bluuebunny/crossref_metadata_2025 huggingface dataset:
Linear Time Thermal Simulation of FDM Process
Authors: Zhang Yaqi , Shapiro Vadim
Published: November 2017

Like many other additive manufacturing processes, FDM process is driven by a moving heat source, and temperature history plays an important role in determining the mechanical properties and geometry of the final parts. Thermal simulation of FDM is challenging due to geometric complexity of manufacturing process and inherent computational complexity which requires numerical solution at every time increment of the process.

we describe a new approach to thermal simulation of the FDM process, formulated as an explicit finite difference method that is applied directly on as-manufactured model described by a typical manufacturing process plan. The thermal model accounts for most relevant thermal effects including heat convection and radiation to the environment, heat conduction with build platform and between adjacent roads (and adjacent layers). We show that the proposed simulation method achieves linear time complexity. This implies that the simulation not only scales to handle 3D printed components of arbitrary complexity but also can achieve real-time performance.
Examining the Influence of Solar Panel Installers on Design Innovation and Market Penetration
Authors: Sinitskaya Ekaterina , Gomez Kelley J. , Bao Qifang , Yang Maria C. , MacDonald Erin F.
Published: November 2017

This work uses an agent-based model to examine how installers of photovoltaic (PV) panels influence panel design and the success of residential solar energy. It provides a novel approach to modelling intermediary stakeholder influence on product design, focusing installer decisions instead of the typical solar stakeholder foci of the final customer (homeowners) and the designer/manufacturer. Installers restrict homeowner choice to a subset of all panel options available, and, consequentially, determine medium-term market dynamics in terms of quantity and design specifications of panel installations. This model investigates installer profit-maximization strategies of exploring new panel designs offered by manufacturers vs. exploiting market-tested technology. Manufacturer design decisions and homeowner purchase decisions are modeled. Realistic details provided from installer and homeowner interviews are included. For example, installers must estimate panel reliability instead of trusting manufacturer statistics, and homeowners make purchase decisions based in part on installer reputation. We find that installers pursue new and more-efficient panels over sticking-with market-tested technology under a variety of panel-reliability scenarios and two different state scenarios (California and Massachusetts). Results indicate that it does not matter if installers are predisposed to an exploration or exploitation strategy — both types choose to explore new panels with higher efficiency.
Hybrid Procedure-Based Design Strategies Augmented With Optimization
Authors: Arora Madhav , Luan Siyao , Thurston Deborah L. , Allison James T.
Published: November 2017

Procedure-based design is well-established, supporting engineers via expert knowledge codified in resources such as handbooks, tables, and heuristic if-then rules of thumb. These procedures enable even inexperienced designers to benefit from the knowledge obtained by more experienced counterparts through years of practice and discovery. While procedural approaches have many advantages, they do have limitations. They tend to produce only satisficing, rather than optimal, solutions. In addition, they are based on historical designs, so offer little assistance for new system types, and are often descriptive rather than normative in nature. In contrast, normative methods — such as constrained optimization — can resolve many of these issues, but at the cost of significant development effort. Here we present a synergistic hybrid strategy with the objective of capitalizing on established procedure-based design methods for a subset of design problem elements, while incorporating normative strategies for the remaining elements. A design procedure is analyzed to identify steps that involve specification of design variables, and a subset of rule-based steps that could be replaced with optimization algorithms. A single-stage spur gear train design example is used to illustrate this process, and for comparing alternative hybrid solution strategies. Initial results indicate that solution quality can be improved significantly over purely procedure-based design when incorporating limited optimization elements, while maintaining a reasonable level of additional modeling effort.
Concept Drift and Evolution Detection in Fusion Diagnosis With Evolving Data Streams
Authors: Abdolsamadi Amirmahyar , Wang Pingfeng
Published: November 2017

Health diagnosis interprets data streams acquired by smart sensors and makes inferences about health conditions of an engineering system thereby making critical operational decisions. A data stream is a flow of continuous data that face some challenges in data mining. This paper addresses concept drift and concept evolution as two major challenges in the classification of streaming data. Concept drift occurs as a result of data distribution changes. Concept evolution happens when new classes appear in the stream. These changes may cause the degradation of classification results over time. This paper presents an adaptive fusion learning approach to build a robust classification model. The proposed approach consists of three steps: (i) proposed fusion formulation using weighted majority voting (ii) active learning to labels selectively instead of querying for all true labels (iii) distance-based approach to monitoring the movement of data distribution. A diagnosis case study has been used to demonstrate the developed fusion diagnosis methodology.
CAD-Integrated Cost Estimation and Build Orientation Optimization to Support Design for Metal Additive Manufacturing
Authors: Barclift Michael , Armstrong Andrew , Simpson Timothy W. , Joshi Sanjay B.
Published: November 2017

