bluuebunny/crossref_metadata_2025 huggingface dataset:
Limited impacts of chronic eye fluke infection on the reproductive success of a fish host
Authors: Nezhybová Veronika , Reichard Martin , Methling Caroline , Ondračková Markéta
Published: November 2019

Parasitic infections may affect the reproductive success of the host either directly, through behavioural modification, or indirectly, by altering their reproductive investment in response to infection. We determined the effects of infection with the eye fluke Diplostomum pseudospathaceum (Trematoda) on the reproductive traits of European bitterling (Rhodeus amarus, Cyprinidae), an intermediate fish host with a resource-based mating system. Male bitterling infected by Diplostomum exhibited a larger but less pronounced red eye spot (sexually selected signal) than control males, suggesting that infected males were less preferred by females. The frequency of female ovulation and number of offspring were comparable between the infected and the control group, although there was a 1–2 week delay in the peak of ovulation and offspring production in infected fish, which is known to coincide with higher juvenile mortality. Chronic eye fluke infection had minimal metabolic costs (measured as oxygen consumption) and, consistent with these results, reproductive activity did not differ between infected and control fish in an experimental test of intersexual selection. Overall, the impact of eye fluke infection on the reproduction of European bitterling was limited. We consider the potential effect of favourable conditions during experiments (abundant food, access to spawning substrate and lack of predators and co-infections) on experimental outcomes and recognize that the effects of chronic eye fluke infection in natural conditions might be more pronounced.
FOXD3, frequently methylated in colorectal cancer, acts as a tumor suppressor and induces tumor cell apoptosis under ER stress via p53
Authors: Xu Ming , Zhu Jing , Liu Shuiping , Wang Chan , Shi Qinglan , Kuang Yeye , Fang Xiao , Hu Xiaotong
Published: November 2019

Forkhead box D3 (FOXD3), an important member of the forkhead box transcription factor family, has many biological functions. However, the role and signaling pathways of FOXD3 in colorectal cancer (CRC) are still unclear. We examined FOXD3 expression and methylation in normal colon mucosa, CRC cell lines and primary tumors by reverse transcription–polymerase chain reaction, methylation-specific PCR and bisulfite genomic sequencing. We also evaluated its tumor-suppressive function by examining its modulation of apoptosis under endoplasmic reticulum (ER) stress in CRC cells. The FOXD3 target signal pathway was identified by western blotting, immunofluorescence and chromatin immunoprecipitation. We found that FOXD3 was frequently methylated and silenced in CRC cell lines and was downregulated in CRC tissues compared with paired adjacent non-tumor tissues. Meanwhile, low FOXD3 protein expression was significantly correlated with poor histopathological grading, lymph node metastasis and poor prognosis of patients, indicating its potential as a tumor marker that may be of potential value as a therapeutic target for CRC. Moreover, restoration of FOXD3 expression inhibited the proliferation and migration of tumor cells. FOXD3 also increased mitochondrial apoptosis through the unfolded protein response under ER stress. Furthermore, we found that FOXD3 could bind directly to the promoter of p53 and enhance its expression. Knockdown of p53 impaired the effect of apoptosis induced by FOXD3. In conclusion, we showed for the first time that FOXD3, which is frequently methylated in CRC, acted as a tumor suppressor inducing tumor cell apoptosis under ER stress via p53.
Slowly-Conducting Pyramidal Tract Neurons in Macaque and Rat
Authors: Kraskov A , Soteropoulos D S , Glover I S , Lemon R N , Baker S N
Published: November 2019

Anatomical studies report a large proportion of fine myelinated fibers in the primate pyramidal tract (PT), while very few PT neurons (PTNs) with slow conduction velocities (CV) (<~10 m/s) are reported electrophysiologically. This discrepancy might reflect recording bias toward fast PTNs or prevention of antidromic invasion by recurrent inhibition (RI) of slow PTNs from faster axons. We investigated these factors in recordings made with a polyprobe (32 closely-spaced contacts) from motor cortex of anesthetized rats (n = 2) and macaques (n = 3), concentrating our search on PTNs with long antidromic latencies (ADLs). We identified 21 rat PTNs with ADLs >2.6 ms and estimated CV 3–8 m/s, and 67 macaque PTNs (>3.9 ms, CV 6–12 m/s). Spikes of most slow PTNs were small and present on only some recording contacts, while spikes from simultaneously recorded fast-conducting PTNs were large and appeared on all contacts. Antidromic thresholds were similar for fast and slow PTNS, while spike duration was considerably longer in slow PTNs. Most slow PTNs showed no signs of failure to respond antidromically. A number of tests, including intracortical microinjection of bicuculline (GABAA antagonist), failed to provide any evidence that RI prevented antidromic invasion of slow PTNs. Our results suggest that recording bias is the main reason why previous studies were dominated by fast PTNs.
Increase of Dose Associated With Decrease in Protection Against Controlled Human Malaria Infection by PfSPZ Vaccine in Tanzanian Adults
Authors: Jongo Said A , Church L W Preston , Mtoro Ali T , Schindler Tobias , Chakravarty Sumana , Ruben Adam J , Swanson Phillip A , Kassim Kamaka R , Mpina Maximillian , Tumbo Anneth-Mwasi , Milando Florence A , Qassim Munira , Juma Omar A , Bakari Bakari M , Simon Beatus , James Eric R , Abebe Yonas , KC Natasha , Saverino Elizabeth , Fink Martina , Cosi Glenda , Gondwe Linda , Studer Fabian , Styers David , Seder Robert A , Schindler Tobias , Billingsley Peter F , Daubenberger Claudia , Sim B Kim Lee , Tanner Marcel , Richie Thomas L , Abdulla Salim , Hoffman Stephen L
Published: November 2019

