bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacokinetics of Cefuroxime in Synovial Fluid
Authors: Schwameis R. , Syré S. , Marhofer D. , Appelt A. , Burau D. , Sarahrudi K. , Kloft C. , Zeitlinger M.
Published: August 2017

Cefuroxime is frequently used as preoperative antibiotic prophylaxis and may be used for the treatment of septic arthritis. A prerequisite for successful treatment of septic arthritis is the ability of an antibiotic agent to penetrate into the target site. Therefore, the concentration of cefuroxime in synovial fluid was evaluated. Ten patients who underwent elective knee arthroscopy were included in this study. Patients were treated with a single dose of 1,500 mg cefuroxime intravenously, and subsequently, the concentrations in plasma, the interstitial fluid of muscle tissue, and synovial fluid were measured by using microdialysis. Pharmacokinetic/pharmacodynamic calculations to predict bacterial killing were performed using the epidemiologically defined MIC
90
for clinical isolates and CLSI breakpoints. Cefuroxime penetrated excellently into muscle tissue (ratio of the area under the concentration-time curve [AUC] for muscle tissue/AUC for free plasma, 1.79) and synovial fluid (ratio of the AUC for synovial fluid/AUC for free plasma, 1.94). The cefuroxime concentration was greater than the MIC
90
for
Staphylococcus aureus
and
S. epidermidis
strains (≤2 mg/liter) over the complete dosing interval (the percentage of the dosing interval during which the free cefuroxime concentration exceeded the MIC for the pathogen [
fT
MIC
]). CLSI defines staphylococci with MICs of ≤8 mg/liter to be susceptible to cefuroxime. For staphylococci with MICs of ≤8 mg/liter, the
fT
MIC
in plasma was 52.5%, while the
fT
MIC
in muscle tissue and synovial fluid was 93.6% and 96.3%, respectively. Cefuroxime may be used to treat septic arthritis caused by susceptible bacterial strains (MIC ≤ 8 mg/liter). The activity of cefuroxime in septic arthritis might be underestimated when relying exclusively on plasma concentrations.
The Fluorocycline TP-271 Is Efficacious in Models of Aerosolized Bacillus anthracis Infection in BALB/c Mice and Cynomolgus Macaques
Authors: Grossman Trudy H. , Anderson Michael S. , Drabek Lindsay , Gooldy Melanie , Heine Henry S. , Henning Lisa N. , Lin Winston , Newman Joseph V. , Nevarez Rene , Siefkas-Patterson Kaylyn , Radcliff Anne K. , Sutcliffe Joyce A.
Published: August 2017

The fluorocycline TP-271 was evaluated in mouse and nonhuman primate (NHP) models of inhalational anthrax. BALB/c mice were exposed by nose-only aerosol to
Bacillus anthracis
Ames spores at a level of 18 to 88 lethal doses sufficient to kill 50% of exposed individuals (LD
50
). When 21 days of once-daily dosing was initiated at 24 h postchallenge (the postexposure prophylaxis [PEP] study), the rates of survival for the groups treated with TP-271 at 3, 6, 12, and 18 mg/kg of body weight were 90%, 95%, 95%, and 84%, respectively. When 21 days of dosing was initiated at 48 h postchallenge (the treatment [Tx] study), the rates of survival for the groups treated with TP-271 at 6, 12, and 18 mg/kg TP-271 were 100%, 91%, and 81%, respectively. No deaths of TP-271-treated mice occurred during the 39-day posttreatment observation period. In the NHP model, cynomolgus macaques received an average dose of 197 LD
50
of
B. anthracis
Ames spore equivalents using a head-only inhalation exposure chamber, and once-daily treatment of 1 mg/kg TP-271 lasting for 14 or 21 days was initiated within 3 h of detection of protective antigen (PA) in the blood. No (0/8) animals in the vehicle control-treated group survived, whereas all 8 infected macaques treated for 21 days and 4 of 6 macaques in the 14-day treatment group survived to the end of the study (56 days postchallenge). All survivors developed toxin-neutralizing and anti-PA IgG antibodies, indicating an immunologic response. On the basis of the results obtained with the mouse and NHP models, TP-271 shows promise as a countermeasure for the treatment of inhalational anthrax.
Fatal Pertussis in the Neonatal Mouse Model Is Associated with Pertussis Toxin-Mediated Pathology beyond the Airways
Authors: Scanlon Karen M. , Snyder Yael G. , Skerry Ciaran , Carbonetti Nicholas H.
Published: August 2017

