bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Barriers and Facilitators to Ambulatory and Home Blood Pressure Monitoring: A Qualitative Study
Authors: Carter Eileen J , Moise Nathalie , Alcántara Carmela , Sullivan Alexandra M , Kronish Ian M
Published: May 2018

BACKGROUND

Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients’ perspectives of the barriers and facilitators to undergoing ABPM or HBPM.

METHODS

Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM.

RESULTS

Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference.

CONCLUSIONS

Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.
Maternal Weight, Snoring, and Hypertension: Potential Pathways of Associations
Authors: Dunietz Galit Levi , Shedden Kerby , Lisabeth Lynda D , Treadwell Marjorie C , O’Brien Louise M
Published: May 2018

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are linked to excessive maternal weight and frequent snoring. However, pathways between maternal excessive weight, pregnancy-onset snoring, and HDP are only partially estimated. We examined and quantified the total and direct associations between excessive maternal weight and incident HDP and their indirect pathway through pregnancy-onset snoring.

METHODS

Third trimester pregnant women enrolled from prenatal clinics of a large tertiary medical center. Sleep data were collected through a questionnaire. Demographic and pregnancy information and first trimester maternal weight were abstracted from medical charts. After exclusion of women with prepregnancy hypertension and/or chronic snoring, causal mediation analysis was used to estimate the total and direct association between maternal weight and incident HDP and their indirect association through pregnancy-onset snoring. The proportion of the mediated association through pregnancy-onset snoring from the total association of maternal weight and HDP was also quantified.

RESULTS

After excluding those with chronic hypertension and/or snoring, the final sample included 1,333 pregnant women. In adjusted analysis, excessive maternal weight was directly associated with incident HDP; odds ratio (OR) = 1.87 (95% confidence interval (CI) 1.30, 2.70). Pregnancy-onset snoring significantly mediated the association between maternal weight and incident HDP; OR = 1.08 (95% CI 1.01, 1.17). The mediated pathway accounted for 15% of the total association between maternal weight and incident HDP.

CONCLUSIONS

Pregnancy-onset snoring mediates the association between maternal weight and incident HDP in women without prepregnancy snoring or hypertension. These findings demonstrate the relative contributions of excessive maternal weight and pregnancy-onset snoring to incident HDP.
Language Learning Strategies: Is the Baby Still in the Bathwater?
Authors: Griffiths Carol
Published: May 2018

When it was suggested that the concept of self-regulation should replace the language learning strategy concept early in the new millennium, there were fears that strategy research had come to an end. Nevertheless, research, debate, and publication on the subject have continued. Although some issues remain (especially regarding definition, underpinning theory, classification, and research methodology), current opinion tends to suggest that language learning strategies remain vibrant and compatible with self-regulation. This article discusses the controversies and concludes by arguing for the need to acknowledge diversity and to engage in productive debate.
Ceftazidime/avibactam versus standard-of-care agents against carbapenem-resistant Enterobacteriaceae harbouring blaKPC in a one-compartment pharmacokinetic/pharmacodynamic model
Authors: Barber Katie E , Pogue Jason M , Warnock Henderson D , Bonomo Robert A , Kaye Keith S
Published: May 2018

Background

‘Last-line’ antimicrobial usage has promoted the emergence of MDR bacteria. Production of Klebsiella pneumoniae carbapenemases (KPCs) is increasingly common and leads to resistance to most antimicrobials. However, ceftazidime/avibactam demonstrates activity against KPC-producing strains. Ceftazidime/avibactam in the empirical setting remains unknown.

Methods

Strains underwent genetic analysis evaluating blaKPC presence/production and MICs were determined. Four strains were assessed in an in vitro, one-compartment pharmacokinetic (PK)/pharmacodynamic (PD) model for 96 h. The following bolus dosing exposures were tested: 2.5 g of ceftazidime/avibactam every 8 h, 2 g of meropenem every 8 h, 1.25 mg/kg polymyxin B every 12 h, amikacin ‘once-daily dosing’ (peak of 70–80 mg/L), tigecycline at 200 mg ×1 dose followed by 100 mg every 12 h, and a drug-free growth control.

Results

Thirty blaKPC-producing strains were evaluated; 97% of strains were ceftazidime/avibactam susceptible with MIC50/MIC90 values of 0.38/1.5 mg/L (range 0.032–16 mg/L). Two K. pneumoniae strains, one Klebsiella oxytoca strain and one Citrobacter freundii strain underwent further analysis in PK/PD models. Ceftazidime/avibactam displayed potent activity with a reduction of 4.23 ± 0.42 cfu/mL from the initial inoculum at 96 h. Against susceptible isolates, amikacin displayed similar activity compared with ceftazidime/avibactam at 96 h, although this was not demonstrated against all strains. Polymyxin B produced comparable activity to ceftazidime/avibactam against two strains. Neither meropenem nor tigecycline produced effective killing and were comparable to the drug-free growth control at 96 h.

