bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic Differences in Nighttime Melatonin and Nighttime Blood Pressure: A Study in European Americans and African Americans
Authors: Jeong Jinhee , Zhu Haidong , Harris Ryan A , Dong Yanbin , Su Shaoyong , Tingen Martha S , Kapuku Gaston , Pollock Jennifer S , Pollock David M , Harshfield Gregory A , Wang Xiaoling
Published: May 2019

BACKGROUND

Ethnic differences in nighttime blood pressure (BP) have long been documented with African Americans (AAs) having higher BP than European Americans (EAs). At present, lower nighttime melatonin, a key regulator of circadian rhythms, has been associated with higher nighttime BP levels in EAs. This study sought to test the hypothesis that AAs have lower nighttime melatonin secretion compared with EAs. We also determined if this ethnic difference in melatonin could partially explain the ethnic difference in nighttime BP.

METHODS

A total of 150 young adults (71 AA; 46% females; mean age: 27.7 years) enrolled in the Georgia Stress and Heart study provided an overnight urine sample for the measurement of 6-sulfatoxymelatonin, a major metabolite of melatonin. Urine melatonin excretion (UME) was calculated as the ratio between 6-sulfatoxymelatonin concentration and creatinine concentration. Twenty-four-hour ambulatory BP was assessed and nighttime systolic BP (SBP) was used as a major index of BP regulation.

RESULTS

After adjustment of age, sex, body mass index, and smoking, AAs had significantly lower UME (P = 0.002) and higher nighttime SBP than EAs (P = 0.036). Lower UME was significantly associated with higher nighttime SBP and this relationship did not depend on ethnicity. The ethnicity difference in nighttime SBP was significantly attenuated after adding UME into the model (P = 0.163).

CONCLUSION

This study is the first to document the ethnic difference in nighttime melatonin excretion, demonstrating that AAs have lower melatonin secretion compared with EAs. Furthermore, the ethnic difference in nighttime melatonin can partially account for the established ethnic difference in nighttime SBP.
Whole genomes: the holy grail. A commentary on: ‘Molecular phylogenomics of the tribe Shoreeae (Dipterocarpaceae) using whole plastidgenomes’
Authors: Olmstead Richard G , Bedoya Ana M
Published: May 2019

This article comments on:

Jacqueline Heckenhauer, Ovidiu Paun, Mark W. Chase, Peter S. Ashton, A.S. Kamariah and Rosabelle Samuel. 2019. Molecular phylogenomics of the tribe Shoreeae (Dipterocarpaceae) using whole plastid genomes. Annals of Botany 123(5): 857–865.
Phenotypic integration and life history strategies among populations of Pinus halepensis: an insight through structural equation modelling
Authors: Santini Filippo , Climent José M , Voltas Jordi
Published: May 2019

Background and Aims

Understanding inter-population variation in the allocation of resources to specific anatomical compartments and physiological processes is crucial to disentangle adaptive patterns in forest species. This work aims to evaluate phenotypic integration and trade-offs among functional traits as determinants of life history strategies in populations of a circum-Mediterranean pine that dwells in environments where water and other resources are in limited supply.

Methods

Adult individuals of 51 populations of Pinus halepensis grown in a common garden were characterized for 11 phenotypic traits, including direct and indirect measures of water uptake at different depths, leaf area, stomatal conductance, chlorophyll content, non-structural carbohydrates, stem diameter and tree height, age at first reproduction and cone production. The population differentiation in these traits was tested through analysis of variance (ANOVA). The resulting populations’ means were carried forward to a structural equation model evaluating phenotypic integration between six latent variables (summer water uptake depth, summer transpiration, spring photosynthetic capacity, growth, reserve accumulation and reproduction).

Key Results

Water uptake depth and transpiration covaried negatively among populations, as the likely result of a common selective pressure for drought resistance, while spring photosynthetic capacity was lower in populations originating from dry areas. Transpiration positively influenced growth, while growth was negatively related to reproduction and reserves among populations. Water uptake depth negatively influenced reproduction.

Conclusions

The observed patterns indicate a differentiation in life cycle features between fast-growing and slow-growing populations, with the latter investing significantly more in reproduction and reserves. We speculate that such contrasting strategies result from different arrays of life history traits underlying the very different ecological conditions that the Aleppo pine must face across its distribution range. These comprise, principally, drought as the main stressor and fire as the main ecological disturbance of the Mediterranean basin.
Sociocultural Influences on Men’s Penis Size Perceptions and Decisions to Undergo Penile Augmentation: A Qualitative Study
Authors: Sharp Gemma , Oates Jayson
Published: May 2019

Background

An increasing number of men, dissatisfied with their penises, are seeking cosmetic procedures to enhance their penis size. However, little is known about the social and cultural factors that influence men to consider these procedures.

Objectives

The aim of this study was to investigate the sociocultural factors affecting men’s attitudes toward their penis size as well as their decisions to undergo penile augmentation.

Methods

One-on-one semistructured interviews were conducted with 6 adult men who had previously undergone a penile augmentation. The men were asked about the sociocultural factors that they thought contributed to dissatisfaction with their penis size, and their motivations for having penile augmentation. All interviews were audio recorded and then transcribed verbatim. Interview transcripts were analyzed through the use of thematic analysis.

