bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypervirulent Group A Streptococcus of Genotypeemm3 Invades the Vascular System in Pulmonary Infection of Mice
Authors: Lei Benfang , Minor Dylan , Feng Wenchao , Liu Mengyao
Published: March 2018

Natural mutations of the two-component regulatory system CovRS are frequently associated with invasive group AStreptococcus(GAS) isolates and lead to the enhancement of virulence gene expression, innate immune evasion, systemic dissemination, and virulence. How CovRS mutations enhance systemic dissemination is not well understood. A hypervirulent GAS isolate of theemm3 genotype, MGAS315, was characterized using a mouse model of pulmonary infection to understand systemic dissemination. This strain has a G1370T mutation in the sensor kinasecovSgene of CovRS. Intratracheal inoculation of MGAS315 led to the lung infection that displayed extensive Gram staining at the alveolar ducts, alveoli, and peribronchovascular and perivascular interstitium. The correction of thecovSmutation did not alter the infection at the alveolar ducts and alveoli but prevented GAS invasion of the peribronchovascular and perivascular interstitium. Furthermore, thecovSmutation allowed MGAS315 to disrupt and degrade the smooth muscle and endothelial layers of the blood vessels, directly contributing to systemic dissemination. It is concluded that hypervirulentemm3 GAScovSmutants can invade the perivascular interstitium and directly attack the vascular system for systemic dissemination.
Antimicrobial Resistance inStreptococcusspp
Authors: Haenni Marisa , Lupo Agnese , Madec Jean-Yves
Published: March 2018

The genusStreptococcusincludes Gram-positive organisms shaped in cocci and organized in chains. They are commensals, pathogens, and opportunistic pathogens for humans and animals. MostStreptococcusspecies of veterinary relevance have a specific ecological niche, such asS. uberis, which is almost exclusively an environmental pathogen causing bovine mastitis. In contrast,S. suiscan be considered as a true zoonotic pathogen, causing specific diseases in humans after contact with infected animals or derived food products. Finally,Streptococcusspecies such asS. agalactiaecan be sporadically zoonotic, even though they are pathogens of both humans and animals independently. For clarification, a short taxonomical overview will be given here to highlight the diversity of streptococci that infect animals. Several families of antibiotics are used to treat animals for streptococcal infections. First-line treatments are penicillins (alone or in combination with aminoglycosides), macrolides and lincosamides, fluoroquinolones, and tetracyclines. Because of the selecting role of antibiotics, resistance phenotypes have been reported in streptococci isolated from animals worldwide. Globally, the dynamic of resistance acquisition in streptococci is slower than what is experienced inEnterobacteriaceae, probably due to the much more limited horizontal spread of resistance genes. Nonetheless, transposons or integrative and conjugative elements can disseminate resistance determinants among streptococci. Besides providing key elements on the prevalence of resistance in streptococci from animals, this article will also largely consider the mechanisms and molecular epidemiology of the major types of resistance to antimicrobials encountered in the most important streptococcal species in veterinary medicine.
From Malawi to Middlesex: the case of the Arbutus Drill Cover System as an example of the cost-saving potential of frugal innovations for the UK NHS
Authors: Prime Matthew , Attaelmanan Ibtehal , Imbuldeniya Arjuna , Harris Matthew , Darzi Ara , Bhatti Yasser
Published: March 2018

Background

Musculoskeletal disease is one of the leading clinical and economic burdens of the UK health system, and the resultant demand for orthopaedic care is only set to increase. One commonly used and one of the most expensive hardware in orthopaedic surgery is the surgical drill and saw. Given financial constraints, the National Health Service (NHS) needs an economic way to address this recurring cost. We share evidence of one frugal innovation with potential for contributing to the NHS’ efficiency saving target of £22 billion by 2020.

Methods

Exploratory case study methodology was used to develop insights and understanding of the innovations potential for application in the NHS. Following a global search for potential frugal innovations in surgery, the Arbutus Drill Cover System was identified as an innovation with potential to deliver significant cost savings for the NHS in the UK.

Results

The Arbutus Drill Cover System is up to 94% cheaper than a standard surgical drill available in the UK. Clinical and laboratory tests show that performance, safety and usability are as good as current offerings in high-income countries and significantly better than hand drills typically used in low-and-middle-income countries. The innovation meets all regulatory requirements to be a medical device in the Europe and North America.

Conclusions

The innovation holds promise in reducing upfront and life span costs for core equipment used in orthopaedic surgery without loss of effectiveness or safety benchmarks. However, the innovation needs to navigate complicated and decentralised procurement processes and clinicians and healthcare leaders need to overcome cognitive bias.
Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases
Authors: Huiart Laetitia , Ferdynus Cyril , Renoux Christel , Beaugrand Amélie , Lafarge Sophie , Bruneau Léa , Suissa Samy , Maillard Olivier , Ranouil Xavier
Published: March 2018

Objective

Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period.