Conclusions

bla KPC-producing organisms demonstrated susceptibility to ceftazidime/avibactam and bactericidal activity was observed in the PK/PD model. Based on these data, ceftazidime/avibactam is a valuable agent for treating KPC-producing organisms and should be considered for treatment of infections caused by these pathogens.
Detection of the Galactic warm neutral medium in H i 21-cm absorption
Authors: Patra Narendra Nath , Kanekar Nissim , Chengalur Jayaram N , Roy Nirupam
Published: May 2018

We report a deep Giant Metrewave Radio Telescope search for Galactic H i 21-cm absorption towards the quasar B0438−436, yielding the detection of wide, weak H i 21-cm absorption, with a velocity-integrated H i 21-cm optical depth of 0.0188 ± 0.0036 km s−1. Comparing this with the H i column density measured in the Parkes Galactic All-Sky Survey gives a column density-weighted harmonic mean spin temperature of 3760 ± 365 K, one of the highest measured in the Galaxy. This is consistent with most of the H i along the sightline arising in the stable warm neutral medium. The low-peak H i 21-cm optical depth towards B0438−436 implies negligible self-absorption, allowing a multi-Gaussian joint decomposition of the H i 21-cm absorption and emission spectra. This yields a gas kinetic temperature of $T_{\rm k} \le (4910 \pm \lt t\gt 1900)$ K, and a spin temperature of $T_{\rm s} = (1000 \pm 345)$ K for the gas that gives rise to the H i 21-cm absorption. Our data are consistent with the H i 21-cm absorption arising from either the stable WNM, with $T_{\rm s} \ll T_{\rm k}$, $\rm T_k \approx 5000$ K, and little penetration of the background Lyman-α radiation field into the neutral hydrogen, or the unstable neutral medium, with $T_{\rm s} \approx T_{\rm k} \approx 1000\,{\rm K}$.
Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery
Authors: Brown Charles H. , Probert Julia , Healy Ryan , Parish Michelle , Nomura Yohei , Yamaguchi Atsushi , Tian Jing , Zehr Kenton , Mandal Kaushik , Kamath Vidyulata , Neufeld Karin J. , Hogue Charles W.
Published: May 2018

Background

Delirium is common after cardiac surgery and has been associated with morbidity, mortality, and cognitive decline. However, there are conflicting reports on the magnitude, trajectory, and domains of cognitive change that might be affected. The authors hypothesized that patients with delirium would experience greater cognitive decline at 1 month and 1 yr after cardiac surgery compared with those without delirium.

Methods

Patients who underwent coronary artery bypass and/or valve or aortic root surgery with cardiopulmonary bypass were eligible for this cohort study. Delirium was assessed using the Confusion Assessment Method. A neuropsychologic battery was administered before surgery, at 1 month, and 1 yr later. Linear regression was used to examine the association between delirium and change in composite cognitive Z score from baseline to 1 month (primary outcome). Secondary outcomes were domain-specific changes at 1 month and composite and domain-specific changes at 1 yr.

Results

The incidence of delirium in 142 patients was 53.5%. Patients with delirium had greater decline in composite cognitive Z score at 1 month (greater decline by –0.19; 95% CI, –0.35 to –0.04; P = 0.017), and in the domains of visuoconstruction and processing speed. From baseline to 1 yr, there was no difference between delirious and nondelirious patients with respect to change in composite cognitive Z score, although greater decline in processing speed persisted among the delirious patients.

Conclusions

Patients who developed delirium had a greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed.

What We Already Know about This Topic

What This Article Tells Us That Is New
Predictive value of excision repair cross-complementing group 2 gene Lys751Gln and Asp312Asn polymorphisms in melanoma risk
Authors: Zhou Xue , Zeng Yong , Jiang Huayong , Xia Limei , Liu Chuan
Published: May 2018

Epidemiological studies have assessed the association between excision repair cross-complementing group 2 (ERCC2) Lys751Gln and Asp312Asn polymorphisms and melanoma risk with conflicting results. Relevant articles were searched from PubMed, Embase, and Web of Science with a time limit of 3 September 2016. Pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of the association. We performed this meta-analysis with 12 studies including 6157 cases and 8873 controls for Lys751Gln and nine studies including 5037 cases and 7542 controls for Asp312Asn polymorphism. Overall, no significant associations were found under all the models for Lys751Gln polymorphism, and significant associations were found for Asp312Asn polymorphism for AA versus GG (OR=1.12, 95% CI=1.00–1.26) and for the recessive model (OR=1.11, 95% CI=1.00–1.24). In the stratification analyses by source of control: for Lys751Gln polymorphism, significant associations were found for CC versus AA (OR=1.19, 95% CI=1.04–1.36) and the recessive model (OR=1.15, 95% CI=1.02–1.30); for Asp312Asn polymorphism, significant associations were found for AA versus GG (OR=1.31, 95% CI=1.11–1.53) and the recessive model (OR=1.29, 95% CI=1.11–1.50). This meta-analysis suggested that both the Lys751Gln and Asp312Asn polymorphisms were risk factors for melanoma risk in population-based subgroup.
Medication Administration Delays in Non–ST Elevation Myocardial Infarction: Analysis of 1002 Patients Admitted to an Academic Medical Center
Authors: Denlinger LeAnn N. , Keeley Ellen C.
Published: May 2018

