bluuebunny/crossref_metadata_2025 huggingface dataset:
How will climate change shape climate opinion?
Authors: Howe Peter D , Marlon Jennifer R , Mildenberger Matto , Shield Brittany S
Published: September 2019

As climate change intensifies, global publics will experience more unusual weather and extreme weather events. How will individual experiences with these weather trends shape climate change beliefs, attitudes, and behaviors? In this article, we review 73 papers that have studied the relationship between climate change experiences and public opinion. Overall, we find mixed evidence that weather shapes climate opinions. Although there is some support for a weak effect of local temperature and extreme weather events on climate opinion, the heterogeneity of independent variables, dependent variables, study populations, and research designs complicate systematic comparison. To advance research on this critical topic, we suggest that future studies pay careful attention to differences between self-reported and objective weather data, causal identification, and the presence of spatial autocorrelation in weather and climate data. Refining research designs and methods in future studies will help us understand the discrepancies in results, and allow better detection of effects, which have important practical implications for climate communication. As the global population increasingly experiences weather conditions outside the range of historical experience, researchers, communicators, and policymakers need to understand how these experiences shape-and are shaped by-public opinions and behaviors.
Numerical study of the heat transfer and flow characteristics of heat pipes
Authors: Huminic A , Huminic G
Published: September 2019

In this work, a three-dimensional (CFD) analysis is used to investigate the heat transfer and fluid flow of a heat pipe using water and nanofluids as working fluids. The study focused mainly on the effects of volume concentrations of nanoparticles and the operating temperature on the heat transfer performance of the heat pipe using the nanofluids, but there is revealed also aspects concerning flow characteristics of fluids. The analysis was performed for water and two types of nanofluids, two volume concentrations of nanoparticles (1.0% and 4 vol.%) and three operating temperatures (70 °C, 80 °C and 90 °C). Nanofluids were composed of water and SiC and TiC nanoparticles with the diameter of 10nm. The numerical results indicate that the volume concentration of nanoparticles has an important effect in reducing of the temperature difference between evaporator and condenser. The present study shows also that the thermal performance of a heat pipe can be significantly improved by using of both wick structure and nanofluids.
Comparative analysis of the study of microclimate parameters in wooden houses in North-Eastern Bulgaria
Authors: Zlateva P , Yordanov K
Published: September 2019

The subject of this study are some parameters of the microclimate in wooden houses in North-Eastern Bulgaria. This is necessary to identify the most influential parameters that affect human health and effectively improve energy efficiency in modern wooden residential buildings. Internal temperature, relative humidity and air speed and fine particulate matter were measured. External temperature and relative air humidity were also measured. The research results confirm that wood is a natural thermo-protective and moisture-regulating material. The analysis proposed can be applied to all energy efficiency projects in areas with similar climatic conditions.
Modelling of CO2/acetone fluid mixture thermodynamic properties for compression/resorption refrigeration systems
Authors: Moreira-da-Silva R J B , Salavera D , Coronas A
Published: September 2019

Compression/resorption refrigeration systems are similar to conventional vapor compression systems but using zeotropic mixtures with large boiling temperature difference, similar to the refrigerant/absorbent mixtures used in absorption technology. A resorber and a desorber replace the conventional condenser and evaporator, respectively. As the saturation temperature in both desorber and resorber change with the composition, there is a gliding temperature that can reduce the irreversibility of the heat transfer with external sensible heat and sink sources. Another advantage of these systems is that they operate at lower pressures and pressure ratios than the conventional ones. CO2/acetone mixture was proposed for automotive air-conditioning with compression/resorption systems. In this paper, different methods are evaluated for modelling the thermodynamic properties, using experimental data. The selected thermodynamic model will be used to study the performance of the compression/resorption refrigeration cycle.
Theoretical and experimental features of the thermodynamic process in oil injection screw compressors
Authors: Neacsu S , Eparu C N , Suditu S , Neacșa A , Toma N , Slujitoru C
Published: September 2019

For optimum performance of screw compressors, reduce wear and improve leakage, oil injection needs to be applied. The injected oil runs through the compressor together with the gas, taking a part of the heat of the gas resulting from compression during the process. The paper presents a theoretical analysis of the compression process affected by the cooling of the oil injection. The oil injection screw compressor is ideal for this process because the oil injected into the compressor along with the lubrication and sealing technology cools the compressed gas, which makes the compression process to be much closer to an isothermal process (minimum compression required). In order to calculate the thermodynamic of the gas lift process, the hydraulic calculation of the process, in which the extracted production, the amount of gas required, the injection pressures and the location of the valves, should be performed. These parameters were determined to correspond to the oil injection screw compressors manufactured in Romania by INCDT-COMOTI. The essential characteristics of those screw compressors that could be used considering the specificity of the location where the compressor will be mounted will be highlighted also.
Hydrogen a new fuel for internal combustion engines
Authors: Gheorghe D , Tutunea D , Bică M , Gruia A , Calbureanu M
Published: September 2019

