bluuebunny/crossref_metadata_2025 huggingface dataset:
Parametric Study of Combined Cooling and Power (CCP) Plant Integrated with Parabolic Trough Solar Collectors (PTSCs)
Authors: Khatti Shakir Shakoor , Memon Abdul Ghafoor , Qureshi Samiullah
Published: June 2019

This study presents a detailed energy analysis of a Combined Cooling and Power (CCP) plant operated by Parabolic Trough Solar Collectors (PTSCs). The integrated cycles; Vapor Absorption Refrigeration Cycle (VARC) and Organic Rankine Cycle (ORC) are used to produce cooling and power, respectively. Six organic working fluids, namely, R113, R141b, R123, R245fa, R142b, and isobutane were selected for ORC, while LiBr-H2O solution used in VARC. Four key energetic parameters, useful heat gain, work output, cooling rate, and energy utilization factor (EUF) were examined during varying direct normal irradiance (DNI). A parametric study was carried out in three modes of operation, power only, combined power and cooling and cooling only under the limits of DNI from 0.6 kW/m2to 0.88 kW/m2recorded on the yearly-average basis in two cities of Pakistan, Lahore, and Quetta respectively. Results enunciated that R113 given the highest thermal efficiency of 17.12%, while isobutane gave the least thermal efficiency of 7.88%, hence R113 was chosen as organic working fluid for further study. The maximumEUF was found in the cooling mode of operation which increased from 63.95% to 66.79% at 0.6 kW/m2 and 0.88 kW/m2 respectively. During the combined cooling and power mode, maximum cooling rate, power output, and EUF were 3456 kW, 822.5 kW, and 41.34% respectively at 0.88 kW/m2.
Reliability Evaluation Algorithm for Distribution Network with DG
Authors: Shenghui Li , Feng Sun , Yu Zhu , Xue Bai
Published: June 2019

The paper proposed reliability evaluation algorithm for distribution network considering the act of weather and DG, the algorithm develops weather model for average failure rate to shows the influence of normal weather and adverse weather on distribution network reliability. Then, the optimal island partition method is proposed to determine the power supply scope after power failure. The improved minimal path method is employs to calculate the reliability index of distribution network with DG. The test covers four cases including without DG and weather, only DG, only weather, and both DG and weather are calculated and compared from the aspects of load points, feeders and system reliability indices. The results about SAIFI, SAIDI, CAIDI and ASAI show that the proposed algorithm can take the influence of distributed power supply and weather into account. The impact of distributed generation and adverse weather on distribution network reliability is studied. Considering both DG and weather, the reliability of distribution network can reflect the actual condition more accurately, which proves the validity of the method and the model.
Uniaxial Tensile Test of Waste Glass Powder Concrete at Different Loading Rates
Authors: Li Shirui , Gan Yuanchu , Ke Guojun
Published: June 2019

Test method by direct stretching. The failure modes and failure mechanisms of concrete specimens with 0%, 10% and 20% of waste glass powder at five different loading rates were studied. The uniaxial tensile view of waste glass powder concrete was established by using parallel-bar model PBS. The damage model is the modified parallel model, and the damage relationship is very similar to the stress-strain curve in the test. It shows that the concrete uniaxial tension meso-damage model can be used in this test. The ultimate tensile strength of waste glass powder concrete increases with the increase of loading rate. The relationship between dynamic tensile strength and loading rate is studied. The linear regression fit is applied to the influence of loading rate and dynamic tensile strength to obtain dynamic tensile strength. The increment is approximately related to the loading rate.
arcasHLA: high-resolution HLA typing from RNAseq
Authors: Orenbuch Rose , Filip Ioan , Comito Devon , Shaman Jeffrey , Pe’er Itsik , Rabadan Raul
Published: June 2019

Motivation

The human leukocyte antigen (HLA) locus plays a critical role in tissue compatibility and regulates the host response to many diseases, including cancers and autoimmune di3orders. Recent improvements in the quality and accessibility of next-generation sequencing have made HLA typing from standard short-read data practical. However, this task remains challenging given the high level of polymorphism and homology between HLA genes. HLA typing from RNA sequencing is further complicated by post-transcriptional modifications and bias due to amplification.

Results

Here, we present arcasHLA: a fast and accurate in silico tool that infers HLA genotypes from RNA-sequencing data. Our tool outperforms established tools on the gold-standard benchmark dataset for HLA typing in terms of both accuracy and speed, with an accuracy rate of 100% at two-field resolution for Class I genes, and over 99.7% for Class II. Furthermore, we evaluate the performance of our tool on a new biological dataset of 447 single-end total RNA samples from nasopharyngeal swabs, and establish the applicability of arcasHLA in metatranscriptome studies.

Availability and implementation

arcasHLA is available at https://github.com/RabadanLab/arcasHLA.