In infants,
Bordetella pertussis
can cause severe disease, manifested as pronounced leukocytosis, pulmonary hypertension, and even death. The exact cause of death remains unknown, and no effective therapies for treating fulminant pertussis exist. In this study, a neonatal mouse model of critical pertussis is characterized, and a central role for pertussis toxin (PT) is described. PT promoted colonization, leukocytosis, T cell phenotypic changes, systemic pathology, and death in neonatal but not adult mice. Surprisingly, PT inhibited lung inflammatory pathology in neonates, a result which contrasts dramatically with observed PT-promoted pathology in adult mice. Infection with a PT-deficient strain induced severe pulmonary inflammation but not mortality in neonatal mice, suggesting that death in these mice was not associated with impaired lung function. Dissemination of infection beyond the lungs was also detected in neonatal mice, which may contribute to the observed systemic effects of PT. We propose that it is the systemic activity of pertussis toxin and not pulmonary pathology that promotes mortality in critical pertussis. In addition, we observed transmission of infection between neonatal mice, the first report of
B. pertussis
transmission in mice. This model will be a valuable tool to investigate causes of pertussis pathogenesis and identify potential therapies for critical pertussis.
17β-Estradiol Dysregulates Innate Immune Responses to Pseudomonas aeruginosa Respiratory Infection and Is Modulated by Estrogen Receptor Antagonism
Authors: Abid Shadaan , Xie ShangKui , Bose Moumita , Shaul Philip W. , Terada Lance S. , Brody Steven L. , Thomas Philip J. , Katzenellenbogen John A. , Kim Sung Hoon , Greenberg David E. , Jain Raksha
Published: August 2017

Females have a more severe clinical course than males in terms of several inflammatory lung conditions. Notably, females with cystic fibrosis (CF) suffer worse outcomes, particularly in the setting of
Pseudomonas aeruginosa
infection. Sex hormones have been implicated in experimental and clinical studies; however, immune mechanisms responsible for this sex-based disparity are unknown and the specific sex hormone target for therapeutic manipulation has not been identified. The objective of this study was to assess mechanisms behind the impact of female sex hormones on host immune responses to
P. aeruginosa
. We used wild-type and CF mice, which we hormone manipulated, inoculated with
P. aeruginosa
, and then examined for outcomes and inflammatory responses. Neutrophils isolated from mice and human subjects were tested for responses to
P. aeruginosa
. We found that female mice inoculated with
P. aeruginosa
died earlier and showed slower bacterial clearance than males (
P
< 0.0001). Ovariectomized females supplemented with 17β-estradiol succumbed to
P. aeruginosa
challenge earlier than progesterone- or vehicle-supplemented mice (
P
= 0.0003). 17β-Estradiol-treated ovariectomized female mice demonstrated increased lung levels of inflammatory cytokines, and when rendered neutropenic the mortality difference was abrogated. Neutrophils treated with 17β-estradiol demonstrated an enhanced oxidative burst but decreased
P. aeruginosa
killing and earlier cell necrosis. The estrogen receptor (ER) antagonist ICI 182,780 improved survival in female mice infected with
P. aeruginosa
and restored neutrophil function. We concluded that ER antagonism rescues estrogen-mediated neutrophil dysfunction and improves survival in response to
P. aeruginosa
. ER-mediated processes may explain the sex-based mortality gap in CF and other inflammatory lung illnesses, and the ER blockade represents a rational therapeutic strategy.
Transforming Growth Factor β1/SMAD Signaling Pathway Activation Protects the Intestinal Epithelium from Clostridium difficile Toxin A-Induced Damage
Authors: Tinoco-Veras Christianne Maria , Santos Ana Angélica Q. A. , Stipursky Joice , Meloni Marcelo , Araujo Ana Paula Bérgamo , Foschetti Danielle Abreu , López-Ureña Diana , Quesada-Gómez Carlos , Leitão Renata F. C. , Gomes Flávia Carvalho Alcantara , Brito Gerly Anne de Castro
Published: August 2017

Clostridium difficile
, the main cause of diarrhea in hospitalized patients, produces toxins A (TcdA) and B (TcdB), which affect intestinal epithelial cell survival, proliferation, and migration and induce an intense inflammatory response. Transforming growth factor β (TGF-β) is a pleiotropic cytokine affecting enterocyte and immune/inflammatory responses. However, it has been shown that exposure of intestinal epithelium to a low concentration of TcdA induces the release of TGF-β1, which has a protective effect on epithelial resistance and a TcdA/TGF-β signaling pathway interaction. The activation of this pathway
in vivo
has not been elucidated. The aim of this study was to investigate the role of the TGF-β1 pathway in TcdA-induced damage in a rat intestinal epithelial cell line (IEC-6) and in a mouse model of an ileal loop. TcdA increased the expression of TGF-β1 and its receptor, TβRII,
in vitro
and
in vivo
. TcdA induced nuclear translocation of the transcription factors SMAD2/3, a hallmark of TGF-β1 pathway activation, both in IEC cells and in mouse ileal tissue. The addition of recombinant TGF-β1 (rTGF-β) prevented TcdA-induced apoptosis/necrosis and restored proliferation and repair activity in IEC-6 cells in the presence of TcdA. Together, these data show that TcdA induces TGF-β1 signaling pathway activation and suggest that this pathway might play a protective role against the effect of
C. difficile
-toxin.
Adaptations to a Loss-of-Function Mutation in the Betaproteobacterium Aromatoleum aromaticum: Recruitment of Alternative Enzymes for Anaerobic Phenylalanine Degradation
Authors: Schmitt G. , Arndt F. , Kahnt J. , Heider J.
Published: August 2017