The depletion of fossil fuels and the strict emissions regulations have motivated researchers to find and invest considerable resources in finding new renewable fuels. Hydrogen can be used in automotive industry to control the pollutant emissions and to improve engine performances. However, the producing of hydrogen is expensive, the supply infrastructure is not ready and the engines are affected by knocking phenomena and the increase of NOx emissions. The focus is now in the research of advance combustion technologies such dual fuel engines, homogeneous charge compression ignition (HCCI) and low-temperature combustion (LTC). The main limitations, challenges and perspectives are presented.
Experimental study of NOx and CO2 emissions at load regimes for a passenger car powered by direct injection diesel engine
Authors: Burciu S M , Coman G
Published: September 2019

The paper presents a study of NOx and CO2 emissions for a standard diesel direct injection engine, which equips the Renault-Dacia Solenza 1.9D-SDI cars. The different pollutions levels are analysed between idling regimes and medium and high loads at different speeds and transmission gearboxes. To simulate the load regimes, chassis dynamometer V-Tech Dyno VT-2/B1 was used. The exhaust gases were taken to various operating modes on the chassis dynamometer, specific regimes in urban and extra-urban mode. In the paper, some recommendations are made on operating regimes that would ensure the functioning of the car at a lower polluting level.
Basic geometric and physical parameters of pumpkin seeds
Authors: Atanasov D , Georgieva M , Kiryakov I , Rulev V
Published: September 2019

The granulometric composition of Pumpkin seeds of the “Samson” variety used as feedstock for food and vegetable oils producing industry are studied. Their geometric dimensions and physical indices are obtained experimentally. Results and dependencies necessary for designing and dimensioning of drying ovens from installation for vegetable oils production are obtained.
Foraging Ecology of the Leaf-Cutter Ant, Acromyrmex subterraneus (Hymenoptera: Formicidae), in a Neotropical Cerrado Savanna
Authors: Calheiros Ana C , Ronque Mariane U V , Soares Hélio , Oliveira Paulo S
Published: September 2019

Fungus-farming ants cultivate a fungal symbiont inside the nest that serves as a food source. Leaf-cutter ants are distinctive among fungus-farmers because they forage for fresh plant material to nurture the fungus. Here we investigate the foraging ecology of Acromyrmex subterraneus (Forel) in the Brazilian cerrado savanna. We examined the species activity pattern, forage material collected, and the relationship between load mass and forager size. Ant activity peaked at night and was negatively related to temperature but positively related to relative air humidity. The majority of the items collected by ants was plant material: dry and fresh leaves, flowers, and fruits. Trunk trails ranged from 0.7 to 13 m and colony home ranged from 2 to 28 m2, indicating that ants collect material nearby the nest. Total load mass was positively associated with forager size, especially in the case of leaves. The negative relationship between ant size and burden suggests that ants might optimize their delivery rate by collecting lighter substrates more frequently. Given their pest status, most studies on leaf-cutters are undertaken in human-altered environments. Information on A. subterraneus in native cerrado is imperative given the threatened status of this vegetation. Leaf-cutters thrive in disturbed cerrado and severe seedling herbivory may hinder vegetation recovery. Our fieldwork may provide insights for management techniques of Acromyrmex colonies in agroecosystems, as well as for restoration programs of degraded cerrado areas.
SH wave scattering by a frozen porous inclusion in fluid-saturated porous media using two approaches: wave function expansion and boundary element method
Authors: Furukawa A , Saitoh T , Hirose S
Published: September 2019

This paper presents SH wave scattering by a frozen porous inclusion embedded in fluid-saturated porous media. We propose two computational methods, wave function expansion (WFE) and boundary element method (BEM), for wave scattering analyses. In WFE formulation, the components of displacement and stress are expressed by the superposition of the Bessel functions. The unknown coefficients in the expression are obtained via boundary conditions. On the other hand, in BEM formulation, boundary values of the frozen porous media are expressed by generalized displacement and traction. The generalized displacement consists of displacement components of the solid skeleton and the ice matrix, and the generalized traction is composed of the traction components of the two solid phases. Several numerical examples provide the validity of the proposed methods and the properties of the scattered waves. The discussion of the scattering properties focuses on the effects of ice saturation parameter, frequency of harmonic incident wave, the incident angle of the harmonic wave and the shape of the inclusion.
Allometry, Scaling, and Ontogeny of Form—An Introduction to the Symposium
Authors: Nijhout H Frederik , McKenna Kenneth Z
Published: September 2019

