bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison Study of Magnetic Stirrer and Sonicator Technique to Disperse 1% Span20 Treated Layered Double Hydroxides (LDHs)
Authors: Teanmetawong S , Chantaramanee T , Lhosupasirirat S , Wongariyakawee A , Srikhirin T
Published: October 2019

Effect of particle size reduction and dispersion of 2-dimensional material, layered double hydroxide (LDHs), prepared by co-precipitation method with the primary particle size of around 100 nm, was investigated. Two simple laboratory dispersing techniques including magnetic stirrer, and sonicator were applied to disperse agglomerated LDHs in 1 wt.% Span20 solution, act as a stabilizer. Magnetic stirrer showed a cluster of agglomerate particles with improved dispersion while, agglomerates with single stack LDHs were presence in case of sonicator product.
Lithium Salt Doped Poly(Vinylidene Fluoride)/Cellulose Acetate Composite Gel Electrolyte Membrane for Lithium Ion Battery
Authors: Asghar Muhammad Rehman , Anwar Muhammad Tuoqeer , Rasheed Tahir , Naveed Ahmad , Yan Xiaohui , Zhang Junliang
Published: October 2019

In this study, composite gel electrolyte based on Polyvinylidene fluoride (PVDF)/cellulose acetate with the addition of different proportions of lithium nitrate (LiNO3) is prepared by a simple casting method. Salt doping effects on gel electrolyte membrane is investigated by scanning electron microscopy, X-ray analysis, DSC, FT-IR and TGA analysis. Salt doped gel electrolyte membrane shows a porous structure with a high uptake of 150%. Furthermore, with the addition of 20 wt% salt in the gel electrolyte membrane increase the ion conductivity from 0.21×10−3 S cm−1 to 3.0×10−3 S cm−1 at room temperature after soaking 1M LiPF6 EC/DEC liquid electrolyte. As compared with PP 2325 separator, pristine PVDF and PVDF/cellulose acetate gel electrolyte membrane, the salt doped PVDF/cellulose acetate membranes exhibit wide electrochemical window and lower interfacial resistance. Composite gel electrolyte membrane with 10 wt% salt contents possess 100% capacity retention after 100 cycles at 1C rate as compared to PP 2325 separator which shows only 87% capacity retention.
An adaptive single channel EMD-TNMF blind source separation algorithm for both instantaneous and convolutive mixed signal
Authors: He Pengju , Qi Mi , Liu Gangyi , Yu Zijiang , Fu Qiang
Published: October 2019

Single channel blind source separation (SCBSS) using time-frequency nonnegative matrix factorization (NMF) has some shortcomings, where the source number and convolution order must be known and it’s sensitive to the factors (e.g. window function, window length and overlap ratio of adjacent windows). To compensate these shortcomings that cannot meet the real application, we proposed an adaptive EMD-TNMF algorithm, which can estimate both the source number and the convolution order and is applicable to both single channel linear instantaneous and convolutive mixtures. Firstly, the single channel signal is mapped into multiple channels by utilizing empirical mode decomposition (EMD), and the number of independent sources is estimated by applying eigenvalue descent ratio of the IMFs’ covariance matrix. Secondly, the autocorrelation-based method is used to estimate the convolution order. Thirdly, the nonnegative matrix is constructed by adding one positive matrix (all elements are positive). Finally, in time domain, NMF algorithm is used to separate source signals. The algorithm’s performance is verified by two experiments where the single channel signal is linear instantaneous mixing of four artificial signals and linear convolutive mixing of two speech signals respectively. Results show that this algorithm can estimate the source number and convolution order correctly and obtain better separated source signals.
Gamification of an asynchronous HTML5-related competency-based guided learning system
Authors: Li Cheng Hsiu
Published: October 2019

Practice e-learning systems with traditional asynchronous drills are the most common assisted-learning tools for cognitive study, and they are often employed in instructional environments. Such systems provide learners with immediate feedback that enables them to develop cognitive abilities through constant learning. In this study, a novel, asynchronous HTML5-related gamified competency-based guided learning (CBGL) system was designed. The CBGL algorithm was embedded in the system to provide personalization for enhanced learning effects. This study used the core drivers of the Octalysis gamification framework to design gamified mechanisms that ameliorated the long and tedious CBGL processes. This study used the system satisfaction test to survey the flow experience of the participants and logged their learning behaviors for data mining. The results of system satisfaction analysis revealed that the system gamification generated a favorable flow experience among participants; they actively used the system to study and felt that the guided learning process was engaging. Results of the data mining analysis also revealed that the percentage of learners who completed the CBGL process rose from 58.3% to 79.2%. Therefore, the gamified mechanism helped participants overcome the boring and lengthy learning processes of the CBGL system.
Towards cloud-based STEP-NC to enhance interoperability in global manufacturing
Authors: Afanasev S , Zhao G , Xiao W
Published: October 2019

