bluuebunny/crossref_metadata_2025 huggingface dataset:
Benchmarked computation of time-domain viscoelastic Love numbers for adiabatic mantles
Authors: Kachuck S B , Cathles L M
Published: June 2019

The viscoelastic load Love numbers encapsulate the Earth’s rheology in a remarkably efficient fashion. When multiplied by a sudden increment of spherical harmonic load change, they give the horizontal and vertical surface displacements and gravity change at all later times. Incremental glacial load changes thus need only be harmonically decomposed, multiplied by the Love numbers and summed to predict the Earth’s response to glacial load redistributions. The computation of viscoelastic Love numbers from the elastic, viscous and adiabatic profiles of the Earth is thus the foundation upon which many glacial isostatic adjustment models are based. Usually, viscoelastic Love numbers are computed using the Laplace transform method, employing the correspondence principle to convert the viscoelastic equations of motion into the elastic equations with complex material parameters. This method works well for a fully non-adiabatic Earth, but can accommodate realistic partially adiabatic and fully adiabatic conditions only by changing the Earth’s density profile. An alternative method of Love number computation developed by Cathles (1975) avoids this dilemma by separating the elastic and viscous equations of motion. The separation neglects a small solid-elastic/fluid-elastic transition for compressible deformation, but allows freely defining adiabatic, partially adiabatic or fully non-adiabatic profiles in the mantle without changing the Earth’s density profile. Here, we update and fully describe this method and show that it produces Love numbers closely similar to those computed for fully non-adiabatic earth models computed by the correspondence principle, finite element and other methods. The time-domain method produces Love numbers as good as those produced by other methods and can also realistically accommodate any degree of mantle adiabaticity. All method implementations are available open source.
Optimizing ethambutol dosing among HIV/tuberculosis co-infected patients: a population pharmacokinetic modelling and simulation study
Authors: Mehta Krina , Ravimohan Shruthi , Pasipanodya Jotam G , Srivastava Shashikant , Modongo Chawangwa , Zetola Nicola M , Weissman Drew , Ivaturi Vijay , Gumbo Tawanda , Bisson Gregory P , Vinnard Christopher
Published: June 2019

Background

Reduced ethambutol serum concentrations are commonly observed among TB patients co-infected with HIV and may lead to treatment failure.

Objectives

To perform a population pharmacokinetic study of ethambutol in HIV/TB patients, and to evaluate an intensified ethambutol weight-based dosing strategy to support pharmacokinetic target attainment.

Methods

We conducted a prospective study of ethambutol pharmacokinetics among HIV/TB patients administered first-line TB treatment in Botswana, with study visits before and after initiation of ART. Clinical and disease status markers, including HIV-associated systemic immune activation and gut dysfunction biomarkers, were evaluated as covariates of ethambutol pharmacokinetic parameters in non-linear mixed effects analysis. Monte Carlo simulations were performed to compare pharmacokinetic target attainment under standard and intensified weight-based ethambutol dosing strategies.

Results

We studied 40 HIV/TB patients prior to initiation of ART, of whom 24 returned for a second visit a median of 33 days following ART initiation. Ethambutol serum concentrations were best explained by a two-compartment model with first-order elimination, with a significant improvement in oral bioavailability following ART initiation. In Monte Carlo simulations, a supplementary ethambutol dose of 400 mg daily led to >2-fold improvements in pharmacokinetic target attainment probabilities in lung tissue, both before and after ART initiation.

Conclusions

Low serum ethambutol concentrations were commonly observed among HIV/TB patients in Botswana, and the oral bioavailability of ethambutol increased following ART initiation. Supplementary ethambutol dosing among HIV/TB patients may provide a strategy to optimize anti-TB treatment regimens in this high-risk population.
Population pharmacokinetics of piperacillin in febrile children receiving cancer chemotherapy: the impact of body weight and target on an optimal dosing regimen
Authors: Thorsted Anders , Kristoffersson Anders N , Maarbjerg Sabine F , Schrøder Henrik , Wang Mikala , Brock Birgitte , Nielsen Elisabet I , Friberg Lena E
Published: June 2019

Background

The β-lactam antibiotic piperacillin (in combination with tazobactam) is commonly chosen for empirical treatment of suspected bacterial infections. However, pharmacokinetic variability among patient populations and across ages leads to uncertainty when selecting a dosing regimen to achieve an appropriate pharmacodynamic target.

Objectives

To guide dosing by establishing a population pharmacokinetic model for unbound piperacillin in febrile children receiving cancer chemotherapy, and to assess pharmacokinetic/pharmacodynamic target attainment (100% fT > 1×MIC and 50% fT > 4×MIC) and resultant exposure, across body weights.

Methods

Forty-three children admitted for 89 febrile episodes contributed 482 samples to the pharmacokinetic analysis. The typical doses required for target attainment were compared for various dosing regimens, in particular prolonged infusions, across MICs and body weights.

Results

A two-compartment model with inter-fever-episode variability in CL, and body weight included through allometry, described the data. A high CL of 15.4 L/h (70 kg) combined with high glomerular filtration rate (GFR) values indicated rapid elimination and hyperfiltration. The target of 50% fT > 4×MIC was achieved for an MIC of 4.0 mg/L in a typical patient with extended infusions of 2–3 (q6h) or 3–4 (q8h) h, at or below the standard adult dose (75 and 100 mg/kg/dose for q6h and q8h, respectively). Higher doses or continuous infusion were needed to achieve 100% fT > 1×MIC due to the rapid piperacillin elimination.