Results

Three main themes emerged from the interviews, namely “influence of pornography,” “comparison with peers,” and “indirect appearance-related teasing.” The men noted that the large penises of male actors in pornography had skewed their perception of normal penis size. All men had compared their penises with those of their peers, usually in the locker room, and often felt their own penis was smaller as a result. None of the participants had received direct negative comments about their penis size, but were aware that having a small penis was a source of mockery from exposure to jokes on mainstream media sources.

Conclusions

These new insights into the sociocultural factors, namely media and peers, that influence men’s desire for penile augmentation may assist clinicians in enhancing their communication with prospective patients.
Correcting for individual quality reveals trade-offs in performance among multiple modes of limbless locomotion in snakes
Authors: Gerald Gary W , Wass Emma D
Published: May 2019

Trade-offs among performance traits are often difficult to detect despite the physiological and morphological incompatibilities that underlie disparate traits being well understood. However, recent studies that have corrected for individual quality have found trade-offs in human athletes performing various performance tasks. Few studies have found trade-offs among multiple performance tasks after correcting for individual quality in non-human animals because of the difficulty in motivating many animals to perform biomechanically different tasks. We examined potential trade-offs in maximal speeds among ten locomotor conditions that involved the utilization of different locomotor modes in cornsnakes (Pantherophis guttatus). Snakes were assessed during terrestrial lateral undulation, swimming, concertina movements (small and large width) and six conditions of arboreal locomotion (combinations of three perch diameters and two inclines). We found no trade-offs among locomotor conditions when analysing uncorrected speeds or speeds corrected for body condition. However, we found several trade-offs among modes and treatments for speeds corrected for individual quality. Terrestrial lateral undulation speeds were negatively related to speeds of concertina and two of the arboreal locomotion conditions. A trade-off between speeds on large and small perch diameters on a 30° incline was also detected and probably reflects potential conflicts in traits that maximize lateral undulation and concertina.
A Method for Controlled Odor Delivery in Olfactory Field-Testing
Authors: Simon Alison G , DeGreeff Lauryn E , Frank Kelvin , Peranich Kimberly , Holness Howard , Furton Kenneth G
Published: May 2019

A widely recognized limitation in mammalian olfactory research is the lack of current methods for measuring odor availability (i.e., the quantifiable amount of odor presented and thus available for olfaction) of training or testing materials during behavioral or operational testing. This research utilized an existing technology known as Controlled Odor Mimic Permeation Systems (COMPS) to produce a reproducible, field-appropriate odor delivery method that can be analytically validated and quantified, akin to laboratory-based research methods, such as permeation devices that deliver a stable concentration of a specific chemical vapor for instrumental testing purposes. COMPS were created for 12 compounds across a range of carbon chain lengths and functional groups in such a way to produce similar permeation rates for all compounds. Using detection canines as a model, field-testing was performed to assess the efficacy of the method. Additionally headspace concentrations over time were measured as confirmation of odor availability using either externally sampled internal standard-solid phase microextraction-gas chromatography-mass spectrometry (ESIS-SPME-GC-MS) or collection onto a programmable temperature vaporizing (PTV) GC inlet with MS detection. Finally, lifetime usage was considered. An efficient method for producing and measuring reliable odor availabilities across various chemical functional groups was developed, addressing a noted gap in existing literature that will advance canine and other nonhuman mammal research testing.
The Limitations of the Rheumatogenic Concept for Group A Streptococcus: Systematic Review and Genetic Analysis
Authors: de Crombrugghe Gabrielle , Baroux Noemie , Botteaux Anne , Moreland Nicole J , Williamson Deborah A , Steer Andrew C , Smeesters Pierre R
Published: May 2019

Background

The concept that a minority of group A streptococcus (GAS) emm types are more “rheumatogenic” than others has been widely disseminated. We aimed to provide a comprehensive list of acute rheumatic fever–associated GAS isolates and assess the presence of associated rheumatogenic motifs.

Methods

Articles reporting GAS emm-type or emm-type–specific antibody responses associated with rheumatic fever were identified from 1 January 1944 to 31 July 2018. The revised Jones criteria were used to define rheumatic fever with a maximum period of 4 weeks between disease onset and microbiological characterization. A database of 175 representative M-protein sequences was used to analyze the protein diversity of rheumatic fever–associated strains in a phylogenetic tree and to identify the presence of 10 previously recognized rheumatogenic motifs.

Results

We included 411 cases of rheumatic fever, for which microbiological characterization identified 73 different emm types associated with the disease. The classic rheumatogenic emm types represented only 12.3% of the 73 emm types and were responsible for 31.6% of the 411 clinical cases. Rheumatic fever–associated emm types were disseminated throughout the phylogeny, suggesting they belong to various genetic backgrounds. Rheumatic fever–associated motifs were present in only 15.1% of the rheumatic fever–associated emm types and only 24.8% of clinical cases.

Conclusions

The concept of rheumatogenicity should be extended to include strains other than those classically described. Our results highlight significant knowledge gaps in the understanding of rheumatic fever pathogenesis and suggest that a GAS vaccine candidate should offer broad coverage against a variety of GAS genetic variants in order to protect against this serious sequela.
Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial
Authors: Sonesson Mikael , Brechter Anna , Abdulraheem Salem , Lindman Rolf , Twetman Svante
Published: May 2019

Background

Self-applied and professional fluorides are key elements to limit caries-related side-effects during orthodontic treatment with fixed appliances.