STEP-NC has been under research for several years, and its manufacturing interoperability is still considered in its infancy. Until recently, seldom STEP-NC compliant CAD/CAM/CNC systems were commercially materialized. The reasons why the CAD/CAM and CNC vendors have not been interested in becoming STEP-compliant are diverse. One of the major is the unmatured interoperability in handling uncertainty in highly dynamic production contexts. STEP-NC requires enormous manufactured data being exchanged among different STEP-compliant systems, whereas little lack of consistency may course the failure of final manufacturing results. The low-volume volatile component production and the complexity of STEP-NC data bring much more risks of uncertainty and unforeseen events, which generally propagate across the different stages of production. The authors believe that the combination of STEP-NC and cloud manufacturing will be the key solution for dealing with the current dilemma of STEP-NC and can promote the intelligent manufacturing into reality. This research proposes a framework of the STEP-NC compliant manufacturing in a cloud environment.
The determinants of smart tourism behavior: evidence in wine tourism context
Authors: TsaiFaYen  , YuJanShen  , Hung ChienJen
Published: October 2019

The main purpose of this study is to investigate theinfluence of satisfaction, involvement, and subjective norms on tourists 'behavioral intentions at a historic district at Yibin, China. This study also attempts to examine the mediating effect of involvement, and subjective norms on the paths from satisfaction to intentions. Data were collected via a nonsite survey and analyzed using a structural equation modeling approach. Results indicate that satisfaction, involvement, andsubjective norms directly contribute to the formation of tourists' intentions of the historic district. Tourists' involvement is positively associated with tourists' satisfaction. Both involvement and subjective norms fully mediates the relationship between satisfaction and intentions. Theoretical and managerial implications are elaborated.
A development and application of maintainability evaluation system using immersive VR
Authors: Wang Meihui , Li Yongxiang , Lyu Chuan , Liu Xi
Published: October 2019

Immersing into virtual reality (VR) is a perception of being physically present in a non-physical world. Using immersive VR in maintenance brings great conveniences. For example, using virtual human operating in hazardous environment before the real person, which can prevent being hurt. In this paper, a system of immersive virtual maintenance (IVM) is presented. It is divided into three parts. The first part is Input, which contains the maintenance task and maintenance design. The second part is Method, with which making the virtual human and the users act in a unified way. The key to build IVM system is the interface between the motion capture system and virtual simulation software. The third part is Output, which presents the maintainability evaluation results. This paper focuses on how to build IVM system, the difficulties and solutions also be detailed. At last, a simple application is given
NOx emission from a sulfur recovery unit thermal reactor with rounded corners or a vector wall
Authors: Yeh Chun Lang
Published: October 2019

A sulfur recovery unit (SRU) thermal reactor is important equipment in a sulfur plant. Because its operating temperature is very high, the nitrogen oxides (NOx) produced by a SRU thermal reactor is one of the possible sources of air pollution. In this paper, NOx emission from a practical SRU thermal reactor is analyzed. Both the prototype thermal reactor and its modifications, including modifying the reactor geometry and using a vector wall are compared. Simulation results show that the SRU thermal reactor with a radius of curvature 1m at the zone 1 corner has the lowest NO emission. Compared with using a choke ring, the NO concentration at the reactor exit is higher using a vector wall.
An invention of multifunction washing ball
Authors: Liu Che Wei , Wu Chuan Wei
Published: October 2019

Ultrasonic clean is a very fashionable trend in cleaning appliance and tools in domestic and international markets, from washing machine, electronic toothbrush to household, ultrasonic cleaning machine (for jewelry, watch, glasses, etc.) Every ultrasonic related thing is very popular and the price is raised immediately. For example, the washing machines under the same brand, the one with ultrasonic will be USD 180 more expensive than the other one as the price could up to 8 times of difference for the ultrasonic function of the electronic toothbrushes of the same brand. Multifunction washing ball is the pioneer creation of the world, which is advanced and can be applied for many purposes. It can replace various cleaning household appliances in modern family with the remarkable cleaning effect. Ultrasonic current powerfully get rid of the hidden dirt among the clothes fiber. It will definitely be popular with the collocation of the trend. In the environmental protection, it reduces washing powder usage, minimum power consumption, save the water, cherish the resource on earth.
Impact of a Novel Antimicrobial Surface Coating on Health Care–Associated Infections and Environmental Bioburden at 2 Urban Hospitals
Authors: Ellingson Katherine D , Pogreba-Brown Kristen , Gerba Charles P , Elliott Sean P
Published: October 2019

Background

Approximately 1 in 25 people admitted to a hospital in the United States will suffer a health care–associated infection (HAI). Environmental contamination of hospital surfaces contributes to HAI transmission. We investigated the impact of an antimicrobial surface coating on HAIs and environmental bioburdens at 2 urban hospitals.

Methods

A transparent antimicrobial surface coating was applied to patient rooms and common areas in 3 units at each hospital. Longitudinal regression models were used to compare changes in hospital-onset multidrug-resistant organism bloodstream infection (MDRO-BSI) and Clostridium difficile infection (CDI) rates in the 12 months before and after application of the surface coating. Incidence rate ratios (IRRs) were compared for units receiving the surface coating application and for contemporaneous control units. Environmental samples were collected pre- and post-application to identify bacterial colony forming units (CFUs) and the percent of sites positive for select, clinically relevant pathogens.