Until recently, the study of allometry has been mostly descriptive, and consisted of a diversity of methods for fitting regressions to bivariate or multivariate morphometric data. During the past decade, researchers have been developing methods to extract biological information from allometric data that could be used to deduce the underlying mechanisms that gave rise to the allometry. In addition, an increasing effort has gone into understanding the kinetics of growth and the regulatory mechanisms that control growth of the body and its component parts. The study of allometry and scaling has now become an exceptionally diverse field, with different investigators applying state of the art methods and concepts in evolution, developmental biology, cell biology, and genetics. Diversity has caused divergence, and we felt that although there is general agreement about the new goals for the study of allometry (understanding underlying mechanisms and how those evolve to produce different morphologies), progress is hindered by lack of coordination among the different approaches. We felt the time was right to bring these diverse practitioners together in a symposium to discuss their most recent work in the hope of forging new functional, conceptual, and collaborative connections among established and novice practitioners.
A suppressive oligodeoxynucleotide expressing TTAGGG motifs modulates cellular energetics through the mTOR signaling pathway
Authors: Yazar Volkan , Kilic Gizem , Bulut Ozlem , Canavar Yildirim Tugce , Yagci Fuat C , Aykut Gamze , Klinman Dennis M , Gursel Mayda , Gursel Ihsan
Published: September 2019

Abstract

Immune-mediated inflammation must be down-regulated to facilitate tissue remodeling during homeostatic restoration of an inflammatory response. Uncontrolled or over-exuberant immune activation can cause autoimmune diseases, as well as tissue destruction. A151, the archetypal example of a chemically synthesized suppressive oligodeoxynucleotide (ODN) based on repetitive telomere-derived TTAGGG sequences, was shown to successfully down-regulate a variety of immune responses. However, the degree, duration and breadth of A151-induced transcriptome alterations remain elusive. Here, we performed a comprehensive microarray analysis in combination with Ingenuity Pathway Analysis (IPA) using murine splenocytes to investigate the underlying mechanism of A151-dependent immune suppression. Our results revealed that A151 significantly down-regulates critical mammalian target of rapamycin (mTOR) activators (Pi3kcd, Pdpk1 and Rheb), elements downstream of mTOR signaling (Rps6ka1, Myc, Stat3 and Slc2a1), an important component of the mTORC2 protein complex (Rictor) and Mtor itself. The effects of A151 on mTOR signaling were dose- and time-dependent. Moreover, flow cytometry and immunoblotting analyses demonstrated that A151 is able to reverse mTOR phosphorylation comparably to the well-known mTOR inhibitor rapamycin. Furthermore, Seahorse metabolic assays showed an A151 ODN-induced decrease in both oxygen consumption and glycolysis implying that a metabolically inert state in macrophages could be triggered by A151 treatment. Overall, our findings suggested novel insights into the mechanism by which the immune system is metabolically modulated by A151 ODN.
The Universally Conserved Residues Are Not Universally Required for Stable Protein Expression or Functions of Cryptochromes
Authors: Liu Huachun , Su Tiantian , He Wenjin , Wang Qin , Lin Chentao
Published: September 2019

Universally conserved residues (UCRs) are invariable amino acids evolutionarily conserved among members of a protein family across diverse kingdoms of life. UCRs are considered important for stability and/or function of protein families, but it has not been experimentally examined systematically. Cryptochromes are photoreceptors in plants or light-independent components of the circadian clocks in mammals. We experimentally analyzed 51 UCRs of Arabidopsis cryptochrome 2 (CRY2) that are universally conserved in eukaryotic cryptochromes from Arabidopsis to human. Surprisingly, we found that UCRs required for stable protein expression of CRY2 in plants are not similarly required for stable protein expression of human hCRY1 in human cells. Moreover, 74% of the stably expressed CRY2 proteins mutated in UCRs retained wild-type-like activities for at least one photoresponses analyzed. Our finding suggests that the evolutionary mechanisms underlying conservation of UCRs or that distinguish UCRs from non-UCRs determining the same functions of individual cryptochromes remain to be investigated.
The effect of maternal high-fat/high-sugar diet on offspring oocytes and early embryo development
Authors: Andreas E , Reid M , Zhang W , Moley K H
Published: September 2019

Observational human data and several lines of animal experimental data indicate that maternal obesity impairs offspring health. Here, we comprehensively tested the model that maternal obesity causes defects in the next three generations of oocytes and embryos. We exposed female F0 mice to a high-fat/high-sugar (HF/HS) diet for 6 weeks before conception until weaning. Sires, F1 offspring and all subsequent generations were fed control chow diet. Oocytes from F1, F2 and F3 offspring of obese mothers had lower mitochondrial mass and less ATP and citrate than oocytes from offspring of control mothers. F0 blastocysts from HF/HS-exposed mice, but not F1 and F2 blastocysts, had lower mitochondrial mass and membrane potential, less citrate and ATP and smaller total cell number than F0 blastocysts from control mothers. Finally, supplementation of IVF media with the anti-oxidant mito-esculetin partially prevented the oocyte mitochondrial effects caused by maternal HF/HS diet. Our results support the idea that maternal obesity impairs offspring oocyte quality and suggest that antioxidant supplementation should be tested as a means to improve IVF outcomes for obese women.
Influence of Acetylsalicylic Acid Use on Risk and Outcome of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Study
Authors: Smit Jesper , Dalager-Pedersen Michael , Adelborg Kasper , Kaasch Achim J , Thomsen Reimar W , Frøslev Trine , Nielsen Henrik , Schønheyder Henrik C , Sørensen Henrik T , Desimone Christopher V , Desimone Daniel C , Søgaard Mette
Published: September 2019

Objective

To investigate the influence of acetylsalicylic acid (ASA) use on risk and outcome of community-acquired Staphylococcus aureus bacteremia (CA-SAB).