Conclusions

The licensed dose for children with febrile neutropenia (80 mg/kg q6h as a 30 min infusion) performs poorly for attainment of fT>MIC pharmacokinetic/pharmacodynamic targets. Given the population pharmacokinetic profile, feasible dosing regimens with reasonable exposure are continuous infusion (100% fT > 1×MIC) or prolonged infusions (50% fT > 4×MIC).
CAESNet: Convolutional AutoEncoder based Semi-supervised Network for improving multiclass classification of endomicroscopic images
Authors: Tong Li , Wu Hang , Wang May D
Published: June 2019

Objective

This article presents a novel method of semisupervised learning using convolutional autoencoders for optical endomicroscopic images. Optical endomicroscopy (OE) is a newly emerged biomedical imaging modality that can support real-time clinical decisions for the grade of dysplasia. To enable real-time decision making, computer-aided diagnosis (CAD) is essential for its high speed and objectivity. However, traditional supervised CAD requires a large amount of training data. Compared with the limited number of labeled images, we can collect a larger number of unlabeled images. To utilize these unlabeled images, we have developed a Convolutional AutoEncoder based Semi-supervised Network (CAESNet) for improving the classification performance.

Materials and Methods

We applied our method to an OE dataset collected from patients undergoing endoscope-based confocal laser endomicroscopy procedures for Barrett’s esophagus at Emory Hospital, which consists of 429 labeled images and 2826 unlabeled images. Our CAESNet consists of an encoder with 5 convolutional layers, a decoder with 5 transposed convolutional layers, and a classification network with 2 fully connected layers and a softmax layer. In the unsupervised stage, we first update the encoder and decoder with both labeled and unlabeled images to learn an efficient feature representation. In the supervised stage, we further update the encoder and the classification network with only labeled images for multiclass classification of the OE images.

Results

Our proposed semisupervised method CAESNet achieves the best average performance for multiclass classification of OE images, which surpasses the performance of supervised methods including standard convolutional networks and convolutional autoencoder network.

Conclusions

Our semisupervised CAESNet can efficiently utilize the unlabeled OE images, which improves the diagnosis and decision making for patients with Barrett’s esophagus.
PARP inhibitors for BRCA wild type ovarian cancer; gene alterations, homologous recombination deficiency and combination therapy
Authors: Matsumoto Koji , Nishimura Meiko , Onoe Takuma , Sakai Hideki , Urakawa Yusaku , Onda Takashi , Yaegashi Nobuo
Published: June 2019

After a brief summary of the current status of poly-ADP ribose polymerase (PARP) inhibitors for ovarian cancer, we summarize the current status of PARP inhibitors for BRCA wild type ovarian cancer, especially regarding gene alterations other than BRCA, homologous recombination deficiency (HRD), and combinations. Discussion of gene alterations other than BRCA include the results of multiple gene panels studying homologous recombination repair deficiency genes and cancer susceptibility genes, and influences of these alterations on efficacy of PARP inhibitors and cancer susceptibility. Discussions of HRD include the results of phase three trials using HRD assay, the definition of HRD assays, and the latest assays. Discussions of combinations include early phase trial results and ongoing trials combining PARP inhibitors with immune checkpoint inhibitors, anti-angiogenic agents, and triplets.
Spectroscopic and photometric studies of four W UMa-type eclipsing binaries
Authors: Long Liu , Zhang Li-Yun , Han Xianming L , Lu Hong-Peng , Pi Qing-feng , Yue Qiang
Published: June 2019

We performed new photometric and spectroscopic studies on four W UMa-type eclipsing binaries (V400 Lyr, V574 Lyr, V1033 Her and V1062 Her). The main aims were to determine the orbital parameters and period variations of these four systems. We classified V574 Lyr, V1033 Her and V1062 Her spectral types based on LAMOST spectra, and used a spectra subtraction technique to measure the properties of the H α, H β and Ca ii H&K lines. We updated the ephemerides of these four systems, and conducted analyses of period variation for three systems (V574 Lyr, V1033 Her and V1062 Her). The period of V400 Lyr shows a continuous decrease, while that of V1033 Her continuously increases. Meanwhile, V574 Lyr and V1062 Her show a cyclic variation, caused by the light-time effect via the third body or magnetic activity cycle. The orbital and star-spot parameters of these four systems were obtained using the Wilson–Devinney program. This is the first time that precise orbital parameters have been obtained for V574 Lyr and V1062. We also concluded that these four objects are shallow contact eclipsing binaries with a cool spot on the primary. We found star-spot variabilities of about one month for V574 Lyr, and on long (years) time-scales for V1033 Her and V1062 Her. There are also obvious variations in the differences of light-curve maxima between 0.25 and 0.75 phases.
Tidal disruption event discs around supermassive black holes: disc warp and inclination evolution
Authors: Zanazzi J J , Lai Dong
Published: June 2019

