bluuebunny/crossref_metadata_2025 huggingface dataset:
Indole Synthesis Using Silver Catalysis
Authors: Clarke Aimee K. , Ho Hon E. , Rossi‐Ashton James A. , Taylor Richard J. K. , Unsworth William P.
Published: March 2019

Indoles are amongst the most important classes of heteroaromatics in organic chemistry, commonly found in biologically active natural products and therapeutically useful compounds. The synthesis of indoles is therefore important and several methods for their synthesis that make use of silver(I) catalysts and reagents have been developed in recent years. This Minireview contains, to the best of our knowledge, a comprehensive coverage of silver‐mediated indole forming reactions since the first reaction of this type was reported in 2004.
Besonderheiten bei der Ausführung semi‐integraler Großbrücken am Beispiel der Wehretalbrücke
Authors: Dietz Jörg
Published: March 2019

Die aktuelle Tendenz im Brückenneubau weist eine zunehmende Anzahl semi‐integraler Großbrücken auf. Die Vorteile geringerer Wartung und höherer Robustheit erfordern zusätzliche Überlegungen in der technischen Bearbeitung. Die Wehretalbrücke ist aufgrund ihrer Schlankheit und komplexen Geometrie gut geeignet, um die Besonderheiten integraler Brücken bei der Planung und Ausführung exemplarisch aufzuzeigen. Das Bauwerk wurde semi‐integral als Rahmen mit vier Stielen ausgeführt. Die Abhängigkeiten zwischen Bau‐ und Endzustand machen frühe Abstimmungen zwischen Planer, Baugrundsachverständigem, Baufirma und Bauherr notwendig, damit ein reibungsloser Bauablauf gewährleistet werden kann.
Understanding plant nitrogen nutrition through a laboratory experiment
Authors: Ortigosa Francisco , Valderrama‐Martín José M. , Ávila Concepción , Cánovas Francisco M. , Cañas Rafael A.
Published: March 2019

Plant nitrogen nutrition is an essential topic in biology that should be included in scientific education. Nitrogen availability is one of the primary limiting factors for plant growth, and these organisms are the primary support for the pluricellular terrestrial life, since they are the fundamental group of autotrophs. For this reason, the use of nitrogen fertilizers is in the basis of the Green Revolution that led to an extraordinary increase in the food production during the twentieth century. To illustrate the importance of plant nitrogen nutrition, a new laboratory experience for students is presented in this manuscript. The aim of the following laboratory teaching activity is training of students through the evaluation of metabolic, biochemical, and molecular markers that are related to the nitrogen nutritional status of plants. For this purpose, cherry tomato plants (Solanum lycopersicum var. cerasiforme) were used, since they exhibit rapid growth and good differential biomass accumulation in response to changes in the nitrogen supply. The proposed laboratory experiment enables the development of the entire protocol for postgraduate students or in a reduced version for students from lower educational levels. © 2019 International Union of Biochemistry and Molecular Biology, 47(4):450–458, 2019.
Quality of life and depression 3 months after intracerebral hemorrhage
Authors: Sallinen Hanne , Sairanen Tiina , Strbian Daniel
Published: March 2019

Objectives

Quality of life (QoL) after intracerebral hemorrhage (ICH) is poorly known. This study investigated factors affecting QoL and depression after spontaneous ICH.

Materials and Methods

This prospective study included patients admitted to Helsinki University Hospital between May 2014 and December 2016. Health‐related QoL (HRQoL) at 3 months after ICH was measured using the European Quality of Life Scale (EQ‐5D‐5L), and the 15D scale. Logistic regression analyses were used to test factors affecting HRQoL. EQ‐5D‐5L anxiety/depression dimension was used to analyze factors associated with anxiety/depression.

Results

Of 277 patients, 220 were alive, and sent QoL questionnaire. The questionnaire was returned by 124 patients. Nonreturners had more severe strokes with admission National Institutes of Health Stroke Scale (NIHSS) 7.8 (IQR 3.0–14.8) versus 5.0 (IQR 2.3–11.0); p = 0.018, and worse outcome assessed as modified Rankin Scale 3–5 at 3 months 59.4% versus 44.4% (p = 0.030). Predictors for lower HRQoL by both scales were higher NIHSS with OR 1.28 (95% CI 1.13–1.46) for EQ‐5D‐5L, and OR 1.28 (1.15–1.44) for 15D, older age (OR 1.10 [1.03–1.16], and OR 1.09 [1.03–1.15]), and chronic heart failure (OR 18.12 [1.73–189.27], and OR 12.84 [1.31–126.32]), respectively. Feeling sad/depressed for more than 2 weeks during the year prior to ICH was predictor for lower EQ‐5D‐5L (OR 10.64 [2.39–47.28]), and history of ICH for lower 15D utility indexes (OR 11.85 [1.01–138.90]). Prior feelings of sadness/depression were associated with depression/anxiety at 3 months after ICH with OR 3.62 (1.14–11.45).

Conclusions

In this cohort of ICH patients with milder deficits, HRQoL was affected by stroke severity, comorbidities and age. Feelings of depression before ICH had stronger influence on reporting depression/anxiety after ICH than stroke severity‐related and outcome parameters. Thus, simple questions on patient's premorbid feelings of sadness/depression could be used to identify patients at risk of depression after ICH for focusing follow‐up and treatment.
Neurobiological correlates of violence perception in martial artists
Authors: Schöne Maria , Seidenbecher Stephanie , Tozzi Leonardo , Kaufmann Jörn , Griep Hendrik , Fenker Daniela , Frodl Thomas , Bogerts Bernhard , Schiltz Kolja
Published: March 2019

Objectives

The direct exertion as well as the visual perception of violence can have a hedonistic effect and elicit positive arousal in predisposed individuals. This appetitive aspect of aggression in healthy subjects has been neglected in psychiatric research so far.