Supplementary information

Supplementary data are available at Bioinformatics online.
Complicated Disease and Response to Initial Therapy Predicts Early Surgery in Paediatric Crohn’s Disease: Results From the Porto Group GROWTH Study
Authors: Levine Arie , Chanchlani Neil , Hussey Seamus , Ziv-Baran Tomer , Escher Johanna C , Amil Dias Jorge , Veres Gabor , Koletzko Sibylle , Turner Dan , Kolho Kaija-Leena , Paerregaard Anders , Staiano Annamaria , Lionetti Paolo , Nuti Federica , Sladek Malgorata , Shaoul Ron , Lazowska-Prezeorek Isabella , Martin de Carpi Javier , Sigall Boneh Rotem , Pfeffer Gik Tamar , Cohen-Dolev Noa , Russell Richard K
Published: June 2019

Introduction

The ability to predict risk for poor outcomes in Crohn’s disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis.

Methods

Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery.

Results

Of 285 children enrolled, 31 [10.9%] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95% confidence interval [CI] 2.02–13.67 [p = 0.001]), and Paediatric Crohn’s Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95% CI 1.02–1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6%], corticosteroid-free remission at week 12 [4.1%] and early immunomodulator therapy [0.8%] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1%, p < 0.001] or elevated PCDAI at week 12 [16.7%, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients.

Discussion

A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.
Digoxin–mortality: randomized vs. observational comparison in the DIG trial
Authors: Aguirre Dávila Lukas , Weber Kristina , Bavendiek Udo , Bauersachs Johann , Wittes Janet , Yusuf Salim , Koch Armin
Published: June 2019

Aims

The Digitalis Investigation Group (DIG) trial, the only large randomized trial of digoxin in heart failure, reported a neutral effect on mortality and a significant reduction in heart failure hospitalizations. Recent observational studies reported increased mortality with digoxin treatment. We present further analyses of the DIG trial displaying the inability to control bias in observational treatment comparisons despite extensive statistical adjustments.

Methods and results

Forty-four percent of the 6800 patients in the DIG trial had been treated with digoxin before randomization, and half of them were randomly withdrawn from digoxin treatment. We contrast the main randomization-based result of the DIG trial with the observational non-randomized comparison of patients pre-treated or not pre-treated with digoxin. Mortality [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.12–1.34; P < 0.001] and heart failure hospitalizations (HR 1.47, 95% CI 1.33–1.61; P < 0.001) were significantly higher in patients pre-treated with digoxin even after adjustment for baseline population differences. The higher risks for both outcomes in those who had previously received digoxin persisted even if they received placebo during the trial (HR 1.24, 95% CI 1.10–1.40; P < 0.001). This sharply contradicts the neutral effect on mortality and the significant reduction in heart failure hospitalizations observed in the randomized comparison.

Conclusion

Prescription of digoxin is an indicator of disease severity and worse prognosis, which cannot be fully accounted for by covariate adjustments in the DIG trial where patients were well-characterized. It is unlikely that weaker research approaches (observational studies of administrative data or registries) can provide more reliable estimates of the effects of cardiac glycosides.
Loss of Wood Formation Genes in Monocot Genomes
Authors: Roodt Danielle , Li Zhen , Van de Peer Yves , Mizrachi Eshchar
Published: June 2019

Woodiness (secondary xylem derived from vascular cambium) has been gained and lost multiple times in the angiosperms, but has been lost ancestrally in all monocots. Here, we investigate the conservation of genes involved in xylogenesis in fully sequenced angiosperm genomes, hypothesizing that monocots have lost some essential orthologs involved in this process. We analyzed the conservation of genes preferentially expressed in the developing secondary xylem of two eudicot trees in the sequenced genomes of 26 eudicot and seven monocot species, and the early diverging angiosperm Amborella trichopoda. We also reconstructed a regulatory model of early vascular cambial cell identity and differentiation and investigated the conservation of orthologs across the angiosperms. Additionally, we analyzed the genome of the aquatic seagrass Zostera marina for additional losses of genes otherwise essential to, especially, secondary cell wall formation. Despite almost complete conservation of orthology within the early cambial differentiation gene network, we show a clear pattern of loss of genes preferentially expressed in secondary xylem in the monocots that are highly conserved across eudicot species. Our study provides candidate genes that may have led to the loss of vascular cambium in the monocots, and, by comparing terrestrial angiosperms to an aquatic monocot, highlights genes essential to vasculature on land.
The Lure of Novelty: “Targeted Killing” and Its Older Terminological Siblings
Authors: Schweiger Elisabeth
Published: June 2019

The concept “targeted killing” has been increasingly adopted in scholarship, policy, and media discourses, particularly in the context of US armed drone attacks. While “targeted killing” is often understood as something new, there are strong historical continuities with more traditional concepts such as “assassination” and “extra-judicial execution,” as well as with the colonial concept “police bombing.” This paper builds on an analysis of over nine hundred Security Council debates, Human Rights Council reports, legal papers, and policy documents. Tracing the conceptual continuities, I argue that the peculiar novelty of “targeted killing” does not mainly stem from the novelty of the practices and claims it describes but from the contradictory modes in which the term has been used, which has problematic repercussions for recent counterterrorism discourses. Posed as a new category that reacts to a new situation, the adoption of the concept “targeted killing” has, I argue, played an important role in the promotion of claims that were long considered unlawful and illegitimate. Demonstrating the importance of language in setting political struggles up in a particular way, the paper contributes to a growing body of critical work on counterterrorism use of force.
The dust content of the Crab Nebula
Authors: De Looze I , Barlow M J , Bandiera R , Bevan A , Bietenholz M F , Chawner H , Gomez H L , Matsuura M , Priestley F , Wesson R
Published: June 2019

