intracortical inhibition. However, optimal exercise parameters for targeting these mechanisms are poorly understood. This study tested the effects of exercise intensity on acute BDNF and neurophysiological responses. Sixteen ambulatory persons >6 mo poststroke performed three different 20-min exercise protocols in random order, approximately 1 wk apart, including the following: 1) treadmill high-intensity interval training (HIT-treadmill); 2) seated-stepper HIT (HIT-stepper); and 3) treadmill moderate-intensity continuous exercise (MCT-treadmill). Serum BDNF and transcranial magnetic stimulation measures of paretic lower limb excitability and inhibition were assessed at multiple time points during each session. Compared with MCT-treadmill, HIT-treadmill elicited significantly greater acute increases in circulating BDNF and corticospinal excitability. HIT-stepper initially showed BDNF responses similar to HIT-treadmill but was no longer significantly different from MCT-treadmill after decreasing the intensity in reaction to two hypotensive events. Additional regression analyses showed that an intensity sufficient to accumulate blood lactate appeared to be important for eliciting BDNF responses, that the interval training approach may have facilitated the corticospinal excitability increases, and that the circulating BDNF response was (negatively) related to intracortical inhibition. These findings further elucidate neurologic mechanisms of aerobic exercise and inform selection of optimal exercise-dosing parameters for enhancing acute neurologic effects.

NEW & NOTEWORTHY Acute exercise-related increases in circulating BDNF and corticospinal excitability are thought to prime the brain for learning. Our data suggest that these responses can be obtained among persons with stroke using short-interval treadmill high-intensity interval training, that a vigorous aerobic intensity sufficient to generate lactate accumulation is needed to increase BDNF, that interval training facilitates increases in paretic quadriceps corticospinal excitability, and that greater BDNF response is associated with lesser intracortical inhibition response.
Architectural and functional specifics of the human triceps surae muscle in vivo and its adaptation to microgravity
Authors: Koryak Yuri A.
Published: December 2018

Long-term exposure to microgravity (μG) is known to reduce the strength of a skeletal muscle contraction and the level of general physical performance in humans, while little is known about its effect on muscle architecture. Architectural and contractile properties of the triceps surae (TS) muscle were determined in vivo for male cosmonauts in response ( n = 8) to a spaceflight (213.0 ± 30.5 days). The maximal voluntary contraction (MVC), tetanic tension ( Ро), and voluntary and electrically evoked contraction times and force deficiency (Pd) were determined. The ankle was positioned at 15° dorsiflexion (−15°) and 0, 15, and 30° plantar flexion, with the knee set at 90°. At each position, longitudinal ultrasonic images of the medial (MG) and lateral (LG) gastrocnemius and soleus (SOL) muscles were obtained while the subject was relaxed. After a spaceflight, MVC and Pо decreased by 42 and 26%, respectively, and Pd increased by 50%. The rate of tension of a voluntary contraction substantially reduced but evoked contractions remained unchanged. In the passive condition, fiber length ( Lf) changed from 43, 57, and 35 mm (knee, 0°; ankle, −15°) to 34, 38, and 25 mm (knee, 0°; ankle, 30°) for MG, LG, and SOL, respectively, and Θf changed from 27, 21, and 23° (knee, 0°; ankle, −15°) to 43, 29, and 34° (knee, 0°; ankle, 30°) for MG, LG, and SOL, respectively. Different Lf and Θf, and their changes after spaceflight, might be related to differences in force-producing capabilities of the muscles and elastic characteristics of tendons and aponeuroses.

NEW & NOTEWORTHY The present work was the first to combine measuring the fiber length and pennation angle (ultrasound imaging) as main determinants of mechanical force production and evaluating the muscle function after a long-duration spaceflight. The results demonstrate that muscles with different functional roles may differently respond to unloading, and this circumstance is important to consider when planning rehabilitation after unloading of any kind, paying particular attention to postural muscles.
Isometric resistance training increases strength and alters histopathology of dystrophin-deficient mouse skeletal muscle
Authors: Lindsay Angus , Larson Alexie A. , Verma Mayank , Ervasti James M. , Lowe Dawn A.
Published: December 2018

Mutation to the dystrophin gene causes skeletal muscle weakness in patients with Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy (BMD). Deliberation continues regarding implications of prescribing exercise for these patients. The purpose of this study was to determine whether isometric resistance exercise (~10 tetanic contractions/session) improves skeletal muscle strength and histopathology in the mdx mouse model of DMD. Three isometric training sessions increased in vivo isometric torque (22%) and contractility rates (54%) of anterior crural muscles of mdx mice. Mice expressing a BMD-causing missense mutated dystrophin on the mdx background showed comparable increases in torque (22%), while wild-type mice showed less change (11%). Increases in muscle function occurred within 1 h and peaked 3 days posttraining; however, the adaptation was lost after 7 days unless retrained. Six isometric training sessions over 4 wk caused increased isometric torque (28%) and contractility rates (22–28%), reduced fibrosis, as well as greater uniformity of fiber cross-sectional areas, fewer embryonic myosin heavy-chain-positive fibers, and more satellite cells in tibialis anterior muscle compared with the contralateral untrained muscle. Ex vivo functional analysis of isolated extensor digitorum longus (EDL) muscle from the trained hindlimb revealed greater absolute isometric force, lower passive stiffness, and a lower susceptibility to eccentric contraction-induced force loss compared with untrained EDL muscle. Overall, these data support the concept that exercise training in the form of isometric tetanic contractions can improve contractile function of dystrophin-deficient muscle, indicating a potential role for enhancing muscle strength in patients with DMD and BMD.