Background

A vaccine would be an ideal tool for reducing malaria’s impact. PfSPZ Vaccine (radiation attenuated, aseptic, purified, cryopreserved Plasmodium falciparum [Pf] sporozoites [SPZ]) has been well tolerated and safe in >1526 malaria-naive and experienced 6-month to 65-year-olds in the United States, Europe, and Africa. When vaccine efficacy (VE) of 5 doses of 2.7 × 105 PfSPZ of PfSPZ Vaccine was assessed in adults against controlled human malaria infection (CHMI) in the United States and Tanzania and intense field transmission of heterogeneous Pf in Mali, Tanzanians had the lowest VE (20%).

Methods

To increase VE in Tanzania, we increased PfSPZ/dose (9 × 105 or 1.8 × 106) and decreased numbers of doses to 3 at 8-week intervals in a double blind, placebo-controlled trial.

Results

All 22 CHMIs in controls resulted in parasitemia by quantitative polymerase chain reaction. For the 9 × 105 PfSPZ group, VE was 100% (5/5) at 3 or 11 weeks (P < .000l, Barnard test, 2-tailed). For 1.8 × 106 PfSPZ, VE was 33% (2/6) at 7.5 weeks (P = .028). VE of dosage groups (100% vs 33%) was significantly different (P = .022). Volunteers underwent repeat CHMI at 37–40 weeks after last dose. 6/6 and 5/6 volunteers developed parasitemia, but time to first parasitemia was significantly longer than controls in the 9 × 105 PfSPZ group (10.89 vs 7.80 days) (P = .039), indicating a significant reduction in parasites in the liver. Antibody and T-cell responses were higher in the 1.8 × 106 PfSPZ group.

Conclusions

In Tanzania, increasing the dose from 2.7 × 105 to 9 × 105 PfSPZ increased VE from 20% to 100%, but increasing to 1.8 × 106 PfSPZ significantly reduced VE.

Clinical Trials Registration

NCT02613520.
Asymmetrical elevation of esophagogastric junction pressure suggests hiatal repair contributes to antireflux surgery dysphagia
Authors: Myers J C , Jamieson G G , Szczesniak M M , Estremera-Arévalo F , Dent J
Published: November 2019

The radial distribution of esophago-gastric junction (EGJ) pressures with regard to troublesome dysphagia (TDysph) after antireflux surgery is poorly understood. Before and after antireflux surgery, end-expiratory and peak-inspiratory EGJ pressures were measured at eight angles of 45° radial separation in patients with reflux disease. All 34 patients underwent posterior crural repair, then either 90° anterior (N = 13) or 360° fundoplication (N = 21). Dysphagia was assessed prospectively using a validated questionnaire (score range 0–45) and TDysph defined as a dysphagia score that was ≥5 above pre-op baseline. Compared with before surgery, for 90° fundoplication, end-expiratory EGJ pressures were highest in the left-anterolateral sectors, the position of the partial fundoplication. In other sectors, pressures were uniformly elevated. Compared with 90° fundoplication, radial pressures after 360° fundoplication were higher circumferentially (P = 0.004), with a posterior peak. Nine patients developed TDysph after surgery with a greater increase in end-expiratory and peak-inspiratory EGJ pressures (P = 0.03 and 0.03, respectively) and significantly higher inspiratory pressure at the point of maximal radial pressure asymmetry (P = 0.048), compared with 25 patients without TDysph. Circumferential elevation of end-expiratory EGJ pressure after 90° and 360° fundoplication suggests hiatal repair elevates EGJ pressure by extrinsic compression. The highly localized focal point of elevated EGJ pressure upon inspiration in patients with TDysph after surgery is indicative of a restrictive diaphragmatic hiatus in the presence of a fundoplication.
Zinc Deficiency Activates the IL-23/Th17 Axis to Aggravate Experimental Colitis in Mice
Authors: Higashimura Yasuki , Takagi Tomohisa , Naito Yuji , Uchiyama Kazuhiko , Mizushima Katsura , Tanaka Makoto , Hamaguchi Masahide , Itoh Yoshito
Published: November 2019

Background and Aims

Patients with inflammatory bowel disease [IBD], especially Crohn’s disease, often develop zinc deficiency. However, the precise mechanisms by which zinc deficiency affects IBD pathology, particularly intestinal macrophage function, remain unclear. We studied the effects of zinc deficiency on the development and progression of colitis in mice.