Results

Across both hospitals, there was a 36% decline in pooled HAIs (combined MDRO-BSIs and CDIs) in units receiving the surface coating application (IRR, 0.64; 95% confidence interval [CI], .44–.91), and no decline in the control units (IRR, 1.20; 95% CI, .92–1.55). Following the surface application, the total bacterial CFUs at Hospitals A and B declined by 79% and 75%, respectively; the percentages of environmental samples positive for clinically relevant pathogens also declined significantly for both hospitals.

Conclusions

Statistically significant reductions in HAIs and environmental bioburdens occurred in the units receiving the antimicrobial surface coating, suggesting the potential for improved patient outcomes and persistent reductions in environmental contamination. Future studies should assess optimal implementation methods and long-term impacts.
Spectra, Hitting Times and Resistance Distances ofq- Subdivision Graphs
Authors: Zeng Yibo , Zhang Zhongzhi
Published: October 2019

Subdivision, triangulation, Kronecker product, corona product and many other graph operations or products play an important role in complex networks. In this paper, we study the properties of $q$-subdivision graphs, which have been applied to model complex networks. For a simple connected graph $G$, its $q$-subdivision graph $S_q(G)$ is obtained from $G$ through replacing every edge $uv$ in $G$ by $q$ disjoint paths of length 2, with each path having $u$ and $v$ as its ends. We derive explicit formulas for many quantities of $S_q(G)$ in terms of those corresponding to $G$, including the eigenvalues and eigenvectors of normalized adjacency matrix, two-node hitting time, Kemeny constant, two-node resistance distance, Kirchhoff index, additive degree-Kirchhoff index and multiplicative degree-Kirchhoff index. We also study the properties of the iterated $q$-subdivision graphs, based on which we obtain the closed-form expressions for a family of hierarchical lattices, which has been used to describe scale-free fractal networks.
Multiantenna Receiver Signal Detection in AmBC Based on Cluster Analysis
Authors: Zhao Jumin , Zhang Liang , Li Deng'ao
Published: October 2019

Ambient backscatter communication (AmBC) has great application prospects in the green Internet of Things due to its shared nature of energy and spectrum. In this paper, we have done research on the signal detection problem in the AmBC system and proposed to use the k-means clustering analysis algorithm to detect the received backscattered signal. At the same time, in order to obtain a more obvious clustering center, this paper introduces a multi-antenna receiver channel detection mechanism. The proposed method can compare and analyze the energy received by the receiver antennas in an extremely short time slots. The channel state information between the reader and the backscatter tag is obtained, and the optimal communication channel is selected, thereby effectively improving the clustering effect. Finally, a large number of experimental simulations are provided to compare and analyze the corresponding BER performance to confirm our theoretical research.
Concomitant tumourous lesions in the left atrium and aortic valve suspected to be myxoma
Authors: Mandryk Yuriy , Czesla Markus , Flora Christian , Massoudy Parwis
Published: October 2019

The occurrence of multiple primary cardiac tumours in a single patient is extremely rare. Despite growing expertise in non-invasive diagnostic modalities, especially in transoesophageal echocardiography, only a few cases report the coincidence of papillary fibroelastoma of the aortic valve and myxoma of the left atrium. Moreover, echocardiographic as well as a macroscopic distinction between cardiac myxoma and cardiac fibroelastoma may be difficult. Only post-excisional histopathology provides diagnostic safety. Cryoablation of the remnant tissue prevents recurrence in both the aortic valve and the left atrium.
Change in Antibiotic Use in Secondary and Tertiary Hospitals Nationwide After a National Antimicrobial Stewardship Campaign Was Launched in China, 2011–2016: An Observational Study
Authors: Xiao Yonghong , Shen Ping , Zheng Beiwen , Zhou Kai , Luo Qixia , Li Lanjuan
Published: October 2019

Background

An antimicrobial stewardship campaign was launched in 2011 by the Ministry of Health. This study aimed to assess the achievements and trends in the clinical use of antibiotics in secondary and tertiary hospitals following this campaign in China.

Methods

This observational study analyzed nationwide hospital antibiotic procurement and consumption data and antibiotic-resistance surveillance data based on claims filed in 2010–2016.

Results

After a 6-year national campaign, the proportion of outpatients and surgical patients who received antibiotic treatment decreased from 19.5% to 8.5% and from 97.9% to 38.3%, respectively. The intensity of antibiotic use among inpatients decreased from 85.3±29.8 defined daily dosage (DDD) per 100 patient days to 48.5±8.0 DDD per 100 patient days. Moreover, the antibiotic procurement expenditure among hospitals declined from 22.3% of total drug procurement costs in 2010 to 12.1% in 2016, although total drug procurement costs doubled during that time. The incidence of methicillin-resistant Staphylococcus aureus isolates also dropped (from 54.4% in 2010 to 34.4% in 2016), as did the proportion of carbapenem-resistant Pseudomonas aeruginosa isolates (from 30.8% to 22.3%).

