bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis of nano emulsion from waste cooking oil for enhanced oil recovery applications
Authors: Noor M I I M , Islam A , Saalah S , Ken C C , Anisuzzaman S M , Kamin Z
Published: September 2019

Enhanced oil recovery (EOR) is a tertiary method to extract potential oil in a matured well. Emulsion, which is one EOR method has properties which enable it to recover oil remains in reservoir rocks of the matured well. Nano sized emulsion or nano emulsion able to recover trapped oil, by capillary force in fine pores of the reservoir rock. Nano emulsion reduces the oil-water interfacial tension and therefore changes the wettability of the reservoir rock. However, the nano emulsion is uneconomical and unstable. Therefore, this work aimed to produce nano emulsions by using low cost waste cooking oil, Tween 80 and Span 80. Ultra-sonication was used to reduce the size of the emulsion. The concentration of surfactant, power of ultra-sonication and time of sonication were varied to study the stability of the oil-in-water and size of the emulsion using the Malvern Zetasizer. The nano emulsion was then tested on a crude oil soak meligan formation sand rock to test the performance of the nano emulsion. The result show values of zeta potential and droplet size were - 15.3 mV and 262.1 d.nm respectively. The emulsion droplet sizes were about 500 nm with milky white appearance. The nano emulsion shows positive results as 63.89 % crude oil displaced from the soaked meligan formation sand rock. As a conclusion, the nano emulsion produced from waste cooking oil can potentially be used for EOR.
Nutrients Recovery Processes for Sewage: A Short Review
Authors: Zahrim A Y , Safie N N , Bolong N , Rajin M , Ismail N M , Saalah S , Yusop M H M , Ongkodun C M , Ricky L N Y
Published: September 2019

The abundance of untreated sewage that consists of valuable nutrients and water scarcity has motivated the community to process and recycle the waste through efficient and sustainable approach. The presence of dissolved nutrients and emerging contaminants are increasing lately due to the rapid anthropogenic activities. Over the years, many studies on sewage processing have been reported in the literature: bioaugmentation, membrane bioreactor, moving bed biofilm as well as adsorption technique for nutrients recovery. The advantages and limitations of these technologies are discussed in brief. Finally, the treated sewage that still contain useful nutrients can be recycled as irrigation water for crops and non-crops plantation, toilet flushing etc. Nutrients that were adsorbed in the filter can be utilized by plant when it is used as growing media.
Spray drying of Mengkudu herbal extract: Effect of wheat flour
Authors: Duduku K , Anisuzzaman S M , Awang B , Rozianie R
Published: September 2019

The aim of this study is to determine the antioxidant activity, total phenolic content and total flavonoid content of Mengkudu, and the mixture of Mengkudu with wheat flour. Three major processes are involved in this research such as extraction of Mengkudu, spray drying of Mengkudu extract and the mixture of Mengkudu with wheat flour at 1400C. From results, it was found that the phenolics and flavonoid compounds are present in concentrated Mengkudu extract (CME) and due to these compounds the antioxidant activity of CME was increased. The total phenolic and flavonoid content in the mixture of concentrated Mengkudu extract with wheat flour (MCMEWF) and also in the mixture of spray dried Mengkudu extract with wheat flour (MSDMEWF) are lower than in CME but antioxidant activity of these mixtures was higher compared to antioxidant activity of their individual components. This shows that antioxidant compounds in the mixture exhibit synergistically to donate the hydrogen to DPPH radicals thus increased the antioxidant activity.
Analysis of Evaporation Data from an Enclosed Pond Ventilated by Solar Chimney
Authors: Mizanur R Md. , Ashikur R Md. , Noor Ajian M L , Ming chu Chi
Published: September 2019

Water removal from industrial effluent streams, salt cultivation farms, biodiesel conversion process from microalgae, and food drying by using pond evaporation with a higher rate of mass flux can be considered as an economical and energy saving scheme. The objective of this study is to utilize a method of enhancing the pond natural evaporation rate to improve the sustainability of industrial operations. In this study, canopied ventilation technology was employed to enhance the pond evaporation. This technology caused the natural draft enhancement by installing a wire mesh on the chimney. The unit consists of a solar irradiated solid wall chimney installed on the evaporation pan as a means to increase the evaporation rate of existing water body. Experiments were conducted in square pan at the same size as class-A pan in three configurations. The experimental result showed that the evaporation flux from configuration YY (Solar chimney with wire mesh) averaged at 13 per cent more than configuration NN (Open Pond) and at 20 per cent more than configuration YN(Solar chimney without wire mesh). Counter to intuition, for configuration YN the evaporation averaged at 6 per cent lower than the evaporation from the open pond configuration. The pan evaporation flux was found to be predicted satisfactorily by the Rayner[5] evaporation model showing it is able to aggregate reasonably the effect of changing characteristics of the three configurations in terms of net radiation, vapor pressure deficit and natural ventilation draft.
Structural Analysis of Laterally Aerated Moving Bed (LAMB) Dryer by using Robot Structural Analysis (RSA) Professional 2018
Authors: Marcellus K , Jidon J , Nancy J S , Willey Y H L
Published: September 2019