Methods

Based on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice.

Results

The cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011–2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54).

Conclusion

Despite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk–benefit assessment of DOACs.
Association of allergic diseases with children’s life satisfaction: population-based study in Finland
Authors: Haanpää Leena , af Ursin Piia , Nermes Merja , Kaljonen Anne , Isolauri Erika
Published: March 2018

Objective

To assess the impact of allergic diseases on the subjective well-being and life satisfaction of primary-school children.

Design

Population-based cohort.

Setting

Finnish sample of children ages 10 and 12 from the International Survey of Children’s Well-Being.

Participants

Nationally representative sample of 1947 school children.

Main outcome measure

Two different instruments to assess the child’s own perception of well-being, the short version of the Student Life Satisfaction Scale (SLSS) and the Brief Multidimensional Student Life Satisfaction Scale (BMSLSS).

Results

Altogether, 51.4% of children reported having at least one allergic condition (10.1% asthma, 23.8% eczema and 40.3% seasonal allergic rhinitis). A statistically significant distinction in life satisfaction emerged between non-allergic and allergic children (inferior in the latter). In particular, children with eczema were more likely to report a reduction in life satisfaction compared with non-allergic children (SLSS β=−128.220; BMSLSS β=−90.694; p<0.01). Apart from freedom from eczema, good life satisfaction was associated with a physically active lifestyle.

Conclusions

Active allergic disease reduces the child’s own perception of well-being. During clinical visits, more attention should be paid to the child’s psychosocial status and impairments, which may differ substantially from those of parents or medical authorities.
Vitamin D, obesity and leptin in relation to bladder cancer incidence and survival: prospective protocol study
Authors: Gislefoss Randi Elin , Stenehjem Jo Steinson , Hektoen Helga Helseth , Andreassen Bettina Kulle , Langseth Hilde , Axcrona Karol , Weiderpass Elisabete , Mondul Alison , Robsahm Trude Eid
Published: March 2018

Introduction

Bladder cancer (BC) (including renal pelvis, ureter and urethra) is one of the most common urogenital cancers and the fourth most frequent cancer in men in the USA. In Norway, the incidence of BC has increased over the last decades. The age-standardised incidence rates per 100 000 for 2011-2015 were 53.7 in men and 16.5 in women. Compared to the 5-year period 2006–2010, the percentage increase in incidence was 6.1% in men and 12.3% in women. The recurrence rate of BC is over 50%, the highest recurrence rate of any malignancy. Smoking and occupational exposure to aromatic amines are recognised as the major risk factors. Recently, low-serum level of 25-hydroxy vitamin D (25(OH)D) and obesity have been suggested to increase the BC risk, and leptin, which is important in weight regulation, may be involved in bladder carcinogenesis. More knowledge on potential risk factors for BC is necessary for planning and implementing primary prevention measures.

Methods and analyses

Cohort and nested case–control studies will be carried out using the population-based Janus Serum Bank Cohort consisting of prediagnostic sera, clinical measurement data (body height and weight, body surface area and weight change over time, blood pressure, cholesterol and triglycerides) and self-reported information on lifestyle factors (smoking, physical activity). Participants were followed from cohort inclusion (1972–2003) through 2014. The cohort will be linked to the Cancer Registry of Norway (cancer data), the National Cause of Death Registry (date and cause of death), National Population Registry (vital status) and Statistic Norway (education and occupation). Serum samples will be analysed for 25(OH)D, vitamin D binding protein, leptin, albumin, calcium and parathyroid hormone. Cox regression and conditional logistic regression models and mediation analysis will be used to estimate association between the exposures and BC.

Ethics and dissemination

The study has been approved by the Regional Committee for Medical Research Ethics and is funded by the Norwegian Cancer Society. Results will be published in peer-reviewed journals, at scientific conferences and through press releases.
Thyroid disorders and breast cancer risk in Asian population: a nationwide population-based case–control study in Taiwan
Authors: Weng Chien-Hsiang , Chen Yi-Huei , Lin Ching-Heng , Luo Xun , Lin Tseng-Hsi
Published: March 2018

Objective

To evaluate whether hyperthyroidism or hypothyroidism increases the risk of subsequent breast cancer in an Asian population.

Design

Nationwide population-based case–control study.

Setting

All healthcare facilities in Taiwan.

Participants

A total of 103 466 women (mean age 53.3 years) were enrolled.

Methods

51 733 adult women with newly diagnosed primary breast cancer without a previous cancer history between 2006 and 2011 were identified and included in our study. 51 733 women with no cancer diagnosis prior to the index date were age matched as controls. Diagnosis of hyperthyroidism or hypothyroidism prior to the diagnosis of breast cancer or the same index date was identified, age, histories of thyroid disease treatment, oestrogen use and radioactive iodine treatment were adjusted.