Methods

Using functional magnetic resonance imaging, we tested whether subjects trained in sports with a violent component (martial arts) show altered brain responses in reward‐associated brain areas when compared to controls. Sixteen martial artists (e.g., boxing, mixed martial arts) and 24 controls watched violent versus neutral pictures while performing a cognitive cover task. Subjects’ aggressiveness was assessed by the aggressiveness factors questionnaire (FAF).

Results

While watching violent pictures, martial artists had a stronger activation in the left amygdala than controls. Within the martial artist group however, there was an inverse correlation between activation in the left amygdala and degree of aggressiveness.

Conclusions

Higher amygdala activation while watching violent pictures might reflect that perception of violence conveys increased salience to martial artists as compared to controls. The inverse correlation between amygdala activation and aggressiveness within the martial artist group might be explained by the assumption that the more aggressive martial artists may be more accustomed to violent situations leading to a down‐modulation of amygdala activation. Appetitive aggression should be taken into account as a factor contributing to violence.
Treatment of Amalgam Tattoo With a New Technique: Mucoabrasion and Free Connective Tissue Graft
Authors: Aguirre‐Zorzano Luis Antonio , García‐De‐La‐Fuente Ana M. , Estefanía‐Fresco Ruth
Published: March 2019

Introduction

A new technique was performed for the removal of an amalgam tattoo (AT), consisting in mucoabrasion combined with a free connective tissue graft (FCTG).

Case Presentation

A 59‐year‐old female presented with a large AT involving the alveolar mucosa and gingiva between teeth #7 and #8, where endodontic treatment and apicoectomy was performed 21 years ago. To avoid compromising esthetics, the lesion was managed with a new technique including mucoabrasion and an FCTG. At the 53‐month follow‐up, the patient exhibited a naturally appearing soft tissue with no evidence of the AT.

Conclusion

When performing a one‐stage treatment of removing ATs in areas of high esthetic demand, it is possible to achieve good results and ideal gingival color.
A hypercoagulable state leading to venous limb gangrene associated with occult lung adenocarcinoma
Authors: Waite Matthew M. A. , Martinelli Anthony W. , Preston Stephen D. , Gudgin Emma , Symington Emily , Rintoul Robert C. , Peryt Adam , Coughlin Patrick , Hayes Paul , Gilligan David , Besser Martin
Published: March 2019

Key Clinical Message

We report a case of lung adenocarcinoma‐associated hypercoagulability leading to venous limb gangrene, managed successfully with argatroban and then dabigatran. Use of idarucizumab permitted diagnostic investigations, leading to targeted antineoplastic therapy with crizotinib, surgical resection with curative intent, and continued survival over 2 years after the index event.
Efficient “Click”‐Dendrimer‐Supported Synergistic Bimetallic Nanocatalysis for Hydrogen Evolution by Sodium Borohydride Hydrolysis
Authors: Kang Naixin , Djeda Rodrigue , Wang Qi , Fu Fangyu , Ruiz Jaime , Pozzo Jean‐Luc , Astruc Didier
Published: March 2019

Hydrogen is efficiently generated upon “click” dendrimer‐supported catalysis of NaBH4 hydrolysis by a series mono‐ and bimetallic nanoparticles (NPs) of the late transition metals. Among the monometallic NPs, PtNPs show the best performances, Co being the best first‐raw transition metal. A remarkable synergy between Pt and Co in Pt/CoNP@dendrimer is also disclosed, compared with various other bimetallic NP catalysts, achieving a TOF of 303 molH2 ⋅ molcatal.−1 ⋅ min−1 when the ratio of Pt to Co is 1 : 1. In the presence of NaOH, the catalytic activity is boosted for all monometallic NPs except PtNPs, but NaOH exerted a negative influence on the bimetallic NP catalysts. The kinetic studies with the catalyst Pt1Co1NP@dendrimer involve in particular a primary kinetic isotope effect kD/kH=3.41 obtained for the hydrolysis reaction with D2O, suggesting that O−H bond cleavage of water is involved in the rate‐determining step, and an overall reaction mechanism is proposed.
CHISA – Worldwide Meeting for Chemical Engineers in the Heart of Europe
Authors: Obalová Lucie
Published: March 2019

No abstract.
Precast bridge construction with UHPFRC—Shear tests and railway bridge pilot application
Authors: Schramm Nicholas , Fischer Oliver
Published: March 2019

Due to the favorable material properties, Ultra‐High Performance Fiber‐Reinforced Concrete (UHPFRC) opens up new potential for precast options in PC bridge construction. On that matter, this article outlines the application, the load‐bearing behavior and advantages of two different possibilities: slender prestressed bridge girders and a prestressed trough‐shaped bridge element. Prestressed bridge girders made of UHPFRC allow for the realization of very slender cross‐sections with thin webs. For these beams, the shear capacity is the governing design issue. Hence, further investigations on the shear behavior with a variation of the fiber content, the prestressing level as well as the amount of shear reinforcement were undertaken. In this context, also size effects were examined using specimens with different construction heights up to 1.0 m. To enable testing of a high number of specimens with realistic cross‐sectional dimensions and at reasonable effort, an innovative experimental setup was developed and used for the investigations. Apart from these laboratory tests the present article deals with the pilot application of a railway bridge made of UHPFRC in Germany. The design and construction process as well as measurement results of the load and deformation behavior of the prestressed precast bridge element are presented and discussed.
Development and serviceability of a highway bridge deck using ultra‐high performance fiber‐reinforced concrete
Authors: Kosaka Takashi , Nishiumi Yoshifumi , Ichinomiya Toshimichi , Saito Kimio
Published: March 2019