We have modelled the near-infrared to radio images of the Crab Nebula with a Bayesian SED model to simultaneously fit its synchrotron, interstellar (IS), and supernova dust emission. We infer an IS dust extinction map with an average AV = 1.08 ± 0.38 mag, consistent with a small contribution (${\lesssim }22{{\ \rm per\ cent}}$) to the Crab’s overall infrared emission. The Crab’s supernova dust mass is estimated to be between 0.032 and 0.049 M⊙ (for amorphous carbon grains) with an average dust temperature Tdust = 41 ± 3 K, corresponding to a dust condensation efficiency of 8–12 ${{\ \rm per\ cent}}$. This revised dust mass is up to an order of magnitude lower than some previous estimates, which can be attributed to our different IS dust corrections, lower SPIRE flux densities, and higher dust temperatures than were used in previous studies. The dust within the Crab is predominantly found in dense filaments south of the pulsar, with an average V-band dust extinction of AV = 0.20–0.39 mag, consistent with recent optical dust extinction studies. The modelled synchrotron power-law spectrum is consistent with a radio spectral index αradio = 0.297 ± 0.009 and an infrared spectral index αIR = 0.429 ± 0.021. We have identified a millimetre excess emission in the Crab’s central regions, and argue that it most likely results from two distinct populations of synchrotron emitting particles. We conclude that the Crab’s efficient dust condensation (8–12 ${{\ \rm per\ cent}}$) provides further evidence for a scenario where supernovae can provide substantial contributions to the IS dust budgets in galaxies.
The DEAH-box RNA helicase Dhr1 contains a remarkable carboxyl terminal domain essential for small ribosomal subunit biogenesis
Authors: Roychowdhury Amlan , Joret Clément , Bourgeois Gabrielle , Heurgué-Hamard Valérie , Lafontaine Denis L J , Graille Marc
Published: June 2019

Ribosome biogenesis is an essential process in all living cells, which entails countless highly sequential and dynamic structural reorganization events. These include formation of dozens RNA helices through Watson-Crick base-pairing within ribosomal RNAs (rRNAs) and between rRNAs and small nucleolar RNAs (snoRNAs), transient association of hundreds of proteinaceous assembly factors to nascent precursor (pre-)ribosomes, and stable assembly of ribosomal proteins. Unsurprisingly, the largest group of ribosome assembly factors are energy-consuming proteins (NTPases) including 25 RNA helicases in budding yeast. Among these, the DEAH-box Dhr1 is essential to displace the box C/D snoRNA U3 from the pre-rRNAs where it is bound in order to prevent premature formation of the central pseudoknot, a dramatic irreversible long-range interaction essential to the overall folding of the small ribosomal subunit. Here, we report the crystal structure of the Dhr1 helicase module, revealing the presence of a remarkable carboxyl-terminal domain essential for Dhr1 function in ribosome biogenesis in vivo and important for its interaction with its coactivator Utp14 in vitro. Furthermore, we report the functional consequences on ribosome biogenesis of DHX37 (human Dhr1) mutations found in patients suffering from microcephaly and other neurological diseases.
Mixotrophic protists and a new paradigm for marine ecology: where does plankton research go now?
Authors: Flynn Kevin J , Mitra Aditee , Anestis Konstantinos , Anschütz Anna A , Calbet Albert , Ferreira Guilherme Duarte , Gypens Nathalie , Hansen Per J , John Uwe , Martin Jon Lapeyra , Mansour Joost S , Maselli Maira , Medić Nikola , Norlin Andreas , Not Fabrice , Pitta Paraskevi , Romano Filomena , Saiz Enric , Schneider Lisa K , Stolte Willem , Traboni Claudia
Published: June 2019

Many protist plankton are mixotrophs, combining phototrophy and phagotrophy. Their role in freshwater and marine ecology has emerged as a major developing feature of plankton research over recent decades. To better aid discussions, we suggest these organisms are termed “mixoplankton”, as “planktonic protist organisms that express, or have potential to express, phototrophy and phagotrophy”. The term “phytoplankton” then describes phototrophic organisms incapable of phagotrophy. “Protozooplankton” describes phagotrophic protists that do not engage in acquired phototrophy. The complexity of the changes to the conceptual base of the plankton trophic web caused by inclusion of mixoplanktonic activities are such that we suggest that the restructured description is termed the “mixoplankton paradigm”. Implications and opportunities for revision of survey and fieldwork, of laboratory experiments and of simulation modelling are considered. The main challenges are not only with taxonomic and functional identifications, and with measuring rates of potentially competing processes within single cells, but with decades of inertia built around the traditional paradigm that assumes a separation of trophic processes between different organisms. In keeping with the synergistic nature of cooperative photo- and phagotrophy in mixoplankton, a comprehensive multidisciplinary approach will be required to tackle the task ahead.
Physical Performance Predictors for Incident Dementia Among Japanese Community-Dwelling Older Adults
Authors: Doi Takehiko , Tsutsumimoto Kota , Nakakubo Sho , Kim Min-Ji , Kurita Satoshi , Hotta Ryo , Shimada Hiroyuki
Published: June 2019

Background

Evaluating physical performance could facilitate dementia risk assessment. However, findings differ regarding which type of physical performance best predicts dementia.