Our goal was to assess adherence to American College of Cardiology/American Heart Association guideline–based medical therapy in patients admitted with type I non–ST elevation myocardial infarction (NSTEMI) and to determine factors associated with medication administration delay. We performed a retrospective analysis using data from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry. Baseline patient demographics, 12-lead electrocardiogram (ECG) findings, laboratory values, medications administered and the time they were administered, and in-hospital clinical outcomes were collected. Global Registry of Acute Coronary Events risk scores were calculated for all patients. We included 1002 patients admitted from the emergency department with a type I NSTEMI. A total of 802 (80%) patients received appropriate initial therapy consisting of therapeutic anticoagulation with heparin and dual antiplatelet therapy. Of the 200 (20%) patients who did not receive therapy, documentation in the chart regarding possible contraindications for administration of the medications was missing in up to half. Female sex, older age, a normal initial ECG, and prolonged time spent in the emergency department were predictors of significant delay in receiving guideline-based medications, while an elevated initial troponin was a predictor of faster medication administration. Global Registry of Acute Coronary Events risk scores had no association with the timing of medication administration. In conclusion, 20% of NSTEMI patients did not receive American College of Cardiology/American Heart Association guideline–based medical therapy. Delay in medication administration was significant for women, older individuals, and patients who did not have ischemic findings on the initial ECG.
Baseline Thromboelastogram as a Predictor of Left Ventricular Assist Device Thrombosis
Authors: Piche Shannon L. , Nei Scott D. , Frazee Erin , Schettle Sarah D. , Boilson Barry A. , Plevak Matthew F. , Dierkhising Ross A. , Stulak John M.
Published: May 2018

Left ventricular assist device (LVAD) pump thrombosis occurs in up to 8.4% of patients within 3-months postimplantation. Thromboelastography (TEG) could be used to signal hypercoagulability at LVAD implantation to predict patients at high risk for thrombosis. We sought to evaluate whether TEG maximum amplitude (MA) hypercoagulability (MA ≥69 mm) at the time of LVAD implantation predicts pump thrombosis. A single center, retrospective, nested case–control study was conducted using patients from January 1, 2005, to March 31, 2015. Each pump thrombosis case was matched to two control subjects based on age ± 5 years, sex, and duration of follow-up. A multivariable logistic regression analysis was performed on the matched sets; the odds ratio with 95% confidence interval (CI) was calculated to estimate the relative risk. Thirty-seven age- and sex-matched case–control sets were included for a total of 111 study participants. TEG-MA hypercoagulability occurred in 10.8% of the case group versus 6.8% of controls. There was no association between TEG-MA hypercoagulability and device thrombosis (odds ratio 1.71, 95% confidence interval 0.42–7.05, p = 0.46). Utilization of baseline TEG-MA hypercoagulability to detect individuals at risk for LVAD thrombosis is a novel concept. This study found no significant association between TEG-MA and LVAD thrombosis.
Early variation of quick sequential organ failure assessment score to predict in-hospital mortality in emergency department patients with suspected infection
Authors: Lemachatti Najla , Ortega Mar , Penaloza Andrea , Le Borgne Pierrick , Claret Pierre-Géraud , Occelli Céline , Truchot Jennifer , Dumas Florence , Feral-Pierssens Anne-Laure , Andrianjafy Héry , Beaune Sebastien , Yordanov Youri , Hausfater Pierre , Riou Bruno , Bloom Ben , Krastinova Evguenia , Freund Yonathan
Published: May 2018

Background

The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA = qSOFA at 3 h−qSOFA at inclusion).

Patients and methods

This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days.

Results

Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA < 0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA = 0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34–0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09–0.22, P < 0.001).

Conclusion

In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.
Cutaneous manifestations of nutritional deficiency
Authors: Lekwuttikarn Ramrada , Teng Joyce M.C.
Published: May 2018

Purpose of review

Childhood malnutrition is a major global health issue. It is often thought of as a developing world problem and therefore, underdiagnosed or misdiagnosed in developed countries. The delay in diagnosis and treatment can lead to increased morbidity and mortality. Cutaneous manifestations are often the initial presenting signs of nutritional deficiency. Early recognition is essential in timely initiation of the necessary interventions. This article will review pertinent cutaneous findings and systemic manifestations associated with common nutritional deficiencies.

Recent findings

Malnutrition has historically been associated with poverty in developing countries. However, recent literatures suggest that the incidence of nutritional deficiencies continuous to rise among infants from developed countries, as a result of dietary restrictions because of perceived food allergies or intolerance. It is also an emerging finding in children with complicated medical problems.

