bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid artery disease in post‐stroke survivors and effects of enriched environment on stroke pathology in a mouse model of carotid artery stenosis
Authors: Hase Y. , Polvikoski T. M. , Ihara M. , Hase M. , Zafar R. , Stevenson W. , Allan L. M. , Ennaceur A. , Horsburgh K. , Gallart‐Palau X. , Sze S. K. , Kalaria R. N.
Published: April 2019

Aims

Carotid artery disease (CAD) is an important risk factor for stroke. We first evaluated CAD and stroke pathology in elderly post‐stroke survivors. To simulate CAD, we assessed long‐term consequences of bilateral common carotid artery stenosis (BCAS) in mice and exposed them to environmental enrichment (EE).

Methods

Histopathological methods were used to determine degrees of CAD (% area stenosis), brain infarct types, sizes and distribution in post‐stroke survivors and BCAS mice. Adult male C57BL/6J mice after BCAS or sham surgery were randomly assigned to standard housing (Std) or limited (3 h) or full‐time (Full) exposure to EE per day for 12 weeks.

Results

High frequencies of moderate carotid artery stenosis (51–75%) were evident in post‐stroke survivors whereas those with severe CAD (>75% stenosis) exhibited greater numbers of cortical rather than subcortical infarcts and, were at higher risk of developing dementia. BCAS in mice reduced cerebral blood flow by 52% (P < 0.01) and thickened carotid artery walls, regardless of EE duration. Remarkably, the total and cortical infarcts declined by >50% in BCAS mice exposed to EE compared with BCAS‐Std (P < 0.01). Frontal lobe and cortical strokes were associated with worsening working memory tested in a radial maze paradigm. Proteomic analysis revealed EE, both BCAS‐3 h and BCAS‐Full attenuated coagulation cascade factors including fibrinogen and von Willebrand factor, markers of blood–brain barrier damage.

Conclusion

Small cortical and subcortical infarcts were evident in both post‐stroke survivors with CAD and BCAS mice. Experimental evidence suggested that moderate exposure to EE is sufficient to reduce subsequent stroke lesions.
The Efficiency‐Equity Tradeoff in School Aid: How Efficiency Targeting in Lump‐Sum Aid Generates Unexpected Effects
Authors: Ryu Jay E.
Published: April 2019

Formulas of state aid to local school districts have recently incorporated efficiency targeting, which incentivizes school districts to enhance the efficiency of school administration and teaching. This paper shows that efficiency targeting in lump‐sum foundation aid fails to make school districts more efficient than typical foundation aid does. Efficiency targeting instead improves fiscal equity across school districts under almost all scenarios. This paper also clarifies why these unexpected equity effects take place and suggests feasible and implementable alternatives to obtain the efficiency improvement from efficiency targeting.
Darwinizing debunking arguments
Authors: Davies Paul Sheldon
Published: April 2019

To ‘Darwinize’ a debunking argument is to broaden and thereby strengthen it in ways inspired by Charles Darwin. It is to employ Darwinian strategies that converge on the conclusion that certain putative phenomena – the reality of stance‐independent moral properties, for instance – are illusory or epistemically problematic for animals like us. The aim of this essay is to defend one such strategy and illustrate its power relative to most evolutionary debunking arguments currently on offer.
Characterization of the novel KIR3DL3*062 allele identified in a Southern Chinese Han individual
Authors: Huang Xiaosheng , Zhao Jun , Siqi Cai , Deng Zhi‐Hui
Published: April 2019

The novel KIR3DL3*062 allele differs from the closest allele KIR3DL3*02602 by a single missense mutation.
De‐Biasing Legal Fact‐Finders With Bayesian Thinking
Authors: Dahlman Christian
Published: April 2019

This article shows how Bayesian thinking can help legal fact‐finders to avoid some common fallacies and biases in the evaluation of legal evidence (false dichotomy, dependence neglect, and miss rate neglect).
Implementation of a script for predonation interviews: impact on human immunodeficiency virus risk in South African blood donors
Authors: Mitchel Josephine , Custer Brian , Kaidarova Zhanna , Murphy Edward L. , van den Berg Karin ,   Recipient Epidemiology and Donor Evaluation Study‐III (REDS‐III) South Africa Program
Published: April 2019

BACKGROUND

The way in which the donor history questionnaire is conducted plays a crucial role in the self‐disclosure of behavioral risk factors for human immunodeficiency virus (HIV) infection by prospective donors. The South African National Blood Service changed its policy on the process of donor assessment in May 2015 by implementing a compulsory interviewer script used to assess donor eligibility.

STUDY DESIGN AND METHODS

A pre‐ and postevaluation study to determine the impact of scripted interviews on high‐risk deferrals and recently acquired HIV infections. We used historical data to compare 18 months before and after the implementation of the script.

RESULTS

We recorded a total of 3,169,656 donor presentations during the two 18‐months periods, of which 52.2% (1,655,352) were made during the scripted period. A multivariable logistic regression analysis adjusting for donor and demographic characteristics found the odds of high‐risk deferral to be slightly greater (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.05‐1.07) during the scripted period. A separate multivariate logistic regression model, also adjusting for donor and demographic characteristics, showed that the odds of recently acquired HIV infection were significantly lower (OR, 0.88; 95% CI, 0.79‐0.97) during the scripted period.

