bluuebunny/crossref_metadata_2025 huggingface dataset:
Overtraining in neural networks that interpret clinical data
Authors: Astion M L , Wener M H , Thomas R G , Hunder G G , Bloch D A
Published: January 2020

Backpropagation neural networks are a computer-based pattern-recognition method that has been applied to the interpretation of clinical data. Unlike rule-based pattern recognition, backpropagation networks learn by being repetitively trained with examples of the patterns to be differentiated. We describe and analyze the phenomenon of overtraining in backpropagation networks. Overtraining refers to the reduction in generalization ability that can occur as networks are trained. The clinical application we used was the differentiation of giant cell arteritis (GCA) from other forms of vasculitis (OTH) based on results for 807 patients (593 OTH, 214 GCA) and eight clinical predictor variables. The 807 cases were randomly assigned to either a training set with 404 cases or to a cross-validation set with the remaining 403 cases. The cross-validation set was used to monitor generalization during training. Results were obtained for eight networks, each derived from a different random assignment of the 807 cases. Training error monotonically decreased during training. In contrast, the cross-validation error usually reached a minimum early in training while the training error was still decreasing. Training beyond the minimum cross-validation error was associated with an increased cross-validation error. The shape of the cross-validation error curve and the point during training corresponding to the minimum cross-validation error varied with the composition of the data sets and the training conditions. The study indicates that training error is not a reliable indicator of a network's ability to generalize. To find the point during training when a network generalizes best, one must monitor cross-validation error separately.
Molecular nanotechnology
Authors: Fahy G M
Published: January 2020

Molecular nanotechnology involves the ability to manufacture objects to precise atomic specifications. A central postulate is that any structure that can be specified and that does not violate physical law can be built. Three pathways to molecular nanotechnology are proximate probe technology (the use of improvements of the scanning tunneling microscope, STM), biotechnology, and supramolecular chemistry. Combinations of these technologies appear particularly powerful. The biotechnological approach should make it possible to use in vitro translation systems to manufacture polymers containing at least 10 times as many different artificial monomers as there are natural amino acids. These polymers could further adsorb various other molecular devices, and the use of STMs should enable the complexes to be arranged into sophisticated machines, including molecular computers. The implications include pocket superautomated analyzers and the ability to base medical therapy on the biochemical individuality of specific patients.
P34 The effect of sex on the efficacy and safety of dabigatran dual therapy in atrial fibrillation after PCI: a subgroup analysis from the RE-DUAL PCI trial
Authors: Eccleston D , Ten Berg J M , Steg P G , Bhatt D L , Hohnloser S H , De Veer A , Nordaby M , Miede C , Kimura T , Lip G Y H , Oldgren J , Cannon C P
Published: January 2020

Funding Acknowledgements

Boehringer Ingelheim International GmbH

On Behalf

The Re-DUAL PCI Investigators

Background

The RE-DUAL PCI study (NCT02164864) compared dabigatran dual antithrombotic therapy (D-DAT) with warfarin triple antithrombotic therapy (W-TAT) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). As previously reported D-DAT reduced bleeding compared with W-TAT and was non-inferior with regard to thromboembolic events. 

Aim 

The aim of this subgroup analysis of RE-DUAL was to assess the relationship between sex and treatment effects of D-DAT and W-TAT on bleeding and thromboembolic outcomes.

Methods

Patients were randomized to receive W-TAT (warfarin, clopidogrel or ticagrelor, and aspirin) or D-DAT (dabigatran 110 or 150 mg twice daily with clopidogrel or ticagrelor; D110- or D150-DAT). Younger patients (aged < 80 yrs. [< 70 yrs. in Japan]) and US patients irrespective of age received D110-DAT, D150-DAT or W-TAT; older patients (aged ≥ 80 yrs. in non-US countries [≥ 70 yrs. in Japan]) received only D110-DAT or W-TAT. Bleeding and thromboembolic outcomes were assessed according to treatment group and by sex (female vs. male).

Results

A total of 2725 patients were randomized; 2070 patients were male (76.0%) and 655 (24.0%) were female. Overall females were older at time of PCI than males (73.2 ± 7.9 vs. 70.0 ± 8.8 years). The mean CHA2DS2-VASc and modified HAS-BLED scores were higher in women at 4.5 and 2.8, respectively, than in men at 3.3 and 2.7, respectively. 

For the primary endpoint of major bleeding events or clinically relevant non-major bleeding events, treatment effects of D110-DAT vs. W-TAT were consistent for female and male patients (females: HR 0.69, 95% CI 0.47-1.01, males HR 0.46, 95%CI 0.37-0.59, interaction p-value 0.084). Similarly, consistent treatment effects were seen for the primary endpoint with D150-DAT vs W-TAT in female and male patients (females HR 0.74, 95% CI 0.48-1.16, males HR 0.71, 95% CI 0.56-0.90, interaction p value 0.83). 

No interaction between sex and treatment was observed for D110- or D150-DAT vs W-TAT with regard to the composite efficacy endpoint of death, thromboembolic events or unplanned revascularization (interaction p values 0.73 and 0.72, respectively) (figure).