It is very important to raise awareness about cutaneous manifestations of nutritional deficiency as early and appropriate treatment results in excellent prognosis.
Quality of the Triage of Children With Anaphylaxis at the Emergency Department
Authors: Arroabarren Esozia , Alvarez-Garcia Jorge , Anda Marta , de Prada Montserrat , Ponce Maria Carmen , Palacios Miriam
Published: May 2018

Objective

Early recognition of symptoms is essential in anaphylaxis management. The Canadian Paediatric Emergency Triage and Acuity Scale prioritizes anaphylaxis to level I or II (resuscitation or emergency). We analyzed the accuracy of pediatric anaphylaxis triage.

Methods

This was a retrospective review of the triage charts (adaptation of the Canadian Paediatric Emergency Triage and Acuity Scale) of 137 children attended for anaphylaxis at our pediatric emergency department. Per triages' accuracy, charts were divided into TR1 (levels I–II) and TR2 (levels III–V), comparing demographics, initial triage level given by initial assessment (Paediatric Assessment Triangle), vital signs, observations recorded by the staff, and waiting times for physician.

Results

Forty-six (33.3%) were triaged correctly (TR1 group), and 91 (66.7%) were not. Median ages were similar (TR1: 5 years [interquartile range, 13.1 years] vs TR2: 4.5 years [interquartile range, 14.5 years]; P = 0.837). Initial triage level 5 was given by Paediatric Assessment Triangle to 69.5% of TR1 and 83% of TR2 cases (P = 0.001; likelihood ratio for TR2: 1.985 [95% confidence interval, 1.11–3.49]). Vital signs were normal in 71.7% of TR1 and 94.5% of TR2 patients (P < 0.001; likelihood ratio for TR2: 2.602 [95% confidence interval, 1.22–5.52]). Symptoms suggestive of anaphylaxis (mention of 2 different organs) were recorded in 45.6% of TR1 and 48.3% of TR2 charts (P = 0.08). Median waiting times were 3 minutes (interquartile range, 26 minutes) and 11 minutes (interquartile range, 111 minutes) for TR1 and TR2, respectively (P = 0.001).

Conclusions

Current triage, based on severity perception, missed most of the cases. Anaphylaxis-defining symptoms were overlooked. Inaccurate triage delayed medical attention. Improving measures, such as emphasizing symptom recognition and defining anaphylaxis risk discriminators, is mandatory to improve their identification.
Impact of Peripheral Venous Catheter Placement With Vein Visualization Device Support on Success Rate and Pain Levels in Pediatric Patients Aged 0 to 3 Years
Authors: Inal Sevil , Demir Duygu
Published: May 2018

Background

Pediatric nurses should be able to use techniques that increase the success rate or shorten the procedural duration of peripheral intravenous catheterization (PIVC).

Objectives

This study was performed to define the effect of the infrared vein visualization device support on the success of PIVC in pediatric patients aged 0 to 3 years. Success was determined based on the number of attempts per patient, the duration of the procedure, the success rate of first attempts, and the pain levels of the children.

Methods

The study was a randomized, controlled experimental study on 54 children aged 0 to 3 years.

Results

Peripheral intravenous catheterization in the study group was performed with fewer attempts (study group: 1.44 ± 0.85 [median, 1]; control group: 2.41 ± 1.99 [median, 2]; P = 0.016) and in a shorter period (study group: 44.37 ± 32.22 [median, 40 seconds]; control group: 168.89 ± 171.54 [median, 112 seconds; P = 0.001), and the first attempt success rate in the study group (74.1%) was higher than in the control group (40.7%; P = 0.028). Also, the pain level of the children in the study group was significantly lower than that in the control group (P < 0.05).

Conclusions

In conclusion, PIVC supported by the infrared vein visualization device reduces the number of attempts per patient, reduces the duration of the procedure, and increases the success rate of first attempts, and there is procedural pain; therefore, vein visualization improves the success of PIVC.
Requirement for Head Magnetic Resonance Imaging in Children Who Present to the Emergency Department With Acute Nontraumatic Visual Disturbance
Authors: Lee Jeong-Yong , Kim Jung-Heon , Cho Hyung-Rae , Lee Jong-Seung , Ryu Jeong-Min , Yum Mi-Sun , Ko Tae-Sung
Published: May 2018

Objectives

This study aimed to investigate the clinical features and head magnetic resonance imaging (MRI) findings in children who presented to the emergency department with acute nontraumatic visual disturbance and to study related clinical factors for discovering positive lesions on head MRI.

Methods

We performed a retrospective study of 1-month to 15-year-old children who underwent head MRI as an evaluation for acute nontraumatic visual disturbance as a chief complaint in our pediatric emergency department between March 2010 and March 2015. The symptoms of visual disturbance were blurred vision, diplopia, loss of vision, and visual hallucination. Head MRI findings were considered positive when lesions could explain the symptoms.

Results

We identified 39 patients (25 with blurred vision, 9 with diplopia, 3 with loss of vision, and 2 with visual hallucination) with a mean age of 8.35 ± 4.06 years. Positive head MRI findings were identified in 13 patients (33.3%). Brain tumors were most common (53.8%), followed by optic nerve inflammations (23.1%), congenital brain lesions (15.4%), and hypertensive encephalopathy (7.7%). Compared with the negative head MRI group, the positive head MRI group showed significantly less transient visual disturbance (duration <1 hour to complete recovery) (P = 0.001), more limited eye movement (P = 0.003), and more pupillary abnormalities (P = 0.030).