CONCLUSION

This study showed that implementation of a scripted interview was associated with increased HIV risk deferral and decreased recent HIV infection. This study indicates potential improvement in blood safety with the implementation of a scripted donor interview and has relevance to blood safety in other sub‐Saharan African countries.
Measuring the Contributions of Sources of Employee-Based Brand Equity to the Market Performance of Deposit Money Banks in Nigeria
Authors: Etim Glory S. , Uford Imoh C.
Published: April 2019

The study attempts to measure the contributions of sources of employee-based brand equity (EBBE) to the market performance of deposit money banks (DMBs) in Nigeria. A quantitative approach using self-administered questionnaires was adopted. Empirical data was drawn from 360 respondents (182 employees and 178 customers) in the six (6) geo-political zones in Nigeria. Structural Equation Modelling was used to analyse the hypothesized paths/relationships. The study found that out of the three sources of EBBE, brand commitment was the strongest predictor of overall EBBE. It also found that out of the three market performance indicators, customers’ intention to pay a price premium was the most dependent on EBBE sources. In relation to employees/customers relationship, this paper provides evidence for issues of potential research and managerial interest. Practically, the study findings will help brand managers, other marketing practitioners and indeed marketing scholars to develop effective internal brand management strategies with a view to implementing them profitably.
Dislocation structures, interfacing, and magnetism in the L1−MnGa on η⊥−Mn3N2 bilayer
Authors: Corbett J. P. , Guerrero-Sanchez J. , Gallagher J. C. , Mandru A.-O. , Richard A. L. , Ingram D. C. , Yang F. , Takeuchi N. , Smith A. R.
Published: April 2019

Ferromagnetic L10−MnGa was grown by molecular beam epitaxy under ultrahigh vacuum conditions to a 73±5nm thickness atop of 50±5nm thick molecular beam epitaxy grown antiferromagnetic η⊥−Mn3N2 on an MgO(001) substrate. The MnGa grew along the c-axis with an out-of-plane spacing of c=3.71±0.01Å and a relaxed in-plane spacing of a=4.00±0.05Å measured with x-ray diffraction and reflection high-energy electron diffraction, respectively. Williamson–Hall analysis revealed 67±17nm tall columnar grains with a residual strain of 2.40±0.26(×10−3). A radial distribution plot of screw dislocations observed in scanning tunneling microscopy images showed an in-plane coherence length of 15±5nm. Reflection high-energy electron diffraction analysis of the in-plane lattice spacing during growth reveals a critical thickness of 1.05±0.65nm for the MnGa, after which the MnGa film relaxes by incorporating dislocations of both edge and screw type. Vibrating sample magnetometry was employed to obtain the magnetic properties of the bilayer system. It is found that the dislocation density plays a significant role in influencing the measured moment per unit cell, where a large dislocation density lowers the moment per unit cell significantly due to chemical layer disordering.
Effects of plasma shield plate design on epitaxial GaN films grown for large-sized wafers in radical-enhanced metalorganic chemical vapor deposition
Authors: Isobe Yasuhiro , Sakai Takayuki , Sugiyama Naoharu , Mizushima Ichiro , Suguro Kyoichi , Miyashita Naoto , Lu Yi , Wilson Amalraj Frank , Kumar Dhasiyan Arun , Ikarashi Nobuyuki , Kondo Hiroki , Ishikawa Kenji , Shimizu Naohiro , Oda Osamu , Sekine Makoto , Hori Masaru
Published: April 2019

Epitaxial growth of GaN films at a low temperature of 800 °C was studied in radical-enhanced metal-organic chemical vapor deposition, focusing on the discharge region of the plasma of a mixture of N2 and H2 gases. The effect of plasma confinement on the growth is crucial for realizing high crystal quality of grown GaN films, owing to the suppression of plasma-induced damage and decomposition of gallium precursors in the gaseous phase. By confined plasma in the discharge region using the plasma shield plates made of metal with multiple small holes effectively, GaN with a relatively flat surface was grown under conditions of higher V/III ratios. Epitaxial growth of GaN films was achieved by modifying the plate design and controlling the high V/III ratio using both the plasma-excitation power and the Ga precursor flow rate.
Mapping efforts envision vast ocean reserves
Authors: Fox Alex
Published: April 2019

Research teams race to help shape new U.N. treaty on protecting life in international waters.
Convergent regulatory evolution and loss of flight in paleognathous birds
Authors: Sackton Timothy B. , Grayson Phil , Cloutier Alison , Hu Zhirui , Liu Jun S. , Wheeler Nicole E. , Gardner Paul P. , Clarke Julia A. , Baker Allan J. , Clamp Michele , Edwards Scott V.
Published: April 2019

All roads lead to regulation

Species from widely divergent taxa can experience similar changes in traits. What underlying genetic drivers cause these parallel changes remains an open question. Sackton
et al.
looked across groups of birds that have repeatedly lost flight, the ratites and tinamous, and found that there is convergence in the regulatory regions associated with genes related to flight, but not within the protein coding regions. Changes within these regulatory regions influenced limb development and may represent quick paths toward convergent change across taxa.

Science
, this issue p.
74
Structure, spatial dynamics, and stability of novel seed dispersal mutualistic networks in Hawai
ʻ
i
Authors: Vizentin-Bugoni Jeferson , Tarwater Corey E. , Foster Jeffrey T. , Drake Donald R. , Gleditsch Jason M. , Hruska Amy M. , Kelley J. Patrick , Sperry Jinelle H.
Published: April 2019

Invasive birds spread native seeds

When humans introduce exotic species to sensitive ecosystems, invasion and extinction of native species often follow. The resulting ecological communities can develop unusual interactions between the survivors and newcomers. Vizentin-Bugoni
et al.
analyzed the structure of seed dispersal networks in Hawai'i, where native bird species have been mostly replaced by invaders. They found that the native plants now depend on the invasive birds for seed dispersal. The network of dispersal interactions is complex and stable, which are features of native seed-dispersal networks in other parts of the world. It appears that introduced species may, in some circumstances, become integrated into native ecosystems.

