13X zeolite as Difunctional nucleating agent regulating the crystal form and improving the Foamability of blocked copolymerized polypropylene in supercritical CO 2 foaming process

Abstract

Comparing with solid counterpart, plastic foams exhibit many merits, such as lightweight, excellent energy absorption, good thermal insulation and sound absorption properties. Blocked copolymerized polypropylene (PPB) is a kind of foamable polymer, but it is challenging to obtain the PPB foam with high expansion ratio, uniform cell structure and good toughness. In this study, 13X zeolite was used as nucleating agent for both crystallization process and foaming process. During the crystallization process, 13X zeolite used as β-nucleating agent not only improved the crystallization behavior but also induced the β-form crystal, thereby improving the toughness of PPB. During the foaming process, 13X zeolite used as cell nucleating agent improved the foamability of PPB by increasing the content of CO₂ dissolved in PPB melt due to its porous structure. The experiment results revealed that when the content of 13X zeolite was 0.5 wt%, the relative content of β-crystal (k_β), the crystallization temperature (T_c) and the impact strength of PPB were greatly increased from 0.17, 114 °C, 838.9 J/m to 0.64, 122 °C, 952.9 J/m respectively. Moreover, at that content, the expansion ratio (R_v) of PPB foam reached the maximum value of 41 times under the optimal foaming temperature and pressure.

http://bit.ly/2WI1Qs3

Genetics of congenital and infantile nephrotic syndrome

Abstract

Background

Congenital and infantile nephrotic syndrome (CNS and INS) are rare inherited defects in glomerular filtration involving a variety of gene mutations. This study aimed to analyze all genetic mutations associated with congenital and infantile nephrotic syndrome treated at our institution. We also discussed our different approach secondary to culture and resources.

Methods

A retrospective single-center study of all children diagnosed as NS before the age of 1 year over a duration of over one decade.

Results

Twenty-nine children (12 boys) were included in the study. Their median age (range) was 2.4 (0.1–12) months (20 CNS and 9 INS). Consanguinity was present in 90% of children. The genetic analysis' results were only available for 20 children. An underlying causative homozygous mutation was detected in 18 children (90%): NPHS1 (9), NPHS2(2), LAMB2(3), PLCE1(1), WT1(1), and ITSN1 novel mutation (2). One child had heterozygous mutation of NPHS2 and another child had heterozygous mutation of NPHS1 which could not explain the disease. All CNS cases were all managed with intermittent intravenous albumin infusion, ACEi, diuretics, and indomethacin. None of the children were managed by nephrectomy followed by peritoneal dialysis (PD) because of limited resources. Only one child achieved partial remission, while 15 children died at a median (range) age of 5.8 (1.25–29) months. The remaining 14 children were followed up for an average of 36 (3.9–120) months. Three children progressed to end-stage kidney disease and PD was performed in only two children.

Conclusions

NPHS1 is the main underlying cause of CNS and INS in our study population. CNS and INS were associated with high morbidity and mortality.

http://bit.ly/2DTXJSo

Gilteritinib: First Global Approval

Abstract

Gilteritinib (Xospata^®) is an orally available small molecule receptor tyrosine kinase inhibitor developed by Astellas Pharma in collaboration with Kotobuki Pharmaceutical for the treatment of acute myeloid leukaemia (AML) harbouring FMS-like tyrosine kinase 3 (FLT3) mutations. Gilteritinib inhibits FLT3 (STK1 or FLK2), AXL (UFO or JTK11) and anaplastic lymphoma kinase (ALK or CD246). Gilteritinib inhibits FLT3 signalling in cells expressing FLT3 internal tandem duplication (ITD), tyrosine kinase domain mutation FLT3-D835Y and the double mutant FLT3-ITD-D835Y, thereby inducing apoptosis. Gilteritinib also binds to and inhibits the wild-type and mutated forms of ALK, resulting in reduced tumour cell proliferation in cancer cell types that overexpress the mutation. Gilteritinib is approved in Japan for the treatment of relapsed or refractory AML with FLT3 mutation. Recently, it was also approved in the USA for the treatment of adult patients who have relapsed or refractory AML with a FLT3 mutation, as detected by an FDA-approved test. Clinical development of gilteritinib is underway in several countries worldwide. Development for non-small cell lung cancer and solid tumours has been discontinued.

http://bit.ly/2t3XX33

Recycling of waste melamine formaldehyde foam as flame-retardant filler for polyurethane foam

Abstract

In the present research, the waste leftovers of a thermoset polymer foam with intrinsic flame resistance, melamine formaldehyde foam (MF), were pulverized to fine powder and added into polyurethane foam (PUF) as a flame-retardant filler. A series of characterizations were employed to investigate the obtained MF powder and the properties of the new flame retardant PUF. It was revealed that the pulverization process could produce fine MF powder. Moreover, it showed that the incorporation of MF powder could greatly decrease the heat release rate (HRR) and flammability of PUF without obvious impairment of mechanical property. Combined with a small amount of guanidine phosphate (GP), it could achieve quick self-extinguishment of the modified PUF. The process for recycling waste MF is easy and cheap, indicating an eco-friendly way for waste MF recycling, as well as a successful preparation of a low-cost and halogen-free flame retardant PUF.

http://bit.ly/2RE1xL9

Factors associated with patient preferences towards deprescribing: a survey of adult patients on prescribed medications

Abstract

Background Deprescribing is a patient-centered intervention with inherent uncertainties and requires shared decision making and patient involvement. Objective In the present study, we aimed to investigate factors associated with patient preferences toward deprescribing in a representative sample in Japan. Methods We conducted a nationwide cross-sectional survey and used a quota sampling method to select representative samples of the Japanese general population. We collected data on participant demographic and clinical factors including the number of chronic health conditions and the number of regular prescription medications. Patients' willingness to deprescribe was assessed using the patients' attitudes towards deprescribing questionnaire. Multivariable logistic regression analyses were conducted to determine factors associated with the outcome measure. Results Data were analyzed for 1483 adult outpatients. The proportion of patients having willingness to deprescribe was 67.8%. After adjustment for age and gender, multimorbidity was significantly positively associated with patients' willingness to deprescribe [adjusted odds ratio (aOR) 1.35; 95% confidence interval (CI) 1.06–1.72]. A similar association was found with polypharmacy (aOR 1.43; 95% CI 1.08–1.88). The number of visits to medical institutions and increasing age were also found to be associated with patients' willingness to deprescribe. Conclusion Our study indicated that patient preferences towards deprescribing are consistent with the established clinical evidence regarding the efficacy of deprescribing for patients with multimorbidity and polypharmacy. These findings may be beneficial for health care providers to implement shared decision making regarding deprescribing effectively.

http://bit.ly/2UIvOdI

Hospitalization period and direct medical cost in patients using warfarin or novel oral anti‐coagulants after a cerebral embolism

Abstract

Background Warfarin has been used in Japan for a long time in patients after cerebral embolism to prevent recurrence. Recently, several novel oral anti-coagulants (NOACs) have been approved for use and are gradually replacing warfarin. However, it remains unclear whether warfarin and other NOACs differ from each other with respect to drug costs and length of stay (LOS) during treatment in Japan. Objective To assess differences in LOS and direct medical cost between patients after cerebral embolism treated with warfarin and those treated with NOACs. Setting Thirteen acute care hospitals in Japan. Method For hospitalized patients with cerebral embolisms who were treated with NOACs and/or warfarin between April 2012 and March 2014, we assessed LOS for patients with warfarin and NOAC using log-rank test, and stratified proportional hazard regression. Also, we assess direct medical cost using paired-t test. Main Outcome measure LOS and medical cost after first treatment with warfarin and NOAC. Results The median LOS for NOACs-treated patients was 12.5 days and that for warfarin treated patients was 19.0 days while the corresponding mean medical costs were USD 7151 ± 6228 [JPY 736,546 ± 641,437] and USD 8950 ± 5891 [JPY 921,830 ± 606,765]. The drug cost for NOACs-treated patients was higher but costs for laboratory-test and hospitalization were lower than those for warfarin-treated patients. Conclusions For NOAC-treated patients, LOS was shorter, and medical cost during hospitalization tended to be lower than those for warfarin-treated patients, whereas NOACs prices were higher than warfarin price.

http://bit.ly/2SekWXZ

Acknowledgement to referees 2018

http://bit.ly/2MQHZCu

Impact of drugs on venous thromboembolism risk in surgical patients

Abstract

Purpose

This review focuses on the most common drugs administered to surgical patients during the perioperative period that affect the risk of venous thromboembolism (VTE).