The structural design of Laterally Aerated Moving Bed (LAMB) dryer is subjected to buckling effects due to the loads of the paddy bed, self-weight and static pressures by the air blower to overcome the air resistance in the paddy bed, perforated tube and the bed chamber perforated wall. The dryer structural type is a spatial complex structure where the boundary conditions are not very clear, thus the Robot Structural Analysis (RSA) Professional 2018 is used to determine the critical values of loads when the overall structural elements instability occurred to form buckling. The RSA analysed the global buckling of a structure to find the critical coefficient value to be multiply with the case load for the critical buckling load determination. Three different model of dryer structural designs were prepared and analysed by RSA to find the buckling critical coefficient values (αcr), displacements (mm), reactions (N) and moments (Nm). All structural design model was designed with similar type of materials, different sizes and geometrical arrangements. The RSA results within the three structural design models were compared. The structural design model with the best buckling coefficient values with minimum displacement had been selected for the actual LAMB dryer structural construction.
Free Neurocognitive Screening Initiative: An Opportunity to Address Health Disparities and Promote Cultural Competence in Northcentral Florida
Authors: Amofa Sr. P , Arias F , Trifilio E , Belser-Ehrlich J , Rohl B , Lopez F , Levy S-A
Published: September 2019

Objective

The risk for cognitive impairment is greater in individuals with low SES and limited education. In rural areas, distance and economic concerns preclude individuals from accessing care. In Alachua County, 23% of residents live below poverty and 16% are uninsured. The Neurocognitive Screening Initiative (NSI) attempts to reduce disparities in Alachua by offering free neurocognitive screening. NSI also aspires to promote cultural competence through unique training opportunities for clinical neuropsychology doctoral students.

Method

Patients learned about NSI through flyers, word of mouth, or referrals. Appointments include a clinical interview, cognitive testing, and mood questionnaires. Patients receive feedback, brain health recommendations, and referrals to community resources. Phase 1 began in November 2017 and involved selection of appropriate cognitive measures, development and dissemination of advertising materials, identification of resources, and trainee recruitment. From February 2018 to August 2018, phase 2 involved administration of cognitive screeners. Phase 3 involved continued provision of clinical services, expansion of the NSI team and increased culturally relevant outreach.

Outcomes

NSI’s greatest challenge is recruitment of the appropriate demographic. Since phase 2, we have evaluated 10 patients with diverse racial, socioeconomic, and clinical characteristics. NSI has recruited an ethnoracially diverse cohort of trainees comprised of 4 graduate students and 2 postdoctoral fellows supervised by a clinical neuropsychologist.

Discussion

Efforts to provide services to marginalized individuals have uncovered challenges in attracting patients who might benefit from these services. NSI is forging community partnerships with churches, libraries, and local organizations to reach the targeted audience. Via weekly meetings, participation in community events/outreach, and clinical work, NSI provides unique training for emerging neuropsychologists.
C-47 Associations of Executive Functioning with Neural Mechanisms of Reward Processing in Youth
Authors: Kryza-Lacombe M , Christian I , Wiggins J
Published: September 2019

Objective

Executive functioning (EF) deficits and difficulty adjusting to reward contingencies in youth are associated with concurrent and future psychopathology. Little is known about how EF relates to reward processing mechanisms. This study examines the associations of neural mechanisms of reward processing with cognitive flexibility and response inhibition, two subdomains of EF.

Method

dYouths (n = 22), ages 11-14, completed a youth-friendly monetary incentive delay task during multiband fMRI acquisition by hitting a piñata target via button press, to obtain a potential reward. The task included anticipation and feedback periods. On the same day, youths also completed two NIH Toolbox EF tasks on an iPad; the Dimensional Change Card Sort task and the Flanker task, measuring cognitive flexibility and response inhibition respectively. Whole-brain analyses evaluate brain activation associated with EF scores during anticipation and feedback periods.

Results

Cognitive flexibility was associated with left insula activation during feedback (xyz = -35,11,10, F(1,20) = 25.36, k = 30, p < .005, uncorrected), with lower scores predicting higher activation in left insula when participants failed to obtain a potential reward (r = -.52, p = 0.014). During reward anticipation, the Cognitive Flexibility x Reward Condition interaction predicted activation in the left fusiform (xyz = -45,-41,-16, F(1,20) = 23.94, k = 38) and left inferior frontal gyri (xyz = -39,33,10, F(1,20) = 16.86, k = 21; both p < .005, uncorrected), but post-hocs were non-significant. Response inhibition analyses are currently underway.