Main outcome measures

To identify risk differences in developing breast cancer among patients with a medical history of hyperthyroidism or hypothyroidism.

Results

There was a significantly increased risk of breast cancer in women with hyperthyroidism under the age of 55 years (age <45: OR 1.16, P=0.049; age 45–55: OR 1.15, P=0.019). Patients with hypothyroidism also showed an increased risk of breast cancer (OR 1.19, P=0.029) without statistical significance after stratification by age group (age <45, 45–55, >55 years). Treatment for thyroid disorders did not alter the association in subgroup analyses (P=0.857; 0.262, respectively).

Conclusions

Asian women under 55 years of age with history of hyperthyroidism have a significantly increased risk of breast cancer regardless of treatment. Women with history of hypothyroidism may also have an increased risk.
Patient perspectives on the HIV continuum of care in London: a qualitative study of people diagnosed between 1986 and 2014
Authors: Bruton Jane , Rai Tanvi , Day Sophie , Ward Helen
Published: March 2018

Objectives

To describe the experiences of the HIV treatment cascade of diagnosis, engagement with care and initiation of treatment from the perspective of patients; we explored whether this differed according to the year of their diagnosis, for example, whether they had experienced HIV care in the pretreatment era.

Design

Qualitative interview study with framework analysis.

Setting

Two large HIV adult outpatient clinics in central London.

Participants

52 HIV-positive individuals, 41 men, 11 women, purposively sampled to include people who had been diagnosed at different stages in the history of the epidemic classified as four ‘generations’: pre-1996 (preantiretroviral therapy (ART)), 1997–2005 (complex ARTs), 2006–2012 (simpler ARTs) and 2013 onwards (recent diagnoses).

Results

Some important differences were identified; for earlier generations, the visible illness and deaths from AIDS made it harder to engage with care following diagnosis. Subsequent decisions about starting treatment were deeply influenced by the fear of severe side effects from early ART. However, despite improvements in ART and life expectancy over the epidemic, we found a striking similarity across participants’ accounts of the key stages of the care continuum, regardless of when they were diagnosed. Diagnosis was a major traumatic life event for almost everyone. Fear of testing positive or having low self-perceived risk affected the timing of testing and diagnosis. Engaging with care was facilitated by a flexible approach from services/clinicians. Initiating treatment was a major life decision.

Conclusion

We found patients’ experiences are influenced by when they were diagnosed, with earliest cohorts facing substantial challenges. However, being diagnosed with HIV and starting treatment continue to be significant life-altering events even in the era of effective, simple treatments. Despite the advances of biomedical treatment, services should continue to recognise the needs of patients for whom the diagnosis and treatment remain significant challenges.
Opportunities and challenges to improving antibiotic prescribing practices through a One Health approach: results of a comparative survey of doctors, dentists and veterinarians in Australia
Authors: Zhuo Annie , Labbate Maurizio , Norris Jacqueline M , Gilbert Gwendolyn L , Ward Michael P , Bajorek Beata V , Degeling Chris , Rowbotham Samantha J , Dawson Angus , Nguyen Ky-Anh , Hill-Cawthorne Grant A , Sorrell Tania C , Govendir Merran , Kesson Alison M , Iredell Jonathan R , Dominey-Howes Dale
Published: March 2018

Objectives

To explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach.

Design

A cross-sectional survey conducted online.

Setting

Doctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia.

Participants

547 doctors, 380 dentists and 403 veterinarians completed the survey.

Main outcome measures

Prescribers’ knowledge, attitudes and perceptions of AbR, the extent to which a range of factors are perceived as barriers to appropriate prescribing practices, and perceived helpfulness of potential strategies to improve antibiotic prescribing in practice.

Results

There was substantial agreement across prescriber groups that action on AbR is required by multiple sectors and stakeholders. However, prescribers externalised responsibility to some extent by seeing the roles of others as more important than their own in relation to AbR. There were common and context-specific barriers to optimal prescribing across the prescriber groups. Prescriber groups generally perceived restrictive policies as unhelpful to supporting appropriate prescribing in their practice.

Conclusions

The results have implications for implementing a One Health approach that involves doctors, dentists and veterinarians as key players to tackling the crisis of AbR. The findings are that (1) prescribers understand and are likely receptive to a One Health policy approach to AbR, (2) policy development should be sensitive to barriers that are specific to individual prescriber groups and (3) the development and introduction of interventions that might be perceived as reducing prescriber autonomy will need to be carefully designed and implemented.
Maternal iron status during pregnancy and respiratory and atopic outcomes in the offspring: a Mendelian randomisation study
Authors: Bédard Annabelle , Lewis Sarah J , Burgess Stephen , Henderson A John , Shaheen Seif O
Published: March 2018

Introduction

Limited evidence from birth cohort studies suggests that lower prenatal iron status may be a risk factor for childhood respiratory and atopic outcomes, but these observational findings may be confounded. Mendelian randomisation (MR) can potentially provide unconfounded estimates of causal effects by using common genetic variants as instrumental variables. We aimed to study the relationship between prenatal iron status and respiratory and atopic outcomes in the offspring using MR.

