bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal dietitian resourcing and roles in New Zealand and Australia: A survey of current practice
Authors: Cormack Barbara , Oliver Colleen , Farrent Shelley , Young Jacqui , Coster Keryn , Gilroy Melissa , Page Denise , Little Helen , McLeod Gemma ,   Australasian Neonatal Dietitians Network (ANDiN)
Published: November 2019

Aim

Dietitian‐led implementation of evidence‐based nutrition support practices improves nutrient intakes, clinical outcomes and growth, decreases length of stay and related costs, and reduces intravenous nutrition costs and prescription errors. We aimed to investigate current neonatal dietitian resourcing and roles in New Zealand and Australian neonatal units, and to compare this with dietitian workforce recommendations and previously reported survey data.

Methods

A two‐part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network members and other dietitians working in neonatal intensive care or special care baby units in New Zealand and Australia. The survey ran from July to October 2018. Descriptive statistics were used to examine the distribution of responses. Responses were compared with other similar surveys and British Dietetic Association workforce recommendations.

Results

There was an 88% response rate for Part 1. Forty‐eight percent of respondents had worked in neonatology for more than 5 years. Ward rounds were attended weekly or more often by 43% of respondents. One‐third regularly attended neonatal conferences or grand rounds. The majority spent less than 25% of their neonatal service allocation on teaching, developing policy or research. All respondents reported their unit had written enteral feeding guidelines. The neonatal dietitian workforce is at 23% of recommended levels.

Conclusions

Australasian neonatal dietitians have great potential to add value in neonatal units which has not yet been fully realised. Funding reallocation, upskilling and on‐going professional development are needed to ensure the neonatal dietitian workforce is at the recommended level to be safe, sustainable and effective.
Hidden Jedi: A critical qualitative exploration of the Fellow credential and advanced expertise
Authors: Palermo Claire , Allen Louise , Dart Janeane , Beck Eleanor J. , Daniels Lynne , Ash Susan
Published: November 2019

Aim

The present study aimed to describe the characteristics of a Fellow and critically review factors relevant to recognition and promotion of excellence within the profession of dietetics in Australia.

Methods

Through the development of revised Competency Standards for the Fellow credential, a critical qualitative approach drawing on action research was used whereby members of the profession were given a voice in the research process. Six focus groups with a total of 30 participants explored descriptions of expertise and perceptions of Fellow by the profession and determinants of uptake. Focus groups were conducted during February and March 2018. Data were examined using a thematic analysis approach, with additional meaning explored through cultural historical activity theory.

Participants/setting – A purposive sample of Australian dietitians.

Results

Fellows embodied leadership, impact, influence, innovation and inspiration, internal and external to the profession and this was reflected in the revised Competency Standards. Potential Fellows perceived they were not capable of achieving the standard required. A lack of recognition of the credential both from within the community of dietetics, and externally, was identified. The role of the social system in which these credentials operate including the role of the professional association in awarding the credential are relevant.

Conclusions

Changes to the standards, and the system, may improve perceptions and uptake of the credential. This example provides highly relevant insights for the profession internationally.
Ligustilide Inhibited Rat Vascular Smooth Muscle Cells Migration via c‐Myc/MMP2 and ROCK/JNK Signaling Pathway
Authors: Luo Zhenhui , Deng Huijian , Fang Zicen , Zeng Ao , Chen Yuankun , Zhang Wei , Lu Qun
Published: November 2019

Vascular smooth muscle cells (VSMCs) excessive migration, a basic change of pathological intimal thickening, can lead to serious cardiovascular diseases such as atherosclerosis, myocardial infarction, and stroke. Ligustilide (LIG), the main active ingredient of angelica volatile oil, has been demonstrated to exert protective effects on the cardiovascular and cerebrovascular, circulatory system, and immune function. However, whether it protects against intimal thickening and VSMCs excessive migration and its underlying mechanism remains largely unknown. The aim of this study is to investigate the effect of LIG on VSMCs migration and its underlying mechanism. The protective effect of LIG on VSMCs excessive migration was assessed using an atherosclerotic spontaneously hypertensive rat model and an angiotensin II (AngII)‐induced VSMCs migration model. The results showed that LIG exerted a protective effect against pathological intimal thickening as demonstrated by decreasing VSMCs migration in vivo and in vitro. In vivo, intimal thickening and VSMCs migration were inhibited and LIG performed a suppressive effect on the expression of c‐Myc protein while enhanced phenotypic transformation related proteins α‐SMA expression. Meanwhile, the administration of LIG significantly lowered the blood pressure and blood lipids level in atherosclerotic spontaneously hypertensive rats. In vitro, LIG suppressed AngII‐induced VSMCs migration and downregulated the expression of migration related protein c‐Myc, MMP2, ROCK1, ROCK2, p‐JNK, and JNK. These findings suggested the protective effect of LIG on VSMCs migration was associated with the decrement of c‐Myc/MMP2 signaling pathway and ROCK‐JNK signaling pathway. Thus, LIG may serve as a novel therapeutic agent for preventing cardiovascular disease.
Fatty Acid Content, Flavor Compounds, and Sensory Quality of Pork Loin as Affected by Dietary Supplementation with l‐arginine and Glutamic Acid
Authors: Guo Qian , Kong Xiangfeng , Hu Chengjun , Zhou Bing , Wang Chengtao , Shen Qingwu W.
Published: November 2019