Conclusion

The treatment effect of dabigatran 110 mg and 150 mg dual therapy vs warfarin triple therapy was consistent across sex groups. This suggests that female and male patients with AF undergoing PCI should be treated equally in terms of the dosage of dabigatran selected for dual therapy strategies.

Abstract P34 Figure. Re-DUAL sex subgroup analysis
P93 The usefulness of dual cardiac autonomic nervous modulation assessment for prediction of mortality in patients with relatively preserved left ventricular ejection fraction
Authors: Kinoshita T , Yuzawa H , Wada R , Yao S , Yano K , Akitsu K , Shinohara M , Koike H , Suzuki T , Abe A , Fujino T , Ikeda T
Published: January 2020

Background

Recent guidelines have stated that reduced left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. Although reduced LVEF identifies patients at an increased risk of cardiac arrest, sudden cardiac deaths (SCDs) occur considerably more often in patients with relatively preserved LVEF. Current guidelines on SCDs risk stratification do not adequately cover this general population pool. Heart rate variability (HRV) and heart rate turbulence (HRT) are non-invasive electrocardiography (ECG)-based techniques capable of providing relevant information on the cardiac autonomic nervous modulation. Although a large body of evidence about autonomic nervous modulation markers has been reported, the usefulness of HRV and HRT parameters for risk stratification in such patients with relatively preserved LVEF has not yet been elucidated.

Purpose

This study aimed to evaluate HRV and HRT parameters for predicting cardiac mortality in patients with structural heart disease (SHD), including ischemic heart disease, dilated cardiomyopathy and valvular heart disease, who have mid-range left ventricular dysfunction (LVD).

Methods

We prospectively enrolled 229 patients (187 men, age 63 ± 13 years) with SHD who have mid-range LVD (LVEF > 40%). HRV and HRT parameters based on 24-hour ambulatory ECG recordings (Fukuda Denshi Co., Ltd., Tokyo, Japan) were evaluated as follows; SDNN, triangular index, high and low frequency HRV, turbulence onset and slope. The primary endpoint was all-cause mortality. Univariate and multivariate Cox regression analysis were used to assess the association between these cardiac autonomic nervous modulation and mortality.

Results

During a mean follow-up of 21 ± 11 months, all-cause mortality was seen in 11 (4.8%) patients. Univariate Cox regression analysis showed that reduced SDNN (<50ms), reduced triangular index (<20ms) and HRT category 2 were significantly associated with the primary endpoint (P < 0.05). When HRT category 2 combined with reduced SDNN, Multivariate Cox regression analysis revealed that this combination more strongly associates with the primary endpoint (hazard ratio =7.91, 95%CI, 1.82-34.2; P = 0.006).

Conclusion

Dual cardiac autonomic nervous modulation assessment which combined HRT and HRV could be a superior technique to predict mortality in patients with relatively preserved LVEF.
P105 Chronic vagal nerve stimulation suppress thirst through decreasing vasopressin secretion in the rats with chronic heart failure
Authors: Zheng C , Li M , Uemura K , Kawada T , Inagaki M , Sugimachi M
Published: January 2020

Introduction

Chronic right cervical vagal nerve electric stimulation (VS) exerted prognostic benefits in heart failure rats. Exploring the mechanism is significant for clinical application. This study examined the effect of VS on arginine vasopressin (AVP) secretion and drinking behavior in the rats with chronic heart failure.

Methods

After a week recovery of myocardial infarction (MI), surviving rats after were randomly instrumented to VS group and sham stimulation (SS) group. A drop sensor was used to record real-time fluid consumption. Blood samples were collected weekly from the 3rd week during the 6 weeks treatment.

Results

Vagal stimulation did not change the daily fluid consumption (Mean ± SE, 76.2 ± 1.1 vs. 77.8 ± 2.1 ml/kg/day, n = 6, P < 0.05). Thirst, which is defined as per drinking volume (PDV), significantly increased during the early weeks after MI (Fig A), while VS significantly suppressed PDV (Fig B is the data of 6th week) by increasing the drinking intervals. The level of plasma AVP was increased to about 2 fold during 6 weeks observation in the SS group, however, VS suppressed this upregulation (Fig C).

Conclusion

These results suggest that VS may activate vagal afferent components which related to inhibition of AVP secretion and then suppressed the augmentation of thirst. Frequent drinking small volume may benefit for homeostasis in CHF.

Abstract P105 Figure. Drinking behavior and AVP
P175 Prognostic value of 99mTc-ECD brain perfusion SPECT in patients with atrial fibrillation and dementia
Authors: Hashimoto H , Nakanishi R , Mizumura S , Hashimoto Y , Okamura Y , Yamanaka K , Ikeda T
Published: January 2020

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and those afflicted have reduced quality of life, functional status, and cardiac performance. The patients with AF have a high risk of coronary heart disease and cardiovascular disease. Although the prevalence of AF is increasing, cognitive disorders are also on the rise in tandem with the aging of the population. The patients with dementia have also experienced lower the quality of life and have increased mortality. Technetium 99m ECD brain perfusion single photon emission computed tomography (99mTc-ECD brain perfusion SPECT) is a useful modality for diagnosing dementia and identifying high risk patients with mild cognitive impairment. However, there are few reports about the relationship between the value of Z score calculated by 99mTc-ECD brain perfusion SPECT and prognosis of patients with AF and dementia.

