bluuebunny/crossref_metadata_2025 huggingface dataset:
Separate and combined influences of heat and hypobaric hypoxia on self-paced aerobic exercise performance
Authors: Bradbury Karleigh E. , Coffman Kirsten E. , Mitchell Katherine M. , Luippold Adam J. , Fulco Charles S. , Kenefick Robert W.
Published: June 2019

Heat and hypobaric hypoxia independently compromise exercise performance; however, their combined impact on exercise performance has yet to be quantified. This study examined the effects of heat, hypobaric hypoxia, and the combination of these environments on self-paced cycling time trial (TT) performance. Twelve subjects [2 female, 10 male; sea level (SL) peak oxygen consumption (V̇o2peak), 41.5 ± 4.4 mL·kg−1·min−1, mean ± SD] completed 30 min of steady-state cycling exercise (50% SL V̇o2peak), followed by a 15-min self-paced TT in four environmental conditions: SL thermoneutral [SLTN; 250 m, 20°C, 30–50% relative humidity (rh)], SL hot (SLH; 250 m, 35°C, 30% rh), hypobaric hypoxia thermoneutral (HTN; 3,000 m, 20°C, 30–50% rh), and hypobaric hypoxia hot (HH; 3,000 m, 35°C, 30% rh). Performance was assessed by the total work (kJ) completed. TT performance was lower ( P < 0.05) in SLH, HTN, and HH relative to SLTN (−15.4 ± 9.7, −24.1 ± 16.2, and −33.1 ± 13.4 kJ, respectively). Additionally, the total work completed in HTN and HH was lower ( P < 0.05) than that in SLH. In SLH, HTN, and HH, work rate was reduced versus SLTN ( P < 0.05) within the first 3 min of exercise and was consistent for the remainder of the bout. No differences ( P > 0.05) existed for heart rate or Ratings of Perceived Exertion at the end of exercise among conditions. The decrease in self-paced TT performance in the heat and/or hypobaric hypoxia conditions compared with SLTN conditions resulted from a nearly immediate reduction in work rate that may have been regulated by environmentally induced changes in physiological strain and perception of effort in response to TT exercise.

NEW & NOTEWORTHY This is the first known study to examine the combined effects of heat and hypobaric hypoxia on short-duration self-paced cycling time trial performance. Regardless of environmental condition, subjects utilized an even work rate for the entire duration of the time trial. The presence of both environmental stressors led to a greater performance impairment than heat or hypobaric hypoxia alone, and the performance decrement stemmed from an early reduction of work rate.
Hopping with degressive spring stiffness in a full-leg exoskeleton lowers metabolic cost compared with progressive spring stiffness and hopping without assistance
Authors: Allen Stephen P. , Grabowski Alena M.
Published: June 2019

When humans hop with a passive-elastic exoskeleton with springs in parallel with both legs, net metabolic power (Pmet) decreases compared with normal hopping (NH). Furthermore, humans retain near-constant total vertical stiffness ( ktot) when hopping with such an exoskeleton. To determine how spring stiffness profile affects Pmetand biomechanics, 10 subjects hopped on both legs normally and with three full-leg exoskeletons that each used a different spring stiffness profile at 2.4, 2.6, 2.8, and 3.0 Hz. Each subject hopped with an exoskeleton that had a degressive spring stiffness (DGexo), where stiffness, the slope of force vs. displacement, is initially high but decreases with greater displacement, linear spring stiffness (LNexo), where stiffness is constant, or progressive spring stiffness (PGexo), where stiffness is initially low but increases with greater displacement. Compared with NH, use of the DGexo, LNexo, and PGexonumerically resulted in 13–24% lower, 4–12% lower, and 0–8% higher Pmet, respectively, at 2.4–3.0 Hz. Hopping with the DGexoreduced Pmetcompared with NH at 2.4–2.6 Hz ( P ≤ 0.0457) and reduced Pmetcompared with the PGexoat 2.4–2.8 Hz ( P < 0.001). ktotwhile hopping with each exoskeleton was not different compared with NH, suggesting that humans adjust leg stiffness to maintain overall stiffness regardless of the spring stiffness profile in an exoskeleton. Furthermore, the DGexoprovided the greatest elastic energy return, followed by LNexoand PGexo( P ≤ 0.001). Future full-leg, passive-elastic exoskeleton designs for hopping, and presumably running, should use a DGexorather than an LNexoor a PGexoto minimize metabolic demand.