Conclusions

The 6-year campaign successfully reduced antibiotic consumption and irrational drug use in Chinese hospitals which was associated with declines in the prevalence of common antibiotic-resistant bacteria.
A Retrospective Analysis of Risk Factors and Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in Nontransplant Patients
Authors: Xiao Tingting , Zhu Yunying , Zhang Shuntian , Wang Yuan , Shen Ping , Zhou Yanzi , Yu Xiao , Xiao Yonghong
Published: October 2019

Background

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a major problem among nosocomial infections, and it is a serious threat to patients. The clinical characteristics and outcome of CRKP bloodstream infection (BSI) in nontransplant patients remains unelucidated. The aim of this study was as follows: identify the risk factors of CRKP infection; generate new ideas for prevention; and generate new ideas for the most effective therapeutic management in nontransplant patients.

Methods

The study retrospectively analyzed the clinical and microbiological data of nontransplant patients with K pneumoniae (KP) bacteremia from January 2013 to December 2015 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis.

Results

Of the 371 patients with KP-BSI in nontransplant patients included in this study, 28.0% (N = 104) had CRKP. The 28-day mortality was higher in patients infected with CRKP (55.8%) than in those with carbapenem-susceptible KP (13.9%) (P < .001). Multivariate analysis showed previous gastric catheterization, previous use of carbapenems, hypoproteinemia, and high Acute Physiologic Assessment and Chronic Health Evaluation II scores as independent risk factors for CRKP-BSIs. Carbapenem-resistant KP infection, severe illness, and tigecycline therapy were independent risk factors for death from KP-BSIs. Taken together, inappropriate antibiotic treatment both in empirical and definitive therapy and imipenem minimum inhibitory concentrations (MICs) of >8 mg/L were associated with poor clinical outcome.

Conclusions

Nontransplant patients with CRKP-BSI had higher mortality. Carbapenems exposure was an independent risk factor for CRKP infection. Imipenem MICs of >8 mg/L, tigecycline therapy, and inappropriate treatments increased the 28-day mortality of KP-BSI patients.
A comparison of individual and ecological indicators of social deprivation and their association with hospital efficiency in the context of infectious diseases in two French general paediatric departments
Authors: Roussel Aphaia , Faye Albert , Lefevre-Utile Alain , De Pontual Loic , Chevreul Karine , Michel Morgane
Published: October 2019

Background

To identify deprivation indicators usable in everyday practice and included in medico-administrative databases, particularly with infectious diseases, which represent the greatest proportion of hospitalizations. Our objective was to compare ecological indicators to individual questionnaires and apply both types to the study of the impact of deprivation on hospital efficiency.

Methods

We conducted an epidemiological observational prospective multicentre study in two French public hospitals between 20 October 2016 and 20 March 2017. Children hospitalized for one of the four most common infectious diseases were included and their parents were asked to answer the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. The ecological indicator French DEPrivation index (FDep) was derived from patients’ address, both at the zip code and at a smaller geographical area (IRIS [ilôts de regroupement pour l'information statistique]) level. Correlation and concordance between the three indicators were assessed. The endpoint used to assess the impact on hospital efficiency was the ratio between patients’ length of stay (LOS) and the national LOS of their disease-related group.

Results

Data were available for 540 patients with a mean age of 9 mo. A total of 56.1% of patients were considered deprived with EPICES, 50.4% with zip code FDep and 45.7% with IRIS FDep. Concordance between EPICES and either type of FDep was <0.1. There was no increase in LOS compared with national LOS with any of the indicators.

Conclusions

Individual and ecological indicators do not measure the same aspects of deprivation. The decision to use one or the other must be carefully weighed when studying the impact of deprivation on the healthcare system.
The logic of imaginary scenarios
Authors: Casas-Roma Joan , Huertas Antonia , Rodríguez M Elena
Published: October 2019

Imagining is something we use everyday in our lives and in a wide variety of ways. In spite of the amount of works devoted to its study from both psychology and philosophy, there are only a few formal systems capable of modelling it; besides, almost all of those systems are static, in the sense that their models are initially predefined, and they fail to capture the dynamic process behind the creation of new imaginary scenarios. In this work, we review some influential theories of imagination and use their insights to distil an algorithm describing such process. Then, we use this algorithm to define a dynamic logical system built upon on a single-agent epistemic logic that provides the necessary tools to capture how the agent voluntarily creates new imaginary worlds; in other words, our system allows the model to be expanded dynamically at any time as a result of the agent performing an act of imagination. Furthermore, we provide an axiomatization and prove that the system is sound and complete.
Measuring the H i mass function below the detection threshold
Authors: Pan Hengxing , Jarvis Matt J , Allison James R , Heywood Ian , Santos Mario G , Maddox Natasha , Frank Bradley S , Kang Xi
Published: October 2019