Method

We used population-based medical databases to identify all patients diagnosed in northern Denmark with first-time CA-SAB and matched population controls from 2000–2011. Categories for ASA users included current users (new or long-term users), former users, and nonusers. The analyses were adjusted for comorbidities, comedication use, and socioeconomic indicators.

Results

We identified 2638 patients with first-time CA-SAB and 26 379 matched population controls. Compared with nonusers, the adjusted odds ratio (aOR) for CA-SAB was 1.00 (95% confidence interval [CI], 0.88–1.13) for current users, 1.00 (95% CI, 0.86–1.16) for former users, 2.04 (95% CI, 1.42–2.94) for new users, and 0.95 (95% CI, 0.84–1.09) for long-term users. Thirty-day cumulative mortality was 28.0% among current users compared with 21.6% among nonusers, yielding an adjusted hazard rate ratio (aHRR) of 1.02 (95% CI, 0.84–1.25). Compared with nonusers, the aHRR was 1.10 (95% CI, 0.87–1.40) for former users, 0.60 (95% CI, 0.29–1.21) for new users, and 1.06 (95% CI, 0.87–1.31) for long-term users. We observed no difference in the risk or outcome of CA-SAB with increasing ASA dose or by presence of diseases commonly treated with ASA.

Conclusions

Use of ASA did not seem to influence the risk or outcome of CA-SAB. The apparent increased risk among new users may relate to residual confounding from the circumstances underlying ASA treatment initiation. Our finding of no association remained robust with increasing ASA dose and across multiple patient subsets.
Developing a national musculoskeletal core capabilities framework for first point of contact practitioners
Authors: Chance-Larsen Kenneth , Backhouse Michael R , Collier Richard , Wright Colin , Gosling Sally , Harden Beverley , Marsh Sarah , Kay Peter , Wyles Hilary , Erwin Jo , Woolf Anthony
Published: September 2019

Objective

We aimed to support service transformation by developing a core capabilities framework for first contact practitioners working with people who have musculoskeletal conditions.

Methods

We conducted a modified three-round Delphi study with a multi-professional panel of 41 experts nominated through 18 national professional and patient organizations. Qualitative data from an open-ended question in round one were analysed using a thematic approach and combined with existing literature to shape a draft framework. Participants rated their agreement with each of the proposed 142 outcomes within 14 capabilities on a 10-point Likert scale in round two. The final round combined round two results with a wider online survey.

Results

Rounds two and three of the Delphi survey were completed by 37 and 27 participants, respectively. Ninety practitioners responded to the wider online survey. The final framework contains 105 outcomes within 14 capabilities, separated into four domains (person-centred approaches; assessment, investigation and diagnosis; condition management, intervention and prevention; and service and professional development). The median agreement for all 105 outcomes was at least nine on the 10-point Likert scale in the final round.

Conclusion

The framework outlines the core capabilities required for practitioners working as the first point of contact for people with musculoskeletal conditions. It provides a standard structure and language across professions, with greater consistency and portability of musculoskeletal core capabilities. Agreement on each of the 105 outcomes was universally high amongst the expert panel, and the framework is now being disseminated by Health Education England, NHS England and Skills for Health.
Mechanical stretch promotes tumoricidal M1 polarization via the FAK/NF‐κB signaling pathway
Authors: Shan Shengzhou , Fang Bin , Zhang Yifan , Wang Chuandong , Zhou Jia , Niu Chenguang , Gao Ya , Zhao Danyang , He Jiahao , Wang Jing , Zhang Xiaoling , Li Qingfeng
Published: September 2019