NEW & NOTEWORTHY When humans hop at 2.4–3.0 Hz normally and with an exoskeleton with different spring stiffness profiles in parallel to the legs, net metabolic power is lowest when hopping with an exoskeleton with degressive spring stiffness. Total vertical stiffness is constant when using an exoskeleton with linear or nonlinear spring stiffness compared with normal hopping. In-parallel spring stiffness influences net metabolic power and biomechanics and should be considered when designing passive-elastic exoskeletons for hopping and running.
Determination of Length of Interdigitation Zone by Optical Coherence Tomography and Retinal Sensitivity by Microperimetry and Their Relationship to Progression of Retinitis Pigmentosa
Authors: Chiba Akihiro , Miura Gen , Baba Takayuki , Yamamoto Shuichi
Published: June 2019

Purpose. To investigate the annual progression of retinitis pigmentosa (RP) by changes in retinal sensitivity and length of photoreceptor microstructures. Method. The medical records of patients with typical RP followed at Chiba University Hospital were reviewed. The retinal sensitivity was measured by Micro Perimeter-1, and the lengths of the intact external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) were measured by spectral-domain optical coherence tomography. The baseline values and annual progression rates were determined. The significance of the correlations among these factors was determined by generalized estimating equation regression analysis. Results. Forty-six eyes of 24 patients who were examined over a mean follow-up period of 3 years were studied. The annual changes in the retinal sensitivity (p = 0.0035) and the lengths of the EZ (p = 0.037) and IZ (p = 0.0033) were significantly correlated with their baseline values. The annual change in the retinal sensitivity was significantly correlated with the length of the EZ at the baseline (p = 0.020). Conclusions. The significant correlation between the annual progression of the retinal sensitivity and the baseline retinal sensitivity and lengths of the EZ and IZ in patients with RP indicate that the retinal sensitivity, the EZ, and the IZ can be useful parameters to predict the annual progression of RP.
A Rare Case of the Digenic Inheritance of Long QT Syndrome Type 2 and Type 6
Authors: Heida Annejet , van der Does Lisette J. M. E. , Ragab Ahmed A. Y. , de Groot Natasja M. S.
Published: June 2019

We report a 37-year-old woman with an out-of-hospital cardiac arrest caused by ventricular fibrillation due to digenic inheritance of long QT syndrome type 2 (KCNH2 gene) and type 6 (KCNE2 gene). During hospitalization, prolonged QTc intervals and frequent episodes of ventricular tachyarrhythmias manifested. Genetic testing identified a mutation of the KCNH2 gene and an unclassified variant, most likely pathogenic, of the KCNE2 gene. This digenic inheritance is extremely rare.
Explanatory Factors for Public Transportation Financing Needs in Spain
Authors: Delgado Jalon María Luisa , Sanchez de Lara Miguel Angel , Gelashvili Vera
Published: June 2019

Public transport financing in Spain has generated interest due to the absence of a governing regulatory framework. There is a need for rules that help allocate public subsidies to guarantee the system’s financial sustainability. Without explicit regulation, the current system for assigning and distributing public funding among Spanish cities has become unbalanced. Our goal is to identify the principal factors that explain why urban transport services in different cities require varying levels of public financing. Our results show that variables such as the “passengers,” “number of vehicles,” “number of employees,” “autonomous community deficit”, and “population density” are influencing factors for the needs of public subsidies.
Local Administration of Caloric Restriction Mimetics to Promote the Immune Control of Lung Metastases
Authors: Le Noci Valentino , Sommariva Michele , Bianchi Francesca , Triulzi Tiziana , Tagliabue Elda , Balsari Andrea , Sfondrini Lucia
Published: June 2019

Caloric restriction mimetics (CRMs), compounds that mimic the biochemical effects of nutrient deprivation, administered via systemic route promote antitumor effects through the induction of autophagy and the modulation of the immune microenvironment; however, collateral effects due to metabolic changes and the possible weight loss might potentially limit their administration at long term. Here, we investigated in mice local administration of CRMs via aerosol to reduce metastasis implantation in the lung, whose physiologic immunosuppressive status favors tumor growth. Hydroxycitrate, spermidine, and alpha-lipoic acid, CRMs that target different metabolic enzymes, administered by aerosol, strongly reduced implantation of intravenously injected B16 melanoma cells without overt signs of toxicity, such as weight loss and changes in lung structure. Cytofluorimetric analysis of lung immune infiltrates revealed a significant increase of alveolar macrophages and CD103+ dendritic cells in mice treated with CRMs that paralleled an increased recruitment and activation of both CD3 T lymphocytes and NK cells. These effects were associated with the upregulation of genes related to M1 phenotype, as IL-12 and STAT-1, and to the decrease of M2 genes, as IL-10 and STAT-6, in adherent fraction of lung immune infiltrate, as revealed by real-time PCR analysis. Thus, in this proof-of-principle study, we highlight the antitumor effect of CRM aerosol delivery as a new and noninvasive therapeutic approach to locally modulate immunosurveillance at the tumor site in the lung.
Recent Advances in Investigation, Prevention, and Management of Healthcare-Associated Infections (HAIs): Resistant Multidrug Strain Colonization and Its Risk Factors in an Intensive Care Unit of a University Hospital
Authors: Zaha Dana Carmen , Kiss Rita , Hegedűs Csaba , Gesztelyi Rudolf , Bombicz Mariann , Muresan Mariana , Pallag Annamaria , Zrinyi Miklos , Pall Denes , Vesa Cosmin Mihai , Micle Otilia
Published: June 2019

