bluuebunny/crossref_metadata_2025_split huggingface dataset:
Model approaches to advance crassulacean acid metabolism system integration
Authors: Chomthong Methawi , Griffiths Howard 
Published: January 2020

SummaryThis review summarises recent progress in understanding crassulacean acid metabolism (CAM) systems and the integration of internal and external stimuli to maximise water‐use efficiency. Complex CAM traits have been reduced to their minimum and captured as computational models, which can now be refined using recently available data from transgenic manipulations and large‐scale omics studies. We identify three key areas in which an appropriate choice of modelling tool could help capture relevant comparative molecular data to address the evolutionary drivers and plasticity of CAM. One focus is to identify the environmental and internal signals that drive inverse stomatal opening at night. Secondly, it is important to identify the regulatory processes required to orchestrate the diel pattern of carbon fluxes within mesophyll layers. Finally, the limitations imposed by contrasting succulent systems and associated hydraulic conductance components should be compared in the context of water‐use and evolutionary strategies. While network analysis of transcriptomic data can provide insights via co‐expression modules and hubs, alternative forms of computational modelling should be used iteratively to define the physiological significance of key components and informing targeted functional gene manipulation studies. We conclude that the resultant improvements of bottom‐up, mechanistic modelling systems can enhance progress towards capturing the physiological controls for phylogenetically diverse CAM systems in the face of the recent surge of information in this omics era.
Keloid scarring or disease: Unresolved quasi‐neoplastic tendencies in the human skin
Authors: Ud‐Din Sara , Bayat Ardeshir 
Published: January 2020

AbstractKeloids are benign fibroproliferative dermal scars of unknown etiopathogenesis resulting in an exophytic protuberant growth with persistent and progressive peri‐lesional expansile behavior. Keloids are likened to benign neoplastic lesions due to their aggressive clinical behavior, genotypic‐phenotypic tissue characteristics, and resistance to treatment. Keloids are traditionally viewed as scars on the healing spectrum; however, keloids are a distinct pathology provoked by cutaneous injury rather than a continuum. In order to elucidate the etiopathogenesis of keloids, the distinction between scar and disease must be made. Therefore, we hypothesize that the link between keloids and their quasi‐neoplastic tendencies distinguish it as a disease rather than a scar alone. The biomarker expression profile in these diseases highlight the striking parallels between keloids and both benign and malignant mesenchymal tumors. Signaling pathways common to these diseases have been found to guide the matrix composition of keloids. This hypothesis underscores the need to identify keloids not as a scar but as a disease in order to develop targeted therapy, which can lead to enhanced diagnosis and theranosis.
Computational and Experimental Study of Hot Streak Transport Within the First Stage of a Gas Turbine
Authors: Gaetani Paolo , Persico Giacomo , Pinelli Lorenzo , Marconcini Michele , Pacciani Roberto 
Published: January 2020

Abstract
The paper discusses the migration, the interaction with the blades, and the attenuation of hot streaks generated by combustor burners, during their propagation within the first turbine stage of aero-engines. Experiments and computational fluid dynamics (CFD) simulations were carried out in the framework of the European Project RECORD and on its follow-up. Measurements considering burner-representative temperature perturbations injected upstream of an un-cooled high-pressure gas turbine stage were performed in the high-speed closed-loop test-rig of the Politecnico di Milano (Italy). The hot streaks were injected in a streamwise direction at the stage inlet in four different circumferential positions with respect to the stator blade. They feature a 20% over-temperature with respect to the main flow. Detailed temperature measurements as well as unsteady aerodynamic measurements upstream and downstream of the blade rows were performed. Time-accurate CFD simulations of the flow upstream and within the turbine stage were performed with the TRAF code, developed by the Università degli Studi di Firenze (Italy). Measurements show a relevant attenuation of hot streaks throughout their transport within the stator and the rotor blade rows, highly depending on the injection azimuthal position. The perturbations were observed to lose their spatial coherence, especially in the transport within the rotor, and to undergo severe spanwise migration. Simulations exhibit a good agreement with the experiments on the measurement planes and allow tracking the complex flow phenomena occurring within the blade rows. Finally, the aerodynamic and thermal implications of the inlet temperature perturbations are properly highlighted and discussed.
Improving Healthcare Access: A Preliminary Design of a Low-Cost Arm Rehabilitation Device
Authors: Piovesan Davide , Kumar Shanmugam Santhosh , Arumugam Yuvarajan , Restifo Adam , Jackson Corey , Devine Nicholas , Legters Kristine 
Published: January 2020