Science
, this issue p.
78
Ligand-triggered allosteric ADP release primes a plant NLR complex
Authors: Wang Jizong , Wang Jia , Hu Meijuan , Wu Shan , Qi Jinfeng , Wang Guoxun , Han Zhifu , Qi Yijun , Gao Ning , Wang Hong-Wei , Zhou Jian-Min , Chai Jijie
Published: April 2019

The plant resistosome comes into focus

Nucleotide-binding, leucine-rich repeat receptors (NLRs) initiate immune responses when they sense a pathogen-associated effector. In animals, oligomerization of NLRs upon binding their effectors is key to downstream activity, but plant systems differ in many ways and their activation mechanisms have been less clear. In two papers, Wang
et al.
studied the composition and structure of an NLR called ZAR1 in the small mustard plant
Arabidopsis
(see the Perspective by Dangl and Jones). They determined cryo–electron microscopy structures that illustrate differences between inactive and intermediate states. The active, intermediate state of ZAR1 forms a wheel-like pentamer, called the resistosome. In this activated complex, a set of helices come together to form a funnel-shaped structure required for immune responsiveness and association with the plasma membrane.

Science
, this issue p.
eaav5868
, p.
eaav5870
; see also p.
31
Reconstitution and structure of a plant NLR resistosome conferring immunity
Authors: Wang Jizong , Hu Meijuan , Wang Jia , Qi Jinfeng , Han Zhifu , Wang Guoxun , Qi Yijun , Wang Hong-Wei , Zhou Jian-Min , Chai Jijie
Published: April 2019

The plant resistosome comes into focus

Nucleotide-binding, leucine-rich repeat receptors (NLRs) initiate immune responses when they sense a pathogen-associated effector. In animals, oligomerization of NLRs upon binding their effectors is key to downstream activity, but plant systems differ in many ways and their activation mechanisms have been less clear. In two papers, Wang
et al.
studied the composition and structure of an NLR called ZAR1 in the small mustard plant
Arabidopsis
(see the Perspective by Dangl and Jones). They determined cryo–electron microscopy structures that illustrate differences between inactive and intermediate states. The active, intermediate state of ZAR1 forms a wheel-like pentamer, called the resistosome. In this activated complex, a set of helices come together to form a funnel-shaped structure required for immune responsiveness and association with the plasma membrane.

Science
, this issue p.
eaav5868
, p.
eaav5870
; see also p.
31
Developmental control of plant Rho GTPase nano-organization by the lipid phosphatidylserine
Authors: Platre Matthieu Pierre , Bayle Vincent , Armengot Laia , Bareille Joseph , Marquès-Bueno Maria del Mar , Creff Audrey , Maneta-Peyret Lilly , Fiche Jean-Bernard , Nollmann Marcelo , Miège Christine , Moreau Patrick , Martinière Alexandre , Jaillais Yvon
Published: April 2019

GTPase clustering in response to a hormone

Some lipid variants that are rare in plasma membranes function as signaling components. Studying root tip cells of the model plant
Arabidopsis
, Platre
et al.
found that phosphatidylserine, which is relatively abundant in plasma membranes, also modulates signaling pathways. Phosphatidylserine is required for the clustering of ROP6, a small guanosine triphosphatase (GTPase), in membranes in response to signals from the plant hormone auxin. Changes in phosphatidylserine concentration altered the clustering of ROP6 and thus the auxin signaling response.

Science
, this issue p.
57
Subsidies, efficiency, and fairness in fisheries policy
Authors: Smith Martin D.
Published: April 2019

Don't flip the burden of proof and ignore theory and evidence
In defense of the black box
Authors: Holm Elizabeth A.
Published: April 2019

Black box algorithms can be useful in science and engineering
Science during crisis
Authors: Colwell Rita R. , Machlis Gary E.
Published: April 2019

In April 1902, on the Caribbean island of Martinique,
La Commission sur le Vulcan
convened to make a fateful decision. Mt. Pelée was sending smoke aloft and spreading ash across the capital city of Saint-Pierre. Comprising physicians, pharmacists, and science teachers, the commission debated the danger of an eruption and the burden of evacuation, and judged the safety of the city's population to be “absolutely assured.” Weeks later, Mt. Pelée erupted and approximately 30,000 residents died within minutes, leaving only two survivors. Environmental crises require pivotal decisions, and such decisions need timely, credible scientific information and science-based advice. This requirement is the focus of a report released last month by the American Academy of Arts and Sciences*, calling attention to improvements in the operation and delivery of science during crises.
A Novel VIM-Type Metallo-β-Lactamase Variant, VIM-60, with Increased Hydrolyzing Activity against Fourth-Generation Cephalosporins in Pseudomonas aeruginosa Clinical Isolates in Japan
Authors: Hishinuma Tomomi , Tada Tatsuya , Uchida Hiroki , Shimojima Masahiro , Kirikae Teruo
Published: April 2019

A novel VIM-type metallo-β-lactamase variant, VIM-60, was identified in multidrug-resistant
Pseudomonas aeruginosa
clinical isolates in Japan. Compared with VIM-2, VIM-60 had two amino acid substitutions (Arg228Leu and His252Arg) and higher catalytic activities against fourth-generation cephalosporins.
Нестационарная термически-неравновесная модель для предсказания выноса шлама при бурении наклонно-направленных скважин
Authors: Лыхин П А , Lykhin P A , Торопецкий Константин Викторович , Toropetskiy Konstantin Viktorovich , Ульянов В Н , Ul'yanov V N , Усов Эдуард Викторович , Usov Eduard Viktorovich , Чухно Владимир Игоревич , Chukhno Vladimir Igorevich
Published: April 2019