Cost estimation techniques for Additive Manufacturing (AM) have limited synchronization with the metadata of 3D CAD models. This paper proposes a method for estimating AM build costs through a commercial 3D solid modeling program. Using an application programming interface (API), part volume and surface data is queried from the CAD model and used to generate internal and external support structures as solid-body features. The queried data along with manipulation of the part’s build orientation allows users to estimate build time, feedstock requirements, and optimize parts for AM production while they are being designed in a CAD program. A case study is presented with a macro programmed using the SolidWorks API with costing for a metal 3D-printed automotive component. Results reveal that an imprecise support angle can under-predict support volume by 34% and build time by 20%. Orientation and insufficient build volume packing can increase powder depreciation costs by nearly twice the material costs.
Optimizing Resilience When Designing Engineered Systems
Authors: Hu Chao , MacKenzie Cameron A.
Published: November 2017

Engineering design increasingly seeks to design resilient systems that can withstand adverse events and recover from the effects of the adverse events. The value-driven design for resilience (VD2R) framework enables the assessment of system resilience and the optimization of decision variables (or design characteristics) that maximize the value of the system for a firm. The VD2R framework it assesses the time-dependent resilience of an engineered system by explicitly modeling the redundancy, robustness, and recoverability of the system. This assessment captures the uncertain behavior of degradation and restoration and their impact on system resilience. Second, it encompasses a value model that links time-dependent system resilience to a design firm’s future profit. The firm can consider the trade-offs between designing a more resilient but costly system and generating less profit after the system is fielded. It facilitates the understanding of how resilience adds value to a firm, a key enabler for determining the optimal level of system resilience. The proposed framework is demonstrated with an illustrative case study, where the resilience of a series-parallel system is modeled and its design characteristics optimized.
Competitive chiral induction in a 2D molecular assembly: Intrinsic chirality versus coadsorber-induced chirality
Authors: Chen Ting , Li Shu-Ying , Wang Dong , Wan Li-Jun
Published: November 2017

Chiral coadsorber overrules expression of intrinsic molecular chirality in 2D molecular assembly.
A remote C–C bond cleavage–enabled skeletal reorganization: Access to medium-/large-sized cyclic alkenes
Authors: Li Lei , Li Zhong-Liang , Gu Qiang-Shuai , Wang Na , Liu Xin-Yuan
Published: November 2017

We report a radical-mediated skeletal reorganization for the synthesis of medium-/large-sized cyclic alkenes.
The spin Nernst effect in tungsten
Authors: Sheng Peng , Sakuraba Yuya , Lau Yong-Chang , Takahashi Saburo , Mitani Seiji , Hayashi Masamitsu
Published: November 2017

The spin Nernst effect, direct conversion of heat current to spin current, is observed in W/CoFeB/MgO heterostructures.
Candidalysin sets off the innate alarm
Authors: Li Xin , Leonardi Irina , Iliev Iliyan D.
Published: November 2017

Candidalysin-induced epithelial cell damage promotes expansion of innate TCRαβ
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Teaching an old pathway new tricks: Targeting BTK to block NLRP3
Authors: Henrickson Sarah E.
Published: November 2017

A proteomics screen identified BTK as a novel inflammasome regulator and demonstrated that blocking BTK can inhibit inflammasome activity.
Oral injuries and occult harm in children evaluated for abuse
Authors: Dorfman Molly V , Metz James B , Feldman Kenneth W , Farris Reid , Lindberg Daniel M
Published: November 2017

Objective

To determine the frequency of occult trauma in children with oral injury evaluated for physical abuse.

Design

This was a retrospectively planned secondary analysis of a prospective, observational study.

Setting

Emergency departments supported by 20 US child abuse teams in the Examining Siblings to Recognize Abuse (ExSTRA) network.

Patients

Children <120 months old evaluated for physical abuse.

Interventions

Analysis of index children with oral injury on initial examination.

Main outcome measures

Rates of physician-recognised oral injury, as well as frequency and results of occult injury testing. Perceived abuse likelihood was described on a 7-point scale (7=definite abuse).