Results

Among analgesics, the risk of VTE is increased in patients treated with diclofenac, ibuprofen, and rofecoxib, but not naproxen, while metamizole can confer a protective effect. The relationship between sedatives and VTE has not been sufficiently studied. Tricyclic antidepressants, low-potency serotonin reuptake inhibitors, and antipsychotics have been associated with increased risk of VTE. The use of diuretics in the perioperative period is poorly researched; however, hyponatremia is considered a risk factor. Other factors that may influence the risk of VTE include bridging anticoagulation, allogeneic transfusion, and hemostatic management before surgery. Pharmacotherapy for HIV or cancer may also increase VTE risk.

Conclusion

Increased monitoring for VTE is therefore advisable in surgical patients and those receiving antipsychotics, antidepressants, diuretics, or analgesics.

http://bit.ly/2GaX0hR

Delayed postoperative hyponatremia after endoscopic transsphenoidal surgery for pituitary adenoma

Abstract

Background

Hyponatremia generally occurs after transsphenoidal surgery (TSS) in a delayed fashion. Most patients with delayed postoperative hyponatremia (DPH) are asymptomatic or only express non-specific symptoms; consequently, DPH is associated with prolonged hospitalization. No consensus has been reached on which patients are at greatest risk of developing DPH. We reviewed patients with DPH and evaluated predictive factors for DPH.

Methods

We retrospectively analyzed 107 consecutive patients who underwent endoscopic TSS for pituitary adenoma (January 2010–December 2016). Patients with DPH (hyponatremia group) and without DPH (normonatremia group) were compared according to their nadir sodium levels on postoperative days 3 to 10. We documented the patients' demographics, clinical features, and postoperative physiological characteristics.

Results

Twenty-five (23.4%) patients developed DPH after endoscopic TSS. The patients' mean age was 54 ± 17 years, and 63.6% of the patients were female. The overall prevalence of DPH was 23.4%. The non-parametric χ2 test and the Mann–Whitney U test revealed statistically significant differences in age, use of antihypertensive drugs, nonfunctioning pituitary adenoma, and higher yet normal preoperative thyroid-stimulating hormone level between the hyponatremia and normonatremia groups (P < 0.05). Logistic regression analysis revealed that only older age was a useful independent predictive factor for DPH (odds ratio, 1.05; 95% confidence interval, 1.01–1.08; P = 0.01). The serum sodium levels on postoperative day 2 were significantly lower in the hyponatremia than normonatremia group (P < 0.01) and were negatively correlated with age (r = − 0.25, P < 0.05). The cut-off age for predicting DPH was 55 years. The hospital stay was significantly longer in the hyponatremia than normonatremia group (P < 0.01).

Conclusions

Age of more than 55 years was an independent predictive factor for DPH even after adjusting for potential confounders. Older age was negatively correlated with the serum sodium level on postoperative day 2. Preventing early decreases in the sodium level could reduce the risk of DPH.

Trial registration

1707-027

http://bit.ly/2Syg7IE

Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury

Abstract

Athletes who wish to resume high-level activities after an injury to the anterior cruciate ligament (ACL) are often advised to undergo surgical reconstruction. Nevertheless, ACL reconstruction (ACLR) does not equate to normal function of the knee or reduced risk of subsequent injuries. In fact, recent evidence has shown that only around half of post-ACLR patients can expect to return to competitive level of sports. A rising concern is the high rate of second ACL injuries, particularly in young athletes, with up to 20% of those returning to sport in the first year from surgery experiencing a second ACL rupture. Aside from the increased risk of second injury, patients after ACLR have an increased risk of developing early onset of osteoarthritis. Given the recent findings, it is imperative that rehabilitation after ACLR is scrutinized so the second injury preventative strategies can be optimized. Unfortunately, current ACLR rehabilitation programs may not be optimally effective in addressing deficits related to the initial injury and the subsequent surgical intervention. Motor learning to (re-)acquire motor skills and neuroplastic capacities are not sufficiently incorporated during traditional rehabilitation, attesting to the high re-injury rates. The purpose of this article is to present novel clinically integrated motor learning principles to support neuroplasticity that can improve patient functional performance and reduce the risk of second ACL injury. The following key concepts to enhance rehabilitation and prepare the patient for re-integration to sports after an ACL injury that is as safe as possible are presented: (1) external focus of attention, (2) implicit learning, (3) differential learning, (4) self-controlled learning and contextual interference. The novel motor learning principles presented in this manuscript may optimize future rehabilitation programs to reduce second ACL injury risk and early development of osteoarthritis by targeting changes in neural networks.

http://bit.ly/2BjkWM0

Microbial ecology of the cryosphere (glacial and permafrost habitats): current knowledge

Abstract

Microorganisms in cold ecosystems play a key ecological role in their natural habitats. Since these ecosystems are especially sensitive to climate changes, as indicated by the worldwide retreat of glaciers and ice sheets as well as permafrost thawing, an understanding of the role and potential of microbial life in these habitats has become crucial. Emerging technologies have added significantly to our knowledge of abundance, functional activity, and lifestyles of microbial communities in cold environments. The current knowledge of microbial ecology in glacial habitats and permafrost, the most studied habitats of the cryosphere, is reported in this review.

http://bit.ly/2UBzldq

Improving the production of isoprene and 1,3-propanediol by metabolically engineered Escherichia coli through recycling redox cofactor between the dual pathways

Abstract

The biosynthesis of isoprene by microorganisms is a promising green route. However, the yield of isoprene is limited due to the generation of excess NAD(P)H via the mevalonate (MVA) pathway, which converts more glucose into CO₂ or undesired reduced by-products. The production of 1,3-propanediol (1,3-PDO) from glycerol is a typical NAD(P)H-consuming process, which restricts 1,3-PDO yield to ~ 0.7 mol/mol. In this study, we propose a strategy of redox cofactor balance by coupling the production of isoprene with 1,3-PDO fermentation. With the introduction and optimization of the dual pathways in an engineered Escherichia coli, ~ 85.2% of the excess NADPH from isoprene pathway was recycled for 1,3-PDO production. The best strain G05 simultaneously produced 665.2 mg/L isoprene and 2532.1 mg/L 1,3-PDO under flask fermentation conditions. The yields were 0.3 mol/mol glucose and 1.0 mol/mol glycerol, respectively, showing 3.3- and 4.3-fold improvements relative to either pathway independently. Since isoprene is a volatile organic compound (VOC) whereas 1,3-PDO is separated from the fermentation broth, their coproduction process does not increase the complexity or cost for the separation from each other. Hence, the presented strategy will be especially useful for developing efficient biocatalysts for other biofuels and biochemicals, which are driven by cofactor concentrations.