Methods

To induce colitis, mice were treated with 2,4,6-trinitrobenzene sulphonic acid. Rag1−/− mice were then given injections of naïve CD4+CD62L+ T cells. The respective degrees of mucosal injury of mice that had received a zinc chelator (TPEN; N,N,N′,N′-tetrakis [2-pyridylmethyl]ethylenediamine) and of control mice were subsequently compared. Colonic lamina propria mononuclear cells were isolated by enzymatic digestion and were examined using flow cytometry. To generate mouse bone marrow-derived macrophages [BMDMs], bone marrow cells were stimulated with mouse macrophage-colony stimulating factor.

Results

Zinc deficiency aggravates colonic inflammation through the activation of type 17 helper T [Th17] cells in mice. Flow cytometric analysis revealed that zinc deficiency significantly increases the proportion of pro-inflammatory [M1] macrophages in colonic lamina propria mononuclear cells obtained from inflamed colon. Interferon-γ plus lipopolysaccharide-mediated M1 skewing alters the expression of zinc transporters in BMDMs and thereby decreases the intracellular free zinc. TPEN treatment mimicking the effects of the M1 skewing up-regulates IL-23p19 expression, which is strongly related to Th17 development. Furthermore, the nuclear accumulation of interferon-regulatory factor 5 is closely involved in IL-23p19 induction in zinc-deficient macrophages.

Conclusions

Zinc deficiency aggravates colonic inflammation through activation of the IL-23/Th17 axis. This activation is controlled by subcellular distribution of interferon-regulatory factor 5.
Potential of Colorado Potato Beetle (Coleoptera: Chrysomelidae) to Adapt to Alternative Host Plants
Authors: Hiiesaar Külli , Williams Ingrid H , Jõgar Katrin , Karise Reet , Ploomi Angela , Metspalu Luule , Mänd Marika
Published: November 2019

Twelve selected cultivated or wild solanaceae (Solanum dulcamara, Solanum nigrum, Solanum villosum, Solanum lycopersicum, Solanum muricatum, Solanum melongena, Datura innoxia, Datura metel, Physalis spp., Capsicum annuum, Nicotiana alata, and Petunia spp.) (all species Solanales: Solanaceae) were tested as potential alternative host plants against Solanum tuberosum for a local population of the Colorado potato beetle Leptinotarsa decemlineata Say (CPB) in Estonia. Some CPB populations in America and southern Europe accept most of these plants. However, geographically isolated populations of beetles can differ in their acceptance of new host plants. Migrants from the southern Europe supplement Estonian beetle population regularly, so individuals may differ in their host plant preferences. S. melongena and S. dulcamara were well accepted by the beetles, Lycopersicum spp. (Solanales: Solanaceae) and N. alata were intermediate, and S. villosum and S. nigrum were least accepted. The beetles rejected S. muricatum, Physalis spp., C. annuum, Petunia spp., and D. metel. First-instar larvae completed a full life cycle only on S. dulcamara, N. alata, S. lycopesicum, S. melongena, although their development rate was slower, mortality was higher and emerging adults were underweight relative to those that fed on S. tuberosum. The fourth-instar larvae were less sensitive in relation to food. We found that S. dulcamara as a native plant could provide resources for CPB during early and late season. At the same time, the cultivated S. melongena would be suitable plant species for further testing as dead-end crop for integrated pest management.
The ‘de Winter’ electrocardiogram pattern as a ST-elevation myocardial infarction equivalent: a case report
Authors: Grandjean Thierry , Degrauwe Sophie , Tessitore Elena , Iglesias Juan F
Published: November 2019

Background

A ‘STEMI equivalent’ electrocardiogram (ECG) pattern reflects an acute thrombotic occlusion of a large epicardial coronary artery without ST-segment elevation. These ECG patterns are less known by caregivers.

Case summary

We describe the case of a 56-year-old patient suffering from acute chest pain, presenting in our emergency department with a ‘de Winter’ ECG pattern: an upsloping ST-segment depression with tall symmetrical T waves associated with left anterior descending artery occlusion.

Discussion

The ‘de Winter’ ECG pattern, as other ‘STEMI equivalent’, must be recognized promptly and treated as soon as possible with emergent reperfusion by percutaneous coronary intervention.
A case report: a 22-year-old septic patient with central venous pO2 of 198 mmHg
Authors: Ehlers Ulrike Elisabeth , Mutter Michael , Fahner Peter Jurriaan , Pfammatter Thomas
Published: November 2019

Background

Central venous saturation and central venous pressure can be determined with central venous catheters. Therefore, the tip of the catheter should be located in the superior vena cava. The location can be monitored by electrocardiography or X-ray. The central venous pressure curve is displayed on the monitor. The reference value of central venous saturation is >70%. Venous pO2 is normally 35–45 mmHg and central venous pressure 1–9 mmHg.

Case summary

We treated a 22-year-old patient with septic shock. Central venous saturation was 100% with a pO2 of 198 mmHg. The arterial blood gas analysis was comparatively low with saturation of 98% and pO2 of 111 mmHg. On chest X-ray, the central venous catheter tip appeared on the left side of the heart. On echocardiography, aortic positioning was not evident. On the monitor, a ‘venous pressure-like’ curve was seen, that did not stand in exact correlation to the electrocardiogram curve. The computed tomography (CT) image showed placement of the catheter in the upper left pulmonary vein. The patient had a partial anomalous pulmonary venous return.