Results

Among 2890 child abuse consultations, 3.3% (n=96) of children had oral injury. Forty-two per cent were 0–12 months old, 39% 1–3 years old and 18% >3 years old. Oral injury was the primary reason for evaluation for 32 (33%). Forty-three per cent (42/96) had frenum injuries. Skeletal surveys were obtained for 84% and 25% of these identified occult fractures. Seventy-five per cent had neuroimaging; 38% identified injuries. Forty-one per cent of children with oral injuries had retinal examinations; 24% of exams showed retinal haemorrhages. More occult injuries were found in children with oral injuries than other ExSTRA subjects. A high level of concern for abusive injury was present in 67% of children with oral injury versus 33% without.

Conclusions

Children with oral injury are at high risk for additional occult abusive injuries. Infants and mobile preschoolers are at risk. Young children with unexplained oral injury should be evaluated for abuse.
A rare localised nasal CD30+primary cutaneous T-cell lymphoma following liver transplantation
Authors: Nhu Quan M , Du Emma Z , Kiyani Amirali , Frenette Catherine T
Published: November 2017

Cutaneous T-cell post-transplant lymphoproliferative disorder (PTLD) is a rare clinical presentation that can potentially turn aggressive in solid-organ transplant recipients if not detected and intervened on early. We encountered a rare case of rapidly worsening primary cutaneous CD30-positive, Epstein-Barr virus-negative anaplastic large cell lymphoma (ALCL) of T-cell origin, manifesting as an isolated nasal tip lesion in a 71-year-old man 4 years after orthotopic liver transplantation. Excisional biopsy with partial rhinectomy showed subepithelial diffuse infiltration of medium-to-large lymphoid cells having round-to-irregular nuclei, partially condensed chromatin and prominent nucleoli. Immunophenotypic studies revealed CD30-positive primary cutaneous ALCL. Positron emission tomography/CT imaging revealed a locally active disease, and radiation therapy was initiated with complete response. A high index of suspicion for PTLD when evaluating skin lesions in a post-transplant patient is paramount for its early recognition, prompt diagnosis and timely intervention while the window for curative therapy remains possible.
Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective
Authors: Alhajji Dalal , Amaral Mendes Rui
Published: November 2017

A 64-year-old institutionalised woman presented to our clinic for the management of black hairy tongue. Despite the predictable outcome in treating this disease, this case presents multiple challenges such as the patients’ cognitive impairment, her family dynamics, social factors and the health system as a whole, that makes it difficult to treat.
How to adapt existing evidence-based clinical practice guidelines: a case example with smoking cessation guidelines in Canada
Authors: Selby Peter , Hunter Katie , Rogers Jess , Lang-Robertson Kelly , Soklaridis Sophie , Chow Virginia , Tremblay Michèle , Koubanioudakis Denise , Dragonetti Rosa , Hussain Sarwar , Zawertailo Laurie
Published: November 2017

Objective

To develop and encourage the adoption of clinical practice guidelines (CPGs) for smoking cessation in Canada by engaging stakeholders in the adaptation of existing high-quality CPGs using principles of the ADAPTE framework.

Methods

An independent expert body in guideline review conducted a review and identified six existing CPGs, which met a priori criteria for quality and potential applicability to the local context. Summary statements were extracted and assigned a grade of recommendation and level of evidence by a second expert panel. Regional knowledge exchange brokers recruited additional stakeholders to build a multidisciplinary network of over 800 clinicians, researchers and decision-makers from across Canada. This interprofessional network and other stakeholders were offered various opportunities to provide input on the guideline both online and in person. We actively encouraged end-user input into the development and adaptation of the guidelines to ensure applicability to various practice settings and to promote adoption.

Results

The final guideline contained 24 summary statements along with supporting clinical considerations, across six topic area sections. The guideline was adopted by various provincial/territorial and national government and non-governmental organisations.

Conclusions

This method can be applied in other jurisdictions to adapt existing high-quality smoking cessation CPGs to the local context and to facilitate subsequent adoption by various stakeholders.
Association between coagulation function and patients with primary angle closure glaucoma: a 5-year retrospective case–control study
Authors: Li Shengjie , Gao Yanting , Shao Mingxi , Tang Binghua , Cao Wenjun , Sun Xinghuai
Published: November 2017

Objective

To evaluate the association between coagulation function and patients with primary angle closure glaucoma (PACG).

Design

A retrospective, hospital-based, case–control study.

Setting

Shanghai, China.

