bluuebunny/crossref_metadata_2025 huggingface dataset:
Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people
Authors: Jacobs E. , Rathmann W. , Tönnies T. , Arendt D. , Marchowez M. , Veith L. , Kuss O. , Brinks R. , Hoyer A.
Published: August 2019

Aim

For many European countries, including Germany, no valid estimates are available on age at diagnosis of Type 2 diabetes. Thus, we aimed to estimate the age at diagnosis in Germany.

Methods

Age at diagnosis of Type 2 diabetes in Germany was estimated based on Type 2 diabetes prevalence and incidence and the age distribution of the German population. Age‐ and sex‐specific incidence and prevalence in 2014/2015, based on claims data from statutory health insurance (n= 69 000 000, ~85% of the German population), and the age pyramid for Germany in 2015 were used for the calculation. Age at Type 2 diabetes diagnosis was stratified by sex. CIs were estimated using bootstrap methods. In addition, the age range in which 50% of the population received a diagnosis of Type 2 diabetes was calculated (the interquartile range).

Results

The mean ± sd age at Type 2 diabetes diagnosis in 2015 was 61.0 ± 13.4 years (95% CI 60.9–61.0) in men. Women were diagnosed ~2 years later than men (mean age 63.4 ± 14.9 years; 95% CI 63.4–63.5). The age range in which 50% of the population was diagnosed with diabetes was 53–72 years for men and 54–76 years for women.

Conclusions

The sex differences are mainly attributable to a higher incidence of Type 2 diabetes in men than women during middle age and the higher absolute number of women in the older ages. The early age at diabetes diagnosis compared to average life expectancy means that the risk of diabetes‐related complications is increased.
Epstein‐Barr virus associated post‐transplant lymphoproliferative disorder mimicking acute graft versus host disease
Authors: Prem Shruti , Al‐Shaibani Zeyad , Michelis Fotios V. , Kim Dennis , Viswabandya Auro , Lipton Jeffrey Howard , Kumar Rajat , Mattsson Jonas , Law Arjun , Lam Wilson
Published: August 2019

We present a case series of 3 patients to highlight the fact that PTLD post‐transplant can mimic GVHD, and should be part of the differential diagnosis for diarrhea post allo‐HCT. Awareness of this presentation has important therapeutic implications, as increased immune suppression for the management of GVHD, can worsen clinical features of PTLD. Diagnostic imaging and tissue biopsies should be undertaken early in post‐transplant patients presenting with diarrhea or hepatic abnormalities, especially with atypical presentations like fever, and EBV PCR monitoring can expedite clinical decision‐making in such complicated scenarios while awaiting results of gut biopsies.
Completion of a Stand‐Alone Versus Coach‐Supported Trial of a Web‐Based Program for Distressed Relationships
Authors: Rothman Karen , Roddy McKenzie K. , Doss Brian D.
Published: August 2019

Objective

To assess program completion of the online OurRelationship program with varying levels of paraprofessional support in an effort to further examine the role of coach support in self‐help couple interventions.

Background

Although the OurRelationship program for distressed couples has been found to statistically improve relationship and individual functioning, the program's provision of paraprofessional coach support limits its dissemination and implementation.

Method

Using an interrupted time series design, we compared completion rates of those who enrolled in a trial of OurRelationship with no coach support (n = 529 couples) to completion rates of a previous trial of OurRelationship in which couples were randomized to receive either one (n = 179 couples) or four (n = 177 couples) calls with a coach.

Results

Individuals were statistically less likely to complete the OurRelationship program when they were not provided a coach than they were when provided with either one or four coach calls. Analyses of moderators of completion rates revealed that a coach was generally equally helpful across demographic factors and measures of baseline relationship and individual functioning; however, coaching was especially helpful for Hispanic individuals and those without elevated depressive symptoms at baseline.

Conclusions

Even a single call with a coach yields higher completion of an online program for relationship distress.

Implications

The findings highlight the growing need for tests of alternate types of program support, such as automated support, in an effort to reduce program costs and increase potential for dissemination without negatively affecting program completion rates.
Anti‐CRISPR AcrIIC3 discriminates between Cas9 orthologs via targeting the variable surface of the HNH nuclease domain
Authors: Kim Youngim , Lee Sang Jae , Yoon Hye‐Jin , Kim Nak‐Kyoon , Lee Bong‐Jin , Suh Jeong‐Yong
Published: August 2019

Clustered regularly interspaced short palindromic repeats (CRISPR)‐Cas systems constitute the adaptive immunity of bacteria and archaea, degrading nucleic acids of invading phages and plasmids. In response, phages employ anti‐CRISPR (Acr) proteins as a counterdefense mechanism to neutralize the host immunity. AcrIIC3 directly inhibits target DNA cleavage of type II‐C Cas9 of Neisseria meningitidis. Here, we show that AcrIIC3 interacts with the HNH nuclease domain of N. meningitidis Cas9 to inhibit its nuclease activity in an allosteric manner. The crystal structure of the AcrIIC3–HNH complex reveals that AcrIIC3 binds opposite the active site on the HNH nuclease domain. AcrIIC3 employs a unique interface for HNH, allowing it to discriminate between Cas9 orthologs, which contrasts with the broad spectrum of Cas9 inhibition by AcrIIC1. Interface residues of HNH provide key electrostatic and hydrophobic interactions that determine the host specificity of AcrIIC3. Mutations that replace HNH interfaces of N. meningitidis Cas9 with those of Geobacillus stearothermophilus Cas9 or Campylobacter jejuni Cas9 significantly attenuate AcrIIC3 binding, illustrating that the divergent interaction surface confers the host specificity of AcrIIC3. Our study demonstrates that the variable sequences of binding interface can define the target specificity of Acr proteins, suggesting potential applications in Cas9 control for gene editing.
A general scenario of fish‐eye crack initiation on the life of high‐strength steels in the very high‐cycle fatigue regime
Authors: Wang Chong , Liu Yongjie , Nikitin Alexander , Wang Qingyuan , Zhou Min
Published: August 2019