To investigate the effect of functional amino acid on meat flavor and eating quality, 60 growing‐finishing pigs (Duroc × Large White × Landrace) were dietarily supplemented with or without 1.0% l‐arginine, glutamic acid, or l‐arginine plus glutamic acid for 2 months. After animals were slaughtered, the muscle fatty acid profile, flavor compounds, and meat sensory quality were comparatively investigated. The results showed that dietary supplementation with arginine, glutamic acid, or arginine plus glutamic acid had little effect on free amino acids, no effect on 5′‐nucleotides and meat sensory taste traits, but supplementation with arginine plus glutamic acid significantly increased (P < 0.05) fat accumulation and fatty acid content in muscle, increased (P < 0.05) the formation of multiple fatty acid oxidation‐derived volatile compounds, and improved the tenderness, juiciness, and overall eating quality of meat. This study revealed that dietary supplementation with 1.0% l‐arginine and glutamic acid could be used to improve meat eating quality in pork production.
Management of immune checkpoint inhibitor‐related rheumatic adverse events
Authors: Zhou Jiaxin , Wang Hanping , Guo Xiaoxiao , Wang Qian , Duan Lian , Si Xiaoyan , Zhang Li , Liu Xiaowei , Li Yue , Zhang Wen , Zhang Li
Published: November 2019

Immune checkpoint inhibitors (ICIs), which target the programmed cell death receptor‐1 and cytotoxic T lymphocyte‐associated antigen‐4 signaling pathways, represent remarkable breakthroughs in cancer treatment and have improved survival among patients with a variety of malignancies. However, the wide use of ICIs is associated with a spectrum of immune‐related adverse events (irAEs) that can affect any organ system, and may sometimes be life threatening. Rheumatic irAEs are not an infrequent type of irAE. In this systematic review, we consider the clinical characteristics of rheumatic irAEs, including patients with pre‐existing rheumatic diseases, and focus on the management of rheumatic irAEs.
Acetylation changes tau interactome to degrade tau in Alzheimer’s disease animal and organoid models
Authors: Choi Heesun , Kim Haeng Jun , Yang Jinhee , Chae Sehyun , Lee Wonik , Chung Sunwoo , Kim Jisoo , Choi Hyunjung , Song Hyeseung , Lee Chang Kon , Jun Jae Hyun , Lee Yong Jae , Lee Kyunghyeon , Kim Semi , Sim Hye‐ri , Choi Young Il , Ryu Keun Ho , Park Jong‐Chan , Lee Dongjoon , Han Sun‐Ho , Hwang Daehee , Kyung Jangbeen , Mook‐Jung Inhee
Published: November 2019

Alzheimer's disease (AD) is an age‐related neurodegenerative disease. The most common pathological hallmarks are amyloid plaques and neurofibrillary tangles in the brain. In the brains of patients with AD, pathological tau is abnormally accumulated causing neuronal loss, synaptic dysfunction, and cognitive decline. We found a histone deacetylase 6 (HDAC6) inhibitor, CKD‐504, changed the tau interactome dramatically to degrade pathological tau not only in AD animal model (ADLPAPT) brains containing both amyloid plaques and neurofibrillary tangles but also in AD patient‐derived brain organoids. Acetylated tau recruited chaperone proteins such as Hsp40, Hsp70, and Hsp110, and this complex bound to novel tau E3 ligases including UBE2O and RNF14. This complex degraded pathological tau through proteasomal pathway. We also identified the responsible acetylation sites on tau. These dramatic tau‐interactome changes may result in tau degradation, leading to the recovery of synaptic pathology and cognitive decline in the ADLPAPTmice.
A retrospective look at the common sense nutrition disclosure act: Small business lifeline or an impediment to informed consumer decision making?
Authors: Adams Ronald
Published: November 2019

As consumer lifestyles have changed over recent decades, people have increasingly turned to meals prepared away from home. A major consequence of this shift in eating patterns has been a concomitant rise in obesity rates worldwide. Research has consistently documented that consumers tend to make less healthy choices when purchasing prepared meals away from home. In part, this can be attributed to inadequate information at the time of purchase; both nutrition experts and lay consumers tend, for example, to underestimate calories in food purchased away from home and thus portion sizes tend to be larger. Thus, by requiring restaurants and other purveyors of prepared foods to provide the calorie content and other nutrition information at the point of purchase, consumers should be able to make more informed decisions and public health should be improved. The often maligned Affordable Care Act (i.e., “Obamacare”) addressed this issue in a mandate calling for compulsory nutrition labeling of prepared foods at the point of sale. In response to this effort, conservatives in Congress introduced the “Common Sense Nutrition Disclosure Act” (CSNDA) which, if enacted, would have effectively eviscerated the menu labeling provisions mandated by the Affordable Care Act. The stated rationale behind this legislation: to protect small business and prevent job loss resulting from overly‐burdensome federal regulations. This article provides a historical look at the evolution of federally mandated menu labeling in the United States with particular emphasis on opposition to its passage. The position is taken such that this legislation is beneficial, warranted, and long overdue, and its opposition, as reflected in the CSNDA, points to the need for new metrics when evaluating public policy.
Evidence‐based policy development for cannabis? Insights on preventing use by youth
Authors: Hathaway Andrew
Published: November 2019