Participants

A total of 1778 subjects were recruited from the Eye & ENT Hospital of Fudan University from January 2010 to December 2015, including patients with PACG (male=296; female=569) and control subjects (male=290; female=623).

Outcome measures

Sociodemographic data and clinical data were collected. The one-way analysis of variance test was used to compare the levels of laboratory parameters among the mild, moderate and severe PACG groups. Multivariate logistic regression analyses were performed to identify the independent risk factors for PACG. The nomogram was constructed based on the logistic regression model using the R project for statistical computing (R V.3.3.2).

Results

The activated partial thromboplastin time (APTT) of the PACG group was approximately 4% shorter (p<0.001) than that of the control group. The prothrombin time (PT) was approximately 2.40% shorter (p<0.001) in patients with PACG compared with the control group. The thrombin time was also approximately 2.14% shorter (p<0.001) in patients with PACG compared with the control group. The level of D-dimer was significantly higher (p=0.042) in patients with PACG. Moreover, the mean platelet volume (MPV) of the PACG group was significantly higher (p=0.013) than that of the control group. A similar trend was observed when coagulation parameters were compared between the PACG and control groups with respect to gender and/or age. Multiple logistic regression analyses revealed that APTT (OR=1.032, 95% CI 1.000 to 1.026), PT (OR=1.249, 95% CI 1.071 to 1.457) and MPV (OR=1.185, 95% CI 1.081 to 1.299) were independently associated with PACG.

Conclusion

Patients with PACG had a shorter coagulation time. Our results suggest that coagulation function is significantly associated with patients with PACG and may play an important role in the onset and development of PACG.
Process evaluation of a primary healthcare validation study of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people: study protocol
Authors: Farnbach Sara , Evans John , Eades Anne-Marie , Gee Graham , Fernando Jamie , Hammond Belinda , Simms Matty , DeMasi Karrina , Hackett Maree
Published: November 2017

Introduction

Process evaluations are conducted alongside research projects to identify the context, impact and consequences of research, determine whether it was conducted per protocol and to understand how, why and for whom an intervention is effective. We present a process evaluation protocol for the Getting it Right research project, which aims to determine validity of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people. In this process evaluation, we aim to: (1) explore the context, impact and consequences of conducting Getting It Right, (2) explore primary healthcare staff and community representatives’ experiences with the research project, (3) determine if it was conducted per protocol and (4) explore experiences with the depression screening tool, including perceptions about how it could be implemented into practice (if found to be valid). We also describe the partnerships established to conduct this process evaluation and how the nationalValues and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Researchis met.

Methods and analysis

Realist and grounded theory approaches are used. Qualitative data include semistructured interviews with primary healthcare staff and community representatives involved with Getting it Right. Iterative data collection and analysis will inform a coding framework. Interviews will continue until saturation of themes is reached, or all participants are considered. Data will be triangulated against administrative data and patient feedback. An Aboriginal and Torres Strait Islander Advisory Group guides this research. Researchers will be blinded from validation data outcomes for as long as is feasible.

Ethics and dissemination

The University of Sydney Human Research Ethics Committee, Aboriginal Health and Medical Research Council of New South Wales and six state ethics committees have approved this research. Findings will be submitted to academic journals and presented at conferences.

Trial registration number

ACTRN12614000705684.
Evidence of accessibility and utility of point-of-care diagnostics as an integral part of prevention of mother-to-child transmission services: systematic scoping review protocol
Authors: Katoba Juliet , Hangulu Lydia , Mashamba-Thompson Tivani Phosa
Published: November 2017

Introduction

Point-of-care (POC) testing has been shown to help improve healthcare access in resource-limited settings. However, there is paucity of evidence on accessibility of POC testing for prevention of mother-to-child transmission (PMTCT) in resource-limited settings. We propose to conduct a systematic scoping review to map the evidence on POC testing services for PMTCT.

Methods and analysis

A scoping review framework, proposed by Arksey and O’Malley, will guide the study. A comprehensive literature search will be performed in the following electronic databases: PubMed, Science Direct, Cochrane Central, Google Scholar and databases within EBSCOhost (Medline and CINAHL). The primary research articles published in peer-reviewed journals and grey articles addressing our question will be included. One reviewer will conduct title screening and the results will be exported to endnote library. Two independent reviewers will perform abstract, then full article screening in parallel. The same process shall be employed to extract data from eligible studies. Data analysis will involve a narrative summary of included studies and thematic content analysis aided by NVIVO software V.11. The mixed methods assessment tool will be used to assess the quality of studies that will be included.