Methods

In the Avon Longitudinal Study of Parents and Children birth cohort, we constructed four maternal genotypic risk scores by summing the total number of risk alleles (associated with lower iron status) across single nucleotide polymorphisms known to be associated with at least one of four iron biomarkers (serum iron, ferritin, transferrin and transferrin saturation). We used MR to study their associations with respiratory and atopic outcomes in children aged 7–9 years (n=6002).

Results

When analyses were restricted to mothers without iron supplementation during late pregnancy, negative associations were found between the maternal transferrin saturation score and childhood forced expiratory volume in 1 s and forced vital capacity (difference in age, height and gender-adjusted SD units per SD increase in genotypic score: −0.05 (−0.09, −0.01) p=0.03, and −0.04 (−0.08, 0.00) p=0.04, respectively).

Conclusion

Using MR we have found weak evidence suggesting that low maternal iron status during pregnancy may cause impaired childhood lung function.
Danegaptide for primary percutaneous coronary intervention in acute myocardial infarction patients: a phase 2 randomised clinical trial
Authors: Engstrøm Thomas , Nepper-Christensen Lars , Helqvist Steffen , Kløvgaard Lene , Holmvang Lene , Jørgensen Erik , Pedersen Frants , Saunamaki Kari , Tilsted Hans-Henrik , Steensberg Adam , Fabricius Søren , Mouritzen Ulrik , Vejlstrup Niels , Ahtarovski Kiril A , Göransson Christoffer , Bertelsen Litten , Kyhl Kasper , Olivecrona Göran , Kelbæk Henning , Lassen Jens Flensted , Køber Lars , Lønborg Jacob
Published: March 2018

Objectives

Reperfusion immediately after reopening of the infarct-related artery in ST-segment elevation myocardial infarction (STEMI) may cause myocardial damage in addition to the ischaemic insult (reperfusion injury). The gap junction modulating peptide danegaptide has in animal models reduced this injury. We evaluated the effect of danegaptide on myocardial salvage in patients with STEMI.

Methods

In addition to primary percutaneous coronary intervention in STEMI patients with thrombolysis in myocardial infarction flow 0–1, single vessel disease and ischaemia time less than 6 hours, we tested, in a clinical proof-of-concept study, the therapeutic potential of danegaptide at two-dose levels. Primary outcome was myocardial salvage evaluated by cardiac MRI after 3 months.

Results

From November 2013 to August 2015, a total of 585 patients were randomly enrolled in the trial. Imaging criteria were fulfilled for 79 (high dose), 80 (low dose) and 84 (placebo) patients eligible for the per-protocol analysis. Danegaptide did not affect the myocardial salvage index (danegaptide high (63.9±14.9), danegaptide low (65.6±15.6) and control (66.7±11.7), P=0.40), final infarct size (danegaptide high (19.6±11.4 g), danegaptide low (18.6±9.6 g) and control (21.4±15.0 g), P=0.88) or left ventricular ejection fraction (danegaptide high (53.9%±9.5%), danegaptide low (52.7%±10.3%) and control (52.1%±10.9%), P=0.64). There was no difference between groups with regard to clinical outcome.

Conclusions

Administration of danegaptide to patients with STEMI did not improve myocardial salvage.

Trial registration number

NCT01977755; Pre-results.
Retrospective natural history of thymidine kinase 2 deficiency
Authors: Garone Caterina , Taylor Robert W , Nascimento Andrés , Poulton Joanna , Fratter Carl , Domínguez-González Cristina , Evans Julie C , Loos Mariana , Isohanni Pirjo , Suomalainen Anu , Ram Dipak , Hughes M Imelda , McFarland Robert , Barca Emanuele , Lopez Gomez Carlos , Jayawant Sandeep , Thomas Neil D , Manzur Adnan Y , Kleinsteuber Karin , Martin Miguel A , Kerr Timothy , Gorman Grainne S , Sommerville Ewen W , Chinnery Patrick F , Hofer Monika , Karch Christoph , Ralph Jeffrey , Cámara Yolanda , Madruga-Garrido Marcos , Domínguez-Carral Jana , Ortez Carlos , Emperador Sonia , Montoya Julio , Chakrapani Anupam , Kriger Joshua F , Schoenaker Robert , Levin Bruce , Thompson John L P , Long Yuelin , Rahman Shamima , Donati Maria Alice , DiMauro Salvatore , Hirano Michio
Published: March 2018

Background

Thymine kinase 2 (TK2) is a mitochondrial matrix protein encoded in nuclear DNA and phosphorylates the pyrimidine nucleosides: thymidine and deoxycytidine. Autosomal recessive TK2 mutations cause a spectrum of disease from infantile onset to adult onset manifesting primarily as myopathy.