Purpose

The aim of this study was to evaluate the prognostic values of brain perfusion using 99mTc-ECD SPECT in patients with AF and dementia.

Methods

Among 405 consecutive patients who were diagnosed as AF in cardiac outpatients and subsequently diagnosed as dementia using Mini-Mental State Examination by neurologists or psychiatrists, we identified 170 patients (81 ± 10 years) who underwent 99mTc-ECD brain perfusion SPECT for the current study. Of those, 73, 73, and 24 were diagnosed as Alzheimer’s dementia (AD), vascular dementia (VD), and non-specified dementia respectively. Multivariate Cox model was used to assess if higher Z score by 99mTc-ECD brain perfusion SPECT and clinical parameters were associated with major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, hospitalization for heart failure, and stroke. Sub-analyses of multivariate Cox models by AD or VD were also assessed. The cut-off values of Z score were determined using area under the curve by a receiver operating characteristic analysis based on MACE occurrences.

Results

During a mean follow-up of 1258 ± 1044 days, 62 MACE occurred. There was not significant difference of MACE between AD and VD (33%, vs. 44%, p = 0.153). By multivariable Cox model, the higher Z score of temporal-occipital-pariental lobe was associated with increased MACE compared to the lower group (HR 2.521, 95% CI 1.465–4.337, p < 0.001). In a sub-analysis of patients with AD, Z score was the most significant prognostic factor for MACE (HR 3.969, 95% CI 1.374–11.468, p = 0.011). The similar trend was observed in those with VD (HR 2.247, 95% CI 1.028–4.913, p = 0.043). Conclusion: This study demonstrated that the Z score of temporal-occipital-pariental lobe by 99mTc-ECD brain perfusion SPECT could be a potential prognostic value among patients with AF and dementia, regardless of type of dementia.
P202 Are Chinese immigrants with CVD ready to use web-based health information: a comparative study in Australia
Authors: Zhang L , Ding D , Gallagher R
Published: January 2020

Background

Immigrant populations often have poor access to cardiovascular disease (CVD) secondary prevention due to linguistic and cultural barriers. Web-based interventions are effective in risk reduction and lifestyle modification and may reach those hard-to-reach populations such as Chinese immigrants. However, less is known about the current use of web-based health information and confidence in use.

Purposes

We compared the use of web-based health information and confidence in use between Chinese immigrants with CVD to those with and without another chronic condition; and explored the factors associated with the confidence in utilization.

Methods

Chinese immigrants with CVD, musculoskeletal conditions, or no chronic condition were recruited from Chinese communities across New South Wales, Australia. E-health literacy scale was used to explore the perceptions of web-based health information and confidence in use. Demographic, clinical data and use of web-based health information were collected and health literacy was measured using a validated single screening question.

Results

Participants (n = 90 CVD, n = 87 musculoskeletal, n = 154 no chronic conditions) were aged mean 59 ± 16 years, mostly female (69%), 75% reported fair to poor English proficiency, and 51% had completed university. The most accessed web-based health information concerned lifestyle (60%), health resources (45%), diseases (35%), and medications (30%). More than half (54%) were confident in using web-based health information.

Participants with CVD were the oldest (71 vs 65 vs 49 years, p<.001) and participants with any chronic condition had less education (p<.001) and English proficiency (p<.001) than the healthy group. Approximately half of the participants with CVD perceived web-based health information as useful (48%) and important (46%), and the most accessed information concerned lifestyle and medication (56% and 32%). Participants with CVD accessed medication information more often than musculoskeletal group (32% vs 23%), but there was no difference in accessing other information. Both chronic groups showed no difference in accessing web-based medication and lifestyle information compared with the healthy group. Confidence in using web-based health information was similar for CVD and musculoskeletal groups and lower than the healthy group (p<.001).

Participants with the least confidence to use web-based health information were older (p=.016), female (p=.014), had less than university level education (p<.001), and lower health literacy (p=.001) after adjusting for age, gender, education, English proficiency, employment status, social support, health literacy, and number of chronic conditions.

Conclusions

There is a strong potential to provide web-based medication and lifestyle information for Chinese immigrants with CVD if support is provided to improve confidence in this technology for older, women, and those with less education and/or health literacy.
P250 Evaluation of coronary endothelial dysfunction by positron emission tomography: does gender make a difference
Authors: Aljizeeri A , Alali Alfaris M , Ahmed D , Farea J , Elneama A , Suliman I , Ahmed A , Alharthi M , Alsaileek A , Al-Mallah M
Published: January 2020

Funding Acknowledgements

None

Introduction

Endothelial dysfunction (ED) manifested as abnormality of coronary microvasculature is associated with poor prognosis in patients presenting with chest pain. ED can be noninvasively evaluated by assessment of coronary flow reserve with positron emission tomography (PET). Studies directly comparing ED in men and women are limited. The aim of this study is to compare gender differences in ED as measured by CFR on PET myocardial perfusion imaging.

Methods

All the consecutive patients referred to PET-MPI between May 2011 and June 2018 were reviewed. Patient without known CAD who had normal perfusion were included in the analysis. Patient with abnormal electrocardiogram, significant transient ischemic dilatation, low left ventricular ejection fraction and high calcium score (>1000 AU) and renal failure were excluded. CFR is calculated as the ratio of stress/rest myocardial blood flow. CFR < 2 was considered as abnormal indicating the presence of ED.