Представлена нестационарная математическая модель для моделирования движения шлама в потоке бурового раствора при бурении горизонтальных и наклоннонаправленных скважин. В основе лежит двухслойная модель, которая учитывает шлам в потоке флюида, а также неподвижную шламовую подложку. Приведены соотношения, которые позволяют рассчитывать массообмен между подложкой и шламом в потоке, трение и теплообмен шлама с потоком флюида, а также теплообмен флюида и подложки с затрубным пространством. Реализованы опции для моделирования движения флюида с обычной и неньютоновской реологией. Предполагается, что жидкость двигается в кольцевом канале, образованном стенкой скважины и буровой колонной. Учитывается наличие эксцентриситета в канале. Для моделирования движения и теплообмена шлама и флюида решается система уравнений, которая отражает собой законы сохранения массы, энергии и импульса для каждого компонента в отдельности. Численная реализация основана на методе конечных объемов, конвективные члены записаны в противопоточном виде. Представлены результаты тестовых расчетов, демонстрирующих работоспособность предложенной модели. Рассмотрена задача по вытеснению шлама из произвольно-ориентированной скважины.
Бифуркационная модель ламинарно-турбулентного перехода в пристеночном слое
Authors: Трошкин Олег Валентинович , Troshkin O V , Козлов С А , Kozlov S A , Фортова Светлана Владимировна , Fortova Svetlana Vladimirovna , Шепелев Вадим Владимирович , Shepelev Vadim Vladimirovich , Ериклинцев И В , Eriklintsev I V
Published: April 2019

Описан процесс построения новой модели (бифуркационной модели турбулентности), описывающей течение сплошной среды как в ламинарном, так и турбулентном режимах. Главной ее особенностью является ламинарно-турбулентный переход, возникающий как новое решение уравнения для напряжений Рейнольдса, замыкающего систему RANS (Reynolds-averaged Navier-Stokes). Статья состоит из трех основных разделов. В первом рассказывается о схемах замыкания второго порядка уравнений Навье-Стокса, осредненных по Рейнольдсу. Во втором разделе изложен вывод уравнений модели турбулентного течения в сдвиговом слое. Третий раздел содержит описание модели турбулентного пограничного слоя на плоской пластине. Приводятся расчеты рассматриваемых течений, результаты сравниваются с экспериментальными.
Математическая модель и алгоритм расчета прессования и спекания
Authors: Бураго Николай Георгиевич , Burago Nikolai Georgievich , Никитин Илья Степанович , Nikitin Il'ya Stepanovich
Published: April 2019

На основе термодинамического подхода получены определяющие соотношения модели прессования и спекания порошковых композитов. В систему уравнений обычной теории упругопластичности добавлено кинетическое уравнение для расчета эволюции пористости при нетермомеханическом воздействии всесторонним сжимающим напряжением спекания. Модификация обычной теории упругопластического течения включена в программу расчета упругопластических сред для адаптации к процессам спекания. Численными расчетами продемонстрирована способность модифицированной теории упругопластичности моделировать основные эффекты прессования и спекания, включая расчет остаточных пористости, напряжений и деформаций в прессовке, а также ее остаточной формы. Также на основе предложенной теории численно решена задача «горячего» спекания под действием подвижного высокоэнергетического импульса («лазерное спекание»). Рассчитано влияние параметров лазерного воздействия на спекание порошкового материала, а также на распределение пористости и температуры.
Разрывный метод частиц на газодинамических примерах
Authors: Богомолов Сергей Владимирович , Bogomolov Sergei Vladimirovich , Кувшинников Артем Евгеньевич , Kuvshinnikov Artem Evgen'evich
Published: April 2019

Работа посвящена исследованию особенностей разрывного метода частиц. Подробно описаны алгоритмические основы метода частиц. Исследована возможность применения лимитеров. Приведены результаты расчeтов для уравнений Хопфа, Бюргерса, мелкой воды и газовой динамики, включая нелинейную акустику. Произведено сравнение численных решений с некоторыми точными. Тесты показывают, что метод хорошо подходит для задач с разрывами. Показано, что для получения более точного численного решения необходимо уточнять исходные математические модели. А именно, если для задачи о структуре фронта ударной волны вместо уравнений Навье-Стокса брать уравнения стохастической газовой динамики, то необходимость в лимитерах отпадает.
Программное обеспечение для моделирования флюидодинамики и трансфазных процессов в коллекторах, содержащих газогидраты
Authors: Рагимли Парвин Ильгар Кызы , Rahimli Parvin Ilgar kizi , Рагимли Орхан Рагим оглы , Rahimly Orkhan Rahim oglu , Повещенко Юрий Андреевич , Poveschenko Yurii Andreevich , Подрыга Виктория Олеговна , Podryga Viktoriya Olegovna , Гасилова Ирина Владимировна , Gasilova Irina Vladimirovna
Published: April 2019

Представлено описание модели, алгоритма и структуры прикладного программного комплекса (кода), предназначенного для моделирования течений в пористой среде, содержащей соединения природных газов (метан и др.) с водой или газовые гидраты. Код «HYDRAT1D» позволяет решать уравнения флюидодинамики в талой зоне и пьезопроводной среде с учетом фазовых переходов. Код “HYDRAT1D” реализован на языке JavaScript и работает в рамках компьютерной архитектуры «клиент-сервер».
Моделирование равномерности обработки покрытий противогололедным жидким реагентом
Authors: Мандровский Константин Петрович , Mandrovskiy Konstantin Petrovich , Садовникова Яна Сергеевна , Sadovnikova Yana Sergeevna
Published: April 2019