Conclusions

We suggest performing urgent head MRI in children with acute nontraumatic visual disturbance if the symptoms last longer than 1 hour without complete recovery and are accompanied by limited eye movement or pupillary abnormality.
Pediatric Esophageal Foreign Body
Authors: Johansen Andrew , Conners Gregory P. , Lee Jacob , Robinson Amie L. , Chew William L. , Chan Sherwin S.
Published: May 2018

Objectives

Foreign body (FB) ingestion is a common reason for emergency department visits, affecting more than 80,000 children in the United States annually. Whereas most ingested FBs are coins or other radiopaque objects, some are radiolucent FBs such as food. Digital tomosynthesis (DTS) is a radiographic technique that produces cross-sectional images with in-plane resolution similar to that of traditional radiographs. Our pilot study evaluated the sensitivity and specificity of DTS to detect FB in comparison to esophagram and clinical impression.

Methods

This was a retrospective review on patients aged 0 to 18 years with suspected esophageal FB who received an esophagram with DTS at our institution between January 2014 and June 2016. Digital tomosynthesis images were analyzed by 3 readers for identification of FB impaction and compared with esophagram and discharge diagnosis. This study was approved by our local institutional review board.

Results

A total of 17 patients underwent an esophagography with DTS for suspected esophageal FB, of which 9 (53%) were suspected of having an FB on esophagram. Compared with esophagram, DTS had a sensitivity of 44%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%. Compared with clinical impression, DTS had a sensitivity of 33%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 38%.

Conclusions

This pilot study showed that chest DTS has a very high positive predictive value, compared with esophagram and clinical impression, in detecting radiolucent esophageal FBs in children. Chest DTS is a promising modality for ruling in the presence of a radiolucent esophageal FB.
Orbital Cellulitis—When Computed Tomography Imaging Is Falsely Reassuring
Authors: Basily Arsany , Mansukhani Sasha , Anzeljc Andrew , Gutierrez Peter
Published: May 2018

An 8-year-old male presented to the pediatric emergency department with subjective fever, blurry vision, and left eye pain. On physical examination, there was mild left lower lid erythema and a subtle left eye elevation deficit. Computed tomography demonstrated preseptal soft tissue swelling without orbital involvement; however, there was varying amounts of paranasal sinus opacification. Despite the negative scan, a diagnosis of orbital cellulitis associated with sinusitis was made and treatment with intravenous antibiotics was initiated. A magnetic resonance imaging performed subsequently revealed orbital fat stranding and inferior rectus enlargement and enhancement near the orbital apex, indicating the presence of orbital cellulitis. This case demonstrates the utility of magnetic resonance imaging when initial computed tomography imaging is negative in patients with concern for orbital cellulitis.
Induced expression of a vestigial sexual signal
Authors: Gray David A. , Hormozi Scherezade , Libby Fritz R. , Cohen Randy W.
Published: May 2018

Vestigial morphological traits are common and well known in a variety of taxa. Identification of vestigial genes has illustrated the potential for evolutionary reversals and the re-expression of atavistic traits. Here we induce expression of a behavioural sexual signal, male calling song, in a cricket species,Gryllus ovisopis,which lacks a functional calling song. We successfully used acetylcholine injections in the frontal space of the head of male crickets to activate cerebral command neurons for cricket calling, and we recorded calling songs with a temporal chirp pattern similar to that ofG. ovisopis' close evolutionary relatives,G. firmusandG. pennsylvanicus, implying that the neural pattern generators that underlie cricket calling behaviour persist in a vestigial state inG. ovisopis. To our knowledge, this is the first demonstration of the induced expression of a vestigial behaviour in any organism. The retention of latent neural capacity to express sexual behaviours could have important implications for rapid evolution, trait re-emergence and reproductive isolation.
Information sensitivity functions to assess parameter information gain and identifiability of dynamical systems
Authors: Pant Sanjay
Published: May 2018

A new class of functions, called the ‘information sensitivity functions’ (ISFs), which quantify the information gain about the parameters through the measurements/observables of a dynamical system are presented. These functions can be easily computed through classical sensitivity functions alone and are based on Bayesian and information-theoretic approaches. While marginal information gain is quantified by decrease in differential entropy, correlations between arbitrary sets of parameters are assessed through mutual information. For individual parameters, these information gains are also presented as marginal posterior variances, and, to assess the effect of correlations, as conditional variances when other parameters are given. The easy to interpret ISFs can be used to (a) identify time intervals or regions in dynamical system behaviour where information about the parameters is concentrated; (b) assess the effect of measurement noise on the information gain for the parameters; (c) assess whether sufficient information in an experimental protocol (input, measurements and their frequency) is available to identify the parameters; (d) assess correlation in the posterior distribution of the parameters to identify the sets of parameters that are likely to be indistinguishable; and (e) assess identifiability problems for particular sets of parameters.
Musical trends and predictability of success in contemporary songs in and out of the top charts
Authors: Interiano Myra , Kazemi Kamyar , Wang Lijia , Yang Jienian , Yu Zhaoxia , Komarova Natalia L.
Published: May 2018

