bluuebunny/crossref_metadata_2025 huggingface dataset:
Embedded Distribution Systems for Enhanced Energy Resilience
Authors: Wang Shuoqi , Kim Amy A. , Reed Dorothy A.
Published: October 2016

Recent disruptions of communities due to natural hazard events such as hurricanes and earthquakes have led to increased calls for improved resiliency of the built environment. The “built environment” denotes constructed facilities such as buildings and bridges, as well as infrastructure systems such as power delivery, transportation roadways, and water utilities. “Resiliency” is defined here as the “recovery and adaptability” during and after events which disrupt civil infrastructure services. In the context of this paper, the critically important service is energy delivery, on which many other services such as communications and transportation networks depend. The robustness of the building energy supply can be significantly enhanced through on-site renewable sources such as photovoltaic panels coupled with storage batteries. The degree to which the energy demand is met by the on-site capacity in the future will be determined largely upon advances in renewable energy generation and storage as well as in efficiency gains for commonly used equipment and appliances such as lighting fixtures and cooling systems. In this paper, we propose an improved design approach for the energy capacity of existing and new buildings as part of a greater regional community in which the total energy capacity requirements are met through increasingly enhanced on-site permanent power links, as opposed to increased reliance on the existing power grid. The metrics for characterizing resiliency will be “robustness,” “redundancy,” “resourcefulness,” and “rapidity,” with the associated metrics for sustainability being self-reliance and intergenerational equity enhancement.
The Role of Movement Variability and Action Experience in the Perceptual Judgment of Passability
Authors: Du Wenchong , Barnett Anna , Wilmut Kate
Published: October 2016

Perception and action are tightly coupled, and previous studies have demonstrated that action experience can improve perceptual judgment. We investigated whether this improvement in perceptual judgment could be attributed to knowledge regarding movement variability being gained during action experience. Fifteen adults made perceptual judgments regarding the passability of a series of aperture sizes. These judgments were made both before and after walking through the same set of apertures (action experience). When considering the group as a whole, perceptual judgment did not change after action experience. However, when splitting the group into those with low and high preaction perceptual judgments, only those with low perceptual judgments showed an improvement in perceptual judgment following action experience, which could be explained in part by movement variability during the approach. These data demonstrate that action informs perception and that this allows adults to account for movement variability when making perceptual judgments regarding action capabilities.
Test of Gross Motor Development—Third Edition: Establishing Content and Construct Validity for Brazilian Children
Authors: Valentini Nadia C. , Zanella Larissa W. , Webster E. Kipling
Published: October 2016

The Test of Gross Motor Development is used to identify children’s level of motor proficiency, specifically to detect motor delays. This study aimed to translate the TGMD-3 items and assess reliability and content and construct validity for the TGMD-3 in Brazil. A cross-cultural translation was used to generate a Brazilian Portuguese version of the TGMD-3. The validation process involved 33 professionals and 597 Brazilian children (ages 3–10) from the five main geographic regions of Brazil. The results confirmed language clarity and pertinence, as well as face validity of the TGMD-3. High intrarater (.60 to .90) and interrater (.85 to .99) reliability was evident, and test-retest temporal stability was confirmed (locomotor .93; ball skills .81). Adequate internal consistency was present for the skills-to-test and subtests correlations (TGMD-3-BR: α .74; locomotor skills: α .63; ball skills: α .76) and performance-criteria-to-test and -subtest correlations (TGMD-3: α .93; locomotor skills: .90; ball skills: .88). Confirmatory factor analysis supported the construct validity of a two-factor model (RMSEA = .04, 90% confidence interval: .03 to .05; CFI = .94; NFI = .91; TLI = .92; GFI = .94; AGFI = .92). The TGMD-3 is a valid and reliable instrument for Brazilian children.
Psychometric Properties of the Test of Gross Motor Development, Third Edition (German Translation): Results of a Pilot Study
Authors: Wagner Matthias O. , Webster E. Kipling , Ulrich Dale A.
Published: October 2016

The Test of Gross Motor Development, 3rd Edition (TGMD-3) is a process-oriented fundamental movement skill assessment to examine the movement patterns displayed by children between the ages of 3 and 10 years. Within this paper, results of a pilot study on the reliability, validity, and measurement invariance across gender of the TGMD-3 (German translation) are presented. In total, performances of 189 typically developing children (99 boys, 90 girls, 56 kindergarten children, 133 elementary school children, Mage = 7.15 ± 2.02 years) are analyzed. Results provide preliminary evidence for test-retest, interrater and intrarater reliability, internal consistency, age- and gender- specific performance trends, factorial validity, measurement invariance across gender, divergent validity, and ball skill–related concurrent and predictive validity of the TGMD-3 (German translation). Subsequent research should be focused on a verification of the present findings on a representative database to foster the application of the TGMD-3 (German translation) in different settings.
Individual Differences in Short-Term Anticipation Training for High-Speed Interceptive Skill
Authors: Müller Sean , Gurisik Yasmin , Hecimovich Mark , Harbaugh Allen G. , Vallence Ann-Maree
Published: October 2016