Lightweight orthotropic steel decks are widely used in urban expressways. However, fatigue cracks occur in the orthotropic steel deck. As a result, their maintenance cost has been increasing. Considering this problem, we have developed a deck slab using ultra‐high performance fiber reinforced concrete (UHPFRC), as an alternative to the steel deck slab. The own weight of the UHPFRC deck slab is almost the same as that of an orthotropic steel deck slab. A UHPFRC deck has very thin components as compared with conventional concrete deck, thus the safety of the UHPFRC deck slab was analyzed via finite element analysis, and the fatigue durability of the UHPFRC deck slab was also confirmed via a wheel running fatigue test. The authors confirmed that the durability of the UHPFRC deck slab was sufficiently high and verified the serviceability of the deck using vibration and load tests. The characteristic frequency and impact coefficient of the deck were calculated, and the result indicated low possibility of resonance between the deck and cars.
Recent Progress in the Synthesis of the Monocarba‐closo‐dodecaborate(−) Anions
Authors: Kanazawa Junichiro , Kitazawa Yu , Uchiyama Masanobu
Published: March 2019

This Concept article focuses on the rapid growth in studies of the chemistry of the monocarba‐closo‐dodecaborate(−) anion (C1 carborane anion). As one of the most stable anions known, the C1 carborane anion has been useful for exploring the chemistry of highly reactive cations. On the other hand, development of novel functional molecules utilizing the unique properties of C1 carborane anion (e.g., σ‐aromaticity, rigid spherical skeleton) has progressed more slowly. The main reason for this is the relatively undeveloped state of synthetic chemistry in this area. Recent advances in the synthetic chemistry of C1 carborane anion are highlighted in this Concept article, focusing on cross‐coupling reactions at the carbon vertex, direct conversion of B−H bonds, and the synthesis of multivalent weakly coordinating anions. These progressions move this species beyond its well‐established role of highly stable “counter” monocharged anion.
Nitrogen/Oxygen Co‐Doped Hierarchically Porous Carbon for High‐Performance Potassium Storage
Authors: Sun Yongwen , Xiao Hao , Li Haibo , He Yezeng , Zhang Ya , Hu Yi , Ju Zhicheng , Zhuang Quanchao , Cui Yanhua
Published: March 2019

Although the insertion of potassium ions into graphite has been proven to be realistic, the electrochemical performance of potassium‐ion batteries (PIBs) is not yet satisfactory. Therefore, more effort is required to improve the specific capabilities and achieve a long cycling life. The mild carbonization process in molten salt (NaCl‐KCl) is used to synthesize nitrogen/oxygen co‐doped hierarchically porous carbon (NOPC) for PIBs by using cyanobacteria as the carbon source. This exhibits highly reversible capacities and ultra‐long cycling stability, retaining a capacity of 266 mA h g−1 at 50 mA g−1 (100 cycles) and presents a capacity of 104.3 mA h g−1 at 1000 mA g−1 (1000 cycles). Kinetics analysis reveals that the potassium ion (K+) storage of NOPC is controlled by a capacitive process, which plays a crucial role in the excellent rate performance and superior reversible ability. The high proportion of capacitive behavior can be ascribed to the hierarchically porous structure and improved conductivity resulting from nitrogen and oxygen doping. Furthermore, density functional theory (DFT) calculations theoretically validate the enhanced potassium storage effect of the as‐obtained NOPC. More importantly, the route to NOPC from cyanobacteria in molten salt provides a green approach to the synthesis of porous carbon materials.
Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?
Authors: Morin Lucas , Todd Adam , Barclay Stephen , Wastesson Jonas W. , Fastbom Johan , Johnell Kristina
Published: March 2019

Background

The continuation of preventive drugs among older patients with advanced cancer has come under scrutiny because these drugs are unlikely to achieve their clinical benefit during the patients’ remaining lifespan.

Methods

A nationwide cohort study of older adults (those aged ≥65 years) with solid tumors who died between 2007 and 2013 was performed in Sweden, using routinely collected data with record linkage. The authors calculated the monthly use and cost of preventive drugs throughout the last year before the patients’ death.

Results

Among 151,201 older persons who died with cancer (mean age, 81.3 years [standard deviation, 8.1 years]), the average number of drugs increased from 6.9 to 10.1 over the course of the last year before death. Preventive drugs frequently were continued until the final month of life, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics. Median drug costs amounted to $1482 (interquartile range [IQR], $700‐$2896]) per person, including $213 (IQR, $77‐$490) for preventive therapies. Compared with older adults who died with lung cancer (median drug cost, $205; IQR, $61‐$523), costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference, $13; 95% confidence interval, $5‐$22) or gynecological cancers (adjusted median difference, $27; 95% confidence interval, $18‐$36). There was no decrease noted with regard to the cost of preventive drugs throughout the last year of life.