Discussion

The C-wave of the central venous pressure curve normally occurs after the R-wave of the electrocardiogram. If C-waves appeared before R-waves, the central venous catheter placement is not central venous and must be checked. In our case, the apparent ‘venous’ pO2 in blood gas examination was higher than arterial pO2. The catheter position had to be in an oxygenated vessel proximal to the left ventricle. A vascular anomaly was a possible diagnosis and was confirmed on CT imaging.
Successful treatment of a spontaneous right coronary artery dissection with a 4-mm diameter cutting balloon: a case report
Authors: Sharma Harish , Vetrugno Vincenzo , Khan Sohail Q
Published: November 2019

Background

Guidelines recommend conservative management for a spontaneous coronary artery dissection (SCAD) in the absence of ongoing ischaemia, haemodynamic instability, or left main dissection. Conventional percutaneous coronary intervention methods for SCAD are associated with an unfavourable prognosis due to difficulties wiring the lesion, dissection propagation, and potential ‘milking’ of the intramural haematoma along the vessel or into other vessels. These factors promote implantation of multiple stents which are often undersized, increasing the risk of in-stent restenosis significantly. There have been several case reports demonstrating the novel use of small diameter cutting balloons in the left anterior descending artery system. Here, we describe the successful use of a larger 4 mm cutting balloon to treat a spontaneous right coronary artery (RCA) dissection.

Case summary

A 53-year-old woman with troponin negative chest pain and was diagnosed with unstable angina due to ischaemic electrocardiographic features. Coronary angiography revealed a tight discrete lesion in the RCA. Intravascular imaging confirmed SCAD and a 4 mm cutting balloon was used to dissect the tunica intima to allow complete resorption of the intramural haematoma and resolution of symptoms.

Discussion

This case demonstrates the safe use of a larger 4 mm cutting balloon to treat an RCA SCAD, resulting in complete resolution of the haematoma.
Tasting theterroirof wine yeast innovation
Authors: Pretorius I S
Published: November 2019

Wine is an archetypal traditional fermented beverage with strong territorial and socio-cultural connotations. Its 7000 year history is patterned by a tradition of innovation. Every value-adding innovation − whether in the vineyard, winery, supply chain or marketplace − that led to the invention of a new tradition spurred progress and created a brighter future from past developments. In a way, wine traditions can be defined as remembered innovations from the distant past − inherited knowledge and wisdom that withstood the test of time. Therefore, it should not be assumed a priori that tradition and innovation are polar opposites. The relations between the forces driven by the anchors of tradition and the wings of innovation do not necessarily involve displacement, conflict or exclusiveness. Innovation can strengthen wine tradition, and the reinvention of a tradition-bound practice, approach or concept can foster innovation. In cases where a paradigm-shifting innovation disrupts a tradition, the process of such an innovation transitioning into a radically new tradition can become protracted while proponents of divergent opinions duke it out. Sometimes these conflicting opinions are based on fact, and sometimes not. The imperfections of such a debate between the ‘ancients’ and the ‘moderns’ can, from time to time, obscure the line between myth and reality. Therefore, finding the right balance between traditions worth keeping and innovations worth implementing can be complex. The intent here is to harness the creative tension between science fiction and science fact when innovation's first-principles challenge the status quo by re-examining the foundational principles about a core traditional concept, such as terroir. Poignant questions are raised about the importance of the terroir (biogeography) of yeasts and the value of the microbiome of grapes to wine quality. This article imagines a metaphorical terroir free from cognitive biases where diverse perspectives can converge to uncork the effervescent power of territorial yeast populations as well as ‘nomadic’ yeast starter cultures. At the same time, this paper also engages in mental time-travel. A future scenario is imagined, explored, tested and debated where terroir-less yeast avatars are equipped with designer genomes to safely and consistently produce, individually or in combination with region-specific wild yeasts and or other starter cultures, high-quality wine according to the preferences of consumers in a range of markets. The purpose of this review is to look beyond the horizon and to synthesize a link between what we know now and what could be. This article informs readers where to look without suggesting what they must see as a way forward. In the context of one of the world's oldest fermentation industries − steeped in a rich history of tradition and innovation − the mantra here is: respect the past, lead the present and secure the future of wine.
Ambient noise Rayleigh wave tomography across the Madagascar island
Authors: Adimah N I , Padhy S
Published: November 2019