Objective

To perform a retrospective natural history study of a large cohort of patients with TK2 deficiency.

Methods

The study was conducted by 42 investigators across 31 academic medical centres.

Results

We identified 92 patients with genetically confirmed diagnoses of TK2 deficiency: 67 from literature review and 25 unreported cases. Based on clinical and molecular genetics findings, we recognised three phenotypes with divergent survival: (1) infantile-onset myopathy (42.4%) with severe mitochondrial DNA (mtDNA) depletion, frequent neurological involvement and rapid progression to early mortality (median post-onset survival (POS) 1.00, CI 0.58 to 2.33 years); (2) childhood-onset myopathy (40.2%) with mtDNA depletion, moderate-to-severe progression of generalised weakness and median POS at least 13 years; and (3) late-onset myopathy (17.4%) with mild limb weakness at onset and slow progression to respiratory insufficiency with median POS of 23 years. Ophthalmoparesis and facial weakness are frequent in adults. Muscle biopsies show multiple mtDNA deletions often with mtDNA depletion.

Conclusions

In TK2 deficiency, age at onset, rate of weakness progression and POS are important variables that define three clinical subtypes. Nervous system involvement often complicates the clinical course of the infantile-onset form while extraocular muscle and facial involvement are characteristic of the late-onset form. Our observations provide essential information for planning future clinical trials in this disorder.
Newborn health benefits or financial risk protection? An ethical analysis of a real-life dilemma in a setting without universal health coverage
Authors: Onarheim Kristine Husøy , Norheim Ole Frithjof , Miljeteig Ingrid
Published: March 2018

Introduction

High healthcare costs make illness precarious for both patients and their families’ economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood.

Methods

Using a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection.

Results

Giving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties—the newborn, family members and health worker—cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people’s substantive freedoms.

Conclusion

In settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty.
Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients
Authors: L’Allinec Vincent , Ernst Marielle , Sevin-Allouet Mathieu , Testard Nathalie , Delasalle-Guyomarch Béatrice , Guillon Benoit , Mazighi Mikael , Desal Hubert , Bourcier Romain
Published: March 2018

Background

Anticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs.

Methods

We analyzed three patient groups from two prospective registries: APs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with IV-rtPA and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified Rankin Scale (mRS) ≤2 and safety (radiologic intracranial hemorrhage (rICH), symptomatic intracranial hemorrhage (sICH) and death rate at 3 months) between groups.

Results

333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the NAP-MT group and NAP-IVTMT groups, respectively. Multivariate analysis showed that the AP-MT group had a lower risk of rICH (OR 2.77, 95% CI 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (OR 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the NAP-IVTMT group. No difference was found between the AP-MT and NAP-MT groups.

Conclusions

With regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. However, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group.
Urinary excretion of platinum from South African precious metals refinery workers
Authors: Linde Stephanus J L , Franken Anja , du Plessis Johannes L
Published: March 2018

Background

Urinary platinum (Pt) excretion is a reliable biomarker for occupational Pt exposure and has been previously reported for precious metals refinery workers in Europe but not for South Africa, the world’s largest producer of Pt.

Objective

This study aimed to quantify the urinary Pt excretion of South African precious metals refinery workers.

Methods

Spot urine samples were collected from 40 workers (directly and indirectly exposed to Pt) at two South African precious metals refineries on three consecutive mornings prior to their shifts. Urine samples were analysed for Pt using inductively coupled plasma-mass spectrometry and were corrected for creatinine content.

Results

The urinary Pt excretion of workers did not differ significantly between sampling days. Urinary Pt excretions ranged from <0.1 to 3.0 µg Pt/g creatinine with a geometric mean of 0.21 µg Pt/g creatinine (95% CI 0.17 to 0.26 µg Pt/g creatinine). The work area (P=0.0006; η2=0.567) and the number of years workers were employed at the refineries (P=0.003; η2=0.261) influenced their urinary Pt excretion according to effect size analyses. Directly exposed workers had significantly higher urinary Pt excretion compared with indirectly exposed workers (P=0.007).