Objective

To evaluate the effectiveness of a new fluoride varnish formula containing 1.5% ammonium fluoride in preventing white spot lesions (WSLs) in adolescents undergoing multi-bracket orthodontic treatment.

Subjects and methods

The study employed a randomized controlled triple-blinded design with two parallel arms. One hundred eighty-two healthy adolescents (12–18 years) referred to three orthodontic specialist clinics were eligible and consecutively enrolled. Informed consent was obtained from 166 patients and they were randomly allocated to a test or a placebo group (with aid of a computer program, generating sequence numbers in blocks of 15). In the test group, fluoride varnish was applied in a thin layer around the bracket base every sixth week during the orthodontic treatment, while patients in the placebo group received a varnish without fluoride. The intervention started at onset of the fixed appliances and continued until debonding. The endpoint was prevalence and severity of WSLs on the labial surfaces of the maxillary incisors, canines, and premolars as scored from high-resolution pre- and post-treatment digital photos with aid of a four-level score.

Results

One hundred forty-eight patients completed the trial, 75 in the test group and 73 in the placebo group (dropout rate 10.8%). The total prevalence of WSL’s on subject level after debonding was 41.8% in the test group and 43.8% in the placebo group. The number of patients exhibiting more severe lesions (score 3 + 4) was higher in the placebo group (P < 0.05); the absolute risk reduction was 14% and the number needed to treat was 7.1.

Limitations

The multicentre design with somewhat diverging routines at the different clinics may have increased risk for performance bias. No health-economic evaluation was carried out.

Conclusions

Regular applications of an ammonium fluoride varnish reduced the prevalence of advanced WSL during treatment with fixed orthodontic appliances.

Clinical trial registration

ClinicalTrials.gov (NCT03725020).

Protocol

The protocol was not published before trial commencement.
Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT)
Authors: Piazza Gregory , Hurwitz Shelley , Galvin Claire E , Harrigan Lindsay , Baklla Sofia , Hohlfelder Benjamin , Carroll Brett , Landman Adam B , Emani Srinivas , Goldhaber Samuel Z
Published: May 2019

Aims

Despite widely available risk stratification tools, safe and effective anticoagulant options, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is underprescribed. We created and evaluated an alert-based computerized decision support (CDS) strategy to increase anticoagulation prescription in hospitalized AF patients at high risk for stroke.

Methods and results

We enrolled 458 patients (CHA2DS2-VASc score ≥1) with AF who were not prescribed anticoagulant therapy and were hospitalized at Brigham and Women’s Hospital. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) vs. control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription. The CDS tool assigned 248 patients to the alert group and 210 to the control group. Patients in the alert group were more likely to be prescribed anticoagulation during the hospitalization (25.8% vs. 9.5%, P < 0.0001), at discharge (23.8% vs. 12.9%, P = 0.003), and at 90 days (27.7% vs. 17.1%, P = 0.007). The alert reduced the odds of a composite outcome of death, myocardial infarction (MI), cerebrovascular event, and systemic embolic event at 90 days [11.3% vs. 21.9%, P = 0.002; odds ratio (OR) 0.45; 95% confidence interval (CI) 0.27–0.76]. The alert reduced the odds of MI at 90 days by 87% (1.2% vs. 8.6%, P = 0.0002; OR 0.13; 95% CI 0.04–0.45) and cerebrovascular events or systemic embolism at 90 days by 88% (0% vs. 2.4%, P = 0.02; OR 0.12; 95% CI 0.0–0.91).

Conclusion

An alert-based CDS strategy increased anticoagulation in high-risk hospitalized AF patients and reduced major adverse cardiovascular events, including MI and stroke.

ClinicalTrials.gov Identifier

NCT02339493.
Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients
Authors: Hilvo Mika , Meikle Peter J , Pedersen Eva Ringdal , Tell Grethe S , Dhar Indu , Brenner Hermann , Schöttker Ben , Lääperi Mitja , Kauhanen Dimple , Koistinen Kaisa M , Jylhä Antti , Huynh Kevin , Mellett Natalie A , Tonkin Andrew M , Sullivan David R , Simes John , Nestel Paul , Koenig Wolfgang , Rothenbacher Dietrich , Nygård Ottar , Laaksonen Reijo
Published: May 2019

Aims

Distinct ceramide lipids have been shown to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular death. As phospholipids have also been linked with CVD risk, we investigated whether the combination of ceramides with phosphatidylcholines (PCs) would be synergistic in the prediction of CVD events in patients with atherosclerotic coronary heart disease in three independent cohort studies.

Methods and results

Ceramides and PCs were analysed using liquid chromatography–mass spectrometry (LC-MS) in three studies: WECAC (The Western Norway Coronary Angiography Cohort) (N = 3789), LIPID (Long-Term Intervention with Pravastatin in Ischaemic Disease) trial (N = 5991), and KAROLA (Langzeiterfolge der KARdiOLogischen Anschlussheilbehandlung) (N = 1023). A simple risk score, based on the ceramides and PCs showing the best prognostic features, was developed in the WECAC study and validated in the two other cohorts. This score was highly significant in predicting CVD mortality [multiadjusted hazard ratios (HRs; 95% confidence interval) per standard deviation were 1.44 (1.28–1.63) in WECAC, 1.47 (1.34–1.61) in the LIPID trial, and 1.69 (1.31–2.17) in KAROLA]. In addition, a combination of the risk score with high-sensitivity troponin T increased the HRs to 1.63 (1.44–1.85) and 2.04 (1.57–2.64) in WECAC and KAROLA cohorts, respectively. The C-statistics in WECAC for the risk score combined with sex and age was 0.76 for CVD death. The ceramide-phospholipid risk score showed comparable and synergistic predictive performance with previously published CVD risk models for secondary prevention.