Conclusions

Preventive drugs commonly are prescribed during the last year of life among older adults with cancer, and often are continued until the final weeks before death. Adequate deprescribing strategies are warranted to reduce the burden of drugs with limited clinical benefit near the end of life.
Growth of β‐ΒaΒ2O4 Crystals from Solution in LiF–NaF Melt and Study of Phase Equilibria
Authors: Simonova Ekaterina , Kokh Alexander , Shevchenko Vyacheslav , Kuznetsov Artem , Kragzhda Alexander , Fedorov Pavel
Published: March 2019

Phase equilibria in the ΒaΒ2O4–LiF–NaF section of the quaternary reciprocal system Li, Na, Ba // BO2, F are studied by the solid‐phase synthesis, differential thermal analysis, and visual polythermal analysis techniques. It is shown that this system can be used for the growth of bulk β‐ΒaΒ2O4 crystals.
Iridium‐Catalyzed Hydrogenation and Dehydrogenation of N‐Heterocycles in Water under Mild Conditions
Authors: Wang Shengdong , Huang Haiyun , Bruneau Christian , Fischmeister Cédric
Published: March 2019

An efficient catalytic method is presented for the hydrogenation of N‐heterocycles. The iridium‐based catalyst operates under mild conditions in water without any co‐catalyst or stoichiometric additives. The catalyst also promotes the reverse reaction of dehydrogenation of N‐heterocycles, hence displaying appropriate characteristics for a future hydrogen economy based on liquid organic hydrogen carriers (LOHCs)
Catalytic Reactivation of Industrial Oxygen Depolarized Cathodes by in situ Generation of Atomic Hydrogen
Authors: Öhl Denis , Franzen David , Paulisch Melanie , Dieckhöfer Stefan , Barwe Stefan , Andronescu Corina , Manke Ingo , Turek Thomas , Schuhmann Wolfgang
Published: March 2019

Electrocatalytically active materials on the industrial as well as on the laboratory scale may suffer from chemical instability during operation, air exposure, or storage in the electrolyte. A strategy to recover the loss of electrocatalytic activity is presented. Oxygen‐depolarized cathodes (ODC), analogous to those that are utilized in industrial brine electrolysis, are analyzed: the catalytic activity of the electrodes upon storage (4 weeks) under industrial process conditions (30 wt % NaOH, without operation) diminishes. This phenomenon occurs as a consequence of surface oxidation and pore blockage, as revealed by scanning electron microscopy, focused ion beam milling, X‐ray photoelectron spectroscopy, and Raman spectroscopy. Potentiodynamic cycling of the oxidized electrodes to highly reductive potentials and the formation of “nascent” hydrogen re‐reduces the electrode material, ultimately recovering the former catalytic activity.
Aspergillus fumigatus corneal infection is regulated by chitin synthases and by neutrophil–derived acidic mammalian chitinase
Authors: de Jesus Carrion Steven , Abbondante Serena , Clark Heather L. , Marshall Michaela E. , Mouyna Isabelle , Beauvais Anne , Sun Yan , Taylor Patricia R. , Leal Sixto M. , Armstrong Brittany , Carrera William , Latge Jean‐Paul , Pearlman Eric
Published: March 2019

Aspergillus fumigatus is an important cause of pulmonary and systemic infections in immune compromised individuals, and of corneal ulcers and blindness in immune competent patients. To examine the role of chitin synthases in Aspergillus corneal infection, we analyzed Aspergillus mutants of chitin synthase family 1 and family 2, and found that compared with the parent strain, the quadruple mutants from both families were more readily killed by neutrophils in vitro, and that both also exhibited impaired hyphal growth in the cornea. Further, inhibition of chitin synthases using Nikkomycin Z enhanced neutrophil killing in vitro and in vivo in a murine model of A. fumigatus corneal infection. Acidic mammalian chitinase (AMCase) is mostly produced by macrophages in asthmatic lungs; however, we now demonstrate that neutrophils are a major source of AMCase, which inhibits hyphal growth. In A. fumigatus corneal infection, neutrophils are the major source of AMCase, and addition of AMCase inhibitors or adoptive transfer of neutrophils from AMCase−/− mice resulted in impaired hyphal killing. Together, these findings identify chitin synthases as important fungal virulence factors and neutrophil‐derived AMCase as an essential mediator of host defense.
An improved hybrid continuum‐atomistic four‐way coupled model for electrokinetics in nanofluidics
Authors: Jahromi Saeed , Amani Ehsan , Movahed Saeid
Published: March 2019

In this study, an efficient hybrid continuum‐atomistic method is proposed to study electrokinetic transport of aqueous solutions in nanofluidics. The aqueous phase is considered as a continuous phase containing immersed ion particles. The behavior of the system is then simulated through utilization of an improved hybrid continuum‐atomistic four‐way coupled approach, including the MultiPhase Particle‐In‐Cell method for the short‐ranged interaction between the ion particles, the Brownian force for the collision between the aqueous phase molecules and the ion particles, and a wall force accounting for the short‐ranged interaction of ions and walls. The validation of the proposed model with the results of Molecular Dynamics simulations suggests that this model can be a promising approach for studying the electrokinetic phenomena in more complicated geometries where the Molecular Dynamics approach is computationally prohibitive. Finally, the effects of electrokinetic parameters, such as the height of the channel, the external electric field, and bulk ionic concentration, on the electroosmotic flow in a nanochannel are investigated and discussed.
Lifecycle energy and greenhouse gas emissions analysis of biomass‐based 2‐ethylhexanol as an alternative transportation fuel
Authors: Poulikidou Sofia , Heyne Stefan , Grahn Maria , Harvey Simon
Published: March 2019