We present a Bayesian stacking technique to directly measure the H i mass function (HIMF) and its evolution with redshift using galaxies formally below the nominal detection threshold. We generate galaxy samples over several sky areas given an assumed HIMF described by a Schechter function and simulate the H i emission lines with different levels of background noise to test the technique. We use Multinest to constrain the parameters of the HIMF in a broad redshift bin, demonstrating that the HIMF can be accurately reconstructed, using the simulated spectral cube far below the H i mass limit determined by the 5σ flux-density limit, i.e. down to MHI = 107.5 M⊙ over the redshift range 0 < z < 0.55 for this particular simulation, with a noise level similar to that expected for the MIGHTEE survey. We also find that the constraints on the parameters of the Schechter function, φ⋆, M⋆ and α can be reliably fit, becoming tighter as the background noise decreases as expected, although the constraints on the redshift evolution are not significantly affected. All the parameters become better constrained as the survey area increases. In summary, we provide an optimal method for estimating the H i mass at cosmological distances that allows us to constrain the H i mass function below the detection threshold in forthcoming H i surveys. This study is a first step towards the measurement of the HIMF at high (z > 0.1) redshifts.
Disc growth and quenching
Authors: Peng Ying-jie , Renzini Alvio
Published: October 2019

Based on well-established scaling relation for star-forming galaxies as a function of redshift, we argue that the implied growth by a large factor of their angular momentum requires that the angular momentum of the inflowing gas fuelling star formation and disc growth must also secularly increase. We then propose that star formation in discs can cease (quench) once the accreted material (mainly atomic hydrogen) comes in with excessive angular momentum for sustaining an adequate radial flow of cold, molecular gas. Existing observational evidence supporting this scenario is mentioned, together with some future observational studies that may validate (or invalidate) it.
Breaking the centrifugal barrier to giant planet contraction by magnetic disc braking
Authors: Ginzburg Sivan , Chiang Eugene
Published: October 2019

During the runaway phase of their formation, gas giants fill their gravitational spheres of influence out to Bondi or Hill radii. When runaway ends, planets shrink several orders of magnitude in radius until they are comparable in size to present-day Jupiter; in 1D models, the contraction occurs on the Kelvin–Helmholtz time-scale tKH, which is initially a few thousand years. However, if angular momentum is conserved, contraction cannot complete, as planets are inevitably spun up to their breakup periods Pbreak. We consider how a circumplanetary disc (CPD) can de-spin a primordially magnetized gas giant and remove the centrifugal barrier, provided the disc is hot enough to couple to the magnetic field, a condition that is easier to satisfy at later times. By inferring the planet’s magnetic field from its convective cooling luminosity, we show that magnetic spin-down times are shorter than contraction times throughout post-runaway contraction: tmag/tKH ∼ (Pbreak/tKH)1/21 ≲ 1. Planets can spin-down until they corotate with the CPD’s magnetospheric truncation radius, at a period Pmax/Pbreak ∼ (tKH/Pbreak)1/7. By the time the disc disperses, Pmax/Pbreak ∼ 20–30; further contraction at fixed angular momentum can spin planets back up to ∼10Pbreak, potentially explaining observed rotation periods of giant planets and brown dwarfs.
Water rights reform and water marketing: Australia vs the US West
Authors: Hanemann Michael , Young Michael
Published: October 2019

We consider the connection between water marketing and the modification of property rights to water in Australia, highlighting the Australian’s distinctiveness through a contrast with water rights in the western US (especially California). Australia started out the same as California, but in the 1880s it abandoned California’s system and adopted a new approach, ending the common law property right to water and creating a statutory right that could be modified by administrative fiat. This shifted the arena for dispute resolution from courts to parliaments. It eliminated the seniority inherent in appropriative water rights and it sidelined issues of third-party impacts. Another difference was the tight control of irrigation institutions by state governments and the national government’s willingness to intervene in state and local water management. Australian water reform was wrapped in politics. When there were successes, this is because the politics were managed adroitly; when political challenges proved insurmountable, reform stalled.
Two Is Better Than One: StudyingUstilago bromivora–BrachypodiumCompatibility by Using a Hybrid Pathogen
Authors: Bosch Jason , Czedik-Eysenberg Angelika , Hastreiter Maximilian , Khan Mamoona , Güldener Ulrich , Djamei Armin
Published: October 2019

Pathogenic fungi can have devastating effects on agriculture and health. One potential challenge in dealing with pathogens is the possibility of a host jump (i.e., when a pathogen infects a new host species). This can lead to the emergence of new diseases or complicate the management of existing threats. We studied host specificity by using a hybrid fungus formed by mating two closely related fungi: Ustilago bromivora, which normally infects Brachypodium spp., and U. hordei, which normally infects barley. Although U. hordei was unable to infect Brachypodium spp., the hybrid could. These hybrids also displayed the same mating-type bias that had been observed in U. bromivora and provide evidence of a dominant spore-killer-like system on the sex chromosome of U. bromivora. By analyzing the genomic composition of 109 hybrid strains, backcrossed with U. hordei over four generations, we identified three regions associated with infection on Brachypodium spp. and 75 potential virulence candidates. The most strongly associated region was located on chromosome 8, where seven genes encoding predicted secreted proteins were identified. The fact that we identified several regions relevant for pathogenicity on Brachypodium spp. but that none were essential suggests that host specificity, in the case of U. bromivora, is a multifactorial trait which can be achieved through different subsets of virulence factors.
Intestinal epithelial deletion of the glucocorticoid receptor NR3C1 alters expression of inflammatory mediators and barrier function
Authors: Aranda Carlos J. , Arredondo‐Amador María , Ocón Borja , Lavín Jose Luis , Aransay Ana María , Martínez‐Augustin Olga , de Medina Fermín Sánchez
Published: October 2019