Conclusions

These preliminary results suggest that EF may moderate reward-related neural activation in brain areas related to stimulus-driven attentional networks. Subjects with lower cognitive flexibility may have difficulty reframing failure when a reward is missed. Findings may inform intervention efforts.
Ataxia–telangiectasia mutated coordinates the ovarian DNA repair and atresia-initiating response to phosphoramide mustard
Authors: Clark Kendra L , Keating Aileen F
Published: September 2019

Ataxia–telangiectasia-mutated (ATM) protein recognizes and repairs DNA double strand breaks through activation of cell cycle checkpoints and DNA repair proteins. Atm gene mutations increase female reproductive cancer risk. Phosphoramide mustard (PM) induces ovarian DNA damage and destroys primordial follicles, and pharmacological ATM inhibition prevents PM-induced follicular depletion. Wild-type (WT) C57BL/6 or Atm+/− mice were dosed once intraperitoneally with sesame oil (95%) or PM (25 mg/kg) in the proestrus phase of the estrous cycle and ovaries harvested 3 days thereafter. Atm+/− mice spent ~25% more time in diestrus phase than WT. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) on ovarian protein was performed and bioinformatically analyzed. Relative to WT, Atm+/− mice had 64 and 243 proteins increased or decreased in abundance, respectively. In WT mice, PM increased 162 and decreased 20 proteins. In Atm+/− mice, 173 and 37 proteins were increased and decreased, respectively, by PM. Exportin-2 (XPO2) was localized to granulosa cells of all follicle stages and was 7.2-fold greater in Atm+/− than WT mice. Cytoplasmic FMR1-interacting protein 1 was 6.8-fold lower in Atm+/− mice and was located in the surface epithelium with apparent translocation to the ovarian medulla post-PM exposure. PM induced γH2AX, but fewer γH2AX-positive foci were identified in Atm+/− ovaries. Similarly, cleaved caspase-3 was lower in the Atm+/− PM-treated, relative to WT mice. These findings support ATM involvement in ovarian DNA repair and suggest that ATM functions to regulate ovarian atresia.
The Selling of Virtual Reality: Novelty and Continuity in the Cultural Integration of Technology
Authors: Nagy Jeff , Turner Fred
Published: September 2019

Since the spring of 2014, the consumer virtual reality (VR) industry has once again been racing to reach the public, providing an opportunity to track an emerging medium’s cultural integration in real time. We examined three sites on the sales chain that stretches from the laboratory to the living room: industry developer conferences, industrial prototypes, and end-user experiences. At each of these sites, marketers renegotiate VR’s novelty in order to sell it to specific constituencies. Paradoxically, these negotiations reveal how VR, typically presented as a disruptive innovation, has been called upon to stabilize and ensure the continuity of the past: that is, of particular cultural forms and of the industrial and technological infrastructures that sustain them. We argue that the enculturation of VR demonstrates that the processes that summon new technologies and construct them as novel also reinforce existing—and often unspoken—agreements about the ways that culture should be organized.
Tumor necrosis factor-α blockade ameliorates diabetic nephropathy in rats
Authors: Cheng Dongsheng , Liang Rulian , Huang Baorui , Hou Jiasheng , Yin Jianyong , Zhao Ting , Zhou Lu , Wu Rui , Qian Youcun , Wang Feng
Published: September 2019

Background

Tubular injury plays a critical role in the development of diabetic nephropathy (DN), but current DN therapies do not combat tubular injury. This study was conducted to investigate if tumor necrosis factor (TNF)-α inhibition protects against tubular injury in diabetic rats and to examine the associated mechanisms.

Methods

Kidney biopsy tissues were collected and analyzed from 12 patients with DN and 5 control subjects. Streptozotocin (STZ)-induced diabetic rats were treated with a TNF-α inhibitor for 12 weeks. Renal function, albuminuria, histological injury, renal TNF-α messenger RNA (mRNA) and the NOD- (nucleotide-binding), LRR- (domain-like receptor) and pyrin domain-containing protein 3 (NLRP3) inflammasome were assessed.

Results

Diabetic patients with tubulointerstitial injury (TIN) presented with higher renal tubular expression of TNF-α mRNA and the NLRP3 inflammasome (P < 0.05). TNF-α inhibition reduced albuminuria, glomerular injury and tubular injury in STZ-induced diabetic rats (P < 0.05). Importantly, TNF-α inhibition significantly reduced the NLRP3 inflammasome in tubules (P < 0.05). Moreover, TNF-α inhibition decreased expression of tubular interleukin (IL)-6 and IL-17A mRNA.

Conclusions

TNF-α inhibition protects against TIN by suppressing the NLRP3 inflammasome in DN rats. Future studies may focus on the clinical protective effects of TNF-α inhibition using prospective observation.
Group Consumption with Caring Individuals
Authors: Cherchye Laurens , Cosaert Sam , Demuynck Thomas , De Rock Bram
Published: September 2019

We propose a novel approach to model joint consumption decisions of individuals who care for each other. The model encompasses a continuum of group consumption models situated between the fully co-operative model and the non-cooperative model without caring. We also define a measure for the degree of intragroup cooperation that quantifies how close the observed group behaviour is to fully co-operative behaviour. Following a revealed preference approach, we derive testable implications of the model for empirical data. We use our model to analyse decisions made by children in an experimental setting.
Assessing health system performance: effective coverage at the Mexican Institute of Social Security
Authors: Leslie Hannah H , Doubova Svetlana V , Pérez-Cuevas Ricardo
Published: September 2019

