bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical Comparison of Three Internal Fixation Techniques for Stabilizing Posterior Pelvic Ring Disruption: A 3D Finite Element Analysis
Authors: Hu Pan , Wu Tao , Wang Hui‐zhi , Qi Xin‐zheng , Yao Jie , Cheng Xiao‐dong , Chen Wei , Zhang Ying‐ze
Published: March 2019

Objective

To compare the biomechanical stability and compatibility of two iliosacral screws (ISS), a tension band plate (TBP), and a minimally invasive adjustable plate (MIAP) for treating Tile C pelvic fractures.

Methods

Three groups of finite element models of the intact pelvis, including the main ligament and the proximal one‐third of both femurs, were developed to simulate vertical sacral fractures and treated with the three abovementioned internal fixation techniques. A 500 N vertical load, a 500 N vertical load plus a 10 Nm moment of forward sagittal direction, and 500 N vertical load plus a 10 Nm moment of right lateral direction were applied to the sacrum to simulate standing status, bending status, and flexion status, respectively. The maximum displacement value, the stress value, and the stress value of the fracture interface were compared among the three internal fixation techniques.

Results

The results showed that all three internal fixation techniques effectively restored the biomechanical transmission of the injured pelvis. The stress on the implants in the TBP model was 167.47% and 53.41% higher than that in the ISS model and the MIAP model, respectively, and the stress shielding phenomenon of the TBP model was more obvious than in the other two models. Meanwhile, the stress between the fracture interfaces in the TBP fixation models was apparently higher than that in the other two models. However, the vertical displacement of the MIAP model was not significantly different from that in the ISS and TBP model; therefore, strong fixation could be obtained in all three models.

Conclusion

Based on our results, we believe that the stability of Tile C pelvic fracture fixed with MIAP was similar to that of fractures fixed with ISS and TBP, but the stress shielding phenomenon and safety of implants in the TBP models were inferior to those in the MIAP and ISS fixation models. Meanwhile, MIAP and ISS fixation were more helpful to the healing processing than was TBP fixation, especially at the fracture interface of the second and third vertebral body levels.
CT‐based Morphometric Analysis of Approach of Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion
Authors: Zhang Kai‐hui , Zhang Wei‐hao , Xu Bao‐shan , Dong Xiao‐man , Guo Lin , Du Li‐long , Xu Hai‐wei
Published: March 2019

Objectives

A radiographic study was designed to measure the relationship of the exiting nerve root and its surroundings to the corresponding intervertebral disc for percutaneous transforaminal endoscopic lumbar interbody fusion to better understand the regional anatomy and to improve clinical applications.

Methods

A retrospective study from January 2017 to October 2017 was conducted at Tianjin Hospital. CT images were obtained from patients presenting low back pain (110 patients), and analysis was performed bilaterally from L2‐3 to L5S1. In the rotating coronal plane we analyzed: the nerve root–dural sac distance at the superior and inferior margins of the disc (Js, Ji); the nerve root–pedicle distance at the medial, middle, and lateral borders of the pedicle (Pa, Pb, Pc); the pedicle width (W); and the safe working zone, defined as a trapezoid bounded by the inferior pedicle and the exiting nerve root (S). In the transverse plane, the nerve root‐articular process and the shortest distance for the nerve root‐articular process joint surface were analyzed at the superior and inferior margins of the disc (Gs, Gi), respectively. The groups were analyzed using ANOVA, and paired t‐tests were used to compare the left and right sides.

Results

From L2‐3 to L5S1, the distance of the nerve root to the dural sac was larger at the inferior margin of the disc. From L2‐3 to L5S1, each segment of the vertebral nerve root‐pedicle distance gradually decreased from medial to lateral. From L2‐3 to L5S1, the distance from the exiting nerve root to the middle and lateral margins of the pedicle gradually decreased, with L5S1 being the minimum. Some significant differences were observed between the left and right sides for L4‐5 and L5S1. The pedicle width of the vertebral body and the mean area for the safe working zone gradually increased from L2‐3 to L5S1. In the axial plane, the shortest distance between the nerve root and articular process joint surface at the inferior margin of the disc was greater than the distance for the nerve root to the articular process at the superior margin of the disc from L2‐3 to L5S1. There were no significant differences between the two sides.

Conclusions

It is more difficult to implant a cage with a width of 10 mm above the L3‐4 level. By removing part of the superior articular process, the safe working area can be expanded, and damage to the nerve or other structures can be avoided when implanting a cage.
Larval but not adult xanthophore pigmentation in zebrafish requires GTP cyclohydrolase 2 (gch2) function
Authors: Lister James A.
Published: March 2019