Results

1711 patients were included in the analysis (mean age 60.2 ± 10 year, 68% females). Females were older and had higher BMI and diabetes (DM). Both resting and peak myocardial blood flow (MBF) was higher in females (1.16 vs 1.02 (p < 0.0001)) and 3.26 vs 2.9 (p < 0.001)0 respectively.  Around 68% of males had abnormal CFR (<2) compared to 63% of females (p = 0.05). After adjusting for the confounders, female gender was associated with higher peak MBF (Hazard ratio 0.29, 95% CI 0.19 –0.40, p < 0.001) and lower chance of having ED (Hazard ratio -0.15, 95% CI -0.29 - -0.005, p = 0.049)

Conclusions

Endothelial dysfunction as measured noninvasively by CFR on PET is prevalent among both sexes. Higher level of peak MBF in females may call for a different cut-off for abnormal CFR in women. Outcome studies are required to evaluate the clinical utility and prognostic value of such a cut-off.
P271 Prophylactic administration of allopurinol with standard IV hydration in preventing contrast-induced nephropathy in patients undergoing cardiac catheterization: a meta-analysis and systematic review
Authors: Larrazabal R , Perez B B P , Chiu H C C , Tan R J T
Published: January 2020

Funding Acknowledgements

None

BACKGROUND

Current advancements has made contrast-guided coronary interventions widely available, however these procedures entail the risk of  developing Contrast-induced nephropathy which is associated with increased morbidity and mortality of patients. One of the mechanisms that has been investigated in the development of CIN is the presence of hyperuricemia. Elevated uric acid levels may injure the microscopic tubules causing kidney injury and may induce the production of inflammatory factors furthering damage. Thus, it has been postulated that using urate lowering agents may be beneficial in preventing CIN.

OBJECTIVE

To determine the efficacy of giving oral prophylactic allopurinol along with standard IV hydration in reducing the incidence of contrast-induced nephropathy.

METHODS

We conducted a systematic literature search using PUBMED, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Kidney and Transplant register of Studies, Google Scholar, and Research Gate. Studies fulfilling the inclusion and exclusion criteria were quality assessed based on the criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. The incidences ofContrast-Induced Nephropathy were combined and analyzed using a fixed-effect model in Review Manager (Rev Man) Version 5.3 with 95% confidence interval.

RESULTS

Five studies were included with a total of 753 patients. Results showed that there is a 63% decrease in CIN [RR = 0.37 (0.25 to 0.54, 95% CI, Z = 5.10, p < 0.00001)] after prophylactic administration of allopurinol with standard IV hydration as compared to those who received hydration alone. When adjusted for heterogeneity, there remains a 35% decrease in the incidence of CIN [RR = 0.65 (0.43 to 0.99, 95% CI, Z = 2.02, p = 0.04) in patients given prophylactic allopurinol.

CONCLUSION

Oral prophylactic allopurinol administration may be protective in the development of CIN in patients undergoing coronary interventions. However larger, multi-centered randomized-controlled trials are needed to validate this claim.

Abstract P271 Figure. Forrest Plot of Study Results
Automation and jobs: when technology boosts employment*
Authors: Bessen James
Published: January 2020

Will new technologies cause industries to shed jobs, requiring novel policies to address mass unemployment? Sometimes productivity-enhancing technology increases industry employment instead. In manufacturing, jobs grew along with productivity for a century or more; only later did productivity gains bring declining employment. What changed? The elasticity of demand. Using data over two centuries for US textile, steel and auto industries, this paper shows that automation initially spurred job growth because demand was highly elastic. But demand later became satiated, leading to job losses. A simple model explains why this pattern might be common, suggesting that today’s technologies may cause some industries to decline and others to grow. Automation might not cause mass unemployment, but it may well require workers to make disruptive transitions to new industries, requiring new skills and occupations.
Automation, performance and international competition: a firm-level comparison of process innovation
Authors: Kromann Lene , Sørensen Anders
Published: January 2020

The automation of production processes is an important topic on the policy agenda in high-wage countries, and Denmark is no exception. However, the knowledge of the adoption of automation technologies across firms, of drivers of investments in automation, and on the association between automation and firm performance are limited. This paper uses a new survey to collect data on automation combined with register data to examine these issues. The variation in the adoption of automation technologies is high but the change in adoption over time is slow, and almost half of Danish manufacturing firms relied greatly on manual production processes in 2010. Increasing international competition from China is a driver for investments in automation, i.e. the manufacturing firms that are exposed to intensifying competition from China in their output markets invest more in automation than firms that are not exposed to this type of competition. We conduct external validation of the automation survey by examining the association between the automation measures and firm performance measures constructed from completely independent data sources. We find that the measures of automation are significantly associated with productivity and profitability.
BigTech and the changing structure of financial intermediation
Authors: Frost Jon , Gambacorta Leonardo , Huang Yi , Shin Hyun Song , Zbinden Pablo
Published: January 2020