Conclusion

The urinary Pt excretion of South African precious metals refinery workers reported in this study is comparable with that of seven other studies conducted in precious metals refineries and automotive catalyst plants in Europe. The Pt body burden of workers is predominantly determined by their work area, years of employment in the refineries and whether they are directly or indirectly exposed to Pt.
Taxonomy and biogeography ofHemphillia(Gastropoda: Pulmonata: Arionidae) in North American rainforests, with description of a new species (Skade’s jumping-slug,Hemphillia skadeisp. nov.)
Authors: Lucid M.K. , Rankin A. , Espíndola A. , Chichester L. , Ehlers S. , Robinson L. , Sullivan J.
Published: March 2018

Species diversity of the genus Hemphillia Bland and W.G. Binney, 1872 (jumping-slugs) was studied across its range in western North America’s inland temperate rainforests. The taxonomic relationships among jumping-slug populations were clarified by integrating morphological, molecular, and biogeographic approaches. A new species, Skade’s jumping-slug (Hemphillia skadei sp. nov.), was discovered in this process and is described herein. We base this taxonomic decision on molecular comparison of representatives from other Hemphillia species and four morphological characters that distinguish H. skadei from its sister species, the pale jumping-slug (Hemphillia camelus Pilsbry and Vanatta, 1897). The distribution of H. skadei and H. camelus is described along with the notable lack of detection of the marbled jumping-slug (Hemphillia danielsi Vanatta, 1914) within the primary survey area.
Average Counting via Approximate Histograms
Authors: Cichoń Jacek , Gotfryd Karol
Published: March 2018

We propose a new algorithm for the classical averaging problem for distributed wireless sensors networks. This subject has been studied extensively and there are many clever algorithms in the literature. These algorithms are based on the idea of local exchange of information. They behave well in dense networks (e.g., in networks whose connections form a complete graph), but their convergence to the real average is very slow in linear or cyclic graphs.

Our solution is different. In order to calculate the average, we first build an approximate histogram of observed data; then, from this histogram, we estimate the average. In our solution, we use the extreme propagation technique and probabilistic counters. It allows us to find the approximation of the average of a set of measurements done by sensor network with arbitrary precision, controlled by two parameters. Our method requires O(D) rounds, where D is the diameter of the network. We study the message complexity of this algorithm and show that it is of order O(log n) for each node, where n is the size of the network.
Requirements Engineering in the Context of Big Data Applications
Authors: Arruda Darlan
Published: March 2018

Requirements Engineering (RE) plays an essential role in the software engineering process, being considered as one of the most critical phases of the software development life-cycle. As we might expect, then, the Requirements Engineering would play a similar role in the context of Big Data applications. However, practicing Requirements Engineering is a challenging and complex task. It involves (i) stakeholders with diverse backgrounds and levels of knowledge, (ii) different application domains, (iii) it is expensive and error-prone, (iii) it is important to be aligned with business goals, to name a few. Because it involves such complex activities, a lot has to be understood in order to properly address Requirements Engineering. Especially, when the technology domain (e.g., Big Data) is not yet well explored. In this context, this paper describes a research plan on Requirements Engineering involving the development of Big Data applications. The high-level goal is to investigate: (i) On the technical front, the Requirements Engineering activities with respect to the analysis and specification of Big Data requirements and, (ii) on the management side, the relationship between RE and Business Goals in the development of Big Data Software applications.
The perplexing pregnancy disorder preeclampsia: what next?
Authors: Roberts James M.
Published: March 2018

Preeclampsia occurs in 3–5% of pregnancies and is a leading cause of deaths of mothers and their infants worldwide. It was initially described over 100 yr ago as a pregnancy abnormality defined by new-onset hypertension and proteinuria. Progress in understanding the pathophysiology was impeded by attention to these diagnostic findings. Hypertension and proteinuria were actually serendipitously recognized components of a complex multisystemic syndrome and not especially pertinent to outcome. With the recognition of inflammatory activation with consequent endothelial dysfunction 30 yr ago redirection of research resulted in an explosive increase in understanding of the disorder. The immunological origins, the role of the placenta and its functional alterations due to endoplasmic reticulum and oxidative stress, identification of placental products linking placental dysfunction to maternal systemic pathophysiology, and the role of the maternal constitution have been elegantly demonstrated by clinical, fundamental, and epidemiological findings and clever animal experimentation. Nonetheless, this increase in knowledge has not translated into improved prediction and prevention of preeclampsia. In this presentation the likelihood is discussed that this is secondary to a much greater complexity than has been previously considered and the existence of subtypes of preeclampsia that may not share an identical pathophysiology. The necessity for collaboration with data, sample, and intellectual sharing is addressed. An approach to addressing the challenges posed to such collaboration exemplified by the Global Pregnancy Collaboration is presented.
Geographic Inequalities in Progress against Lung Cancer among Women in the United States, 1990–2015
Authors: Ross Katherine , Kramer Michael R. , Jemal Ahmedin
Published: March 2018

Background: Lung cancer–related death rates in the United States have declined steadily since 1990 in men but not until the mid-2000s in women, with the gap in mortality narrowing during the most recent time period. We examined variation in the declining trend among women by county, where many tobacco control policies are implemented.