Although xanthophores are found widely among poikilothermic species, the developmental and biochemical pathways underlying differentiation of these pteridine‐ and carotenoid‐containing cells remain murky. I have identified a recessive zebrafish mutant, camembert (cmm), which displays defective xanthophore pigmentation during embryonic and larval stages with cells appearing grayish rather than yellow, but as an adult appears to have normally pigmented xanthophores and wild‐type stripe pattern. Examination of molecular markers reveals that xanthophores are present in typical numbers and position in cmm embryos; however, the localization of transcripts for the gene GTP cyclohydrolase 2 (gch2), encoding a critical protein in the pteridine biosynthetic pathway, is strikingly altered. RT‐PCR analysis indicates that gch2 transcripts in mutant embryos skip an exon or retain the intron upstream and that no correctly spliced mRNA is made. Sequencing of genomic DNA reveals that the skipped exon is intact, but the retained intron contains a deletion of approximately 180 base pairs, just upstream of the splice acceptor. Microinjection of a gch2 BAC clone rescues yellow pigmentation in camembert larvae, confirming that the pigmentation defect is due to mutation of gch2.
Indication for voiding cystourethrography during first urinary tract infection
Authors: Kobayashi Yoshinori , Mishina Hiroki , Michihata Nobuaki , Miyasaka Mikiko , Takayama John Ichiro
Published: March 2019

Background

There is confusion surrounding the precise indications for voiding cystourethrography (VCUG) during the assessment of vesicoureteral reflex (VUR) after a first febrile urinary tract infection (UTI). The aim of this study was to determine the combination of clinical, laboratory and ultrasonography factors correlating with grades IV–V VUR in young children with a first febrile UTI.

Methods

Children 0–24 months of age who were brought to the emergency department at National Center for Child Health and Development with the diagnosis of first time febrile UTI between March 2004 and May 2011, were enrolled. We compared clinical, laboratory and ultrasonography findings between children with grades IV–V VUR (high‐grade VUR) and those with no or grades I–III VUR (normal or low‐grade VUR).

Results

A total of 231 patients were eligible and 19 had high‐grade VUR. Poor clinical appearance, presence of a uropathogen other than Escherichia coli, positive blood culture, hydroureter and thickened renal pelvic wall were all independently associated with high‐grade VUR. When one or more of these factors were present, sensitivity, specificity, positive or negative predictive value, and positive or negative likelihood ratio were 94.7%, 69.4%, 23.1%, 99.3%, 3.1 and 0.1, respectively. When none of the factors was present, the proportion of high‐grade VUR was 0.7%; if one factor, 11.3%; two factors, 55.6%; three factors, 85.7%.

Conclusions

In the absence of five specific factors during the first febrile UTI episode in young children, VCUG is not necessary to detect high‐grade VUR. When more than one factor is present, however, VCUG is indicated.
What is quantum information?
Authors: Duwell Armond
Published: March 2019

Since the early 90s, philosophers and physicists have been asking the question, “What is quantum information?” In this paper, I will present Shannon and quantum information theories and a minimal interpretation of them which has come to be known as the deflationary view of information. I will present several criticisms that have been leveled at the deflationary view of quantum information and offer responses. This will provide the reader an up‐to‐date view of the debate over the nature of quantum information.
Operational Role of Retail Bundling and Its Implications in a Supply Chain
Authors: Cao Qingning , Geng Xianjun , Stecke Kathryn E. , Zhang Jun
Published: March 2019

We study the impacts of retail bundling on a supply chain with a manufacturer and a retailer. The retailer orders a primary product from the manufacturer before demand uncertainty materializes, and can retail it in a bundle with a secondary product afterwards. Our findings reveal three effects of bundling. First, bundling can help a retailer mitigate the adverse consequences of demand uncertainty in the primary product and price‐discriminate customers of the secondary product. Second, bundling can lower the retailer’s wholesale‐price elasticity and partition the retailer’s ordering decision into bundling and no‐bundling regions, between which there is a marked drop in the retailer’s optimal order quantity. Third, bundling affects the manufacturer’s wholesale price decision in an unexpected way: The manufacturer may lower the wholesale price when the retailer bundles. Our analysis shows bundling benefits the manufacturer, but can sometimes hurt the retailer. Further, when uncertainty in retail order is considered, while the manufacturer always benefits from retail bundling in expectation, it might be worse off with bundling depending on the realization of the uncertain market size. This explains why retail bundling has been a concern to some major manufacturers whereas they do not prohibit bundling up front.
Victim and Perpetrator Groups’ Divergent Perspectives on Collective Violence: Implications for Intergroup Relations
Authors: Bilali Rezarta , Vollhardt Johanna Ray
Published: March 2019

Groups in conflict develop strikingly different construals of the same violent events. These clashing perceptions of past violence can have detrimental consequences for intergroup relations and might provoke new hostilities. In this article, we integrate and juxtapose what we know about construals of collective violence by delineating the different dimensions along which these construals differ between victim and perpetrator groups: regarding the question of who is the victim, who is responsible for the harm doing, what the perpetrator’s intent was, how severe the violence was, and when it took place. Then, we discuss the individual‐ and group‐level factors (e.g., collective narratives, social identities) that shape these construals, as well as their implications for attitudes regarding the conflict and support for relevant policies. We distinguish two different core motives that drive construals and their outcomes among victim and perpetrator groups: Perpetrator groups try to cope with moral identity threats and preserve a positive image of the ingroup, while victim groups try to protect their ingroup from future harm doing and desire acknowledgment of their group’s experiences. Lastly, we discuss implications for strategies and interventions to address victim and perpetrator groups’ divergent perspectives of collective violence.
Implant placement in fresh extraction sockets
Authors: Blanco Juan , Carral Cristina , Argibay Olalla , Liñares Antonio
Published: March 2019