Macrophages (Mφs) can be used as a part of cell‐based cancer immunotherapy. However, they may be hampered by a failure to effectively and stably regulate their polarization state to enhance their tumoricidal effects. In this work, mechanical stretch (MS), as a biology‐free modulatory method, was shown to enhance M1 polarization and tumoricidal effects. By using an in vitro Flexcell Tension system, we found that murine Mφ RAW264.7 cells showed higher M1 polarization‐related mRNA expression and cytokine release after MS. Further molecular analyses found that focal adhesion kinase and NF‐κB activation occurred in the MS‐induced M1 polarization. Coculture of MS‐preconditioned Mφ with B16F10 skin melanoma cells in vitro showed that the proliferation of B16F10 cells decreased, whereas caspase‐3‐induced apoptosis increased. Importantly, the injection of MS‐preconditioned Mφ into murine skin melanomas in vivo impeded tumor growth; lesions were characterized by increased amounts of M1 Mφ, decreased tumor cell proliferation, and increased tumor cell apoptosis in the tumor microenvironment. Together, our results suggest that MS could be used as a simple preconditioning approach to prepare tumoricidal M1 Mφ for cancer immunotherapy.—Shan, S., Fang, B., Zhang, Y., Wang, C., Zhou, J., Niu, C., Gao, Y., Zhao, D., He, J., Wang, J., Zhang, X., Li, Q. Mechanical stretch promotes tumoricidal M1 polarization via the FAK/NF‐κB signaling pathway. FASEB J. 33, 13254–13266 (2019). www.fasebj.org
Population Pharmacodynamics of Propofol and Sevoflurane in Healthy Volunteers Using a Clinical Score and the Patient State Index
Authors: Kuizenga Merel H. , Colin Pieter J. , Reyntjens Koen M. E. M. , Touw Daan J. , Nalbat Hasan , Knotnerus Froukje H. , Vereecke Hugo E. M. , Struys Michel M. R. F.
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The population pharmacodynamics of propofol and sevoflurane with or without opioids were compared using the endpoints no response to calling the person by name, tolerance to shake and shout, tolerance to tetanic stimulus, and two versions of a processed electroencephalographic measure, the Patient State Index (Patient State Index-1 and Patient State Index-2).

Methods

This is a reanalysis of previously published data. Volunteers received four anesthesia sessions, each with different drug combinations of propofol or sevoflurane, with or without remifentanil. Nonlinear mixed effects modeling was used to study the relationship between drug concentrations, clinical endpoints, and Patient State Index-1 and Patient State Index-2.

Results

The C50 values for no response to calling the person by name, tolerance to shake and shout, and tolerance to tetanic stimulation for propofol (µg · ml−1) and sevoflurane (vol %; relative standard error [%]) were 1.62 (7.00)/0.64 (4.20), 1.85 (6.20)/0.90 (5.00), and 2.82 (15.5)/0.91 (10.0), respectively. The C50 values for Patient State Index-1 and Patient State Index-2 were 1.63 µg · ml−1 (3.7) and 1.22 vol % (3.1) for propofol and sevoflurane. Only for sevoflurane was a significant difference found in the pharmacodynamic model for Patient State Index-2 compared with Patient State Index-1. The pharmacodynamic models for Patient State Index-1 and Patient State Index-2 as a predictor for no response to calling the person by name, tolerance to shake and shout, and tetanic stimulation were indistinguishable, with Patient State Index50 values for propofol and sevoflurane of 46.7 (5.1)/68 (3.0), 41.5 (4.1)/59.2 (3.6), and 29.5 (12.9)/61.1 (8.1), respectively. Post hoc C50 values for propofol and sevoflurane were perfectly correlated (correlation coefficient = 1) for no response to calling the person by name and tolerance to shake and shout. Post hoc C50 and Patient State Index50 values for propofol and sevoflurane for tolerance to tetanic stimulation were independent within an individual (correlation coefficient = 0).

Conclusions

The pharmacodynamics of propofol and sevoflurane were described on both population and individual levels using a clinical score and the Patient State Index. Patient State Index-2 has an improved performance at higher sevoflurane concentrations, and the relationship to probability of responsiveness depends on the drug used but is unaffected for Patient State Index-1 and Patient State Index-2.
Role of Imaging, Tissue Sampling, and Biomarkers for Diagnosis of SSI in Spine Surgery
Authors: Divi Srikanth N. , Kepler Christopher K. , Segar Anand H. , Russo Glenn S. , Bronson Wesley H. , Boody Barrett S. , Galetta Matthew S. , Goyal Dhruv K.C. , Fang Taolin , Schroeder Gregory D. , Vaccaro Alexander R.
Published: September 2019

In July 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 15 focused on the use of imaging, tissue sampling, and biomarkers in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Panton-Valentine Positive Staphylococcus aureus in Community-Acquired and Hospital-Acquired Pediatric Infections
Authors: Bádue Pereira Maria Fernanda , Bando Silvia Yumi , Sasagawa Suzethe Matiko , da Silva Cely Barreto , Mimica Marcelo Jenne , Berezin Eitan Naaman
Published: September 2019

From July 2009 to July 2015, Staphylococcus aureus isolated from pediatric sterile sites were selected. Polymerase chain reaction was used to detect mecA and lukS-PV/lukF-PV genes. The rate of methicillin-resistant Staphylococcus aureus was 37.7%. Ten isolates had the lukS-PV/lukF-PV genes, 2 of which were methicillin-resistant Staphylococcus aureus. Skin and soft tissues infections were significantly associated with lukS-PV/lukF-PV positive isolates, P = 0.008.
Microbiota of Children With Complex Appendicitis
Authors: The Sarah-May M. L. , Bakx Roel , Budding Andries E. , de Meij Tim G. J. , van der Lee Johanna H. , Bunders Madeleine J. , Poort Linda , Heij Hugo A. , van Heurn L. W. Ernst , Gorter Ramon R.
Published: September 2019

Background:

Two types of appendicitis are hypothesized, simple and complex, with potential different treatment strategies. To improve differentiation, underlying pathogeneses need to be further unraveled.