Pablo Zbinden?>We consider the drivers and implications of the growth of ‘BigTech’ in finance – i.e. the financial services offerings of technology companies with established presence in the market for digital services. BigTech firms often start with payments. Thereafter, some expand into the provision of credit, insurance and money management products, either directly or in cooperation with financial institution partners. Focusing on credit, we show that BigTech firms lend more in countries with less competitive banking sectors and less stringent bank regulation. Analysing the case of Argentina, we find support for the hypothesis that BigTech lenders, by acquiring a vast amount of non-traditional information, have an advantage in credit assessment relative to a traditional credit bureau. They also serve unbanked borrowers, and may have an advantage in contract enforcement. It is too early to judge the extent of BigTech’s eventual advance into the provision of financial services. However, the early evidence allows us to pose pertinent questions that bear on their impact on financial stability and overall economic welfare.
Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices
Authors: Yalcin Yunus C , Kooij Claudette , Theuns Dominic A M J , Constantinescu Alina A , Brugts Jasper J , Manintveld Olivier C , Yap Sing-Chien , Szili-Torok Tamas , Bogers Ad J J C , Caliskan Kadir
Published: January 2020

Aims

To investigate the prevalence of electromagnetic interference (EMI) between left ventricular assist devices (LVADs) and implantable cardioverter-defibrillators (ICDs)/pacemakers (PMs).

Methods and results

A retrospective single-centre study was conducted, including all patients undergoing HeartMate II (HMII) and HeartMate 3 (HM3) LVAD implantation (n = 106). Electromagnetic interference was determined by the inability to interrogate the ICD/PM. Overall, 85 (mean age 59 ± 8, 79% male) patients had an ICD/PM at the time of LVAD implantation; 46 patients with HMII and 40 patients with HM3. Among the 85 LVAD patients with an ICD’s/PM’s, 11 patients (13%) experienced EMI; 6 patients (15%) with an HMII and 5 patients (11%) with an HM3 (P = 0.59). Electromagnetic interference from the HMII LVADs was only present in patients with a St Jude/Abbott device; 6 of the 23 St Jude/Abbott devices. However, in the HM3 patients, EMI was mainly present in patients with Biotronik devices: 4 of the 18 with only one (1/25) patient with a Medtronic device. While initial interrogation of these devices was not successful, none of the 11 cases experienced pacing inhibition or inappropriate shocks.

Conclusion

In summary, the prevalence of EMI between ICDs in the older and newer type of LVAD's remains rather high. While HMII patients experienced EMI with a St Jude/Abbott device (which was already known), HM3 LVAD patients experience EMI mainly with Biotronik devices. Prospective follow-up, preferably in large registries, is warranted to investigate the overall prevalence and impact of EMI in LVAD patients.
Age Differences in the Subcomponents of Executive Functioning
Authors: Maldonado Ted , Orr Joseph M , Goen James R M , Bernard Jessica A
Published: January 2020

Objectives

Across the life span, deficits in executive functioning (EF) are associated with poor behavioral control and failure to achieve goals. Though EF is often discussed as one broad construct, a prominent model of EF suggests that it is composed of three subdomains: inhibition, set shifting, and updating. These subdomains are seen in both younger (YA) and older adults (OA), with performance deficits across subdomains in OA. Therefore, our goal was to investigate whether subdomains of EF might be differentially affected by age, and how these differences may relate to broader global age differences in EF.

Methods

To assess these age differences, we conducted a meta-analysis at multiple levels, including task level, subdomain level, and of global EF. Based on previous work, we hypothesized that there would be overall differences in EF in OA.

Results

Using 1,268 effect sizes from 401 articles, we found overall differences in EF with age. Results suggested that differences in performance are not uniform, such that variability in age effects emerged at the task level, and updating was not as affected by age as other subdomains.

Discussion

These findings advance our understanding of age differences in EF, and stand to inform early detection of EF decline.
Shocks, stress and everyday health system resilience: experiences from the Kenyan coast
Authors: Kagwanja Nancy , Waithaka Dennis , Nzinga Jacinta , Tsofa Benjamin , Boga Mwanamvua , Leli Hassan , Mataza Christine , Gilson Lucy , Molyneux Sassy , Barasa Edwine
Published: January 2020

Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses and organizational capacities underpinning those responses, with a view to contributing to the understanding of health system resilience. We drew on learning and experiences gained through working with managers using a learning site approach over the years. We also collected in-depth qualitative data through informal observations, reflective meetings and in-depth interviews with middle-level managers (sub-county and hospital) and peripheral facility managers (n = 29). We analysed the data using a framework approach. Health managers reported a wide range of health system stressors related to resource scarcity, lack of clarity in roles and political interference, reduced autonomy and human resource management. The health managers adopted absorptive, adaptive and transformative strategies but with mixed effects on system functioning. Everyday resilience seemed to emerge from strategies enacted by managers drawing on a varying combination of organizational capacities depending on the stressor and context.
Can Dogs be Racist? The Colonial Legacies of Racialized Dogs in Kenya and Zambia
Authors: Doble Josh
Published: January 2020