Anaerobic phenylalanine (Phe) degradation in the betaproteobacterium
Aromatoleum aromaticum
involves transamination and decarboxylation to phenylacetaldehyde, followed by oxidation to phenylacetate. The latter reaction is catalyzed simultaneously by two enzymes, a highly specific phenylacetaldehyde dehydrogenase (PDH) and a rather unspecific tungsten-dependent aldehyde oxidoreductase (AOR). Attempting to establish increased synthesis of AOR, we constructed a mutant lacking the gene for PDH. This mutant still grew on phenylalanine, exhibiting increased AOR activities on medium containing tungstate. In the absence of tungstate, the mutant showed initially severe growth deficiency, but it resumed growth on Phe after longer incubation times. Moreover, the growth rates of the mutant increased during several reinoculation cycles on either tungstate-proficient or -deficient media, reaching the same values as recorded in wild-type strains. We confirmed AOR as the major alternative enzyme serving Phe degradation under tungstate-supplied conditions and identified and characterized the alternative NAD-dependent aldehyde dehydrogenase AldB taking over the function under tungstate-deficient conditions. Sequence analysis of the respective genes from adapted cultures under either growth condition revealed a mutation in the upstream region of the
aor
operon and a mutation within the coding region of
aldB
, which are likely involved in the observed adaptation of the deletion mutant to regain fast growth on Phe.

IMPORTANCE
The betaproteobacterium
Aromatoleum aromaticum
degrades many aromatic compounds under denitrifying conditions. One of the steps of phenylalanine degradation is catalyzed by two simultaneously induced enzymes, a NAD(P)-dependent phenylacetaldehyde dehydrogenase and a W-containing aldehyde oxidoreductase. We report here that the latter fully complements a constructed deletion mutant lacking the gene for phenylacetaldehyde dehydrogenase and is overproduced after several reinoculations. Moreover, an alternative NAD-dependent dehydrogenase is recruited to resume growth in tungstate-free medium, which does not allow the production of aldehyde oxidoreductase. This alternative enzyme is overproduced and seems to have acquired a point mutation in the active center. Our research illustrates the flexibility of environmentally important bacteria in adapting their metabolic pathways to new challenges within only a few generations.
Roles of Transcriptional and Translational Control Mechanisms in Regulation of Ribosomal Protein Synthesis in Escherichia coli
Authors: Burgos Hector L. , O'Connor Kevin , Sanchez-Vazquez Patricia , Gourse Richard L.
Published: August 2017

Bacterial ribosome biogenesis is tightly regulated to match nutritional conditions and to prevent formation of defective ribosomal particles. InEscherichia coli, most ribosomal protein (r-protein) synthesis is coordinated with rRNA synthesis by a translational feedback mechanism: when r-proteins exceed rRNAs, specific r-proteins bind to their own mRNAs and inhibit expression of the operon. It was recently discovered that the second messenger nucleotide guanosine tetra and pentaphosphate (ppGpp), which directly regulates rRNA promoters, is also capable of regulating many r-protein promoters. To examine the relative contributions of the translational and transcriptional control mechanisms to the regulation of r-protein synthesis, we devised a reporter system that enabled us to genetically separate thecis-acting sequences responsible for the two mechanisms and to quantify their relative contributions to regulation under the same conditions. We show that the synthesis of r-proteins from the S20 and S10 operons is regulated by ppGpp following shifts in nutritional conditions, but most of the effect of ppGpp required the 5′ region of the r-protein mRNA containing the target site for translational feedback regulation and not the promoter. These results suggest that most regulation of the S20 and S10 operons by ppGpp following nutritional shifts is indirect and occurs in response to changes in rRNA synthesis. In contrast, we found that the promoters for the S20 operon were regulated during outgrowth, likely in response to increasing nucleoside triphosphate (NTP) levels. Thus, r-protein synthesis is dynamic, with different mechanisms acting at different times.

IMPORTANCEBacterial cells have evolved complex and seemingly redundant strategies to regulate many high-energy-consuming processes. InE. coli, synthesis of ribosomal components is tightly regulated with respect to nutritional conditions by mechanisms that act at both the transcription and translation steps. In this work, we conclude that NTP and ppGpp concentrations can regulate synthesis of ribosomal proteins, but most of the effect of ppGpp is indirect as a consequence of translational feedback in response to changes in rRNA levels. Our results illustrate how effects of seemingly redundant regulatory mechanisms can be separated in time and that even when multiple mechanisms act concurrently their contributions are not necessarily equivalent.
Abdominal aortic aneurysm in the setting ofClostridium perfringenspancreatitis
Authors: Karam Paul Anthony , Moslim Maitham A , Park Woosup Michael , Morris-Stiff Gareth
Published: August 2017

We report a case of a 56-year-old woman who presented with worsening abdominal pain located in the left upper quadrant together with abdominal distention, nausea and anorexia. One month prior to this admission, she had presented and had been diagnosed with concurrent acute pancreatitis and rapidly expanding abdominal aortic aneurysm. The aneurysm was prioritised over the pancreatitis and she underwent uncomplicated endovascular repair. Cross-sectional imaging was consistent with infected pancreatic necrosis and also revealed a large collection located in the anterior pararenal space with extensive gas formation. An image-guided fluid aspiration revealedClostridium perfringensas the causative organism. She was treated by placement of large bore drains along with irrigation and targeted intravenous antibiotic for 6 weeks. The collections resolved completely and at 6 months follow-up she was well and symptom free.
Aggressive large-cell neuroendocrine carcinoma of the sigmoid colon in a patient with ulcerative colitis
Authors: Stoner Patrick , Ghaffaripour Taban , Cohen David
Published: August 2017