When high‐strength steels are subjected to very high‐cycle fatigue loading, crack initiation site shifts from surfaces to the interior, and a fish‐eye forms on the fracture surface. Majority of the fatigue life is estimated to be associated with the formation of this internal crack morphology. In the present work, features of such internal cracks in two high‐strength steels are studied. Specifically, three initiation patterns are investigated. A general internal crack initiating scenario is proposed base on an understanding of dislocation slip in the materials. A simplified threshold is calculated from Young's modulus and interatomic spacing, defining the transition from the initiation stage to the crack propagation. The relationship between internal crack initiation and slower descending S‐N curves is discussed.
Oxygen‐Containing Compounds Identified in Groundwater from Fuel Release Sites Using GCxGC‐TOF‐MS
Authors: O'Reilly Kirk T. , Mohler Rachel E. , Zemo Dawn A. , Ahn Sungwoo , Magaw Renae I. , Espino Devine Catalina
Published: August 2019

This research continues a 7‐year study of oxygen‐containing organic compounds present in groundwater at gasoline and diesel fuel release sites that are quantified as diesel‐range “total petroleum hydrocarbons” when measured by methods utilizing solvent extraction and gas chromatography. Two‐dimensional gas chromatography with time‐of‐flight mass spectrometry was used to tentatively identify 1162 compounds (TICs) in 113 groundwater samples from 22 sites. Samples were collected from wells either upgradient of the release, within the source zone, or downgradient of the source but still within the plume of dissolved organics associated with release. The names and formulas of all TICs found in samples from each well type are presented and the results from upgradient and downgradient locations are compared in detail. About 60% of the most frequently detected TICs in downgradient wells were also detected in upgradient wells. A majority of these were saturated straight chain alkyl acids, commonly called fatty acids, or fatty acid esters. Of TICs frequently detected in downgradient wells but not upgradient wells, over half were branched alkyl alcohols. Hierarchical cluster analysis results suggest about 80% of the chemical composition of downgradient samples is more similar to upgradient samples than to source area samples. This similarity is due to the presence of the same types of fatty acids and esters. Principal component analysis indicates a continuum of biodegradation between the source area and downgradient samples with the latter becoming more consistent with upgradient samples. Results suggest some TICs may not be petroleum degradation intermediates but compounds synthesized by microorganisms through secondary production and carbon cycling.
Neonatal diabetes caused by the heterozygous Pro1198Leu mutation in the ABCC8 gene in a male infant: 6‐year clinical course
Authors: Uraki Shinsuke , Furuta Hiroto , Miyawaki Masakazu , Matsutani Norihiko , Shima Yuko , Iwamoto Miki , Matsuno Shohei , Morita Shuhei , Furuta Machi , Doi Asako , Iwakura Hiroshi , Ariyasu Hiroyuki , Nishi Masahiro , Suzuki Hiroyuki , Akamizu Takashi
Published: August 2019

Neonatal diabetes is a rare disease, often caused by a monogenic abnormality. A male infant patient developed diabetic ketoacidosis at 2 months‐of‐age due to the heterozygous ABCC8 gene mutation (p.Pro1198Leu). After genetic diagnosis, insulin therapy was successfully transitioned to oral sulfonylurea therapy. For >6 years, oral sulfonylurea therapy has been safe and effective, and the required amount of sulfonylureas has progressively decreased. The mutation was transmitted in an autosomal‐dominant fashion across three generations of his family, but the severity of diabetes varied among members from neonatal diabetes to mild diabetes. One family member had normal glucose tolerance despite having the mutation. This case presentation could help in the understanding of neonatal diabetes caused by the ABCC8 gene mutation.
Plectorhinchus macrolepis (Actinopterygii: Haemulidae) in the western Atlantic Ocean
Authors: Adelir‐Alves J. , Spier D. , Gerum H. L. N. , Machado L. F. , Spach H. L. , Boza B. R. , Oliveira C.
Published: August 2019

Morphometric measurements, meristic counts and DNA barcoding identified the presence of a biglip grunt Plectorhinchus macrolepis in the western Atlantic Ocean. As the species is endemic to the tropical eastern Atlantic Ocean and has not previously been reported in the western Atlantic Ocean, we discuss the possible means by which it might have dispersed to the western Atlantic Ocean. Even though this species is not considered established in Paranaguá Bay, we advocate monitoring of possible new individuals and other exotic fish species.
Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia
Authors: Harrison Krista L. , Ritchie Christine S. , Patel Kanan , Hunt Lauren J. , Covinsky Kenneth E. , Yaffe Kristine , Smith Alexander K.
Published: August 2019

OBJECTIVES

Little population‐level evidence exists to guide the development of interventions for people with dementia in non–nursing home settings. We hypothesized people living at home with moderately severe dementia would differ in social, functional, and medical characteristics from those in either residential care or nursing home settings.