Conclusion

A simple ceramide- and phospholipid-based risk score can efficiently predict residual CVD event risk in patients with coronary artery disease.
Myocardial blood flow reserve assessed by positron emission tomography myocardial perfusion imaging identifies patients with a survival benefit from early revascularization
Authors: Patel Krishna K , Spertus John A , Chan Paul S , Sperry Brett W , Al Badarin Firas , Kennedy Kevin F , Thompson Randall C , Case James A , McGhie A Iain , Bateman Timothy M
Published: May 2019

Aims 

Positron emission tomography (PET) myocardial perfusion imaging (MPI) can non-invasively measure myocardial blood flow reserve (MBFR). We aimed to examine whether MBFR identifies patients with a survival benefit after revascularization, helping to guide post-test management.

Methods and results 

We examined all-cause mortality in 12 594 consecutive patients undergoing Rb82 rest/stress PET MPI from January 2010 to December 2016, after excluding those with cardiomyopathy, prior coronary artery bypass surgery (CABG), and missing MBFR. Myocardial blood flow reserve was calculated as the ratio of stress to rest absolute myocardial blood flow. A Cox model adjusted for patient and test characteristics, early revascularization (percutaneous coronary intervention or CABG ≤90 days of MPI), and the interaction between MBFR and early revascularization was developed to identify predictors of all-cause mortality. After a median follow-up of 3.2 years, 897 patients (7.1%) underwent early revascularization and 1699 patients (13.5%) died. Ischaemia was present in 4051 (32.3%) patients, with 1413 (11.2%) having ≥10% ischaemia. Mean MBFR was 2.0 ± 1.3, with MBFR <1.8 in 4836 (38.5%). After multivariable adjustment, every 0.1 unit decrease in MBFR was associated with 9% greater hazard of all-cause death (hazard ratio 1.09, 95% confidence interval 1.08–1.10; P < 0.001). There was a significant interaction between MBFR and early revascularization (P < 0.001); such that patients with MBFR ≤1.8 had a survival benefit with early revascularization, regardless of type of revascularization or level of ischaemia.

Conclusion 

Myocardial blood flow reserve on PET MPI is associated with all-cause mortality and can identify patients who receive a survival benefit with early revascularization compared to medical therapy. This may be used to guide revascularization, and prospective validation is needed.
Predictivity and Manifestation Factors in Aging Effects on the Orienting of Spatial Attention
Authors: Zivony Alon , Erel Hadas , Levy Daniel A
Published: May 2019

Objective

Prior attention research has asserted that endogenous orienting of spatial attention by willful focusing may be differently influenced by aging than exogenous orienting, the capture of attention by external cues. However, most such studies confound factors of manifestation (locational vs symbolic cues) and the predictivity of cues. We therefore investigated whether age effects on orienting are mediated by those factors.

Method

We measured accuracy and response times of groups of younger and older adults in a discrimination task with flanker distracters, under three spatial cueing conditions: nonpredictive locational cues, predictive symbolic cues, and a hybrid predictive locational condition.

Results

Age differences were found to be related to the factor of cue predictivity, but not to the factor of spatial manifestation. These differences were not modulated by flanker congruency.

Discussion

The results indicate that the orienting of spatial attention in healthy aging may be adversely affected by less effective perception or utilization of the predictive value of cues, but not by the requirement to voluntarily execute a shift of attention.
Neglect of Older People: Touching on Forensic and Pathophysiological Aspects
Authors: Altendorf Annette , Draper Brian , Wijeratne Chanaka , Schreiber Jason , Kanareck Daniella
Published: May 2019

Background and Objectives

Neglect of older people is common and may result in fatal and nonfatal outcomes. Normal changes of aging and disease-related symptoms may overlap with markers of neglect and lead to under-detection. This review aims to delineate medical, psychiatric, and pathophysiological indicators in the victim—identified in forensic case reports—to point out areas of overlap and raise awareness in Health Care Professionals.

Research Design and Methods

Medical and forensic databases were searched with the search terms: neglect, elder, elderly, forensic, homicide for detailed case reports on elder neglect. Cases were reviewed as to victim age, sex, medical/psychiatric diagnosis, perpetrator, victim-to-perpetrator relationship, cause of death (if fatal), location of incident, autopsy findings (if fatal), and ancillary studies. A total of 168 publications were retrieved, of these 11 publications, containing a total of 25 cases, yielded sufficient detail on each case to be included in the qualitative analysis.

Results

Neglect is associated with poor physical, psychological, and mental health. Neglect can be a direct cause of death or contribute to a fatal outcome by exacerbating existing conditions. Red flags of neglect included malnutrition, dehydration, poor hygiene, untreated decubitus ulcers, hypothermia, contractures, and an uncooperative caregiver. However, incontrovertible evidence of neglect is not always easy to obtain due to age and disease-related changes.