Universal health coverage is a national priority in Mexico, with active efforts to expand public healthcare system access, increase financial protection and improve quality of care. We estimated effective coverage of multiple conditions within the Mexican Institute of Social Security (IMSS), which covers 62 million individuals. We identified routinely collected performance indicators at IMSS from 2016 related to use and quality of care for conditions avertable with high-quality healthcare; where candidate indicators were available, we quantified need for service from a population-representative survey and calculated effective coverage as proportion of individuals in need who experience potential health gains. We assessed subnational inequality across 32 states, and we weighted conditions by relative contribution to national disease burden to estimate composite effective coverage. Conditions accounting for 51% of healthcare-avertable disability-adjusted life years lost in Mexico could be assessed: antenatal care, delivery care, newborn care, childhood diarrhoea, cardiovascular disease and diabetes. Estimated effective coverage ranged from a low of 27% for childhood diarrhoea to a high of 74% for newborn care. Substantial inequality in effective coverage existed between states, particularly for maternal and child conditions. Overall effective coverage of these six conditions in IMSS was 49% in 2016. Gaps in use and quality of care must be addressed to ensure good health for all in Mexico. Despite extensive monitoring of health status and services in Mexico, currently available data are inadequate to the task of fully and routinely assessing health system effective coverage. Leaders at IMSS and similar healthcare institutions must be more purposeful in planning the assessment of population need, utilization of care and quality impacts of care to enable linkage of these data and disaggregation by location or population sub-group. Only then can complex health systems be fairly and fully evaluated.
Identification of Key Pro-Survival Proteins in Isolated Colonic Goblet Cells of Winnie, a Murine Model of Spontaneous Colitis
Authors: Wilson Richard , Gundamaraju Rohit , Vemuri Ravichandra , Angelucci Constanza , Geraghty Dominic , Gueven Nuri , Eri Rajaraman D
Published: September 2019

This proteomics study reveals novel proteins and pathways that potentially underpin the survival and proliferation of goblet cells in the colon of Winnie mice, an ulcerative colitis model caused by misfolding of mucin-2 that results in endoplasmic reticulum stress.
Histological examination of explanted tissue-engineered bovine pericardium following heart valve repair
Authors: Deutsch Oliver , Bruehl Frido , Cleuziou Julie , Prinzing Anatol , Schlitter Anna Melissa , Krane Markus , Lange Rüdiger
Published: September 2019

OBJECTIVES

Our goal was to present histopathological findings of human explants of a tissue-engineered bovine pericardium CardioCel (Admedus Regen Pty Ltd, Malaga, WA, Australia) used for heart valve repair in patients with congenital and acquired heart valve disease.

METHODS

Sixty patients underwent heart valve repair from May 2014 to November 2018 using CardioCel as a substitute for valve tissue. We identified 9 cases in which the CardioCel patch was explanted following valve repair and available for histomorphological analyses. CardioCel explants were evaluated histologically using haematoxylin and oeosin, Elastica van Gieson and immunohistochemical stains.

RESULTS

The indications for explantation were related to the CardioCel patch in 6 patients. Median time between the implantation and explantation was 242 (range 3–1247) days. We demonstrated a characteristic remodelling pattern with superficial coating of the tissue-engineered bovine pericardium by granulation tissue composed of histiocytes, few lymphocytes and fibrin. We had 2 cases with a multifocal nodular disruption, fragmentation and sclerosis of the decellularized collagen matrix with focal calcification after 795 and 1247 days in situ.

CONCLUSIONS

Our data suggest that the tissue-engineered CardioCel patch is initially tolerated in the valvular position in the majority of patients. However, we also experienced graft failures that showed degeneration with fragmentation of the collagen matrix and even 2 cases with focal calcification evident from the histopathological analysis. Further analyses of mid- and long-term performance are mandatory.
Left atrial appendage clipping as an adjunctive therapy in lung cancer surgery for patients with atrial fibrillation: a case report
Authors: Toale Conor , Jones John , Fitzmaurice Gerard J , Eaton Donna
Published: September 2019

The left atrial appendage (LAA) is thought to be responsible for the vast majority of embolic strokes, and has become an important target in the surgical management of atrial fibrillation (AF). Epicardial clipping of the LAA has emerged as a potentially safe, durable and effective method of surgical closure, and has been performed both as a stand-alone procedure (thoracoscopic LAA clipping) and as an adjunct in patients undergoing open cardiac surgery. To our knowledge, the use of epicardial clipping in the setting of non-cardiac thoracic surgery for patients with concurrent diagnosis of AF has not been previously reported. This report highlights the case of a 70-year-old gentleman with a diagnosis of AF, who underwent concomitant LAA clipping at the time of elective thoracoscopic left upper lobectomy for a pT2aN0 lung adenocarcinoma.