Training studies in a variety of domains focus on between-group comparisons. This study investigated individual differences in learning based upon visual anticipation training using field hockey goalkeeping as the exemplar motor skill. In a within-subject design, four state-league level field hockey goalkeepers were tested before and after visual anticipatory training in an in-situ test that required them to save goals from a drag flick. Response initiation time and response accuracy were measured. Participants were tested at baseline, completed a control phase of sport-specific practice, were retested, then given an intervention phase of temporal occlusion training plus sport-specific practice, and retested. Results indicated that two goalkeepers’ response initiation times were earlier after the intervention. Effect sizes indicated that the two goalkeepers improved response accuracy after the intervention. Another goalkeeper’s response initiation time was later after the intervention, but this did not impede response accuracy of goals saved. The mechanism of individual learning appeared to be modulation of response timing to save goals. Anticipation training can improve in-situ visual-perceptual motor skill performance in an individualized and nonlinear fashion. Further research is needed to better understand how each individual learns the visual-perceptual motor skills of high time-stress tasks in the sport domain.
Understanding Brand Equity in Campus Recreational Sports: A Consumer-Based Perspective
Authors: Mills Isabell , Williams Antonio
Published: October 2016

The purpose of this study was to develop an understanding of brand equity in campus recreational sports by applying a consumer-based brand equity perspective. The study examined the relationships among attitudes toward advertising, word-of-mouth, past experiences, consumer-based brand equity, and brand loyalty in campus recreational sports. The findings of the study provide support for previous research which posits that marketing mix elements and consumer experiences influence consumer-based brand equity (Berry, 2000; Keller, 1993; Ross, 2006; Williams & Pedersen, 2012; Williams, Rhenwrick, Wright, Choi, Kim, & Vickey, 2014; Yoo & Donthu, 2001). In addition, the findings allow managers to gauge which antecedents contribute to consumer-based brand equity and aid in their selection of appropriate marketing strategies. Furthermore, the finding that brand equity has a positive relationship with brand loyalty supports previous research (Williams, Pedersen, & Walsh, 2012) and may be used as leverage for campus recreational sports departments who are seeking internal and external funding.
Benefits of Campus Recreational Sports: A Rasch Calibration
Authors: Kim Kyungun R. , Sparvero Emily S. , Olmeda Nicole
Published: October 2016

The purpose of this study is to introduce Rasch analysis as a methodological advance in recreational sports research. Specifically, the Rasch technique is illustrated through its application to an empirical investigation of college students' perceived benefits from recreational sports participation. This study seeks to develop and calibrate sources of the Perceived Benefit Scale (PBS) for recreational sports participants at the college level using the Rasch model. Survey data from 940 students at a large public university in the southwestern United States were used in the study. The Rasch analysis results demonstrated that the 15 items were confirmed a unidimensional structure with any biased items, and the four-category response format functioned well. This research shows that the PBS is a valid and reliable instrument that can be used in the campus recreational sport setting to evaluate the benefit to students and develop management strategies.
An Exploration of the Sport Club President's Experience
Authors: Flosdorf Megan L. , Carr Benjamin H. , Carr Julia Wallace , Pate Joshua R.
Published: October 2016

Extensive research has shown that sport club participation enhances student development, but little research has examined how specific officer roles in sport clubs may shape the experience. The purpose of this case study was to explore how sport club presidents at a midsized, public, four year institution in the Mid-Atlantic region described their involvement in an on-campus leadership opportunity. Eleven sport club presidents participated in the study, and shared their experiences through reflective journaling, and 30-min semistructured interviews. The researchers conducted document analysis for further review of the sport club program and president experience. Findings suggest that participation in the presidential role within the campus recreation sport club program at this institution provides an impactful developmental experience for students by enhancing specific skills that prepare students for careers beyond college more candidly than classroom education. Recommendations for sport club professionals and students regarding the outcomes associated with this ongoing campus leadership opportunity are provided.
Exploring Student Perceptions of Sales: A Case Study of a Sport-Sales Course
Authors: Sattler Liz A. , Warren Clinton
Published: October 2016