http://bit.ly/2Sqkq8J

Opposite effects of Vaccinia and modified Vaccinia Ankara on trained immunity

Abstract

Vaccines such as Vaccinia or BCG have non-specific effects conferring protection against other diseases than their target infection, which are likely partly mediated through induction of innate immune memory (trained immunity). MVA85A, a recombinant strain of modified Vaccinia Ankara (MVA), has been suggested as an alternative vaccine against tuberculosis, but its capacity to induce positive or negative non-specific immune effects has not been studied. This study assesses whether Vaccinia and MVA are able to induce trained innate immunity in monocytes. Human primary monocytes were primed in an in vitro model with Vaccinia or MVA for 1 day, after which the stimulus was washed off and the cells were rechallenged with unrelated microbial ligands after 1 week. Heterologous cytokine responses were assessed and the capacity of MVA to induce epigenetic changes at the level of cytokine genes was investigated using chromatin immunoprecipitation and pharmacological inhibitors. Monocytes trained with Vaccinia showed significantly increased IL-6 and TNF-α production to stimulation with non-related stimuli, compared to non-trained monocytes. In contrast, monocytes primed with MVA showed significant decreased heterologous IL-6 and TNF-α responses, an effect which was abrogated by the addition of a histone methyltransferase inhibitor. No effects on H3K4me3 were observed after priming with MVA. It can be thus concluded that Vaccinia induces trained immunity in vitro, whereas MVA induces innate immune tolerance. This suggests the induction of trained immunity as an immunological mechanism involved in the non-specific effects of Vaccinia vaccination and points to a possible explanation for the lack of effect of MVA85A against tuberculosis.

http://bit.ly/2Tv2kiZ

Biomass-based negative emission technology options with combined heat and power generation

Abstract

Biomass-based combined heat and power (CHP) generation with different carbon capture approaches is investigated in this study. Only direct carbon dioxide (CO₂) emissions are considered. The selected processes are (i) a circulating fluidized bed boiler for wood chips connected to an extraction/condensation steam cycle CHP plant without carbon capture; (ii) plant (i), but with post-combustion CO₂ capture; (iii) chemical looping combustion (CLC) of solid biomass connected to the steam cycle CHP plant; (iv) rotary kiln slow pyrolysis of biomass for biochar soil storage and direct combustion of volatiles supplying the steam cycle CHP plant with the CO₂ from volatiles combustion escaping to the atmosphere; (v) case (iv) with additional post-combustion CO₂ capture; and (vi) case (iv) with CLC of volatiles. Reasonable assumptions based on literature data are taken for the performance effects of the CO₂ capture systems and the six process options are compared. CO₂ compression to pipeline pressure is considered. The results show that both bioenergy with carbon capture and storage (BECCS) and biochar qualify as negative emission technologies (NETs) and that there is an energy-based performance advantage of BECCS over biochar because of the unreleased fuel energy in the biochar case. Additional aspects of biomass fuels (ash content and ash melting behavior) and sustainable soil management (nutrient cycles) for biomass production should be quantitatively considered in more detailed future assessments, as there may be certain biomass fuels, and environmental and economic settings where biochar application to soils is indicated rather than the full conversion of the biomass to energy and CO₂.

http://bit.ly/2Go0nBq

Betrixaban for Extended Venous Thromboembolism Prophylaxis in High-Risk Hospitalized Patients: Putting the APEX Results into Practice

Abstract

Acutely ill hospitalized medical patients remain at high thromboembolic risk for several weeks after discharge. Previous trials with extended-duration thromboprophylaxis using enoxaparin, apixaban, and rivaroxaban failed to achieve acceptable net clinical benefit, largely due to excess of major bleeding. Betrixaban is a novel factor Xa inhibitor with unique pharmacokinetic properties, including low renal clearance, long half-life, and low peak-to-trough ratio. The phase III APEX trial (N = 7513) compared a betrixaban 160 mg loading dose followed by 80 mg once daily for 35–42 days, with enoxaparin 40 mg once daily for 6–14 days; the betrixaban dose was reduced for renal impairment or a concomitant strong P-glycoprotein (P-gp) inhibitor. The primary efficacy endpoint of composite thrombotic events was not different between treatment arms in cohort 1 (d-dimer ≥ 2 × upper limit of normal). Subsequent exploratory analyses showed a statistically significant difference favoring betrixaban for symptomatic venous thromboembolism and net clinical benefit in the overall population. For the primary safety outcome, betrixaban did not significantly increase major bleeding compared with enoxaparin. Based on available data from the APEX trial and subanalyses, the use of betrixaban in patients similar to those enrolled in the APEX trial can reduce the risk of thromboembolic events without increasing the risk of major bleeding. Patients who may benefit more from betrixaban therapy include those with elevated d-dimer, history of venous thromboembolism, hospitalized for ischemic stroke, hospitalized for heart failure with N-terminal pro-B-type natriuretic peptide ≥ 1975 ng/L, or two or more VTE risk factors. Reduced-dose betrixaban does not appear to provide the same clinical utility as full-dose betrixaban.

http://bit.ly/2BnTOeJ

Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?

Abstract

Coronary artery disease (CAD) is a leading cause of death worldwide, and percutaneous transluminal coronary angiography (PTCA) and/or percutaneous coronary intervention (PCI; angioplasty) are commonly used to diagnose and/or treat the obstructed coronaries. Exercise-based rehabilitation is recommended for all CAD patients; however, most guidelines do not specify when exercise training should commence following PTCA and/or PCI. Catheterization can result in arterial dysfunction and acute injury, and given the fact that exercise, particularly at higher intensities, is associated with elevated inflammatory and oxidative stress, endothelial dysfunction and a pro-thrombotic milieu, performing exercise post-PTCA/PCI may transiently elevate the risk of cardiac events. This review aims to summarize extant literature relating to the impacts of coronary interventions on arterial function, including the time-course of recovery and the potential deleterious and/or beneficial impacts of acute versus long-term exercise. The current literature suggests that arterial dysfunction induced by catheterization recovers 4–12 weeks following catheterization. This review proposes that a period of relative arterial vulnerability may exist and exercise during this period may contribute to elevated event susceptibility. We therefore suggest that CAD patients start an exercise training programme between 2 and 4 weeks post-PCI, recognizing that the literature suggest there is a 'grey area' for functional recovery between 2 and 12 weeks post-catheterization. The timing of exercise onset should take into consideration the individual characteristics of patients (age, severity of disease, comorbidities) and the intensity, frequency and duration of the exercise prescription.

http://bit.ly/2MOB9gC

TiO 2 hollow spheres with surface-rich Ti 3+ under Pd-catalyzed hydrogenation for improved visible-light photocatalysis

Abstract

To enhance the utilization of visible light and prevent photogenerated electrons/holes from recombination, black TiO₂ hollow spheres of varying shell thicknesses rich in Ti³⁺ were synthesized via hydrogenation with the aid of Pd. With increasing hydrogenation temperature from room temperature to 200 °C, the thickness of the disordered layer increases, and the concentration of Ti³⁺, which is the main active site for photocatalysis, also increases. Owing to the intense visible-light harvesting nature and rich active sites introduced by the disordered layer, the black TiO₂ hollow spheres obtained at 200 °C degrade rhodamine B (RhB) to 95.2% within 120 min under visible-light illumination. In addition to the role of enhanced visible-light absorbance, Ti³⁺ also improves the conductivity, which is further confirmed with Li-ion batteries. The enhanced conductivity favors the separation of photogenerated electrons/holes.

http://bit.ly/2HS8Saj

Introduction of heterologous transcription factors and their target genes into Penicillium oxalicum leads to increased lignocellulolytic enzyme production