DESIGN

Retrospective cohort study using pooled data from the National Health and Aging Trends Study, an annual survey of a nationally representative sample of Medicare beneficiaries.

SETTING

US national sample.

PARTICIPANTS

Respondents newly meeting criteria for incident moderately severe dementia, defined as probable dementia with functional impairment: 728 older adults met our definition between 2012 and 2016.

MEASUREMENTS

Social characteristics examined included age, sex, race/ethnicity, country of origin, income, educational attainment, partnership status, and household size. Functional characteristics included help with daily activities, falls, mobility device use, and limitation to home or bed. Medical characteristics included comorbid conditions, self‐rated health, hospital stay, symptoms, and dementia behaviors.

RESULTS

Extrapolated to the population, an estimated 3.3 million older adults developed incident moderately severe dementia between 2012 and 2016. Within this cohort, 64% received care at home, 19% in residential care, and 17% in a nursing facility. social, functional, and medical characteristics differed across care settings. Older adults living at home were 2 to 5 times more likely to be members of disadvantaged populations and had more medical needs: 71% reported bothersome pain compared with 60% in residential care or 59% in nursing homes.

CONCLUSION

Over a 5‐year period, 2.1 million people lived at home with incident moderately severe dementia. People living at home had a higher prevalence of demographic characteristics associated with systematic patterns of disadvantage, more social support, less functional impairment, worse health, and more symptoms compared with people living in residential care or nursing facilities. This novel study provides insight into setting‐specific differences among people with dementia. J Am Geriatr Soc 67:1907–1912, 2019
The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age
Authors: Miner Brienne , Gill Thomas M. , Yaggi Henry Klar , Redeker Nancy S. , Van Ness Peter H. , Han Ling , Vaz Fragoso Carlos A.
Published: August 2019

OBJECTIVE

To examine the epidemiology and key demographic and clinical correlates of patient‐reported hypersomnia in persons with advanced age.

DESIGN

Cross‐sectional design.

SETTING

Community.

PARTICIPANTS

A total of 357 community‐dwelling persons from the Yale Precipitating Events Project with a mean age of 84.2 years (range = 78‐102 years).

MEASUREMENTS

We studied patient‐reported hypersomnia, defined categorically by an Epworth Sleepiness Scale (ESS) score of 10 or greater; as well as the severity of hypersomnia symptoms, defined continuously by an ESS score range of 0 to 24 (higher scores denote greater sleepiness). In multivariable regression models, we examined cross‐sectional associations between key correlates and ESS score, expressed as categorical and continuous variables. Key correlates included: demographics, education, smoking status, body mass index, self‐reported medical conditions, Center for Epidemiologic Studies Depression score, Mini‐Mental State Examination score, Physical Activity Scale for the Elderly, restless legs syndrome (RLS), self‐reported sleep‐disordered breathing (SDB), medications, and Insomnia Severity Index.

RESULTS

Mean ESS score for all participants was 6.4. Patient‐reported hypersomnia (ESS score ≥10) was established in 82 participants (23.0%)—their mean ESS score was 13.0. In multivariable models, male sex, nonwhite race, arthritis, depressive symptoms, low physical activity, RLS, SDB, central nervous system depressant medications, and insomnia severity were cross‐sectionally associated with patient‐reported hypersomnia (higher adjusted odds ratios, ranging from 1.93‐2.86) and/or with the severity of hypersomnia symptoms (higher ESS scores, ranging from 0.11‐2.86 points).

CONCLUSION

Patient‐reported hypersomnia was prevalent in a sample of community‐dwelling persons with advanced age. In addition, based on cross‐sectional associations with the ESS score, key demographic and clinical characteristics were identified that may inform screening strategies for hypersomnia in advanced age. J Am Geriatr Soc 67:2545–2552, 2019
Measuring Underuse and Overuse of Medications
Authors: Hanlon Joseph T. , Schmader Kenneth E.
Published: August 2019

See the Reply by Fried et al
Reply to Measuring Under‐ and Over‐Use of Medications
Authors: Fried Terri R. , Mecca Marcia
Published: August 2019

This letter comments on the letter by Hanlon and Schmader.
Effect of local diets on nutritional and sensory quality of meat of indigenous goats in Tunisian arid regions
Authors: Ayeb Naziha , Addis Margherita , Fiori Myriam , Atti Naziha , Barmat Ahmed , Hammadi Mohamed , Boukhris Hager , Damergi Chokri , Khorchani Touhami
Published: August 2019

The valorization of natural resources in small ruminants feeding can reduce the cost of feed and produce good meat quality. The objective was to evaluate the effects of local feed resources on the physico‐chemical aspects, the sensorial characteristics and the fatty acid profile of goat kid's meat. Twenty‐six kids are divided in three groups (average body weight = 15.85 kg; age = 4 months). The groups received oat hay (group control C), dried olive leaves + dried Stipa tenacissima (group OL) or grass hay (group Ko). The animals were slaughtered after 90 days of experience, with an approximate final live weight of 18.5 kg. Total solids, pH, fat, crude protein, vitamin, cholesterol and fatty acid contents of meat were determined. The OL group had the highest ultimate pH (6.82 vs. 6.73); cooking loss, gross composition (total solids, protein and fat), cholesterol and colour coordinates (L, a* and b*) were similar among groups. The vitamin E, affected by diet, was higher in group OL than the other groups (3.71 mg/kg vs. 1.32 and 2.17 mg/kg, respectively, for C and Ko groups). Moreover, meat from this group showed the highest saturated fatty acid. Unsaturated fatty acids content was higher in the meat of C and Ko groups. On the other side, polyunsaturated fatty acid level was not affected by the diet treatment. The n6/n3 ratio was significantly affected by the diet; it was lower in meat of groups Ko and OL (3.17 and 3.38 respectively). The feeding effect on sensory quality of meat was not significant.
Mycobacterium tuberculosis requires glyoxylate shunt and reverse methylcitrate cycle for lactate and pyruvate metabolism
Authors: Serafini Agnese , Tan Lendl , Horswell Stuart , Howell Steven , Greenwood Daniel J. , Hunt Deborah M. , Phan Minh‐Duy , Schembri Mark , Monteleone Mercedes , Montague Christine R. , Britton Warwick , Garza‐Garcia Acely , Snijders Ambrosius P. , VanderVen Brian , Gutierrez Maximiliano G. , West Nicholas P. , de Carvalho Luiz Pedro S.
Published: August 2019