This article challenges the assumptions underlying the shared federal, provincial, and territorial goals of reducing criminal involvement in the drug trade and preventing substance use by youth. These official government objectives, it is argued, reflect a harmful tendency that continues the tradition of neglecting decades of sociological research on the efficiency of informal sources of control. Rather than continue to prioritize prevention, consistent evidence‐based policy development for cannabis requires articulation of more informed and realistic goals of harm reduction. New educational initiatives need to build on informal controls that more effectively regulate responsible substance use behaviour.
Dynamic multibenefit solutions for global water challenges
Authors: Rohde Melissa M. , Reynolds Mark , Howard Jeanette
Published: November 2019

Increasing water scarcity and extreme weather due to climate change have implications for securing water for food, drinking, and the environment. These 21st century global water challenges are often co‐located, yet the solutions to these issues are often decoupled. To efficiently address global water challenges, implementing dynamic multibenefit solutions is needed to respond rapidly and nimbly to diverse and multiple water needs simultaneously. In this article, we provide an example of how dynamic multibenefit solutions have been used to provide “pop‐up” wetland habitat for migratory birds, while replenishing depleted aquifers to create environmental and water supply benefits. Additionally, this article outlines six design principles that can enhance the scalability of multibenefit solutions through the use of recent technological advances borrowing concepts from the shared economy that enable scarce water resources to be dynamically shared between people and nature when and where it is needed.
Therapie von Patienten mit cholinergischer Urtikaria im Alltag in deutschsprachigen Ländern
Authors: Mellerowicz Emilia , Weller Karsten , Zuberbier Torsten , Maurer Marcus , Altrichter Sabine
Published: November 2019

Hintergrund

Die cholinergische Urtikaria (CholU) ist eine häufige Unterform der chronischen induzierbaren Urtikaria. Die aktuellen Leitlinien empfehlen eine symptomatische Therapie mit Antihistaminika (AH) der zweiten Generation (sgAH, second‐generation antihistamines) als Therapie der ersten Wahl. Allerdings ist wenig darüber bekannt, welche Therapien CholU‐Patienten im klinischen Alltag tatsächlich erhalten und wie sie auf diese ansprechen.

Ziel

Untersuchung der Therapie der CholU in deutschsprachigen Ländern unter Alltagsbedingungen.

Methoden

Patienten mit CholU (n = 111) nahmen an einer Online‐Befragung teil und gaben Auskunft über die eingesetzten Therapieformen und das Ansprechen.

Ergebnisse

Praktisch alle Patienten (97 %) hatten bereits Antihistaminika eingenommen, davon 87 % sgAH, 23 % auch Antihistaminika der ersten Generation (fgAH). Der Anteil der Patienten, die von einer AH‐Therapie in Standarddosierung profitierten, war niedrig (sgAH: 32 % vs. fgAH: 16 %); die Nebenwirkungen unter sgAH und fgAH waren vergleichbar. 66 Patienten (59 %) hatten es bereits mit einem Updosing der AH (meist sgAH [98 %, n = 65]) versucht und das Ansprechen darunter war marginal besser (sgAH: 38 % vs. fgAH: 32 %). Nur sehr wenige Patienten hatten andere Behandlungsoptionen ausprobiert, zumeist Glukokortikosteroide (30 %) und Omalizumab (5 %).

Schlussfolgerungen

sgAH wurden häufig eingesetzt, erwiesen sich aber bei etwa zwei Dritteln der CholU‐Patienten als nicht ausreichend wirksam. Entsprechend sollten die Therapieoptionen der dritten und vierten Linie effektiver genutzt werden. Auch ist die Entwicklung von besseren Therapieoptionen für Patienten mit CholU erforderlich.
Rapid recovery of the beetle richness‐elevation relationship and its environmental correlates after a major volcanic event in northwestern Patagonia, Argentina
Authors: Baudino Florencia , Werenkraut Victoria , Ruggiero Adriana
Published: November 2019

Volcanic eruptions often modify the structure and function of ecosystems at large geographical scales. However, the extent to which species diversity patterns respond to these major natural disturbances is still poorly known. We tested the shape of the species richness – elevation relationship (SRER) and its environmental correlates (thermal environment at ground level, vegetation structure and soil attributes) before and 6 months after (in the first summer) the most recent eruption of the Puyehue Cordon Caulle volcanic complex (PCCVC), which caused an extensive ash accumulation in northwestern Patagonia, Argentina.

We re‐established 32, 100‐m2 sampling plots of nine pitfall traps, placed every 100 m of altitude from the base to the summit of three mountains differentially affected by ash deposition, and from which we had pre‐eruption data on richness and environmental variables.

Coverage‐based rarefaction/extrapolation curves showed a local post‐eruptive decrease in richness on only one mountain. Generalised additive models (GAMs) showed no significant differences between pre‐ and post‐eruptive SRER shapes. Partial least squares structural equation modelling (PLS‐SEM) showed that woody vegetation and the thermal environment accounted for most of the variation in richness before and after the eruption. Soil attributes were only indirectly associated with beetle richness and the association was mediated by woody vegetation. Ash accumulation ameliorated the thermal environment, promoting a local increase in beetle richness.