Active screening for resistant multidrug strain carriers remains an important component of infection control policy in any healthcare setting indifferent of financial and logistical costs. The objective of our study was to determine the spectrum of bacterial colonization individually among intensive care unit patients. A retrospective observational study was performed in the Intensive Care Unit of Emergency Clinical County Hospital of Oradea during 2017. Medical records of the patients were used for evaluation of source of ICU admission, previous antibiotic therapy, comorbidities, and length of hospital stay. Nasal and groin swabs for MRSA detection and rectal swabs for ESBL, VRE, and CRE detection were collected upon ICU admission of all patients in the first 24 hours and after 7 days. Swab samples were processed for isolation and identification of these resistant multidrug strains. Bacterial colonization on admission was detected in a quarter of patients included in the study. Carbapenemase-producing bacteria were the most common colonizers (21.16%). On admission, 12.06% of patients have been colonized by ESBL-producing members of the family Enterobacterales. Risk factors for colonization on admission to the ICU were chronic liver diseases and chronic renal failure for ESBL infection and chronic liver disease for CRE in male patients. Evaluation of Carmeli’s score for male patients showed association only with CRE colonization. Chronic renal failure was found as risk factor for ESBL colonization in female patients. The prevalence of MRSA was 5.23% and less than 1% for VRE. There was no association between any risk factors studied and the presence of S. aureus or VRE upon admission. The 7-day ICU stay also proved to be an increased risk for ESBL and CRE infection.
Treatment Strategies Based on Histological Targets against Invasive and Resistant Glioblastoma
Authors: Hara Akira , Kanayama Tomohiro , Noguchi Kei , Niwa Ayumi , Miyai Masafumi , Kawaguchi Masaya , Ishida Kazuhisa , Hatano Yuichiro , Niwa Masayuki , Tomita Hiroyuki
Published: June 2019

Glioblastoma (GBM) is the most common and the most malignant primary brain tumor and is characterized by rapid proliferation, invasion into surrounding normal brain tissues, and consequent aberrant vascularization. In these characteristics of GBM, invasive properties are responsible for its recurrence after various therapies. The histomorphological patterns of glioma cell invasion have often been referred to as the “secondary structures of Scherer.” The “secondary structures of Scherer” can be classified mainly into four histological types as (i) perineuronal satellitosis, (ii) perivascular satellitosis, (iii) subpial spread, and (iv) invasion along the white matter tracts. In order to develop therapeutic interventions to mitigate glioma cell migration, it is important to understand the biological mechanism underlying the formation of these secondary structures. The main focus of this review is to examine new molecular pathways based on the histopathological evidence of GBM invasion as major prognostic factors for the high recurrence rate for GBMs. The histopathology-based pharmacological and biological targets for treatment strategies may improve the management of invasive and resistant GBMs.
Mean Square Exponential Stability of Stochastic Complex‐Valued Neural Networks with Mixed Delays
Authors: Xu Xiaohui , Yang Jibin , Xu Yanhai
Published: June 2019

This paper investigates the mean square exponential stability problem of a class of complex‐valued neural networks with stochastic disturbance and mixed delays including both time‐varying delays and continuously distributed delays. Under different assumption conditions concerning stochastic disturbance term from the existing ones, some sufficient conditions are derived for assuring the mean square exponential stability of the equilibrium point of the system based on the vector Lyapunov function method and differential‐integral theorem. The obtained results not only generalize the existing ones, but also reduce the conservatism of the previous stability results about complex‐valued neural networks with stochastic disturbances. Two numerical examples with simulation results are given to verify the feasibility of the proposed results.
The Orbital Stability of Solitary Wave Solutions for the Generalized Gardner Equation and the Influence Caused by the Interactions between Nonlinear Terms
Authors: Zhang Wei-Guo , Ling Xing-Qian , Li Xiang , Li Shao-Wei
Published: June 2019

In this paper, the orbital stability of solitary wave solutions for the generalized Gardner equation is investigated. Firstly, according to the theory of orbital stability of Grillakis‐Shatah‐Strauss, a general conclusion is given to determine the orbital stability of solitary wave solutions. Furthermore, on the basis of the two bell‐shaped solitary wave solutions of the equation, the explicit expressions of the orbital stability discriminants are deduced to give the orbitally stable and instable intervals for the two solitary waves as the wave velocity changing. Moreover, the influence caused by the interaction between two nonlinear terms is also discussed. From the conclusion, it can be seen that the influences caused by this interaction are apparently when 0 < p < 4, which shows the complexity of this system with two nonlinear terms. Finally, by deriving the orbital stability discriminant d′′(c) in the form of Gaussian hypergeometric function, the numerical simulations of several main conclusions are given in this paper.
Experimental Research on Antiseismic Performance of High‐Strength Concrete High‐Shear Walls with Built‐In Steel Plates
Authors: Yu Yu , Gan Min , Zhang Yan , Li Liren , Zhang Huakun
Published: June 2019