Bacterial nutrition is an essential aspect of host–pathogen interaction. For the intracellular pathogen Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis in humans, fatty acids derived from lipid droplets are considered the major carbon source. However, many other soluble nutrients are available inside host cells and may be used as alternative carbon sources. Lactate and pyruvate are abundant in human cells and fluids, particularly during inflammation. In this work, we study Mtb metabolism of lactate and pyruvate combining classic microbial physiology with a ‘multi‐omics’ approach consisting of transposon‐directed insertion site sequencing (TraDIS), RNA‐seq transcriptomics, proteomics and stable isotopic labelling coupled with mass spectrometry‐based metabolomics. We discovered that Mtb is well adapted to use both lactate and pyruvate and that their metabolism requires gluconeogenesis, valine metabolism, the Krebs cycle, the GABA shunt, the glyoxylate shunt and the methylcitrate cycle. The last two pathways are traditionally associated with fatty acid metabolism and, unexpectedly, we found that in Mtb the methylcitrate cycle operates in reverse, to allow optimal metabolism of lactate and pyruvate. Our findings reveal a novel function for the methylcitrate cycle as a direct route for the biosynthesis of propionyl‐CoA, the essential precursor for the biosynthesis of the odd‐chain fatty acids.
Improvement of abnormal systolic motion of the interventricular septum with cardiac resynchronization therapy
Authors: Yaman Belma , Kemal Hatice S , Dönmez Yurdaer , Cerit Levent , Usalp Songül , Yüksek Ümit , Günsel Aziz , Duygu Hamza , Akpınar Onur
Published: August 2019

Background

There is no consensus in the literature regarding what is the responsible mechanism of left ventricular dyssynchrony; septal dyskinesia or late movement of left ventricle (LV) lateral wall. We aim to evaluate the abnormal systolic motion in each myocardial segment and the improvement of LV systolic function with pulsed tissue Doppler imaging (TDI) in patients undergoing cardiac resynchronization therapy (CRT) with left bundle branch block (LBBB).

Methods

A total of 26 patients undergoing CRT implantation with LBBB, wide QRS duration (≥120 ms), and low ejection fraction (EF) (<35%) were included. Pulsed TDI was taken from apical 4‐chamber view and parasternal short axis view (PSAX). All echocardiographic parameters were measured when CRT is on and off.

Results

Systolic ejection time (ET) of anteroseptal and posterolateral wall of LV in PSAX was statistically significantly longer in CRT on group (321.6 ± 62.7 vs 237.5 ± 59.3 ms, P < .001; 323.9 ± 58.0 vs 289.4 ± 43.7 ms, P = .015, respectively). In apical 4‐chamber view, septal annulus systolic ET is significantly longer in CRT on group than CRT off group (315.8 ± 57.2 vs 287.3 ± 42.2, P = .014). Also, there was a strong correlation between systolic ET of the septum in PSAX with aortic velocity time integral (VTI), QRS duration and EF (r = .587, P = .002; r = .479, P = .013; r = .440, P = .025; respectively).

Conclusion

Circumferential contraction of septal myocardial fibers is improved with CRT and it is strongly correlated with increase of aortic VTI and shortening of QRS duration. These findings predict the deterioration of septal contraction as the main mechanism in patients with LBBB pattern and, CRT may improves myocardial contraction by correcting septal systolic motion.
Ventricular asystole in a CRT‐D device. What is the mechanism?
Authors: Reddy Pavan , Do Khuyen , Doshi Rahul , Shinbane Jerold , Konecny Tomas
Published: August 2019

We present a case of an 89‐year‐old man with a left ventricular assist device and cardiac resynchronization therapy device (CRT‐D) who presented with multiple presyncopal events. On the night of admission, telemetry revealed a 13‐s pause with appropriately timed pacing spikes but with failure to capture, followed by intermittent ventricular contraction with different QRS morphology. What was the mechanism for his ventricular asystole?
Gender and technology in Frantz Fanon: Confrontations of the clinical and political
Authors: Paris William Michael
Published: August 2019