Abstract

Genetic engineering of transcription factors is an efficient strategy to improve lignocellulolytic enzyme production in fungi. In this study, the xylanase transcriptional regulators of Trichoderma reesei (Xyr1) and Neurospora crassa (XLR-1), as well as their constitutively active mutants (Xyr1^A824V and XLR-1^A828V), were heterologously expressed in Penicillium oxalicum. The two heterologous regulators were identified to be able to activate lignocellulolytic enzyme gene expression in P. oxalicum. Particularly, expression of T. reesei Xyr1 resulted in a higher cellulase production level compared with the expression of native xylanase transcriptional regulator XlnR using the same promoter. Xyr1^A824V and XLR-1^A828V were found to be able to confer P. oxalicum more enhanced lignocellulolytic abilities than wild-type regulators Xyr1 and XLR-1. Furthermore, introduction of regulatory modules containing Xyr1^A824V/XLR-1^A828V and their target cellulase genes resulted in greater increases in cellulase production than alone expression of transcriptional regulators. Through the cumulative introduction of three regulatory modules containing regulator mutants and their corresponding target cellulase genes from P. oxalicum, T. reesei, and N. crassa, a 2.8-fold increase in cellulase production was achieved in P. oxalicum.

http://bit.ly/2t5zcTW

Discordant isolates in bone specimens from patients with recurrent foot osteomyelitis

Abstract

We compared paired operative bone cultures (initial operation and reoperation) for 35 patients who experienced foot osteomyelitis treatment failure at a single hospital. Concordance was poor (kappa = 0.180). Staphylococcus aureus, gram negatives, and anaerobes were the most common discordant bacteria seen at reoperation, while Enterococcus was the most persistent.

http://bit.ly/2t6LknF

Evaluation of enhanced oviposition attractant formulations against Aedes and Culex vector mosquitoes in urban and semi-urban areas

Abstract

Surveillance is not only an important tool to assess the population dynamics of vector mosquitoes, but it can also be used to control vector-borne diseases. Mosquito vectors that belong to several genera such as Anopheles, Aedes, and Culex play a crucial role in the transmission of malaria, dengue, chikungunya, Zika, and elephantiasis diseases worldwide. We tested the efficacy of two commercial-grade oviposition attractant formulations that were developed for the container-inhabiting Aedes aegypti, Aedes albopictus, and Culex quinquefasciatus mosquitoes present in urban or semi-urban environments. These attractants can lure gravid females. Field trials were conducted in residential yards during a post-rainy season in September and October. Our data showed considerable efficacy for both attractants. Aedes-attractant collected 1.6-fold more larvae (101.2 ± 10.5 larvae/trap) than the control, and Culex-attractant collected 1.27-fold more larvae (151.2 ± 12.5 larvae/trap) than the control, resulting in 0.8 and 0.7 oviposition attraction indices (OAIs), respectively. Regression analysis indicated that the Aedes-attractant was more stable than the Culex-attractant. Location and time did not alter the efficacy of these attractants. Our experiment suggests that these attractants can be used for the development of species-specific gravid traps to detect, estimate, and control the mosquito population in urban and semi-urban areas.

http://bit.ly/2SqTHbZ

Leaving footprints, not scars: a qualitative pilot study of Hispanic mothers’ willingness to communicate with dependent children about an advanced cancer diagnosis

Abstract

Purpose

US Hispanics are more likely to be diagnosed with advanced cancer as parents than their non-Hispanic white counterparts but little is known about Hispanic parents' willingness to discuss a terminal cancer diagnosis with dependent children, potentially resulting in suboptimal child coping. Therefore, we investigated Hispanic mothers' willingness to communicate with dependent children about her actual or hypothetical advanced cancer diagnosis.

Methods

Two focus groups (n = 6 participants) and three one-on-one interviews (n = 3) were conducted in either Spanish or English among adult, Mexican-American mothers with a current cancer diagnosis of any stage residing in US-Mexico border communities. Participants reported their perceived concerns, parenting challenges, and openness to discussing an incurable cancer diagnosis with a dependent child. Audio files were transcribed into English and qualitatively coded using content analysis.

Results

Participants, most with breast cancer, ranged in age from 25 to 47. Five had considered the possibility of their own death from advanced cancer and three had previously discussed this with their children. While many expected their children would carry on well without them, seven expressed concern for the emotional/spiritual well-being of their children. Mothers anticipated physical and time-based parenting challenges but wanted the opportunity to focus on themselves and their children in advance of death. All but one would be willing to discuss an advance cancer diagnosis with dependent children; four expressed the value of doing so or the potential harm of abdicating this responsibility.

Conclusions

If faced with an advanced cancer diagnosis, Mexican-American mothers are open to communicating with dependent children.

http://bit.ly/2GrUovv

Unmet needs in psoriatic arthritis patients receiving immunomodulatory therapy: results from a large multinational real-world study

Abstract

Objective

There are limited data on therapy selection and switching in psoriatic arthritis (PsA). This 18 country, real-world study assessed use and switching of immunomodulatory therapy (biologic/apremilast), the extent of treatment failure and its association with reduced physical functioning, health-related quality of life (HRQoL), and work productivity and activity impairment (WPAI).

Methods

PsA patients under routine care and their treating physicians provided demographics, current therapy, reasons for switching, duration of first therapy, HRQoL, HAQ-DI, and WPAI. Current immunomodulatory therapy was determined as "failing" if, after ≥ 3 months, physician-rated disease severity had worsened, remained severe, was "unstable/deteriorating," or they were dissatisfied with disease control and/or did not consider treatment a "success."

Results

Included were 3714 PsA patients; 1455 (40.6%) had never received immunomodulatory therapy; 1796 (50.1%) had ever received 1 immunomodulatory therapy and 331 (9.2%) ≥ 1. Lack of efficacy with first immunomodulatory therapy was the most common reason for switching; patients whose physicians indicated "primary lack of efficacy" as the reason, switched after a mean of 9.4 months. Patients currently failing immunomodulator therapies (n = 246) had poorer HRQoL compared with treatment success (n = 1472) measured by EQ-5D-3L (0.60 vs 0.77%; P < 0.0001); SF-36 PCS (40.8% vs 46.1%; P < 0.0001) MCS (41.1% vs 45.3%; P < 0.0001). Physical functioning, activity, and work productivity were also more impaired (HAQ-DI: 0.88 vs 0.56; activity impairment: 46.7% vs 29.7%; overall work impairment: 35.4% vs 26.1%; all P < 0.0001).

Conclusions

Poor treatment response in PsA is associated with substantial negative patient impact. In cases of primary treatment failure, timely switching is needed.

http://bit.ly/2S9BmB8

Spotting malignancies from gastric endoscopic images using deep learning

Abstract

Background

Gastric cancer is a common kind of malignancies, with yearly occurrences exceeding one million worldwide in 2017. Typically, ulcerous and cancerous tissues develop abnormal morphologies through courses of progression. Endoscopy is a routinely adopted means for examination of gastrointestinal tract for malignancy. Early and timely detection of malignancy closely correlate with good prognosis. Repeated presentation of similar frames from gastrointestinal tract endoscopy often weakens attention for practitioners to result in true patients missed out to incur higher medical cost and unnecessary morbidity. Highly needed is an automatic means for spotting visual abnormality and prompts for attention for medical staff for more thorough examination.

Methods

We conduct classification of benign ulcer and cancer for gastrointestinal endoscopic color images using deep neural network and transfer-learning approach. Using clinical data gathered from Gil Hospital, we built a dataset comprised of 200 normal, 367 cancer, and 220 ulcer cases, and applied the inception, ResNet, and VGGNet models pretrained on ImageNet. Three classes were defined—normal, benign ulcer, and cancer, and three separate binary classifiers were built—those for normal vs cancer, normal vs ulcer, and cancer vs ulcer for the corresponding classification tasks. For each task, considering inherent randomness entailed in the deep learning process, we performed data partitioning and model building experiments 100 times and averaged the performance values.

Results

Areas under curves of respective receiver operating characteristics were 0.95, 0.97, and 0.85 for the three classifiers. The ResNet showed the highest level of performance. The cases involving normal, i.e., normal vs ulcer and normal vs cancer resulted in accuracies above 90%. The case of ulcer vs cancer classification resulted in a lower accuracy of 77.1%, possibly due to smaller difference in appearance than those cases involving normal.