Objective

The objective of this study was to examine the association between physical performance and incidence of dementia in Japanese community-dwelling older adults.

Design

This was a prospective study of community-dwelling older adults.

Methods

Of 14,313 invited individuals who were ≥ 65 years old, 5104 agreed to participate from 2011 to 2012, and 4086 (52% women; mean age = 72.0 years) met the criteria. Baseline assessments of the following physical performance indicators were obtained: grip strength, the Five-Times Sit-to-Stand Test, and the Timed “Up & Go” Test. The physical performance level in each test was categorized as C1 (highest), C2 (middle–high), C3 (middle–low), or C4 (lowest) on the basis of sex-stratified quartile values. Incident dementia status was obtained from medical records that were updated monthly.

Results

During follow-up (mean duration = 42.9 months), there were 243 incident cases of dementia (5.9%). Log-rank test results indicated that a lower physical performance level constituted a significant risk factor for dementia. After adjustment for covariates, Cox proportional hazards models (reference: highest physical performance level [C1]) demonstrated that the Five-Times Sit-to-Stand Test in the group with the lowest physical performance level (hazard ratio = 1.69; 95% CI = 1.10–2.59) was significantly associated with a risk of dementia. Likewise, the Timed “Up & Go” Test in the group with the lowest physical performance level (hazard ratio = 1.54; 95% CI = 1.01–2.35) was significantly associated with a risk of dementia. However, grip strength was not significantly associated with a risk of dementia.

Limitations

This study was limited by the use of medical record data.

Conclusions

A lower mobility-related physical performance level was associated with dementia risk. Dementia risk assessment should include an adequate evaluation of physical function.
Innovations in parental smoking cessation assistance delivered in the child healthcare setting
Authors: Nabi-Burza Emara , Winickoff Jonathan P , Drehmer Jeremy E , Gorzkowski Julie A , Klein Jonathan D , Levy Douglas E , Ossip Deborah J , Regan Susan , Rigotti Nancy A , Hipple Walters Bethany
Published: June 2019

Addressing parental smoking in the child healthcare setting improves the health of all family members. Innovative approaches, such as mobilizing technology-based platforms, may streamline screening and motivate acceptance of behavioral health services to treat tobacco use and dependence. The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use. Child healthcare practices in five states (IN, NC, OH, TN, and VA) used an electronic tablet screener to identify tobacco use within families and deliver tobacco cessation assistance to smokers. Motivational/educational videos on cessation were displayed via the screener to enhance its utility. Five CEASE intervention practices screened 50,111 family members for tobacco use and identified 6,885 families with children exposed to tobacco smoke. The mean number of screeners per practice per month was 417; the mean number of households with smokers identified per month was 57. Of 2,764 smokers who were at visits and consented, 57% indicated that they wanted a prescription to reduce or quit smoking; 94% of these were given preprinted prescriptions. Of 41% who requested connection to the quitline, 93% were given enrollment forms. Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke. Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice.

CLINICAL TRIALS REGISTRATION: Trial Number NCT01882348
Occurrence of sdh Mutations in German Alternaria solani Isolates and Potential Impact on Boscalid Sensitivity In Vitro, in the Greenhouse, and in the Field
Authors: Metz Nicole , Adolf Birgit , Chaluppa Nicole , Hückelhoven Ralph , Hausladen Hans
Published: June 2019

The fungus Alternaria solani is the main pathogen causing early blight on potatoes (Solanum tuberosum L.). An increase in the development of resistance to the succinate dehydrogenase inhibitor (SDHI) boscalid, one of the main active ingredients for the control of early blight, has been reported. For this study, monitoring data from Germany were collected between 2013 and 2016 and an increase in the occurrence of A. solani succinate dehydrogenase (SDH) mutant isolates was observed. In addition to the known point mutations in sdh complex II, a new mutation in subunit C was found in German isolates (SdhC-H134Q). SDHI fungicide sensitivity testing was performed in the laboratory, greenhouse, and field. Reduced boscalid sensitivity was shown for mutant isolates (SdhB-H278Y and SdhC-H134R) both in vitro and in vivo. In addition, field trials with artificial inoculation were performed in 2016 and 2017. In both years, fungicide efficacy was significantly reduced after mutant inoculation compared with wild-type inoculation.
Optimal Trajectory and Length of S2 Alar Iliac Screws
Authors: Weisenthal Benjamin M. , Doss Derek J. , Henry Abigail L. , Stephens Byron F.
Published: June 2019

Study Design:

A radiographic study of computed tomography scans of the pelvis converted to 3-dimensional imaging.

Objective:

The objective of this study was to determine the optimal length and trajectory of S2 alar iliac (S2AI) screws.

Summary of Background Data:

Solid pelvic fixation is a necessary component in thoracolumbar deformity surgery to protect sacral fixation and promote arthrodesis. The S2AI technique has been promoted as a way to reduce hardware prominence and instrumentation issues associated with traditional iliac fixation.