AbstractA low-cost continuous passive motion (CPM) machine, the Gannon Exoskeleton for Arm Rehabilitation (GEAR), was designed. The focus of the machine is on the rehabilitation of primary functional movements of the arm. The device developed integrates two mechanisms consisting of a four-bar linkage and a sliding rod prismatic joint mechanism that can be mounted to a normal chair. When seated, the patient is connected to the device via a padded cuff strapped on the elbow. A set of springs have been used to maintain the system stability and help the lifting of the arm. A preliminary analysis via analytical methods is used to determine the initial value of the springs to be used in the mechanism given the desired gravity compensatory force. Subsequently, a multibody simulation was performed with the software simwise 4D by Design Simulation Technologies (DST). The simulation was used to optimize the stiffness of the springs in the mechanism to provide assistance to raising of the patient's arm. Furthermore, the software can provide a finite element analysis of the stress induced by the springs on the mechanism and the external load of the arm. Finally, a physical prototype of the mechanism was fabricated using polyvinyl chloride (PVC) pipes and commercial metal springs, and the reaching space was measured using motion capture. We believed that the GEAR has the potential to provide effective passive movement to individuals with no access to postoperative or poststroke rehabilitation therapy.
Improved Treatment of Postpartum Hemorrhage: Design, Development, and Bench-Top Validation of a Reusable Intrauterine Tamponade Device for Low-Resource Settings
Authors: Hu Katherine , Lapinski Maya M. , Mischler Gavin , Allen Robert H. , Manbachi Amir , Seay Rachel Chan 
Published: January 2020

AbstractPostpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, and effective interventions for addressing PPH are urgently needed. Uterine balloon tamponade (UBT) is a technique to control PPH. Commercially available UBT devices are expensive and frequently require imaging technology to ensure placement. Condom-catheter uterine tamponade (C-UBT) is a technique appropriate for low-resource settings. Testing of the C-UBT is needed to better understand and optimize this technique for use in a variety of clinical settings including low-resource contexts. We describe here the design, development, and bench-top validation of a reusable C-UBT device optimized for low-resource settings. The device was tested in three differently sized uterine models using a variety of condom balloon configurations. Intrauterine wall pressure application was measured to evaluate the device capacity to apply pressure of at least 90 mmHg, estimating the mean arterial pressure within the uterine vasculature. Bench-top experimental validation of pressure exerted in uterine models demonstrated the device's capability of reaching hemostatic pressure in uterine volumes ranging from 170 to 1740 mL. Device adaptability and versatility were shown through its ability to reach the target pressure of 90 mmHg in different uterine sizes by varying balloon parameters, including condom thickness and condom configuration. The results of this study show the potential of a low-cost, reusable C-UBT device optimized to treat PPH in a variety of clinical settings, including low-resource contexts.
A Novel Intermediate Attachment to Reduce Contamination in Reusable Core Needle Biopsy Devices
Authors: Berges Alexandra J. , Callanan Megan , Zawicki Valerie , Shi Richard , Athey Thomas , Ayyappan Vinay , Metzger Schuyler , Farrell Alanna , Manbachi Amir , Harvey Susan , Durr Nicholas J. 
Published: January 2020

Abstract
One barrier to breast cancer diagnosis in low-resource settings is that devices for core needle biopsy (CNB) are either disposable and expensive, or reusable and susceptible to internal contamination. Through interviews with field workers and verification experiments, we identified that a common, commercially available, reusable CNB device allows contaminants to enter the driver chamber during firing, necessitating laborious cleaning of the entire device after every use. We introduce a novel CNB device attachment that eliminates this contamination mode and interfaces with existing commercial reusable drivers and low-cost disposable needles. This attachment repositions the driver–needle connection to the exterior of the driver, preventing retrograde flow of blood. Using an unmodified commercial CNB, we replicate chamber contamination by firing into a body fluid-mimicking glycerol solution. Prototypes were tested for their performance in eliminating this contamination. We tested the effectiveness of a cleaning procedure to reduce trace contamination by using a fluorescent dye and measuring the intensity of fluorescence after cleaning. The device's ability to reliably and consistently biopsy tissue with the novel attachment was evaluated using breast tissue models. In these tests, a reusable CNB with our attachment exhibited no measurable internal contamination, and maintained full biopsy functionality as measured by tissue sample weight and length. Minimizing internal device contamination would simplify the cleaning process for reusable biopsy devices. This would improve the accessibility of breast cancer biopsies in low- and middle-income countries (LMICs).
Children and young people with inflammatory bowel disease attend less school than their healthy peers
Authors: Barnes Claire , Ashton James John , Borca Florina , Cullen Mick , Walker Dawn-Marie , Beattie Robert Mark 
Published: January 2020