Целью статьи является изучение равномерности обработки покрытий жидким противогололeдным реагентом при помощи математических методов. Задача представленного в статье моделирования состоит в формировании основных принципов разработки математического и программного обеспечения мониторинговой системы дорожных и аэродромных машин для распределения реагентов. Для этого предложена математическая модель движения капель жидкого противогололедного реагента в воздушной среде, учитывающая действие ветра, а также физические свойства рассматриваемой среды. На еe основе разработан оригинальный программный код в среде QtOctave. С помощью компьютерного моделирования исследовано влияние высоты установки рабочего органа машины - распределительного диска - на плотность распыления реагента. С использованием возможностей программного продукта QtOctave показана графическая зависимость равномерности распределения капель по длине обрабатываемой зоны от скорости ветра. Выявлен характер влияния направления движения воздушных масс на появление неравномерности в оседании капель реагента на покрытии. Представлен график и результаты расчетов, подтверждающие отсутствие связи между частотой вращения приводного вала диска и отклонением от равномерности распределения капель в процессе противогололедной обработки аэродромных и дорожных покрытий. Полученные численные и аналитические результаты следует использовать в работе мониторинговых систем, главное назначение которых заключается в обеспечении равномерного распыления реагента с заданными дальностью и расходом.
Acute ataxia in paediatric emergency departments: a multicentre Italian study
Authors: Garone Giacomo , Reale Antonino , Vanacore Nicola , Parisi Pasquale , Bondone Claudia , Suppiej Agnese , Brisca Giacomo , Calistri Lucia , Cordelli Duccio Maria , Savasta Salvatore , Grosso Salvatore , Midulla Fabio , Falsaperla Raffaele , Verrotti Alberto , Bozzola Elena , Vassia Cristina , Da Dalt Liviana , Maggiore Rosario , Masi Stefano , Maltoni Lucia , Foiadelli Thomas , Rossetti Annalisa , Greco Carla , Marino Silvia , Di Paolantonio Claudia , Papetti Laura , Urbino Antonio Francesco , Rossi Rossella , Raucci Umberto
Published: April 2019

Objectives

To evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP).

Study design

This is a retrospective medical chart analysis of children (1–18 years) attending to 11 paediatric emergency departments (EDs) for AA in an 8-year period. A logistic regression model was applied to identify clinical risk factors for CUNP.

Results

509 patients (mean age 5.8 years) were included (0.021% of all ED attendances). The most common cause of AA was acute postinfectious cerebellar ataxia (APCA, 33.6%). Brain tumours were the second most common cause (11.2%), followed by migraine-related disorders (9%). Nine out of the 14 variables tested showed an OR >1. Among them, meningeal and focal neurological signs, hyporeflexia and ophthalmoplegia were significantly associated with a higher risk of CUNP (OR=3–7.7, p<0.05). Similarly, the odds of an underlying CUNP were increased by 51% by each day from onset of ataxia (OR=1.5, CI 1.1 to 1.2). Conversely, a history of varicella-zoster virus infection and vertigo resulted in a significantly lower risk of CUNP (OR=0.1 and OR=0.5, respectively; p<0.05).

Conclusions

The most frequent cause of AA is APCA, but CUNPs account for over a third of cases. Focal and meningeal signs, hyporeflexia and ophthalmoplegia, as well as longer duration of symptoms, are the most consistent ‘red flags’ of a severe underlying pathology. Other features with less robust association with CUNP, such as seizures or consciousness impairment, should be seriously taken into account during AA evaluation.
Intraoesophageal migration of Teflon pledgets used for hiatal hernia repair: a serious adverse event
Authors: Rancourt Maude , Paré Alex , Comeau Émilie
Published: April 2019

11 months following an elective paraoesophageal hernia repair, a female patient presents to the emergency department with severe dysphagia. A CT showed a distention of the distal oesophagus caused by a foreign body and dense material inside and outside the oesophagus wall. A gastroscopy confirmed the presence of a bezoar and secondary oesophagitis due to the intraoesophageal migration of Teflon pledgets. Even when used appropriately, only for the crus repair, the use of Teflon pledgets may result in fistulisation through the oesophagus. This complication suggests that the use of Teflon pledgets to buttress a hiatal hernia repair should be used with caution and that an alternative technique (eg, resorbable pledgets) could be preferred.
Chronic non-granulomatous supraglottitis of a male adolescent and its successful management with azathioprine
Authors: Kovacs Aaron , Haran Shankar , Paddle Paul
Published: April 2019

Chronic non-granulomatous supraglottitis (CNGS) is a rare disorder of the supraglottic larynx, characterised by chronic supraglottic inflammation in the absence of granulomata, vasculitis, neoplasia, autoimmune disease or infective changes on histology. We present the case of a male adolescentwho attended with progressively worsening exertional dyspnoea, stridor and symptoms of obstructive sleep apnoea. Flexible nasendoscopy revealed marked supraglottic subepithelial thickening sparing the glottis and subglottis, confirmed on microlaryngoscopy. MRI of the head and neck demonstrated diffuse, homogenous supraglottic oedema. At the peak of his symptomology, the patient was admitted for further investigations and intravenous steroid therapy, and switched to prolonged oral steroids on discharge. Tracheostomy was avoided. After 3 months, he was successfully weaned from steroids to azathioprine with gradual symptomatic improvement. This case represents the first successful use of a steroid-sparing agent in the management of CNGS.
Takotsubo twins
Authors: Ekenbäck Christina , Tornvall Per , Spaak Jonas
Published: April 2019