Materials and Methods:

In total, 64 of 100 patients randomly selected from our institution’s spine registry were able to be converted to 3-dimensional imaging. Virtual screws were then placed in the optimal position for an S2AI screw on each side of the pelvis. The lateral and inferior angles were measured off-axial and sagittal planes, respectively. The distances from the notch and the remaining available screw length were also recorded.

Results:

The average patient age was 38±16 years. The average lateral angle was 42.5±2.0 degrees and the inferior angle was 18.2±1.8 degrees. The screws fit bilaterally in all 64 patients without cortical breach. The remaining available screw distance was measured in all patients and found to be 40.5±8.7 mm. The average distance from the sciatic notch was 13.8±4.1 mm. Men had significantly more potential screw length when compared with women.

Conclusions:

We found an average inferior angle of 18.2 degrees, which is less than the previously described angle range of 20–40 degrees. These findings suggest that an ideal trajectory may be significantly different than the previously described trajectory. We found that with the optimal trajectory, a 100 mm screw can fit in all patients without concern for cortical breach of the pelvis or violation of the hip joint.
Clinical Outcomes, Complications, and Cost-effectiveness in Surgically Treated Adult Spinal Deformity Over 70 Years
Authors: Yagi Mitsuru , Fujita Nobuyuki , Okada Eijiro , Tsuji Osahiko , Nagoshi Narihito , Asazuma Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: June 2019

Study Design:

This is a multicentered retrospective study.

Summary of Background Data:

Surgical correction for the adult spinal deformity (ASD) is effective but carries substantial risks for complications. The diverse pathologies of ASD make it difficult to determine the effect of advanced age on outcomes.

Objective:

The objective of this study was to assess how advanced age affects outcomes and cost-effectiveness for corrective surgery for ASD.

Materials and Methods:

We used data from a multicenter database to conduct propensity score–matched comparisons of 50 patients who were surgically treated for ASD when at least 50 years old and were followed for at least 2 years, to clarify whether advanced age is a risk factor for inferior health-related quality of life and cost-effectiveness. Patients were grouped by age, 50–65 years (M group: 59±4 y) or >70 years (O group: 74±3 y), and were propensity score–matched for sex, body mass index, upper and lower instrumented vertebrae, the use of pedicle-subtraction osteotomy, and sagittal alignment. Cost-effectiveness was determined by cost/quality-adjusted life years.

Results:

Oswestry Disability Index and Scoliosis Research Society-22 (SRS-22) pain and self-image at the 2-year follow-up were significantly inferior in the O group (Oswestry Disability Index: 32±9% vs. 25±13%, P=0.01; SRS-22 pain: 3.5±0.7 vs. 3.9±0.6, P=0.05; SRS-22 self-image: 3.5±0.6 vs. 3.8±0.9, P=0.03). The O group had more complications than the M group (55% vs. 29%). The odds ratios in the O group were 4.0 for postoperative complications (95% confidence interval: 1.1–12.3) and 4.9 for implant-related complications (95% confidence interval: 1.2–21.1). Cost-utility analysis at 2 years after surgery indicated that the surgery was less cost-effective in the O group (cost/quality-adjusted life year: O group: $211,636 vs. M group: 125,887, P=0.01).

Conclusions:

Outcomes for corrective surgery for ASD were inferior in geriatric patients compared with middle-aged patients, in whom the extent of spinal deformity and the operation type were adjusted similarly. Special attention is needed when considering surgical treatment for geriatric ASD patients.
Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung*
Authors: Broche Ludovic , Pisa Pauline , Porra Liisa , Degrugilliers Loïc , Bravin Alberto , Pellegrini Mariangela , Borges João Batista , Perchiazzi Gaetano , Larsson Anders , Hedenstierna Göran , Bayat Sam
Published: June 2019

Objectives:

Airway closure is involved in adverse effects of mechanical ventilation under both general anesthesia and in acute respiratory distress syndrome patients. However, direct evidence and characterization of individual airway closure is lacking. Here, we studied the same individual peripheral airways in intact lungs of anesthetized and mechanically ventilated rabbits, at baseline and following lung injury, using high-resolution synchrotron phase-contrast CT.

Design:

Laboratory animal investigation.

Setting:

European synchrotron radiation facility.

Subjects:

Six New-Zealand White rabbits.

Interventions:

The animals were anesthetized, paralyzed, and mechanically ventilated in pressure-controlled mode (tidal volume, 6 mL/kg; respiratory rate, 40; Fio
2, 0.6; inspiratory:expiratory, 1:2; and positive end-expiratory pressure, 3 cm H2O) at baseline. Imaging was performed with a 47.5 × 47.5 × 47.5 μm voxel size, at positive end-expiratory pressure 12, 9, 6, 3, and 0 cm H2O. The imaging sequence was repeated after lung injury induced by whole-lung lavage and injurious ventilation in four rabbits. Cross-sections of the same individual airways were measured.

Measurements and Main Results:

The airways were measured at baseline (n = 48; radius, 1.7 to 0.21 mm) and after injury (n = 32). Closure was observed at 0 cm H2O in three of 48 airways (6.3%; radius, 0.35 ± 0.08 mm at positive end-expiratory pressure 12) at baseline and five of 32 (15.6%; radius, 0.28 ± 0.09 mm) airways after injury. Cross-section was significantly reduced at 3 and 0 cm H2O, after injury, with a significant relation between the relative change in cross-section and airway radius at 12 cm H2O in injured, but not in normal lung (R = 0.60; p < 0.001).