Conclusions

The overall level of performance of the proposed method was very promising to encourage applications in clinical environments. Automatic classification using deep learning technique as proposed can be used to complement manual inspection efforts for practitioners to minimize dangers of missed out positives resulting from repetitive sequence of endoscopic frames and weakening attentions.

http://bit.ly/2TBUKn3

Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies

Abstract

Background

To evaluate short- and long-term outcomes of robotic gastrectomy (RG) in patients with gastric cancer to determine whether RG is an acceptable alternative to laparoscopic gastrectomy (LG).

Methods

PubMed, Embase, the Cochrane Library, and Chinese Biomedical Database were searched for prospective observational studies (POSs) comparing RG with LG for gastric cancer until October 2017. We compared short-term and long-term outcomes using systematic review with meta-analysis and trial sequential analysis (TSA).

Results

Sixteen POSs including 4576 patients were included in the meta-analyses. Compared with LG, RG had longer operative time (MD 57.98 min, P < 0.00001), lesser blood loss (MD − 23.71 ml, P = 0.005), and shorter time to first post-operative flatulence (MD − 0.14 days, P = 0.03). No significant difference was found in terms of the number of harvested lymph nodes, complications, reoperation, mortality, open conversion, proximal resection margin, and distal resection margin. The meta-analyses of complications, overall survival, and disease-free survival did not yield any sign of statistically significant difference between the two treatments, and the cumulative Z-curve crossed neither the traditional boundary nor the trial sequential monitoring boundary, suggesting the lack of firm evidence. TSA demonstrated that the cumulative Z-curve crossed either the traditional boundary or the trial sequential monitoring boundary on blood loss and operative time.

Conclusions

The present study demonstrates that RG is as acceptable as LG in terms of short- and long-term outcomes. The TSA demonstrated that further studies are not needed to evaluate the operative time and blood loss differences between these techniques.

http://bit.ly/2Bg1iQL

Recumbent stepping aerobic exercise in amyotrophic lateral sclerosis: a pilot study

Abstract

Objectives

Aerobic exercise can promote neuroplastic responses in the healthy and injured brain. Although the role of exercise in amyotrophic lateral sclerosis (ALS) is debated, new evidence suggests that exercise may reduce disease progression. While common exercise modalities such as the treadmill and cycle ergometer have been explored in ALS, the safety and feasibility of a total body recumbent stepper have not been investigated. Additionally, the functional and neurophysiological effects of recumbent stepping in ALS are still unknown. Here, we investigated the safety and feasibility of a 4-week recumbent stepping program to slow disease progression in ALS and possibly facilitate neuroplasticity.

Method

Nine individuals with ALS performed moderate intensity recumbent stepping for four weeks. Outcomes included participation satisfaction questionnaire, ALS Functional Rating Scale Revised (ALSFRS-R), clinical tests of walking and endurance, fatigue severity scale, Beck depression inventory, SF-12, and transcranial magnetic stimulation-induced motor evoked potentials (MEPs). All measurements were collected at baseline, post-intervention, and at the 1-month follow-up.

Results

Eight participants completed the study without any adverse events. The ALSFRS-R scores were similar at the end of the study and at follow-up. No significant differences were noted for any of the clinical outcomes. MEPs were present only in two participants and changes in corticomotor excitability after exercise were minimal.

Conclusions

Results from this preliminary study support the safety and feasibility of 12 sessions of total body recumbent stepping in individuals with ALS.

http://bit.ly/2D6mqcw

Predictors of moderate to severe obstructive sleep apnea: identification of sex differences

Abstract

Purpose

Home sleep apnea tests are recommended only for patients at high risk of moderate to severe obstructive sleep apnea (OSA, apnea-hypopnea index [AHI] ≥ 15/h). We evaluated 14 factors known to be associated with OSA and identified sex differences in predictors of moderate to severe OSA.

Methods

Retrospective analysis was done on 545 subjects who completed sleep questionnaires and underwent diagnostic polysomnogram at a tertiary sleep center. Univariate and multivariate analysis was conducted separately in males and females to determine which variables were independent predictors of moderate to severe OSA.

Results

Overall, physical traits were stronger predictors in both males and females. For each sex, only 3 variables were found to be independently predictive of moderate to severe OSA. In order of predictive strength, this included body mass index (BMI) ≥ 38 kg/m² (aOR 5.80, p < 0.001), neck circumference (NC) ≥ 17 in. (aOR 2.52, p = 0.002), and Epworth sleepiness scale (ESS) ≥ 13 (aOR 2.22, p = 0.015) for males and age ≥ 50 years (aOR 4.19, p < 0.001), NC ≥ 14.5 in. (aOR 3.13, p = 0.003), and report of morning headaches (aOR 2.00, p = 0.039) for females. Applying the Bonferroni correction, BMI and NC remained significant for males, and age and NC remained significant for females.

Conclusions

In a subject population referred for sleep evaluation at a tertiary care center only a few variables are independently predictive of moderate to severe OSA, and these variables differed between males and females. Only BMI, NC, and a high ESS were independently predictive of moderate to severe OSA in males, whereas age, NC, and morning headaches were independently predictive in females.

http://bit.ly/2Gp4RI6

Chain structure comparison of two low density polyethylene resins fractionated by temperature rising elution fractionation and thermal fractionation

Abstract

Two low-density polyethylene resins were fractionated into 11 fractions using the temperature rising elution fractionation technique. The resins were of injection molding grade with similar densities but different melt indexes and mechanical properties. High-temperature gel permeation chromatography (HT-GPC), ¹³C-nuclear magnetic resonance (¹³C-NMR) spectroscopy, differential scanning calorimetry (DSC), and successive self-nucleation/annealing (SSA) thermal fractionation were employed to characterize the original resins and their fractions. Resin A had a higher molecular weight and broader molecular weight distribution than resin B did. The highest contents were found for the 80 °C and 75 °C fractions of resins A and B, respectively. In addition, the highest molecular weights for resins A and B at 2.14 × 10⁵ and 1.42 × 10⁵ g/mol, respectively, were attained for the fractions eluted at 80 °C. According to the results of ¹³C-NMR, the total branching contents of resins A and B, including short- and long-chain branching, were 3.63 mol% and 4.89 mol%, respectively. DSC analysis revealed that the crystallinity of fractions 3–10 of resin A was lower than that of resin B. We noted the presence of approximately eight multiple melting peaks in the original sample and fractions from the results of SSA. These peaks indicated the inhomogeneity of the molecular chain. L_w and L_n of resin A were longer than those of resin B. Lastly, the relationship between chain structure and property was also discussed.

http://bit.ly/2BiUZwa

A differentiated approach to repeat small-bowel anastomoses in patients with postoperative peritonitis: a prospective cohort study

Abstract

Background

Postoperative peritonitis still remains the cause of a high mortality rate in emergency abdominal surgery. Here we aimed to evaluate the efficacy of different surgical strategies for small-bowel perforations that resulted in postoperative peritonitis.

Methods

Surgical management results for 140 patients with postoperative peritonitis due to small-bowel perforations, necrosis and anastomotic leakage were comparatively analyzed. Using the APACHE-II and MPI scoring systems, different surgeon attitudes were examined in three patient groups (primary anastomosis, delayed anastomosis, and enterostomy).

Results

The surgical approach in patient group I (n = 47, APACHE-II 11.7 ± 1.2, MPI 14.7 ± 1.3) involved the closure of small-bowel perforations or small-bowel resection to place primary anastomosis. The mortality rate was 17%. Patient group II (n = 48, APACHE-II 16.8 ± 0.7, MPI 19.3 ± 0.3) underwent delayed small-bowel anastomosis during planned relaparotomies. The mortality rate was 18.8%. Because patients in patient group III (n = 45, APACHE-II 22.3 ± 1.3, MPI 24.6 ± 1.2) were in very critical condition, anastomoses were not placed after bowel resection, and the surgical procedure was completed with enterostomy. The highest mortality rate of 37.8% was documented in this patient group.