Aim:

To determine if the microbial composition in the appendix differs between children with simple and complex appendicitis.

Methods:

Two-center, prospective cohort study including 40 children (0–17 years old) undergoing appendectomy for suspected appendicitis. Appendix tissue was used for IS-pro analysis to identify bacterial species by their length of 16S-23S rDNA interspacer (IS) region. Cluster analysis, based on IS-profiles, and correspondence with type of appendicitis, using Fisher exact test, was performed. Simple and complex appendicitis were compared regarding bacterial presence, intensity and diversity, using Fisher exact test and Mann-Whitney U test, respectively.

Results:

Appendicitis was confirmed in 36 of 40 patients (16 simple, 20 complex). Cluster analysis identified 2 clusters, encompassing 34 patients. Distribution of simple and complex appendicitis was 12 (80%) and 3 (20%) versus 3 (16%) and 16 (84%) patients for clusters 1 and 2, respectively (P < 0.001). Complex appendicitis was on phylum level characterized by an increased intensity (Bacteroidetes P = 0.001, Firmicutes, Actinobacteria, Fusobacteria and Verrucomicrobia (FAFV) P = 0.005 and Proteobacteria P < 0.001) and diversity (Bacteroidetes P = 0.001 and Proteobacteria P = 0.016) and an increased abundance of 5 species (Alistipes finegoldii P = 0.009, Bacteroides fragilis P = 0.002, Escherichia coli P = 0.014, Parvimonas micra P = 0.022 and Sutterella spp P = 0.026).

Conclusions:

The microbial composition of the appendix differs between children with simple and complex appendicitis, regarding both composition and diversity. Future research should focus on the role of these bacteria in the pathogenesis of both types and its implications for preoperative diagnostics.
Estimated Annual Health and Cost Impact of PHiD-CV Immunization Program in Brazil
Authors: Gomez Jorge A. , Lopes de Abreu Ariane de Jesus , Caceres Diana C. , Nieto Javier , Ortega-Barria Eduardo
Published: September 2019

Background:

Streptococcus pneumoniae causes invasive pneumococcal disease (IPD), community-acquired pneumonia (CAP) and acute otitis media (AOM). Two higher-valent pneumococcal conjugate vaccines (PCV) are available, pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and 13-valent PCV (PCV-13). This study estimated the economic and health impact of PHiD-CV vaccination on pneumococcal disease burden in children <5 years of age in Brazil.

Methods:

The disease burden prior to the PHiD-CV vaccination program was estimated from literature and databases. The effect of PHiD-CV was estimated as a reduction of 70% for IPD, 26% for CAP and 40% for AOM, based on published studies. Residual IPD cases attributable to serotype 19A were estimated using surveillance data. PCV-13 effectiveness against 19A-IPD was set at 30%–70% higher than PHiD-CV. Vaccine prices were US$12.85/dose for PHiD-CV and US$14.50/dose for PCV-13.

Results:

PHiD-CV vaccination reduced IPD by 6359, CAP by 315,016 and AOM by 669,943 cases, with estimated cost savings of >US$84 million annually and US$211–22,232 per case averted depending on the outcome. Switching from PHiD-CV to PCV-13 would avoid only a few additional IPD cases at additional costs exceeding US$18 million per year (US$125,192–386,230 per IPD case averted).

Conclusions:

The PHiD-CV vaccination program in Brazil has resulted in important reductions of pneumococcal disease and substantial cost savings. Instead of switching PCVs, expanding vaccine coverage or investing in other health care interventions would be a more efficient use of resources to improve the health of the population in Brazil.
Moderate Aortic Insufficiency with a Left Ventricular Assist Device Portends a Worse Long-Term Survival
Authors: Auvil Bryan , Chung Jennifer , Ameer Alyse , Han Jason , Helmers Mark , Birati Edo , Acker Michael , Atluri Pavan
Published: September 2019

The development of aortic insufficiency (AI) is known to be associated with prolonged left ventricular assist device (LVAD) support, but its overall significance with regards to long-term outcomes is unclear. This uncertainty translates to a lack of consensus regarding the management of AI in this patient population—an increasingly pertinent question as more patients are placed on LVAD support as destination therapy. A retrospective review of a single, high-volume institution was performed to assess outcomes in patients who received a HeartMate II or HeartWare (LVAD) between 2008 and 2018. Patients were stratified by AI severity at 6 months, and those with LVAD support of less than 6 months were excluded. The primary endpoint was 2 year mortality, and secondary endpoints were right heart failure and functional exercise capacity. At 6 month follow-up 111, 92, and 18 patients had no (0), mild (1), and moderate (2) AI, respectively. Moderate AI was a significant predictor of 2 year mortality in a multivariable model (p = 0.024). Functional exercise capacity (measured by 6 minute walk test) and incidence of right heart failure at 1 year were not significantly different between groups (P = 0.1421; P = 0.2189). In conclusion, moderate AI at 6 months post-LVAD implant is associated with worse long-term mortality. More aggressive management strategies targeting AI development in long-term LVAD patients may be warranted.
New-Onset Refractory Status Epilepticus in Children: Etiologies, Treatments, and Outcomes*
Authors: Husari Khalil S. , Labiner Katherine , Huang Rong , Said Rana R.
Published: September 2019

Objectives:

To elucidate etiologies, treatment, functional and neurocognitive outcomes of children with new-onset refractory status epilepticus.