The rapid recovery of the SRER shape and its environmental correlates suggest that the structuring of local diversity patterns at temperate latitudes of the southern hemisphere is resilient to major volcanic eruptions.
Structure and electrical properties of Zn‐doped BiFeO3 films
Authors: Shen Peng , Zhang Fengqing , Wang Lingxu , Guo Xiaodong , Zhao Xuefeng , Liu Huiying , Tian Qingbo , Fan Suhua
Published: November 2019

BiFe1−xZnxO3 (x = 0, 0.5, 1, 1.5, 2 mol%) (BFZO) films were prepared on ITO/glass substrates by a sol‐gel method. The effects of different Zn contents on the structures and electrical properties of the BFZO films were investigated. From X‐ray diffraction (XRD), microstructure and X‐ray spectroscopy (XPS) results, the BFZO films with a Zn content of 1 mol% showed a better crystal structure and grain development, and the Fe2+ and oxygen vacancy concentrations in this sample were the lowest among all the evaluated BFZO films. The P‐E hysteresis loop indicated that the BFZO films with 1 mol% Zn had the highest remanent polarization (2Pr), which was 82.4 μC/cm2, along with a coercive field (2Ec) of 887 kV/cm at the tested electric field of 857 kV/cm. The BFZO film with 1 mol% Zn had the lowest leakage current density, which was 3.54 × 10−7 A/cm2 at the tested electric field of 200 kV/cm. Both at high and low electric fields, the space charge‐limited current (SCLC) conduction mechanism was the main leakage mechanism. When the test frequency was 105 Hz, the dielectric constant was 133, and the dissipation factor was 0.015.
Pain reduction of topical sevoflurane vs intravenous opioids in pressure ulcers
Authors: Fernández‐Ginés F. Dámaso , Cortiñas‐Sáenz Manuel , Agudo‐Ponce Desirée , Navajas‐Gómez de Aranda Ana , Morales‐Molina José A. , Fernández‐Sánchez Carmen , Sierra‐García Francisco , Mateo‐Carrasco Héctor
Published: November 2019

Recently, it has been reported that topical irrigations of liquid sevoflurane on the bed of painful wounds produce a rapid, intense, and lasting analgesic effect. In this paper, A cohort of 112 patients with painful pressure ulcers who were refractory to opioids (or who exhibited undesirable adverse events to them) was treated with topical sevoflurane as per local institutional policy. These patients were recruited from an intensive care unit for a period of 3 years. The main aim was to determine the effectiveness of topical sevoflurane in reducing the pain of PUs and reducing the ulcer area. Study findings are reported and discussed herein and suggest that sevoflurane is a viable and promising treatment option for PUs.
The thermo‐mechanical properties and ferroelastic phase transition of RENbO4(RE = Y, La, Nd, Sm, Gd, Dy, Yb) ceramics
Authors: Wu Fushuo , Wu Peng , Zhou Yunxuan , Chong Xiaoyu , Feng Jing
Published: November 2019

In this work, RENbO4(RE = Y, La, Nd, Sm, Gd, Dy, Yb) ceramics with low density, low Young's modulus, low thermal conductivity, and high thermal expansion have been systematically investigated, the excellent thermo‐mechanical properties indicate that RENbO4ceramics possess the potential as the new generation of thermal barrier coatings (TBCs) materials. X‐ray diffraction and Raman spectroscopy phase structure identification reveal that all dense bulk specimens obtained by high‐temperature solid‐state reaction belonged to the monoclinic (m) phase with C12/c1 space group. The ferroelastic domains are detected in the specimens, revealing the ferroelastic transformation between tetragonal (t) and monoclinic (m) phases of RENbO4ceramics. The Young's modulus and hardness of the RENbO4ceramics measured by the NanoBlitz 3D nanoindentation method are discussed in details, and the lower Young's modulus (60‐170 GPa) and higher hardness (the maximum value reaches 11.48 GPa) indicating that higher resistance of RENbO4ceramics to failure and damage. Lower thermal conductivity (1.42‐2.21 W [m k]−1at 500°C‐900°C) and lower density (5.330‐7.400 g/cm3) than other typical TBCs materials give RENbO4ceramics the unique advantage of being new TBCs materials. Meanwhile, the thermal expansion coefficients of RENbO4ceramics reach 9.8‐11.6 × 10−6 k−1and are comparable or higher than other typical TBCs materials. According to the first‐order derivative of the thermal expansion rate, the temperature of the ferroelastic transformation of RENbO4ceramics can be observed.
Investigating the relationship between vaginal microbiota and host genetics and their impact on immune response and farrowing traits in commercial gilts
Authors: Sanglard Leticia P. , Schmitz‐Esser Stephan , Gray Kent A. , Linhares Daniel C. L. , Yeoman Carl J. , Dekkers Jack C. M. , Niederwerder Megan C. , Serão Nick V. L.
Published: November 2019