To study the antiseismic performance of the high‐strength concrete composite shear wall with built‐in steel plates, an experiment on a high‐strength concrete composite shear wall with four built‐in steel plates (SPRCW‐1∼4) was set up. Based on the experimental result, the paper discusses the antiseismic performance, failure mode, and failure mechanism of the high‐strength concrete composite shear wall with built‐in steel plates under different steel ratios and different positions of steel plates. The experimental result has shown that the differences in steel plate position and steel ratios have certain effects on wall cracking. The use of high steel content and the placement of steel plates on both sides of the wall can limit wall cracking to some extent. When the bearing capacity of the steel plates located on both sides of the wall is larger than that in the middle of the wall, a high content of steel in the wall can effectively increase the bearing capacity of the test piece to some extent. Under a high axial compression ratio, the horizontal bar of the wall can substantially limit the vertical cracks in concrete arising from compression. Moreover, the built‐in steel plates in the shear wall play a significant role in inhibiting the propaganda of the oblique cracks under the action of earthquakes. The research result has very good economy and operability and can provide a basis for promotion and application of the mid‐ and high‐rise buildings in regions with high seismic intensity.
Evaluation of Level of Essential Elements and Toxic Metal in the Medicinal Plant Hymenaea martiana Hayne (Jatobá) Used by Mid-West Population of Brazil
Authors: Rocha Layza S. , Arakaki Daniela G. , Bogo Danielle , Melo Elaine S. P. , Lima Nayara V. , Souza Igor D. de , Garrison-Engbrecht Anthony J. , Guimarães Rita de Cassia A. , Nascimento Valter A.
Published: June 2019

Hymenaea martiana Hayne belongs to the family Fabaceae (Leguminosae) and presents the popular name of jatobá. It is a tree that demonstrates medicinal purposes and represents a food source in Brazil. The potential contribution of each species to recommended nutrient intakes (DRI) and Brazilian Health Surveillance Agency (ANVISA) for children and adults were calculated. A comparison between the quantified contents of micro- and macronutrients Al, Ca, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, P, S, and Zn in leaves tea and tea of the bark of this plant was made with the recommendation of FDA and ANVISA. General safety regarding metal content (Na, K, Ca, Fe, Zn, and Ni) and nonmetal (P) was assured as none of them exceed the safety limit of the daily intake. However, the content of Mn observed in the teas of H. martiana Hayne is above the UL for tolerable intake level for children aged 1-6 years. There are no limits established for the UL of Cr and S for children and adults. The data on quantification of mineral concentration in the species Hymenaea martiana Hayne obtained can serve as a tool to decide the dosage of preparations from this plant used for medicinal purposes.
Vitamin D as an Adjunctive Treatment to Standard Drugs in Pulmonary Tuberculosis Patients: An Evidence-Based Case Report
Authors: Soeharto Diajeng Ayesha , Rifai Diana Ashilah , Marsudidjadja Stella , Roekman Aisha Emilirosy , Assegaf Chadijah Karima , Louisa Melva
Published: June 2019

Background. Vitamin D has a prominent role in the body’s innate immunity as it is important in the maintenance of macrophages and monocytes and its function in defending against infections.In-vitrostudies have established vitamin D’s potential role in tuberculosis (TB) infection, in that it restrictsMycobacterium tuberculosisgrowth, thus implying the potential benefit of vitamin D as an adjunctive treatment for TB. However, clinical trials and reviews have contradicting findings regarding the true clinical efficacy of adjunctive vitamin D, particularly in reducing the sputum conversion rate (SCR).Objective. This study aims to update the current evidence regarding vitamin D supplementation as an adjunctive treatment in achieving the smear sputum conversion rate (SCR) among pulmonary TB patients.Method. A comprehensive search was conducted in October 2018 in PubMed-NCBI, MEDLINE-OVID, SCOPUS-Elsevier, and Cochrane. The selection of studies was done as per the predetermined inclusion and exclusion criteria of this EBCR and resulted in the inclusion of 11 eligible studies (8 RCTs and 3 systematic reviews). The selected studies were then critically appraised for their validity, importance, and applicability according to the CEBM (Centre for Evidence-Based Medicine) appraisal tools.Results. Overall, most of the trials showed no statistically significant changes in terms of the proportion of TB patients with a negative sputum smear conversion in the group treated with an adjunctive therapy vs. the group treated with standard antituberculosis therapy alone. Only one trial showed significant results, which was conducted in a population of TB patients with vitamin D deficiency. Furthermore, overall the reviews showed no significant change in the 8-week sputum smear conversion after treatment within the group given vitamin D in comparison to those who were not.Conclusion. Vitamin D as adjunctive therapy in TB patients shows no clinical improvement in terms of sputum conversion to antituberculosis management.
Nonlinear Dynamic Characteristics of Fixed‐Axis Gear Wear in Multistage Gear Transmission Systems
Authors: Wang Xin
Published: June 2019

With the increasing service life of a gear transmission system, the gear teeth become constantly worn and the gear clearance increases. The increase in the clearance will produce a series of nonlinear changes that change the stability of the system and can even cause the loss of stability. In this paper, dimensionless dynamic equations of a multistage gear transmission system that contains a two‐stage fixed‐axis gear and a one‐stage planetary gear were derived. The wear fault was simulated by changes in the gear clearance. System bifurcation diagrams with an increase in the clearance were studied. The motion state and transition process of the multistage gear transmission system with a wear fault were studied using the Poincaré section. The change in the spectrum characteristics with an increase in the clearance was analyzed. The frequency spectrum characteristics of the wear fault were discovered. The vibration mechanism and a fault wear diagnosis method in a multistage gear transmission system were obtained.
Design of an Interacting Multiple Model‐Cubature Kalman Filter Approach for Vehicle Sideslip Angle and Tire Forces Estimation
Authors: Hou SuoJun , Xu Wenbo , Liu Gang
Published: June 2019