Recent systematic reviews have shown that the survival rate of immediate implant placement is similar to those with a delayed approach. However, preclinical models and human studies have shown that immediate implant placement per se does not preserve the anatomy of the alveolus, mainly at the buccal bone crest, leading to bony dehiscences and subsequently to soft‐tissue recession, with a great impact on esthetic outcomes. On the other hand, preclinical and human studies have identified factors that may prevent bone resorption after immediate implant placement, such as anatomical/biological (alveolus, gingival biotype, periapical/periodontal pathology) and surgical/restorative ones (implant diameter and positioning, flap/flapless, bone and connective tissue grafts, immediate loading/provisionalization, antibiotics). Taking these factors together and with a critical treatment plan made by an expert professional, the immediate treatment approach could be possible and beneficial for the patient.
Adaptation of the toxic freshwater cyanobacterium Microcystis aeruginosa to salinity is achieved by the selection of spontaneous mutants
Authors: Melero‐Jiménez Ignacio José , Martín‐Clemente Elena , García‐Sánchez María Jesús , Flores‐Moya Antonio , Bañares‐España Elena
Published: March 2019

The cyanobacterium Microcystis aeruginosa causes most of the harmful toxic blooms in freshwater ecosystems. Some strains of M. aeruginosa tolerate low‐medium levels of salinity, and because salinization of freshwater aquatic systems is increasing worldwide it is relevant to know what adaptive mechanisms allow tolerance to salinity. The mechanisms involved in the adaptation of M. aeruginosa to salinity (acclimation vs. genetic adaptation) were tested by a fluctuation analysis design, and then the maximum capacity of adaptation to salinity was studied by a ratchet protocol experiment. Whereas a dose of 10 g NaCl L−1 completely inhibited the growth of M. aeruginosa, salinity‐resistant genetic variants, capable of tolerating up to 14 g NaCl L−1, were isolated in the fluctuation analysis experiment. The salinity‐resistant cells arose by spontaneous mutations at a rate of 7.3 × 10−7 mutants per cell division. We observed with the ratchet protocol that three independent culture populations of M. aeruginosa were able to adapt to up to 15.1 g L−1 of NaCl, suggesting that successive mutation‐selection processes can enhance the highest salinity level to which M. aeruginosa cells can initially adapt. We propose that increasing salinity in water reservoirs could lead to the selection of salinity‐resistant mutants of M. aeruginosa.
Treatment of interstitial lung disease: Do the ends justify the means?
Authors: Kass Daniel J.
Published: March 2019

See related Article
Tuberculous mediastinal lymphadenopathy: Reaching the target
Authors: Kalsdorf Barbara , Lange Christoph
Published: March 2019

See related Article
Optimal Social Insurance with Endogenous Health*
Authors: Laun Tobias
Published: March 2019

In this paper, I analyze optimal insurance against unemployment and disability in a private information economy with endogenous health and search effort. Individuals can reduce the probability of becoming disabled by exerting prevention effort. I show that the optimal sequence of consumption is increasing for a working individual and constant for a disabled individual. During unemployment, decreasing benefits are not necessarily optimal. The prevention constraint implies increasing benefits while the search constraint demands decreasing benefits while being unemployed. However, if individuals respond sufficiently to search incentives, the latter effect dominates the former and the optimal consumption sequence is decreasing during unemployment.
A new HLA‐C allele, HLA‐C*15:144, identified in a Chinese family
Authors: Ai Xiaofei , Wang Jiying , Zhang Yan , Li Qinghua , Wang Xiaojing
Published: March 2019

HLA‐C*15:144 differs from HLA‐C*15:07 (343G‐>A, G91R).
Timing of combination antiretroviral therapy (cART) initiation is not associated with stillbirth among HIV‐infected pregnant women in Malawi
Authors: Msukwa Malango T. , Keiser Olivia , Jahn Andreas , van Oosterhout Joep J. , Edmonds Andrew , Phiri Nozgechi , Manjomo Ronald , Davies Mary‐Ann , Estill Janne
Published: March 2019

Objective

To assess the association between timing of maternal combination ART (cART) initiation and stillbirth among HIV‐infected pregnant women in Malawi's Option B+ programme.

Methods

Cohort study of HIV‐infected pregnant women delivering singleton live or stillborn babies at ≥28 weeks of gestation using routine data from maternity registers between 1 January 2012 and 30 June 2015. We defined stillbirth as death of a foetus at ≥28 weeks of gestation. We report proportions of stillbirth according to timing of maternal cART initiation (before pregnancy, 1st or 2nd trimester, or 3rd trimester or labour). We used logistic regression, with robust standard errors to account for clustering of women within health facilities, to investigate the association between timing of cART initiation and stillbirth.