Discussion and Implications

The findings document the extent and seriousness of elder neglect and highlight the importance of detailed documentation as well as collaboration between clinicians, allied health professionals, law enforcement and medical forensic services to improve patient outcomes and reduce the risk of further incidents.
Culture-centeredness in community-based participatory research: contributions to health education intervention research
Authors: Wallerstein Nina , Oetzel John G , Duran Bonnie , Magarati Maya , Pearson Cynthia , Belone Lorenda , Davis Joyce , DeWindt Lori , Kastelic Sarah , Lucero Julie , Ruddock Charmaine , Sutter Erika , Dutta Mohan J
Published: May 2019

Health education research emphasizes the importance of cultural understanding and fit to achieve meaningful psycho-social research outcomes, community responsiveness and external validity to enhance health equity. However, many interventions address cultural fit through cultural competence and sensitivity approaches that are often superficial. The purpose of this study was to better situate culture within health education by operationalizing and testing new measures of the deeply grounded culture-centered approach (CCA) within the context of community-based participatory research (CBPR). A nation-wide mixed method sample of 200 CBPR partnerships included a survey questionnaire and in-depth case studies. The questionnaire enabled the development of a CCA scale using concepts of community voice/agency, reflexivity and structural transformation. Higher-order confirmatory factor analysis demonstrated factorial validity of the scale. Correlations supported convergent validity with positive associations between the CCA and partnership processes and capacity and health outcomes. Qualitative data from two CBPR case studies provided complementary socio-cultural historic background and cultural knowledge, grounding health education interventions and research design in specific contexts and communities. The CCA scale and case study analysis demonstrate key tools that community–academic research partnerships can use to assess deeper levels of culture centeredness for health education research.
Asexual parasites and their extraordinary host ranges
Authors: Gibson Amanda K
Published: May 2019

In diverse parasite taxa, from scale insects to root-knot nematodes, asexual lineages have exceptionally large host ranges, larger than those of their sexual relatives. Phylogenetic comparative studies of parasite taxa indicate that increases in host range and geographic range increase the probability of establishment of asexual lineages. At first pass, this convergence of traits appears counter-intuitive: intimate, antagonistic association with an enormous range of host taxa correlates with asexual reproduction, which should limit genetic variation within populations. Why would narrow host ranges favor sexual parasites and large host ranges favor asexual parasites? To take on this problem I link theory on ecological specialization to the two predominant hypotheses for the evolution of sex. I argue that both hypotheses predict a positive association between host range and the probability of invasion of asexual parasites, mediated either by variation in population size or in the strength of antagonistic coevolution. I also review hypotheses on colonization and the evolution of niche breadth in asexual lineages. I emphasize parasite taxa, with their diversity of reproductive modes and ecological strategies, as valuable assets in the hunt for solutions to the classic problems of the evolution of sex and geographic parthenogenesis.
Review on window-glazing technologies and future prospects
Authors: Aguilar-Santana Jorge Luis , Jarimi Hasila , Velasco-Carrasco Mariana , Riffat Saffa
Published: May 2019

Windows are one of the significant indicators of the energy efficiency of a building and have undergone extensive research since the last decades. This paper reviews the performance of various window technologies covering the physical and optical properties of traditional windows and advanced window technologies. In window technologies, one of the most critical parameters is its thermal transmittance value or also known as U-value. In this paper, we discuss the relationship between the physical and optical parameters of the different types of windows and its U-value. Additionally, this paper will also provide interested readers with a wide range of information, including the research gaps in window technologies. Among the main conclusions, we found that, although several advancements have been achieved in this field in the last decade, further research is needed to develop window technologies that not only have high insulating properties but also can generate power.
Pure Viral Sepsis Secondary to Community-Acquired Pneumonia in Adults: Risk and Prognostic Factors
Authors: Cillóniz Catia , Dominedò Cristina , Magdaleno Daniel , Ferrer Miquel , Gabarrús Albert , Torres Antoni
Published: May 2019

We investigated the risk and prognostic factors of pure viral sepsis in adult patients with community-acquired pneumonia (CAP), using the Sepsis-3 definition. Pure viral sepsis was found in 3% of all patients (138 of 4028) admitted to the emergency department with a diagnosis of CAP, 19% of those with CAP (138 of 722) admitted to the intensive care unit, and 61% of those (138 of 225) with a diagnosis of viral CAP. Our data indicate that males and patients aged ≥65 years are at increased risk of viral sepsis.
Once-Weekly Oral Dosing of MK-8591 Protects Male Rhesus Macaques From Intrarectal Challenge With SHIV109CP3
Authors: Markowitz Martin , Gettie Agegnehu , St. Bernard Leslie , Andrews Chasity D , Mohri Hiroshi , Horowitz Amir , Grasperge Brooke F , Blanchard James L , Niu Tao , Sun Li , Fillgrove Kerry , Hazuda Daria J , Grobler Jay A
Published: May 2019

Background

MK-8591 (4′-ethynyl-2-fluoro-2′-deoxyadenosine [EFdA]) is a novel reverse transcriptase–translocation inhibitor.