Vehicle states estimation (e.g., vehicle sideslip angle and tire force) is a key factor for vehicle stability control. However, the accurate values of these parameters could not be obtained directly. In this paper, an interacting multiple model‐cubature Kalman filter (IMM‐CKF) is used to estimate the vehicle state parameters. And improvements about estimation method are achieved in this paper. Firstly, the accuracy of the reference model is improved by building two different models: one is 7‐degree‐of‐freedom (7 DOF) vehicle model with linear tire model, and the other is 7 DOF vehicle model with nonlinear Dugoff tire model. Secondly, the different models are switched by IMM‐CKF to match different driving condition. Thirdly, the lateral acceleration correction for sideslip angle estimation is considered, because the sensor of lateral acceleration is easy to be influenced by the gravity on banked road. Then, to compare cubature Kalman filter (CKF) estimation method and IMM‐CKF estimation method Hardware‐In‐Loop (HIL) tests are carried out in the paper. And simulation results show that IMM‐CKF methodology can provide accurate estimation values of vehicle states parameters.
Gait Recognition of Acceleration Sensor for Smart Phone Based on Multiple Classifier Fusion
Authors: Huan Zhan , Chen Xuejie , Lv Shiyun , Geng Hongyang
Published: June 2019

Gait, as a kind of biological feature, has a profound value in personnel identification. This paper analyzes gait characteristics based on acceleration sensors of smart phones and proposes a new gait recognition method. First, in view of the existing methods in the process of extraction of gait features, a large number of redundant calculations, cycle detection error, and the phase deviation issue during the week put forward the Shape Context (SC) and Linear Time Normalized (LTN) combining SCLTN calibration method of gait cycle sequence matching, to represent the whole extract typical gait cycle gait. In view of the existing extracted gait features are still some conventional features; the velocity change of relatively uniform acceleration and the change of acceleration per unit time are proposed as new features. Secondly, combining new features with traditional features to form a new feature is set for training alternative feature set, from which the training time and recognition effect of multiple classifiers are screened. Finally, a new multiclassifier fusion method, Multiple Scale Voting (MSV), is proposed to fuse the results of Multiple classifiers to obtain the final classification results. In order to verify the performance of the proposed method, gait data of 32 testers are collected. The final experimental results show that the new feature has good separability, and the recognition rate of fusion feature set after MSV algorithm is 98.42%.
Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis
Authors: Albert Lara , Profitós Joaquím , Sánchez-Delgado Jordi , Capel Ismael , González-Clemente José Miguel , Subías David , Cano Albert , Berlanga Eugenio , Espinal Anna , Hurtado Marta , Pareja Rocío , Rigla Mercedes , Dalmau Blai , Vergara Mercedes , Miquel Mireia , Casas Meritxell , Giménez-Palop Olga
Published: June 2019

Purpose. The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 μg intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients. Methods. We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0’(T0) and at 30-minute intervals after intravenous administration of 250 μg ACTH [30’(T30), 60’(T60), and 90’(T90)]. Results. Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T0< 0.08 μg/dL (2.2 nmol/L), SaC-T60 < 1.43 μg/dl (39.5 nmol/L), or ΔSaC<1 μg/dl (27.6 nmol/L). We compared AI determination in cirrhotic patients with the ACTH test using these SaC thresholds versus established TSC thresholds (TSC-T0< 9 μg/dl [248 nmol/L], TSC-T60 < 18 μg/dl [497 nmol/L], or ΔTSC<9 μg/dl [248 nmol/L]). SaC correlated well with TSC. The prevalence of AI in cirrhotic patients was higher when determined by TSC (48.7%) than by SaC (30.8%); however, this difference did not reach statistical significance. AI was associated with sex, cirrhosis etiology, and Child-Pugh classification. Conclusions. Measuring SaC was more accurate than TSC in the ACTH stimulation test. Measuring TSC overestimated the prevalence of AI in noncritically ill cirrhotic patients.
Neutrophil-to-Lymphocyte Ratio, Mediterranean Diet, and Bone Health in Coeliac Disease Patients: A Pilot Study
Authors: Palmacci Francesca , Toti Elisabetta , Raguzzini Anna , Catasta Giovina , Aiello Paola , Peluso Ilaria , Biava Mariangela , Palmery Maura
Published: June 2019

Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a bone loss index in postmenopausal women and as a marker of inflammation in coeliac patients. The aims of this work were to evaluate the effect of gluten-free diet (GFD) on NLR retrospectively and study the relationship between NLR and Mediterranean diet adherence and selected food groups (fruits, vegetables, red meat, potatoes, and unrefined and refined cereals). Adult individuals (n=50), who had been on a strict GFD by at least 6 months, were recruited. The degree of adherence to the Mediterranean diet was calculated with two different scores: the Mediterranean Diet Score (MDS-14), assessed through the validated 14-item questionnaire of the PREDIMED study, and the MEDScore (Score-55) proposed by Panagiotakos. The latter includes the consumption of unrefined cereals (UC). High percentages of osteopenia and osteoporosis were found within the recruited subjects, who furnished the reports of bone mineral density (BMD), in particular in postmenopausal (Post-M) women. Recent NLR was higher in subjects with osteoporosis compared to osteopenia and normal BMD. However, retrospective analysis showed both increase and decrease in NLR after GFD, with no significant differences between Marsh grade, anemia, and BMD status. Moreover, premenopausal previous pregnancy (Pre-MPP) and Post-M had higher NLR at diagnosis compared to Men and premenopausal (Pre-M), but higher differences were observed in recent NLR between Pre-MPP and Men only. Chocolate consumption was associated with lower recent NLR, whereas the latter was correlated with Score-55, but not with MDS-14. Moreover, refined cereal consumption was correlated with recent NLR. Although large prospective studies are needed in order to clarify the relationship between UC and NLR in coeliac patients, in this pilot study, we have investigated for the first time the relationship between NLR, dietary habit, and osteoporosis in coeliac disease.
Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis
Authors: de Sousa Fernanda Santos de Oliveira , dos Santos Ana Paula Pires , Nadanovsky Paulo , Hujoel Philippe , Cunha-Cruz Joana , de Oliveira Branca Heloisa
Published: June 2019

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was –0.30 (95% CI –0.69, 0.09) and at the surface level –0.77 (95% CI –1.23, –0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.
Familial Clustering of Cardiac Conduction Defects and Pacemaker Insertion
Authors: Kaess Bernhard M. , Andersson Charlotte , Duncan Meredith S. , Larson Martin G. , Aasbjerg Kristian , Gislason Gunnar H. , Torp-Pedersen Christian , Vasan Ramachandran S.
Published: June 2019

Background:

The etiopathogenesis of electrocardiographic bundle branch and atrioventricular blocks is not fully understood. We investigated familial clustering of cardiac conduction defects and pacemaker insertion in the FHS (Framingham Heart Study). Additionally, we assessed familial clustering of pacemaker insertion in the Danish general population.

Methods:

In FHS, we used multivariable-adjusted logistic regression models to investigate the association of parental atrioventricular block (PR interval, ≥0.2 s), complete bundle branch block (QRS, ≥0.12 s), or pacemaker insertion with the occurrence of cardiac conduction abnormalities in their offspring. The Danish nationwide administrative registries were interrogated to assess the relations of parental pacemaker insertion with offspring pacemaker insertion.

Results:

In FHS (n=371 cases with first-degree atrioventricular block, complete bundle branch block, or pacemaker insertion, and 1471 age- and sex-matched controls), individuals with at least 1 affected parent with a conduction defect had a 1.65-fold odds (odds ratio, 95% CI, 1.32–2.07) for manifesting an atrioventricular block and a 1.62-fold odds (95% CI, 1.08–2.42) for developing a complete bundle branch block. If at least 1 parent had any electrocardiographic conduction defect or pacemaker insertion, the offspring had a 1.62-fold odds (95% CI, 1.31–2.00) for experiencing any of these conditions. In Denmark (n=2 824 199 individuals; 5397 incident pacemaker implantations), individuals with at least 1 first-degree relative with history of pacemaker insertion had a multivariable-adjusted 1.68-fold (incidence rate ratio, 95% CI, 1.49–1.89) risk of undergoing a pacemaker insertion. If the affected relative was ≤45 years of age, the incidence rate ratio was markedly increased to 51.0 (95% CI, 32.7–79.9).

Conclusions:

Cardiac conduction blocks and risk for pacemaker insertion cluster within families. A family history of conduction system disturbance or pacemaker insertion should trigger increased awareness of a similar propensity in other family members, especially so when the conduction system disease occurs at a younger age.
Machine Learning Prediction of Response to Cardiac Resynchronization Therapy
Authors: Feeny Albert K. , Rickard John , Patel Divyang , Toro Saleem , Trulock Kevin M. , Park Carolyn J. , LaBarbera Michael A. , Varma Niraj , Niebauer Mark J. , Sinha Sunil , Gorodeski Eiran Z. , Grimm Richard A. , Ji Xinge , Barnard John , Madabhushi Anant , Spragg David D. , Chung Mina K.
Published: June 2019

Background:

Cardiac resynchronization therapy (CRT) has significant nonresponse rates. We assessed whether machine learning (ML) could predict CRT response beyond current guidelines.

Methods:

We analyzed CRT patients from Cleveland Clinic and Johns Hopkins. A training cohort was created from all Johns Hopkins patients and an equal number of randomly sampled Cleveland Clinic patients. All remaining patients comprised the testing cohort. Response was defined as ≥10% increase in left ventricular ejection fraction. ML models were developed to predict CRT response using different combinations of classification algorithms and clinical variable sets on the training cohort. The model with the highest area under the curve was evaluated on the testing cohort. Probability of response was used to predict survival free from a composite end point of death, heart transplant, or placement of left ventricular assist device. Predictions were compared with current guidelines.