Methods: We obtained county-level lung cancer death rates among women from the National Center for Health Statistics mortality file and calculated relative changes from 1990–1999 to 2006–2015. Optimized hotspot analysis identified contiguous counties with small declines or increases in death rates.

Results: We identified two distinct clusters of counties: 669 in Appalachia and the Midwest (Hotspot 1) and 81 in the northern Midwest (Hotspot 2). From 1990–1999 to 2006–2015, death rates among women increased by 13% in Hotspot 1 and by 7% in Hotspot 2 counties, while rates decreased by 6% in the non-hotspot United States. From 1990–2015, death rate ratios (RRs) in hotspot versus non-hotspot counties changed from 4% lower (RR, 0.96; 95% CI, 0.94–0.99) to 28% higher [RR, 1.28; 95% confidence interval (CI), 1.25–1.31] for Hotspot 1 counties and from 18% lower (RR, 0.82; 95% CI, 0.76–0.89) to unity (RR, 0.99; 95% CI, 0.93–1.05) for Hotspot 2 counties.

Conclusions: We identified areas in the Midwest and Appalachia where progress against lung cancer mortality among women has lagged compared with a steady national decline.

Impact: Targeted tobacco control programs could reduce the excess burden of lung cancer among women living in hotspot counties and prevent widening geographic inequity. Cancer Epidemiol Biomarkers Prev; 27(11); 1261–4. ©2018 AACR.
Predictors of Acute Failure Ablation of Intra‐atrial Re‐entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation
Authors: Roca‐Luque Ivo , Rivas‐Gándara Nuria , Dos‐Subirà Laura , Francisco‐Pascual Jaume , Pijuan‐Domenech Antònia , Pérez‐Rodon Jordi , Santos‐Ortega Alba , Roses‐Noguer Ferran , Ferreira‐Gonzalez Ignacio , García‐Dorado García David , Moya Mitjans Angel
Published: March 2018

Background

Intra‐atrial re‐entrant tachycardia (
IART
) in patients with congenital heart disease (
CHD
) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first‐line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed
IART
radiofrequency catheter ablation in
CHD
.

Methods and Results

The observational study included all consecutive patients with
CHD
who underwent a first ablation procedure for
IART
at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114
IART
were ablated (acute success: 74.6%; 1.21±0.41
IART
per patient) with an acute success of 74.5%. Cavotricuspid isthmus–related
IART
was the only arrhythmia in 51%; non–cavotricuspid isthmus–related
IART
was the only mechanism in 27.7% and 21.3% of the patients had both types of
IART
. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus
IART
(odds ratio 7.3; confidence interval [CI], 1.9–17.9;
P
=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3–18.4;
P
=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4–17.2;
P
=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1–21.7;
P
=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74–0.93,
P
=0.001). After a mean follow‐up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure).

Conclusions

Although ablation in
CHD
is a challenging procedure, acute success of 75% can be achieved in moderate–highly complex
CHD
patients in a referral center. Predictors of failed ablation are
IART
different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex
CHD
(transposition of great arteries, systemic ventricle dilation).
Effect of chemical treatments and additives on properties of chicken feathers thermoplastic biocomposites
Authors: Casadesús M , Macanás J , Colom X , Cañavate J , Álvarez MD , Garrido N , Molins G , Carrillo F
Published: March 2018

The valorisation of chicken feathers waste was researched in this work through the preparation of composites using ground chicken feathers as a filler (20% vol/vol) and polypropylene or low-density polyethylene matrices. In order to improve the compatibility between chicken feathers and the matrices, two different strategies were followed: first, by the chemical modification of the chicken feathers by either acetylation or silanization and second, by the addition of adhesion promoters like maleated polypropylene and maleated polyethylene. The effect of those treatments on the physical, mechanical and structural properties of the thermoplastic-chicken feathers biocomposites, which are mainly related to the fibre–matrix compatibility, was analysed. Results show that the addition of 20% (vol/vol) of unmodified chicken feathers to the thermoplastic matrices results in a significant decrease of the tensile strength associated to a weak interfacial adhesion as it was demonstrated by scanning electron microscopy. However, when the adhesion promoters were added to the mixture, a significant increase in the tensile strength was noticed, particularly when the composites were obtained by a process at 180℃. On the contrary, acetylation and silane treatments of the chicken feathers did not result in any practical improvement of the macroscopic properties of the biocomposites.
Feigned Miranda Impairment by Legally Involved Juveniles: The Vulnerability of Forensic Measures and the Development of Effective Screens
Authors: Rogers Richard , Sharf Allyson J. , Henry Sarah A. , Drogin Eric Y.
Published: March 2018