ObjectiveChronic diseases, such as inflammatory bowel disease (IBD), can impact negatively on education and social development. Examining the impact of IBD on school/college attendance for children and young people (CYP) is vital to provide targeted support to patients, families and schools.MethodsWe performed a cross-sectional survey to determine the school/college attendance rates, the reasons for absence related to IBD and facilitators or barriers to school/college attendance. In a subset of patients followed up locally, we performed a detailed review of hospital attendance data to assess healthcare burden.ResultsTwo hundred and thirty-one questionnaires were given to CYP with IBD aged 5–17 years. Response rate was 74% (final sample 169). The median school/college attendance rate was 92.5%, significantly lower than all children in England (95.2%). 39.6% of children with IBD were persistently absent, defined nationally as missing 10% or more of school. Only five children (3%) had a 100% attendance record. Increasing age and use of monoclonal therapy were predictors of poor school attendance. Concerns about feeling unwell at school/college, access to toilets, keeping up with work and teachers’ understanding of IBD are the main issues for CYP with IBD. There was a significant negative correlation between number of days in hospital and school attendance.ConclusionIBD has a significant impact on school/college attendance, with hospital attendance, disease burden and school difficulties being major factors. Employing strategies to minimise healthcare burden and developing a partnership between health and education to support children with IBD will serve to facilitate school/college attendance.
Patterns of long-term ADHD medication use in Australian children
Authors: Efron Daryl , Mulraney Melissa , Sciberras Emma , Hiscock Harriet , Hearps Stephen , Coghill David 
Published: January 2020

ObjectiveAdherence to attention-deficit/hyperactivity disorder (ADHD) medication treatment is often suboptimal. This can compromise patient outcomes. We aimed to describe the patterns of ADHD medication use in Australian children, and characteristics associated with patterns of use.DesignDispensing data were analysed for all redeemed prescriptions of methylphenidate, dexamphetamine and atomoxetine between May 2002 and March 2015 from waves 1 to 6 of the Longitudinal Study of Australian Children (n=4634, age 4–5 years at wave 1). Medication coverage was defined as the proportion of time between the first and the last redeemed prescriptions in which the child was taking medication. Associations between predictor variables (child sex, ADHD symptom severity, age at first prescription, family socioeconomic status (SES), single parent status, parent education and parent mental health) and medication coverage were examined using regression analyses.Results166 (3.6%) children had ever redeemed a prescription for an ADHD medication. Boys had higher odds of having taken ADHD medication than girls (OR=3.9; 95% CI 2.7 to 5.7). The mean medication coverage was 59.8%. Medication coverage was lower in children from families of lower SES (β=4.0; 95% CI 0.2 to 7.8, p=0.04). Medication coverage was relatively high in the first year of prescription, then decreased progressively, only increasing again after 5 or 6 years of treatment.ConclusionsChildren with ADHD from socially disadvantaged families were less likely to receive medication consistently. Prescribers need to continue to support families over many years to ensure medication is used consistently for children with ADHD.
Temporal trends in incidence of Rolandic epilepsy, prevalence of comorbidities and prescribing trends: birth cohort study
Authors: Stephen Jacqueline , Weir Christopher J , Chin Richard FM 
Published: January 2020

ObjectiveTo examine temporal trends in incidence of Rolandic epilepsy (RE), prevalence of comorbidities and antiepileptic drug (AED) prescribing patterns.DesignRetrospective cohort study.SettingThe UK.PatientsChildren aged 0–16 years born 1994–2012 were followed from birth until September 2017, transfer to another general practitioner practice or death or practice withdrawal from The Health Improvement Network (THIN), whichever occurred first.Main outcome measuresIncidence of RE, prevalence of comorbidity and AED prescribing patterns. Read codes for comorbidities and AEDs were adapted from other UK population-based epilepsy studies.ResultsThere were 379 children with first RE event recorded between 2000 and 2014 from active THIN practices with available mid-year population counts. Crude annual incidence across all years was 5.31/100 000 (95% CI 4.81 to 5.88). There was no significant time trend in adjusted incidence rate ratios (aIRR) (0.99/year, 95% CI 0.96 to 1.02). Males had higher aIRR (1.48, 95% CI 1.20 to 1.82) as did children aged 6–8 and 9–11 years compared with 4–5 years (aIRR 2.43, 95% CI 1.73 to 3.40; aIRR 2.77, 95% CI 1.97 to 3.90, respectively). There was recorded comorbidity in 12% with 6% with a recorded diagnosis of pervasive developmental disorder. Half of children with RE had a record of being prescribed AEDs.ConclusionsUK incidence of RE has remained stable with crude incidence of 5/100 000/year. Carers and clinicians need to be aware that comorbidities may exist, particularly pervasive developmental disorders. Carbamazepine is consistently the most commonly prescribed AED for RE in the UK.
Mixed methods protocol for a realist evaluation of electronic personal health records design features and use to support medication adherence (ePHRma)
Authors: Andrikopoulou Elisavet , Scott Philip J , Herrera Helena 
Published: January 2020