The unusual complex lithospheric structure of Madagascar is a product of a number of important geological events, including: the Pan-African Orogeny, episodes of Late Cenozoic intraplate volcanism and several phases of deformation and metamorphism. Despite this rich history, its detailed crustal structure remains largely underexplored. Here, we take advantage of the recently obtained data set of the RHUM-RUM (Réunion Hotspot and Upper Mantle–Réunions Unterer Mantel) seismological experiment, in addition to previously available data sets to generate the first Rayleigh wave group velocity maps across the entire island at periods between 5 and 30 s using the ambient noise tomography technique. Prior to preliminary data preparation, data from Ocean Bottom Seismometers are cleaned of compliance and tilt noise. Cross-correlating noise records yielded over 1900 Rayleigh wave cross-correlation functions from which group velocities were measured to perform surface wave tomography. Dispersion curves extracted from group velocity tomographic maps are inverted to compute a 3-D shear velocity model of the region. Our velocity maps have shown relative improvement in imaging the three sedimentary basins in the western third of the island compared to those of previous studies. The Morondava basin southwest of the island is the broadest and contains the thickest sedimentary rocks while the Antsirinana basin at the northern tip is narrowest and thinnest. The lithosphere beneath the island is characterized by a heterogeneous crust which appears thickest at the centre but thins away towards the margins. A combined effect of uneven erosion of the crust and rifting accommodates our observations along the east coast. Average 1-D shear velocity models in six different tectonic units, support the causes of low velocity zones observed in the west coast of the island and reveal an intermediate-to-felsic Precambrian upper and middle crust consistent with findings of previous seismic studies. Our findings, especially at short periods provide new constraints on shallow crustal structure of the main island region.
Identification of hospitalized patients with community-acquired infection in whom treatment guidelines do not apply: a validated model
Authors: Cardoso Teresa , Rodrigues Pedro Pereira , Nunes Cristina , Almeida Mónica , Cancela Joana , Rosa Fernando , Rocha-Pereira Nuno , Ferreira Inês , Seabra-Pereira Filipa , Vaz Prudência , Carneiro Liliana , Andrade Carina , Davis Justin , Marçal Ana , Friedman N Deborah
Published: November 2019

Objectives

To develop and validate a clinical model to identify patients admitted to hospital with community-acquired infection (CAI) caused by pathogens resistant to antimicrobials recommended in current CAI treatment guidelines.

Methods

International prospective cohort study of consecutive patients admitted with bacterial infection. Logistic regression was used to associate risk factors with infection by a resistant organism. The final model was validated in an independent cohort.

Results

There were 527 patients in the derivation and 89 in the validation cohort. Independent risk factors identified were: atherosclerosis with functional impairment (Karnofsky index <70) [adjusted OR (aOR) (95% CI) = 2.19 (1.41–3.40)]; previous invasive procedures [adjusted OR (95% CI) = 1.98 (1.28–3.05)]; previous colonization with an MDR organism (MDRO) [aOR (95% CI) = 2.67 (1.48–4.81)]; and previous antimicrobial therapy [aOR (95% CI) = 2.81 (1.81–4.38)]. The area under the receiver operating characteristics (AU-ROC) curve (95% CI) for the final model was 0.75 (0.70–0.79). For a predicted probability ≥22% the sensitivity of the model was 82%, with a negative predictive value of 85%. In the validation cohort the sensitivity of the model was 96%. Using this model, unnecessary broad-spectrum therapy would be recommended in 30% of cases whereas undertreatment would occur in only 6% of cases.

Conclusions

For patients hospitalized with CAI and none of the following risk factors: atherosclerosis with functional impairment; previous invasive procedures; antimicrobial therapy; or MDRO colonization, CAI guidelines can safely be applied. Whereas, for those with some of these risk factors, particularly if more than one, alternative antimicrobial regimens should be considered.
lncRNA CCAT1/miR-490-3p/MAPK1/c-Myc positive feedback loop drives progression of acute myeloid leukaemia
Authors: Wang Chenghong , Chen Fangping , Fan Zili , Yao Chenjiao , Xiao Lijun
Published: November 2019

Acute myeloid leukaemia (AML) is a frequently diagnosed malignancy in adults. Long non-coding RNA (lncRNA) colon cancer-associated transcript 1 (CCAT1) has been well known to play vital roles in multiple malignancies including AML. Unfortunately, the detailed mechanism of CCAT1 in AML progression remains obscure. In this study, we demonstrated that CCAT1 was up-regulated in AML samples while its target, miR-490-3p, was relatively down-regulated. CCAT1 markedly increased viability and metastasis of AML cells, while miR-490-3p had opposite effects. CCAT1 could specifically bind to miR-490-3p and reduce its expression and activity, and MAPK1 was a target gene of miR-490-3p. Overexpressed CCAT1 could induce MAPK1 expression and c-Myc reciprocally increased CCAT1 expression. Our data implied that miR-490-3p could be a novel therapeutic target for AML, and highlights the crucial role of CCAT1/miR-490-3p/MAPK1/c-Myc positive feedback loop in AML progression.
Addressing Hunger and Starvation in Situations of Armed Conflict — Laying the Foundations for Peace
Authors: Lander Brian , Richards Rebecca Vetharaniam
Published: November 2019