Ethics and dissemination

Ethical approval is not applicable to this study. The study findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences related to syphilis, HIV, PMTCT, bacterial infections and POC diagnostics.

Trial registration number

CRD42017056267.
Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach
Authors: Ni Melody Zhifang , Huddy Jeremy R , Priest Oliver H , Olsen Sisse , Phillips Lawrence D , Bossuyt Patrick M M , Hanna George B
Published: November 2017

Objectives

The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1–9.

Materials and methods

We mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0–100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs.

Results

The pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky.

Discussion

The safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements.

Conclusions

The pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.

Trial registration number

ISRCTN11170249; Pre-results.
Prostatectomy versus radiotherapy for early-stage prostate cancer (PREPaRE) study: protocol for a mixed-methods study of treatment decision-making in men with localised prostate cancer
Authors: Smith Allan Ben , Mancuso Pascal , Sidhom Mark , Wong Karen , Berry Megan , Rincones Orlando , Forstner Dion , Bokey Lesley , Girgis Afaf
Published: November 2017

Background

Men diagnosed with localised prostate cancer (LPC) wanting curative treatment face a highly preference-sensitive choice between prostatectomy and radiotherapy, which offer similar cure rates but different side effects. This study aims to determine the information, decision-making needs and preferences of men with LPC choosing between robotic prostatectomy and standard external beam or stereotactic radiotherapy.

Methods and analysis

This study will be conducted at a large public teaching hospital in Australia offering the choice between robotic prostatectomy and radiotherapy from early 2017. Men (20–30) diagnosed with LPC who want curative treatment and meet criteria for either treatment will be invited to participate. In this mixed-methods study, patients will complete semistructured interviews before and after attending a combined clinic in which they consult a urologist and a radiation oncologist regarding treatment and four questionnaires (one before treatment decision-making and three after) assessing demographic and clinical characteristics, involvement in decision-making, decisional conflict, satisfaction and regret. Combined clinic consultations will also be audio-recorded and clinicians will report their perceptions regarding patients’ suitability for, openness to and preferences for each treatment. Qualitative data will be transcribed verbatim and thematically analysed and descriptive statistical analyses will explore quantitative decision-making outcomes, with comparison according to treatment choice.

Discussion

Results from this study will inform how to best support men diagnosed with LPC deciding which curative treatment option best suits their needs and may identify the need for and content required in a decision aid to support these men.

Ethics and dissemination

All participants will provide written informed consent. Data will be rigorously managed in accordance with national legislation. Results will be disseminated via presentations to both scientific and layperson audiences and publications in peer-reviewed scientific journals.
Prospective cohort study to investigate the burden and transmission of acute gastroenteritis in care homes: a study protocol
Authors: Inns Thomas , Pulawska-Czub Anna , Harris John P , Vivancos Roberto , Read Jonathan M , Beeching Nicholas J , Allen David J , Iturriza-Gomara Miren , O’Brien Sarah J
Published: November 2017

Introduction

Noroviruses are the leading cause of acute gastroenteritis in all age groups, but illness is more severe and causes excess mortality in the elderly, particularly those in long-term care. The total burden of norovirus disease in the elderly in the UK is poorly defined; no current surveillance programmes systematically or accurately quantify norovirus infection in those living in care homes. The aim of this study is to evaluate an enhanced surveillance system for acute gastroenteritis among the elderly in care homes.

Methods and analysis

We will conduct this prospective cohort study in care homes in North West England; residents and staff at study care homes will be asked to participate. We will prospectively enrol a cohort of participants in an enhanced surveillance system to capture the incidence of acute gastroenteritis and use multiplex PCR to detect pathogens. We will sample symptomatic and non-symptomatic participants to understand characteristics of norovirus disease and susceptibility to infection. We will generate novel data on transmission dynamics by collecting data on the pattern of interactions within care homes using electronic proximity sensors. Comparisons of outbreak and non-outbreak periods will be used to quantify the impact of norovirus outbreaks on care homes.