After the tidal disruption event (TDE) of a star around a supermassive black hole (SMBH), the bound stellar debris rapidly forms an accretion disc. If the accretion disc is not aligned with the spinning SMBH’s equatorial plane, the disc will be driven into Lense–Thirring precession around the SMBH’s spin axis, possibly affecting the TDE’s light curve. We carry out an eigenmode analysis of such a disc to understand how the disc’s warp structure, precession, and inclination evolution are influenced by the disc’s and SMBH’s properties. We find an oscillatory warp may develop as a result of strong non-Keplarian motion near the SMBH. The global disc precession frequency matches the Lense–Thirring precession frequency of a rigid disc around a spinning black hole within a factor of a few when the disc’s accretion rate is high, but deviates significantly at low accretion rates. Viscosity aligns the disc with the SMBH’s equatorial plane over time-scales of days to years, depending on the disc’s accretion rate, viscosity, and SMBH’s mass. We also examine the effect of fallback material on the warp evolution of TDE discs, and find that the fallback torque aligns the TDE disc with the SMBH’s equatorial plane in a few to tens of days for the parameter space investigated. Our results place constraints on models of TDE emission which rely on the changing disc orientation with respect to the line of sight to explain observations.
The lifetime of binary black holes in Sérsic galaxy models
Authors: Biava Nadia , Colpi Monica , Capelo Pedro R , Bonetti Matteo , Volonteri Marta , Tamfal Tomas , Mayer Lucio , Sesana Alberto
Published: June 2019

In the local Universe, black holes of $10^{5-6}\, {\rm M_\odot }$ are hosted in galaxies displaying a variety of stellar profiles and morphologies. These black holes are the anticipated targets of LISA, the Laser Interferometer Space Antenna that will detect the low-frequency gravitational-wave signal emitted by binary black holes in this mass interval. In this paper, we infer upper limits on the lifetime of binary black holes of $10^{5-6}\, {\rm M_\odot }$ and up to $10^8\, {\rm M_\odot }$, forming in galaxy mergers, exploring two underlying stellar density profiles, by Dehnen and by Prugniel & Simien, and by exploiting local scaling relations between the mass of the black holes and several quantities of their hosts. We focus on the phase of the dynamical evolution when the binary is transitioning from the hardening phase ruled by the interaction with single stars to the phase driven by the emission of gravitational waves. We find that different stellar profiles predict very distinct trends with binary mass, with lifetimes ranging between fractions of a Gyr to more than 10 Gyr, and with a spread of about one order of magnitude, given by the uncertainties in the observed correlations, which are larger in the low-mass tail of the observed black hole population.
Testing the scale-dependent hemispherical asymmetry with the 21-cm power spectrum from the epoch of reionization
Authors: Li Botao , Chen Zhaoting , Cai Yi-Fu , Mao Yi
Published: June 2019

Hemispherical power asymmetry has emerged as a new challenge to cosmology in early Universe. While the cosmic microwave background (CMB) measurements indicated the asymmetry amplitude A ≃ 0.07 at the CMB scale $k_{\rm CMB}\simeq 0.0045\, {\rm Mpc}^{-1}$, the high-redshift quasar observations found no significant deviation from statistical isotropy. This conflict can be reconciled in some scale-dependent asymmetry models. We put forwards a new parametrization of scale-dependent asymmetric power spectrum, inspired by a multispeed inflation model. The 21-cm power spectrum from the epoch of reionization can be used to constrain the scale-dependent hemispherical asymmetry. We demonstrate that an optimum, multifrequency observation by the Square Kilometre Array (SKA) Phase 2 can impose a constraint on the amplitude of the power asymmetry anomaly at the level of ΔA ≃ 0.2 at $0.056 \lesssim k_{\rm 21cm} \lesssim 0.15 \, {\rm Mpc}^{-1}$. This limit may be further improved by an order of magnitude as ΔA ≃ 0.01 with a cosmic variance limited experiment such as the Omniscope.
MORC2 regulates DNA damage response through a PARP1-dependent pathway
Authors: Zhang Lin , Li Da-Qiang
Published: June 2019

Microrchidia family CW-type zinc finger 2 (MORC2) is a newly identified chromatin remodeling enzyme with an emerging role in DNA damage response (DDR), but the underlying mechanism remains largely unknown. Here, we show that poly(ADP-ribose) polymerase 1 (PARP1), a key chromatin-associated enzyme responsible for the synthesis of poly(ADP-ribose) (PAR) polymers in mammalian cells, interacts with and PARylates MORC2 at two residues within its conserved CW-type zinc finger domain. Following DNA damage, PARP1 recruits MORC2 to DNA damage sites and catalyzes MORC2 PARylation, which stimulates its ATPase and chromatin remodeling activities. Mutation of PARylation residues in MORC2 results in reduced cell survival after DNA damage. MORC2, in turn, stabilizes PARP1 through enhancing acetyltransferase NAT10-mediated acetylation of PARP1 at lysine 949, which blocks its ubiquitination at the same residue and subsequent degradation by E3 ubiquitin ligase CHFR. Consequently, depletion of MORC2 or expression of an acetylation-defective PARP1 mutant impairs DNA damage-induced PAR production and PAR-dependent recruitment of DNA repair proteins to DNA lesions, leading to enhanced sensitivity to genotoxic stress. Collectively, these findings uncover a previously unrecognized mechanistic link between MORC2 and PARP1 in the regulation of cellular response to DNA damage.
A Novel Bacterial Nitrate Transporter Composed of Small Transmembrane Proteins
Authors: Maeda Shin-ichi , Aoba Risa , Nishino Yuma , Omata Tatsuo
Published: June 2019