Food is a common denominator for human survival and is often the source of national pride and cultural significance. Yet, famine and starvation remain a real threat to millions of people around the world. This article sets the scene for an exploration of the relationship between food and security within conflict settings and of how the response of humanitarian actors can pave the way for improving the prospects for peace. Through examining the trends that are impacting the food security of civilians, including humanitarian access and attacks against objects indispensable to the survival of these populations and against humanitarian workers, this article considers the linkages between hunger and conflict as well as the avenues that must be pursued to prevent and end conflicts. Focus is given to the contributions of organizations like the United Nations World Food Programme (WFP) to address underlying root causes in an inclusive, integrated and sustainable manner. The available tools such organizations have at their disposal are also considered, highlighting the need for a more comprehensive framework that builds on existing legal foundations, international commitments, and the efforts of humanitarian, development and peace actors. The engagement of the international community in averting famine, relapse into conflict and exacerbation of conflict through food insecurity requires a multi-faceted response given the nature of famine and starvation in the world today. The article concludes with thoughts on ways of utilizing existing rules and frameworks to protect civilians from starvation in times of armed conflict.
Diagnostic Reasoning in the Pain-Focused Encounter
Authors: Hogans Beth B.
Published: November 2019

Chapter 7 addresses the processes and pitfalls of evaluating, reasoning about, and attending to the needs of patients with pain. This chapter builds on Chapter 6, which addressed clinical assessment, explaining in detail the process of extracting and abstracting information from the pain narrative (clinical history or interview) to lay the foundation for a problem list and differential diagnosis. The problem list and differential diagnosis are described and contrasted so that clinicians will be comfortable with both. A clinical model explains the need for patient-centered approaches to be omnipresent but balanced with an appropriate disease-centered knowledge base that is likewise informed by understanding the patient’s healthcare-related values and motivations. A balanced approach is emphasized. The process of planning for diagnostic testing, including imaging, laboratory testing, provocative maneuvers, and targeted referrals, is described. The last section of the chapter addresses the impact and nature of cognitive and affective biases that can mitigate the effectiveness of diagnostic reasoning. A coordinated strategy to limit the negative impact of diagnostic reasoning biases is presented in a memorable way. Finally, the ethics of errors and error disclosure are discussed as well as the process of error disclosure.
Pain Emergencies and Complications of Pain Treatments
Authors: Tong Isaac , Yong R. Jason , Hogans Beth B.
Published: November 2019

Chapter 13 reviews some common pain-associated emergencies and also discusses some complications of pain treatments that require immediate attention. Pain is a common occurrence in emergent illness, and some complications of pain treatments require emergent management. Chest pain is an excellent example of clinical decision-making following a process of organized, rapid pain assessment and then diagnostic and treatment reasoning based on the findings and observations of the clinical assessment. Providers assessing patients for acute chest pain elicit basic pain characteristics of region, quality, severity, and timing as well as usually associated factors and then pursue testing and treatment for elements in the differential diagnosis accordingly. The chapter illustrates this same process applied to conditions of acute abdominal, limb, headache, and spine emergencies. In the second part of the chapter, emergencies arising in the context of pain treatments are discussed, including overdose and withdrawal from opioids, benzodiazepines, and other pain-active medications as well as pump and device complications.
Multiscale dynamics in star-forming regions: the interplay between gravity and turbulence
Authors: Traficante A , Fuller G A , Duarte-Cabral A , Elia D , Heyer M H , Molinari S , Peretto N , Schisano E
Published: November 2019

In this work, we investigate the interplay between gravity and turbulence at different spatial scales and in different density regimes. We analyse a sample of 70-μm quiet clumps that are divided into three surface density bins, and we compare the dynamics of each group with the dynamics of their respective filaments. The densest clumps form within the densest filaments, on average, and they have the highest value of the velocity dispersion. The kinetic energy is transferred from the filaments down to the clumps most likely through a turbulent cascade, but we identify a critical value of the surface density, Σ ≃ 0.1 g cm−2, above which the dynamics change from being mostly turbulent-driven to mostly gravity-driven. The scenario we obtain from our data is a continuous interplay between turbulence and gravity, where the former creates structures at all scales and the latter takes the lead when the critical surface density threshold is reached. In the densest filaments, this transition can occur at the parsec, or even larger scales, leading to a global collapse of the whole region and most likely to the formation of the massive objects.
Sunspot observations by Hisako Koyama: 1945–1996
Authors: Hayakawa Hisashi , Clette Frédéric , Horaguchi Toshihiro , Iju Tomoya , Knipp Delores J , Liu Huixin , Nakajima Takashi
Published: November 2019

Sunspot records are the only observational tracer of solar activity that provides a fundamental, multicentury reference. Its homogeneity has been largely maintained with a succession of long-duration visual observers. In this article, we examine observations of one of the primary reference sunspot observers, Hisako Koyama. By consulting original archives of the National Museum of Nature and Science of Japan (hereafter, NMNS), we retrace the main steps of her solar-observing career, from 1945 to 1996. We also present the reconstruction of a full digital data base of her sunspot observations at the NMNS, with her original drawings and logbooks. Here, we extend the availability of her observational data from 1947–1984 to 1945–1996. Comparisons with the international sunspot number (Version 2) and with the group sunspot number series show a good global stability of Koyama's observations, with only temporary fluctuations over the main interval 1947–1982. Identifying drawings made by alternate observers throughout the series, we find that a single downward baseline shift in the record coincides with the partial contribution of replacement observers mostly after 1983. We determine the correction factor to bring the second part (1983–1996) to the same scale with Koyama's main interval (1947–1982). We find a downward jump by 9 per cent after 1983, which then remains stable until 1995. Overall, the high quality of Koyama's observations with her life-long dedication leaves a lasting legacy of this exceptional personal achievement. With this comprehensive recovery, we now make the totality of this legacy directly accessible and exploitable for future research.
Diagnostic accuracy of ultrasound for detecting large-vessel giant cell arteritis using FDG PET/CT as the reference
Authors: Nielsen Berit Dalsgaard , Hansen Ib Tønder , Keller Kresten Krarup , Therkildsen Philip , Gormsen Lars Christian , Hauge Ellen-Margrethe
Published: November 2019