This study investigates the environmental performance of 2‐ethylhexanol (2‐EH), as a potential drop‐in transport fuel alternative. Three different biomass‐based production pathways are evaluated and compared using life cycle assessment (LCA) methodology. The environmental impact of 2‐EH is assessed in terms of cumulative energy demand (CED) and global warming potential (GWP). Among the three alternative pathways, 2‐EH produced via syngas results in the lowest primary energy demand and GHG emissions under the baseline assumptions of this work. The two biochemical production pathways (via ethanol and butanol) exhibit higher CED and GWP during biomass conversion steps mainly due to process materials and chemicals used. Process specifications such as transport distance to production facility or the fate of the obtained by‐products are shown to influence the overall environmental impact of the fuel for all studied pathways. The use phase performance of 2‐EH was also considered in this work, as part of a 100% renewable blend and was compared to existing fossil and renewable fuels. The studied blend has the potential to reduce GHG emissions by more than 85% compared to fossil diesel while when certain production pathways are followed, it exhibits lower GWP than renewable fuels already in the market such as ethanol blends and biodiesel. 2‐EH can therefore provide a competitive alternative to fossil transport fuels increasing the share of renewable content in the current vehicle fleet, thus enhancing the efforts for a sustainable transport sector.
Modeling the Fate of Metal Concentrates in Surface Water
Authors: Carbonaro Richard F. , Farley Kevin J. , Delbeke Katrien , Baken Stijn , Arbildua Jose J. , Rodriguez Patricio H. , Rader Kevin J.
Published: March 2019

Metals present in concentrates are in a solid form and are not bioavailable, but they can dissolve or potentially transform to more soluble forms. Transformation/dissolution laboratory protocols have been developed to assess the importance of dissolution of sparingly soluble metal substances in the context of hazard classification; however, these tests represent worst-case scenarios for metal bioavailability because attenuation mechanisms such as complexation, sorption, and transport to the sediment are not considered. A unit world model (UWM) for metals in lakes, tableau input coupled kinetics equilibrium transport (TICKET)-UWM, has been developed that considers key processes affecting metal transport, fate, and toxicity including complexation by aqueous inorganic and ligands, partitioning to dissolved organic carbon (DOC) and particulate organic carbon (POC), precipitation, and transport of dissolved metals and solids between the water column and sediment. The TICKET-UWM model was used to assess the fate of a metal concentrate and dissolved metal ions released from the concentrate following an instantaneous input to a generalized lake. Concentrate dissolution rates in the water column were parameterized using results from batch transformation/dissolution tests for 2 specific concentrates containing lead (Pb), copper (Cu), and cobalt (Co). The TICKET-UWM results for a generalized lake environment showed that water column concentrations of metals in the lake environment after 28 d were several orders of magnitude lower than the 28-d concentration from the transformation/dissolution tests because Pb, Cu, and Co partitioned to POC in the water column and were subsequently removed due to settling. Resuspension of sediment served to increase total metal in the water column, but the resulting concentrations were still much lower than the 28-d concentrations from the transformation/dissolution tests. Information from TICKET-UWM could be used to refine the environmental hazard profiles of metals. Environ Toxicol Chem 2019;38:1256–1272. © 2019 SETAC
Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function
Authors: Lindroth Heidi , Bratzke Lisa , Twadell Sara , Rowley Paul , Kildow Janie , Danner Mara , Turner Lily , Hernandez Brandon , Brown Roger , Sanders Robert D.
Published: March 2019

Objectives

Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP‐SC) or risk of death (NSQIP‐D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors.

Methods/Design

Data from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP‐SC, NSQIP‐D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale‐R‐98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) identified delirium. LASSO and best subsets linear regression were employed to identify predictive risk factors.

Results

Ninety‐seven participants with a mean age of 71.68 ± 4.55, 55% male (31/97 CAM+, 32%), and a mean peak DRS of 21.5 ± 6.40 were analyzed. LASSO and best subsets regression identified NSQIP‐SC and TMTB to predict postoperative delirium severity (P < 00.001, adjusted R2: 0.30). NSQIP‐SC and TMTB were also selected as predictors for postoperative delirium incidence (AUROC 0.81, 95% CI, 0.72‐0.90).

Conclusions

In this cohort, we identified NSQIP risk score for serious complications and a measure of executive function, TMT‐B, to predict postoperative delirium severity using advanced modeling techniques. Future studies should investigate the utility of these variables in a formal delirium severity prediction model.
Cardiovascular health and dementia incidence among older adults in Latin America: Results from the 10/66 study
Authors: Perales‐Puchalt Jaime , Vidoni Michelle L. , Llibre Rodríguez Juan , Vidoni Eric D. , Billinger Sandra , Burns Jeffrey , Guerchet Maëlenn , Lee MinJae
Published: March 2019

Objectives

Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. This study aimed to assess the longitudinal association between CVH and dementia in six Latin American countries.

Methods

We analyzed longitudinal data from the 10/66 study that included nondementia residents at baseline aged 65+ in six Latin American countries (n = 6447) and were followed up for 3 years. An index of modifiable CVH factors (ranging from 0 to 14) was calculated. Incident dementia was modeled using competing risk regression to adjust for risk of death.

Results

The sample included 6.2% participants with poor (0‐5), 81.0% with moderate (6‐10), and 12.8% with ideal CVH (11‐14). At follow‐up, 9.4% had developed dementia and 13.1% had died. Compared with those with poor CVH, participants with moderate and ideal levels of CVH had a significantly lower risk of dementia in both the unadjusted (subhazard ratio for moderate, 0.77; ideal, 0.59) and adjusted models (moderate, 0.73; ideal, 0.66).