A putative silent gene of the freshwater cyanobacterium Synechococcus elongatus strain PCC 7942, encoding a small protein with two transmembrane helices, was named nrtS, since its overexpression from an inducible promoter conferred nitrate uptake activity on the nitrate transport-less NA4 mutant of S. elongatus. Homologs of nrtS, encoding proteins of 67–118 amino acid residues, are present in a limited number of eubacteria including mostly cyanobacteria and proteobacteria, but some others, e.g. the actinobacteria of the Mycobacterium tuberculosis complex, also have the gene. When expressed in NA4, the nrtS homolog of the γ-proteobacterium Marinomonas mediterranea took up nitrate with higher affinity for the substrate as compared with the S. elongatus NrtS (Km of 0.49 mM vs. 2.5 mM). Among the 61 bacterial species carrying the nrtS homolog, the marine cyanobacterium Synechococcus sp. strain PCC 7002 is unique in having two nrtS genes (nrtS1 and nrtS2) located in tandem on the chromosome. Coexpression of the two genes in NA4 resulted in nitrate uptake with a Km (NO3−) of 0.15 mM, while expression of either of the two resulted in low-affinity nitrate uptake activity with Km values of >3 mM, indicating that NrtS1 and NrtS2 form a heteromeric transporter complex. The heteromeric transporter was shown to transport nitrite as well. A Synechococcus sp. strain PCC 7002 mutant defective in the nitrate transporter (NrtP) showed a residual activity of nitrate uptake, which was ascribed to the NrtS proteins. Blue-native PAGE and immunoblotting analysis suggested a hexameric structure for the NrtS proteins.
Phototropins Mediate Chloroplast Movement in Phalaenopsis aphrodite (Moth Orchid)
Authors: Lin Yi-Jyun , Chen Yu-Chung , Tseng Kuan-Chieh , Chang Wen-Chi , Ko Swee-Suak
Published: June 2019

Chloroplast movement is important for plants to avoid photodamage and to perform efficient photosynthesis. Phototropins are blue light receptors in plants that function in chloroplast movement, phototropism, stomatal opening, and they also affect plant growth and development. In this study, full-length cDNAs of two PHOTOTROPIN genes, PaPHOT1 and PaPHOT2, were cloned from a moth orchid Phalaenopsis aphrodite, and their functions in chloroplast movement were investigated. Phylogenetic analysis showed that PaPHOT1 and PaPHOT2 orthologs were highly similar to PHOT1 and PHOT2 of the close relative Phalaenopsis equestris, respectively, and clustered with monocots PHOT1 and PHOT2 orthologs, respectively. Phalaenopsis aphrodite expressed a moderate level of PaPHOT1 under low blue light of 5 μmolï¿½m−2ï¿½s−1 (BL5) and a high levels of PaPHOT1 at >BL100. However, PaPHOT2 was expressed at low levels at  BL100. Analysis of light-induced chloroplast movements using the SPAD method indicated that orchid accumulated chloroplasts at BL25 and significant chloroplast avoidance movement was observed at >BL100. Virus-induced gene silencing of PaPHOTs in orchids showed decreased gene expression of PaPHOTs and reduced both chloroplast accumulation and avoidance responses. Heterologous expression of PaPHOT1 in Arabidopsis phot1phot2 double mutant recovered chloroplast accumulation response at BL5, but neither PaPHOT1 nor PaPHOT2 was able to restore mutant chloroplast avoidance at BL100. Overall, this study showed that phototropins mediate chloroplast movement in Phalaenopsis orchid is blue light-dependent but their function is slightly different from Arabidopsis which might be due to gene evolution.
Reducing the use of screen electronic devices in the evening is associated with improved sleep and daytime vigilance in adolescents
Authors: Perrault Aurore A , Bayer Laurence , Peuvrier Mathias , Afyouni Alia , Ghisletta Paolo , Brockmann Celine , Spiridon Mona , Hulo Vesely Sophie , Haller Dagmar M , Pichon Swann , Perrig Stephen , Schwartz Sophie , Sterpenich Virginie
Published: June 2019

The use of screen electronic devices in the evening negatively affects sleep. Yet, sleep is known to be essential for brain maturation and a key factor for good academic performance, and thus is particularly critical during childhood and adolescence. Although previous studies reported associations between screen time and sleep impairment, their causal relationship in adolescents remains unclear. Using actigraphy and daily questionnaires in a large sample of students (12 to 19 years old), we assessed screen time in the evening and sleep habits over 1 month. This included a 2 week baseline phase, followed by a 40 min sleep education workshop and a 2 week interventional phase, in which participants were asked to stop using screen devices after 9 pm during school nights. During the interventional phase, we found that the reduction of screen time after 9 pm correlated with earlier sleep onset time and increased total sleep duration. The latter led to improved daytime vigilance. These findings provide evidence that restricting screen use in the evening represents a valid and promising approach for improving sleep duration in adolescents, with potential implications for daytime functioning and health.
Retesting for verification of HIV diagnosis before antiretroviral therapy initiation in Harare, Zimbabwe: Is there a gap between policy and practice?
Authors: Dupwa Beatrice , Kumar Ajay M V , Tripathy Jaya Prasad , Mugurungi Owen , Takarinda Kudakwashe C , Dzangare Janet , Bara Hilda , Mukeredzi Innocent
Published: June 2019

Background

WHO recommends retesting of HIV-positive patients before starting antiretroviral therapy (ART). There is no evidence on implementation of retesting guidelines from programmatic settings. We aimed to assess implementation of HIV retesting among clients diagnosed HIV-positive in the public health facilities of Harare, Zimbabwe, in June 2017.