Colonic inflammation seen in inflammatory bowel disease (IBD) predisposes to the development of colorectal adenocarcinoma. In contrast, colorectal neuroendocrine carcinomas (NECs) have rarely been reported in the setting of IBD, and no definitive relationship between these tumours and IBD has been established. Dysplasia from chronic inflammation leading to neuroendocrine cell differentiation may be responsible for NEC development, though this finding has not been seen consistently. We present a case of large-cell neuroendocrine carcinoma of the sigmoid colon in a 65-year-old woman with long-standing ulcerative colitis. Although she underwent regular endoscopic follow-ups and was receiving the tumour necrosis factor alpha inhibitor infliximab, her tumour was large and aggressive, with metastases to the liver discovered at time of diagnosis. This case highlights the aggressive nature and poor prognosis of NECs and stresses the need to identify patients at high risk of developing NECs and develop improved surveillance guidelines for detecting them.
Staged retroperitoneal mesenteric revascularisation and aortobifemoral bypass after endovascular rescue for acute mesenteric ischaemia
Authors: Johnson Shepard Peir , Lighter Melani , Anderson Harry Linne , Aziz Abdulhameed
Published: August 2017

Visceral artery revascularisation through a retroperitoneal approach provides an infrequent yet viable, alternative means of managing mesenteric ischaemia in patients with previous abdominal operations. We present a unique case implementing this surgical approach in a 55-year-old man in which we performed a retroperitoneal aortobifemoral bypass with concomitant retrograde jump graft from the aortic prosthesis to the superior mesenteric artery (SMA) for bilateral lower extremity rest pain and chronic mesenteric ischaemia. Three months previously, the patient had presented with acute mesenteric ischaemia and colonic perforation. He underwent emergent celiac artery stenting followed by an exploratory laparotomy with total abdominal colectomy and diverting loop ileostomy. Given the patient's hostile abdomen, a retroperitoneal approach to SMA revascularisation was elected over a transabdominal approach during concomitant lower extremity revascularisation for critical limb ischaemia. We achieved an excellent technical result with resolution of limb ischaemia and abdominal symptoms.
Twisted intra-abdominal cyst in a neonate: a surprise revelation
Authors: Mohamed Ferzine , Telugu Ramesh Babu , Karl Immanuel Sampath
Published: August 2017

We, herein, present a male neonate with an antenatally detected intra-abdominal cyst who presented at 18 days of life at which time, the ultrasound revealed a 5×4 cm cyst. Since he was asymptomatic, we planned to repeat the ultrasound a month later and operate if the cyst showed no regression. However, a week later, he presented with an acute abdomen, irritable cry and a repeat ultrasound showing a larger (8×6 cm) cystic mass with debris within. He was taken up for an emergency laparotomy. Intraoperatively, the cyst was found arising from the left lateral abdominal wall free from all structures with a twisted pedicle. Histopathology surprisingly revealed seminiferous tubules within the cyst wall with the vas deferens, thus confirming the diagnosis of a torsion of intra-abdominal testis. Hence, we emphasise the importance of examining for an undescended testis when dealing with a male neonate presenting with a cystic intra-abdominal mass.
Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis
Authors: Toohey Liam A , Drew Michael K , Cook Jill L , Finch Caroline F , Gaida Jamie E
Published: August 2017

Background

Previous injury is a strong risk factor for recurrent lower limb injury in athletic populations, yet the association between previous injury and a subsequent injury different in nature or location is rarely considered.

Objective

To systematically review data on the risk of sustaining a subsequent lower limb injury different in nature or location following a previous injury.

Methods

Eight medical databases were searched. Studies were eligible if they reported lower limb injury occurrence following any injury of a different anatomical site and/or of a different nature, assessed injury risk, contained athletic human participants and were written in English. Two reviewers independently applied the eligibility criteria and performed the risk of bias assessment. Meta-analysis was conducted using a random effects model.

Results

Twelve studies satisfied the eligibility criteria. Previous history of an ACL injury was associated with an increased risk of subsequent hamstring injury (three studies, RR=2.25, 95% CI 1.34 to 3.76), but a history of chronic groin injury was not associated with subsequent hamstring injury (three studies, RR=1.14, 95% CI 0.29 to 4.51). Previous lower limb muscular injury was associated with an increased risk of sustaining a lower limb muscular injury at a different site. A history of concussion and a variety of joint injuries were associated with an increased subsequent lower limb injury risk.

Conclusions

The fact that previous injury of any type may increase the risk for a range of lower limb subsequent injuries must be considered in the development of future tertiary prevention programmes.

Systematic review registration number

CRD42016039904 (PROSPERO).
Assessing the global reach and value of a provider-facing healthcare app using large-scale analytics
Authors: O'Reilly-Shah Vikas , Easton George , Gillespie Scott
Published: August 2017

Background

The rapid global adoption of mobile health (mHealth) smartphone apps by healthcare providers presents challenges and opportunities in medicine. Challenges include ensuring the delivery of high-quality, up-to-date and optimised information. Opportunities include the ability to study global practice patterns, access to medical and surgical care and continuing medical education needs.