To our knowledge, this is the first report demonstrating the feasibility of LAA clipping as an adjunctive procedure in lung cancer surgery.
The Impact of Nonsampling Errors on Estimators of Catch from Electronic Reporting Systems
Authors: Stokes S Lynne , Williams Benjamin M , McShane Ryan P A , Zalsha Shalima
Published: September 2019

The National Marine Fisheries Service is the agency charged with estimating the number of fish removed from US oceans by recreational anglers. Two surveys produce data for these estimates; one measures number of angler trips and the other fish caught per trip by species, geography, and time period. Both surveys collect data from people and have the usual sources of nonsampling error afflicting demographic surveys. Due to lack of accessibility to fishing sites, they also have additional sources such as undercoverage. The rare incidence of saltwater fishing among the general population makes the current method costly and time-consuming. Consequently, new ways of obtaining information to supplement or replace the current method are of interest. One is the electronic logbook (ELB); this approach allows anglers to self-report their catch using cellphones or other communication devices. Estimation of catch from these data are possible with estimators using capture-recapture methods, but new sources of nonsampling error are rising. In this article, we examine three sources of nonsampling error in estimators of catch and approximate their biasing effect. We illustrate the method by comparing the effects using data from an ELB study in the Gulf of Mexico.
Exploring the role of expectations and stimulus relevance on stimulus-specific neural representations and conscious report
Authors: Meijs Erik L , Mostert Pim , Slagter Heleen A , de Lange Floris P , van Gaal Simon
Published: September 2019

Subjective experience can be influenced by top-down factors, such as expectations and stimulus relevance. Recently, it has been shown that expectations can enhance the likelihood that a stimulus is consciously reported, but the neural mechanisms supporting this enhancement are still unclear. We manipulated stimulus expectations within the attentional blink (AB) paradigm using letters and combined visual psychophysics with magnetoencephalographic (MEG) recordings to investigate whether prior expectations may enhance conscious access by sharpening stimulus-specific neural representations. We further explored how stimulus-specific neural activity patterns are affected by the factors expectation, stimulus relevance and conscious report. First, we show that valid expectations about the identity of an upcoming stimulus increase the likelihood that it is consciously reported. Second, using a series of multivariate decoding analyses, we show that the identity of letters presented in and out of the AB can be reliably decoded from MEG data. Third, we show that early sensory stimulus-specific neural representations are similar for reported and missed target letters in the AB task (active report required) and an oddball task in which the letter was clearly presented but its identity was task-irrelevant. However, later sustained and stable stimulus-specific representations were uniquely observed when target letters were consciously reported (decision-dependent signal). Fourth, we show that global pre-stimulus neural activity biased perceptual decisions for a ‘seen’ response. Fifth and last, no evidence was obtained for the sharpening of sensory representations by top-down expectations. We discuss these findings in light of emerging models of perception and conscious report highlighting the role of expectations and stimulus relevance.
An Online Calculator for the Prediction of Survival in Glioblastoma Patients Using Classical Statistics and Machine Learning
Authors: Senders Joeky T , Staples Patrick , Mehrtash Alireza , Cote David J , Taphoorn Martin J B , Reardon David A , Gormley William B , Smith Timothy R , Broekman Marike L , Arnaout Omar
Published: September 2019

BACKGROUND

Although survival statistics in patients with glioblastoma multiforme (GBM) are well-defined at the group level, predicting individual patient survival remains challenging because of significant variation within strata.

OBJECTIVE

To compare statistical and machine learning algorithms in their ability to predict survival in GBM patients and deploy the best performing model as an online survival calculator.

METHODS

Patients undergoing an operation for a histopathologically confirmed GBM were extracted from the Surveillance Epidemiology and End Results (SEER) database (2005-2015) and split into a training and hold-out test set in an 80/20 ratio. Fifteen statistical and machine learning algorithms were trained based on 13 demographic, socioeconomic, clinical, and radiographic features to predict overall survival, 1-yr survival status, and compute personalized survival curves.

RESULTS

In total, 20 821 patients met our inclusion criteria. The accelerated failure time model demonstrated superior performance in terms of discrimination (concordance index = 0.70), calibration, interpretability, predictive applicability, and computational efficiency compared to Cox proportional hazards regression and other machine learning algorithms. This model was deployed through a free, publicly available software interface (https://cnoc-bwh.shinyapps.io/gbmsurvivalpredictor/).

CONCLUSION

The development and deployment of survival prediction tools require a multimodal assessment rather than a single metric comparison. This study provides a framework for the development of prediction tools in cancer patients, as well as an online survival calculator for patients with GBM. Future efforts should improve the interpretability, predictive applicability, and computational efficiency of existing machine learning algorithms, increase the granularity of population-based registries, and externally validate the proposed prediction tool.
Persistent Postoperative Hyperglycemia as a Risk Factor for Operative Treatment of Deep Wound Infection After Spine Surgery
Authors: Pennington Zach , Lubelski Daniel , Westbroek Erick M , Ahmed A Karim , Passias Peter G , Sciubba Daniel M
Published: September 2019

BACKGROUND

Surgical site infections (SSIs) affect 1% to 9% of all spine surgeries. Though previous work has found diabetes mellitus type 2 (DM2) to increase the risk for wound infection, the influence of perioperative hyperglycemia is poorly described.

OBJECTIVE

To investigate perioperative hyperglycemia as an independent risk factor for surgical site infection.

METHODS

We retrospectively identified patients undergoing operative management of SSIs occurring after spinal surgery for degenerative pathologies. These patients were individually matched to controls based upon age, surgical invasiveness, ICD-10CM, race, and sex. Cases and controls were compared regarding medical comorbidities (including diabetes), postoperative hyperglycemia, and operative time.