Design:

A single-center retrospective study.

Setting:

A tertiary care children’s hospital.

Patients:

All patients between 1 month and 21 years old admitted with new-onset refractory status epilepticus between January 2004 and July 2017.

Interventions:

None.

Measurements and Main Results:

Clinical presentation, laboratory data, imaging studies, and treatments were collected during hospitalization. Outcomes were assessed at hospital discharge and follow-up in the outpatient neurology clinic based on functional and neurocognitive outcomes as well as development of epilepsy. A total of 674 unique patients presented with status epilepticus of which 40 had new-onset refractory status epilepticus. Patients were classified into either refractory status epilepticus or super-refractory status epilepticus. The etiology of most children with new-onset refractory status epilepticus remained cryptogenic. The most common identified etiology was viral (20%). None of the patients had a contributory positive neuronal antibody test. Several treatments were tried including immunotherapy which was used in half of the patients. Five patients died (12.5%) during the acute phase of their disease, with four lost to follow-up. Twenty out of the remaining 31 patients (65%) developed epilepsy and 18 (58%) had persistent neurocognitive impairment. There was no statistical significant difference in various outcome measures and various etiologies, patients’ characteristics, and treatments.

Conclusions:

In this single-center cohort, more than half of the children with new-onset refractory status epilepticus did not have an identifiable etiology. Unlike adult patients, the presence of positive neuronal antibody syndrome was rare. There was no difference in outcome between those with or without an identifiable etiology. As expected, patients with super-refractory status epilepticus had worse functional and neurocognitive outcomes. More standardized diagnostic and treatment algorithms are needed along with prospective multicenter studies.
Prioritizing a sequence of short-duration groups as the standardized pathway for chronic noncancer pain at an Australian tertiary multidisciplinary pain service: preliminary outcomes
Authors: Rajappa Hema , Wilson Michelle , White Ruth , Blanchard Megan , Tardif Hilarie , Hayes Chris
Published: September 2019

Objective:

To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain.

Design:

Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set.

Setting:

An Australian tertiary multidisciplinary pain service.

Subjects:

Patients with chronic noncancer pain actively participating in the group pathway in 2016.

Methods:

Referred patients were prioritized to a short-duration group–based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set.

Results:

In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose.

Conclusion:

Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.
Comparing Glycaemic Benefits of Active Versus Passive Lifestyle Intervention in Kidney Allograft Recipients: A Randomized Controlled Trial
Authors: Kuningas Kulli , Driscoll Joanne , Mair Reena , Smith Helen , Dutton Mary , Day Edward , Sharif and Adnan
Published: September 2019

Background.

New-onset diabetes is common after kidney transplantation, but the benefit of lifestyle intervention to improve glucose metabolism posttransplantation is unproven.

Methods.

We conducted a single-center, randomized controlled trial involving 130 nondiabetic kidney transplant recipients with stable function between 3 and 24 months post-transplantation. Participants were randomly assigned in a 1:1 ratio to receive active intervention (lifestyle advice delivered by renal dietitians using behavior change techniques) versus passive intervention (leaflet advice alone). Primary outcome was 6-month change in insulin secretion, insulin sensitivity, and disposition index. Secondary outcomes included patient-reported outcomes, cardiometabolic parameters, clinical outcomes, and safety endpoints.

Results.

Between August 17, 2015 and December 18, 2017, 130 individuals were recruited, of whom 103 completed the study (drop-out rate 20.8%). Active versus passive intervention was not associated with any change in glucose metabolism: insulin secretion (mean difference, −446; 95% confidence interval [CI], −3184 to 2292; P = 0.748), insulin sensitivity (mean difference, −0.45; 95% CI, −1.34 to 0.44; P = 0.319), or disposition index (mean difference, −940; 95% CI, −5655 to 3775; P = 0.693). Clinically, active versus passive lifestyle intervention resulted in reduced incidence of posttransplantation diabetes (7.6% versus 15.6%, respectively, P = 0.123), reduction in fat mass (mean difference, −1.537 kg; 95% CI, −2.947 to −0.127; P = 0.033), and improvement in weight (mean difference, −2.47 kg; 95% CI, −4.01 to −0.92; P = 0.002). No serious adverse events were noted.

Conclusions.