Ethics and dissemination

The study has been approved by the North West–Greater Manchester South NHS Research Ethics Committee (REC Reference: 16/NW/0541). Study outputs will be disseminated through scientific conferences and peer-reviewed publications. This study will provide detailed insight on the burden and aetiology of acute gastroenteritis in care homes, in addition to generating novel data on transmission dynamics and risks. The study will identify areas for improving infection control practice and allow more accurate modelling of the introduction of interventions such as vaccination.
ARDS following oesophagectomy: a comparison of two trials
Authors: Howells Phillip A , Aldridge Kerrie A , Parekh Dhruv , Park Daniel , Tucker Olga , Dancer Rachel C A , Gao Fang , Perkins Gavin D , Thickett David R
Published: November 2017

Introduction

The Beta Agonist Lung Injury Trial-Prevention (BALTI-P) translational substudy and Vitamin D to Prevent Acute Lung Injury Following Oesophagectomy (VINDALOO) trials recruited patients undergoing oesophagectomy, 4 years apart. The acute respiratory distress syndrome (ARDS) rates were lower in the VINDALOO trial. We sought to identify changes between these two trials and identify risk factors for ARDS in oesophagectomy.

Methods

There were data available from 61 patients in the BALTI-P substudy and 68 from VINDALOO. Databases were available for both trials; additional data were collected. Multivariate logistic regression was used to analyse risk factors for ARDS and postoperative complications in the cohorts combined.

Results

Logistic regression analysis showed active smoking was associated with an increase in ARDS (OR 3.91; 95% CI 1.33 to 11.5) and dihydropyridine use (OR 5.34;95% CI 1.56 to 18.3). Hospital length of stay was longer for those who took dihydropyridines (median 29 days (IQR 17–42) vs 13 days (IQR 10–18), P=0.0007) or were diabetic (median 25 days (IQR 14–39) vs 13 (IQR 10–19), P=0.023) but not for current smokers (median in never/ex-smokers 13 (IQR 10–23) vs current smokers 15 (IQR 11–20), P=0.73).

Conclusions

Smoking cessation trials should be promoted. Dihydropyridine effects perioperatively require further clinical and mechanistic evaluation. Patients undergoing oesophagectomy are a useful model for studying perioperative ARDS.
A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?
Authors: Rouse Colin , Hayre Jefferson , French James , Fraser Jacqueline , Watson Ian , Benjamin Susan , Chisholm Allison , Sealy Beth , Erdogan Mete , Green Robert S , Stoica George , Atkinson Paul
Published: November 2017

Background

Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems.

Methods

This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common Injury Severity Score (ISS) collected by both registries was ISS≥13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher’s exact test and the Student’s t-test.

Results

101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR 1.98, 95% CI 0.66 to 5.99; p=0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS>24) there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR 1.96, 95% CI 0.40 to 9.63; p=0.50).

Conclusion

Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded.
Gastric microbial community profiling reveals a dysbiotic cancer-associated microbiota
Authors: Ferreira Rui M , Pereira-Marques Joana , Pinto-Ribeiro Ines , Costa Jose L , Carneiro Fatima , Machado Jose C , Figueiredo Ceu
Published: November 2017

Objective

Gastric carcinoma development is triggered by Helicobacter pylori. Chronic H. pylori infection leads to reduced acid secretion, which may allow the growth of a different gastric bacterial community. This change in the microbiome may increase aggression to the gastric mucosa and contribute to malignancy. Our aim was to evaluate the composition of the gastric microbiota in chronic gastritis and in gastric carcinoma.

Design

The gastric microbiota was retrospectively investigated in 54 patients with gastric carcinoma and 81 patients with chronic gastritis by 16S rRNA gene profiling, using next-generation sequencing. Differences in microbial composition of the two patient groups were assessed using linear discriminant analysis effect size. Associations between the most relevant taxa and clinical diagnosis were validated by real-time quantitative PCR. Predictive functional profiling of microbial communities was obtained with PICRUSt.

Results

The gastric carcinoma microbiota was characterised by reduced microbial diversity, by decreased abundance of Helicobacter and by the enrichment of other bacterial genera, mostly represented by intestinal commensals. The combination of these taxa into a microbial dysbiosis index revealed that dysbiosis has excellent capacity to discriminate between gastritis and gastric carcinoma. Analysis of the functional features of the microbiota was compatible with the presence of a nitrosating microbial community in carcinoma. The major observations were confirmed in validation cohorts from different geographic origins.