Results

Of 10 558 mother–infant pairs abstracted from registers, 8380 (79.4%) met inclusion criteria. The overall rate of stillbirth was 25 per 1000 deliveries (95% confidence interval 22–29). We found no significant association between timing of maternal cART initiation and stillbirth. In multivariable models, older maternal age, male sex of the infant, breech vaginal delivery, delivery at < 34 weeks of gestation and experience of any maternal obstetric complication were associated with higher odds of stillbirth. Deliveries managed by a mission hospital or health centre were associated with lower odds of stillbirth.

Conclusion

Pregnant women's exposure to cART, regardless of time of its initiation, was not associated with increased odds of stillbirth.
El análisis de las diferencias en el proceso de transferencia de tecnología entre regiones
Authors: Caicedo Asprilla Henry
Published: March 2019

Este artículo analiza la transferencia de tecnología entre regiones, con base en la teoría de redes sociales. Se aplicó el método del ARS a 137 regiones de diferente nivel de desarrollo, y se encontró que la transferencia de tecnología varía en dos sentidos: en uno lineal, en donde las regiones más desarrolladas, derraman conocimiento a las de menor nivel de desarrollo. Y en uno no lineal e interactivo, en donde las regiones desarrolladas y las de menor nivel de desarrollo intercambian conocimiento. También se verificó que existen regiones más transmisoras que receptoras, así como regiones más receptoras que transmisoras de tecnología. Se concluye que todas las regiones tienen algún conocimiento que ofrecer, pero también algún conocimiento que necesitan adquirir.
In-Ground-Effect Modeling and Nonlinear-Disturbance Observer for Multirotor Unmanned Aerial Vehicle Control
Authors: He Xiang , Kou Gordon , Calaf Marc , Leang Kam K.
Published: March 2019

This paper focuses on modeling and control of in-ground-effect (IGE) on multirotor unmanned aerial vehicles (UAVs). As the vehicle flies and hovers over, around, or underneath obstacles, such as the ground, ceiling, and other features, the IGE induces a change in thrust that drastically affects flight behavior. This effect on each rotor can be vastly different as the vehicle's attitude varies, and this phenomenon limits the ability for precision flight control, navigation, and landing in tight and confined spaces. An exponential model describing this effect is proposed, analyzed, and validated through experiments. The model accurately predicts the quasi-steady IGE for an experimental quadcopter UAV. To compensate for the IGE, a model-based feed-forward controller and a nonlinear-disturbance observer (NDO) are designed for closed-loop control. Both controllers are validated through physical experiments, where results show approximately 23% reduction in the tracking error using the NDO compared to the case when IGE is not compensated for.
The Influence of Cylindrical Spray Chamber Geometry on the Evolution of High Pressure Diesel Sprays
Authors: Nguyen Dung , Honnery Damon
Published: March 2019

While much is known on the effect of combustion chamber geometry on spray evolution in engines, less is known about its role in laboratory combustion chambers. This paper reports on a study, which investigates the effect of internal chamber geometry on the penetration and spreading angle of common rail nonreacting diesel sprays at room temperature conditions in a cylindrical constant volume chamber. This chamber has dimensions similar to those used in the literature. Spray chamber geometry was modified to yield three different chamber height-to-diameter ratios and two different nozzle stand-off distances. Sprays from three nozzles, two single-hole nozzles with different diameter and one twin-hole nozzle (THN), were examined for two injection pressures of 100 MPa and 150 MPa into two chamber pressures of 0.1 MPa and 5 MPa. To characterize the spray structure, a volume illumination method was used to study the spray tip penetration/speed and spread angle. For both injection pressures used with chamber pressure of 5 MPa, little sensitivity to vessel geometry was found in penetration distance and tip speed for variation in height to diameter ratio from 0.6 to 2.6 and variation in nozzle stand-off distance from 2 mm to 54 mm. For atmospheric chamber pressure, sensitivity to chamber geometry was evident and found to vary with nozzle type. Spread angle was found more largely affected by the calculation method and very sensitive to the image intensity threshold value for the cases investigated.
Online Analytics Framework of Sensor-Driven Prognosis and Opportunistic Maintenance for Mass Customization
Authors: Xia Tangbin , Fang Xiaolei , Gebraeel Nagi , Xi Lifeng , Pan Ershun
Published: March 2019

In mass customization, a manufacturing line is required to be kept in reliable operation to handle product demand volatility and potential machine degradations. Recent advances in data acquisition and processing allow for effective maintenance scheduling. This paper presents a systematic framework that integrates a sensor-driven prognostic method and an opportunistic maintenance policy. The prognostic method uses degradation signals of each individual machine to predict and update its time-to-failure (TTF) distributions in real time. Then, system-level opportunistic maintenance optimizations are dynamically made according to real-time TTF distributions and variable product orders. The online analytics framework is demonstrated through the case study based on the collected reliability information from a production line of engine crankshaft. The results can effectively prove that the real-time degradation updating and the opportunistic maintenance scheduling can efficiently reduce maintenance cost, avoid system breakdown, and ensure product quality. Furthermore, this framework can be applied not only in an automobile line but also for a broader range of manufacturing lines in mass customization.
High-fructose corn syrup enhances intestinal tumor growth in mice
Authors: Goncalves Marcus D. , Lu Changyuan , Tutnauer Jordan , Hartman Travis E. , Hwang Seo-Kyoung , Murphy Charles J , Pauli Chantal , Morris Roxanne , Taylor Sam , Bosch Kaitlyn , Yang Sukjin , Wang Yumei , Van Riper Justin , Lekaye H Carl , Roper Jatin , Kim Young , Chen Qiuying , Gross Steven S. , Rhee Kyu Y. , Cantley Lewis C. , Yun Jihye
Published: March 2019