Methods

We studied users of a free anaesthesia calculator app used worldwide. We combined traditional app analytics with in-app surveys to collect user demographics and feedback.

Results

31 173 subjects participated. Users were from 206 countries and represented a spectrum of healthcare provider roles. Low-income country users had greater rates of app use (p<0.001) and ascribed greater importance of the app to their practice (p<0.001). Physicians from low-income countries were more likely to adopt the app (p<0.001). The app was used primarily for paediatric patients. The app was used around the clock, peaking during times typical for first start cases.

Conclusions

This mHealth app is a valuable decision support tool for global healthcare providers, particularly those in more resource-limited settings and with less training. App adoption and use may provide a mechanism for measuring longitudinal changes in access to surgical care and engaging providers in resource-limited settings. In-app surveys and app analytics provide a window into healthcare provider behaviour at a breadth and level of detail previously impossible to achieve. Given the potentially immense value of crowdsourced information, healthcare providers should be encouraged to participate in these types of studies.
Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia
Authors: Bucciardini Raffaella , Fragola Vincenzo , Abegaz Teshome , Lucattini Stefano , Halifom Atakilt , Tadesse Eskedar , Berhe Micheal , Pugliese Katherina , Fucili Luca , Gregorio Massimiliano Di , Mirra Marco , Castro Paola De , Terlizzi Roberta , Tatarelli Paola , Binelli Andrea , Zegeye Teame , Campagnoli Michela , Vella Stefano , Abraham Loko , Godefay Hagos
Published: August 2017

Introduction

Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.

Methods

We used data from the ‘Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan–Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.

Results

A total of 1198 patients were included in the study. Kaplan–Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.

Conclusions

The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.
Does the index-to-ring finger length ratio (2D:4D) differ in amyotrophic lateral sclerosis (ALS)? Results from an international online case–control study
Authors: Parkin Kullmann Jane Alana , Pamphlett Roger
Published: August 2017

Objectives

The ratio of the length of the index finger (2D) to the ring finger (4D) (2D:4D) has been reported to be lower (ie, 2D<4D) in people with amyotrophic lateral sclerosis (ALS) than non-ALS controls. This has led to suggestions that exposure to increased prenatal testosterone, which also lowers this ratio, could be a risk factor for ALS. In an attempt to test this hypothesis, we examined 2D:4Ds from large numbers of patients with ALS and controls.

Setting

An online multilingual questionnaire enabling respondents to measure their own index and ring finger lengths.

Participants

Of the initial 949 respondents, 572 remained for analysis after elimination for inability to straighten fingers, not answering the question, statistical outliers and aged <40 years. Respondents remaining for analysis were 202 patients with ALS (125 males, 77 females) and 370 non-ALS controls (112 males, 258 females).

Results

Unpaired t-tests with 95% CIs were used to assess differences in mean 2D:4Ds. Males had significantly lower mean 2D:4Ds than females, in both ALS and control groups, for both left and right hands. No significant differences were found in 2D:4Ds between ALS and control groups, in either males or females, for either left or right hands. Receiver operating characteristic curves showed no power for 2D:4Ds to predict ALS status in either males or females.

Conclusions

2D:4Ds did not differ between patients with ALS and controls in this study. This was despite the dataset being large enough to confirm the established finding of lower 2D:4Ds in males compared with females. These findings do not support the hypothesis that exposure to increased prenatal testosterone is a risk factor for ALS. A putative lower 2D:4D has been proposed to explain the link between ALS and exercise, but our results indicate that other exercise-related factors are more likely to explain this association.
Effectiveness of a standardised exercise programme for recurrent neck and low back pain: a multicentre, randomised, two-arm, parallel group trial across 34 fitness clubs in Finland
Authors: Suni Jaana H , Rinne Marjo , Tokola Kari , Mänttäri Ari , Vasankari Tommi
Published: August 2017

Background

Neck and low back pain (LBP) are common in office workers. Exercise trials to reduce neck and LBP conducted in sport sector are lacking. We investigated the effectiveness of the standardised Fustra20Neck&Back exercise program for reducing pain and increasing fitness in office workers with recurrent non-specific neck and/or LBP.

Method

Volunteers were recruited through newspaper and Facebook. The design is a multi-centre randomised, two-arm, parallel group trial across 34 fitness clubs in Finland. Eligibility was determined by structured telephone interview. Instructors were specially educated professionals. Neuromuscular exercise was individually guided twice weekly for 10 weeks. Webropol survey, and objective measurements of fitness, physical activity, and sedentary behavior were conducted at baseline, and at 3 and 12 months. Mean differences between study groups (Exercise vs Control) were analysed using a general linear mixed model according to the intention-to-treat principle.

Results

At least moderate intensity pain (≥40 mm) in both the neck and back was detected in 44% of participants at baseline. Exercise compliance was excellent: 92% participated 15−20 times out of 20 possible. Intensity and frequency of neck pain, and strain in neck/shoulders decreased significantly in the Exercise group compared with the Control group. No differences in LBP and strain were detected. Neck/shoulder and trunk flexibility improved, as did quality of life in terms of pain and physical functioning.