NEW & NOTEWORTHY We focused on adaptive responses of dystrophin-deficient mouse skeletal muscle to isometric contraction training and report that in the absence of dystrophin (or in the presence of a mutated dystrophin), strength and muscle histopathology are improved. Results suggest that the strength gains are associated with fiber hypertrophy, reduced fibrosis, increased number of satellite cells, and blunted eccentric contraction-induced force loss in vitro. Importantly, there was no indication that the isometric exercise training was deleterious to dystrophin-deficient muscle.
Four-Chamber Intracardiac Thrombi Complicating Wild-Type TTR Amyloidosis
Authors: Griffin Jan M. , Judge Daniel P. , Zehr Kenton J. , Madrazo Jose , Rouf Rosanne
Published: December 2018

Cardiac amyloidosis is a rare disease, and its prevalence varies depending on the type of amyloid protein involved. Several case reports make reference to the increased risk of thrombosis and thromboembolic events in cardiac amyloidosis. We report a case of rapidly evolving, multichamber thrombi in a patient who was ultimately diagnosed with wild-type TTR cardiac amyloidosis.
Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
Authors: Youssef Alexey , Kasso Nawara , Torloni Antonio Sergio , Stanek Michael , Dragovich Tomislav , Gimbel Mark , Mahmoud Fade
Published: December 2018

Ipilimumab is a monoclonal antibody that enhances the efficacy of the immune system by targeting a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which is a protein receptor that downregulates the immune system. Nivolumab is also a humanized monoclonal antibody that targets another protein receptor that prevents activated T cells from attacking the cancer; this receptor is called programmed cell death 1 (PD-1). The FDA approved ipilimumab combined with nivolumab as a frontline therapy for patients with metastatic melanoma or renal cell carcinoma and as a second-line therapy for patients with microsatellite instability-high (MSI-H) metastatic colon cancer. Immune-related adverse events such as autoimmune colitis, pneumonitis, hepatitis, nephritis, hypophysitis, and thyroiditis may occur during or weeks to months after therapy. We report a case of thrombotic thrombocytopenic purpura (TTP) in a patient with metastatic renal cell carcinoma following one cycle of ipilimumab and nivolumab. Only one case report of ipilimumab-induced TTP exists in the medical literature. With the wide use of immunotherapy to treat cancers, physicians need to be aware of this rare immune-related adverse event.
Adaptive Finite-Time Synchronization for Complex Dynamical Network with Different Dimensions of Nodes and Time-Varying Outer Coupling Structures
Authors: Yan Lihong , Li Junmin
Published: December 2018

In this paper, we investigate finite-time synchronization problems of complex dynamical networks with different dimensions of nodes, which contain unknown periodically coupling structures and bounded time-varying delay. Based on finite-time stability theory, the inequality techniques, and the properties of Kronecker production of matrices, some useful finite-time synchronization criteria for complex dynamical network with unknown periodical couplings have been obtained. In addition, with proper adaptive periodical learning law designed, the unknown periodical couplings have been estimated successfully. Finally, some simulation examples are performed to verify the theoretical findings.
Multiple and Bilateral Sporadic Renal Cell Carcinomas: A Surgical Challenge
Authors: Katsimantas Antonios , Paparidis Spyridon , Bouropoulos Konstantinos , Ferakis Nikolaos
Published: December 2018

Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68-year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient’s estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.
Transient Thermal-Electric Simulation and Experiment of Heat Transfer in Welding Tip for Reflow Soldering Process
Authors: Thongsri Jatuporn
Published: December 2018