Conclusion

Moderate and ideal levels of CVH in old age may protect against dementia incidence. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries.
The change in circulating tumor cells before and during concurrent chemoradiotherapy is associated with survival in patients with locally advanced head and neck cancer
Authors: Wang Hung‐Ming , Wu Min‐Hsien , Chang Pei‐Hung , Lin Hung‐Chi , Liao Chun‐Da , Wu Sheng‐Min , Hung Tsung‐Min , Lin Chine‐Yu , Chang Tung‐Chieh , Tzu‐Tsen Yen , Hsieh Jason Chia‐Hsun
Published: March 2019

Background

This study aimed to evaluate the role of baseline circulating tumor cells (CTCs) before and during concurrent chemoradiotherapy and attempted to determine the impacts of CTCs on the outcomes in patients with head and neck squamous cell carcinoma.

Methods

CTCs were detected using a negative selection strategy and flow cytometry protocol.

Results

We observed a significant correlation between baseline CTCs and staging (P = 0.001). The CTC counts were significantly reduced within 2‐4 weeks in 47 concurrent chemoradiotherapy responders (P < 0.001). Change of CTC counts correlates with progression‐free survival (PFS, P = 0.01) and overall survival (OS, P = 0.01). CTC decline status was an independent prognostic factor in PFS (P = 0.03) and OS (P = 0.05) in multivariate analyses.

Conclusion

In chemoradiotherapy responders, CTCs are significantly reduced. CTC decline within the first month indicates a longer PFS and OS, suggesting that the dynamics of CTCs could be more important than CTC number alone.
Overview of Existing Science to Inform Oil Sands Process Water Release: A Technical Workshop Summary
Authors: Tanna Rajiv N , Redman Aaron D , Frank Richard A , Arciszewski Tim J , Zubot Warren A , Wrona Frederick J , Brogly John A , Munkittrick Kelly R
Published: March 2019

The extraction of oil sands from mining operations in the Athabasca Oil Sands Region uses an alkaline hot water extraction process. The oil sands process water (OSPW) is recycled to facilitate material transport (e.g., ore and tailings), process cooling, and is also reused in the extraction process. The industry has expanded since commercial mining began in 1967 and companies have been accumulating increasing inventories of OSPW. Short- and long-term sustainable water management practices require the ability to return treated water to the environment. The safe release of OSPW needs to be based on sound science and engineering practices to ensure downstream protection of ecological and human health. A significant body of research has contributed to the understanding of the chemistry and toxicity of OSPW. A multistakeholder science workshop was held in September 2017 to summarize the state of science on the toxicity and chemistry of OSPW. The goal of the workshop was to review completed research in the areas of toxicology, chemical analysis, and monitoring to support the release of treated oil sands water. A key outcome from the workshop was identifying research needs to inform future water management practices required to support OSPW return. Another key outcome of the workshop was the recognition that methods are sufficiently developed to characterize chemical and toxicological characteristics of OSPW to address and close knowledge gaps. Industry, government, and local indigenous stakeholders have proceeded to utilize these insights in reviewing policy and regulations. Integr Environ Assess Manag 2019;15:519–527. © 2019 SETAC
Polymers Used in US Household Cleaning Products: Assessment of Data Availability for Ecological Risk Assessment
Authors: Pecquet Alison , McAvoy Drew , Pittinger Charles , Stanton Kathleen
Published: March 2019

The purpose of this study was to identify, characterize, and assess data needs for ecological risk of household cleaning product polymers currently being used in the United States (US). Because of their range in properties and functions, polymers are used in a wide variety of household cleaning products, including fabric, dish, and hard surface cleaners. Understanding their potential environmental impact is essential for good ingredient and product stewardship. The household cleaning product polymers were first identified using several databases. Of the 185 polymers initially identified, 120 were eliminated from the list because they did not fit the definition of a polymer, were not well defined (e.g., no Chemical Abstracts Service [CAS] or trade name only), or were not in current use. Forty-seven of the remaining polymers had either adequate environmental fate and hazard data and/or sufficient data for conducting a comprehensive ecological risk assessment and were determined to be of low concern by either the United States Environmental Protection Agency (USEPA), the European Chemicals Agency (ECHA), and/or the Human and Environmental Risk Assessment (HERA) Project. The remaining 18 polymers were determined to need further review because of a lack of publicly available information for conducting ecological risk assessments. Additional data for these 18 polymers could be obtained by accessing privately held data, conducting laboratory tests on their fate and effects in aquatic environments, or by conducting read-across of similar structured polymers. These steps can be utilized by industry to determine where best to dedicate future environmental stewardship efforts. Integr Environ Assess Manag 2019;15:621–632. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC)
Muscle mass determined from urinary creatinine excretion rate, and muscle performance in renal transplant recipients
Authors: Stam Suzanne P. , Eisenga Michele F. , Gomes‐Neto Antonio W. , van Londen Marco , de Meijer Vincent E. , van Beek André P. , Gansevoort Ron T. , Bakker Stephan J.L.
Published: March 2019

Background

Muscle mass, as determined from 24‐h urinary creatinine excretion rate (CER), is an independent predictor for mortality and graft failure in renal transplant recipients (RTR). It is currently unknown whether CER is comparable with healthy controls after transplantation and whether it reflects muscle performance besides muscle mass. We aimed to compare urinary CER and muscle performance between RTR and healthy controls and to investigate whether urinary CER is associated with muscle performance in RTR.