Glucocorticoids (GCs) are important hormones involved in the regulation of multiple physiologic functions. GCs are also widely used in anti‐inflammatory/immunosuppressant drugs. GCs are synthesized by the adrenal cortex as part of the hypothalamus‐pituitary‐adrenal axis and also by intestinal epithelial cells, among other peripheral sites. GCs are one of the main therapy choices for the exacerbations of inflammatory bowel disease, but they are not useful to prolong remission, and development of tolerance with secondary treatment failure is frequent. Thus, GC actions at the intestinal epithelial level are of great importance, both physiologically and pharmacologically. We generated a tamoxifen‐inducible nuclear receptor subfamily 3 group C member 1 (NR3C1)ΔIEC mouse model to study the effects of GCs on epithelial cells in vivo. Nr3c1 deletion in epithelial cells of the small intestine and colon was associated with limited colonic inflammation at 1 wk postdeletion, involving augmented epithelial proliferation and mucus production, plus local and systemic immune/inflammatory changes. This phenotype regressed substantially, but not completely, after 2 wk. The mechanism may involve augmented inflammatory signaling by epithelial cells or defective barrier function. We conclude that the epithelial GC receptor plays a significant role in colonic homeostasis in basal conditions, but its deficiency can be compensated in the short term. Future studies are required to assess the impact of Nr3c1 deletion in other conditions such as experimental colitis.—Aranda, C. J., Arredondo‐Amador, M., Ocón, B., Lavín, J. L., Aransay, A. M., Martínez‐Augustin, O., Sánchez de Medina, F. Intestinal epithelial deletion of the glucocorticoid receptor NR3C1 alters expression of inflammatory mediators and barrier function. FASEB J. 33, 14067‐14082 (2019). www.fasebj.org
Inositol polyphosphate multikinase is a metformin target that regulates cell migration
Authors: Tu‐Sekine Becky , Padhi Abinash , Jin Sunghee , Kalyan Srivathsan , Singh Karanpreet , Apperson Matthew , Kapania Rakesh , Hur Soojung Claire , Nain Amrinder , Kim Sangwon F.
Published: October 2019

Metformin has been shown to alter cell adhesion protein expression, which is thought to play a role in its observed antitumor properties. We found that metformin treatment down‐regulated integrin β1 concomitant with the loss of inositol polyphosphate multikinase (IPMK) in murine myocytes, adipocytes, and hepatocytes. To determine if IPMK was upstream of integrin β1 expression, we examined IPMK‐/‐ mouse embryonic fibroblast cells and found that integrins β1and β3 gene expression was reduced by half, relative to wild‐type cells, whereas focal adhesion kinase (FAK) activity and Rho/Rac/Cdc42 protein levels were increased, resulting in migration defects. Using nanonet force microscopy, we determined that cell:extracellular matrix adhesion and cell contractility forces were decreased, confirming the functional relevance of integrin and Rho protein dysregulation. Pharmacological studies showed that inhibition of both FAK1 and proline‐rich tyrosine kinase 2 partially restored integrin β1 expression, suggesting negative regulation of integrin β1 by FAK. Together our data indicate that IPMK participates in the regulation of cell migration and provides a potential link between metformin and wound healing impairment.—Tu‐Sekine, B., Padhi, A., Jin, S., Kalyan, S., Singh, K., Apperson, M., Kapania, R., Hur, S. C., Nain, A., Kim, S. F. Inositol polyphosphate multikinase is a metformin target that regulates cell migration. FASEB J. 33, 14137‐14146 (2019). www.fasebj.org
Focus on pharmacotherapy for depression
Authors: Chesebro Jennifer , Armes Katelyn , Peterson Kathleen
Published: October 2019

Many patients are prescribed antidepressants. This article discusses depression, as well as the available first- and second-line prescription medications used to manage the disorder in adults.
Patients With Persistent Low Back Pain and Nerve Root Involvement
Authors: Petersen Tom , Juhl Carsten B. , Fournier Gilles L.
Published: October 2019

Study Design.

Prospective cohort study.

Objective.

The aims of this study were to evaluate the outcome of surgical and nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after 2 years and to identify predictors for nonsuccess.

Summary of Background Data.

Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.

Methods.

This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Nonsuccess was defined as a Roland-Morris Disability score above 4 (0–23) or a Numeric Rating Scale back and leg pain score above 20 (0–60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and magnetic resonance imaging findings.

Results.

Rates of nonsuccess at 2 years were approximately 30% in surgically treated patients with LHD, approximately about 60% in patients with LSS for disability, and 30% and 40%, respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male sex (odds ratio [OR] 2.04, 95% confidence interval [CI]: 1.02–4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28–5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51–6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36–9.46, P = 0.01).