Results:

Nine hundred twenty-five patients were included. On the training cohort (n=470: 235, Johns Hopkins; 235, Cleveland Clinic), the best ML model was a naive Bayes classifier including 9 variables (QRS morphology, QRS duration, New York Heart Association classification, left ventricular ejection fraction and end-diastolic diameter, sex, ischemic cardiomyopathy, atrial fibrillation, and epicardial left ventricular lead). On the testing cohort (n=455, Cleveland Clinic), ML demonstrated better response prediction than guidelines (area under the curve, 0.70 versus 0.65;
P
=0.012) and greater discrimination of event-free survival (concordance index, 0.61 versus 0.56;
P
<0.001). The fourth quartile of the ML model had the greatest risk of reaching the composite end point, whereas the first quartile had the least (hazard ratio, 0.34;
P
<0.001).

Conclusions:

ML with 9 variables incrementally improved prediction of echocardiographic CRT response and survival beyond guidelines. Performance was not improved by incorporating more variables. The model offers potential for improved shared decision-making in CRT (online calculator:
http://riskcalc.org:3838/CRTResponseScore
). Significant remaining limitations confirm the need to identify better variables to predict CRT response.
Emerging Concepts in Precision Medicine and Cardiovascular Diseases in Racial and Ethnic Minority Populations
Authors: Mensah George A. , Jaquish Cashell , Srinivas Pothur , Papanicolaou George J. , Wei Gina S. , Redmond Nicole , Roberts Megan C. , Nelson Cheryl , Aviles-Santa Larissa , Puggal Mona , Green Parker Melissa C. , Minear Mollie A. , Barfield Whitney , Fenton Kathleen N. , Boyce Cheryl Anne , Engelgau Michael M. , Khoury Muin J.
Published: June 2019

Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities; and the importance of ensuring ancestry-matched controls in variant interpretation. We address the relevance of epigenetics, pharmacogenomics, genetic testing and counseling, and their social and cultural implications. We also examine the potential impact of precision medicine on racial and ethnic disparities. The National Institutes of Health’s
All of Us
Research Program and the National Heart, Lung, and Blood Institute’s Trans-Omics for Precision Medicine Initiative are presented as examples of research programs at the forefront of precision medicine and diversity to explore research implications in minorities. We conclude with an overview of implementation research challenges in precision medicine and the ethical implications in minority populations. Successful implementation of precision medicine in cardiovascular disease in minority populations will benefit from strategies that directly address diversity and inclusion in genomics research and go beyond race and ethnicity to explore ancestry-matched controls, as well as geographic, cultural, social, and environmental determinants of health.
The Short Happy Life of the SADC Tribunal: the Perils of Regional Integration in Southern Africa
Authors: Nkhata Mwiza Jo
Published: June 2019

Under the Treaty Establishing the Southern African Development Community (the Treaty) one of the institutions of the Southern African Development Community (SADC) was the Southern African Development Community Tribunal (the Tribunal). The Tribunal was established as the sole judicial organ of SADC. The Tribunal was established as part of the reorganisation of regional integration efforts within Southern Africa. The global atmosphere prevailing at the time the Tribunal was established, together with the lofty statements in the SADC’s founding instruments, suggest that there was a regional commitment to the ideals of human rights, rule of law and democracy among SADC member States. The Tribunal’s life, however, was short-lived. This paper analyses the prospects and lessons for regional integration within the SADC region from the perspective of the disbanding of the Tribunal and attempts to decipher the implications of the disbanding for regional integration in Southern Africa.
Strengthening Rule of Law Enforcement in Sub-Saharan Africa: the Role of African Union
Authors: Gelaye Tsega Andualem
Published: June 2019

Rule of law violation is a chronic problem in sub-Saharan Africa. Yet the African Union (AU), which is the main regional organization in the continent, is not playing a significant role in ensuring the observance of rule of law in its member states compared to its counterparts such as the European Union. This paper argues that, beside the issue of lack of political will, the existing legal framework of the AU has contributed its part for the negligible rule of law monitoring involvement of the organization at the moment and underscores the need for urgent remedy to address these lacunas. In undertaking this investigation, the paper adopts a comparative approach relying heavily on the lessons from the experience of the European Union, which is assumed to have a better mechanism in this regard.
Afrotropical ants of the ponerine genera Centromyrmex Mayr, Promyopias Santschi gen. rev. and Feroponera gen. n., with a revised key to genera of African Ponerinae (Hymenoptera: Formicidae)
Authors: BOLTON BARRY , FISHER BRIAN L.
Published: June 2019

The ponerine ant genus Centromyrmex Mayr is redefined and its Afrotropical species are fully revised. Ten Afrotropical species are recognised of which six are described as new (decessor, ereptor, fugator, praedator, raptor, secutor). Two former infraspecific names are elevated to species rank (angolensis, longiventris) and four new junior synonyms of sellaris (= arnoldi, = congolensis, = constanciae, = guineensis) are established. The monotypic genus Promyopias Santschi is revived from synonymy and a new monotypic genus, Feroponera, type-species F. ferox sp. n., is introduced. The possibility of a Centromyrmex genus group is discussed and a revised key to Afrotropical genera of Ponerinae is presented.
Definition of Anthaxia (A.) hackeri species-group with description of a new species from China (Coleoptera: Buprestidae)
Authors: OBOŘIL MARTIN , BAŇAŘ PETR
Published: June 2019