Sales pedagogy and student perceptions of sales have long been studied in business programs across college campuses. While sales pedagogy is a growing content area for sport management programs, it continues to be an area in the field in need of further understanding. The purpose of this study was to explore student perceptions of sales throughout a 16-week course. A qualitative case study methodology was used to develop a rich description of how sport management students perceive sales as a content area, and as a potential profession in the sport industry. Analysis of the themes indicates that throughout the course of the semester, students developed more holistic perceptions of sales, viewed sales as a necessary skill for many jobs in the sport industry, and were more open to a sales job as an entryway into the sport industry.
The neural basis of perceived intensity in natural and artificial touch
Authors: Graczyk Emily L. , Schiefer Matthew A. , Saal Hannes P. , Delhaye Benoit P. , Bensmaia Sliman J. , Tyler Dustin J.
Published: October 2016

Electrical connections between nerves and a prosthetic device enable amputees to discern precise, graded sensory intensity ranging from light touch to intense pressure.
Melanocortin-1 receptor activation is neuroprotective in mouse models of neuroinflammatory disease
Authors: Mykicki Nadine , Herrmann Alexander M. , Schwab Nicholas , Deenen René , Sparwasser Tim , Limmer Andreas , Wachsmuth Lydia , Klotz Luisa , Köhrer Karl , Faber Cornelius , Wiendl Heinz , Luger Thomas A. , Meuth Sven G. , Loser Karin
Published: October 2016

The approved drug NDP-MSH ameliorates neurodegeneration in mouse models of neuroinflammatory disease.
A twist of fat(e): Liposuction to treat vascular disease
Authors: Bhakta Nirav R.
Published: October 2016

Human adipose–derived stem cells produce tissue-engineered blood vessels with robust material properties and an intact endothelial lining to prevent thrombosis.
Resolvin’ inflammation
Authors: Rayner Katey J
Published: October 2016

Plaque progression was halted by inducing inflammation resolution in the blood vessel walls of a mouse model of atherosclerosis with the preresolving lipid mediator RvD1.
Identification of a New Lipoprotein Export Signal in Gram-Negative Bacteria
Authors: Lauber Frédéric , Cornelis Guy Richard , Renzi Francesco
Published: October 2016

Bacteria of the phylum
Bacteroidetes
, including commensal organisms and opportunistic pathogens, harbor abundant surface-exposed multiprotein membrane complexes (Sus-like systems) involved in carbohydrate acquisition. These complexes have been mostly linked to commensalism, and in some instances, they have also been shown to play a role in pathogenesis. Sus-like systems are mainly composed of lipoproteins anchored to the outer membrane and facing the external milieu. This lipoprotein localization is uncommon in most studied Gram-negative bacteria, while it is widespread in
Bacteroidetes
. Little is known about how these complexes assemble and particularly about how lipoproteins reach the bacterial surface. Here, by bioinformatic analyses, we identify a lipoprotein export signal (LES) at the N termini of surface-exposed lipoproteins of the human pathogen
Capnocytophaga canimorsus
corresponding to K-(D/E)
2
or Q-A-(D/E)
2
. We show that, when introduced in sialidase SiaC, an intracellular lipoprotein, this signal is sufficient to target the protein to the cell surface. Mutational analysis of the LES in this reporter system showed that the amino acid composition, position of the signal sequence, and global charge are critical for lipoprotein surface transport. These findings were further confirmed by the analysis of the LES of mucinase MucG, a naturally surface-exposed
C. canimorsus
lipoprotein. Furthermore, we identify a LES in
Bacteroides fragilis
and
Flavobacterium johnsoniae
surface lipoproteins that allow
C. canimorsus
surface protein exposure, thus suggesting that
Bacteroidetes
share a new bacterial lipoprotein export pathway that flips lipoproteins across the outer membrane.

IMPORTANCE
Bacteria of the phylum
Bacteroidetes
are important human commensals and pathogens. Understanding their biology is therefore a key question for human health. A main feature of these bacteria is the presence of abundant lipoproteins at their surface that play a role in nutrient acquisition. To date, the underlying mechanism of lipoprotein transport is unknown. We show for the first time that
Bacteroidetes
surface lipoproteins share an N-terminal signal that drives surface localization. The localization and overall negative charge of the lipoprotein export signal (LES) are crucial for its role. Overall, our findings provide the first evidence that
Bacteroidetes
are endowed with a new bacterial lipoprotein export pathway that flips lipoproteins across the outer membrane.
Release of gp120 Restraints Leads to an Entry-Competent Intermediate State of the HIV-1 Envelope Glycoproteins
Authors: Herschhorn Alon , Ma Xiaochu , Gu Christopher , Ventura John D. , Castillo-Menendez Luis , Melillo Bruno , Terry Daniel S. , Smith Amos B. , Blanchard Scott C. , Munro James B. , Mothes Walther , Finzi Andrés , Sodroski Joseph
Published: October 2016