Objectives

The diagnostic accuracy of axillary artery US in the diagnosis of large-vessel (LV)-GCA using 18F-fluorodeoxyglucose (FDG) PET/CT as reference standard was prospectively evaluated in GCA-suspected patients. As an exploratory analysis, the diagnostic accuracy of cranial artery FDG PET/CT was evaluated.

Methods

Briefly, the inclusion criteria were age ≥50 years, raised inflammatory markers and potential GCA symptoms. Patients in immunosuppressive therapy or with a previous diagnosis of GCA or PMR were excluded. Examinations were performed pre-treatment. LV-GCA reference diagnosis was a clinical diagnosis of GCA and PET-proven LV inflammation. GCA patients fulfilling ACR criteria were considered as cranial-GCA (c-GCA). Patients without GCA were considered controls. Receiver operating characteristic curve analysis of the US-measured axillary intima-media thickness was performed. FDG uptake in temporal, maxillary and vertebral arteries was also assessed.

Results

Forty-six patients were diagnosed with LV-GCA, 10 with isolated c-GCA, and in 34 patients GCA was dismissed. Axillary US yielded a sensitivity of 76% and a specificity of 100% for LV-GCA. An axillary intima-media thickness cut-off of 1.0 mm yielded a sensitivity of 74% and a specificity of 92%. Adding LV US to temporal assessment increased sensitivity from 71% to 97% (all GCA patients). Cranial artery PET showed a diagnostic sensitivity of 78% and specificity of 100% for c-GCA.

Conclusion

Axillary artery US shows high accuracy for the LV-GCA diagnosis. Building upon the recent EULAR recommendations, we propose a diagnostic algorithm with US as the first-line confirmatory test, not only in c-GCA-suspected patients, but in all patients suspected of GCA.
Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis
Authors: Rezaei Elham , Hogan Daniel , Trost Brett , Kusalik Anthony J , Boire Gilles , Cabral David A , Campillo Sarah , Chédeville Gaëlle , Chetaille Anne-Laure , Dancey Paul , Duffy Ciaran , Watanabe Duffy Karen , Gordon John , Guzman Jaime , Houghton Kristin , Huber Adam M , Jurencak Roman , Lang Bianca , Morishita Kimberly , Oen Kiem G , Petty Ross E , Ramsey Suzanne E , Scuccimarri Rosie , Spiegel Lynn , Stringer Elizabeth , Taylor-Gjevre Regina M , Tse Shirley M L , Tucker Lori B , Turvey Stuart E , Tupper Susan , Yeung Rae S M , Benseler Susanne , Ellsworth Janet , Guillet Chantal , Karananayake Chandima , Muhajarine Nazeem , Roth Johannes , Schneider Rayfel , Rosenberg Alan M
Published: November 2019

Objective

To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling.

Methods

Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes.

Results

From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively.

Conclusion

A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.
Addressing Needs of Hospitalized Patients With Autism
Authors: Quiban Carlota
Published: November 2019

Evidence suggests that improved health outcomes and reducing the hospital length of stay of individuals with autism require working in partnership between parents and health care professionals. Parents' ability to cope in their daily caregiving responsibilities to their child with autism and assessment of their hospital experience can have an impact on their participation with the care team. Nurses working in the inpatient setting can provide support to parents during their encounter with them. This article presented some of the helpful approaches that can help in building positive relationships with parents that may help facilitate addressing the needs of their child with autism. Suggestions that nurses can implement to support the parents cope with their daily challenges are presented. The approaches were discussed in relation to literature and suggestions from parents of individuals with autism spectrum disorder.
Pulmonary Adenocarcinoma Metastatic to Periocular Skin and Orbital Tissue Presenting as Orbital Cellulitis
Authors: Li Emily , Sinard John , Sohrab Mahsa
Published: November 2019

A 56-year-old man presented with a periorbital subcutaneous mass and ipsilateral visually significant orbital inflammation that was refractory to broad-spectrum antibiotics. Orbitotomy with biopsy revealed the diagnosis of metastatic lung cancer, and the patient was initiated on systemic chemotherapy and adjuvant radiation. This is the first report of pulmonary adenocarcinoma metastatic simultaneously to the periocular cutaneous and intraorbital soft tissues. Atypical periorbital and orbital inflammation may be the initial presentation of occult malignancy and require a high index of suspicion and tissue biopsy for diagnosis and life-saving management.
Perspectives and Practice: Physical Therapist Students' Clinical Reasoning
Authors: Gilliland Sarah , Wainwright Susan Flannery
Published: November 2019

Introduction.