We analyse more than 500 000 songs released in the UK between 1985 and 2015 to understand the dynamics of success (defined as ‘making it’ into the top charts), correlate success with acoustic features and explore the predictability of success. Several multi-decadal trends have been uncovered. For example, there is a clear downward trend in ‘happiness’ and ‘brightness’, as well as a slight upward trend in ‘sadness’. Furthermore, songs are becoming less ‘male’. Interestingly, successful songs exhibit their own distinct dynamics. In particular, they tend to be ‘happier’, more ‘party-like’, less ‘relaxed’ and more ‘female’ than most. The difference between successful and average songs is not straightforward. In the context of some features, successful songs pre-empt the dynamics of all songs, and in others they tend to reflect the past. We used random forests to predict the success of songs, first based on their acoustic features, and then adding the ‘superstar’ variable (informing us whether the song’s artist had appeared in the top charts in the near past). This allowed quantification of the contribution of purely musical characteristics in the songs’ success, and suggested the time scale of fashion dynamics in popular music.
Transcriptional analyses provide new insight into the late-stage immune response of a diseased Caribbean coral
Authors: Fuess Lauren E. , Mann Whitney T. , Jinks Lea R. , Brinkhuis Vanessa , Mydlarz Laura D.
Published: May 2018

Increasing global temperatures due to climate change have resulted in respective increases in the severity and frequency of epizootics around the globe. Corals in particular have faced rapid declines due to disease outbreaks. Understanding immune responses and associated potential life-history trade-offs is therefore a priority. In the autumn of 2011, a novel disease of octocorals of the genusEuniceawas first documented in the Florida Keys. Termed Eunicea Black Disease (EBD), the disease is easily identified by the dark appearance of affected tissue, caused by a strong melanization response on the part of the host. In order to better understand the response of corals to EBD, we conducted full transcriptome analysis of 3 healthy and 3 diseased specimens ofEunicea calyculatacollected from offshore southeast Florida. Differential expression and protein analyses revealed a strong, diverse immune response to EBD characterized by phagocytosis, adhesion and melanization on the part of the host. Furthermore, coexpression network analyses suggested this might come at the cost of reduced cell cycle progression and growth. This is in accordance with past histological studies of naturally infected hard corals, suggesting that potential trade-offs during infection may affect post-outbreak recovery of reef ecosystems by reducing both organismal growth and fecundity. Our findings highlight the importance of considering factors beyond mortality when estimating effects of disease outbreaks on ecosystems.
Survival and weak chaos
Authors: Nee Sean
Published: May 2018

Survival analysis in biology and reliability theory in engineering concern the dynamical functioning of bio/electro/mechanical units. Here we incorporate effects of chaotic dynamics into the classical theory. Dynamical systems theory now distinguishes strong and weak chaos. Strong chaos generates Type II survivorship curves entirely as a result of the internal operation of the system, without any age-independent, external, random forces of mortality. Weak chaos exhibits (a) intermittency and (b) Type III survivorship, defined as a decreasingper capitamortality rate: engineering explicitly defines this pattern of decreasing hazard as ‘infant mortality’. Weak chaos generates two phenomena from the normal functioning of thesamesystem. First, infant mortality—sensuengineering—without any external explanatory factors, such as manufacturing defects, which is followed by increased average longevity of survivors. Second, sudden failure of units during their normal period of operation, before the onset of age-dependent mortality arising from senescence. The relevance of these phenomena encompasses, for example: no-fault-found failure of electronic devices; high rates of human early spontaneous miscarriage/abortion; runaway pacemakers; sudden cardiac death in young adults; bipolar disorder; and epilepsy.
Research on regeneration methods of animal glue waste sand for foundry
Authors: Ying-min Li , Tian-shu Wang , Wei-hua Liu
Published: May 2018

Sand moulds are used in the casting process. However, after heating, the binder in the sand loses the binding properties, and the most part of the foundry sand has to be discarded from the process. The waste foundry sand after the regeneration can be recycled, and reclamation can reduce the production cost and lower waste emissions. The objective of this work was to investigate the possibility of reusing the animal glue binder waste foundry sand from the study of three regeneration methods. Studies with the waste foundry sand and reclaimed sand were performed in order to compare the results obtained with raw sand. The characterization of the samples was performed by scanning electron microscopy and energy dispersive spectroscopy. Results show that the waste sand was regenerated by mechanical regeneration, thermal regeneration and wet reclamation, respectively. The reclaimed sands have a better performance than the waste foundry sand, and are similar to raw sand. Further, the wet regeneration method is the best one among the three methods.
Gold Nanoprisms as Optical Coherence Tomography Contrast Agents in the Second Near Infrared Window for Enhanced Angiography in Live Animals
Authors: Si Peng , Yuan Edwin , Liba Orly , Winetraub Yonatan , Yousefi Siavash , SoRelle Elliott Daniel , Yecies Derek William , Dutta Rebecca , de la Zerda Adam
Published: May 2018