Methods

We included RTR, transplanted between 1975 and 2016 in the University Medical Center Groningen. Healthy controls were subjects screened for kidney donation. CER was calculated from a 24‐h urine collection. Muscle performance was assessed by handgrip strength, sit‐to‐stand test, and 2‐min walk test. Statistical analyses were performed using linear regression analyses.

Results

We included 184 RTR (mean age 56.9 ± 11.9 years, 54% male recipient) and 78 healthy controls (age 57.9 ± 9.9, 47% male recipient). RTR were at a median time of 4.0 (1.1–8.8) years after transplantation. Mean CER was lower in RTR compared to healthy controls (11.7 ± 4.0 vs. 13.1 ± 5.2 mmol/24 h; P = 0.04). Significantly poorer results in muscle performance were found in RTR compared to controls for the handgrip strength (30.5 [23.7–41.1] N vs. 38.3 [29.3–46.0] N, P < 0.001) and the 2‐min walk test (151.5 ± 49.2 m vs. 172.3 ± 12.2 m, P < 0.001) but not for the sit‐to‐stand (12.2 ± 3.3 m vs. 11.9 ± 2.8 m, P = 0.46). In RTR, CER was significantly associated with handgrip strength (std. β 0.33; P < 0.001), independent of adjustment for potential confounders. In RTR, CER was neither associated with the time used for the sit‐to‐stand test (std. β −0.09; P = 0.27) nor with the distance covered during the 2‐min walk test (std. β 0.07; P = 0.40).

Conclusions

Muscle mass as measured by CER in RTR is lower compared to controls. CER is positively associated with muscle performance in RTR. The results demonstrate that CER does not only reflect muscle mass but also muscle performance in this patient setting. Determination of CER could be an interesting addition to the imaging technique armamentarium available and applied for evaluation of muscle mass in clinical intervention studies and observational studies.
Giant serous cystadenoma of the pancreas appearing sonographically as a remote pararenal mass
Authors: Theodorou Daphne J. , Theodorou Stavroula J. , Kakitsubata Yousuke , Miyata Yuko , Shirao Kazusada , Marutsuka Kousuke
Published: March 2019

Macrocystic serous cystadenoma (MSC) of the pancreas is a rare benign neoplasm with varied imaging appearances. We describe an intriguing case of a surgically resected and histologically proven giant MSC, developed in the pararenal space. Ultrasonography (US) revealed a large, oligocystic mass around the lower pole of right kidney. Like US, computed tomography, and magnetic resonance imaging were unable to detect the origin of the lesion, which was only verified at surgical exploration. A bizarre finding was the unusual location of the pancreatic tumor growing seemingly apart from the pancreas itself, with no obvious connection to it.
Optimizing HIV testing services in sub‐Saharan Africa: cost and performance of verification testing with HIV self‐tests and tests for triage
Authors: Eaton Jeffrey W , Terris‐Prestholt Fern , Cambiano Valentina , Sands Anita , Baggaley Rachel C , Hatzold Karin , Corbett Elizabeth L , Kalua Thoko , Jahn Andreas , Johnson Cheryl C
Published: March 2019

Introduction

Strategies employing a single rapid diagnostic test (RDT) such as HIV self‐testing (HIVST) or “test for triage” (T4T) are proposed to increase HIV testing programme impact. Current guidelines recommend serial testing with two or three RDTs for HIV diagnosis, followed by retesting with the same algorithm to verify HIV‐positive status before anti‐retroviral therapy (ART) initiation. We investigated whether clients presenting to HIV testing services (HTS) following a single reactive RDT must undergo the diagnostic algorithm twice to diagnose and verify HIV‐positive status, or whether a diagnosis with the setting‐specific algorithm is adequate for ART initiation.

Methods

We calculated (1) expected number of false‐positive (FP) misclassifications per 10,000 HIV negative persons tested, (2) positive predictive value (PPV) of the overall HIV testing strategy compared to the WHO recommended PPV ≥99%, and (3) expected cost per FP misclassified person identified by additional verification testing in a typical low‐/middle‐income setting, compared to the expected lifetime ART cost of $3000. Scenarios considered were as follows: 10% prevalence using two serial RDTs for diagnosis, 1% prevalence using three serial RDTs, and calibration using programmatic data from Malawi in 2017 where the proportion of people testing HIV positive in facilities was 4%.

Results

In the 10% HIV prevalence setting with a triage test, the expected number of FP misclassifications was 0.86 per 10,000 tested without verification testing and the PPV was 99.9%. In the 1% prevalence setting, expected FP misclassifications were 0.19 with 99.8% PPV, and in the Malawi 2017 calibrated setting the expected misclassifications were 0.08 with 99.98% PPV. The cost per FP identified by verification testing was $5879, $3770, and $24,259 respectively. Results were sensitive to assumptions about accuracy of self‐reported reactive results and whether reactive triage test results influenced biased interpretation of subsequent RDT results by the HTS provider.

Conclusions

Diagnosis with the full algorithm following presentation with a reactive triage test is expected to achieve PPV above the 99% threshold. Continuing verification testing prior to ART initiation remains recommended, but HIV testing strategies involving HIVST and T4T may provide opportunities to maintain quality while increasing efficiency as part of broader restructuring of HIV testing service delivery.
HIV self‐testing: breaking the barriers to uptake of testing among men and adolescents in sub‐Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe
Authors: Hatzold Karin , Gudukeya Stephano , Mutseta Miriam N , Chilongosi Richard , Nalubamba Mutinta , Nkhoma Chiwawa , Munkombwe Hambweka , Munjoma Malvern , Mkandawire Phillip , Mabhunu Varaidzo , Smith Gina , Madidi Ngonidzashe , Ahmed Hussein , Kambeu Taurai , Stankard Petra , Johnson Cheryl C , Corbett Elizabeth L
Published: March 2019

Introduction

Social, structural and systems barriers inhibit uptake of HIV testing. HIV self‐testing (HIVST) has shown promising uptake by otherwise underserved priority groups including men, young people and first‐time testers. Here, we use characteristics of HIVST kit recipients to investigate delivery to these priority groups during HIVST scale‐up in three African countries.