Conclusions

Detailed analysis of the gastric microbiota revealed for the first time that patients with gastric carcinoma exhibit a dysbiotic microbial community with genotoxic potential, which is distinct from that of patients with chronic gastritis.
Induction of Deubiquitinating Enzyme USP50 during Erythropoiesis and its Potential Role in the Regulation of Ku70 Stability
Authors: Cai Junting , Wei Jianxin , Schrott Valerie , Zhao Jing , Bullock Grant , Zhao Yutong
Published: November 2017

Anemia is a very common blood disorder that affects the lives of billions of people worldwide. Anemia is caused by the loss of blood, increased destruction of red blood cells (RBCs), or reduced production of RBCs. Erythropoiesis is the complex process of RBC differentiation and maturation, in which protein degradation plays a crucial role. Protein ubiquitination regulates programmed protein degradation, which can be reversed by deubiquitinating enzymes (DUBs); however, the role of DUBs in erythropoiesis has not been well studied. We examined the expression of DUBs during erythropoiesis using an ex vivo human CD34+ hematopoietic progenitor cell culture system. Here we show that ubiquitin-specific protease 50 (USP50) levels are increased during erythropoiesis. USP50 mRNA levels are significantly increased on day 3 and protein levels are elevated on day 9 of erythroid differentiation. Coimmunoprecipitation and proteomics analyses reveal that Ku70, a DNA-binding protein, is associated with USP50. Overexpression of USP50 has no effect on Ku70 mRNA levels, while it reduces Ku70 protein levels by promoting Ku70 degradation, suggesting that USP50 may indirectly regulate Ku70 protein stability. USP50 protein is also not stable. USP50 protein degradation is independent of the proteasomal and the lysosomal degradation systems. This study suggests that DUBs like USP50 may regulate protein stability during erythropoiesis; however, more investigation is warranted.
Do-not-attempt-resuscitation (DNAR) orders: understanding and interpretation of their use in the hospitalised patient in Ireland. A brief report
Authors: O’Brien Helen , Scarlett Siobhan , Brady Anne , Harkin Kieran , Kenny Rose Anne , Moriarty Jeanne
Published: November 2017

Following the introduction of do-not-resuscitate (DNR) orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate (DNAR), decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5% (187/527), 19.8% (292/1477) in the nurses group but 68.8% (150/218) in the specialist nurses group and 40% (40/100) in the primary care physician group.

Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences (p<0.001). Furthermore, a higher percentage of staff nurses (26.8%) and primary care physicians (22.5%) believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups (p<0.001). Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans.
Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study
Authors: Tseng Joshua , Loper Brandi , Jain Monica , Lewis Azaria V , Margulies Daniel R , Alban Rodrigo F
Published: November 2017

Background

Surgical intervention for ischemic colitis is associated with significant postoperative morbidity and mortality. Predictive factors of adverse outcomes have been reported in the literature, but are based on small sample populations. We sought to identify risk factors for mortality after emergent colectomy for ischemic colitis using a clinical outcomes database.

Methods

The American College of Surgeons National Surgical Quality Improvement Project database was queried from 2010 to 2015 to identify emergent colectomies performed for ischemic colitis using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Univariate and multivariate logistic regression analysis was used to identify independent risk factors associated with increased risk of mortality.

Results

A total of 4548 patients undergoing emergent colectomies for ischemic colitis were identified. Overall, 30-day postoperative mortality was 25.3%. On univariate analysis, preoperative risk factors associated with a higher rate of mortality include dyspnea, functional status, ventilator dependency, history of chronic obstructive pulmonary disease, ascites, congestive heart failure exacerbation, hypertension, dialysis dependency, cancer, open wounds, chronic steroids, weight loss >10%, transfusions within 72 hours before surgery, septic shock and duration from hospital admission to surgery. Factors that were significant for mortality on logistic regression analysis include elderly age, poor functional status, multiple comorbidities, septic shock, blood transfusion, acute renal failure and the duration of time from hospital admission to surgery.

Conclusions

Postoperative morbidity and mortality rates for ischemic colitis remain significantly high. Identification of risk factors may help patient selection for surgical interventions, and make informed decisions with patients and family members. Although it is certainly challenging, early diagnosis and prompt surgical intervention for patients with ischemic colitis may improve outcomes.