One of the most pertinent sites of investigation in Fanon studies is the question of how Fanon theorizes the imbrication of gender with that of race and colonialism. For many, his silence or disavowals, whether explicit or implicit, allow an uncritical masculinism to slip into his theories of subjectivity, subjugation, and revolution. This article contributes to these discussions by arguing that for Fanon, gender and race are colonial technologies rather than natural sites of experience. Bringing together Fanon's recently translated clinical writings and his political essay on the revolutionary roles of Algerian women in the war against French colonization, it is possible to see how Fanon theorizes the French imposition of gender norms as attempts to engineer the social reproduction of a marginalized and racialized population. In short, gender is an implicitly racialized technology in French colonial society whose aim is the naturalization of political and sexual arrangements of power that justify the continuation of French occupation. Fanon works to demystify gender and race as technologies so that the colonized may seize them in the interest of their own liberatory invention.
Building a sustainable peace: How peace processes shape and are shaped by the international legal framework for the governance of natural resources
Authors: Dam‐de Jong Daniëlla
Published: August 2019

Natural resources are strongly connected to the onset, duration and recurrence of armed conflicts. However, even after an armed conflict has formally ended, natural resources can be an important trigger for a relapse into armed conflict. For these reasons, it is of the utmost importance, both from a security and a development perspective, to address natural resources as an integral part of the peace process. This article aims to assess how provisions in peace agreements addressing natural resource governance are embedded in the international legal framework. It inquires into the particularities and legal nature of peace agreements and examines the various functions of natural resource arrangements as part of peace agreements. Finally, as each category of natural resources comes with distinct legal questions and peacebuilding challenges, the article zooms in on water governance as a case study to explore the different ways in which natural resource arrangements in peace agreements and international law interact. The analysis is based on a study of 40 intra‐State agreements, including the 2015 South Sudan agreement, the 2015 Mali agreement and the 2016 Colombian agreement.
Incorporating sprawl and adjacency measures in land‐use forecasting model: A case study of Collin County, TX
Authors: Sinha Parmanand , Griffith Daniel A.
Published: August 2019

Sprawl measures have largely been neglected in land‐use forecasting models. The current approach for land‐use allocation using optimization mostly utilizes objective functions and constraints that are non‐spatial in nature. Application of spatial constraints could take care of the contiguity and compactness of land uses and can be utilized to address urban sprawl. Because a land‐use model is used as an input to transportation modeling, a better spatial allocation strategy for more compact land‐use projections will promote better transportation planning and sustainable development. This study formulates a scenario‐based approach to normative modeling of urban sprawl. In doing so, it seeks to improve the land‐use projections by employing a spatial optimization model with contiguity and compactness consideration. This study incorporates urban sprawl measures based on smart growth principles together with a mixed‐use factor, and adjacency consideration of nearby land uses. The objective function used in the study maximizes net suitability based on imposed constraints. These constraints are based on smart growth principles that enhance walkability in neighborhoods, promote better health for residents, and encourage mixed‐use development. The formulated model has been applied to Collin County, TX, a fast‐developing suburban county located to the north of the Dallas–Fort Worth metroplex. The suitability of land cells indicates the probability of conversion, which is calculated using spatial discrete choice analysis with Moran eigenvector spatial filtering for vacant cells at a resolution of 150 × 150 m employing factors of the built environment, and socioeconomic and demographic characteristics. This study demonstrates how spatial proximity between land uses, which has been ignored to date, can be used to control sprawl, resulting in better mixing of different land uses based on constraints imposed in a spatial optimization problem.
A targeted fungal prophylaxis protocol with static dosed fluconazole significantly reduces invasive fungal infection after liver transplantation
Authors: Jorgenson Margaret R. , Descourouez Jillian L. , Marka Nicholas A. , Leverson Glen E. , Smith Jeannina A. , Andes David R. , Fernandez Luis A. , Foley David P.
Published: August 2019

Background

Invasive fungal infection (IFI) after liver transplant (LTx) is associated with extensive morbidity and mortality. Targeted prophylaxis reduces risk, but qualifying criteria, drug of choice and regimen are unclear and compliance is inconsistent.

Objective

Assess the impact of a risk factor‐based fungal prophylaxis protocol (FPP) after LTx on fungal infection rates, fungal epidemiology, and transplant outcomes.

Methods

Observational cohort study of adult LTx recipients between July 1, 2009, and June 30, 2017. Patients in the FPP group were given a set dose of 400 mg fluconazole without renal adjustment on POD 1‐14 via pharmacist delegation protocol.

Results

One hundred and eighty‐nine patients met inclusion criteria; 50 in the FPP and 139 in the pre‐implementation comparator group. Of those who would be considered high‐risk, 22.3% received antifungal prophylaxis prior to FPP implementation vs 92% after implementation (P < .0001). There were significantly fewer fungal infections in the FPP group at 1 year (12.5% vs 26.6%, P = .03). IFI in the pre‐implementation control group was due to Candida species in 95% of cases; 30% were species with reduced fluconazole susceptibility. IFI in the FPP group was due to Candida species in all cases, and no isolates had reduced fluconazole susceptibility. Aspergillus did not account for any IFI between the groups. One‐year patient and graft survival were similar between groups. In a multivariable model accounting for patient and donor age, donor type, MELD, and cold ischemic time, FPP was protective against fungal infection (HR 0.3, P = .015). FPP did not significantly impact graft survival (HR 0.4, P = .14), but trended toward improved patient survival. (HR 0.18, P = .06).

Conclusion

Implementation of a targeted FPP utilizing static dosing of fluconazole 400 mg × 14 days to those that meet high‐risk criteria significantly reduces invasive fungal infection after liver transplant. Use of this protocol did not adversely affect fungal epidemiology and may have a positive impact on allograft and patient survival. Future large prospective studies are needed to better evaluate survival impact.
Prevalence and health effects of communicable and non‐communicable disease comorbidity in rural KwaZulu‐Natal, South Africa
Authors: Sharman Monica , Bachmann Max
Published: August 2019

Objectives

To describe changes in prevalence of hypertension, diabetes, HIV and tuberculosis, and prevalence of comorbidity, and to investigate associations between each condition, and combinations of conditions, with self‐reported general health and hospital admission.