Optical coherence tomography angiography (OCTA) is an important tool for investigating vascular networks and microcirculation in living tissue. Traditional OCTA detects blood vessels via intravascular dynamic scattering signals derived from the movements of red blood cells (RBCs). However, the low hematocrit and long latency between RBCs in capillaries makes these OCTA signals discontinuous, leading to incomplete mapping of the vascular networks. OCTA imaging of microvascular circulation is particularly challenging in tumors due to the abnormally slow blood flow in angiogenic tumor vessels and strong attenuation of light by tumor tissue. Here we demonstrate in vivo that gold nanoprisms (GNPRs) can be used as OCT contrast agents working in the second near infrared window, significantly enhancing the dynamic scattering signals in microvessels and improving the sensitivity of OCTA in skin tissue and melanoma tumors in live mice. This is the first demonstration that nanoparticle-based OCT contrast agent work in vivo in the second near infrared window, which allows deeper imaging depth by OCT. With GNPRs as contrast agents, the post-injection OCT angiograms showed 41% and 59% more microvasculature than pre-injection angiograms in healthy mouse skin and melanoma tumors, respectively. By enabling better characterization of microvascular circulation in vivo, GNPR-enhanced OCTA could lead to better understanding of vascular functions during pathological conditions, more accurate measurements of therapeutic response, and improved patient prognoses.
Engagement of pulvino-cortical feedforward and feedback pathways in cognitive computations
Authors: Jaramillo Jorge , Mejias Jorge F. , Wang Xiao-Jing
Published: May 2018

Computational modeling of brain mechanisms of cognition has been largely focused on the cortex, but recent experiments have shown that higher-order nuclei of the thalamus, in particular the pulvinar, participate in major cognitive functions and are implicated in psychiatric disorders. Here we show that a pulvino-cortical circuit model, composed of two cortical areas and the pulvinar, captures a range of physiological and behavioral observations related to the macaque pulvinar. Effective connections between the two cortical areas are gated by the pulvinar, allowing the pulvinar to shift the operation regime of these areas during attentional processing and working memory, as well as to resolve decision-making conflict. Furthermore, cortico-pulvinar projections that engage the thalamic reticular nucleus enable the pulvinar to estimate decision-making confidence. Finally, feedforward and feedback pulvino-cortical pathways participate in frequency-dependent inter-areal interactions that modify the relative hierarchical positions of cortical areas. Overall, our model suggests that the pulvinar provides crucial contextual modulation to cortical computations associated with cognition.
High-throughput identification and marker development of perfect SSR for cultivated genus of passion fruit (Passiflora edulis)
Authors: Wu Yanyan , Huang Weihua , Huang Yongcai , Liu Jieyun , Tian Qinglan , Yang Xinghai , Xia Xiuzhong , Mou Haifei
Published: May 2018

Simple sequence repeat (SSR) markers are characterized by high polymorphism, good reproducibility and co-dominance etc. They can be easily applied to develop efficient, simple and practical molecular markers. In the present study, bioinformatics methods were applied to identify high-throughput perfect SSRs of cultivar Passiflora genome. A total of 13104 perfect SSRs were obtained. SSR core sequence structure is mainly 2-4 bases, the maximum numbers are TA, AT, TC and AG. The maximum numbers of repetitions were up to 20 times. A total of 12934 pairs of SSR markers were developed by using bioinformatics software, and 20 pairs of markers were selected for amplification specificity assessment of MTX and WJ10, and the polymorphism rate was as high as 60%. The large-scale development of the SSR markers of Passiflora cultivar has paved a foundation for the efficient utilization of the germplasm resources of passion fruit, genetic improvement of the varieties and molecular breeding.
Monocyte and Macrophage Subtypes as Paired Cell Biomarkers for Coronary Artery Disease
Authors: Arnold Kathryn A. , Blair John E. , Paul Jonathan D. , Shah Atman P. , Nathan Sandeep , Alenghat Francis J.
Published: May 2018

Background: Monocytes and macrophages are central to atherosclerosis, but how they mark progression of human coronary artery disease (CAD) is unclear. We tested whether patients’ monocyte subtypes paired with their derived macrophage profiles correlate with extent of CAD.

Methods: Peripheral blood was collected from 30 patients undergoing cardiac catheterization, and patients were categorized as having no significant CAD, single vessel disease, or multivessel disease according to the number of affected coronary arteries. Mononuclear cells were measured for monocyte markers CD14 and CD16 by flow cytometry, and separate monocytes were cultured into macrophages over 7 days and measured for polarization markers CD86 and CD206.