Welding tip is an appliance for making footprint to connect the arm and head gimbal assembly (HGA) together in reflow soldering process. The welding tip is made from 3 materials: copper alloy, stainless steel, and haynes 230. It works based on Joule heating effect. The haynes 230 head tip is the area used to create a footprint. In the past, failure in the reflow soldering process of a hard disk drive factory was found resulting in defective products; therefore, a solution to resolve this problem must be researched. This article reports a solution to the aforementioned problem by using transient thermal-electric simulation to investigate the heat transfer in the welding tip and a simple experiment to verify the simulation. By using ANSYS, the simulation results revealed the temperature of welding tip. The maximum temperature was 406°C on the head tip at t=0.7s and then it rapidly decreased. The reflow soldering process failure occurred when footprint was done after 0.7s causing the temperature to be too low for melting the solder so the arm and HGA were unable to connect to each other. We proposed simple solutions and ways to improve the efficacy of the reflow soldering process; e.g., footprints should be done at 0.7s, and the welding tip’s material should be changed from haynes 230 to 556. After the factory implemented our results, the problem could truly be resolved. Not only do products have a higher quality but also miscellaneous expenses from defective products are saved.
Laboratory and Centrifuge Model Tests on Influence of Swelling Rock with Drying‐Wetting Cycles on Stability of Canal Slope
Authors: Zhang Chen , Cai Zheng-yin , Huang Ying-hao , Chen Hao
Published: December 2018

This study focused on the swelling behavior of swelling rock from canal basement under multiple drying‐wetting (D‐W) cycles. A series of laboratory tests were conducted on a swelling rock, with the cracking and strength behaviors investigated. By using image‐processing technique, the crack patterns were described, and then quantitatively analyzed on the basis of the fractal dimension. The experimental data indicated that swelling ability, including cracking level, fractal dimension, and strength, decrease with increasing drying and wetting cycle. On this basis, a series of centrifuge model simulations for simulating slope failure by drying‐wetting cycles were performed, where the drying process was achieved by heat bulbs. The monitoring results suggested that a global slope failure has occurred after total cycle of 4th corresponding to 4 years. Due to the development of surface cracking, the infiltration in the slope was severe and nonuniform in space and time. Meanwhile, the failure mechanism of soft rock slope induced by D‐W was discussed.
Fat Embolism and Nonconvulsive Status Epilepticus
Authors: Olivera Arencibia Yanetsy , Vo Mai , Kinaga Jennifer , Uribe Jorge , Velasquez Gloria , Madruga Mario , Carlan S. J.
Published: December 2018

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.
Resveratrol Suppresses Gut-Derived NLRP3 Inflammasome Partly through Stabilizing Mast Cells in a Rat Model
Authors: Zhao Weicheng , Huang Xiaolei , Han Xue , Hu Dan , Hu Xiaohuai , Li Yuantao , Huang Pinjie , Yao Weifeng
Published: December 2018

Background. Inflammatory responses induced by intestinal ischemia-reperfusion (IIR) lead to serious systemic organ dysfunction and pose a challenge for current treatment. This study aimed at investigating the effects of resveratrol on IIR-induced intestinal injury and its influence on mast cells (MCs) in rats. Methods. Rats subjected to intestinal ischemia for 60 min and 4 h of IIR were investigated. Animals were randomly divided into five groups (n=8 per group): sham, IIR, resveratrol (RESV, 15 mg/kg/day for 5 days before operation) + IIR, cromolyn sodium (CS, MC membrane stabilizer) + IIR, and RESV + compound 48/80 (CP, MC agonist) + IIR. Results. Intestinal injury and increased proinflammatory cytokines including tumor necrosis factor-α, interleukin-1β, and interleukin-18 were observed in the IIR group. Intestinal MC-related tryptase and β-hexosaminidase levels were also increased after rats were subjected to IIR accompanied by activation of NLRP3 inflammasomes. Interestingly, pretreatment with resveratrol significantly suppressed the activities of proinflammatory cytokines and attenuated intestinal injury. Resveratrol also reduced MC and NLRP3 inflammasome activation, which was consistent with the effects of cromolyn sodium. However, the protective effects of resveratrol were reversed by the MC agonist compound 48/80. Conclusions. In summary, these findings reveal that resveratrol suppressed IIR injury by stabilizing MCs, preventing them from degranulation, accompanied with intestinal mucosa NLRP3 inflammasome inhibition and intestinal epithelial cell apoptosis reduction.
Oxidative Stress Induced by Excess of Adiposity Is Related to a Downregulation of Hepatic SIRT6 Expression in Obese Individuals
Authors: Carreira Marcos C. , Izquierdo Andrea G. , Amil Maria , Casanueva Felipe F. , Crujeiras Ana B.
Published: December 2018

Sirt6 is a member of the sirtuin family involved in physiological and pathological processes including aging, cancer, obesity, diabetes, and energy metabolism. This study is aimed at evaluating the relationship between liver SIRT6 gene expression and the oxidative stress network depending on adiposity levels in Zucker rats, an animal model of metabolic syndrome. We observed that liver‐specific SIRT6 expression is reduced in an in vivo model of spontaneous obesity and metabolic syndrome. We also observed that SIRT6 expression in the liver is positively associated with SIRT1 and GST-M2 expressions, two proteins involved in antioxidant protection pathways and inversely related to body weight and plasmatic oxidative status. Interestingly, the SIRT6 expression is upregulated after energy restriction‐induced weight loss concomitantly with an improvement in oxidative stress markers. These results suggest that SIRT6 may be a potential therapeutic target for the treatment of obesity and associated metabolic disorders, such as liver disease.