Methods

This cohort study involved analysis of secondary data collected routinely by the programme.

Results

Of 1729 study participants, 639 (37%) were retested. Misdiagnosis of HIV was found in six (1%) of the patients retested—all were infants retested with DNA-PCR. There was no HIV misdiagnosis among adults. Among those retested, 95% were retested on the same day and two-thirds were tested by a different provider as per national guidelines. Among those retested and found positive, 95% were started on ART, while none of those with negative retest results were started on ART. Of those not retested, about half (51%) were started on ART. The median (IQR) time to ART initiation from diagnosis was 0 (0–1) d.

Conclusion

The implementation of HIV-retesting policy in Harare was poor. While most HIV retest positives were started on ART, only half non-retested received ART. Future research is needed to understand the reasons for non-retesting and non-initiation of ART among those not retested.
Dynamics of Race Structures of the Rice Blast Pathogen Population in Heilongjiang Province, China From 2006 Through 2015
Authors: Zhang Yaling , Wang Jinyan , Yao Yongxiang , Jin Xuehui , Correll James , Wang Ling , Pan Qinghua
Published: June 2019

Rice blast caused by the fungus Magnaporthe oryzae is one of the most destructive diseases of rice. Its control through the deployment of host resistance genes would be facilitated by understanding the pathogen’s race structure. Here, dynamics of race structures in this decade in Heilongjiang province were characterized by Chinese differential cultivars. Two patterns of dynamics of the race structures emerged: both race diversity and population-specific races increased gradually between 2006 and 2011, but they increased much more sharply between 2011 and 2015, with concomitant falls in both the population-common races and dominant races. Four races (ZD1, ZD3, ZD5, and ZE1) were among the top three dominant races over the whole period, indicating that the core of the race structure remained stable through this decade. On the host side, the composition of resistance in the cultivar differential set could be divided in two: the three indica-type entries of the differential set expressed a higher level of resistance to the population of M. oryzae isolates tested than did the four japonica-type entries. The cultivars Tetep and Zhenlong 13 as well as two additional resistance genes α and ε were confirmed as the most promising donors of blast resistance for the local rice improvement programs.

[Formula: see text]Copyright © 2019 The Author(s). This is an open-access article distributed under the CC BY-NC-ND 4.0 International license .
Consensus on Wound Care of SSI in Spine Surgery
Authors: Galetta Matthew S. , Kepler Christopher K. , Divi Srikanth N. , Russo Glenn S. , Segar Anand H. , Boody Barrett S. , Bronson Wesley H. , Rihn Jeffrey A. , Goyal Dhruv K.C. , Fang Taolin , Schroeder Gregory D. , Vaccaro Alexander R.
Published: June 2019

In July of 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 7 focused on wound care, for which this article provides the recommendations, voting results, and rationales.
Exposure to Heat Wave During Pregnancy and Adverse Birth Outcomes
Authors: Wang Jiajia , Tong Shilu , Williams Gail , Pan Xiaochuan
Published: June 2019

Background:

Several studies have investigated the acute effects of high ambient temperature or extreme weather on preterm birth and stillbirth. However, little was known about whether there are any particular stages during which high ambient temperature or heat wave exposure is most harmful to fetal growth. The aim of this study was to examine the effects of heat wave exposure in different gestational months on the risk of preterm birth and stillbirth.

Methods:

Based on all singleton birth records between 2000 and 2010 and the corresponding environmental data in Brisbane, Australia, we explored relationships between heat wave exposure in different months of pregnancy and preterm birth or stillbirth. Six heat wave definitions were used in this study. After controlling for confounding factors, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using extended Cox proportional hazards regression models with time-dependent covariates.

Results:

For most heat wave definitions, the adjusted HRs of preterm birth varied by different gestational months and ranged from 1.08 (HR = 1.08; 95% CI = 1.00, 1.18) to 1.53 (HR = 1.53; 95% CI = 1.41, 1.68). Heat wave exposure in early pregnancy was more likely to increase the risk of stillbirth compared with heat wave exposure in late pregnancy.

Conclusions:

Overall, we found relationships between preterm birth and heat wave exposure in all months of pregnancy based on most heat wave definitions. We did not find a specifically high period of susceptibility during pregnancy for preterm birth associated with heat wave exposure. However, earlier gestational months might be key exposure windows for heat-wave–affected stillbirth.
Neurodevelopmental Trajectory During Infancy and Diagnosis of Autism Spectrum Disorder as an Outcome at 32 Months of Age
Authors: Nishimura Tomoko , Takei Nori , Tsuchiya Kenji J.
Published: June 2019

Background:

Little is known about the extent to which neurodevelopmental trajectories in infancy predict a later diagnosis of autism spectrum disorder (ASD).

Methods:

We investigated the association between the neurodevelopmental trajectory classes identified using a latent class growth analysis and the distal clinical outcome. Participants included 952 infants from the Hamamatsu Birth Cohort for Mothers and Children (HBC study). Neurodevelopment was measured using the Mullen Scales of Early Learning, which contains five subscales (gross motor, fine motor, visual reception, receptive language, and expressive language), at seven time points from 1 to 24 months of age. ASD was diagnosed in 3.1% of the children at 32 months of age. The clinical outcome was included in our analysis model.