Takotsubo syndrome is an intriguing condition of often stress induced reversible cardiac dysfunction mimicking myocardial infarction, but without explanatory coronary obstructions. The pathogenesis of the syndrome is not yet fully understood, though altered sympathetic regulation or response to cardiac sympathetic stimuli is likely to be involved. We present a unique and clinically detailed report of identical twin sisters, who both developed Takotsubo syndrome in association to mental stress shortly after menopause, also covering a potential relapse of disease in one of the twins, supporting the theory of a genetic contribution to the development of the syndrome proposed by previous case reports and small genetic studies.
Severe hypertriglyceridaemia and pancreatitis in a patient with lipoprotein lipase deficiency based on mutations in lipoprotein lipase (LPL) and apolipoprotein A5 (APOA5) genes
Authors: Koopal Charlotte , Bemelmans Remy , Marais A David , Visseren Frank LJ
Published: April 2019

A 44-year-old woman was admitted with pancreatitis caused by hypertriglyceridaemia (fasting triglycerides 28 mmol/L). She used oral contraceptives and ezetimibe 10 mg. She was overweight (body mass index 29.7 kg/m2). Diabetes mellitus was ruled out, as were nephrotic syndrome, alcohol abuse, hypothyroidism and dysbetalipoproteinaemia. Genetic analysis revealed mutations in two genes involved in triglyceride metabolism (apolipoprotein A5 and lipoprotein lipase [LPL]). The LPL activity was 45% compared with pooled healthy controls. The post-heparin triglyceride reduction was 6%, compared with a normal reduction of >20%. The patient was initially treated with gemfibrozil, but this was discontinued due to side effects. Dietary triglyceride restriction and discontinuation of the oral contraceptives lowered the plasma triglycerides within 2 weeks to 3.4 mmol/L. Hypertriglyceridaemia is a risk factor for pancreatitis and cardiovascular disease, and has a broad differential diagnosis including genetic causes. Patients can achieve near-normal triglyceride values with a low-fat diet only.
Intramural duodenal haematoma with mucosal prolapse causing intestinal obstruction
Authors: Loganathan Arun Kumar , Bal Harshjeet Singh
Published: April 2019

Intramural small bowel haematoma is a rare cause of intestinal obstruction in children. Coagulation disorders or anticoagulant therapy are the most common cause followed by blunt trauma. A one and half-year-old boy, with known case of gastro-oesophageal reflux disease had undergone upper gastrointestinal endoscopy and biopsy. Four days later, he presented to us with clinical features of small bowel obstruction. CT of the abdomen showed features suggestive of haemorrhagic duplication cyst. Explorative laparotomy revealed 15–20 cm of bowel from the third part of the duodenum to proximal jejunum filled with clotted blood and thinned out serosa. There was no evidence of intraluminal blood in the distal bowel loops. Resection of the involved bowel with primary anastomoses was done. Histopathological examination of bowel revealed intramural haematoma associated with prolapse of the mucosa. There was no evidence of duplication cyst or vascular malformations. Postoperative period was uneventful.
Ocular toxocariasis: atypical clinical course
Authors: Fonseca Cristina , Silva Andreia Mendes , Freire Sandra , Proença Rui
Published: April 2019

A 17-year-old man presented to the emergency department with complaints of retro-orbital pain of the left eye and an altitudinal visual field defect for 2 weeks. Fundus examination revealed ipsilateral hyperaemic optic disc oedema, and the patient was admitted with the presumptive diagnosis of left optic neuritis. Subsequently, during follow-up, the patient developed a retinal granulomatous lesion in the superior temporal arcade with vitritis and fibrotic strands extending to the mid-periphery. Serum antibodies detection by ELISA and aqueous humour immunoblot were positive forToxocara canis. Medical therapy with albendazole and oral steroids was instituted with satisfactory results. One year later, a new macular lesion developed with consequent vision loss.
Paediatric orbital trapdoor fracture misdiagnosed as a head injury: a cautionary tale!
Authors: Dunphy Louise , Anand Pradeep
Published: April 2019

Trapdoor fractures, otherwise known as ‘white-eyed blowout’ fractures, occur predominantly in the paediatric cohort and have a male predilection. Patients commonly present with acute fractures to the emergency department, and delayed diagnosis can result in significant morbidity. A lack of external signs, such as oedema or ecchymosis, often misleads physicians into underestimating the seriousness of the injury. It can be initially misdiagnosed as a head injury due to the oculocardiac reflex, nausea, vomiting, poor patient compliance and a failure to examine the eye appropriately. The incarcerated muscles may become necrotic because of ischaemia, resulting in ocular motility problems. Immediate surgery is recommended for symptomatic persistent diplopia or clinical evidence of muscle entrapment. The authors present the case of a 16-year-old male adolescent initially diagnosed with a head injury due to his nausea and vomiting following trauma to his orbit. This resulted in a delay to surgery. This article highlights the importance of performing an ophthalmic assessment to detect other features of a trapdoor fracture in children presenting with orbital trauma. It also reinforces the importance of knowledge of the oculocardiac reflex as its association with orbital injuries is well documented.
Comparison of anterior capsulotomy techniques: continuous curvilinear capsulorhexis, femtosecond laser-assisted capsulotomy and selective laser capsulotomy
Authors: Daya Sheraz , Chee Soon-Phaik , Ti Seng-Ei , Packard Richard , Mordaunt David H
Published: April 2019

Purpose

To compare the anterior capsulotomy edge tear strength created by manual continuous curvilinear capsulorhexis (CCC), femtosecond laser-assisted capsulotomy (FLACS), and selective laser capsulotomy (SLC).