Can dogs be racist? Posing this question may seem odd and at worst, unhelpfully provocative at a time when the discourse of ‘colour-blindness’ is so pervasive. Yet the idea of ‘racist dogs’ remains salient within the post-settler societies of eastern and southern Africa, where dogs have been an integral if overlooked tool of colonial practices of racialization. This article traces the colonial demarcation of ‘native dogs’ – juxtaposed to white settlers’ ‘pet’ dogs – to understand how racial categories were imposed on domesticated animals, and how these racialized animals were then colonized through rabies legislation. Although the formal racialization of dogs ended with the dawn of political decolonization in the early 1960s, dogs continued to be co-opted for postcolonial racial discourse. Dogs were in a prominent position in postcolonial society due to their prevalence in the security arrangements of white homes as well as in the security forces of white supremacist Rhodesia and apartheid South Africa. The intensity of the relationship between white minorities, their canine pets and the surrounding African population points toward the uncomfortable conclusion that in the heightened racial environments of decolonizing settler Africa, dogs could be made to be racist.
Klebsiella pneumoniae ST307 with OXA-181: threat of a high-risk clone and promiscuous plasmid in a resource-constrained healthcare setting
Authors: Strydom K A , Chen L , Kock M M , Stoltz A C , Peirano G , Nobrega D B , Lowe M , Ehlers M M , Mbelle N M , Kreiswirth B N , Pitout J D D
Published: January 2020

Introduction

Klebsiella pneumoniae with OXA-48-like enzymes were introduced into Tshwane Tertiary Hospital (TTH) (Pretoria, South Africa) during September 2015, causing nosocomial outbreaks.

Methods

PCR methodologies and WGS were used to characterize K. pneumoniae with carbapenemases (n = 124) from TTH (July 2015–December 2016).

Results

PCR was used to track K. pneumoniae ST307 with OXA-181 among 60% of carbapenemase-positive isolates in different wards/units over time and showed the transmission of IncX3 plasmids to other K. pneumoniae clones. WGS identified different ST307 clades: 307_OXA181 (consisting of two lineages, A and B) with OXA-181 on IncX3 plasmids (named p72_X3_OXA181) and clade 307_VIM with VIM-1 on IncFII plasmids. Clade 307_OXA181 lineage B was responsible for the rapid increase and transmission of OXA-181 K. pneumoniae in various wards/units throughout TTH, while the numbers of clade 307_OXA181 lineage A and clade 307_VIM remained low. Separate outbreaks were due to K. pneumoniae ST17 and ST29 with p72_X3_OXA181 plasmids.

Conclusions

The high-risk clone K. pneumoniae ST307 with OXA-181 rapidly spread to different wards/units despite infection and prevention measures. ST307 clades and lineages seemingly acted differently in outbreak situations. This study also highlighted the threat of promiscuous plasmids such as p72_X3_OXA181.
Digestive tract microbiota of beef cattle that differed in feed efficiency
Authors: Freetly Harvey C , Dickey Aaron , Lindholm-Perry Amanda K , Thallman Richard M , Keele John W , Foote Andrew P , Wells James E
Published: January 2020

We hypothesized cattle that differed in BW gain had different digestive tract microbiota. Two experiments were conducted. In both experiments, steers received a diet that consisted of 8.0% chopped alfalfa hay, 20% wet distillers grain with solubles, 67.75% dry-rolled corn, and 4.25% vitamin/mineral mix (including monensin) on a dry matter basis. Steers had ad libitum access to feed and water. In experiment 1, 144 steers (age = 310 ± 1.5 d; BW = 503 ± 37.2 kg) were individually fed for 105 d. Ruminal digesta samples were collected from eight steers with the greatest (1.96 ± 0.02 kg/d) and eight steers with the least ADG (1.57 ± 0.02 kg/d) that were within ±0.32 SD of the mean (10.1 ± 0.05 kg/d) dry matter. In experiment 2, 66 steers (age = 396 ± 1 d; BW = 456 ± 5 kg) were individually fed for 84 d. Rumen, duodenum, jejunum, ileum, cecum, and colon digesta samples were collected from eight steers with the greatest (2.39 ± 0.06 kg/d) and eight steers with the least ADG (1.85 ± 0.06 kg/d) that were within ±0.55 SD of the mean dry matter intake (11.9 ± 0.1 kg/d). In both studies, DNA was isolated and the V1 to V3 regions of the 16S rRNA gene were sequenced. Operational taxonomic units were classified using 0.03 dissimilarity and identified using the Greengenes 16S rRNA gene database. In experiment 1, there were no differences in the Chao1, Shannon, Simpson, and InvSimpson diversity indexes or the permutation multivariate analysis of variance (PERMANOVA; P = 0.57). The hierarchical test returned six clades as being differentially abundant between steer classifications (P < 0.05). In experiment 2, Chao1, Shannon, Simpson, and InvSimpson diversity indexes and PERMANOVA between steer classified as less or greater ADG did not differ (P > 0.05) for the rumen, duodenum, ileum, cecum, and colon. In the jejunum, there tended to be a difference in the Chao1 (P = 0.09) and Simpson diversity (P = 0.09) indexes between steer classifications, but there was no difference in the Shannon (P = 0.14) and InvSimpson (P = 0.14) diversity indexes. Classification groups for the jejunum differed (P = 0.006) in the PERMANOVA. The hierarchical dependence false discovery rate procedure returned 11 clades as being differentially abundant between steer classifications in the jejunum (P < 0.05). The majority of the OTU were in the Families Corynebacteriaceae and Coriobacteriaceae. This study suggests that intestinal differences in the microbiota of ruminants may be associated with animal performance.
Herbal Products for Treatment of Burn Wounds
Authors: Herman Anna , Herman Andrzej P
Published: January 2020