Conclusions:

Airway collapsibility increases in the injured lung with a significant dependence on airway caliber. We identify “compliant collapse” as the main mechanism of airway closure in initially patent airways, which can occur at more than one site in individual airways.
Impact of Telemonitoring of Critically Ill Emergency Department Patients Awaiting ICU Transfer*
Authors: Kadar Rachel B. , Amici David R. , Hesse Kathleen , Bonder Adam , Ries Michael
Published: June 2019

Objectives:

Because of overcrowding and limited critical care resources, critically ill patients in the emergency department may spend hours to days awaiting transfer to the ICU. In these patients, often termed “ICU boarders,” delayed ICU transfer is associated with poor outcomes. We implemented an emergency department–based, electronic ICU monitoring system for ICU boarders. Our aim was to investigate the effect of this initiative on morbidity, mortality, and ICU usage.

Design:

Single-center, retrospective cohort study.

Setting:

Nonprofit, tertiary care, teaching hospital with greater than 100,000 emergency department visits per year.

Patients:

Emergency department patients with admission orders for the medical ICU, who spent more than 2 hours boarding in the emergency department after being accepted for admission to the medical ICU, were included in the study.

Interventions:

None.

Measurements and Main Results:

During the study period, a total of 314 patients were admitted to the medical ICU from the emergency department, 214 of whom were considered ICU boarders with a delay in medical ICU transfer over 2 hours. Of ICU boarders, 115 (53.7%) were enrolled in electronic ICU telemonitoring (electronic ICU care), and the rest received usual emergency department care (emergency department care). Age, mean illness severity (Acute Physiology and Chronic Health Evaluation IVa scores), and admitting diagnoses did not differ significantly between ICU boarders receiving electronic ICU care and emergency department care. Forty-one electronic ICU care patients (36%) were ultimately transitioned to a less intensive level of care in lieu of ICU admission while still in the emergency department, compared with zero patients in the emergency department care group. Among all ICU boarders transferred to the ICU, in-hospital mortality was lower in the electronic ICU care cohort when compared with the emergency department care cohort (5.4% vs 20.0%; adjusted odds ratio, 0.08).

Conclusions:

In critically ill patients awaiting transfer from the emergency department to the medical ICU, electronic ICU care was associated with decreased mortality and lower ICU resource utilization.
Misuse of Regression Adjustment for Additional Confounders Following Insufficient Propensity Score Balancing
Authors: Shinozaki Tomohiro , Nojima Masanori
Published: June 2019

After propensity score (PS) matching, inverse probability weighting, and stratification or regression adjustment for PS, one may compare different exposure groups with or without further covariate adjustment. In the former case, although a typical application uses the same set of covariates in the PS and the stratification post-PS balancing, several studies adjust for additional confounders in the stratification while ignoring the covariates that have been balanced by the PS. We show the bias arising from such partial adjustments for distinct sets of confounders by PS and regression or stratification. Namely, the stratification or regression after PS balancing causes imbalance in the confounders that have been balanced by the PS if PS-balanced confounders are ignored. We empirically illustrate the bias in the Rotterdam Tumor Bank, in which strong confounders distort the association between chemotherapy and recurrence-free survival. If additional covariates are adjusted for after PS balancing, the covariate sets conditioned in PS should be again adjusted for, or PS should be reestimated by including the additional covariates to avoid bias owing to covariate imbalance.
Does Co-administration of Antihypertensive Drugs and Statins Alter Their Efficacy and Safety? A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Kanukula Raju , Esam Hariprasad , Sundström Johan , Rodgers Anthony , Salam Abdul
Published: June 2019

Antihypertensive drugs (AHTDs) and statins are frequently administered together, but there is uncertainty on whether the presence of one affects the main effects of the other. This systematic review and meta-analysis assessed the effects of co-administered AHTDs and statins on blood pressure (BP) and cholesterol. MEDLINE, Cochrane Central Register of Controlled Trials and drug regulatory agency websites were searched, until January 2018. Twelve double-blind randomized controlled trials that allocated adults with or without hypertension and/or hyperlipidemia (n = 4434) to fixed doses of AHTD alone, statin alone and both drugs together, for ≥4 weeks, were included. BP lowering was similar with AHTD + statin compared with AHTD alone [systolic BP −0.1 mm Hg, 95% confidence interval (CI), −1.0 to 0.8, and diastolic BP −1.0 mm Hg, 95% CI, −2.3 to −0.2]. AHTD + statin compared with statin alone resulted in small reduction in low-density lipoprotein cholesterol (−3.9 mg/dL, 95% CI, −6.1 to −1.7), and this effect was largely associated with co-administration of amlodipine and atorvastatin or rosuvastatin. There was no difference in safety outcomes. Overall, it can be concluded that there is no clinically important difference in the effects of AHTDs and statins whether used separately or together for reduction in BP and low-density lipoprotein cholesterol.
Role of Mitochondrial Aldehyde Dehydrogenase in Nitroglycerin-Mediated Vasodilation: Observations Concerning the Dose–Response Relationship
Authors: He Jerry D. , Lytvyn Yuliya , Zhou Kangbin , Parker John D.
Published: June 2019