Primary human immunodeficiency virus (HIV-1) envelope glycoprotein (Env) trimers [(gp120/gp41)
3
] typically exist in a metastable closed conformation (state 1). Binding the CD4 receptor triggers Env to undergo extensive conformational changes to mediate virus entry. We identified specific gp120 residues that restrain Env in state 1. Alteration of these restraining residues destabilized state 1, allowing Env to populate a functional conformation (state 2) intermediate between state 1 and the full CD4-bound state (state 3). Increased state 2 occupancy was associated with lower energy barriers between the states. State 2 was an obligate intermediate for all transitions between state 1 and state 3. State 2-enriched Envs required lower CD4 concentrations to trigger virus entry and more efficiently infected cells expressing low levels of CD4. These Envs were resistant to several broadly neutralizing antibodies and small-molecule inhibitors. Thus, state 2 is an Env conformation on the virus entry pathway; sampling state 2 increases the adaptability of HIV-1 to different host cell receptor levels and immune environments. Our results provide new insights into the conformational regulation of HIV-1 entry.

IMPORTANCE
The envelope glycoproteins (Env) of HIV-1 mediate virus entry and are the sole targets of neutralizing antibodies. Understanding the way that Env promotes HIV-1 entry can expedite drug and vaccine development. By destabilizing Env, we found that it assumes an intermediate state that is functional and obligate for transitions to entry-competent conformations. Increased sampling of this state enhances the ability of HIV-1 to infect cells that express low levels of the CD4 receptor and allows the virus to evade neutralizing antibodies and small-molecule inhibitors. These findings provide new mechanistic insights into the function and inhibition of HIV-1 Env and will contribute to ongoing therapeutic and prevention efforts to combat HIV-1.
Pharmacological Inhibition of Host Heme Oxygenase-1 Suppresses Mycobacterium tuberculosis Infection
In Vivo
by a Mechanism Dependent on T Lymphocytes
Authors: Costa Diego L. , Namasivayam Sivaranjani , Amaral Eduardo P. , Arora Kriti , Chao Alex , Mittereder Lara R. , Maiga Mamoudou , Boshoff Helena I. , Barry Clifton E. , Goulding Celia W. , Andrade Bruno B. , Sher Alan
Published: October 2016

Heme oxygenase-1 (HO-1) is a stress response antioxidant enzyme which catalyzes the degradation of heme released during inflammation. HO-1 expression is upregulated in both experimental and human
Mycobacterium tuberculosis
infection, and in patients it is a biomarker of active disease. Whether the enzyme plays a protective versus pathogenic role in tuberculosis has been the subject of debate. To address this controversy, we administered tin protoporphyrin IX (SnPPIX), a well-characterized HO-1 enzymatic inhibitor, to mice during acute
M. tuberculosis
infection
.
These SnPPIX-treated animals displayed a substantial reduction in pulmonary bacterial loads comparable to that achieved following conventional antibiotic therapy. Moreover, when administered adjunctively with antimycobacterial drugs, the HO-1 inhibitor markedly enhanced and accelerated pathogen clearance. Interestingly, both the pulmonary induction of HO-1 expression and the efficacy of SnPPIX treatment in reducing bacterial burden were dependent on the presence of host T lymphocytes. Although
M. tuberculosis
expresses its own heme-degrading enzyme, SnPPIX failed to inhibit its enzymatic activity or significantly restrict bacterial growth in liquid culture. Together, the above findings reveal mammalian HO-1 as a potential target for host-directed monotherapy and adjunctive therapy of tuberculosis and identify the immune response as a critical regulator of this function.

IMPORTANCE
There is no reliable vaccine against tuberculosis (TB), and conventional antibiotic therapy is administered over at least 6 months. This prolonged treatment period can lead to noncompliance resulting in relapsed infection as well as the emergence of multidrug resistance. Thus, there is an urgent need for improved therapeutic regimens that can more rapidly and efficiently control
M. tuberculosis
in infected patients. Here, we describe a potential strategy for treating TB based on pharmacological inhibition of the host heme-degrading enzyme HO-1. This approach results in significantly reduced bacterial burdens in mice, and when administered in conjunction with conventional antibiotic therapy, leads to faster, more effective pathogen clearance without detectable direct effects on the mycobacteria themselves. Interestingly, the effects of HO-1 inhibition on
M. tuberculosis
infection
in vivo
are dependent on the presence of an intact host immune system. These observations establish mammalian HO-1 as a potential target for host-directed therapy of TB.
Quorum Quenching of Nitrobacter winogradskyi Suggests that Quorum Sensing Regulates Fluxes of Nitrogen Oxide(s) during Nitrification
Authors: Mellbye Brett L. , Giguere Andrew T. , Bottomley Peter J. , Sayavedra-Soto Luis A.
Published: October 2016