The purpose of this review is to summarize the current knowledge acquired during preclinical and clinical studies regarding topically used herbal products with burn wound-healing activity. Moreover, antimicrobial, anti-inflammatory, and antioxidant mechanisms of their action as well as adverse effects of herbal therapy will be also described.
Border effects in European public procurement
Authors: Herz Benedikt , Varela-Irimia Xosé-Luís
Published: January 2020

In this paper, we document border effects in the award of public contracts in the European single market. We use a dataset of 1.8 million contract awards, which we match to geolocations to estimate a gravity model of procurement flows between European NUTS3 region pairs. We find very sizable cross-national border effects for all types of goods and services, even after controlling for physical distance, currency, cultural differences and other variables. For example, ‘local’ bidders for IT services contracts are almost 250 times more likely to be awarded a contract than ‘foreign’ bidders. More surprisingly, we find substantial cross-regional border effects within countries. While we document that firms’ bidding decisions are subject to border effects, we cannot exclude a home bias of contracting authorities in the award of public contracts.
Swedish Patent and Market Court of Appeal clarifies rules on influencer marketing
Authors: Fassihi Rebecca , Zenk Kajsa
Published: January 2020

The Consumer Ombudsman v Alexandra Media Sweden AB and Tourn Media AB, Patent and Market Court of Appeal, PMT 2054-18, 5 December 2019

The Swedish Patent and Market Court of Appeal ruled in favour of the Swedish Consumer Ombudsman, setting out guidelines for how Swedish law shall be interpreted in relation to influencer marketing.
Estrogen/estrogen receptor promotes the proliferation of endometrial carcinoma cells by enhancing hMOF expression
Authors: Qi Yue , Tan Mingzi , Zheng Mingjun , Jin Shan , Wang Huimin , Liu Juanjuan , Wang Peiyao , Nie Xin , Gao Lingling , Lin Bei
Published: January 2020

Background

This study aims to analyse the expression of human MOF in endometrial carcinoma cells and its relationship with estrogen and estrogen receptor and to investigate the effect of estrogen–human MOF on the malignant biological behaviours of endometrial carcinoma cells.

Methods

The expression of human MOF was detected in different endometrial tissues by immunohistochemistry. The effects of human MOF, human MOF combined with estrogen stimulation and estrogen plus anti-human MOF antibody blocking on the proliferation of endometrial carcinoma cells were evaluated by western blotting, real-time polymerase chain reaction, cell proliferation assay and cell cycle distribution. Bioinformatics was used to identify the correlations of human MOF and estrogen and involved pathways.

Results

The expression levels of human MOF in endometrial carcinoma tissues were significantly higher than that in atypical hyperplasia and normal endometrial tissues. High expression of human MOF was associated with late-stage cancer, lymph node metastasis and short survival time, and it was also an independent prognostic risk factor for endometrial carcinoma. After human MOF knockdown, the proliferation, migration and invasive capacity of Ishikawa cells decreased and cell apoptosis increased. After stimulation with estrogen, the PI3K/Akt and Ras–Raf–MEK–ERK signalling pathways were activated, and the expression of the human MOF protein was increased. human MOF (KAT8) expression showed a positive correlation with ESR1 expression, and KAT8-associated genes were enriched in the cell cycle pathways and splicing pathways.

Conclusion

Human MOF was highly expressed in endometrial carcinoma and associated with proliferation. Estrogen/estrogen receptor enhanced human MOF expression; promoted the proliferation, migration and invasion of Ishikawa cells; and inhibited cell apoptosis by activating the PI3K/Akt and Ras–Raf–MEK–ERK signalling pathways.
An allelic variant of GAME9 determines its binding capacity with the GAME17 promoter in the regulation of steroidal glycoalkaloid biosynthesis in tomato
Authors: Yu Gang , Li Changxing , Zhang Lei , Zhu Guangtao , Munir Shoaib , Shi Caixue , Zhang Hongyan , Ai Guo , Gao Shenghua , Zhang Yuyang , Yang Changxian , Zhang Junhong , Li Hanxia , Ye Zhibiao
Published: January 2020

Steroidal glycoalkaloids (SGAs) are cholesterol-derived molecules found in the family Solanaceae. SGA content varies among different plant species and varieties. However, the genetic mechanisms regulating SGA content remain unclear. Here, we demonstrate that genetic variation in GLYCOALKALOID METABOLISM 9 (GAME9) is responsible for the variation in SGA content in tomato (Solanum lycopersicum). During a sequential analysis we found a 1 bp substitution in the AP2/ERF binding domain of GAME9. The 1 bp substitution in GAME9 was significantly associated with high SGA content and determined the binding capacity of GAME9 with the promoter of GAME17, a core SGA biosynthesis gene. The high-SGA GAME9 allele is mainly present in S. pimpinellifolium and S. lycopersicum var. cerasiforme populations and encodes a protein that can bind the GAME17 promoter. In contrast, the low-SGA GAME9 allele is mainly present in the big-fruited varieties of S. lycopersicum and encodes a protein that shows weak binding to the GAME17 promoter. Our findings provide new insight into the regulation of SGA biosynthesis and the factors that affect the accumulation of SGA in tomato.
Aphid fecundity and defenses in wheat exposed to a combination of heat and drought stress
Authors: Xie Haicui , Shi Jianqin , Shi Fengyu , Xu Haiyun , He Kanglai , Wang Zhenying
Published: January 2020