Conclusion.

The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male sex, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.

Level of Evidence: 3
Diagnostic Delays Lead to Greater Disability in Degenerative Cervical Myelopathy and Represent a Health Inequality
Authors: Pope Daniel H. , Mowforth Oliver D. , Davies Benjamin M. , Kotter Mark R.N.
Published: October 2019

Study Design.

Online survey.

Objective.

This study seeks to quantify delays faced, determine demographics of patients most likely to face delay, and determine whether delays affect surgical management and outcomes.

Summary of Background Data.

Patients report significant delays in diagnosis of degenerative cervical myelopathy (DCM).

Methods.

Seven hundred seventy-eighty patients with self-reported DCM recruited via online survey hosted on myelopathy.org. A cumulative odds ordinal logistic regression was run to determine the effects of demographic (sex, country of residence, ethnicity, household income, and educational status) on the delay in diagnosis of DCM. Chi-square tests of homogeneity were run to determine the effects of delayed diagnosis on functional outcomes (patient-derived modified Japanese Orthopaedic Association disability score, support dependence, and employment status) and surgical management (anterior/posterior approach, single-/multilevel surgery). A Kruskal-Wallis H test was used to determine whether delayed diagnosis affected the number of operations undergone.

Results.

The average delay in diagnosis faced was “1–2 years." Greater delays in diagnosis were faced by Black or African American patients (P = 0.010). Delayed diagnosis was predictive of greater disability as assessed by patient-derived modified Japanese Orthopaedic Association score (P = 0.001), support dependence (P = 0.040), and employment status (P < 0.0005). Delayed diagnosis did not affect the likelihood of surgery, the number of operations undergone or perioperative characteristics.

Conclusion.

Patients continue to face significant delays in diagnosis of DCM. Ethnicity significantly influences length of delay experienced. Longer delays do not appear to affect surgical management but are associated with greater disability.

Level of Evidence: 3
Fulcrum-assisted Ankle Reduction Maneuver
Authors: Ernst Lt. Andrew , Mattox Lt. Benjamin , Douglas Cdr. Thomas J.
Published: October 2019

Short leg splinting is the standard initial temporizing measure of choice for acute ankle fractures. When possible, a reduced ankle mortise is the ideal resting place for the ankle from point of injury to surgery or continued nonoperative management. Multiple ways of reducing fractures and keeping them reduced within the ankle mortised have been described. Adequacy of analgesia, patient factors, and degree of displacement can impede the fracture reduction and splinting process. We describe a novel maneuver to aid in the application of short leg splints in the initial management of fibula fractures with lateral displacement of the talus.
Four-Flanged Intrascleral Intraocular Lens Fixation Technique: No Flaps, No Knots, No Glue
Authors: Canabrava Sergio , Canêdo Domingos Lima Ana Carolina , Ribeiro Guilherme
Published: October 2019

Purpose:

To develop a novel, sutureless, single-piece, nonfoldable intraocular lens (IOL) intrascleral fixation technique based on the existing Malbran IOL scleral fixation and Yamane double-needle techniques.

Methods:

The novel method uses a 5.0 polypropylene suture and a bipolar cautery to create 2 flanges in the eyelets of the IOL and 2 flanges outside to insert inside the scleral tunnel and thus fixate the IOL.

Results:

This technique had been applied in 4 patients with aphakia after phacoemulsification complications. The mean preoperative and postoperative corrected distance visual acuities were 0.45 ± 0.17 and 0.67 ± 0.27 (Snellen decimal units), respectively.

Conclusions:

The 4-flanged technique improves and simplifies the existing single-piece, nonfoldable IOL intrascleral fixation techniques.
Surgical Outcomes and Quality Assessment of Trabeculectomy: Leveraging Electronic Health Records for Clinical Data Visualization
Authors: Guo Xinxing , Li Bowen , Friedman David S. , Boland Michael V.
Published: October 2019

Précis:

This electronic medical record-based study demonstrates 1 approach to monitor clinical outcomes for individual physicians performing trabeculectomy.

Purpose:

The purpose of this study was to develop an interactive data visualization platform for evaluating trabeculectomy outcomes and monitoring clinical care quality.

Patients and Methods:

This is a retrospective electronic health record study in a glaucoma division of an academic medical center. We included 633 patients who underwent trabeculectomy between July 2016 and December 2018. Data were collected for intraocular pressure (IOP), vision loss, number of follow-up visits, and return to the operating room within the initial 3 months. Regression analyses were used to assess factors associated with these study outcomes. Risk of IOP ≤5 mm Hg was assessed using survival analysis. An interactive data visualization platform was created.

Results:

A total of 429 trabeculectomy and 204 combined surgeries were analyzed, with preoperative IOP of 21.9±9.4 and 19.4±6.9 mm Hg, respectively. Mean pressure declined by 53% and 41% (P=0.001) by 3 months. Risk of pressure ≤5 mm Hg was higher in white patients and those who underwent trabeculectomy alone. At 3 months, patients on average had 5 clinic visits; 5.5% required additional surgical procedures, and 18% experienced loss of at least 3 lines of best-recorded (not best-corrected) vision. Returning to the operating room was significantly associated with an increased number of clinic visits (coefficient=3.94) and higher odds of vision loss (odds ratio=11.12).