Methods

This study used data from a longitudinal population‐based HIV and health surveillance cohort, conducted by the Africa Health Research Institute in Umkhanyakude district of rural KwaZulu‐Natal, South Africa.

Results

Prevalence of hypertension, HIV and diabetes increased from 2009 to 2015, and prevalence of tuberculosis decreased. 81% of the 47 334 participants were female; hypertension and diabetes were the commonest conditions in people over age 50, whereas HIV was most common in those younger than 50 years. Comorbidity of communicable and non‐communicable conditions was commonest in 40‐ to 60‐year‐olds. The adjusted odd ratios (OR) for better self‐reported general health with multimorbidity were 0.53 (95% CI 0.51–0.56), 0.29 (95% CI 0.27–0.29), 0.25 (95% CI 0.21–0.37) and 0.21 (95% CI 0.12–0.37) for one, two, three and four conditions, respectively, vs. no conditions. Tuberculosis was most strongly and inversely associated with better general health (OR 0.34 (0.31–0.37) and most strongly associated with hospital admission (OR 3.26 (2.32–2.99)).

Conclusion

The high prevalence of communicable and non‐communicable conditions in this rural South African population is giving rise to a burden of multimorbidity, as increased access to antiretroviral treatment has reduced mortality in people with HIV. Healthcare systems must adapt by working towards integrated primary care for HIV/AIDS and non‐communicable diseases.
Laparoscopic Cholecystectomy with Single Port Access System in 15 Dogs
Authors: Simon Allen , Monnet Eric
Published: August 2019

Objective

To evaluate the outcome of laparoscopic cholecystectomy performed with a single port access system (SPAS) in dogs.

Study Design

Retrospective study.

Animals

Fifteen client‐owned dogs with nonobstructive gallbladder disease.

Methods

Medical records were reviewed for signalment, clinical signs, diagnostic imaging, surgical findings, and outcome until suture removal.

Results

The SPAS was placed 1 cm caudal to the umbilicus. The procedure was completed with the SPAS alone in two cases. An additional cannula was added in 12 cases. In the last 10 cases, the additional cannula was placed at the beginning of the procedure. Dissection began at the cystic duct in 11 dogs (73%). In three cases (20%), the SPAS procedure was converted to a laparotomy; two of these conversions were elective, and one was emergent. The risk of conversion was affected by the experience of the surgeon (odds ratio = 0.53; P = .0105), and the rate of conversion was reduced when a cannula was added at the beginning of the procedure (P = .022). Fourteen dogs were discharged from the hospital. One dog died after being discharged due to severe cholangiohepatitis, and another dog died due to leakage of a gastrostomy tube.

Conclusions

The use of SPAS for cholecystectomy in dogs has an acceptable outcome. The experience gained by the surgeon and the addition of a cannula reduced the risk of conversion.

Clinical Relevance/Impact

Laparoscopic cholecystectomy can be performed with a SPAS. The placement of an additional cannula at the beginning of the procedure is highly recommended.
A new species of Scutacarus and description of larva and male of Petalomium megasolenidiatum Silva, Khaustov & Oliveira (Acari: Heterostigmatina: Neopygmephoridae, Scutacaridae) from Brazil

Authors: Silva Rafaela , Khaustov Alexander A. , Delabie Jacques H.C. , Oliveira Anibal Ramadan
Published: August 2019

The female, male and larva of a new species of Scutacarus Gros, 1845 (Acari: Heterostigmatina: Scutacaridae) and male and larva of Petalomium megasolenidiatum Silva, Khaustov & Oliveira, 2018a (Neopygmephoridae) are described. These mites were found associated with Camponotus cingulatus Mayr, 1862 (Hymenoptera: Formicidae) in the state of Bahia, Northeastern Brazil. Biological aspects of the mites living in the ant’s nest are discussed.
Estimating tropospheric and stratospheric winds using infrasound from explosions
Authors: Blixt Erik Mårten , Näsholm Sven Peter , Gibbons Steven J. , Evers Läslo G. , Charlton-Perez Andrew J. , Orsolini Yvan J. , Kværna Tormod
Published: August 2019

The receiver-to-source backazimuth of atmospheric infrasound signals is biased when cross-winds are present along the propagation path. Infrasound from 598 surface explosions from over 30 years in northern Finland is measured with high spatial resolution on an array 178 km almost due North. The array is situated in the classical shadow-zone distance from the explosions. However, strong infrasound is almost always observed, which is most plausibly due to partial reflections from stratospheric altitudes. The most probable propagation paths are subject to both tropospheric and stratospheric cross-winds, and the wave-propagation modelling in this study yields good correspondence between the observed backazimuth deviation and cross-winds from the European Centre for Medium-Range Weather Forecasts Reanalysis (ERA)-Interim reanalysis product. This study demonstrates that atmospheric cross-winds can be estimated directly from infrasound data using propagation time and backazimuth deviation observations. This study finds these cross-wind estimates to be in good agreement with the ERA-Interim reanalysis.
Azimuthal shear-wave anisotropy measurement in a borehole: Physical modeling and dipole acoustic verification
Authors: Zhuang Chunxi , Xu Song , Li Huanran , Su Yuanda , Tang Xiaoming
Published: August 2019