Conclusions

The Fustra20Neck&Back exercise program was effective for reducing neck/shoulder pain and strain, but not LBP. Evidence-based exercise programs of sports clubs have potential to prevent persistent, disabling musculoskeletal problems.
Understanding cardiac troponin part 1: avoiding troponinitis
Authors: Body Richard , Carlton Edward
Published: August 2017

Cardiac troponin (cTn) is a highly specific biomarker of myocardial injury and is central to the diagnosis of acute myocardial infarction (AMI). By itself, however, cTn cannot identify the cause of myocardial injury. ‘Troponinitis’ is the condition that leads clinicians to falsely assign a diagnosis of AMI based only on the fact that a patient has an elevated cTn concentration. There are many causes of myocardial injury other than AMI. Clinicians are required to differentiate myocardial injury caused by AMI from other causes.

In part 1 of this series on cTn, we provide a structured overview to help practising clinicians to interpret ‘positive’ cTn results appropriately. There are three core principles. First, when reviewing a cTn result, clinicians must carefully consider the clinical context. Only this can distinguish primary (termed type 1) AMI caused by coronary artery disease from secondary (termed type 2) AMI caused by another condition with an imbalance in the supply and demand of oxygen to the myocardium. Second, clinicians must consider the patient’s baseline condition in order to determine the presence or absence of factors that may predict a chronic cTn elevation. Third, clinicians should routinely use serial sampling to detect a change of cTn that is expected in patients with acute (rather than chronic) myocardial injury. Using these simple principles, clinicians can avoid underdiagnosis and overdiagnosis of AMI.
North-South disparities in English mortality1965–2015: longitudinal population study
Authors: Buchan Iain E , Kontopantelis Evangelos , Sperrin Matthew , Chandola Tarani , Doran Tim
Published: August 2017

Background

Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 2008–2009 Great Recession.

Methods

Population-wide longitudinal (1965–2015) study of mortality in England's five northernmost versus four southernmost Government Office Regions – halves of overall population. Main outcome measure: directly age-sex adjusted mortality rates; northern excess mortality (percentage excess northern vs southern deaths, age-sex adjusted).

Results

From 1965 to 2010, premature mortality (deaths per 10 000 aged <75 years) declined from 64 to 28 in southern versus 72 to 35 in northern England. From 2010 to 2015 the rate of decline in premature mortality plateaued in northern and southern England. For most age groups, northern excess mortality remained consistent from 1965 to 2015. For 25–34 and 35–44 age groups, however, northern excess mortality increased sharply between 1995 and 2015: from 2.2% (95% CI –3.2% to 7.6%) to 29.3% (95% CI 21.0% to 37.6%); and 3.3% (95% CI –1.0% to 7.6%) to 49.4% (95% CI 42.8% to 55.9%), respectively. This was due to northern mortality increasing (ages 25–34) or plateauing (ages 35–44) from the mid-1990s while southern mortality mainly declined.

Conclusions

England's northern excess mortality has been consistent among those aged <25 and 45+ for the past five decades but risen alarmingly among those aged 25–44 since the mid-90s, long before the Great Recession. This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality.
Outcome comparison in dogs with a presumptive diagnosis of thoracolumbar fibrocartilaginous embolic myelopathy and acute non‐compressive nucleus pulposus extrusion
Authors: Mari Lorenzo , Behr Sebastien , Shea Anita , Dominguez Elisabet , Johnson Philippa J , Ekiri Abel , De Risio Luisa
Published: August 2017

Dogs with fibrocartilaginous embolic myelopathy (FCEM) or acute non‐compressive nucleus pulposus extrusion (ANNPE) are reported to have a fair prognosis; however, persistent motor/autonomic deficits are possible. Specific MRI patterns have been suggested to differentiate these diseases although never been validated with histopathology in large studies. The aim of this retrospective study was to evaluate if these MRI patterns are associated with different clinical outcomes in dogs with peracute non‐progressive T3‐L3 myelopathy. Two hundred and one dogs were included. Outcome data were obtained via medical records and telephone questionnaires. MRIs were blindly reviewed by three board‐certified observers, obtaining substantial to almost perfect interobserver agreement on diagnoses (κ=0.635–0.828). Presumptive ANNPE and FCEM were diagnosed in 157 and 44 dogs, respectively. Ambulatory function was regained in 99 per cent of cases, with persistent motor deficits in 83.6 per cent and 92.5 per cent of dogs with presumptive ANNPE and FCEM, respectively. The presumptive diagnosis was not associated with motor function recovery, recovery times or urinary continence. Faecal incontinence was five times more likely in dogs with presumptive ANNPE (23 per cent) compared with presumptive FCEM (7.5 per cent).