RESULTS

Patients in the infection group were found to have a higher BMI (33.7 vs 28.8), higher prevalence of DM2 (48.5% vs 14.7%), and longer inpatient stay (8.8 vs 4.3 d). They also had higher average (136.6 vs 119.6 mg/dL) and peak glucose levels (191.9 vs 153.1 mg/dL), as well as greater variability in glucose levels (92.1 vs 58.1 mg/dL). Multivariable logistic regression identified BMI (odds ratio [OR] = 1.13), diabetes mellitus (OR = 2.12), average glucose on the first postoperative day (OR = 1.24), peak postoperative glucose (OR = 1.31), and maximal daily glucose variation (OR = 1.32) as being significant independent predictors of postoperative surgical site infection.

CONCLUSION

Postoperative hyperglycemia and poor postoperative glucose control are independent risk factors for surgical site infection following surgery for degenerative spine disease. These data suggest that, particularly among high-risk diabetic patients, strict perioperative glucose control may decrease the risk of SSI.
Parents' Self-efficacy for Tobacco Exposure Protection and Smoking Abstinence Mediate Treatment Effects on Child Cotinine at 12-Month Follow-up: Mediation Results from the Kids Safe and Smokefree Trial
Authors: Collins Bradley N , Lepore Stephen J , Winickoff Jonathan P , Sosnowski David W
Published: September 2019

Introduction

Compared with the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations.

Methods

Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines (“Ask, Advise, Refer” [AAR]) plus individualized telephone counseling (AAR + counseling), or AAR + control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers.

Results

Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways.

Conclusions

Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking.

Implications

Pediatric harm reduction interventions to protect children of smokers from tobacco smoke have emerged to address tobacco-related health disparities in underserved populations. Low-income smokers experience greater tobacco-related disease burden and more difficulty with smoking behavior change in standard evidence-based interventions than the general population of smokers. Therefore, improving knowledge about putative behavioral mechanisms of smoking behavior change that results in lower child exposure risk could inform future intervention improvements.
Emergence and Persistence of Letermovir-Resistant Cytomegalovirus in a Patient With Primary Immunodeficiency
Authors: Popping Stephanie , Dalm Virgil A S H , Lübke Nadine , Cristanziano Veronica di , Kaiser Rolf , Boucher Charles A B , Van Kampen Jeroen J A
Published: September 2019

Background

Letermovir is a novel cytomegalovirus antiviral that is approved for prophylaxis in hematopoietic stem cell transplantation recipients

Methods

After obtaining informed consent, letermovir prophylaxis was started in a patient with a presumed late-onset primary, combined T- and B-cell immunodeficiency. Plasma CMV DNAemia was monitored with real-time polymerase chain reaction, and letermovir resistance analyses were performed using Sanger sequencing and Illumina MiSeq next-generation sequencing.

Results

A letermovir-resistant cytomegalovirus variant (C325Y mutation in UL56) emerged 17 weeks after start of prophylaxis. The letermovir-resistant variant was able to reactivate without drug selective pressure as this variant was again detected in plasma 20.6 weeks after stopping of letermovir.

Conclusions

This case indicates that the C325Y mutation in UL56 does not significantly alter fitness of cytomegalovirus in vivo.
Disseminated Cutaneous and Osteoarticular Sporotrichosis Mimicking Pyoderma Gangrenosum
Authors: Saeed Lina , Weber Robert J , Puryear Sarah B , Bahrani Eman , Peluso Michael J , Babik Jennifer M , Haemel Anna , Coates Sarah J
Published: September 2019

Disseminated sporotrichosis may present with inflammatory arthritis and cutaneous ulcerations that mimic noninfectious skin conditions such as pyoderma gangreonsum (PG). Sporotrichosis must therefore be ruled out before administering immunosuppressive agents for PG. Furthermore, dimorphic fungi such as sporotrichosis may grow as yeast in bacterial cultures, even before fungal cultures become positive. We present a case of disseminated cutaneous and osteoarticular sporotrichosis mimicking PG and describe the differential diagnosis and the diagnostic and treatment approach to this condition.
Recurrent Endocarditis in Persons Who Inject Drugs
Authors: Rodger Laura , Shah Meera , Shojaei Esfandiar , Hosseini Seyed , Koivu Sharon , Silverman Michael
Published: September 2019

Background

Infective endocarditis (IE) is increasing among persons who inject drugs (PWID) and has high morbidity and mortality. Recurrent IE in PWID is not well described.

Methods

This was a retrospective cohort study conducted between February 2007 and March 2016. It included adult inpatients (≥18) at any of 3 tertiary care centers in London, Ontario, with definite IE based on the Modified Duke's Criteria. The objectives were to characterize recurrent IE in PWID, identify risk factors for recurrent IE, identify the frequency of fungal endocarditis, and establish whether fungal infection was associated with higher mortality.

Results

Three hundred ninety patients had endocarditis, with 212/390 in PWID. Sixty-eight of 212 (32%) PWID had a second episode, with 28/212 (12%) having additional recurrences. Second-episode IE was more common in PWID (11/178 [6.2%] vs 68/212 [32.1%]; P < .001). Peripherally inserted central catheter (PICC) line abuse was associated with increased risk of recurrent endocarditis (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01–3.87; P = .04). In PWID, fungal IE was more common in second episodes than first episodes (1/212 [0.5%] vs 5/68 [7.4%]; P = .004). Additionally, fungal infections were associated with mortality in second-episode IE in PWID with an adjusted OR of 16.49 (95% CI, 1.12–243.17; P = .041). Despite recurrent infection, likely due to continued drug use, there was a low rate of referral to addiction treatment (14/68 [20.6%]).