Entry-level physical therapist (PT) educational programs need to prepare practitioners who engage in patient-centered clinical reasoning. Many factors, including health care practitioners' beliefs and values, influence how clinicians engage in clinical reasoning. Variations in students' characterizations of physical therapy practice may explain some of the differences observed in previous studies of clinical reasoning. This paper examines the relationship between PT students' characterizations of practice and their clinical reasoning during an encounter with a patient.

Methods.

This paper used a qualitative, descriptive case study method with thematic analysis. Eight entry-level doctor of physical therapy students from 2 programs participated in semistructured conceptual interviews and standardized patient encounters with retrospective think-aloud for this paper. Qualitative thematic analysis was used to examine the students' perspectives on practice and clinical reasoning strategies. The students' perspectives on the purpose and the patient's role in the physical therapy encounter were then analyzed for their relationship with the students' clinical decision-making processes during a standardized patient encounter.

Results.

The students demonstrated a spectrum of qualitative differences in both their perspectives and their reasoning. The students' clinical decision-making processes paralleled their views on practice. A negative case example illustrates the complexity of the relationship between perspective and practice.

Discussion and Conclusion.

Physical therapist students' approaches to a patient encounter parallel their perspectives on practice; however, students must also have the appropriate clinical skills to enact their characterization of practice. Entry-level PT educational programs should include learning opportunities that support students in developing patient-centered perspectives as well as the skills to carry out that practice.
Functional Head Impulse Test With and Without Optokinetic Stimulation in Subjects With Persistent Postural Perceptual Dizziness (PPPD): Preliminary Report
Authors: Teggi Roberto , Gatti Omar , Cangiano Jacopo , Fornasari Francesco , Bussi Mario
Published: November 2019

Objective:

Persistent postural perceptual dizziness (PPPD) is a clinical condition characterized by unsteadiness present on most days for a period of at least 3 months. The aim of our work was to assess vestibular function, the role of anxiety, and possible interactions between visual and vestibular systems in patients with PPPD.

Study Design:

Cross-sectional prospective study.

Setting:

Tertiary referral center.

Patients:

Twenty-five PPPD patients.

Interventions:

Clinical history was collected before examination; vestibular function was assessed through bedside examination, video and functional head impulse test (video-HIT, f-HIT). The latter test was based on having the patient identify an optotype displayed on a computer screen during passive head rotations. The test was repeated while optokinetic stimulation (OKS) was given on the screen. Results were compared with those of 25 controls. State and trait anxiety levels were measured with the State-Trait Anxiety Inventory (STAI) questionnaire. Anxiety before and after vestibular examination was assessed using a VAS scale.

Main Outcome Measure:

Results of video and functional HIT with and without OKS.

Results:

Video-HIT and f-HIT showed normal values in all subjects. f-HIT with OKS provoked more reading errors in patients than in controls. The interaction of group per time detected different decreasing trends between the two groups (p = 0.0002).

Patients presented a reduction in anxiety levels after examination. Nine patients fulfilled diagnostic criteria for vestibular migraine, eight of whom presented nystagmus either to positional tests or vibration test. Only anxiety levels before testing were predictive of worsening of f-HIT with optokinetic stimulation (p = 0.0007).

Conclusions:

Our data support the hypothesis that increased anxiety may play a role in visuo-vestibular interactions; moreover, they are not inconsistent with the hypothesis that OKS might provoke a “threatening effect,” leading to gaze bias during examination.
Inner Ear Proteins as Potential Biomarkers
Authors: Mulry Erin , Parham Kourosh
Published: November 2019

Objective:

The purpose of this manuscript is to identify proteins exclusive to the inner ear based on published research to identify potential candidate biomarkers and guide future inner ear research.

Data Sources:

Literature on inner ear proteins published on Pubmed, Google Scholar, and Scopus was reviewed using key words such as “inner ear molecule,” “inner ear exclusive protein,” and several specific protein searches such as “prestin” based on findings from the initial searches.

Study Selections:

Studies were selected for abstract review based on title relevance, and full text was chosen for review based on abstract relevance. Several related studies cited in initially reviewed literature were also chosen to compile more detailed information on specific molecules with the goal of at least two to three published articles for each protein.

Data Extraction & Synthesis:

Proteins that were cited to have only been found within the inner ear were included in this review, including some proteins that were later identified outside the inner ear. Information regarding their size, location, function, and clinical significance was recorded.

Conclusions:

Based on this literature search, eight proteins exclusive to the inner ear were identified including otolin-1, otoconin 90/95, prestin, otoancorin, otogelin, α-tectorin, β-tectorin, and cochlin. Proteins initially found to be exclusive to the inner ear though later identified outside of the inner ear included oncomodulin, otospiralin, and otoraplin. This literature review may serve as a focused guide for future research on proteins exclusive to the inner ear as potential biomarkers for diseases of the inner ear.