Setting

Singapore National Eye Centre, Singapore and Excel-Lens, Livermore, California, USA.

Design

Three armed study in paired human eyes.

Methods

Capsulotomies were performed in 60 cadaver eyes of 30 donors using CCC, Victus Femtosecond Laser, (Bausch & Lomb, Rochester, New York, USA) or CAPSULaser, (Excel-Lens, Los Gatos, California, USA). Three pairwise study groups each involved 10 pairs of eyes. Study group 1: SLC eyes compared with fellow eyes with CCC. Study group 2: CCC eyes compared with fellow eyes with FLACS. Study group 3: FLACS eyes compared with fellow eyes with SLC.

A shoe-tree method was used to apply load to the capsulotomy edge, and Instron tensile stress instrument measured distension and threshold load applied to initiate capsule fracture. Relative fracture strengths and distension of CCC, FLACS and SLC were determined. Scanning electron microscopy (SEM) of capsule edges were reviewed

Results

Anterior capsulotomies behave as non-linear elastic (elastomeric) systems when exposed to an external load. The pairwise study demonstrated that the SLC fracture strength was superior to that of CCC by a factor of 1.46-fold with SLC 277±38 mN versus CCC with 190±37 mN. Furthermore, CCC fracture strength was superior to that of FLACS by a factor of 1.28-fold with CCC 186 + 37 mN versus FLACS 145 ± 35 mN (p < 0.001). This was determined by statistical analysis utilising the Wilcoxon matched-pairs signed-ranks test and in accordance with the Consolidated Standards of Reporting Trials guidelines. The capsule edge of SLC on SEM demonstrated a rolled over edge anteriorly and an alteration of collagen.

Conclusions

The strength of the capsulotomy edge for SLC was significantly stronger than that of CCC which and both were significantly stronger than FLACS. The relative strengths can be explained by SEM of each type of capsulotomy.
Alcohol and hepatocellular carcinoma
Authors: Matsushita Hiroshi , Takaki Akinobu
Published: April 2019

Background

Alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer because it induces hepatocellular carcinoma (among other cancers) in humans. An excessive alcohol intake may result in fatty liver, acute/chronic hepatitis, and cirrhosis and eventually lead to hepatocellular carcinoma. It has been reported that alcohol abuse increases the relative risk of hepatocellular carcinoma by 3- to 10-fold.

Aim and Methods

To clarify the known mechanisms of alcohol-related carcinogenesis, we searched Pubmed using the terms alcohol and immune mechanism, alcohol and cancer, and immune mechanism and cancer and summarized the articles as a qualitative review.

Results

From a clinical perspective, it is well known that alcohol interacts with other factors, such as smoking, viral hepatitis, and diabetes, leading to an increased risk of hepatocellular carcinoma. There are several possible mechanisms through which alcohol may induce liver carcinogenicity, including the mutagenic effects of acetaldehyde and the production of ROS due to the excessive hepatic deposition of iron. Furthermore, it has been reported that alcohol accelerates hepatitis C virus-induced liver tumorigenesis through TLR4 signaling. Despite intense investigations to elucidate the mechanisms, they remain poorly understood.

Conclusion

This review summarizes the recent findings of clinical and pathological studies that have investigated the carcinogenic effects of alcohol in the liver.
Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria
Authors: Ekhaguere Osayame A , Oluwafemi Rosena O , Badejoko Bolaji , Oyeneyin Lawal O , Butali Azeez , Lowenthal Elizabeth D , Steenhoff Andrew P
Published: April 2019

Background

Sub-Saharan Africa has high under-5 mortality and low childhood immunisation rates. Vaccine-preventable diseases cause one-third of under-5 deaths. Text messaging reminders improve immunisation completion in urban but not rural settings in sub-Saharan Africa. Low adult literacy may account for this difference. The feasibility and impact of combined automated voice and text reminders on immunisation completion in rural sub-Saharan Africa is unknown.

Methods

We randomised parturient women at the Mother and Child Hospitals Ondo State, Nigeria, owning a mobile phone and planning for child immunisation at these study sites to receive automated call and text immunisation reminders or standard care. We assessed the completion of the third pentavalent vaccine (Penta-3) at 18 weeks of age, immunisation completion at 12 months and within 1 week of recommended dates. We assessed selected demographic characteristics associated with completing immunisations at 12 months using a generalised binomial linear model with ‘log’ link function. Feasibility was assessed as proportion of reminders received.

Results

Each group had 300 mother−baby dyads with similar demographic characteristics. At 18 weeks, 257 (86%) and 244 (81%) (risk ratio (RR) 1.05, 95% CI 0.98 to 1.13; p=0.15) in the intervention and control groups received Penta-3 vaccine. At 12 months, 220 (74%) and 196 (66%) (RR 1.12, 95% CI 1.01 to 1.25; p=0.04) in the intervention and control groups received the measles vaccine. Infants in the intervention group were more likely to receive Penta-3 (84% vs 78%, RR 1.09, 95% CI 1.01 to 1.17; p=0.04), measles (73% vs 65%, RR 1.13, 95% CI 1.02 to 1.26; p=0.02) and all scheduled immunisations collectively (57% vs 47%, RR 1.13, 95% CI 1.02 to 1.26; p=0.01) within 1 week of the recommended date. No demographic character predicted immunisation completion. In the intervention group, 92% and 86% reported receiving a verification reminder and at least one reminder during the study period, respectively.