A sweetener's not-so-sweet effects

Obesity increases an individual's risk of developing many types of cancer, including colorectal cancer. One of the factors driving the rise in obesity rates is thought to be the use of high-fructose corn syrup (HFCS) as a sweetener in soft drinks. Goncalves
et al.
found that ingestion of HFCS promotes the growth of intestinal cancer even in the absence of obesity in mouse tumor models. An enzyme in tumors (ketohexokinase) converts fructose to fructose-1-phosphate, which alters tumor cell metabolism and leads to enhanced cell growth. Whether a similar process occurs in humans remains to be seen.

Science
, this issue p.
1345
The reductive coupling of dinitrogen
Authors: Légaré Marc-André , Rang Maximilian , Bélanger-Chabot Guillaume , Schweizer Julia I. , Krummenacher Ivo , Bertermann Rüdiger , Arrowsmith Merle , Holthausen Max C. , Braunschweig Holger
Published: March 2019

Boron brings nitrogen together

Whereas carbon is prone to making chains, nitrogen usually sticks to itself just once in the particularly stable form of N
2
. Légaré
et al.
now show that boron can coax two N
2
molecules together under reductive conditions below room temperature. Two borylene units sandwiched the resulting N
4
chain between them.

Science
, this issue p.
1329
Comment on “Insulator-metal transition in dense fluid deuterium”
Authors: Desjarlais Michael P. , Knudson Marcus D. , Redmer Ronald
Published: March 2019

Celliers
et al
. (Reports, 17 August 2018, p. 677), in an attempt to reconcile differences in inferred metallization pressures, provide an alternative temperature analysis of the Knudson
et al
. experiments (Reports, 26 June 2015, p. 1455). We show that this reanalysis implies an anomalously low specific heat for the metallic fluid that is clearly inconsistent with first-principles calculations.
Adversarial attacks on medical machine learning
Authors: Finlayson Samuel G. , Bowers John D. , Ito Joichi , Zittrain Jonathan L. , Beam Andrew L. , Kohane Isaac S.
Published: March 2019

Emerging vulnerabilities demand new conversations
A cytochrome P450 allele confers pyrethroid resistance on a major African malaria vector, reducing insecticide-treated bednet efficacy
Authors: Weedall Gareth D. , Mugenzi Leon M. J. , Menze Benjamin D. , Tchouakui Magellan , Ibrahim Sulaiman S. , Amvongo-Adjia Nathalie , Irving Helen , Wondji Murielle J. , Tchoupo Micareme , Djouaka Rousseau , Riveron Jacob M. , Wondji Charles S.
Published: March 2019

A cytochrome P450 DNA marker in a major mosquito vector of malaria indicates that pyrethroid resistance reduces bednet efficacy.
Advances in artificial pancreas systems
Authors: Boughton Charlotte K. , Hovorka Roman
Published: March 2019

The artificial pancreas for managing type 1 diabetes has progressed from research into clinical practice, revealing areas for future advancements.
Conserved Pyridoxal 5'-Phosphate-Binding Protein YggS Impacts Amino Acid Metabolism through Pyridoxine 5'-Phosphate in
Escherichia coli
Authors: Ito Tomokazu , Yamamoto Kana , Hori Ran , Yamauchi Ayako , Downs Diana M. , Hemmi Hisashi , Yoshimura Tohru
Published: March 2019

Recent studies showed that deletion or mutation of members of the YggS protein family causes pleiotropic effects in many organisms. Little is known about the causes, mechanisms, and consequences of these diverse phenotypes. It was previously shown that
yggS
mutations in
E. coli
result in the accumulation of PNP and some metabolites in the Ile/Val biosynthetic pathway. This work revealed that some exogenous stresses increase the aberrant accumulation of PNP in the
yggS
mutant. In addition, the current report provides evidence indicating that some, but not all, of the phenotypes of the
yggS
mutant in
E. coli
are due to the elevated PNP level. These results will contribute to continuing efforts to determine the molecular functions of the members of the YggS protein family.
Whole-Genome Sequences of a Cluster of 14 Unidentified Related
Veillonella
sp. Strains from Human Clinical Samples and Type Strains of 3
Veillonella
Validated Species
Authors: Aujoulat Fabien , Popoff Michel R. , Diancourt Laure , Criscuolo Alexis , Jean-Pierre Hélène , Jumas-Bilak Estelle , Marchandin Hélène
Published: March 2019

We report 17 draft genomes for 14 unidentified
Veillonella
sp. strains closely related in 16S rRNA gene-based phylogeny and type strains of 3
Veillonella
species with the aims of deciphering relationships between related species, evaluating the accuracy of current thresholds for species delineation, and robustly describing new species in the genus.
Blocking a rash diagnosis: a rare case of infective endocarditis
Authors: Halford Brittne , Piazza Mariah Barstow , Berka Haley , Taylor Caitlin
Published: March 2019