Our objectives were to evaluate the interaction between host genetics and vaginal microbiota and their relationships with antibody (Ab) response to porcine reproductive and respiratory syndrome virus (PRRSV) vaccination and farrowing performance in commercial gilts. The farrowing performance traits were number born alive, number weaning (NW), total number born, number born dead, stillborn, mummies and preweaning mortality (PWM). The vaginal microbiota was collected on days 4 (D4) and 52 (D52) after vaccination for PRRSV. Blood samples were collected on D52 for Ab measurement. Actinobacteria, Bacterioidetes, Firmicutes, Proteobacteria and Tenericutes were the most abundant Phyla identified in the vaginal microbiota. Heritability ranged from ~0 to 0.60 (Fusobacterium) on D4 and from ~0 to 0.63 (Terrisporobacter) on D52, with 43 operational taxonomic units (OTUs) presenting moderate to high heritability. One major QTL on chromosome 12 was identified for 5 OTUs (Clostridiales, Acinetobacter, Ruminococcaceae, Campylobacter and Anaerococcus), among other 19 QTL. The microbiability for Ab response to PRRSV vaccination was low for both days (<0.07). For farrowing performance, microbiability varied from <0.001 to 0.15 (NW on D4). For NW and PWM, the microbiability was greater than the heritability estimates. Actinobacillus, Streptococcus, Campylobacter, Anaerococcus, Mollicutes, Peptostreptococcus, Treponema and Fusobacterium showed different abundance between low and high Ab responders. Finally, canonical discriminant analyses revealed that vaginal microbiota was able to classify gilts in high and low Ab responders to PRRSV vaccination with a misclassification rate of <0.02. Although the microbiota explained limited variation in Ab response and farrowing performance traits, there is still potential to explore the use of vaginal microbiota to explain variation in traits such as NW and PWM. In addition, these results revealed that there is a partial control of host genetic over vaginal microbiota, suggesting a possibility for genetic selection on the vaginal microbiota.
Role of melatonin as an SIRT1 enhancer in chronic obstructive pulmonary disease induced by cigarette smoke
Authors: Shin Na‐Rae , Ko Je‐Won , Kim Jong‐Choon , Park Gunhyuk , Kim Sung‐Hwan , Kim Min‐Seok , Kim Joong‐Sun , Shin In‐Sik
Published: November 2019

Background

Melatonin has various biological activities that improve the health of an individual. We evaluated the effects of melatonin on inflammatory response in chronic obstructive pulmonary disease (COPD), focusing on the regulation of SIRT1 expression.

Methods

To investigate the effect of melatonin, we used cigarette smoke (CS)‐induced COPD mouse model and CS condensate (CSC)‐stimulated J774 macrophage cells.

Results

CSC‐stimulated J774 macrophages exhibited increased p65 acetylation with a reduction in SIRT1 expression. However, melatonin induced the enhancement of SIRT1 expression, which eventually decreased p65 acetylation in CSC‐stimulated J774 cells. Melatonin‐treated mice exhibited an enhancement in SIRT1 expression with the reduction in p65 acetylation, which decreased the level of inflammatory mediators induced by CS. Additionally, SIRT1 inhibitor treatment increased the level of inflammatory mediators, which was accompanied by an increase in p65 acetylation. However, cotreatment with melatonin and an SIRT1 inhibitor reduced the level of inflammatory mediators compared with that by treatment with the SIRT1 inhibitor alone, which was accompanied by elevation in SIRT1 expression and reduction in p65 acetylation.

Conclusions

Overall, the results indicated that melatonin has therapeutic effects against COPD, owing to its property to enhance SIRT1 expression.
Longitudinal Investigation of Older Adults' Ability to Self‐Manage Complex Drug Regimens
Authors: Bailey Stacy Cooper , Opsasnick Lauren A. , Curtis Laura M. , Federman Alex D. , Benavente Julia Y. , O'Conor Rachel , Wolf Michael S.
Published: November 2019

OBJECTIVES

We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self‐management.

DESIGN

Longitudinal cohort study funded by the National Institute on Aging.

SETTING

One academic internal medicine clinic and six community health centers.

PARTICIPANTS

Beginning in 2008, 900 English‐speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4).

MEASUREMENTS

At T1, subjects were given a standardized, seven‐drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini‐Mental State Examination.

RESULTS

Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0‐21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1‐18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18‐1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70‐2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07‐.34; P = .01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1.

CONCLUSIONS

Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow‐up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569–575, 2020
New method for determining fibrinogen and FDP threshold criteria by artificial intelligence in cases of massive hemorrhage during delivery
Authors: Miyagi Yasunari , Tada Katsuhiko , Yasuhi Ichiro , Maekawa Yuka , Okura Naofumi , Kawakami Kosuke , Yamaguchi Ken , Ogawa Masanobu , Kodama Takashi , Nomiyama Makoto , Mizunoe Tomoya , Miyake Takahito
Published: November 2019

Aim

To investigate the feasibility of a novel method using artificial intelligence (AI), in which the fibrinogen criterion was determined by the quantitative relation between the distributions of fibrin/fibrinogen degradation products (FDPs) and fibrinogen.

Methods

A dataset of 154 deliveries comprising more than 2000 g of blood lost due to hemorrhage, excluding disseminated intravascular coagulation (DIC), among patients from eight national perinatal centers in Japan from 2011 to 2015 were obtained. The fibrinogen threshold criterion was identified by using the function that best fit the distributions of FDP as determined by AI. FDP production was described by differential equations using a dataset containing fibrinogen levels less than the fibrinogen criterion and solved numerically.

Results

A fibrinogen level of 237 mg/dL as the threshold criterion was obtained. The FDP threshold criteria were 2.0 and 8.5 mg/dL for no coagulopathy and a failed coagulation system, respectively.