The mechanism of the bioactivation of nitroglycerin has long been controversial, with a number of suggested enzymatic pathways. More recently, aldehyde dehydrogenase-2 (ALDH-2) has been reported as the important enzyme involved in the bioactivation of nitroglycerin at therapeutically relevant concentrations. Other previously described enzyme systems can also bioactivate nitroglycerin, but only at concentrations, which are significantly higher than achieved in clinical practice. This study investigated the vascular response to nitroglycerin given over a wide range of concentrations in subjects with and without the ALDH-2 Glu504Lys polymorphism, a common genetic variant that greatly reduces the activity of ALDH-2 (n = 10 in both groups). Forearm blood flow (FBF) responses to a brachial artery infusion of nitroglycerin were assessed using venous occlusion plethysmography. Intra-arterial infusion of nitroglycerin caused a significant increase in FBF beginning at 0.464 µg/min with increasing responses seen in both groups at all infusion rates. However, there were no differences in the FBF responses to nitroglycerin in those with and without the ALDH-2 polymorphism, suggesting that ALDH-2 is not solely responsible for the bioactivation of nitroglycerin at either low (therapeutically relevant) or high concentrations of nitroglycerin.
Direct Smartphone Disc Video Documentation for Pediatric Glaucomas During Evaluation Under Anesthesia
Authors: Pujari Amar , Selvan Harathy , Goel Siddhi , Dada Tanuj
Published: June 2019

The newer version of iPhone, that is iPhone Xs max camera application is opened and a video mode is selected with a with continuous light source on. This device is now slowly advanced towards the patient’s eye (pharmacologically dilated while evaluating under anesthesia) and the optic disc and peripapillary area findings can be documented with great ease. This video graphic and/or standstill images obtained from the video can be stored in the smartphones or on the cloud memory for future assessment/comparison.
Obstructive Sleep Apnea in Patients With Primary-open Angle Glaucoma: No Role for a Screening Program
Authors: Wozniak Dariusz , Bourne Rupert , Peretz Gil , Kean Jane , Willshire Catherine , Harun Shabbir , Villar Sofia , Chiu Yi-Da , Smith Ian
Published: June 2019

Précis:

In this study, we found a high prevalence of obstructive sleep apnea (OSA) among patients with primary open-angle glaucoma (POAG) but this was not different (nor was OSA more severe) to matched people without glaucoma.

Rationale:

It has been proposed that OSA might be a contributing factor in the development of POAG and by extension that there could be a role for screening people with POAG for OSA.

Objectives:

To assess whether the prevalence of OSA among patients with POAG is different from that in people without glaucoma and to examine for associations between apnea-hypopnea index (AHI) and markers of functional and structural changes in POAG.

Methods:

Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed.

Results:

Data from 395 participants, 235 POAG patients, and 160 controls were analyzed. The prevalence of OSA was 58% [95% confidence interval (CI), 52-65] in POAG patients and 54% (95% CI, 47-62) in controls, with 22% (95% CI, 16-27) of POAG patients and 16% (95% CI, 11-22) of controls diagnosed with moderate or severe OSA. A total of 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (P=0.91 for AHI≥5 and P=0.66 for AHI≥15). The AHI was not associated with the severity of visual field defect or retinal nerve fiber layer thinning after adjustment for confounders.

Conclusions:

This study confirms a high prevalence of OSA among patients with POAG which is, however, not higher than in people without glaucoma matched for known OSA risk factors. Our results do not support screening for OSA in patients with POAG.
Highlights From Clinical Practice Guidelines by the Infectious Diseases Society of America for the Diagnosis and Treatment of Seasonal Influenza
Authors: File Thomas M.
Published: June 2019

Seasonal influenza remains a significant cause of morbidity and mortality. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the diagnosis and treatment of seasonal influenza. The guideline provides new recommendations for management of this infection. Clinicians should use rapid molecular assays for diagnosis. Antiviral therapy of patients with severe or progressive illness should be started regardless of illness duration.
Alveolar Hydatid
Authors: Choh Naseer A. , Ilyas Mohd , Ahmad Zubair , Shafi Fahad , Yattoo Ghulam Nabi , Kazimi Mir Junaid Ahmad , Gojwari Tariq A. , Shaheen Feroze A.
Published: June 2019

Background

The aim of the present study was to study the different imaging appearances on proven cases of hepatic alveolar hydatid, which is often misdiagnosed as a tumor.

Materials and Methods

We studied ultrasonography, computed tomography, and magnetic resonance imaging findings in 21 histopathologically proven cases of hepatic alveolar hydatid disease over a period of 1½ year. The ultrasonography findings were heterogeneous hyperechoic mass in 14 cases, multilocular cystic mass in 3 cases, and hyperechoic mass with calcification giving dense acoustics in 4 cases. Computed tomography findings were a sheet-like hypodense, infiltrative, nonenhancing mass without biliary or portal encasement or infiltration in 16 cases, biliary infiltration in 4 cases, and portal encasement in 3 cases. The magnetic resonance imaging findings showed that all 21 patients had a characteristic microvesicular appearance of the parasitic mass on T2-weighted images corresponding to the microvesicles demonstrated on histopathology. The portal encasement and biliary infiltration were also demonstrated on magnetic resonance (MR) images.