BackgroundNational Health Service policy suggests that increasing usage of electronic personal health records (PHR) by patients will result in cost savings and improved public health. Medication adherence means that patients take their prescribed medication as agreed with their doctors. Some of the claimed benefits of PHRs are decreasing healthcare costs and improving medication adherence and patient outcomes.MethodsThis is a mixed methods convergent study, primarily qualitative. The qualitative and quantitative data collection and analysis will occur in parallel, and then be synthesised. We are interviewing and surveying adults with long-term conditions to identify what are the most important and useful features of their current PHR. The data collection comprises patient demographics, the Medication Adherence Questionnaire, the personality scale Big Five Inventory-2 Extra-Short Form and the WHO Quality of Life-BREF scale. Qualitative data will be analysed using the Framework method.EthicsWe have received a favourable ethical opinion from the Health Research Authority/Research Ethics Committee.
Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study
Authors: Aristide Christine , Mwakisole Agrey , Mwakisole Nelusigwe , Emmanuel Mary , Laizer Evarist , Kihunrwa Albert , Downs David , Wamoyi Joyce , Downs Jennifer 
Published: January 2020

BackgroundUse of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided.MethodsWe performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar.ResultsKey interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members.ConclusionsAddressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.
Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations
Authors: Szeto Cheuk-Chun , Sugano Kentaro , Wang Ji-Guang , Fujimoto Kazuma , Whittle Samuel , Modi Gopesh K , Chen Chen-Huen , Park Jeong-Bae , Tam Lai-Shan , Vareesangthip Kriengsak , Tsoi Kelvin K F , Chan Francis K L 
Published: January 2020

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications, but they are associated with a number of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications.ObjectiveTo develop a set of multidisciplinary recommendations for the safe prescription of NSAIDs.MethodsRandomised control trials and observational studies published before January 2018 were reviewed, with 329 papers included for the synthesis of evidence-based recommendations.ResultsWhenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, blood pressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Blood pressure and renal function should be monitored in most cases.ConclusionNSAIDs are a valuable armamentarium in clinical medicine, but appropriate recognition of high-risk cases, selection of a specific agent, choice of ulcer prophylaxis and monitoring after therapy are necessary to minimise the risk of adverse events.
Haptoglobin genotype and outcome after aneurysmal subarachnoid haemorrhage
Authors: Morton Matthew J , Hostettler Isabel C , Kazmi Nabila , Alg Varinder S , Bonner Stephen , Brown Martin M , Durnford Andrew , Gaastra Benjamin , Garland Patrick , Grieve Joan , Kitchen Neil , Walsh Daniel , Zolnourian Ardalan , Houlden Henry , Gaunt Tom R , Bulters Diederik O , Werring David J , Galea Ian 
Published: January 2020

ObjectiveAfter aneurysmal subarachnoid haemorrhage (aSAH), extracellular haemoglobin (Hb) in the subarachnoid space is bound by haptoglobin, neutralising Hb toxicity and helping its clearance. Two exons in theHPgene (encoding haptoglobin) exhibit copy number variation (CNV), giving rise to HP1 and HP2 alleles, which influence haptoglobin expression level and possibly haptoglobin function. We hypothesised that theHPCNV associates with long-term outcome beyond the first year after aSAH.MethodsTheHPCNV was typed using quantitative PCR in 1299 aSAH survivors in the Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study, a retrospective multicentre cohort study with a median follow-up of 18 months. To investigate mediation of theHPCNV effect by haptoglobin expression level, as opposed to functional differences, we used rs2000999, a single nucleotide polymorphism associated with haptoglobin expression independent of theHPCNV. Outcome was assessed using modified Rankin and Glasgow Outcome Scores. SAH volume was dichotomised on the Fisher grade. Haemoglobin-haptoglobin complexes were measured in cerebrospinal fluid (CSF) of 44 patients with aSAH and related to theHPCNV.ResultsThe HP2 allele associated with a favourable long-term outcome after high-volume but not low-volume aSAH (multivariable logistic regression). However rs2000999 did not predict outcome. The HP2 allele associated with lower CSF haemoglobin-haptoglobin complex levels. The CSF Hb concentration after high-volume and low-volume aSAH was, respectively, higher and lower than the Hb-binding capacity of CSF haptoglobin.ConclusionThe HP2 allele carries a favourable long-term prognosis after high-volume aSAH. Haptoglobin and the Hb clearance pathway are therapeutic targets after aSAH.