Conclusion

The fibrinogen threshold criterion for patients with massive hemorrhage excluding DIC at delivery were obtained by selecting the functions that best fit the distributions of FDP data by using AI.
Myelin Damage in Normal Appearing White Matter Contributes to Impaired Cognitive Processing Speed in Multiple Sclerosis
Authors: Abel Shawna , Vavasour Irene , Lee Lisa Eunyoung , Johnson Poljanka , Ackermans Nathalie , Chan Jillian , Dvorak Adam , Schabas Alice , Wiggermann Vanessa , Tam Roger , Kuan Annie J. , Morrow Sarah A. , Wilken Jeffrey , Laule Cornelia , Rauscher Alexander , Bhan Virender , Sayao Ana‐Luiza , Devonshire Virginia , Li David KB , Carruthers Robert , Traboulsee Anthony , Kolind Shannon H.
Published: November 2019

BACKGROUND AND PURPOSE

Cognitive impairment is a core symptom in multiple sclerosis (MS). Damage to normal appearing white matter (NAWM) is likely involved. We sought to determine if greater myelin heterogeneity in NAWM is associated with decreased cognitive performance in MS.

METHODS

A total of 27 participants with MS and 13 controls matched for age, sex, and education underwent myelin water imaging (MWI) from which the myelin water fraction (MWF) was calculated. Corpus callosum, superior longitudinal fasciculus, and cingulum were chosen as regions of interest (ROIs) a priori based on their involvement in MS‐related cognitive impairment. Cognitive performance was assessed using the Symbol Digit Modalities Test (SDMT). Pearson ́s product moment correlations were performed to assess relationships between cognitive performance and myelin heterogeneity (variance of MWF within an ROI).

RESULTS

In MS, myelin heterogeneity in all three ROIs was significantly associated with performance on the SDMT. These correlations ranged from moderate (r = −.561) to moderately strong (r = −.654) and were highly significant (P values ranged from .001 to .0002). Conversely, myelin heterogeneity was not associated with SDMT performance in controls in any ROI (P > .108).

CONCLUSION

Increased myelin heterogeneity in NAWM is associated with decreased cognitive processing speed performance in MS.
Titanium particles and ions favor dysbiosis in oral biofilms
Authors: Souza João G. S. , Costa Oliveira Bárbara E. , Bertolini Martinna , Lima Carolina Veloso , Retamal‐Valdes Belén , de Faveri Marcelo , Feres Magda , Barão Valentim A. R.
Published: November 2019

Objective

To evaluate the effect of titanium (Ti) particles and ions on oral biofilm growth and composition.

Background

Particles and ions of Ti released from dental implants can trigger unfavorable biological responses in human cells. However, their effect on oral biofilms composition has not been tested.

Methods

In this blind in situ study, volunteers wore a palatal appliance containing Ti disks for 7 days to allow biofilm formation. Disks were then collected and biofilms were treated, in vitro, with Ti particles (0.75% and 1%), ions (10 and 20 ppm), or a combination of both (1% particles + 20 ppm ions). Biofilms exposed only to medium was used as control group. After 24 hours, biofilms were collected and analyzed by checkerboard DNA‐DNA hybridization. Direct effects of Ti particles and ions on biofilm/cellular morphology were evaluated by transmission electron microscopy (TEM).

Results

Ti particles affected biofilm composition, increasing population of four bacterial species (P < .05), while Ti ions showed higher levels of putative pathogens from the orange complex with reduction in species from the yellow complex (P < .05), compared with control. The combination of particles + ions increased green complex and reduced yellow complex proportions (P < .05). TEM showed clusters of particles agglomerated in extracellular environment, while Ti ions were precipitated in both extracellular and intracellular sites.

Conclusions

Ti products, especially Ti ions, have the potential to change the microbiological composition of biofilms formed on Ti surfaces. Therefore, the presence of Ti products around dental implants may contribute to microbial dysbiosis and peri‐implantitis.
The intracellular pathogen concept
Authors: Casadevall Arturo , Fang Ferric C.
Published: November 2019

The intracellular pathogen concept classifies pathogenic microbes on the basis of their site of replication and dependence on host cells. This concept played a fundamental role in establishing the field of cellular microbiology, founded in part by Dr. Pascale Cossart, whose seminal contributions are honored in this issue of Molecular Microbiology. The recognition that microbes can access and replicate in privileged compartments within host cells has led to many new and fruitful lines of investigation into the biology of the cell and mechanisms of cell‐mediated immunity. However, like any scientific concept, the intracellular pathogen concept can become a dogma that constrains thinking and oversimplifies complex and dynamic host–pathogen interactions. Growing evidence has blurred the distinction between “intracellular” and “extracellular” pathogens and demonstrated that many pathogens can exist both within and outside of cells. Although the intracellular pathogen concept remains useful, it should not be viewed as a rigid classification of pathogenic microbes, which exhibit remarkable variation and complexity in their behavior in the host.
Geographical distribution of mycetoma cases in senegal over a period of 18 years
Authors: Badiane Aïda Sadikh , Ndiaye Mouhamadou , Diongue Khadim , Diallo Mamadou Alpha , Seck Mame Cheikh , Ndiaye Daouda
Published: November 2019

Background

Mycetoma is a pathological process in which fungal or actinomycotic agents of exogenous origin produce grains. In the absence of data on the global burden, it is important to map mycetoma cases, which are useful to implement control strategies.