An anisotropic physical model is constructed to evaluate the anisotropy measurement. The model consists of a series of equally spaced thin limestone slab sheets cemented with concrete, resulting in a transversely isotropic medium. For the anisotropy measurement evaluation, the borehole model is tested by a standard multipole acoustic tool. The measurement finds an S-wave anisotropy magnitude about 20% and determines the fast S-wave polarization along the alignment direction of the slab sheets. The results of the work not only validate the borehole measurement technology, but also provide a testing facility for calibrating the measurement acoustic tool.
Acute Effects of Resistance-Exercise Intensity in Depressed Black/African Americans Living With HIV: A Randomized Pilot Study
Authors: Nosrat Sanaz , Whitworth James W. , SantaBarbara Nicholas J. , Dunsiger Shira I. , Ciccolo Joseph T.
Published: August 2019

Depressive symptoms and fatigue are prevalent among people living with human immunodeficiency virus. Resistance exercise is known to stimulate a positive affective response. Objective: To examine the acute psychological effects of resistance-exercise intensity among Black/African-American people living with human immunodeficiency virus and experiencing depressive symptoms. Methods: A total of 42 participants were randomized into a moderate- (n = 21) or high-intensity (n = 21) group. Assessments were collected before exercise (PRE), at the midpoint (MID), immediately following (POST) exercise, and 15 (DELAY 15) and 30 (DELAY 30) min after. Results: In the moderate-intensity group, affect improved PRE to POST, PRE to DELAY 15 and DELAY 30, and perceived distress decreased from PRE to all time points. In the high-intensity group, affect declined PRE to MID, and perceived distress decreased PRE to DELAY 15 and DELAY 30. Perceived activation increased PRE to MID, and POST in both groups (ps < .01). Conclusions: The moderate-intensity group compared with the high-intensity group is more effective at improving affect and energy and at reducing distress.
Aging is just a state of marrow
Authors: Kerr Bethany A.
Published: August 2019

Aging induces proliferation of bone marrow progenitor cells and disseminated tumor cells, leading to therapeutic resistance and bone metastasis.
A Novel Bacteriophage Exclusion (BREX) System Encoded by the
pglX
Gene in Lactobacillus casei Zhang
Authors: Hui Wenyan , Zhang Wenyi , Kwok Lai-Yu , Zhang Heping , Kong Jian , Sun Tiansong
Published: August 2019

Lactobacillus casei
Zhang is a probiotic that confers beneficial effects on the host, and it is thus increasingly used in the dairy industry. The possession of an effective bacterial immune system that can defend against invasion of phages and exogenous DNA is a desirable feature for industrial bacterial strains. The bacteriophage exclusion (BREX) system is a recently described phage resistance system in prokaryotes. This work confirmed the function of the BREX system in
L. casei
and that the methyltransferase (
pglX
) is an indispensable part of the system. Overall, our study characterizes a BREX system component gene in lactic acid bacteria.
Draft Genome Sequences of Potentially Pathogenic Clostridium perfringens Strains from Environmental Surface Water in the North West Province of South Africa
Authors: Fourie Johannes Cornelius Jacobus , Sanko Tomasz J. , Bezuidenhout Cornelius Carlos , Mienie Charlotte , Adeleke Rasheed Adegbola
Published: August 2019

Surface water systems in South Africa are experiencing a major decline in quality due to various anthropogenic factors. This poses a possible health risk for humans. Here, we present the draft genome sequences of three
Clostridium perfringens
isolates obtained from a fecally polluted river system in the North West province of South Africa.
Genome Sequences of Two Azospirillum sp. Strains, TSA2S and TSH100, Plant Growth-Promoting Rhizobacteria with N
2
O Mitigation Abilities
Authors: Gao Nan , Shen Weishou , Nishizawa Tomoyasu , Isobe Kazuo , Guo Yong , Ying Hanjie , Senoo Keishi
Published: August 2019

Azospirillum
sp. strains TSA2S and TSH100 are plant growth-promoting rhizobacteria with the capacity to mitigate N
2
O from agricultural soil. They were isolated from the rhizosphere of paddy soil in Tokyo, Japan. Here, we present the genome sequences of these two strains.
Complete Genome Sequence of
Nissabacter
sp. Strain SGAir0207, Isolated from an Air Sample Collected in Singapore
Authors: Gaultier Nicolas E. , Junqueira Ana Carolina M. , Uchida Akira , Purbojati Rikky W. , Houghton James N. I. , Chénard Caroline , Wong Anthony , Kolundžija Sandra , Clare Megan E. , Kushwaha Kavita K. , Putra Alexander , Kee Carmon , Premkrishnan Balakrishnan N. V. , Heinle Cassie E. , Lim Serene B. Y. , Vettath Vineeth Kodengil , Drautz-Moses Daniela I. , Schuster Stephan C.
Published: August 2019

Nissabacter
sp. strain SGAir0207 was isolated from a tropical air sample collected in Singapore. Its genome was assembled using a hybrid approach with long and short reads, resulting in one chromosome of 3.9 Mb and 7 plasmids. The complete genome consists of 4,403 protein-coding, 84 tRNA, and 22 rRNA genes.
Whole-Genome Sequencing of Four
Campylobacter
Strains Isolated from Gull Excreta Collected from Hobie Beach (Oxnard, CA, USA)
Authors: Gomez-Alvarez Vicente , Ashbolt Nicholas J. , Griffith John F. , Santo Domingo Jorge , Lu Jingrang
Published: August 2019