Quorum sensing (QS) is a widespread process in bacteria used to coordinate gene expression with cell density, diffusion dynamics, and spatial distribution through the production of diffusible chemical signals. To date, most studies on QS have focused on model bacteria that are amenable to genetic manipulation and capable of high growth rates, but many environmentally important bacteria have been overlooked. For example, representatives of proteobacteria that participate in nitrification, the aerobic oxidation of ammonia to nitrate via nitrite, produce QS signals called acyl-homoserine lactones (AHLs). Nitrification emits nitrogen oxide gases (NO, NO
2
, and N
2
O), which are potentially hazardous compounds that contribute to global warming. Despite considerable interest in nitrification, the purpose of QS in the physiology/ecology of nitrifying bacteria is poorly understood. Through a quorum quenching approach, we investigated the role of QS in a well-studied AHL-producing nitrite oxidizer,
Nitrobacter winogradskyi
. We added a recombinant AiiA lactonase to
N. winogradskyi
cultures to degrade AHLs to prevent their accumulation and to induce a QS-negative phenotype and then used mRNA sequencing (mRNA-Seq) to identify putative QS-controlled genes. Our transcriptome analysis showed that expression of
nirK
and
nirK
cluster genes (
ncgABC
) increased up to 19.9-fold under QS-proficient conditions (minus active lactonase). These data led to us to query if QS influenced nitrogen oxide gas fluxes in
N. winogradskyi
. Production and consumption of NO
x
increased and production of N
2
O decreased under QS-proficient conditions. Quorum quenching transcriptome approaches have broad potential to identify QS-controlled genes and phenotypes in organisms that are not genetically tractable.

IMPORTANCE
Bacterial cell-cell signaling, or quorum sensing (QS), is a method of bacterial communication and gene regulation that is well studied in bacteria. However, little is known about the purpose of QS in many environmentally important bacteria. Here, we demonstrate quorum quenching coupled with mRNA-Seq to identify QS-controlled genes and phenotypes in
Nitrobacter winogradskyi
, a nitrite-oxidizing bacterium. Nitrite oxidizers play an important role in the nitrogen cycle though their participation in nitrification, the aerobic oxidation of ammonia to nitrate via nitrite. Our quorum quenching approach revealed that QS influences production and consumption of environmentally important nitrogen oxide gases (NO, NO
2
, and N
2
O) in
N. winogradskyi
. This study demonstrated a novel technique for studying QS in difficult-to-work-with microorganisms and showed that nitrite oxidizers might also contribute to nitrification-dependent production of nitrogen oxide gases that contribute to global warming.
Takotsubo cardiomyopathy with severe bradyarrhythmia following epidural insertion
Authors: Gamble David T , Shuttleworth Kara J , Scally Caroline , Leslie Stephen J
Published: October 2016

We present a case of takotsubo cardiomyopathy (TTC) with ventricular stand still and atrioventricular block. TTC can mimic ST elevation myocardial infarction and heart failure, but in this case resulted in a severe cardiac conduction disorder and ventricular standstill. This is a recognised but unusual presentation and serves as a lesson to those undertaking anaesthetics to be vigilant for TTC.
Cotrimoxazole treats fluoroquinolone-resistantSalmonella typhiH58 infection
Authors: Karki Manan , Pandit Sarbagya , Baker Stephen , Basnyat Buddha
Published: October 2016

A woman aged 20 years presented with fever and no localising signs. She was treated with cotrimoxazole and the subsequent blood culture was positive forSalmonella typhi(S. typhi), which was resistant to fluoroquinolones but susceptible to cotrimoxazole. Genotyping identified an FQ-R subclade of H58S. typhi. Fever clearance time was 4 days after starting the antibiotics, and no relapses were noted on 2 months of follow-up. This inexpensive, well-known and easily available antimicrobial could be suitably redeployed for fluoroquinolone-resistant enteric fever in South Asia.
Crizotinib inROS1rearranged non-small cell lung cancer (NSCLC), from response to resistance
Authors: Zhong Eric , Huang Hua
Published: October 2016

We examined an immediate, but short-lived, response to crizotinib, a drug with a new indication forROS1rearranged non-small cell lung cancer (NSCLC) in a middle-aged non-smoker. The patient presented with metastatic NSCLC and extensive disease in multiple organs. He was treated with crizotinib 250 mg twice a day. Within 2–3 days, his condition rapidly improved, which was evident in a CT scan 2 months later. However, after 3 months of treatment, his condition deteriorated dramatically. The patient did not respond to ceritinib, a second-line drug that targets anaplastic lymphoma kinase, and died shortly after. This case demonstrated an impressive but brief response to crizotinib.
Bilateral primary adrenal lymphoma with adrenal insufficiency
Authors: Ekhzaimy Aishah , Mujamammi Ahmad
Published: October 2016