Methods

We assessed MK-8591 as preexposure prophylaxis in the rhesus macaque model of intrarectal challenge with simian/human immunodeficiency virus (SHIV). In study 1, 8 rhesus macaques received 3.9 mg/kg of MK-8591 orally on day 0 and once weekly for the next 14 weeks. Eight controls were treated with vehicle. All rhesus macaques were challenged with SHIV109CP3 on day 6 and weekly for up to 12 challenges or until infection was confirmed. The dose of MK-8591 was reduced to 1.3 and 0.43 mg/kg/week in study 2 and further to 0.1 and 0.025 mg/kg/week in study 3. In studies 2 and 3, each dose was given up to 6 times once weekly, and animals were challenged 4 times once weekly with SHIV109CP3.

Results

Control macaques were infected after a median of 1 challenge (range, 1–4 challenges). All treated animals in studies 1 and 2 were protected, consistent with a 41.5-fold lower risk of infection (P < .0001, by the log-rank test). In study 3, at a 0.1-mg/kg dose, 2 rhesus macaques became infected, consistent with a 7.2-fold lower risk of infection (P = .0003, by the log-rank test). The 0.025-mg/kg dose offered no protection.

Conclusions

These data support MK-8591’s potential as a preexposure prophylaxis agent.
Medication safety alert fatigue may be reduced via interaction design and clinical role tailoring: a systematic review
Authors: Hussain Mustafa I , Reynolds Tera L , Zheng Kai
Published: May 2019

Objective

Alert fatigue limits the effectiveness of medication safety alerts, a type of computerized clinical decision support (CDS). Researchers have suggested alternative interactive designs, as well as tailoring alerts to clinical roles. As examples, alerts may be tiered to convey risk, and certain alerts may be sent to pharmacists. We aimed to evaluate which variants elicit less alert fatigue.

Materials and Methods

We searched for articles published between 2007 and 2017 using the PubMed, Embase, CINAHL, and Cochrane databases. We included articles documenting peer-reviewed empirical research that described the interactive design of a CDS system, to which clinical role it was presented, and how often prescribers accepted the resultant advice. Next, we compared the acceptance rates of conventional CDS—presenting prescribers with interruptive modal dialogs (ie, “pop-ups”)—with alternative designs, such as role-tailored alerts.

Results

Of 1011 articles returned by the search, we included 39. We found different methods for measuring acceptance rates; these produced incomparable results. The most common type of CDS—in which modals interrupted prescribers—was accepted the least often. Tiering by risk, providing shortcuts for common corrections, requiring a reason to override, and tailoring CDS to match the roles of pharmacists and prescribers were the most common alternatives. Only 1 alternative appeared to increase prescriber acceptance: role tailoring. Possible reasons include the importance of etiquette in delivering advice, the cognitive benefits of delegation, and the difficulties of computing “relevance.”

Conclusions

Alert fatigue may be mitigated by redesigning the interactive behavior of CDS and tailoring CDS to clinical roles. Further research is needed to develop alternative designs, and to standardize measurement methods to enable meta-analyses.
Reconstruction of Deep Burn Wounds Around the Ankle With Free Fascia Flaps Transfer and Split-Thickness Skin Graft
Authors: Yang Xuekang , Fang Zhuoqun , Liu Mengdong , Zhang Yue , Chen Qiaohua , Tao Ke , Han Juntao , Hu Dahai
Published: May 2019

We aimed to introduce a technique by combining free fascia flaps transfer with split-thickness skin graft for the reconstruction of deep burn wounds at the ankle. Fifteen patients from 2009 to 2016 were enrolled in this study. Patients in this series suffered from a deep burn injury around the ankle, which was accompanied with exposure of tendon and medial or lateral malleolus exposure due to severe soft-tissue defects (N = 15). All the 15 wounds were repaired combining free fascia flaps with split-thickness skin graft operations, including nine anterolateral thigh fascia lata flaps (ATFL flaps) and six superficial temporal fascia flaps (STF flaps). All the fascia flaps completely survived. Two patients showed partial grafting skin necrosis due to either wound infection or subcutaneous hematoma infection, and this was eventually healed satisfactorily after conventional dressing change. All patients achieved esthetic outcome and acceptable functionality without further revisions needed. Our present study reports a useful method that involves using free fascia flaps in combination with split-thickness skin graft to repair deep burn wounds around the ankle. This method provided reliable and durable soft-tissue coverage with good outcomes.
Comparative analysis of the mine pressure at non-pillar longwall mining by roof cutting and traditional longwall mining
Authors: Zhou Peng , Wang Yajun , Zhu Guolong , Gao Yubing
Published: May 2019

Non-pillar coal mining has been developed and implemented in the recent decades in China's coal mining industry. The non-pillar longwall mining by roof cutting without pre-excavated entry (N00 mining method) is one of the latest non-pillar mining methods and this method has the advantages of reduced roadway drivage ratio and increased resource recovery ratio. Previous studies show that the mining pressure during the working face advancing is one of the main factors that affect the stability of underground structures and the safety production. However, there is no evaluation or analysis of the mining pressure at the mining face using entry retaining with roof pre-cutting and an absence of pre-excavated tail entry. In this paper, both field monitoring and numerical simulation approaches are employed in the analysis of the mining pressure distribution characteristics within a range of the whole working face during the face advancing. The results are compared with the field data and simulation results from the traditional mining method performed in the same coal mine. Results supported the idea that the N00 mining method can generate a low-stress area for the retained entry. The stability of the working face and retained entry can be well maintained due to the mine pressure optimization. This paper can aid in the understanding of structural mechanic modeling and mine pressure distribution features, structural mechanic analysis and mine pressure distribution features of the N00 mining method.
Assessing Children’s Eudaimonic Well-Being: The PROMIS Pediatric Meaning and Purpose Item Banks
Authors: Forrest Christopher B , Bevans Katherine B , Filus Ania , Devine Janine , Becker Brandon D , Carle Adam C , Teneralli Rachel E , Moon JeanHee , Ravens-Sieberer Ulrike
Published: May 2019

Objective

To describe the development of the Patient-Reported Outcome Measurement Information System (PROMIS) Pediatric Meaning and Purpose item banks, child-report and parent-proxy editions.