Conclusions

T2-weighted MR images correlate with the histologic characteristic of the hepatic alveolar hydatid disease. Ultrasonography and computed tomography may help in initial assessment of the extent of the disease, but MR helps in exact diagnosis.
Transverse Myelitis Caused by Varicella Zoster Virus
Authors: Ari Buse Cagla , Karaci Rahsan , Mayda Domac Fusun , Ulker Mustafa , Bolluk Basak , Ofluoglu Demet , Ozgen Kenangil Gulay
Published: June 2019

Introduction

The varicella zoster virus (VZV) infection causes chickenpox and herpes zoster. Primary infection occurs more frequently in the pediatric age as chickenpox. Virus can be latent in cranial nerve or dorsal root ganglia and reactivate several decades later as the form of herpes zoster generally in immunosuppressed patients. Varicella zoster virus is associated with severe neurological complications, including post herpetic neuralgia, aseptic meningitis, polyneuropathy, cranial nerve palsy, meningoencephalitis, vasculopathy, encephalitis, and transverse myelitis. The transverse myelitis caused by VZV is reported rarely.

Case Report

A 77-year-old immunocompetent patient presented with muscle weakness and sensation loss due to the demyelinating lesion caused by VZV on C5 dermatome. Proprioception and vibratory sensation loss were also marked. Cervical spinal magnetic resonance imaging showed expansive intramedullary high-signal intensity lesion on C5 with focal swelling on T2-weighted images and gadalinium enhancement on T1-weighted images. cerebrospinal fluid viral antibody test was positive for immunoglobulin G of VZV but negative for VZV DNA. The patient was treated with oral valacyclovir (1 g) 3 times daily for 7 days and with methylprednisolone (1.0 g) every day for 5 days. After treatment, his muscle strength increased but sensorial loss and neuropathic pain did not recover.

Conclusions

About 40% of transverse myelitis cases are caused by viral infections, some of them are herpes viruses and poliovirus. Varicella zoster infection is a common disease but not a common cause of transverse myelitis particularly in immuncompetent patients. The clinicians must be aware of this rare complication of VZV.
Scale-free amplitude modulation of low-frequency fluctuations in episodic migraine
Authors: Hodkinson Duncan J. , Lee Danielle , Becerra Lino , Borsook David
Published: June 2019

Arrhythmic fluctuations in neural activity occur at many levels of the nervous system. Such activity does not have a characteristic temporal periodicity but can exhibit statistical similarities, most commonly power-law scaling behavior, which is indicative of scale-free dynamics. The recurrence of scaling laws across many different systems and its manifestation in behavior has prompted a search for unifying principles in human brain function. With this in mind, a focused search for abnormities in scale-free dynamics is of considerable clinical relevance to migraine and other clinical pain disorders. Here, we examined the scale-free properties of the resting-state functional magnetic resonance imaging (fMRI) signal in the broadband frequency range known to be related to spontaneous neural activity (0.01-0.1 Hz). In a large cohort of episodic migraine patients (N = 40), we observed that the strength of long-range temporal correlations in the fMRI signal (captured by the scaling exponent α) was significantly higher in the sensorimotor network compared with healthy controls. Increases in the scaling exponent were positively correlated with fMRI signal variance and negatively correlated with the patient's self-reported headache intensity. These changes in the fMRI signal suggest that the temporal structure of amplitude fluctuations carries valuable information about the dynamic state of the underlying neuronal networks and ensuing sensory impairments in migraine. The demonstrated scaling laws pose a novel quantitative approach for examining clinically relevant interindividual variability in migraine and other pain disorders.
Net In-Neutrality's Impact on Health Care
Authors: Griner Todd E.
Published: June 2019

The Internet is a utility, just as water and electricity are, and is directly linked to care outcomes, budgeting considerations, and workforce acquisition. If water or electricity services were to be throttled up and down or commoditized, it would be important for health care leaders to understand and prepare for the resulting disruptions. In 2017, the Federal Communications Commission voted to eliminate consumer protection regulations that stopped Internet service providers from interfering with Internet service put in place under President Bush and maintained during the Obama administration. The elimination of these protections threatens to disrupt the Internet as the platform on which our health care industry builds capacity for health information exchange. The ability of Internet service providers to throttle up and down speed based on their own interests threatens our ability to meet community needs and increases the likelihood of health care disparities, just as would happen if city water providers could ration water based on their own economic interests. Proponents for net in-neutrality argue that not all Internet traffic should be equal. For instance, there could be an advantage for health care if data traffic related to health care operations was prioritized over video streaming a movie or uploading a video, but if health care companies would be required to pay for that speed, there would be financial considerations. Nurse leaders need to understand the real and possible consequences of the Internet's lack of consumer protection regulations.
Telehealth
Authors: Finley Brooke A. , Shea Kimberley D.
Published: June 2019

Telehealth, defined simply as the delivery of health care services over a distance by using telecommunication technology, has become one of the most disruptive innovations in modern health care. This article explores the history and impact telehealth has had on provider and consumer supply and demand for time, becoming a widely adopted technological health care service delivery model that has demonstrated significant benevolent contributions to the health care industry and the patients it serves.