Results:

Five neurodevelopmental classes were identified: high normal (11.5%), normal (49.2%), low normal (21.2%), delayed (14.1%), and markedly delayed (4.0%). The probability of a diagnosis of ASD in the markedly delayed class was highest (32.6%) when compared with the other classes. The probabilities of receiving a diagnosis of ASD in the delayed and low normal classes were 6.4% and 4.0%, respectively, whereas the probabilities in the normal and high normal classes were both 0%.

Conclusions:

A diagnosis of ASD may be predicted by the neurodevelopmental trajectories during infancy, which can be evaluated both routinely and objectively in clinical settings. In this representative population, children diagnosed with ASD showed early signs in neurodevelopmental domains during the first 2 years of life.
Short-term Association Between Meteorological Factors and Childhood Pneumonia Hospitalization in Hong Kong
Authors: Lam Holly Ching Yu , Chan Emily Ying Yang , Goggins William Bernard
Published: June 2019

Background:

Pneumonia is a common cause of childhood hospitalization. Both host and pathogen factors are associated with environmental conditions, but the associations between childhood pneumonia and meteorological variables are unclear. This study investigated the short-term associations between childhood pneumonia admissions and meteorological variables.

Methods:

A retrospective time-series analysis was conducted using distributed lagged nonlinear models. Daily pneumonia admissions among children <15-year-old in Hong Kong during 2004–2011 were regressed on daily meteorological variables with air pollutants, influenza admissions, seasonal trend, and long-term trend adjusted. Analyses were stratified by age group.

Results:

There were 34,303 admissions during 2004–2011. Temperature had a u-shaped association with childhood pneumonia admissions with minimum morbidity temperature at 25°C and with a long lagged effect up to 45 days. The cumulative relative risk (cum RR [95% confidence interval]) (vs. 25°C; lag 0–45 days) at 30°C was 1.41 (1.11, 1.79) and was 1.58 (1.21, 2.06) at 12°C. Relative humidity (RH) showed a u-shaped association with minimum risk at 65% and lagged effect up to 45 days. The cum RR (vs. 65%; lag 0–45 days) at 53% was 1.26 (1.04, 1.54) and was 2.22 (1.78, 2.77) at 94%. Children 5- to 14-year-olds were highly sensitive to temperature and RH while admissions among children <5-year-old were only associated with high RH.

Conclusions:

Childhood pneumonia admissions were very strongly associated with both high and low temperature and RH for children 5–14-year-olds. Efforts to reduce exposure of children to extreme temperatures and RH may have the potential to reduce the burden of pediatric pneumonia.
Interaction of Air Pollutants and Meteorological Factors on Birth Weight in Shenzhen, China
Authors: Wang Qiong , Liang Qianhong , Li Changchang , Ren Meng , Lin Shao , Knibbs Luke D. , Zhang Huanhuan , Gong Wei , Bao Junzhe , Wang Suhan , Wang Xuemei , Zhao Qingguo , Huang Cunrui
Published: June 2019

Background:

This study aimed to assess if air pollutants and meteorological factors synergistically affect birth outcomes in Shenzhen, China.

Methods:

A total of 1,206,158 singleton live births between 2005 and 2012 were identified from a birth registry database. Daily average measurements of particulate matter ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ambient air temperature (T), and dew point temperature (Td), a marker of humidity, were collected. Multivariable logistic regression models were used to evaluate associations between air pollution and small for gestational age (SGA), and full-term low birth weight (TLBW). We classified births into those conceived in the warm (May–October) and cold seasons (November–April) and then estimated interactions between air pollutants and meteorological factors.

Results:

An interquartile range (IQR) increase in PM10 exposure during the first trimester (23.1 µg/m3) and NO2 during both the first and second trimesters (15.1 and 13.4 µg/m3) was associated with SGA and TLBW risk; odds ratios ranged from 1.01 (95% confidence interval [CI] = 1.00, 1.02) to 1.09 (1.07, 1.12). We observed interactive effects of both air temperature and humidity on PM10 and SGA for newborns conceived in the warm season. Each IQR increase in PM10 (11.1 µg/m3) increased SGA risk by 90% (95% CI = 19%, 205%), 29% (23, 34%), 61% (10, 38%), and 26% (21, 32%) when T < 5th percentile, 5th < T < 95th percentile, Td < 5th percentile, and 5th < Td < 95th percentile, respectively.

Conclusions:

Our study found evidence of an interactive effect of air temperature and humidity on the relationship between PM10 exposure and SGA among newborns conceived in the warm season (May–October). Relatively low air temperature or humidity exacerbated the effects of PM10.
Exposure Duration and History of Hypertension Predicted Neurological Sequelae in Patients with Carbon Monoxide Poisoning
Authors: Huang Chien-Cheng , Lee Jui-Chi , Lin Kao-Chang , Lin Hung-Jung , Su Shih-Bin , Hsu Chien-Chin , Guo How-Ran
Published: June 2019

Background:

Carbon monoxide poisoning (COP) accounts for a large number of emergency department visits worldwide and is fatal in many cases. In surviving patients, neurological sequelae (NS) attributable to cerebral hypoxia are the most devastating outcome, but reliable predictors are limited. Therefore, we conducted a study to identify predictors of NS in patients with COP and evaluate their effects.

Methods:

In this retrospective case–control study, we identified patients with COP in a medical center in Southern Taiwan between January 2005 and December 2014. Cases were patients with NS, and controls were patients without NS. We obtained information on potential predictors of NS from medical records and evaluated their association with NS, including demographic characteristics, exposure source, suicide attempts, duration of exposure (by tertile), histories, symptoms, signs, laboratory data, treatment, and the length of hospital stay.