Distinguishing between MRI patterns of presumptive ANNPE or FCEM in dogs with peracute non‐progressive T3‐L3 myelopathy may help predict the risk of developing faecal incontinence.
Systematics and biogeography of some early Cambrian (Series 2) bradoriids (Arthropoda) from Laurentia (Greenland)
Authors: Peel John S.
Published: August 2017

Bradoriid arthropods are described from the Kap Troedsson and Henson Gletscher formations of North Greenland and the Bastion Formation of North-East Greenland (Cambrian Series 2, Stage 4). Hipponicharion skovstedi n. sp. and Beyrichona avannga n. sp. represent species of genera originally described from Avalonia (New Brunswick) that are characteristic of middle-latitude assemblages in the early Cambrian. They are described for the first time from low-latitude environments in the early Cambrian of Laurentia where they occur together in a middle to upper carbonate ramp succession. Navarana n. gen. is proposed for a rare hipponicharionid currently known only from North Greenland.
The Zeeman-split superconductivity with Rashba and Dresselhaus spin–orbit coupling
Authors: Zhao Jingxiang , Yan Xu , Gu Qiang
Published: August 2017

The superconductivity with Rashba and Dressehlaus spin–orbit coupling and Zeeman effect is investigated. The energy gaps of quasi-particles are carefully calculated. It is shown that the coexistence of two spin–orbit coupling might suppress superconductivity. Moreover, the Zeeman effect favors spin-triplet Cooper pairs.
Research on traffic flow characteristics at signal intersection
Authors: Zeng Jun-Wei , Yu Sen-Bin , Qian Yong-Sheng , Wei Xu-Ting , Feng Xiao , Wang Hui
Published: August 2017

Based on the cautious driving behavior and the principle of the vehicles at left-side having priority to pass in the intersection, a two-dimensional cellular automata model for planar signalized intersection (NS-STCA) is established. The different turning vehicles are regarded as the research objects and the effect of the left-turn probability, signal cycle, vehicle flow density on traffic flow at the intersection is investigated.
Formulae for maximum yield and mean escape depth of secondary electrons emitted from metals
Authors: Xie Ai-Gen , Xia Yu-Qing , Wang Xing , Liu Hao-Yu , Cheng Shi
Published: August 2017

Based on the characteristics of secondary electron emission, the former formulae for the maximum yield of metals [Formula: see text] and primary range in the energy range of [Formula: see text] eV, relation [Formula: see text] among secondary electron escape probability [Formula: see text], average energy required to produce an internal secondary electron [Formula: see text], [Formula: see text], primary energy of [Formula: see text] ([Formula: see text] and parameter [Formula: see text] was deduced. On the basis of [Formula: see text] and the former formula for [Formula: see text], relation [Formula: see text] among mean escape depth of secondary electrons emitted from metals [Formula: see text], atomic number [Formula: see text], back-scattering coefficient [Formula: see text], material density [Formula: see text], [Formula: see text], atomic weight [Formula: see text] and [Formula: see text] was deduced. According to the deduced [Formula: see text], the formula for the ratio of [Formula: see text] to [Formula: see text] and experimental ratio of [Formula: see text] to [Formula: see text], relation [Formula: see text] among [Formula: see text], original work function [Formula: see text] and [Formula: see text] were empirically obtained. According to the characteristics of metal surface, [Formula: see text], [Formula: see text] and [Formula: see text], the formula for [Formula: see text] as a function of [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] and that for [Formula: see text] as a function of [Formula: see text], [Formula: see text] and [Formula: see text] were deduced, respectively. The influences of surface change on [Formula: see text] and [Formula: see text] were analyzed. Calculated [Formula: see text] and [Formula: see text] were compared with the corresponding experimental ones. It was concluded that the deduced formulae for [Formula: see text] and [Formula: see text] can be used to estimate [Formula: see text] and [Formula: see text], respectively.
Analyzing Lie symmetry and constructing conservation laws for time-fractional Benny–Lin equation
Authors: Rashidi Saeede , Hejazi S. Reza
Published: August 2017

This paper investigates the invariance properties of the time fractional Benny–Lin equation with Riemann–Liouville and Caputo derivatives. This equation can be reduced to the Kawahara equation, fifth-order Kdv equation, the Kuramoto–Sivashinsky equation and Navier–Stokes equation. By using the Lie group analysis method of fractional differential equations (FDEs), we derive Lie symmetries for the Benny–Lin equation. Conservation laws for this equation are obtained with the aid of the concept of nonlinear self-adjointness and the fractional generalization of the Noether’s operators. Furthermore, by means of the invariant subspace method, exact solutions of the equation are also constructed.
𝔞𝔣𝔣(1|1)-Relative cohomology on ℝ1|1
Authors: Khalfoun Hafedh
Published: August 2017

Over the [Formula: see text]-dimensional real superspace [Formula: see text], we classify [Formula: see text]-invariant bilinear differential operators acting on the superspaces of weighted densities. We compute the second [Formula: see text]-relative cohomology space of [Formula: see text] with coefficients in the module of [Formula: see text]-densities [Formula: see text] on [Formula: see text], where [Formula: see text] is the Lie superalgebra of contact vector fields on [Formula: see text] and [Formula: see text] is the affine Lie superalgebra. This result allows us to compute the second [Formula: see text]-relative cohomology space of [Formula: see text] with coefficients in the Poisson superalgebra [Formula: see text]. We explicitly give 2-cocycles spanning these cohomology spaces.
Analysis of a fuzzy epidemic model with saturated treatment and disease transmission
Authors: Nandi Swapan Kumar , Jana Soovoojeet , Manadal Manotosh , Kar T. K.
Published: August 2017