Conclusions

PWID have a high risk of recurrent endocarditis, particularly in patients who abuse PICC lines. Fungal endocarditis is more common in second-episode endocarditis and is associated with increased mortality. Consideration of empiric antifungal therapy in PWID with IE history and suspected IE should be considered.
Invasive Ureaplasma Infection in Patients Receiving Rituximab and Other Humoral Immunodeficiencies—A Case Report and Review of the Literature
Authors: Jhaveri Vimal V , Lasalvia Mary T
Published: September 2019

Ureaplasma species are small, fastidious bacteria that frequently colonize the lower reproductive tract of asymptomatic hosts. These organisms have been well described to cause chorioamnionitis, neonatal infection, and urethritis, and to a lesser degree surgical site infection and infection in transplant recipients. Outside of these settings, invasive Ureaplasma infections are rare. We describe the case of a young woman receiving rituximab for multiple sclerosis who presented with fever and bilateral renal abscesses due to Ureaplasma spp., which was successfully treated with oral doxycycline. We searched the literature for cases of invasive Ureaplasma infection and found a patient population that predominates with humoral immunodeficiency, either congenital or iatrogenic. Diagnostic and therapeutic interventions are discussed.
Poaceae Type II Galactinol Synthase 2 from Antarctic Flowering Plant Deschampsia antarctica and Rice Improves Cold and Drought Tolerance by Accumulation of Raffinose Family Oligosaccharides in Transgenic Rice Plants
Authors: Cui Li Hua , Byun Mi Young , Oh Hyeong Geun , Kim Sung Jin , Lee Jungeun , Park Hyun , Lee Hyoungseok , Kim Woo Taek
Published: September 2019

Deschampsia antarctica is a Poaceae grass that has adapted to and colonized Antarctica. When D. antarctica plants were subjected to cold and dehydration stress both in the Antarctic field and in laboratory experiments, galactinol, a precursor of raffinose family oligosaccharides (RFOs) and raffinose were highly accumulated, which was accompanied by upregulation of galactinol synthase (GolS). The Poaceae monocots have a small family of GolS genes, which are divided into two distinct groups called types I and II. Type II GolSs are highly expanded in cold-adapted monocot plants. Transgenic rice plants, in which type II D. antarctica GolS2 (DaGolS2) and rice GolS2 (OsGolS2) were constitutively expressed, were markedly tolerant to cold and drought stress as compared to the wild-type rice plants. The RFO contents and GolS enzyme activities were higher in the DaGolS2- and OsGolS2-overexpressing progeny than in the wild-type plants under both normal and stress conditions. DaGolS2 and OsGolS2 overexpressors contained reduced levels of reactive oxygen species (ROS) relative to the wild-type plants after cold and drought treatments. Overall, these results suggest that Poaceae type II GolS2s play a conserved role in D. antarctica and rice in response to drought and cold stress by inducing the accumulation of RFO and decreasing ROS levels.
INVESTIGATION OF THE RADIOPROTECTIVE EFFECT OF ORTHOVANADATE IN MICE AFTER TOTAL BODY IRRADIATION
Authors: Šinkorová Zuzana , Filipová Alžběta , Vávrová Jiřina , Pejchal Jaroslav , Andrejsová Lenka , Jeličová Marcela , Marek Jan , Havelek Radim , Seifrtová Martina , Řezáčová Martina , Tichý Aleš
Published: September 2019

The increasing risk of acute large-scale exposure of ionising irradiation on the population underlines the necessity of developing effective radioprotective and mitigating agents. The aim of this work was to investigate the effect of sodium orthovanadate pre-treatment on mice exposed to high doses of gamma rays (from 5 to 13 Gy). The determination of median lethal dose within 30 days confirmed that orthovanadate applied to total-body-irradiated mice intra-peritoneally has a radioprotective but not a mitigating effect. With orthovanadate pre-treatment, the composition of cellularity in the bone marrow improved substantially and the main lymphocyte populations restored during the first month after irradiation. These findings contribute to ‘gap-filling’ in radioprotective effects and demonstrate the importance of haematological parameters in radiation–response prediction.
Contested applications to remove executors-quite unlike ordinary inter partes litigation
Authors: Bishop Toby
Published: September 2019

‘Everyone thinks of changing the world, but no one thinks of changing himself’ (Leo Tolstoy, Three Methods of Reform).

The jurisdiction to replace incumbents is a tool of revolution in estate administration. Recent judgments remind us that these applications are more persuasive when framed with restraint.
Pediatric ambulatory anesthesia: an update
Authors: Lerman Jerrold
Published: September 2019

Purpose of review

Ambulatory surgery is the standard for the majority of pediatric surgery in 2019 and adenotonsillectomy is the second most common ambulatory surgery in children so it is an apt paradigm. Preparing and managing these children as ambulatory patients requires a thorough understanding of the current literature.