Campylobacter
spp. are commensal organisms in avian species and are one of the leading causes of bacterial foodborne human diarrheal disease worldwide. We report the draft genome sequences of
Campylobacter volucris
,
C. lari
, and
C. jejuni
strains isolated from California gull (
Larus californicus
) excreta collected from a California beach.
Complete Genome Sequence of
Brachybacterium
sp. Strain SGAir0954, Isolated from Singapore Air
Authors: Hlaing Phu Pwint Thin , Junqueira Ana Carolina M. , Uchida Akira , Purbojati Rikky W. , Houghton James N. I. , Chénard Caroline , Wong Anthony , Clare Megan E. , Kushwaha Kavita K. , Putra Alexander , Kee Carmon , Gaultier Nicolas E. , Premkrishnan Balakrishnan N. V. , Heinle Cassie E. , Lim Serene B. Y. , Vettah Vineeth Kodengil , Drautz-Moses Daniela I. , Schuster Stephan C.
Published: August 2019

Brachybacterium
sp. strain SGAir0954 was isolated from tropical air collected in Singapore, and its genome was sequenced and assembled using long reads generated by single-molecule real-time (SMRT) sequencing. The complete genome has a size of 3.41 Mb and consists of 2,955 protein coding genes, 50 tRNAs, and 9 rRNAs.
Complete Genome Sequence and Methylome Analysis of Thermoactinomyces vulgaris 2H
Authors: Mankai Houda , Anton Brian P. , Wu Victoria , Vincze Tamas , Roberts Richard J. , Limam Ferid , Fomenkov Alexey
Published: August 2019

Here, we report the complete genome sequence and full methylome analysis of a newly isolated, aerobic, thermophilic, Gram-positive actinomycete, a strain of
Thermoactinomyces vulgaris
designated strain 2H.
Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound
Authors: Dubbink-Verheij Gerdina H , Visser Remco , Roest Arno A , van Ommen Cornelia Heleen , te Pas Arjan B , Lopriore Enrico
Published: August 2019

Background

Umbilical venous catheters (UVCs) are associated with thrombus formation. Most studies on thrombosis in infants with UVCs focus on only one part of the route, and none assessed a control group of infants without UVCs.

Objective

To determine the incidence and location of thrombi in infants after umbilical catheterisation and compare this with a control group of infants without umbilical catheters.

Design

Prospective observational study with serial ultrasonography of the UVC route from the umbilico-portal confluence to the heart. Ultrasonography was performed until day 14 after catheterisation in cases and day 14 after birth in controls.

Results

Thrombi in the UVC route were detected in 75% (30/40) of infants with UVCs in the study group, whereas no thrombi were detected in the control group of infants without UVCs (0/20) (p<0.001). Six thrombi (20%) were located in the right atrium. Most of these were also partly present in the ductus venosus. Six thrombi (20%) were located in the ductus venosus only, and in 12 infants (40%), the thrombus was at least partly located in the umbilico-portal confluence. Thrombi persisted after UVC removal in 25/30 cases. Two infants with thrombotic events were treated with low-molecular-weight heparin and resolution was found. In the other 23 infants managed expectantly, 2 died due to necrotising enterocolitis, 1 was lost to follow-up and in 20 spontaneous regression was seen.

Conclusions

Thrombotic events occur frequently in infants after umbilical catheterisation. Most thrombi were asymptomatic and regressed spontaneously with expectant management. Routine screening for thrombi in UVCs is therefore not advised.
Process evaluations of primary care interventions addressing chronic disease: a systematic review
Authors: Liu Hueiming , Mohammed Alim , Shanthosh Janani , News Madeline , Laba Tracey-Lea , Hackett Maree L , Peiris David , Jan Stephen
Published: August 2019

Objective

Process evaluations (PEs) alongside randomised controlled trials of complex interventions are valuable because they address questions of for whom, how and why interventions had an impact. We synthesised the methods used in PEs of primary care interventions, and their main findings on implementation barriers and facilitators.

Design

Systematic review using the UK Medical Research Council guidance for PE as a guide.

Data sources

Academic databases (MEDLINE, SCOPUS, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Global Health) were searched from 1998 until June 2018.

Eligibility criteria

We included PE alongside randomised controlled trials of primary care interventions which aimed to improve outcomes for patients with non-communicable diseases.

Data extraction and synthesis

Two independent reviewers screened and conducted the data extraction and synthesis, with a third reviewer checking a sample for quality assurance.

Results

69 studies were included. There was an overall lack of consistency in how PEs were conducted and reported. The main weakness is that only 30 studies were underpinned by a clear intervention theory often facilitated by the use of existing theoretical frameworks. The main strengths were robust sampling strategies, and the triangulation of qualitative and quantitative data to understand an intervention’s mechanisms. Findings were synthesised into three key themes: (1) a fundamental mismatch between what the intervention was designed to achieve and local needs; (2) the required roles and responsibilities of key actors were often not clearly understood; and (3) the health system context—factors such as governance, financing structures and workforce—if unanticipated could adversely impact implementation.

Conclusion

Greater consistency is needed in the reporting and the methods of PEs, in particular greater use of theoretical frameworks to inform intervention theory. More emphasis on formative research in designing interventions is needed to align the intervention with the needs of local stakeholders, and to minimise unanticipated consequences due to context-specific barriers.

PROSPERO registration number

CRD42016035572.