Methods

Data were collected from two samples. The first comprised 1,895 children (8–17 years old) and 927 parents of children 5–17 years old recruited from an Internet panel, medical clinics, and schools. The second comprised a nationally representative sample of 990 children 8–17 years old and 1,292 parents of children 5–17 years old recruited from a different Internet panel. Item pool evaluation was done with Sample 1 and analyses were used to support decisions about item retention. The combined sample was used for item response theory (IRT) calibration of the item bank. Both samples were used in validation studies.

Results

Eleven items were deleted from the item pool because of poor psychometric performance. The final versions of the scales showed excellent reliability (>0.90). Short form scales (4 or 8 items) had a high degree of precision across over 4 SD units of the latent variable. The item bank positively correlated with extant measures of positive psychological functioning, and negatively correlated with measures of emotional distress, pessimism, and pain. Lower meaning and purpose scores were associated with adolescence and presence of a special healthcare need.

Conclusion

The PROMIS Pediatric Meaning and Purpose item banks and their short forms are ready for use in clinical research and practice. They are measures of children’s eudaimonic well-being and indicative of children’s hopefulness, optimism, goal-directedness, and feelings that life is worth living.
Impact of delivery characteristics on dose delivery accuracy of volumetric modulated arc therapy for different treatment sites
Authors: Li Jiaqi , Zhang Xile , Li Jun , Jiang Rongtao , Sui Jing , Chan Maria F , Yang Ruijie
Published: May 2019

This study aimed to investigate the impact of delivery characteristics on the dose delivery accuracy of volumetric modulated arc therapy (VMAT) for different treatment sites. The pretreatment quality assurance (QA) results of 344 VMAT patients diagnosed with gynecological (GYN), head and neck (H&N), rectal or prostate cancer were randomly chosen in this study. Ten metrics reflecting VMAT delivery characteristics were extracted from the QA plans. Compared with GYN and rectal plans, H&N and prostate plans had higher aperture complexity and monitor units (MU), and smaller aperture area. Prostate plans had the smallest aperture area and lowest leaf speed compared with other plans (P < 0.001). No differences in gantry speed were found among the four sites. The gamma passing rates (GPRs) of GYN, rectal and H&N plans were inversely associated with union aperture area (UAA) and leaf speed (Pearson’s r: −0.39 to −0.68). GPRs of prostate plans were inversely correlated with aperture complexity, MU and small aperture score (SAS) (absolute Pearson’s r: 0.34 to 0.49). Significant differences in GPR between high SAS and low SAS subgroups were found only when leaf speed was <0.42 cm s–1 (P < 0.001). No association of GPR with gantry speed was found in four sites. Leaf speed was more strongly associated with UAA. Aperture complexity and MU were more strongly associated with SAS. VMAT plans from different sites have distinct delivery characteristics. Affecting dose delivery accuracy, leaf speed is the key factor for GYN, rectal and H&N plans, while aperture complexity, MU and small apertures have a higher influence on prostate plans.
Proton therapy for non-squamous cell carcinoma of the head and neck: planning comparison and toxicity
Authors: Iwata Hiromitsu , Toshito Toshiyuki , Hayashi Kensuke , Yamada Maho , Omachi Chihiro , Nakajima Koichiro , Hattori Yukiko , Hashimoto Shingo , Kuroda Yo , Okumura Yoshihide , Mizoe Jun-etsu , Ogino Hiroyuki , Shibamoto Yuta
Published: May 2019

To investigate optimal treatment planning using proton beams for non-squamous cell carcinoma of the head and neck (NSCHN), the dose distributions of plans involving pencil beam scanning (PBS) with or without a patient-specific aperture system (PSAS), passive-scattering proton therapy (PSPT) and X-ray intensity-modulated radiotherapy (IMRT) were compared. As clinical results, toxicities of PBS with PSAS, including changes in quality of life, were reported. Between April 2014 and August 2016, a total of 30 patients were treated using PBS with PSAS. In 20 patients selected at random, the dose distributions of PBS with or without the PSAS, PSPT and IMRT plans were compared. Neutron exposure by proton therapy was calculated using a Monte Carlo simulation. Toxicities were scored according to CTCAE ver. 4.0. Patients completed EORTC quality of life survey forms (QLQ-C30 and QLQ-HN35) before and 0–12 months after proton therapy. The 95% conformity number of PBS with the PSAS plan was the best, and significant differences were detected among the four plans (P < 0.05, Bonferroni tests). Neutron generation by PSAS was ~1.1-fold higher, but was within an acceptable level. No grade 3 or higher acute dermatitis was observed. Pain, appetite loss and increased weight loss were more likely at the end of treatment, but recovered by the 3 month follow-up and returned to the pretreatment level at the 12 month follow-up. PBS with PSAS reduced the penumbra and improved dose conformity in the planning target volume. PBS with PSAS was tolerated well for NSCHN.
Application of laser capture microdissection and polymerase chain reaction in the diagnosis of Trichoderma longibrachiatum infection: a promising diagnostic tool for ‘fungal contaminants’ infection
Authors: Zhou Ya Bin , Zhang Gong Jie , Song Ying Gai , Sun Li Na , Chen Ya Hong , Sun Ting Ting , Li Ruo Yu , Liu Wei , Li Dong Ming
Published: May 2019