Conclusions:

Over the initial 3 months after trabeculectomy, additional surgeries are rare, while a significant proportion of patients lost vision, and this was strongly associated with a need to return to the operating room. Interactive electronic health record data visualization can be a useful tool for monitoring clinical outcomes.
Long-Term Follow-up on Glaucoma Patients With Initial Single-Hemifield Defect: Progression Patterns and Associated Factors
Authors: Baek Sung Uk , Kim Young Kook , Park Ki Ho , Jeoung Jin Wook
Published: October 2019

Purpose:

The purpose of this study was to investigate the clinical outcomes of primary open-angle glaucoma (POAG) with an initial single-hemifield defect on visual field (VF) testing and the related risk factors for the involvement of the opposite hemifield during follow-up.

Methods:

This longitudinal observational study included 108 POAG eyes of 108 patients who met the following conditions: (1) single-hemifield defect at initial VF examination; (2) follow-up >5 years. Eyes having undergone noncataract surgeries and laser treatment during the follow-up period were excluded. Patients were divided into group A (sparing of opposite hemifield) and group B (involvement of opposite hemifield) according to the patterns of VF progression. Baseline demographic and clinical characteristics were compared between the 2 groups. The Cox proportional hazards model was used to identify the risk factors for the involvement of the opposite hemifield.

Results:

A total of 63 eyes (58.3%) were classified as group A and 45 (41.7%) as group B. The average follow-up period was 7.9 years. Between the 2 groups, significant differences were found in the age (55.7±10.7 vs. 61.0±10.5 y, P=0.015) and presence of optic disc vertical tilt (54.0% vs. 28.9%, P=0.034). According to the multivariate Cox proportional hazards model, older age (hazard ratio=1.704; P=0.025) and absence of optic disc vertical tilt (hazard ratio=1.430; P=0.017) were risk factors for the involvement of the opposite hemifield.

Conclusions:

In 108 POAG eyes with an initial single-hemifield defect, 41.7% showed involvement of the opposite hemifield during the average 8.0-year follow-up. Older age and absence of optic disc vertical tilt were significantly associated with a greater probability of involvement of the opposite hemifield.
The Social and Economic Impact of Chronic Obstructive Pulmonary Disease on Maintenance-of-Way Railroad Workers
Authors: Ruttenberg Ruth
Published: October 2019

Thousands of railroad maintenance-of-way (MOW) workers develop chronic obstructive pulmonary disease (COPD) from their work.

Objective:

This study calculates the social and economic burdens of COPD borne by thousands of MOW workers.

Methods:

Economic calculations are derived from the literature and also from a survey of 4800 MOW respondents, 155 in-depth interviews, and two focus groups.

Results:

COPD alone costs at least $179 million over the course of cases currently diagnosed among MOW workers. Many individuals work through significant pain and breathing difficulties or have to leave the profession. Some are crippled for life.

Conclusion:

When a worker has COPD, beyond pain and suffering, there are often financial burdens that affect families, railroad companies, insurers, communities, and taxpayers as well as the injured workers.
Can an automatic oscillometric device replace a mercury sphygmomanometer on blood pressure measurement? a systematic review and meta-analysis
Authors: Park Seong-Hi , Park Young-Su
Published: October 2019

Objective:

A mercury sphygmomanometer has been considered a gold standard for measuring blood pressure. However, by the Minamata Convention on Mercury, the traditional mercury sphygmomanometer is being replaced by an automated oscillometric device. This study aimed to provide scientific evidence to determine whether an automated oscillometric device can replace a mercury sphygmomanometer and if it is applicable in routine practice.

Methods:

MEDLINE, EMBASE, the Cochrane Library, and CINAHL were searched on 4 May 2018. Studies comparing blood pressure measurements between automated oscillometric devices and mercury sphygmomanometers were included. Study characteristics were abstracted using the evidence table, and random-effects meta-analyses were conducted.

Results:

Data were compiled from 24 studies comprising 47 759 subjects. The results of meta-analysis showed that automated oscillometric devices measured lower than mercury sphygmomanometers for both systolic blood pressure (mean differences −1.75 mmHg, 95% confidence intervals: −3.05 to −0.45, I2 = 91.0%) and diastolic blood pressure (mean differences −1.20 mmHg, 95% confidence intervals: −2.16 to −0.24, I2 = 95.0%). In sub-group analyses by manufacturer, BpTRU measured lower than the mercury sphygmomanometer and OMRON showed no difference compared to the mercury sphygmomanometer for both systolic and diastolic blood pressure, but the results differed depending on the devices.

Conclusion:

As a result of this review, the difference in blood pressure between the mercury sphygmomanometer and the automated oscillometric device was within 5 mmHg, but the heterogeneity between the studies was very high. The automated oscillometric devices showed differences in blood pressure results according to the manufacturer and product type.