Results: At baseline, patients with greater CAD burden were older with higher rates of statin use, whereas all other characteristics were similar across the spectrum of coronary disease. Non-classical (CD14loCD16hi) and all CD16+ monocytes were elevated in patients with single vessel and multivessel disease compared to those without significant CAD (8.6% and 10.5% vs. 2.8%, p < 0.05), whereas regulatory M2 macrophages (CD206+) were decreased in patients with single vessel and multivessel disease (0.34% and 0.34% vs. 1.4%, p < 0.05). An inverse relationship between paired CD16+ monocytes and M2 macrophages marked CAD severity. CAD was also found to be more tightly associated with CD16+ cells than age or traditional cardiovascular risk factors on multiple regression analysis of these patients.

Conclusions: CAD extent is correlated directly with CD16+ monocytes and inversely with M2 (CD206+) macrophages, suggesting circulating monocytes may influence downstream polarization of lesional macrophages. These measures of monocyte and macrophage subtypes hold potential as biomarkers in CAD.
High Temporal-Resolution Dynamic PET Image Reconstruction Using A New Spatiotemporal Kernel Method
Authors: Wang Guobao
Published: May 2018

Current clinical dynamic PET has an effective temporal resolution of 5-10 seconds, which can be adequate for traditional compartmental modeling but is inadequate for exploiting the benefit of more advanced tracer kinetic modeling. There is a need to improve dynamic PET to allow fine temporal sampling of 1-2 seconds. However, reconstruction of these shorttime frames from tomographic data is extremely challenging as the count level of each frame is very low and high noise presents in both spatial and temporal domains. Previously the kernel framework has been developed and demonstrated as a statistically efficient approach to utilizing image prior for low-count PET image reconstruction. Nevertheless, the existing kernel methods mainly explore spatial correlations in the data and only have a limited ability in suppressing temporal noise. In this paper, we propose a new kernel method which extends the previous spatial kernel method to the general spatiotemporal domain. The new kernelized model encodes both spatial and temporal correlations obtained from image prior information and is incorporated into the PET forward projection model to improve the maximum likelihood (ML) image reconstruction. Computer simulations and an application to real patient scan have shown that the proposed approach can achieve effective noise reduction in both spatial and temporal domains and outperform the spatial kernel method and conventional ML reconstruction method for improving high temporal-resolution dynamic PET imaging.
Alanine scanning mutagenesis of the MEDI4839 (Suvratoxumab) epitope reduces alpha toxin lytic activity in vitro and S. aureus fitness in infection models
Authors: Tkaczyk C , Semenova E , Shi Y.Y , Rosenthal K , Oganesyan V , Warrener P , Stover C.K , Sellman B.R
Published: May 2018

Alpha toxin (AT) is a cytolytic pore-forming toxin that plays a key role in Staphylococcus aureus pathogenesis, consequently extensive research was undertaken to understand the AT mechanism of action and its utility as a target for novel prophylaxis and treatment strategies against S. aureus infections. MEDI4893 (Suvratoxumab) is a human anti-AT IgG1 monoclonal antibody (mAb), which targets AT and is currently in Phase 2 clinical development. As shown previously, the MEDI4893-binding epitope on AT is comprised of the highly conserved amino acid regions 177-200 and 261-271, suggesting these amino acids are important for AT function. To test this hypothesis, and gain insight into the effect mutations in the epitope on AT neutralization by MEDI4893, nine MEDI4893 contact residues in AT were individually mutated to alanine. Consistent with our hypothesis, 8 out of 9 mutants exhibited >2-fold loss in lytic activity resulting from a defect in cell binding and pore formation. MEDI4893 binding affinity was reduced >2-fold (2 – 27-fold) for 7 out of 9 mutants and no binding detected for W187A mutant. MEDI4893 effectively neutralized all of the lytic mutants in vitro and in vivo. When the defective mutants were introduced into a S. aureus clinical isolate, the mutant-expressing strains exhibited less severe disease in mouse models and were effectively neutralized by MEDI4893. These results indicate the MEDI4893 epitope is highly conserved due, in part to its role in AT pore-formation and bacterial fitness, thus decreasing the likelihood for the emergence of mAb-resistant variants.
Short-term plasticity of the human adult visual cortex measured with 7T BOLD
Authors: Binda Paola , Kurzawski Jan W. , Lunghi Claudia , Biagi Laura , Tosetti Michela , Morrone Maria Concetta
Published: May 2018

Visual cortex, particularly V1, is considered to be resilient to plastic changes in adults. In particular, ocular dominance is assumed to be hard-wired after the end of the critical period. We show that short-term (2h) monocular deprivation in adult humans boosts the BOLD response to the deprived eye, changing ocular dominance of V1 vertices, consistently with homeostatic plasticity. The boost is strongest in V1, present in V2, V3 & V4 but absent in V3a and MT. Assessment of spatial frequency tuning in V1 by a population Receptive-Field technique shows that deprivation primarily boosts high spatial frequencies, consistent with a primary involvement of the parvocellular pathway. Crucially, the V1 deprivation effect correlates across participants with the perceptual increase of the deprived eye dominance assessed with binocular rivalry, suggesting a common origin. Our results demonstrate that visual cortex, particularly the ventral pathway, retains a high potential for homeostatic plasticity in the human adult.