Objective

The objective of this study was to map mycetoma cases diagnosed in Senegal over a period of eighteen years.

Methodology

The cases of mycetoma identified in the laboratory of Mycology at Aristide Le Dantec Hospital were extracted from the notebooks; information on the dates of collection, geographical origin and fungal agent identified was entered in Excel and analysed.

Results

Three hundred and thirty‐seven cases of mycetoma were diagnosed from 1993 to 2016 at Aristide Le Dantec Hospital. Mapping shows that overall, the western zone presented the majority of cases 47% (120), followed, respectively, by the central zone 32% (80), the northern zone 18% (47) and the southern zone 2% (6). However, over the years, this distribution is different with a decrease in cases from the periods 1993‐2000 and 2011‐2016 of 19% in the western and a progressive increase of cases in northern and central zones of, respectively, 13% and 14%. In the 1990s, the cases were predominant in Dakar, Louga and Diourbel. During 2011‐2016, Thies, Diourbel, Fouta and Louga presented more cases.

Conclusion

The spatial distribution of mycetoma in Senegal changed over the years, most frequent in the west of the country, and during 1993 to 2000, mycetoma is now more common in the north.
Creative targeting of the Gram‐negative outer membrane in antibiotic discovery
Authors: MacNair Craig R. , Tsai Caressa N. , Brown Eric D.
Published: November 2019

The rising threat of multidrug‐resistant Gram‐negative bacteria is exacerbated by the scarcity of new antibiotics in the development pipeline. Permeability through the outer membrane remains one of the leading hurdles in discovery efforts. However, the essentiality of a robust outer membrane makes itself an intriguing antimicrobial target. Herein, we review drug discovery efforts targeting the outer membrane and the prospective antimicrobial leads identified.
Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly
Authors: Zhao Lei , Qi Yi‐min , Yang Lei , Wang Gang‐rui , Zheng Sheng‐nai , Wang Qiang , Liang Bin , Jiang Chun‐zhi
Published: November 2019

Objective

To compare and analyze the clinical outcomes of the proximal humeral internal locking system (PHILOS) alone and the PHILOS combined with fibular allograft in the treatment of Neer three‐ and four‐part proximal humerus fractures (PHF) in the elderly.

Methods

From January 2014 to January 2018, a total of 42 elderly patients with Neer three‐ or four‐part PHF admitted to our hospital were randomly divided into observation group and control group, with 21 patients in each group. The observation group was treated with the PHILOS combined with fibular allograft. The control group was treated with the PHILOS alone. Perioperative parameters and fracture classification were recorded in the two groups. Function results were assessed by Visual Analog Scale (VAS), Constant‐Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, and the Disability of Arm‐Shoulder‐Hand (DASH) score. Radiological results were evaluated using the neck‐shaft angle (NSA) and humeral head height (HHH), and complications were also recorded in each group.

Results

There were no significant differences between the two groups in terms of preoperative status, age, gender, cause of trauma, fracture site, and fracture classification. The average follow‐up time was 12 months. At the last follow‐up, the VAS and DASH observation groups were lower than the control group, and there was significant difference between the two groups (P < 0.05). The CMS and ASES were higher in the observation group than the control group, and there was significant difference between the two groups (P < 0.05). The mean difference in the NSA and HHH were lower in the observation group than the control group, and there was a significant difference between the two groups (P < 0.05). There was one postoperative complication in the observation group, which was humeral head avascular necrosis (AVN). There were seven postoperative complications in the control group, including three cases of humeral head collapse and three cases of screw cutout and one case of humeral head AVN. The incidence of postoperative complications in the observation group was significantly lower than the control group (P < 0.05), there was a significant difference between the two groups.

Conclusions

For Neer three‐ or four‐part PHF in the elderly patients, PHILOS fixation with fibular allograft shows satisfactory short‐term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a PHILOS alone.
A quantitative cross‐sectional analysis of the melanin index in the skin of preterm newborns and its association with gestational age at birth
Authors: Silva Paola Conceição , Guimarães Rodney Nascimento , Souza Rayner Guilherme , Reis Zilma Silveira Nogueira
Published: November 2019

Background

Estimation of gestational age (GA) is important to make timely decisions and provide appropriate neonatal care. Clinical maturity scales to estimate GA have used skin texture and color to assess maturity at birth facing situations of the uncertainty of pregnancy dating. The size and darkness of the areola around the nipple to grade skin characteristics are based on visual appearance. The melanin index (M‐Index) is an optical skin parameter related to the melanin content in the tissue. This study is aimed to associate the M‐Index of the skin with the GA.

Methods

A cross‐sectional study evaluated 80 newborns at birth. A photometer device quantified the skin pigmentation on the areolae, forearms, and soles. Paired average differences of M‐Index were compared among the three body sites. The skin M‐Indexes were compared between subgroups of newborns until 34 weeks or with 34 and more.

Results

The skin over the areola had the highest values of M‐Index compared with the forearm or sole areas (P < .001 for both). Infants with a GA between 34 and <37 weeks had higher M‐Index values over the areola than the group with a GA with 24 to <34 weeks: 41.7 (8.9) and 38.3 (10.5) median (IQR), P = .005.