Conclusion

The differentiated surgical approach undertaken herein using delayed small-bowel anastomosis in more serious patients with postoperative peritonitis was able to mitigate the risk of recurrent anastomotic leaks and was not accompanied by a considerable rise in mortality. The mortality for primary repair and delayed primary closure was basically the same (17.0% and 18.8%, p = 0.03); however, delayed anastomosis in the patients with postoperative peritonitis at higher APACHE-II and MPI scores for severity of illness showed 15.1% less complications in the form of anastomotic leaks (p = 0.04).

http://bit.ly/2HONRND

Rapid reconstitution packages (RRPs) for stable storage and delivery of glucagon

Abstract

Current emergency injectors of glucagon require manual reconstitution, which involves several steps that may lead to dosage errors. Rapid reconstitution packages (RRPs) are new devices, designed using computational fluid dynamics (CFD) to optimize fluid mixing, integrating physical properties of active pharmaceutical ingredients (APIs), excipients and diluents. RRPs improve drug stability for long-term storage and ease of delivery. Device prototypes were manufactured using advanced stereolithography apparatus (SLA) 3D printing technology. Reconstitution of glucagon with RRPs was evaluated by high-performance liquid chromatography (HPLC) and optical spectroscopy methods. Enzyme-linked immunosorbent assays were performed to test in vitro activity. Experimental results showed that RRPs effectively reconstituted glucagon even after exposure to 60 °C for a 24-h period. RRPs exhibited improved performance at maintaining drug stability compared to lyophilized glucagon stored in a standard glass vial under the same temperature conditions. RRPs represent a portable platform for rapid reconstitution of lyophilized drugs, compatible with standard syringes available in any clinical setting. The RRP provides an alternative to manual reconstitution process, especially designed for medical emergencies.

http://bit.ly/2G9Oqjh

The Role of Short Vowels in Reading Arabic: A Critical Literature Review

Abstract

The purpose of the present review is to examine the studies that tested the role of short vowels in reading Arabic. Most of the studies are reviewed in this paper and two contradicted data are presented: data that support positive contribution of short vowels in reading Arabic, and the other data that reject the assumption that short vowels contribute to the quality of reading, and suggest that these short vowels do not add any positive contribution and maybe the opposite; short vowels hinder reading in Arabic orthography. The results are criticized indicating some methodological problems and suggestions for further studies are presented.

http://bit.ly/2TuzxLC

How does climate change adaptation affect public budgets? Development of an assessment framework and a demonstration for Austria

Abstract

Public adaptation to climate change affects government budgets directly on the expenditure side, but also indirectly via changes in the tax base and government consumption patterns. While such indirect effects have been analyzed intensively for mitigation policies, similarly detailed model-based frameworks and studies for adaptation policy are still missing. The objectives of the present paper are (i) to fill this gap by proposing a general modeling framework that allows for a comprehensive analysis of effects of adaptation on federal budgets, both on the expenditure and the revenue side, as well as of macroeconomic effects and (ii) to demonstrate its usefulness by applying this framework to the case of Austria. We find that public adaptation can lead to substantial positive macroeconomic effects on gross domestic product (GDP), welfare, and employment. The results are robust with respect to assumptions about the effectiveness of adaptation. Also, we demonstrate that it is essential for analysis to cover both the expenditure and revenue side, as overall government revenues can increase due to adaptation, offsetting additional direct public expenses for adaptation, thus increasing the budget balance. This is because of less severe climate change impacts and the corresponding lower payments for post-disaster relief and unemployment benefits as well as higher tax revenues. We thus strongly recommend making use of economy-wide modeling frameworks when planning for adaptation, as they shed light on the true costs and benefits of adaptation.

http://bit.ly/2TvxV49

Ictal dancing-like semiology in frontal lobe epilepsy

http://bit.ly/2WIXYaj

Development and characterization of Lyophilized Transparized Decellularized stroma as a replacement for living cornea in deep anterior lamellar keratoplasty

Abstract

Corneal disease is the second cause of blindness in developing countries, where the number of corneal grafts needed by far exceeds the number available. In industrialized countries, although corneas are generally available for keratoplasty, onto inflamed and vascularized host beds they are often rejected despite immune-suppression. A non-immunogenic, transparent, cytocompatible stroma is therefore required, which can be lyophilized for long-term conservation. Decellularization methods were tested on porcine corneal stromas before validation on human corneas. Decellularization and lyophilization led to opacification of the stroma, which could be reversed by soaking in 100% glycerol. Cell-depleted transparized stromas were then lyophilized (LTDC) to allow their long-term conservation and water content was measured. The ultrastructure of LTDC corneas was examined by transmission electron microscopy (TEM). Histocompatibility antigens were undetectable on LTDC stromas by antibody staining. Finally, cytocompatibility of LTDC stromas was demonstrated on an ex vivo model of anterior lamellar keratoplasty. Differential staining was used to monitor colonization of LTDC stromas by cells from the receiving cornea. Only SDS-based decellularization produced acellular porcine stromas. The lowest SDS concentration tested (0.1%) was validated on human corneas. Unlike lyophilized corneas, LTDC stromas without residual water, express no histocompatibility markers, although TEM revealed the presence of cellular debris in an ultrastructural arrangement of collagen fibers very close to that of native corneas. This structure is compatible with colonization by cells from the receiver cornea in an ex vivo lamellar graft model. Our procedure produced non-immunogenic, transparent stromas with conserved ultrastructure compatible with long-term conservation.

http://bit.ly/2REbKae

Public support for carbon dioxide removal strategies: the role of tampering with nature perceptions

Abstract

Carbon dioxide removal (CDR) describes a suite of controversial approaches to mitigating climate change that involve removing existing carbon dioxide from the atmosphere. Through an online survey experiment with US adults (N = 980), we examine three factors that may shape public support for different types of CDR strategies: (1) perceptions that CDR tampers with nature, (2) individual-level variation in the degree to which people are uncomfortable with activities that tamper with nature, and (3) information about the risks and benefits associated with each CDR strategy. Using a moderated mediation analysis, we find that support for different CDR strategies is, in part, a function of how much each strategy is perceived to tamper with nature. Support for bioenergy with carbon capture and storage (BECCS) and direct air capture (DAC) was lower than support for afforestation and reforestation (AR), as BECCS and DAC were perceived to tamper with nature more. These effects were particularly strong among individuals generally opposed to the idea of humans interfering with natural processes. Moreover, we find evidence that describing the risks and benefits of each CDR strategy dampens support; for AR and BECCS, this effect was again mediated through perceptions of tampering, while for DAC, the effect of describing these tradeoffs appeared to operate independently of perceived tampering. We conclude that policymakers and science communicators need to be mindful of how CDR strategies are described to the public, as perceptions of tampering with nature may be an important driver of their acceptance.

http://bit.ly/2HTrPJz

Epidemie der Depression?

Zusammenfassung

Hintergrund

In Deutschland berichten Kostenträger seit dem Beginn regelmäßiger Gesundheitsberichterstattung vor etwa 20 Jahren von einem stetigen Bedeutungszuwachs von Depressionen im Versorgungsgeschehen. Zugleich zeigt sich in epidemiologischen Feldstudien eine stabile Depressionsprävalenz in der Bevölkerung. Anhand von Daten des Robert Koch-Instituts wurde untersucht, inwieweit sich die Inanspruchnahme professioneller Hilfe bei Menschen mit Depression über die Zeit verändert hat.