In this paper, we describe an SIS epidemic model where both the disease transmission rate and treatment function are considered in saturated forms. The dynamical behavior of the system is analyzed. The system is customized by considering the disease transmission rate and treatment control as fuzzy numbers and then fuzzy expected value of the infected individuals is determined. The fuzzy basic reproduction number is investigated and a threshold condition of pathogen is derived at which the system undergoes a backward bifurcation.
Dynamic Loading Assembly for Testing Actuators of Segmented Mirror Telescope
Authors: Deshmukh Prasanna Gajanan , Parihar Padmakar , Balasubramaniam Karthik A. , Mishra Deepta Sundar , Mahesh P. K.
Published: August 2017

Upcoming large telescopes are based on Segmented Mirror Telescope (SMT) technology which uses small hexagonal mirror segments placed side by side to form the large monolithic surface. The segments alignment needs to be maintained against external disturbances like wind, gravity, temperature and structural vibration. This is achieved by using three position actuators per segment working at few-nanometer scale range along with a local closed loop controller. The actuator along with a controller is required to meet very stringent performance requirements, such as track rates up to 300[Formula: see text]nm/s (90[Formula: see text]mN/s) with tracking errors less than 5[Formula: see text]nm, dynamical forces of up to [Formula: see text][Formula: see text]N, ability to reject disturbances introduced by the wind as well as by mechanical vibration generated in the mirror cell, etc. To conduct these performance tests in more realistic manner, we have designed and developed a Dynamic Loading Assembly (DLA) at Indian Institute of Astrophysics (IIA), Bangalore. DLA is a computer controlled force-inducing device, designed in a modular fashion to generate different types of user-defined disturbances in extremely precise and controlled manner. Before realizing the device, using a simple spring-mass-damper-based mathematical model, we ensured that the concept would indeed work. Subsequently, simple concept was converted into a detailed mechanical design and parts were manufactured and assembled. DLA has static and dynamic loading capabilities up to 250[Formula: see text]N and 18[Formula: see text]N respectively, with a bandwidth sufficient to generate wind disturbances. In this paper, we present various performance requirements of SMT actuators as well as our effort to develop a dynamic loading device which can be used to test these actuators. Well before using DLA for meaningful testing of the actuator, the DLA itself have gone through various tests and improvements phases. We have successfully demonstrated that DLA can be used to check the extreme performance of two different SMT actuators, which are expected to track the position/force with a few nanometer accuracy.
Nudges for Privacy and Security
Authors: Acquisti Alessandro , Adjerid Idris , Balebako Rebecca , Brandimarte Laura , Cranor Lorrie Faith , Komanduri Saranga , Leon Pedro Giovanni , Sadeh Norman , Schaub Florian , Sleeper Manya , Wang Yang , Wilson Shomir
Published: August 2017

Advancements in information technology often task users with complex and consequential privacy and security decisions. A growing body of research has investigated individuals’ choices in the presence of privacy and information security tradeoffs, the decision-making hurdles affecting those choices, and ways to mitigate such hurdles. This article provides a multi-disciplinary assessment of the literature pertaining to privacy and security decision making. It focuses on research on assisting individuals’ privacy and security choices with soft paternalistic interventions that nudge users toward more beneficial choices. The article discusses potential benefits of those interventions, highlights their shortcomings, and identifies key ethical, design, and research challenges.
Responding to public health crises
Authors: Angeli Elizabeth L. , Norwood Christina D.
Published: August 2017

This paper examines how the cognitive framework of collective mindfulness complements tenets of user experience in public health crisis communication. Collective mindfulness attunes an organization into preemptively identifying and avoiding potential failures that can have adverse safety and public relations outcomes. To illustrate the connection between this cognitive framework and user experience, this article shares findings from a case study with the 2014 Johns Hopkins Medicine Ebola Crisis Communications Team, whose primary goals were to improve the usability of Ebola personal protective equipment protocols and to prepare healthcare providers for a U.S. Ebola crisis. Based on a grounded theory investigation, this article suggests that the collective mindfulness principles of deference to expertise, resilience, and refusal to simplify complex procedures informed the team's ability to avoid a catastrophic communication failure. Additionally, these principles allowed the team to attune to key user experience principles, including addressing user context and user limitations.
HOW DO YOU KNOW IF 85% ACCURACY is good enough for your application?
Authors: Kay Matthew , Patel Shwetak N. , Kientz Julie A.
Published: August 2017

Many people who want to build mobile applications based on sensing systems have to decide what type of sensing approaches to use, often trading off factors like accuracy, time, and battery life. If you're building an app that uses location, motion data, or inferred data about usage, there will necessarily be inaccuracy in the output of those systems -- some error that cannot be completely eliminated from the system. In the ubiquitous computing community, there is an unofficial standard that 85% accuracy is "good enough" for sensing based on machine learning. But it's not so simple to say that 85% should be your target accuracy to consider a system useful. Maybe 85% accuracy is good enough for an app that helps you identify wasteful appliances so you can conserve water in your home, but is completely unacceptable when three times out of 20 your fall detection app accidentally calls emergency services thinking your loved one has fallen down even though she hasn't.