Methods

Kit distributors collected individual‐level age, sex and testing history from all clients. These data were aggregated and analysed by country (Malawi, Zambia and Zimbabwe) for five distribution models: local community‐based distributor (CBD: door‐to‐door, street and local venues), workplace distribution (WD), integration into HIV testing services (IHTS), or public health facilities (IPHF) and during demand creation for voluntary male medical circumcision (VMMC). Used kits were collected and re‐read from CBD and IHTS recipients.

Results

Between May 2015 and July 2017, 628,705 HIVST kits were distributed in Malawi (172,830), Zambia (190,787) and Zimbabwe (265,091). Community‐based models, the first to be established, accounted for 519,658 (82.7%) of kits distributed, with 275,419 (53.0%) used kits returned. Subsequent model diversification delivered 54,453 (8.7%) test‐kits through IHTS, 23,561 (3.7%) through VMMC, 21,183 (3.4%) through IPHF and 9850 (1.7%) through WD. Men took 294,508 (48.2%) kits, and 263,073 (43.1%) went to young people (16 to 24 years). A higher proportion of male self‐testers (65,577; 22.3%) were first‐time testers than women (54,096; 17.1%) with this apparent in Zimbabwe (16.2% vs. 11.4%), Zambia (25.4% vs. 17.7%) and Malawi (27.9% vs. 25.9%). The highest proportions of first‐time testers were in young (16 to 24 years) and older (>50 years) men (country‐ranges: 18.7% to 35.9% and 13.8% to 26.8% respectively). Most IHTS clients opted for HIVST in preference to standard HTS in each of 12 delivery sites, with those selecting HIVST having lower HIV prevalence, potentially due to self‐selection.

Conclusions

HIVST delivered at scale using several different models reached a high proportion of men, young people and first‐time testers in Malawi, Zambia and Zimbabwe, some of whom may not have tested otherwise. As men and young people have limited uptake under standard facility‐and community‐based HIV testing, innovative male‐ and youth‐sensitive approaches like HIVST may be essential to reaching UNAIDS fast‐track targets for 2020.
Applying user preferences to optimize the contribution of HIV self‐testing to reaching the “first 90” target of UNAIDS Fast‐track strategy: results from discrete choice experiments in Zimbabwe
Authors: Sibanda Euphemia L , d'Elbée Marc , Maringwa Galven , Ruhode Nancy , Tumushime Mary , Madanhire Claudius , Ong Jason J , Indravudh Pitchaya , Watadzaushe Constancia , Johnson Cheryl C , Hatzold Karin , Taegtmeyer Miriam , Hargreaves James R , Corbett Elizabeth L , Cowan Frances M , Terris‐Prestholt Fern
Published: March 2019

Introduction

New HIV testing strategies are needed to reach the United Nations’ 90‐90‐90 target. HIV self‐testing (HIVST) can increase uptake, but users’ perspectives on optimal models of distribution and post‐test services are uncertain. We used discrete choice experiments (DCEs) to explore the impact of service characteristics on uptake along the testing cascade.

Methods

DCEs are a quantitative survey method that present respondents with repeated choices between packages of service characteristics, and estimate relative strengths of preferences for service characteristics. From June to October 2016, we embedded DCEs within a population‐based survey following door‐to‐door HIVST distribution by community volunteers in two rural Zimbabwean districts: one DCE addressed HIVST distribution preferences; and the other preferences for linkage to confirmatory testing (LCT) following self‐testing. Using preference coefficients/utilities, we identified key drivers of uptake for each service and simulated the effect of changes of outreach and static/public clinics’ characteristics on LCT.

Results

Distribution and LCT DCEs surveyed 296/329 (90.0%) and 496/594 (83.5%) participants; 81.8% and 84.9% had ever‐tested, respectively. The strongest distribution preferences were for: (1) free kits – a $1 increase in the kit price was associated with a disutility (U) of −2.017; (2) door‐to‐door kit delivery (U = +1.029) relative to collection from public/outreach clinic; (3) telephone helpline for pretest support relative to in‐person or no support (U = +0.415); (4) distributors from own/local village (U = +0.145) versus those from external communities. Participants who had never HIV tested valued phone helplines more than those previously tested. The strongest LCT preferences were: (1) immediate antiretroviral therapy (ART) availability: U = +0.614 and U = +1.052 for public and outreach clinics, respectively; (2) free services: a $1 user fee increase decreased utility at public (U = −0.381) and outreach clinics (U = −0.761); (3) proximity of clinic (U = −0.38 per hour walking). Participants reported willingness to link to either location; but never‐testers were more averse to LCT. Simulations showed the importance of availability of ART: ART unavailability at public clinics would reduce LCT by 24%.

Conclusions

Free HIVST distribution by local volunteers and immediately available ART were the strongest relative preferences identified. Accommodating LCT preferences, notably ensuring efficient provision of ART, could facilitate “resistant testers” to test while maximizing uptake of post‐test services.