Results:

We included 371 patients with COP. Of them, 93 developed NS, and their mean ages (41.4 ± 14.7 years vs. 39.7 ± 14.2 years) and proportions of males (59.1% vs. 58.6%) were similar to those in the 298 controls. Multivariate logistic regression showed that a history of hypertension (adjusted odds ratio = 2.1; 95% confidence interval = 1.0, 4.5) and a longer duration of carbon monoxide exposure (adjusted odds ratio = 1.7; 95% confidence interval = 1.1, 2.8; the longest tertile [>5 hours] vs. the other two tertiles [≤5 hours]) were independent predictors for NS, but not the level of carboxyhemoglobin.

Conclusions:

This study identified two independent predictors for NS that may be useful for public healthcare workers and physicians in predicting outcomes and deciding on treatment strategies for COP patients.
Association Between Ambient Air Pollution Exposure and Spontaneous Pneumothorax Occurrence
Authors: Han Changwoo , Lim Youn-Hee , Jung Kweon , Hong Yun-Chul
Published: June 2019

Background:

Spontaneous pneumothorax is hypothesized to be associated with air pollution exposure based on pathophysiological mechanisms involving airway inflammation. Therefore, we analyzed the association between daily concentrations of air pollutants [sulfur dioxide, nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), particulate matter (PM) less than 2.5 μm in diameter (PM2.5), PM less than 10 μm in diameter (PM10), and coarse PM (PM10-2.5)] and the number of spontaneous pneumothorax-related hospital visits.

Methods:

We analyzed a subset of data from the National Health Insurance Service-National Sample Cohort, a nationally representative dynamic cohort based on health insurance claims data in Korea. Using time series analysis with the Poisson generalized additive model, we evaluated hospital visit data of over 100,000 male cohort members residing in Seoul from 2007 to 2010.

Results:

We identified 516 hospital visits due to spontaneous pneumothorax. In a single-pollutant model, an interquartile range increase of PM and CO exposure at lag day 1 was associated with spontaneous pneumothorax hospital visits (relative risk, 95% confidence interval: PM2.5: 1.10 (1.01, 1.21); PM10: 1.09 (1.01, 1.18); PM10-2.5: 1.06 (1.00, 1.12); CO: 1.11 (1.01, 1.23)). For lag day 2, NO2 and PM exposure was associated with pneumothorax hospital visits (NO2: 1.15 (1.01, 1.32); PM10: 1.10 (1.02, 1.18); PM10-2.5: 1.07 (1.02, 1.13)). In a multipollutant model, the association was consistent for PM.

Conclusion:

The number of hospital visits due to spontaneous pneumothorax increased with air pollution exposure, especially with PM. Our finding suggests that air pollution is a possible predisposing factor for spontaneous pneumothorax.
Bringing Depth and Meaning to Perinatal Quality Improvement by Partnering With Patients
Authors: ROUSE TARA B. , DEJOSEPH JODI , OLLENDORFF ARTHUR T.
Published: June 2019

The quality of maternal care in the United States has garnered attention as the public has been made aware of outcome data and stories of patients’ experiences. Calls to action from national leaders include a focus on evidence-based clinical practice and on interventions that meaningfully include patients and their families in their own care and in identifying promising practices to fill existing gaps. This article provides a look at the methods to identify needs from the patient and family perspective to help improve the quality of maternal care.
Assessing the relationship of the human resource, finance, and information technology functions on reported performance in hospitals using the Lean management system
Authors: Shortell Stephen M. , Rundall Thomas G. , Blodgett Janet C.
Published: June 2019

Background

Given pressures to control costs and improve quality of care, one of the most prevalent transformational performance improvement approaches in health care is Lean management. However, the roles of support functions such as human resource (HR), finance, and information technology (IT) in Lean management and the relationships of these support functions with performance are unknown.

Purpose

The aim of this study was to examine the relationships between the HR, finance, and IT functions, overall Lean implementation, and self-reported performance improvement in hospitals that have implemented Lean.

Methodology/Approach

Data from a national survey of Lean in U.S. hospitals (N = 1,222; 847 reported using Lean) were analyzed using multivariable regression and bootstrapped mediation analysis. The extent to which HR, finance, and IT functions support Lean management was measured using indices including six, three, and six items respectively. Lean implementation was measured by the number of units doing Lean (up to 29) and by a four-level self-reported maturity scale. Performance improvement was measured using an index of self-reported achievements (ranging from 0 to 16).

Results

There were significant positive associations between Lean HR, finance, and IT functions and self-reported performance impact (controlling for organizational and market variables). Tests of mediation indicated that the associations of HR, finance, and IT functions with self-reported performance were significantly mediated by the number of Lean units (mediated proportion ranging from 40% to 73%), and HR function was also mediated by self-reported maturity (61% mediated). There were no moderating effects.

Conclusion

HR, finance, and IT functions are positively associated with self-reported Lean impact on performance and primarily explained by the overall degree of Lean implementation.