Conclusion

Paired automated call and text reminders significantly improved immunisation completion and timeliness.

Trial registration number

NCT02819895.
Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau
Authors: Yaya Sanni , Bishwajit Ghose , Gunawardena Nathali
Published: April 2019

Background

Maternal death outcome remains high in Guinea-Bissau. Delivery-related complications and maternal mortality could be prevented by increasing women’s access to skilled pregnancy care. Socioeconomic status (SES) is often associated with low health service utilisation in low/middle-income countries. In Guinea-Bissau, little is known on the relationship between SES and use of health facility for delivery. In this study, we examined the association between women’s choice of health facility delivery with their SES.

Methods

Current data from Multiple Indicator Cluster Survey conducted in Guinea-Bissau, 2014 were used in this study. The place of delivery (home or health facility) was the outcome variable of interest using 7532 women of reproductive age (15–49 years). Respondents’ characteristics were described by summary statistics, while multivariable logistic regression model was used to examine the association of demographic and socioeconomic characteristics on facility-based delivery. Adjusted ORs, 95% CIs and p values were computed to identify significant determinants.

Results

Results show that in proportion of women delivering at home was higher than of delivery at a health facility. Overall percentage of women who delivered at health facility was 39.8%, with the rate being substantially higher among urban (67.8%) compared with their rural (30.2%) counterparts. Percentage of delivering at home was highest in Oio region (23.8%) and that of delivery at a health facility was highest in the Sector Autónomo de Bissau region (18.7%). In the multivariable analysis, women in urban areas compared those who had no education, those who had primary and secondary/higher level of education were 2.2 and 3.3 times more likely to deliver at a health facility. The odds of facility were also highest among the women from the richest households, 5.3 and 5 times among urban and rural women, respectively.

Conclusion

Based on these findings, the study concludes that the percentage of health facility delivery is low in Guinea-Bissau, which can be promoted through scaling up women’s SES. The findings could guide healthcare policy-makers to address the issue of unskilled delivery services and increase the use of facility-based delivery particularly among the disadvantaged women.
Exploring determinants of health provider choice and heterogeneity in preference among outpatients in Beijing: a labelled discrete choice experiment
Authors: Zhu Jingrong , Li Jinlin , Zhang Zengbo , Li Hao , Cai Lingfei
Published: April 2019

Objective

For a long time in China, public hospitals have been the most prominent provider of healthcare. However, recent policy reforms mean the private sector is experiencing rapid development. Thus, the purpose of this study is to detect whether the policies published by the government aimed to improve the quality of healthcare services were catering to patient’s preferences.

Participants and methods

Our work uses dental care as an example of services provided in outpatient setting and takes advantage of a labelled discrete choice experiment with a random sample of respondents from Beijing. Participants were asked to make a choice between four healthcare providers with different attributes. Mixed logit and latent class models were used for the analysis.

Result

Care provided by high-level private hospitals and community hospitals were valued RMB154 and 216 less, respectively, than care provided by class A tertiary hospitals, while the most disliked provider was private clinics. This was the most valued attribute of dental care. Respondents also value: lower waiting times, the option to choose their doctor, lower treatment costs, shorter travel times and a clean waiting room. However, when the level of provider was analysed, the prevailing notion that patients in China were always likely to choose public services than private services no longer holds. Four classes of patients with distinct preferences for dental care provider choice were identified, which can partly be explained by age, income, experience and Hukou status—a household registration permit.

Discussion

The study to some extent challenged the overwhelming predominance of public healthcare providers in China. The preference heterogeneity we found was relatively large. Our findings are significant for providers in developing more specific services for patients and for policymakers in weighing the pros and cons of future initiatives in medical reform.
Social deprivation, gender and obesity: multiple stigma? Results of a population survey from Germany
Authors: Makowski Anna Christin , Kim Tae Jun , Luck-Sikorski Claudia , von dem Knesebeck Olaf
Published: April 2019

Objectives

Individuals with obesity are subject to stigmatisation, resulting in discrimination. Studies focusing on obesity stigma often do not account for social conditions that also may be associated with stigmatisation. Following an intersectional approach, social categories such as gender and socioeconomic status (SES) can interact and form a basis for multiple stigma. The present study analyses differences in public obesity stigma depending on gender and SES, as well as possible interdependencies between these social categories.

Design

Representative cross-sectional telephone survey.

Participants

692 randomly selected adults (≥ 18 years) in Germany.

Methods

Different vignettes were presented, depicting a lawyer (male/female) or a janitor/cleaner (male/female) with obesity. Following the vignette, different components of stigma were assessed: (1) fat phobia, (2) emotional reactions to a person with obesity and (3) desire for social distance. Associations between gender, SES and stigma components were tested in multiple linear regression analyses.

Results

A low SES in the obesity vignette (janitor/cleaner) was significantly associated with higher fat phobia scores as well as desire for social distance, compared with the vignette with a person with obesity and a high SES (lawyer). Being a male with obesity was significantly associated with more pronounced negative emotional reactions and greater desire for social distance. There were no significant interaction effects between gender and SES.

Conclusions

Results support the hypothesis of multiple stigma. Being male or of low SES was significantly associated with more pronounced negative attitudes in the German public. Following the concept of intersectionality, our findings indicate that obesity stigma can exacerbate pre-existing inequalities. This needs to be considered in development and implementation of prevention and anti-stigma measures.