Recent findings

The criteria for undertaking pediatric adenotonsillectomy on an ambulatory basis, fasting after clear fluids, postoperative nausea and vomiting (PONV), perioperative pain management and discharge criteria comprise the themes addressed in this review.

Three criteria determine suitability of adenotonsillectomy surgery on an ambulatory basis: the child's age, comorbidities and the severity of the obstructive sleep apnea syndrome (OSAS). Diagnosing OSAS in children has proven to be a challenge resulting in alternate, noninvasive techniques, which show promise. Abbreviating the 2 h clear fluid fasting guideline has garnered attention, although the primary issue is that parents do not follow the current clear fluid fasting regimen and until that is resolved, consistent fasting after clear fluids will remain elusive. PONV requires aggressive prophylactic measures that fail in too many children. The importance of unrecognized genetic polymorphisms in PONV despite prophylactic treatment is understated as are the future roles of palonosetron and Neurokinin-1 receptor antagonists that may completely eradicate PONV when combined with dexamethasone. Pain management requires test doses of opioids intraoperatively in children with OSAS and nocturnal desaturation to identify those with reduced opioid dosing thresholds, an uncommon practice as yet. Furthermore, postdischarge nonsteroidal anti-inflammatory agents as well as other pain management strategies should replace oral opioids to prevent respiratory arrests in those who are ultra-rapid CYP2D6 metabolizers. Finally, discharge criteria are evolving and physiological-based criteria should replace time-based, reducing the risk of readmission.
Migraine and Other Headache Disorders
Authors: Lucas Sylvia
Published: September 2019

Migraine is a common headache disorder for which women are likely to seek care. This primary headache disorder, which often may be debilitating, has a higher prevalence in women than in men that is likely related to times of hormonal changes throughout the reproductive life cycle, such as menarche, pregnancy, postpartum period, lactation, perimenopause, and menopause, as well as to external hormonal changes associated with the use of oral contraceptives and hormone therapy. The obstetrician–gynecologist is well positioned to recognize and treat migraine and to recognize a potential relationship between estrogen fluctuation and migraine exacerbation. Migraine frequency is likely to decrease during pregnancy, but migraine often recurs during breastfeeding. Because headache does occur during these reproductive events, a careful evaluation and possible medication change may be necessary. Women also have unique risks for secondary headache during pregnancy, particularly pregnant women with a history of migraine. Therefore, a large portion of this monograph is devoted to evaluation, management, and drug safety in pregnant or breastfeeding women.
Antibiotic Prophylaxis During Catheter-Managed Postoperative Urinary Retention After Pelvic Reconstructive Surgery
Authors: Lavelle Erin Seifert , Alam Pakeeza , Meister Melanie , Florian-Rodriguez Maria , Elmer-Lyon Cara , Kowalski Joseph , Carter-Brooks Charelle , Mazloomdost Donna , Zyczynski Halina , Lowder Jerry , Gutman Robert , Sutkin Gary
Published: September 2019

OBJECTIVE:

To estimate whether nitrofurantoin prophylaxis decreases the incidence of culture-documented urinary tract infection for women with catheter-managed urinary retention after pelvic reconstructive surgery.

METHODS:

This double-blind, placebo-controlled, randomized trial was conducted at five academic institutions. Women with urinary retention after surgery for prolapse or incontinence were randomized to oral nitrofurantoin 100 mg daily during indwelling or clean intermittent self-catheterization. The primary outcome was the incidence of symptomatic urinary tract infection within 6 weeks of surgery, confirmed by culture demonstrating more than 1,000 colony forming units per milliliter of uropathogenic bacteria. Secondary outcomes were adverse symptoms possibly attributable to nitrofurantoin and bacterial resistance to nitrofurantoin. A sample size of 154 would detect a decrease in urinary tract infection incidence from 33% to 13%, with 80% power, two-sided alpha of 0.05, and allow 10% dropout.

RESULTS:

Of 154 participants randomized from September 2016 to May 2018, 151 were eligible for analysis: 75 received nitrofurantoin, and 76 received placebo. Demographics were similar between groups. The indication for surgery was prolapse (46%), incontinence (20%), or a combination (34%). Participants were discharged with an indwelling catheter (58%) or performing self-catheterization (42%). Median duration of catheter use was 4 days (interquartile range 3–7). Thirteen women in the nitrofurantoin group and 13 women in the placebo group experienced urinary tract infection (17.3% vs 17.1%, P=.97, relative risk [RR] [95% CI] 1.01 [0.50–2.04]). Adverse symptoms possibly attributable to nitrofurantoin were common in both groups (68% vs 61%, P=.34, RR [95% CI] 1.12 [0.88–1.43]). Resistance to nitrofurantoin was identified in seven urine cultures, four among nitrofurantoin and three among placebo recipients. In total, 52 urine cultures were obtained to evaluate symptoms of urinary tract infection, and only 27 of 52 grew at least 1,000 cfu/mL of uropathogenic bacteria.

CONCLUSION:

Daily nitrofurantoin did not reduce the incidence of culture-proven urinary tract infection among women with catheter-managed urinary retention after pelvic reconstructive surgery. Culture confirmed urinary tract infection in only half of symptomatic episodes.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02727322.