A new species Anthaxia (Anthaxia) tichyi sp. nov. from Yunnan, Southern China, is described, illustrated, including male genitalia and compared with the most similar species Anthaxia (A.) cupressi Bílý, 2005. The new species belongs to newly defined Anthaxia (Anthaxia) hackeri J. Frivaldszky, 1884 species-group.
“Ino Budensis var. Mollis” Grum-Grshimailo, 1893 (Lepidoptera: Zygaenidae) from Eastern Asia recognized as a valid species on the base of morphological and molecular analysis
Authors: EFETOV KONSTANTIN A. , TARMANN GERHARD M. , PARSHKOVA EKATERINA V.
Published: June 2019

Based on morphological and molecular data, Ino budensis var. mollis Grum-Grshimailo, 1893, from China, so far treated as a synonym of Jordanita (Roccia) paupera (Christoph, 1887), is here recognized as a good species, Jordanita (Roccia) mollis (Grum-Grshimailo, 1893), stat. nov. This species is recorded as new for the fauna of Russia and Korea. An identification key for this species is provided.
Atlantic-Origin Overflow Water in the East Greenland Current
Authors: Håvik Lisbeth , Almansi Mattia , Våge Kjetil , Haine Thomas W. N.
Published: June 2019

Dense water masses transported southward along the east coast of Greenland in the East Greenland Current (EGC) form the largest contribution to the Denmark Strait Overflow. When exiting Denmark Strait these dense water masses sink to depth and feed the deep circulation in the North Atlantic. Based on one year of mooring observations upstream of Denmark Strait and historical hydrographic profiles between Fram Strait and Denmark Strait, we find that a large part (75%) of the overflow water ( ≥ 27.8 kg m−3) transported by the EGC is of Atlantic origin (potential temperature θ > 0°C). The along-stream changes in temperature of the Atlantic-origin Water are moderate north of 69°N at the northern end of Blosseville basin, but southward from this point the temperature decreases more rapidly. We hypothesize that this enhanced modification is related to the bifurcation of the EGC taking place close to 69°N into the shelfbreak EGC and the separated EGC. This is associated with enhanced eddy activity and strong water mass modification reducing the intermediate temperature and salinity maxima of the Atlantic-origin Water. During periods with a large (small) degree of modification the separated current is strong (weak). Output from a high-resolution numerical model supports our hypothesis and reveals that large eddy activity is associated with an offshore shift of the surface freshwater layer that characterizes the Greenland shelf. The intensity of the eddy activity regulates the density and the hydrographic properties of the Denmark Strait Overflow Water transported by the EGC system.
Cost and Risk Analysis of Lifelong Penicillin Allergy
Authors: Au Lauren Y. C. , Siu Andrea M. , Yamamoto Loren G.
Published: June 2019

Patients labeled as being penicillin-allergic require the use of alternative antibiotics. The objective of this study was to estimate the lifetime antibiotic costs of patients labeled as being penicillin allergic prior to age 10 compared with those who were not penicillin allergic and to compare antibiotic utilization between these 2 groups with regard to risks of adverse effects. Using the low end of the antibiotic cost range, penicillin-allergic patients had a mean lifetime antibiotic cost of $8171 per patient, compared with $6278 for non–penicillin-allergic patients, a difference of $1893. Penicillin-allergic patients utilized more moderate-spectrum antibiotics, more fluoroquinolones, and had a higher estimated Clostridium difficile risk.
Protecting Victims of Human Trafficking from Liability: An Evaluation of Section 45 of the Modern Slavery Act
Authors: Muraszkiewicz Julia
Published: June 2019

The evolution of protective measures offered to victims of human trafficking at a European regional level has begun to have an impact at a national level. In this article, the author explores a provision intended to guard victims of human trafficking, who have been compelled to commit crimes, against prosecution and punishment. The provision under scrutiny is the statutory defence found in s 45 of the Modern Slavery Act, 2015 (England and Wales). The article draws on the obligations spelt out in regional law (the 2005 Council of Europe Convention on Action Against Trafficking in Human Beings and Directive 2011/36 on preventing and combating trafficking in human beings and protecting its victims) and asks if England and Wales fulfil their duties with respect to protecting trafficked persons from being prosecuted and punished.
Effects of State Anxiety and Ego Depletion on Performance Change in Golf Putting: A Hierarchical Linear Model Application
Authors: Shin Myoungjin , Kim Yoora , Park Seungha
Published: June 2019

This study employed a hierarchical linear model analysis to examine the effects of ego depletion and state anxiety on performance changes in golf putting. We randomly assigned 51 female college students with no previous golf putting experience to either an ego-depletion (experimental) group ( n = 26) or a non-ego-depletion (control) group ( n = 25). Putting performance changes over repeated trials displayed a quadratic curve, and both ego depletion and state anxiety exerted negative effects on early, but not late, putting performance. Contrary to previous findings, the interaction effect between ego depletion and state anxiety on performance was nonsignificant.