We report a case of a previously healthy, afebrile patient who presented with subacute bilateral lower extremity rash and complete heart block, which was later found to be secondary to infective endocarditis. His transoesophageal echocardiogram detected multiple vegetations and blood cultures were positive forGranulicatella adiacens, a nutritionally variant streptococcus that is a normal component of oral flora and thought to be responsible for approximately 5% of all cases of streptococcal endocarditis. Due to concerns for renal failure, the patient was treated with an unconventional regimen of ampicillin and ceftriaxone. He underwent a valve replacement and pacemaker placement and has done well since hospital discharge.
Iatrogenic transverse myelitis in a patient with rheumatoid arthritis
Authors: Sarathchandran Pournamy , Alboudi Ayman , AlSuwaidi Reem , Almadani Abubaker AbdulRahman
Published: March 2019

We report the case of a 59-year-old Arab woman who was presented with acute onset of neck pain followed by quadriparesis, paraesthesias of lower limbs and incontinence of urine. Examination revealed asymmetric sensorimotor quadriparesis with sensory level at T1, establishing a clinical diagnosis of transverse myelitis. Cervical and thoracic spinal MRI showed enhancing T2/fluid attenuated inversion recovery (FLAIR) hyperintense lesion extending from C4 to C7 level in addition to long-segment lesion extending the whole of the spinal cord. She was known to have rheumatoid arthritis for the past 20 years and has been on etanercept for the past 8 years and methotrexate since past 3 years. Etanercept was stopped and she was treated with methylprednisolone followed by oral steroids and physiotherapy with which she had near complete recovery.
Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults
Authors: Zhao Min , Veeranki Sreenivas P , Li Shengxu , Steffen Lyn M , Xi Bo
Published: March 2019

Background

Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all-cause, cardiovascular disease (CVD) and cancer-specific mortality.

Methods

Data were from 12 waves of the National Health Interview Surveys (1997–2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40–85 years were included.

Results

Compared with inactive individuals, those performing 10–59 min/week of PA had 18% lower risk of all-cause mortality (hazard ratio (HR): 0.82, 95% confidence interval (CI): 0.72–0.95). Those who reported 1–2 times (150–299 min/week) the recommended level of leisure time PA had 31% (HR: 0.69, 95%CI: 0.63–0.75) reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times (≥1500 min/week) the recommended minimum level (HR: 0.54, 95% CI: 0.45–0.64). For 10–59, 150–299 and ≥1500 min/week of PA, the corresponding HRs (95% CIs) for CVD-specific mortality were 0.88 (0.67–1.17), 0.63 (0.52–0.78) and 0.67 (0.45–0.99), respectively: for cancer-specific mortality were 0.86 (0.66–1.11), 0.76 (0.64–0.89) and 0.53 (0.39–0.73), respectively. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA.

Conclusions

We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits.
Prenatal and infant exposure to ambient pesticides and autism spectrum disorder in children: population based case-control study
Authors: von Ehrenstein Ondine S , Ling Chenxiao , Cui Xin , Cockburn Myles , Park Andrew S , Yu Fei , Wu Jun , Ritz Beate
Published: March 2019

Objective

To examine associations between early developmental exposure to ambient pesticides and autism spectrum disorder.

Design

Population based case-control study.

Setting

California’s main agricultural region, Central Valley, using 1998-2010 birth data from the Office of Vital Statistics.

Population

2961 individuals with a diagnosis of autism spectrum disorder based on the
Diagnostic and Statistical Manual of Mental Disorders
, fourth edition, revised (up to 31 December 2013), including 445 with intellectual disability comorbidity, were identified through records maintained at the California Department of Developmental Services and linked to their birth records. Controls derived from birth records were matched to cases 10:1 by sex and birth year.

Exposure

Data from California state mandated Pesticide Use Reporting were integrated into a geographic information system tool to estimate prenatal and infant exposures to pesticides (measured as pounds of pesticides applied per acre/month within 2000 m from the maternal residence). 11 high use pesticides were selected for examination a priori according to previous evidence of neurodevelopmental toxicity in vivo or in vitro (exposure defined as ever
v
never for each pesticide during specific developmental periods).

Main outcome measure

Odds ratios and 95% confidence intervals using multivariable logistic regression were used to assess associations between pesticide exposure and autism spectrum disorder (with or without intellectual disabilities) in offspring, adjusting for confounders.

Results

Risk of autism spectrum disorder was associated with prenatal exposure to glyphosate (odds ratio 1.16, 95% confidence interval 1.06 to 1.27), chlorpyrifos (1.13, 1.05 to 1.23), diazinon (1.11, 1.01 to 1.21), malathion (1.11, 1.01 to 1.22), avermectin (1.12, 1.04 to 1.22), and permethrin (1.10, 1.01 to 1.20). For autism spectrum disorder with intellectual disability, estimated odds ratios were higher (by about 30%) for prenatal exposure to glyphosate (1.33, 1.05 to 1.69), chlorpyrifos (1.27, 1.04 to 1.56), diazinon (1.41, 1.15 to 1.73), permethrin (1.46, 1.20 to 1.78), methyl bromide (1.33, 1.07 to 1.64), and myclobutanil (1.32, 1.09 to 1.60); exposure in the first year of life increased the odds for the disorder with comorbid intellectual disability by up to 50% for some pesticide substances.