Primary adrenal lymphoma is an extremely rare condition. We describe a case of bilateral adrenal lymphoma in a man aged 55 years who was admitted to our hospital. He had a 3-month history of left flank pain, nausea and vomiting with weight loss. A CT scan at a private hospital revealed bilateral large adrenal masses; the patient was referred to our centre based on these findings. He was evaluated for pheochromocytoma by an endocrinology team; however, all findings were negative. In addition, a cosyntropin stimulation test indicated adrenal insufficiency. A Trucut biopsy of the adrenal gland revealed diffuse large B-cell lymphoma of the adrenal glands, and the patient responded extremely well to chemotherapy.
Commonly forgotten complication of Hashimoto's thyroiditis
Authors: Chiang Brenda , Cheng Shaun , Seow Cherng Jye
Published: October 2016

Hashimoto's thyroiditis (HT) is a frequently encountered condition in clinical practice and management is generally uncomplicated with patients on a stable dose of thyroxine supplementation. However, complications of thyroid lymphoma can develop, though it is rare and hence commonly forgotten by physicians. We present a case of a patient with HT who developed thyroid lymphoma. A 61-year-old woman presented with an enlarged goitre complicated by compressive symptoms and was diagnosed with HT. She was treated with stable dose of thyroxine but her constitutional symptoms of weight loss prompted further investigations and diagnosis of diffuse large B-cell lymphoma was eventually made. She underwent chemotherapy and adjuvant radiotherapy and is currently in remission 1 year post-treatment. There should be an increased index of suspicion of primary thyroid lymphoma in patients with HT for early diagnosis and treatment for better outcomes.
Supporting the provision of palliative care in the home environment: a proof-of-concept single-arm trial of a PalliativE Carers Education Package (PrECEPt)
Authors: Forbat Liz , Haraldsdottir Erna , Lewis Marsha , Hepburn Ken
Published: October 2016

Introduction

Practical educational interventions for palliative carers are needed. Current supports frequently rely on carers travelling to a central venue to receive education. A substantial gap therefore exists around determining how high-quality relevant information can be delivered nationally, with limited cost implications, using educational methods that are acceptable to carers in palliative care. This study seeks to design and assess feasibility and acceptability of a distance-learning approach to educating carers.

Methods

This is an embedded mixed-method feasibility and acceptability study. It embeds an unblinded 1-arm pilot test, with subsequent qualitative interviews which will be used to inform the assessment of the intervention's acceptability and feasibility. The theoretical framework is self-efficacy theory, whereby we seek to impact carers' beliefs in their ability to carry out and succeed in caring tasks and situations. The educational materials focused on pain and nutrition/hydration will be developed in phase 1 with former carers (n=8) providing input into the content and style of materials. The educational package privileges adult-learning styles, recognising and responding to the learner's context including their learning needs, prior knowledge and motivations for engaging in education. The materials will be tested with up to 24 current carers.

Analysis

Analysis will focus on determining recruitment processes for a full-scale study, data collection procedures/completion rates, queries directed to the hospice from carers involved in the feasibility work, mode of delivery and content of the materials. The primary outcome measure is self-efficacy, with other measures focused on caregiver preparedness and caregiving tasks, consequences and needs questionnaire. Adherence to educational components will also be collected and reported.

Ethics and dissemination

Ethical approval has been provided by the participating site, Calvary Healthcare, Canberra, reference 02–2016, and the Australian Catholic University. Results will be published in peer-reviewed journals, presented at conferences and a lay summary sent to participants.

Trial registration number

ACTRN12616000601437; Pre-results.
Rehabilitation Enablement in Chronic Heart Failure—a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial
Authors: Eyre V , Lang C C , Smith K , Jolly K , Davis R , Hayward C , Wingham J , Abraham C , Green C , Warren F C , Britten N , Greaves C J , Doherty P , Austin J , Van Lingen R , Singh S , Buckingham S , Paul K , Taylor R S , Dalal H M
Published: October 2016

Introduction

The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed.

Methods and analysis

A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients.

Ethics and dissemination

The study is approved by the East of Scotland Research Ethics Service (Ref: 15/ES/0036). Findings will be disseminated via journals and presentations to clinicians, commissioners and service users.

Trial registration number

ISRCTN78539530; Pre-results .
Reasons and evolution of non-thrombolysis in acute ischaemic stroke
Authors: Reiff T , Michel P
Published: October 2016

Introduction

Despite increasing evidence of its efficacy in advanced age or in mild or severe strokes, intravenous thrombolysis remains underused for acute ischaemic stroke (AIS). Our aim was to obtain an updated view of reasons for non-thrombolysis and to identify its changing patterns over time.