Methodik

Datengrundlage bilden der Bundes-Gesundheitssurvey mit dem Zusatzsurvey „Psychische Störungen" (BGS98, 1997–1999, 18–65 Jahre, n = 4181) sowie die Studie zur Gesundheit Erwachsener in Deutschland und ihr Modul „Mental Health" (DEGS1-MH, 2009–2012, 18–65 Jahre, n = 3320). Mittels des Composite International Diagnostic Interview (CIDI) wurden Personen mit Depression standardisiert nach DSM-IV ermittelt und zu Kontakten zu Hilfs- und Versorgungsangeboten wegen psychischer Probleme befragt (BGS98: n = 346, DEGS1-MH: n = 229).

Ergebnisse

Insgesamt lassen sich nur geringfügige (nicht signifikante) Veränderungen im selbstberichteten Hilfesuchverhalten beobachten. Bei Männern mit Depression zeigt sich eine Zunahme in der Kontaktaufnahme zu psychotherapeutischen/psychologischen Angeboten. Barrieren der Inanspruchnahme bestehen in der Angst vor Stigmatisierung und mangelnder Aufklärung; fast ein Viertel berichtet von Zugangsbarrieren.

Diskussion

Die im Versorgungsgeschehen berichtete Zunahme an Depressionen lässt sich nicht hinreichend durch Veränderungen im Hilfesuchverhalten bei Menschen mit Depression begründen. Barrieren der Inanspruchnahme und geringe Konkordanzen zwischen Primär- und Sekundärdaten zeigen Evaluationsbedarf und Optimierungsmöglichkeiten in der Versorgung von Depressionen auf.

http://bit.ly/2RE0Q4f

Prävention bei Kindern mit depressiven oder angsterkrankten Eltern

Zusammenfassung

Hintergrund

Kinder psychisch erkrankter Eltern sind aufgrund deren Erkrankung vielfältigen Belastungen ausgesetzt. Altersspezifische präventive Maßnahmen und Interventionen sind notwendig, um das Risiko für Kinder, selbst zu erkranken, zu minimieren.

Fragestellung

Erfassung evidenzbasierter Präventionsangebote auf nationaler und internationaler Ebene für Kinder unterschiedlicher Altersgruppen zwischen 3 und 14 Jahren mit depressiven oder angsterkrankten Eltern.

Material und Methode

Anhand einer systematischen Literaturrecherche wurden aktuelle Präventions- und Interventionsmaßnahmen für die benannte Zielgruppe erfasst und hinsichtlich Altersspezifität und Evidenz analysiert.

Ergebnisse

Aus 107.573 Publikationen konnten 43 Interventionen ermittelt werden, von denen nach Bewertung der Evidenz der Ansätze 25 Projekte in die Analyse eingeschlossen wurden. Für die verschiedenen Altersklassen werden die jeweils am besten evaluierten Projekte vorgestellt.

Schlussfolgerung

Es gibt eine Vielzahl von Projekten, diese sind jedoch mehrheitlich nicht ausreichend evaluiert bzw. psychometrisch abgesichert. Die wenigen gut evaluierten Projekte für Kinder entsprechen allerdings weitgehend den altersspezifischen Bedürfnissen. Die evaluierten Projekte im Kindergartenalter sind elternbezogen und beziehen sich auf Elemente des Elterntrainings. Für Schulkinder gibt es verschiedene präventive Angebote, die insbesondere die Stärkung von Ressourcen bei Kindern adressieren, wie etwa die Verbesserung des Selbstwertes und die Entwicklung von Copingstrategien. Die Projekte für Jugendliche beziehen sich auf die eigene Entwicklung der Jugendlichen mit psychoedukativen Elementen, Verbesserung sozialer Beziehungen u.s.w. Über alle Altersgruppen hinweg fehlt es an einer flächendeckenden und systemübergreifenden Vernetzung der Angebote.

http://bit.ly/2WHYNQk

Differences Over Time in the Prognostic Effect of Return to Work Self-Efficacy on a Sustained Return to Work

Abstract

Purpose This study investigated the association between return to work self-efficacy (RTW-SE) and sustained return to work (RTW) at two different time points, over a 12-month period. The primary objective of the study was to examine if the relationship between RTW-SE and a sustained RTW changed over the RTW timeline. Methods This study used survey responses from a longitudinal cohort of n = 410 workers' compensation claimants with either an upper-body musculoskeletal injury or a psychological injury. A path analysis tested the associations between RTW-SE and a sustained RTW at two time-points. A Wald χ² test compared nested models to determine if the association changed over time. Results RTW-SE measured at time- point 1 (T1) was associated with a sustained RTW at time-point two (T2) (β = 0.24, P < 0.05) but no association was found between RTW-SE at T2 and a sustained RTW at time-point three (T3) (β = 0.017, n.s.). Model comparisons revealed significant differences in the associations between RTW-SE and a sustained RTW, with the relationship being stronger in the early phase of RTW compared to the latter phase (χ² = 5.002, p = 0.03). Conclusions The results indicate that RTW-SE at 4–6 months post-injury is important for a sustained RTW 6-months later although RTW-SE at 10–12 months post-injury had a negligible association over the same duration. Further research should investigate whether these findings generalize to other populations and what factors other than RTW-SE are associated with RTW in the later stages of the RTW process.

http://bit.ly/2Gd5HIu

Epidemiology of gastrointestinal nematodes of alpacas in Australia: I. A cross-sectional study

Abstract

This study involved a national cross-sectional survey of gastrointestinal nematodes (GINs) of alpacas in Australia. A total of 1545 fresh faecal samples were collected from both sexes of alpacas and processed for faecal egg counts (FEC) and molecular identification of nematodes using the multiplexed tandem PCR assay. Based on egg morphology, the overall prevalence of GINs was 66% while that for strongyles was 59%. The overall mean FEC was 276 eggs per gram (EPG) of faeces, with the highest count of 17,415 EPG. Male alpacas had a higher prevalence (68%, 334/490) as well as mean FEC (328 ± 60 EPG) of GINs than females (63%, 602/954; 227 ± 26, respectively). Weaners had the highest prevalence (80%) whereas tuis had the highest FEC (402 EPG) of nematodes. The highest prevalence (77%, 293/383) and FEC (630 EPG) of GINs were observed in the summer rainfall zone followed by the Mediterranean-type rainfall, non-seasonal rainfall and winter rainfall zones. The characterisation of nematode DNA isolated from faeces revealed the occurrence of seven different GINs, including Camelostrongylus mentulatus, Cooperia spp., Haemonchus spp., Oesophagostomum spp., Ostertagia ostertagi, Teladorsagia circumcincta and Trichostrongylus spp. Besides, Nematodirus spp. and Trichuris spp. were also found during FECs. The prevalence of Haemonchus spp. was highest in the summer rainfall zone while that of C. mentulatus was highest in the Mediterranean-type rainfall, non-seasonal rainfall and winter rainfall zones. The findings of this study revealed that alpacas harbour many of the same nematodes as sheep and cattle.

http://bit.ly/2Tw9K5M

The Domestication of Animals and the Roots of the Anthropocene

http://bit.ly/2GaOHmf

The Domestication of Animals and the Roots of the Anthropocene

http://bit.ly/2GaOHmf

Dynamic Temperature Analysis Under Variable Rate and Pressure Conditions for Transient and Boundary Dominated Flow