Forensic studies have almost entirely neglected research on adolescent offenders and their abilities to engage in malingering and other forms of deception. The present research represents the first empirical investigation into feigned Miranda-specific impairment by legally involved juveniles. Feigners ( n = 62) were compared with archival data ( n = 245) under genuine conditions. With virtually no preparation, juveniles effectively feigned major impairment on the Miranda Rights Comprehension Instruments (MRCI) and most aggregate scores of the Juvenile Miranda Quiz (JMQ). Based on established detection strategies, feigning scales were examined for both the MRCI and JMQ. Consistent with adult detainee research, the JMQ floor effect (JMQ FE) yielded good sensitivities and very high specificities. Low scale scores on the MRCI Comprehension of Miranda Rights–Recognition-II (CMR-R-II) evidenced strong promise at identifying potential feigners for more extensive evaluations. As discussed, forensic evaluators cannot afford to ignore feigned legal incapacities when examining pre-adjudicated adolescents.
Feeding the City, Feeding the Fortress: Cracow’s Food Supply in World War I
Authors: Ogórek Bartosz
Published: March 2018

This article seeks to analyze the efficiency of the food supply to the city of Cracow during World War I. Several causes of significant drop in food availability in Cracow are discussed: isolation of the city and fortress from the natural food import areas, inconsistent policy of civil and military authorities, and inefficiency of the intraurban food production. However, the decrease in the food supply was visible not only in the falling imports but also in the deterioration of staples’ quality. Both processes had a critical impact on the consumption levels, resulting in the drop of approximately 75 percent in the meat consumption. Finally, the article is intended to contribute significantly to the understanding of how Cracovians’ standard of living changed in wartime with some references to the situation in other European cities.
Women as Pleasure Seekers: Courtesans, Actresses, and Female Visitors in the Amusement Halls of Early Republican Shanghai
Authors: Lam Nga Li
Published: March 2018

Shanghai of the early twentieth century represents the blossoming of urban culture in Modern China. With an extensive research on archival materials, this paper examines the amusement industry of the city by looking into the two major amusement halls, Great World ( da shijie) and New World ( xin shijie), and their associated tabloids, known as “amusement hall newspapers.” Specifically, it asks, “How might have women experienced amusement differently?” With the term pleasure seeker, this study surveys female visitors who were seeking fun in these amusement halls, whose existence has yet to be acknowledged. Second, it questions the presumed relationship between women and pleasure, object and subject of the gaze. It discusses in particular the presence of courtesans, actresses and female audience in such pleasurable mechanism.
Parental involvement in the learning of adolescents with and without ADHD
Authors: Musabelliu Gladiola , Wiener Judith , Rogers Maria
Published: March 2018

This study examined parental involvement in adolescents' learning of parents of 108 adolescents 13- to 18-years of age (54 mothers of adolescents with ADHD, 44 mothers of adolescents without ADHD; 42 fathers of adolescents with ADHD and 35 fathers of adolescents without ADHD). Compared to mothers and fathers of adolescents without ADHD, both mothers and fathers of adolescents with ADHD reported lower self-efficacy in their ability to help their teens on the Parent Involvement Project Questionnaire-Modified (PIPQ-M). On the Parental Support for Learning Scale (PSLS), mothers of adolescents with ADHD perceived themselves as being less supportive and having fewer aspirations regarding their adolescents' future, compared with mothers of adolescents without ADHD. There were no differences between parents of adolescents with and without ADHD in any other aspects of involvement beliefs, experiences, and behaviors according to parent and adolescent report. Implications for school psychology practice are discussed.
Reliability and convergent validity of the Emotional Intelligence Admission Essay Scale, revised
Authors: Gutman Sharon A , Falk-Kessler Janet P
Published: March 2018

Introduction

The purpose of this study was to reassess the reliability and convergent validity of the revised Emotional Intelligence Admission Essay Scale, and determine whether the scale could identify students demonstrating professional behavior problems in the classroom and fieldwork environments.

Method

Thirty-six student participants completed the revised Emotional Intelligence Admission Essay Scale and Schutte Assessing Emotions Scale. Interrater reliability, internal consistency, and convergent validity were established.

Results

Interrater reliability and internal consistency were found to be high (intraclass correlation coefficient = .82, p < .001; Cronbach’s alpha = .96, p < .001, respectively). When participants were separated by age, convergent validity between the Emotional Intelligence Admission Essay Scale and Schutte Assessing Emotions Scale of participants aged ≥ 26 years was high ( rs = .83, p < .002) compared to those ≤ 25 years ( rs = .58, p < .002). Six participants (16.6%) received Emotional Intelligence Admission Essay Scale scores of 0 and were identified as potentially exhibiting professional behavioral problems; three of these students demonstrated professional behavior problems in the academic and/or fieldwork settings.

Conclusion

The Emotional Intelligence Admission Essay Scale can be used as a screen to identify whether students may exhibit professional behavior problems; however, caution should be used as some identified students may be able to prevent professional behavior problems once aware of program expectations.