Methods

This is a retrospective study of prospectively collected data from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) from the years 2003–2011. Patients admitted with acute stroke in the past 24 hours who had not had thrombolysis were identified; reasons for non-thrombolysis documented in the prospectively entered data were tabulated and analysed for the group as a whole. Data were analysed for the years 2003–2006 and 2007 forward because of changes in contraindications. A subgroup of patients who arrived within the treatment window ≤180 min was separately analysed for reasons for non-thrombolysis. Predictors of non-thrombolysis were investigated via multivariate regression analyses.

Results

In the 2019 non-thrombolysed patients the most frequent reasons for non-thrombolysis were admission delays (66.3%), stroke severity (mostly mild) (47.9%) and advanced age (14.1%); 55.9% had more than one exclusion criterion. Among patients arriving ≤180 min after onset, the main reasons were stroke severity and advanced age. After 2006, significantly fewer patients were excluded because of age (OR 2.65, p<0.001) or (mostly mild) stroke severity (OR 10.56, p=0.029). Retrospectively, 18.7% of all non-thrombolysed patients could have been treated because they only had relative contraindications.

Conclusion

Onset-to-admission delays remain the main exclusion criterion for thrombolysis. Among early arrivals, relative contraindications such as minor stroke severity and advanced age were frequent. Thrombolysis rate increased with the reduction of thrombolysis restrictions (eg, age and stroke severity).
A comparison of pain assessment by physicians, parents and children in an outpatient setting
Authors: Brudvik Christina , Moutte Svein-Denis , Baste Valborg , Morken Tone
Published: October 2016

Introduction

Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.

Patients and methods

This cross-sectional study involved 243 children aged 3–15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments.

Results

Physicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child–parent agreement was moderate (Cohen's weighted κ=0.55), but low between child–physician (κ=0.12) and parent–physician (κ=0.17). Physicians significantly underestimated pain in all paediatric patients ≥3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians’ pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS≥7) received pain relief.

Conclusions

Paediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED.
Skin and soft tissue infection management failure in the emergency department observation unit: a systematic review
Authors: Abetz Jeremy W , Adams Nicholas G , Mitra Biswadev
Published: October 2016

Introduction

Skin and soft tissue infections (SSTIs) are commonly treated in ED observation units (EDOUs). The management failure rate in this setting is high, as evidenced by a large proportion of patients requiring inpatient admission. This systematic review sought to quantify the management failure rate and identify risk factors associated with management failure.

Methods

Searches of six databases and grey literature were conducted with no limits on publication year or language. Manuscripts describing patients admitted to an EDOU setting (≤24 hours planned admission to EDOU) with a primary diagnosis of cellulitis or other SSTIs were included. Variables associated with failure of management, defined as inpatient admission, stay >28 hours (4 hours in ED, 24 hours in EDOU) or death, were extracted. A narrative description of variables associated with failure of EDOU admission was conducted.

Results

There were 1119 unique articles identified through the literature search. Following assessment, 10 studies were included in the final systematic review, 9 of which reported the management failure rate (range 15%–38%). The presence of fever, a high total white blood cell count and known methicillin-resistantStaphylococcus aureusexposure were the most commonly reported variables associated with management failure.

Conclusion

A higher rate of EDOU management failure in SSTIs than the generally accepted rate of 15% was observed in most studies identified by this review. Risk factors identified were varied, but presence of a fever and elevated inflammatory markers were commonly associated with failure of EDOU admission by multiple studies. Recognition of risk factors and the increased application of clinical decision tools may help to improve disposition of patients at high risk for clinical deterioration or management failure.
Development of an index to define overall disease severity in IBD
Authors: Siegel Corey A , Whitman Cynthia B , Spiegel Brennan M R , Feagan Brian , Sands Bruce , Loftus Edward V , Panaccione Remo , D'Haens Geert , Bernstein Charles N , Gearry Richard , Ng Siew C , Mantzaris Gerassimos J , Sartor Balfour , Silverberg Mark S , Riddell Robert , Koutroubakis Ioannis E , O'Morain Colm , Lakatos Peter L , McGovern Dermot P B , Halfvarson Jonas , Reinisch Walter , Rogler Gerhard , Kruis Wolfgang , Tysk Curt , Schreiber Stefan , Danese Silvio , Sandborn William , Griffiths Anne , Moum Bjorn , Gasche Christoph , Pallone Francesco , Travis Simon , Panes Julian , Colombel Jean-Frederic , Hanauer Stephen , Peyrin-Biroulet Laurent
Published: October 2016

Background and aim

Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC.

Methods

Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute.

Results

For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities.