Although Trichoderma species are usually considered to be culture contaminants, an increasing number of case reports have demonstrated their pathogenicity. Current diagnostic tools, including fungal culture, radiology, histopathology, and direct microscopy examination, are often unable to differentiate the pathogenicity of ‘fungal contaminants’ such as Trichoderma species in patients. Accurate diagnostic tools for ‘fungal contaminants’ infection have become the urgent needs. To that end, we applicated laser capture microdissection (LCM) and polymerase chain reaction (PCR) to confirm T. longibrachiatum infection for the first time. A 57-year-old man presented with a cough and hemoptysis lasting for more than 40 days. Computed tomography scan revealed a mass at the left hilum. In addition to pulmonary spindle cell carcinoma, fungal hyphae were also detected in histopathological examination. The cultured fungus was identified as T. longibrachiatum using molecular procedures. The results from DNA sequencing of DNA obtained by LCM revealed the identical result. Antifungal susceptibility testing revealed resistance to itraconazole, fluconazole and flucytosine. The patient was managed with oral voriconazole for 4 months. No relapse of Trichoderma infection was observed at a year follow-up visit. Although there are potential disadvantages, LCM-based molecular biology technology is a promising diagnostic tool for ‘fungal contaminants’ infection.
False negative diagnostic errors with polymerase chain reaction for the detection of cryptococcal meningoencephalitis
Authors: Lewis Paul O , Lanier Cameron G , Patel Paras D , Krolikowski Whitney D , Krolikowski Matthew A
Published: May 2019

The accuracy of the BioFire FilmArray Meningitis/Encephalitis (ME) panel for the identification of Cryptococcus has recently been called into question. The primary objective of this study was to assess the agreement between the BioFire ME polymerase chain reaction (PCR) and other markers of cryptococcal infection. This retrospective review identified five patients with cryptococcal meningoencephalitis, 4 of whom had a negative ME panel for Cryptococcus. All five cases had positive serum cryptococcal antigens, and three of five had a positive cerebrospinal fluid (CSF) culture for Cryptococcus. The BioFire ME panel does not appear to be reliable for ruling out Cryptococcus meningoencephalitis; multiple testing methods are recommended.
Superluminous supernovae from the Dark Energy Survey
Authors: Angus C R , Smith M , Sullivan M , Inserra C , Wiseman P , D’Andrea C B , Thomas B P , Nichol R C , Galbany L , Childress M , Asorey J , Brown P J , Casas R , Castander F J , Curtin C , Frohmaier C , Glazebrook K , Gruen D , Gutierrez C , Kessler R , Kim A G , Lidman C , Macaulay E , Nugent P , Pursiainen M , Sako M , Soares-Santos M , Thomas R C , Abbott T M C , Avila S , Bertin E , Brooks D , Buckley-Geer E , Burke D L , Carnero Rosell A , Carretero J , da Costa L N , De Vicente J , Desai S , Diehl H T , Doel P , Eifler T F , Flaugher B , Fosalba P , Frieman J , García-Bellido J , Gruendl R A , Gschwend J , Hartley W G , Hollowood D L , Honscheid K , Hoyle B , James D J , Kuehn K , Kuropatkin N , Lahav O , Lima M , Maia M A G , March M , Marshall J L , Menanteau F , Miller C J , Miquel R , Ogando R L C , Plazas A A , Romer A K , Sanchez E , Schindler R , Schubnell M , Sobreira F , Suchyta E , Swanson M E C , Tarle G , Thomas D , Tucker D L ,   (DES Collaboration)
Published: May 2019

We present a sample of 21 hydrogen-free superluminous supernovae (SLSNe-I) and one hydrogen-rich SLSN (SLSN-II) detected during the five-year Dark Energy Survey (DES). These SNe, located in the redshift range 0.220 < z < 1.998, represent the largest homogeneously selected sample of SLSN events at high redshift. We present the observed g, r, i, z light curves for these SNe, which we interpolate using Gaussian processes. The resulting light curves are analysed to determine the luminosity function of SLSNe-I, and their evolutionary time-scales. The DES SLSN-I sample significantly broadens the distribution of SLSN-I light-curve properties when combined with existing samples from the literature. We fit a magnetar model to our SLSNe, and find that this model alone is unable to replicate the behaviour of many of the bolometric light curves. We search the DES SLSN-I light curves for the presence of initial peaks prior to the main light-curve peak. Using a shock breakout model, our Monte Carlo search finds that 3 of our 14 events with pre-max data display such initial peaks. However, 10 events show no evidence for such peaks, in some cases down to an absolute magnitude of <−16, suggesting that such features are not ubiquitous to all SLSN-I events. We also identify a red pre-peak feature within the light curve of one SLSN, which is comparable to that observed within SN2018bsz.