Conclusion

Findings suggest that an offspring’s risk of autism spectrum disorder increases following prenatal exposure to ambient pesticides within 2000 m of their mother’s residence during pregnancy, compared with offspring of women from the same agricultural region without such exposure. Infant exposure could further increase risks for autism spectrum disorder with comorbid intellectual disability.
Commitments by the biopharmaceutical industry to clinical trial transparency: the evolving environment
Authors: Baronikova Slavka , Purvis Jim , Southam Eric , Beeso Julie , Panayi Antonia , Winchester Christopher
Published: March 2019

Clinical trial sponsors have ethical obligations to register protocols, report study results and comply with applicable legal requirements. To evaluate public commitments to trial disclosure and rates of disclosure by members and non-members of the European Federation of Pharmaceutical Industries and Associations (EFPIA) and/or the Pharmaceutical Research and Manufacturers of America (PhRMA). Websites of the top 50 biopharmaceutical companies by 2015 sales were searched for statements relating to trial data disclosure. Disclosure of trial results completed by biopharmaceutical industry and non-industry sponsors of at least 30 trials (2006–2015) was assessed using TrialsTracker. Among the top 50 companies, 30 were EFPIA/PhRMA members and 20 were non-members, of which 26 and none, respectively, had a statement on their website committing to the disclosure of trials data. Of 29 377 trials in TrialsTracker, 9511 were industry sponsored (69 companies) and 19 866 were non-industry sponsored (254 institutions). The overall mean disclosure rate was 55%, with higher rates for industry (74%) than for non-industry sponsors (46%). Of the 30 companies within the top 50 with data in TrialsTracker, the mean disclosure rate was 76% (77% for EFPIA/PhRMA members [n=25] vs 67% for non-members [n=5]). Most of the top 50 biopharmaceutical companies have publicly committed to the disclosure of trial data. Industry sponsors have responded to the ethical and legal demands of trial disclosure by disclosing three quarters of their trials compared with less than half for non-industry sponsors. Further improvements in clinical trial disclosure are needed.
Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work–life balance and happiness
Authors: Sexton J Bryan , Adair Kathryn C
Published: March 2019

Objectives

High rates of healthcare worker (HCW) burn-out have led many to label it an ‘epidemic’ urgently requiring interventions. This prospective pilot study examined the efficacy, feasibility and evaluation of the ‘Three Good Things’ (3GT) intervention for HCWs, and added burn-out and work–life balance to the set of well-being metrics.

Methods

228 HCWs participated in a prospective, repeated measures study of a web-based 15-day long 3GT intervention. Assessments were collected at baseline and 1, 6 and 12-month post-intervention. The primary measure of efficacy was a derivative of the emotional exhaustion subscale of the Maslach Burnout Inventory. The secondary measures were validated instruments assessing depression symptoms, subjective happiness, and work–life balance. Paired samples t-tests and Cohen’s d effect sizes for correlated samples were used to examine the efficacy of the intervention.

Results

3GT participants exhibited significant improvements from baseline in emotional exhaustion, depression symptoms and happiness at 1 month, 6 months and 12 months, and in work–life balance at 1 month and 6 months (effect sizes 0.16–0.52). Exploratory subgroup analyses of participants meeting ‘concerning’ criteria at baseline revealed even larger effects at all assessment points (0.55–1.57). Attrition rates were similar to prior 3GT interventions.

Conclusion

3GT appears a promising low-cost and brief intervention for improving HCW well-being.

Ethics and dissemination

This study is approved by the Institutional Review Board of Duke University Health System (Pro00063703). All participants are required to give their informed consent prior to any study procedure.
Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study
Authors: Kailasam Manimegalai , Guo Wenjia , Hsann Yin Maw , Yang Kok Soong
Published: March 2019

Objective

To measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care.

Design

A retrospective cross-sectional study.

Setting

Specialist outpatient clinics (SOCs) in a Singapore regional hospital.

Participants

A total of 40 333 patients aged 21 and above with at least two SOC visits in the year 2016. Data for 146 792 physician consultation visits were used in the analysis and visits for allied health services and medical procedures were excluded.

Outcome measures

The Fragmentation of Care Index (FCI) was used to measure care fragmentation for specialist outpatients. Log-linear regression with stepwise selection was used to investigate the association between FCI and patient age, gender, race and Most Frequently Visited Specialty (MFVS), controlling for number of different specialities seen.

Results

About 36% experienced fragmented care (FCI >0) and their mean FCI was 0.70 (SD=0.20). FCI was found to be positively associated with age (p<0.001). Patients who most frequently visited Haematology, Endocrinology and Anaesthesiology specialities were associated with more fragmented care while those who most frequently visited Medical Oncology, Ophthalmology and Orthopaedics Surgery specialities were associated with less fragmented care.