Conclusions

Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.
Lactoferrin and prematurity: a promising milk protein?
Authors: Ochoa Theresa J. , Sizonenko Stéphane V.
Published: October 2016

Lactoferrin (Lf) is the major whey protein in milk, with multiple beneficial health effects including direct antimicrobial activities, anti-inflammatory effects, and iron homeostasis. Oral Lf supplementation in human preterm infants has been shown to reduce the incidence of sepsis and necrotizing enterocolitis. In preclinical models of antenatal stress and perinatal brain injury, bovine Lf protected the developing brain from neuronal loss, improved connectivity, increased neurotrophic factors, and decreased inflammation. It also supported brain development and cognition. Further, Lf can prevent preterm delivery by reducing proinflammatory factors and inhibiting premature cervix maturation. We review here the latest research on Lf in the field of neonatology.
Rainwater harvesting for restoring degraded dry agro-pastoral ecosystems: a conceptual review of opportunities and constraints in a changing climate
Authors: Oweis Theib Y.
Published: October 2016

Water resources in dry environments are becoming scarcer, especially under the changing climate. In response, rainwater harvesting (RWH) is being reemphasized with calls to revive the practice. Ancient knowledge on RWH — mainly the collection through runoff, storage, and use of rainwater for various purposes — is still relevant, especially for dry environments. However, many old practices and technologies may not be suitable or feasible for the present and future. Little has been done to modernize and (or) develop new practices and technologies based on ancient indigenous knowledge. Modernizing old practices or developing new ones and using them in integrated rangelands restoration packages with enabling policy environment can unlock their potential in many water-scarce regions of the world. This paper reviews the state-of-the-art of micro-catchment rainwater harvesting (MIRWH) in dry environments and discusses the opportunities available and the major obstacles faced in using it to restore degraded agro-pastoral ecosystems and support their sustainability. The review highlights the knowledge behind it, the practices developed over the years, and their relevance to today and the future. The paper indicates areas of modernization that can make it more feasible for the future of the dry environments, especially their role in mitigating and adapting to climate change. Conventional and passive approaches to restoring/rehabilitating degraded dry agro-pastoral ecosystems are either too slow to show an obvious impact or not progressing satisfactorily. One main reason is that, because of land degradation, the majority of rain falling on such ecosystems and needed for revegetation is lost with little benefit being gained. Adopting a more progressive intervention to alter the processes of degradation and move towards new system equilibrium is required. MIRWH can enable a large portion of this otherwise lost rainwater to be stored in the soil, and, if used in an integrated packages including suitable plant species and sound grazing management, it may support meaningful vegetation growth and help system restoration. The Badia Benchmark project, implemented by ICARDA in Jordan and Syria, has demonstrated the potential for adoption at large scale in similar environments. This case study illustrates the potential and the constraints of this practice.
Determination of the temperature dependence of the up- and down-quark masses in QCD
Authors: Dominguez C. A. , Hernandez L. A.
Published: October 2016

The temperature dependence of the sum of the QCD up- and down-quark masses, (mu[Formula: see text]+[Formula: see text]md) and the pion decay constant, f[Formula: see text], are determined from two thermal finite energy QCD sum rules for the pseudoscalar-current correlator. This quark mass remains mostly constant for temperatures well below the critical temperature for deconfinement/chiral-symmetry restoration. As this critical temperature is approached, the quark mass increases sharply with increasing temperature. This increase is far more pronounced if the temperature dependence of the pion mass (determined independently from other methods) is taken into account. The behavior of f[Formula: see text](T) is consistent with the expectation from chiral symmetry, i.e. that it should follow the thermal dependence of the quark condensate, independently of the quark mass.
Passive Dynamic Walking with a Torso Coupled via Torsional Springs
Authors: Deng Ka , Zhao Mingguo , Xu Wenli
Published: October 2016

The passive dynamic walker is well known for its success in human mimicry; however, the torso, an important part of humans and human-like biped robot, is usually ignored in the model. In this paper, a fully passive torso is coupled to the passive dynamic walker via two hip torsional springs. The performances of the walker are studied by means of numerical simulation, and the benefits brought by the torso are revealed. Comparisons with the walker without a torso are performed. On a regular slope, the gait's existence and specifications are studied with respect to the slope angle and the spring coefficient. An interesting dynamical phenomenon of having two stable walking cycles is observed, and the differences between them are presented via a parametric study. The ranges of stable walking slopes and gait performances are significantly improved. On an irregular slope, the disturbance rejection ability (DRA) is measured for three types of disturbances. The slope range of stable gait with strong DRA is significantly extended. The walker with a torso is more flexible by adjusting the slope angle, the spring coefficient and its initial state. The unique properties of our model can be utilized to design humanoid robots and walking enhancing equipment.