Practice Implications

Efforts to align HR, finance, and IT functions with overall Lean implementation can help to ensure that frontline caregivers and managers have the data and skills required to meet transformational improvement goals.
Clinical features of liver cirrhosis patients with muscle cramping: a multicenter study
Authors: Hiraoka Atsushi , Yoshiji Hitoshi , Iwasa Motoh , Nakanishi Hiroyuki , Karino Yoshiyasu , Nakajima Tomoaki , Miyaaki Hisamitsu , Shiraki Makoto , Kawaguchi Takumi , Sawada Yasuhiko , Michitaka Kojiro , Okita Kiwamu
Published: June 2019

Background

There has been a small number of reports mention the clinical features including quality of life (QOL) in liver cirrhosis (LC) patients with muscle cramping and therapeutic efficacy for muscle cramping. We evaluated clinical features of muscle cramping and treatments in such patients.

Patients and methods

Two-hundred and eighty-nine LC outpatients (70.6 ± 10.5 years old; male: female = 149: 140) were questioned regarding the presence or absence of muscle cramps within the last 3 months, including frequency, severity of related pain using a visual analogue scale, cramp locations, time of day, duration, sleep disturbance, daily activity decline, and being conscious of QOL decline. At the next hospital-visit, 3 or 4 months later, the subjects, who treated with medical intervention, received the same questionnaire.

Results

Patients with muscle cramps (n = 160) included a higher percentage of females (53.8 vs. 41.9%, P = 0.045), worse Child–Pugh score (5: 6: 7: 8: 9: 10 = 91: 36: 15: 10: 4: 4 vs. 85: 25: 12: 5: 0: 2, P = 0.043) and lower platelet count (10.2 ± 4.7 vs. 11.8 ± 5.0 × 104/µl, P = 0.006) as compared to those without cramps (n = 129). Of the 160 with cramping, 82 (51.3%), received treatment with several types of medication, with l-carnitine the most administered drug (n = 66: 80.5%), and those also showed a tendency to complain about muscle cramps at night, sleep disturbance, reduced daily activity, and being conscious of QOL decline (each P < 0.01). We observed that frequency, visual analogue scale, sleep disturbance, daily activity, duration of muscle cramping, and being conscious of QOL decline were improved after the intervention (each P < 0.001, respectively).

Conclusion

Intervention for muscle cramping improves total QOL in LC patients with such symptom.
Gluteal Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Mendes José , Mendes Maykeh Vinicius A. , Frascino Luiz Fernando , Zacchi Flavia F. S.
Published: June 2019

The association of anaplastic large cell lymphoma (ALCL) to breast implants (breast implant-associated ALCL) has brought back the discussion on the clinical safety of the use of silicone implants. A 63-year-old woman came to our institution in early 2015, reporting a gluteal augmentation with silicone implants in 2006 and a recent increasing volume and distortion of the left buttock. Radiologic imaging showed a large amount of fluid collection around the implant. The left side implant was removed and the capsule was left intact, presupposing a future reimplantation. The fluid collected was positive for Staphylococcus aureus. Three years later, she presented again with a new seroma on the explanted side and was submitted to total capsulectomy and fluid drainage, and the material was submitted to laboratory examination. Culture results were negative. Pathologic preparation and sections of the capsule and lumps showed large cells characterized by horseshoe-shaped nuclei. Immunohistochemistry was positive for CD30/CD4 and negative for anaplastic lymphoma kinase, confirming the presence of ALCL, then associated with gluteal implant, an event not described in literature. Positron emission tomography/computed tomography and bone marrow biopsy were performed, and neither showed any other sites involved. The same disease in a new location introduces important discussions about the understanding of this abnormality and poses certain risks and safety issues to clinical scenarios to be discussed. Regardless of whether it is a breast implant-associated ALCL or a gluteal implant-associated ALCL, now we are probably facing an implant augmentation–associated disease and a new international alert should be addressed to the scientific community.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review
Authors: Bennett Katelyn G. , Vick Alexis D. , Ettinger Russell E. , Archer Steven M. , Vercler Christian J. , Buchman Steven R.
Published: June 2019

Background:

Ocular abnormalities in craniosynostosis are a persistent concern for patients and providers, and some surgeons feel that early surgical intervention for synostosis alleviates the progression of ophthalmologic abnormalities. In contradistinction, the authors hypothesize that operating early will have no bearing on postoperative ophthalmologic outcomes.

Methods:

Single-suture craniosynostosis patients who underwent surgical correction between 1989 and 2015 were reviewed. Patients with multisuture craniosynostosis, syndromic diagnoses, no preoperative ophthalmology evaluation, and less than 2 years of follow-up were excluded. Logistic regression was used to determine odds of preoperative and postoperative ophthalmologic abnormalities by age, while controlling for patient-level covariates.

Results:

One hundred seventy-two patients met inclusion criteria. The median age at surgery was 10 months (interquartile range, 7 to 12.9 months). Increasing age at the time of surgery was associated with increased odds of preoperative ophthalmologic diagnoses (OR, 1.06; p = 0.037) but not postoperative diagnoses (OR, 1.00; p = 0.91). Increasing age at surgery was also not associated with increased odds of ophthalmologic diagnoses, regardless of timing (OR, 1.04; p = 0.08). Patients with coronal synostosis (OR, 3.94; p = 0.036) had significantly higher odds of preoperative ophthalmologic diagnoses. Patients with metopic (OR, 5.60; p < 0.001) and coronal (OR, 7.13; p < 0.001) synostosis had significantly higher odds of postoperative ophthalmologic diagnoses.

Conclusions:

After reviewing an expansive cohort, associations of both overall and postoperative ophthalmologic diagnoses with age at surgery were not found. The authors’ findings thus run counter to the theory that early surgical intervention lessens the likelihood of postoperative ophthalmologic diagnoses and improves ophthalmologic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.