Plants are routinely subjected simultaneously to different abiotic and biotic stresses, such as heat, drought, and insect infestation. Plant–insect interactions in such complex stress situations are poorly understood. We evaluated the performance of the grain aphid (Sitobion avenae) in wheat (Triticum aestivum L.) exposed to a combination of heat and drought stresses. We also performed assays of the relative water content, nutritional quality, and responses of phytohormone signaling pathways. Lower relative water content and accumulation of soluble sugars and amino acids were observed in plants exposed to combined heat and drought stress. These conditions increased abscisic acid levels in the absence of aphids, as well as leading to higher levels of jasmonate-dependent transcripts. The grain aphid infestation further increased abscisic acid levels and the abundance of jasmonic acid- and salicylic acid-dependent defenses under the combined stress conditions. Aphids reared on plants grown under drought stress alone showed lower net reproductive rates, intrinsic rates of increase, and finite rates of increase compared with aphids reared on plants in the absence of stress. The heat-treated plants also showed a decreased aphid net reproductive rate. These findings demonstrate that exposure to a combination of stresses enhances plant defense responses against aphids as well as altering nutritional quality.
The H i morphology and stellar properties of strongly barred galaxies: support for bar quenching in massive spirals
Authors: Newnham L , Hess Kelley M , Masters Karen L , Kruk Sandor , Penny Samantha J , Lingard Tim , Smethurst R J
Published: January 2020

Galactic bars are able to affect the evolution of galaxies by redistributing their gas, possibly contributing to the cessation of star formation. Several recent works point to ‘bar quenching’ playing an important role in massive disc galaxies. We construct a sample of six gas-rich and strongly barred disc galaxies with resolved H i observations. This sample of galaxies, which we call H i-rich barred galaxies, was identified with the help of Galaxy Zoo to find galaxies hosting a strong bar, and the Arecibo Legacy Fast Arecibo L-band Feed Array blind H i survey to identify galaxies with a high H i content. The combination of strong bar and high gas fraction is rare, so this set of six galaxies is the largest sample of its type with resolved H i observations. We measure the gas fractions, H i morphology and kinematics, and use archival optical data from the Sloan Digital Sky Survey to reveal star formation histories and bar properties. The galaxies with the lowest gas fractions (still very high for their mass) show clear H i holes, dynamically advanced bars, and low star formation rates, while those with the highest gas fractions show little impact from their bar on the H i morphology, and are still actively star-forming. These galaxies support a picture in which the movement of gas by bars can lead to star formation quenching. How these unusual galaxies came to be is an open question.
The evolution of rest-frame UV properties, Ly α EWs, and the SFR–stellar mass relation at z ∼ 2–6 for SC4K LAEs
Authors: Santos S , Sobral D , Matthee J , Calhau J , da Cunha E , Ribeiro B , Paulino-Afonso A , Arrabal Haro P , Butterworth J
Published: January 2020

We explore deep rest-frame UV to FIR data in the COSMOS field to measure the individual spectral energy distributions (SED) of the ∼4000 SC4K (Sobral et al.) Lyman α (Ly α) emitters (LAEs) at z ∼ 2–6. We find typical stellar masses of 109.3 ± 0.6 M⊙ and star formation rates (SFR) of SFR$_{\rm SED}=4.4^{+10.5}_{-2.4}$ M⊙ yr−1 and SFR$_{\rm Ly\,\alpha }=5.9^{+6.3}_{-2.6}$ M⊙ yr−1, combined with very blue UV slopes of $\beta =-2.1^{+0.5}_{-0.4}$, but with significant variations within the population. MUV and β are correlated in a similar way to UV-selected sources, but LAEs are consistently bluer. This suggests that LAEs are the youngest and/or most dust-poor subset of the UV-selected population. We also study the Ly α rest-frame equivalent width (EW0) and find 45 ‘extreme’ LAEs with EW0 > 240 Å (3σ), implying a low number density of (7 ± 1) × 10−7 Mpc−3. Overall, we measure little to no evolution of the Ly α EW0 and scale length parameter (w0), which are consistently high (EW$_0=140^{+280}_{-70}$ Å, $w_0=129^{+11}_{-11}$ Å) from z ∼ 6 to z ∼ 2 and below. However, w0 is anticorrelated with MUV and stellar mass. Our results imply that sources selected as LAEs have a high Ly α escape fraction (fesc,Ly α) irrespective of cosmic time, but fesc,Ly α is still higher for UV-fainter and lower mass LAEs. The least massive LAEs (<109.5 M⊙) are typically located above the star formation ‘main sequence’ (MS), but the offset from the MS decreases towards z ∼ 6 and towards 1010 M⊙. Our results imply a lack of evolution in the properties of LAEs across time and reveals the increasing overlap in properties of LAEs and UV-continuum selected galaxies as typical star-forming galaxies at high redshift effectively become LAEs.