Conclusion

Multispecialty care fragmentation was found to be moderately high in the outpatient specialist clinics and was found to be associated with patients’ age and certain medical specialties. With an ageing population and a rising prevalence of multimorbidity, healthcare providers should seek to eliminate unnecessary referrals to reduce the extent of care fragmentation.
HIV risk and pre-exposure prophylaxis interest among female bar workers in Dar es Salaam: cross-sectional survey
Authors: Harling Guy , Muya Aisa , Ortblad Katrina F , Mashasi Irene , Dambach Peter , Ulenga Nzovu , Barnhart Dale , Mboggo Eric , Oldenburg Catherine E , Bärnighausen Till , Spiegelman Donna
Published: March 2019

Objective

Female bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW’s sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa.

Design

Cross-sectional survey covering respondents’ work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC).

Setting

Eight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM).

Participants

66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit.

Results

Half of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive.

Conclusions

FBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.
Protocol for the PreventIT feasibility randomised controlled trial of a lifestyle-integrated exercise intervention in young older adults
Authors: Taraldsen Kristin , Mikolaizak A Stefanie , Maier Andrea B , Boulton Elisabeth , Aminian Kamiar , van Ancum Jeanine , Bandinelli Stefania , Becker Clemens , Bergquist Ronny , Chiari Lorenzo , Clemson Lindy , French David P , Gannon Brenda , Hawley-Hague Helen , Jonkman Nini H , Mellone Sabato , Paraschiv-Ionescu Anisoara , Pijnappels Mirjam , Schwenk Michael , Todd Chris , Yang Fan Bella , Zacchi Anna , Helbostad Jorunn L , Vereijken Beatrix
Published: March 2019

Introduction

The European population is rapidly ageing. In order to handle substantial future challenges in the healthcare system, we need to shift focus from treatment towards health promotion. The PreventIT project has adapted the Lifestyle-integrated Exercise (LiFE) programme and developed an intervention for healthy young older adults at risk of accelerated functional decline. The intervention targets balance, muscle strength and physical activity, and is delivered either via a smartphone application (enhanced LiFE, eLiFE) or by use of paper manuals (adapted LiFE, aLiFE).

Methods and analysis

The PreventIT study is a multicentre, three-armed feasibility randomised controlled trial, comparing eLiFE and aLiFE against a control group that receives international guidelines of physical activity. It is performed in three European cities in Norway, Germany, and The Netherlands. The primary objective is to assess the feasibility and usability of the interventions, and to assess changes in daily life function as measured by the Late-Life Function and Disability Instrument scale and a physical behaviour complexity metric. Participants are assessed at baseline, after the 6 months intervention period and at 1 year after randomisation. Men and women between 61 and 70 years of age are randomly drawn from regional registries and respondents screened for risk of functional decline to recruit and randomise 180 participants (60 participants per study arm).

Ethics and dissemination

Ethical approval was received at all three trial sites. Baseline results are intended to be published by late 2018, with final study findings expected in early 2019. Subgroup and further in-depth analyses will subsequently be published.

Trial registration number

NCT03065088; Pre-results.
Developing and trialling a school-based ovulatory-menstrual health literacy programme for adolescent girls: a quasi-experimental mixed-method protocol
Authors: Roux Felicity , Burns Sharyn , Chih HuiJun Jun , Hendriks Jacqueline
Published: March 2019

Introduction

A review of international and Australian school-based resources suggests that teaching of the ovulatory-menstrual (OM) cycle is predominantly couched in biology. A whole-person framework that integrates spiritual, intellectual, social and emotional dimensions with the physical changes of the OM cycle is needed to facilitate adolescent OM health literacy. This paper describes the protocol for a study that aims to develop and trial an intervention for adolescent girls aged 13–16 years that enhances positive attitudes towards OM health coupled with developing skills to monitor and self-report OM health. These skills aim to foster acceptance of the OM cycle as a ‘vital sign’ and facilitate confident communication of common OM disturbances (namely, dysmenorrhoea, abnormal uterine bleeding and premenstrual syndrome), which are known to impact school and social activities.

Methods and analysis

Phase I will comprise a Delphi panel of women’s health specialists, public health professionals and curriculum consultants and focus groups with adolescent girls, teachers and school healthcare professionals. This will inform the development of an intervention to facilitate OM health literacy. The Delphi panel will also inform the development of a valid and reliable questionnaire to evaluate OM health literacy. Phase II will trial the intervention with a convenience sample of at least 175 adolescent girls from one single-sex school. The mixed-method evaluation of the intervention will include a pre-intervention and post-intervention questionnaire. One-on-one interviews with teachers and school healthcare professionals will expand the understanding of the barriers, enablers and suitability of implementation of the intervention in a school-based setting. Finally, focus groups with purposively selected trial participants will further refine the intervention.

Ethics and dissemination

The study findings will be disseminated through local community seminars, conferences, peer-review articles and media channels where appropriate. The Curtin University of Human Research Ethics Committee has approved this study (approval HRE2018-0101). This project is registered with the ‘Australian and New Zealand Clinical Trials Registry’.

Trial registration number

ACTRN12619000031167; Pre-results.