Active lifestyle intervention led by renal dietitians did not improve surrogate markers of glucose metabolism. Further investigation is warranted to determine if clinical outcomes can be improved using this methodology.
Prospective metrological validation of multifrequency bioelectrical impedance analysis against volumetric imaging to identify sarcopenia in head and neck cancer patients undergoing radiation therapy
Authors: Grossberg Aaron J. , Rock Crosby D. , Edwards Jared , Mohamed Abdallah S.R. , Ruzensky Debra , Currie Angela , Rosemond Patricia , Phan Jack , Gunn G. Brandon , Frank Steven J. , Morrison William H. , Garden Adam S. , Fuller Clifton D. , Rosenthal David I.
Published: September 2019

Importance

Depleted skeletal muscle mass (sarcopenia) is associated with decreased survival and cancer control in head and neck cancer patients treated with radiotherapy. There is a need for validated measures of body composition that can be implemented in routine clinical workflow.

Objective

To validate the use of bioelectrical impedance analysis (BIA) for body composition analysis and diagnosis of sarcopenia in head and neck cancer patients.

Design

In this prospective observational cohort study, baseline 50 patients with head and neck cancer undergoing radiation therapy (RT) were enrolled between February 2016 and March 2017. Baseline BIA measures of skeletal muscle (SM) mass, fat-free mass (FMM), and fat mass (FM) were compared to CT-based estimates of body composition using linear regression. Sex-specific BIA-derived thresholds for sarcopenia were defined by the maximum Youden Index on receiver operator characteristic (ROC) curves of BIA against CT-defined sarcopenia. Changes in body composition across treatment were compared against changes in body weight using linear regression.

Participants

In total, 50 patients with pathologically confirmed stage I to IVB non-metastatic head and neck cancer treated with definitive radiation therapy were enrolled.

Setting

Single academic referral center.

Main Outcome and Measure

The primary outcome was relative agreement between baseline lean body mass and fat body mass predicted from BIA measurement and CT imaging.

Results

Of the 48 evaluable patients 16 (33.3%) were sarcopenic at baseline based on CT analysis. BIA measures of body composition were strongly correlated with CT measures: SM mass (r = 0.97; R2 = 0.94; p < 0.0001), FFM (r = 0.97; R2 = 0.94; p < 0.0001) and FM (r = 0.95; R2 = 0.90; p < 0.0001). Relationship with normalized indices of SM mass, FFM, and FM was similar between BIA and CT, but not BIA and body mass index (BMI). Patients lost a mean of 5.7 ± 5.8 kg during treatment, of which 1.5 ± 1.9 kg was SM, 2.6 ± 3.3 kg was FFM, and 2.2 ± 2.6 kg was FM. Eight additional patients developed sarcopenia by the end of RT.

Conclusions

BIA provides accurate estimates of body composition in head and neck cancer patients. Implementation of BIA in clinical practice may identify patients with sarcopenia.

Trial Registration

ClinicalTrials.gov identifier: NCT02615275
STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea
Authors: de Carvalho Anderson Albuquerque , Amorim Fábio Ferreira , Santana Levy Aniceto , de Almeida Karlo Josefo Quadros , da Cruz Santana Alfredo Nicodemos , Rocha Neves Francisco de Assis
Published: September 2019

Study Objectives

To determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population.

Methods

Cross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index - REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires).

Results

Results show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang ≥3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29.

Conclusions

Adults with DS have a very high prevalence of OSA. Hematocrit levels, BMI and SBQ showed a strong correlation with OSA severity. The SBQ performed well in identifying moderate to severe OSA in this population. Considered together, these results point to the need to perform OSA screening in all adults with DS, and STOP-Bang may play a role in this screening.
A rapid review of patient and family perspectives on inappropriateness of intensive care treatments at the end of life
Authors: Cardona Magnolia , Shanmugam Shantiban , Lewis Ebony T , Psirides Alex , Anstey Matthew , Hillman Ken
Published: September 2019

Aim

To understand patient/family perspective of inappropriate intensive care unit (ICU) admissions and treatment.

Methods

Rapid literature review of English language articles published between 2001 and 2017 in Medline or PsycInfo.

Results

Thirteen articles covering 6,194 elderly patients or surrogate decision-makers from four countries were eligible. Perceived inappropriateness of ICU treatments was mainly expressed as dissatisfaction with clinicians’ as surrogate decision-makers, inconsistency with patient/family values, family distrust of physician’s predictions on poor prognosis, and inadequate communication on over-aggressive treatment causing suffering. Consultation on opinion before ICU admission varied from 1% to 53.6%, and treatment goals from 1.4 to 31.7%. Satisfaction with the decision-making process in ICU was higher for those who had certain level of control and involvement in the process.

Conclusions

The patient/family perspective on inappropriateness of ICU treatments involves preferences, values and social constructs beyond medical criteria. Earlier consultation with families before ICU admission, and patient education on outcomes of life-sustaining therapies may help reconcile these provider-patient disagreements.

Take-home message

The patient/family perspective oninappropriatenessof ICU at the end of life often differs from the clinician’s opinion due to the non-medical frame of mind. To improve satisfaction with communication on treatment goals, consultation on patient values and inclusion of social constructs in addition to clinical prediction are a good start to reconcile differences between physician and health service users’ viewpoint.