Study type and level of evidence

Therapeutic/care management, level II
NF-κB at the Crossroads of Normal Mammary Gland Biology and the Pathogenesis and Prevention of BRCA1-Mutated Breast Cancer
Authors: Sau Andrea , Cabrita Miguel A. , Pratt M.A. Christine
Published: November 2017

Recent studies have shown that progesterone receptor (PR)–expressing cells respond to progesterone in part through the induction of the receptor activator of NF-κB ligand (RANKL), which acts in a paracrine manner to induce expansion of a RANK-expressing luminal progenitor cell population. The RANK+ population in human breast tissue from carriers of BRCA1 mutations (BRCA1mut/+) as well as the luminal progenitor population in Brca1-deficient mouse mammary glands is abnormally amplified. Remarkably, mouse Brca1+/− and human BRCA1mut/+ progenitor cells are able to form colonies in vitro in the absence of progesterone, demonstrating a hormone-independent proliferative capacity. Our research has demonstrated that proliferation in BRCA1-deficient cells results in a DNA damage response (DDR) that activates a persistent NF-κB signal, which supplants progesterone/RANKL signaling for an extended time period. Thus, the transcriptional targets normally activated by RANKL that promote a proliferative response in luminal progenitors can contribute to the susceptibility of mammary epithelial cells to BRCA1-mutated breast cancers as a consequence of DDR-induced NF-κB. Together, these latest findings mark substantial progress in uncovering the mechanisms driving high rates of breast tumorigenesis in BRCA1 mutation carriers and ultimately reveal possibilities for nonsurgical prevention strategies. Cancer Prev Res; 11(2); 69–80. ©2017 AACR.
Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
Authors: Ogawa Aiko , Satoh Toru , Fukuda Tetsuya , Sugimura Koichiro , Fukumoto Yoshihiro , Emoto Noriaki , Yamada Norikazu , Yao Atsushi , Ando Motomi , Ogino Hitoshi , Tanabe Nobuhiro , Tsujino Ichizo , Hanaoka Masayuki , Minatoya Kenji , Ito Hiroshi , Matsubara Hiromi
Published: November 2017

Background—

Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy—the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry.

Methods and Results—

A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent follow-up right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%–98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%–97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients.

Conclusions—

This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
Counterclockwise and Clockwise Rotation of QRS Transitional Zone: Prospective Correlates of Change and Time‐Varying Associations With Cardiovascular Outcomes
Authors: Patel Siddharth , Kwak Lucia , Agarwal Sunil K. , Tereshchenko Larisa G. , Coresh Josef , Soliman Elsayed Z. , Matsushita Kunihiro
Published: November 2017

Background

A few studies have recently reported clockwise and counterclockwise rotations of
QRS
transition zone as predictors of mortality. However, their prospective correlates and associations with individual cardiovascular disease (
CVD
) outcomes are yet to be investigated.

Methods and Results

Among 13 567
ARIC
(Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite
CVD
(4124 events), 898
CVD
deaths, and 3469 non‐
CVD
deaths over 23 years of follow‐up. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow‐up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20; 95% confidence interval [CI], 1.02–1.41) and non‐
CVD
death (hazard ratio, 1.28; 95% CI, 1.12–1.46) after adjusting for potential confounders including other ECG parameters. On the contrary, counterclockwise rotation was significantly related to lower risk of composite
CVD
(hazard ratio, 0.93; 95% CI, 0.87–0.99]),
CVD
mortality (hazard ratio, 0.76; 95% CI, 0.65–0.88), and non‐
CVD
deaths (hazard ratio, 0.92; 95% CI, 0.85–0.99 [borderline significance with heart failure]).

Conclusions

Counterclockwise rotation, the most prevalent
QRS
transition zone pattern, demonstrated the lowest risk of
CVD
and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non‐
CVD
mortality. These results have implications on how to interpret
QRS
transition zone rotation when ECG was recorded.
A Comparison of Perceptions of Barriers to Academic Success Among High-Ability Students From High- and Low-Income Groups: Exposing Poverty of a Different Kind
Authors: Cross Jennifer Riedl , Frazier Andrea Dawn , Kim Mihyeon , Cross Tracy L.
Published: November 2017

In 14 focus group interviews, sixth- to eighth-grade high-ability students from high- ( n = 36) and low-income ( n = 45) families were asked to describe the barriers they perceived to their academic success. Three themes were identified through the qualitative analysis: Constraining Environments, Integration versus Isolation, and Resource Plenty versus Resource Poor. Students in both groups experienced environments not conducive to learning, inhibiting peers, and teachers as a barrier. Students in the low-income group described mayhem in their schools, which interfered significantly with learning. These students were highly integrated in their school community, whereas the students in the high-income group were socially isolated from both peers and teachers. Both groups exhibited issues of poor fit within their schools: autonomy and competence for both, relatedness for students in the high-income group. Attention to these issues will help support these students in achieving their potential.