Conclusions

The measurable M‐Index values have the potential to improve physical evaluation in assessing GA at birth.
Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes
Authors: Bhatt Pinki J. , Ali Mohsin , Rana Meenakshi , Patel Gopi , Sullivan Timothy , Murphy Joseph , Pinney Sean , Anyanwu Anelechi , Huprikar Shirish , Taimur Sarah
Published: November 2019

Background

Infections secondary to multidrug‐resistant organisms (MDRO) have emerged as a growing problem in solid organ transplantation (SOT). Most of the published data on MDRO infections in SOT pertains to abdominal organ transplantation and data specific to heart transplantation (HT) are limited.

Methods

This is a retrospective review of HT recipients at our institution from 2011 to 2016; with the aim to investigate the epidemiology, microbiologic spectrum, and outcomes in patients with post‐HT MDRO infections, classified as multidrug‐resistant (MDR), extensively drug‐resistant (XDR), and pandrug‐resistant (PDR) using standardized definitions.

Results

Of the 149 HT recipients, 82 episodes of bacterial infection were seen in 46 patients (31%) in the year following HT. Thirty (37%) were due to MDR pathogens and 13 (16%) were XDR. The most common gram‐negative MDR pathogens were extended‐spectrum beta‐lactamase (ESBL) Escherichia coli and Klebsiella pneumoniae; while XDR pathogens were most commonly Pseudomonas aeruginosa followed by carbapenem‐resistant Klebsiella pneumoniae. Majority of infection episodes were bloodstream (54, 66%) followed by pulmonary infection (20, 24%). Within a year after transplant, HT recipients with any bacterial infection had significantly higher mortality versus those without infection; and XDR infections were associated with a 26‐fold greater hazard of death on average compared to those without infection (adjusted HR, 26.1; 95% CI, 6.4‐107.0; P < .001). There were no PDR infections.

Conclusion

Bacterial infections were a significant predictor of 1‐year post‐HT mortality, which was highest among those with XDR infections. This study highlights the burden of MDRO infections in HT recipients and identifies an area of future research.
Effect of Carbon Dioxide Recirculation and Pressure on Efficiency of the TIPS and ENEL Oxy-Coal Power Cycles
Authors: Khan Md. Moheiminul I. , Chowdhury Mehrin , Chowdhury A. S. M. Arifur Rahman , Aboud Jad , Love Norman
Published: November 2019

This paper presents the results of thermal efficiency of two coal based oxy-combustion thermodynamic cycles that are modeled using aspen plus. The objective of the present study is to perform a parametric analysis, investigating the effect of different recirculation ratios at different pressures on the efficiencies of the cycle named for the company, ENEL, and the thermo energy power system, TIPS, cycles using aspen plus® software. Variables include the flue gas recycle flow rate, the combustor temperature, and the operational pressure. Five recirculation ratios were investigated, ranging from 20% to 75%. It was determined that as the amount of recycled gas into the combustor increased, the thermal efficiency increased for both the TIPS and ENEL cycles. The highest thermal efficiency for TIPS is 37% and for ENEL is 38%, both occurring at a 75% recirculation ratio. After investigation, since combustion temperature and specific heat capacity decreases at higher recirculation ratios, the mass flow rate was the dominant factor that contributes to the increase in thermal efficiency of the cycle. At each recirculation ratio, the effect of pressure is also determined. For ENEL, the increase in cycle efficiency is 10% over the pressure range of 1–12 bar at a recirculation ratio of 20%, while the increase in cycle efficiency is only 1.5% at a higher recirculation ratio of 75%. For TIPS, the cycle efficiency increases by 4% at the recirculation ratio of 20% and increases by 3% at the recirculation ratio of 75% for a pressure range of 50–80 bar.
Optimal Design of Reaction Hydro Turbine Model Stay Vane by Vane Angle and Thickness Distribution
Authors: Shrestha Ujjwal , Park Jungwan , Choi Young-Do
Published: November 2019

Optimization is uprising technology in the engineering field, which enhance the performance of mechanical components. Likewise, upcoming turbomachinery designs need to be more efficient, cost-effective and easy manufacturing. Many optimization techniques have implemented for the development of efficient turbomachines. In this study, the optimization has mostly confined to the stay vane of reaction turbine like Francis, Pump Turbine etc. Stay vanes are mainly used to direct the flow towards guide vane and runner in the reaction type turbine (Francis, Pump Turbine). The three-dimensional flow field from the spiral casing is highly distorted, which causes secondary flow. However, the uniform flow field has maintained by stay vane. Due to steady flow field from stay vane, the performance of the runner has improved. Therefore, the better design of stay vane has been required for the improvement of the flow field around the runner passage. The design parameters of the stay vane are vane angle distribution and thickness distribution from leading edge to trailing edge. The vane angle distribution controls the stability of flow field direction and momentum towards the runner. Similarly, the thickness distribution will maintain the profile of the stay vane. The optimization of stay vane has improved turbine efficiency, flow uniformity, and pressure loss. The multi-objective genetic algorithm (MOGA) was selected for the optimization of stay vane because it satisfies all the objective functions without being dominated by any specific solution. MOGA is a more realistic approach to optimization. The validation test of performance is conducted to compare the result of experimental and numerical methods. The optimized stay vane has improved the flow uniformity around the stay vane.