Abstract

Current analytical approaches for temperature transient analysis heavily rely on the assumption of the constant rate production, which is often invalid for the extended period of oil production. This work addresses this issue by introducing novel analytical approaches to model the temperature signal under dynamic rate and pressure conditions. The introduced methods share underlying theories of superposition principle and production rate normalization from pressure transient analysis and include a newly derived analytical solution when these theories are not applicable. With adapting these methods, cases with complex production history are modeled using analog cases producing with a constant rate. The dynamic temperature analysis developed herein is validated using synthetic temperature data both graphically and by quantitative estimation of reservoir properties. The estimation outputs of these methods include permeability, drainage area, and damaged zone properties. Other features of existing temperature transient analysis, such as fluid property correction and monitoring well surveillance, are also extended to variable rate and pressure conditions in this paper. Two cases documented in the literature are addressed by dynamic temperature analysis for which decent reservoir characterization results are obtained. The dynamic temperature analysis proposed in this paper extends the scope of temperature transient analysis to complex production constraints and demonstrates convincing results for practical purposes.

http://bit.ly/2WFfv30

Modelling of the mechanical response of Zr–Nb and Ti–Nb alloys in a wide temperature range

Abstract

This article presents the results of modeling the mechanical behavior of Zr–Nb and Ti–Nb alloys in a range of strain rates from 0.001 to 1000 1/s and temperature range 297–1273 K. A modification of constitutive equations describing the mechanical response of fine-grained and coarse-grained Zr–1Nb and Ti–13Nb–13Zr alloys in a wide temperature range is proposed. It was shown that the phase transition between the hexagonal closed packed and body-centered cubic crystal structure at elevated temperatures leads to a sharp change in strain rate sensitivity of the yield strength of Zr–Nb and Ti–Nb alloys. The proposed modifications of constitutive equations make it possible to describe the strain hardening and the strain rate sensitivity of the plastic flow stress over a wide temperature range in the coarse-crystalline and ultrafine-grained Zr–Nb and Ti–Nb alloys. The results can be used for engineering analysis of structural elements of technical systems and design of manufacturing technologies for biomedical products.

http://bit.ly/2HQTR8H

Nonlinear analysis of flexoelectric energy harvesters under force excitations

Abstract

This work focuses on theoretical modeling and dynamic analysis of a flexoelectric beam energy harvester with the consideration of geometric nonlinearity. We assume that the beam energy harvester has a thickness at nanoscale and a width and length at microscale. Under a harmonic concentrated force, the proposed energy harvester generates electric power due to the phenomenon of flexoelectricity. Based on the theory of flexoelectricity and Euler–Bernoulli beam assumption, the nonlinear electromechanical coupling equations are derived. Galerkin method is employed to obtain the discrete nonlinear equations, which are then solved numerically. Frequency response curves are plotted to reveal the nonlinear characteristics of the energy harvester and it is found that the frequency response curves of the flexoelectric energy harvester exhibit hardening behaviors. Case studies are provided and we emphasize on the influences of load resistance, tip mass, concentrated force and damping ratio on the output performance of the energy harvester. In addition, it is suggested that the flexoelectric energy harvester has a better output performance under a square waveform force among different forms of the concentrated force. The results obtained are significant for designing optimal flexoelectric energy harvesters.

http://bit.ly/2t6obBM

Role of bone marrow adipocytes in leukemia and chemotherapy challenges

Abstract

Adipose tissue (AT) is an extramedullary reservoir of normal hematopoietic stem cells (HSCs). Adipocytes prevent the production of normal HSCs via secretion of inflammatory factors, and adipocyte-derived free fatty acids may contribute to the development and progression of leukemia via providing energy for leukemic cells. In addition, adipocytes are able to metabolize and inactivate therapeutic agents, reducing the concentrations of active drugs in adipocyte-rich microenvironments. The aim of this study was to detect the role of adipocytes in the progression and treatment of leukemia. Relevant literature was identified through a PubMed search (2000–2018) of English-language papers using the following terms: leukemia, adipocyte, leukemic stem cell, chemotherapy, and bone marrow. Findings suggest the striking interplay between leukemic cells and adipocytes to create a unique microenvironment supporting the metabolic demands and survival of leukemic cells. Based on these findings, targeting lipid metabolism of leukemic cells and adipocytes in combination with standard therapeutic agents might present novel treatment options.

http://bit.ly/2WANaLf

Phylogeography, Population Genetics, and Conservation of Javan Gibbons ( Hylobates moloch )

http://bit.ly/2t3487c

Australian General Practitioners’ and Compensable Patients: Factors Affecting Claim Management and Return to Work

Abstract

Purpose General Practitioners (GPs) play an important role in personal injury compensation systems yet system processes have been perceived as burdensome. Objectives were to (1) determine attitudes of Australian GPs on health benefits of return to work (RTW) after injury/illness and (2) identify associations between GP characteristics and agreement with issues surrounding treating compensable patients. Methods Cross-sectional postal survey of 423 Australian GPs to determine agreement with issues associated with compensable patients (including patient advocacy, conflicting opinions between GPs and compensation systems, fitness-for-work certification, and refusal to treat). Results The vast majority of GPs agreed there was a health benefit to early RTW. GPs with 16–20 years' experience had significantly higher odds of agreeing that the certificate of work capacity is the primary method of communication between RTW stakeholders (OR 2.36 [1.13–4.92]) than those with greater experience. 49% of GPs agreed they should be able to refuse to treat compensable patients. Female GPs had significantly lower odds (OR 0.60 [0.40–0.90]) of agreeing with right to refuse than male GPs, as did those from remote or regional practices (OR 0.43 [0.20–0.94]; OR 0.60 [0.39–0.92]) than GPs from urban practices. Conclusions Reducing administrative barriers identified by Australian GPs and improving communication with compensation systems will likely have a positive impact on their refusal to treat compensable patients.

http://bit.ly/2MMsL17

Nephrogenic Systemic Fibrosis: A Review of History, Pathophysiology, and Current Guidelines

Abstract

Purpose of Review

Nephrogenic systemic fibrosis (NSF) is a rare systemic disease with a high mortality. The purpose of this review is to provide clinicians with guidance regarding safe administration of GBCAs to patients with renal disease.

Summary

Development of NSF has been linked to the administration of gadolinium-based contrast agents (GBCAs) in patients with renal disease. Due to the wide variety of available GBCAs and recommendations regarding safe administration of these agents, it can be difficult for clinicians to choose the best GBCA for this patient population.

Recent Findings

Although the current ACR guidelines have virtually eliminated the risk of NSF, future research may lead to the development of alternative contrast agents for patients at risk of NSF who require contrast-enhanced MRIs.

http://bit.ly/2G9VQDh

State-of-the-Art Imaging in Cardiac Oncology

Abstract

Purpose of Review

Imaging modalities play an important role in the diagnosis and management of cardiotoxicity and cardiac tumors. In this review, we provide an overview of the imaging modalities that are relevant to the field of cardio-oncology.

Recent Findings

Cardiac magnetic resonance provides comprehensive tissue characterization in the assessment of cardiac tumors and cardiomyopathy. The combination of positron emission tomography/computed tomography offers improved localization of lesions, staging, targeting of biopsy and therapy, and greater confidence in interpretation.

Summary

Overall, cardiac imaging plays a critical role in the assessment and management of cardiac tumors either for surgical planning or for initiation of appropriate cancer therapies. For certain higher risk cancer patients and survivors, routine surveillance with cardiac imaging may be warranted so appropriate interventions can be instituted to stabilize or even improve the cardiac dysfunction.

http://bit.ly/2D7awPK

Intravascular Ultrasound in the Creation of Transjugular Intrahepatic Portosystemic Shunts: Review of the Literature and Future Directions

Abstract

Purpose of Review

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established interventional radiology procedure for treating sequelae of portal hypertension involving shunting portal blood flow to the hepatic vein bypassing the liver through a stent graft. Creating a TIPS can be a complex and radiation-intensive procedure due to the technically challenging step of cannulating the portal vein from the hepatic vein. As this is the most unpredictable step in TIPS creation, multiple techniques have been described for visualizing the portal vein to facilitate its access. The use of intravascular ultrasound (IVUS) has gained significant interest over the last few years due to reports of improved procedural metrics such as shortened procedural time and radiation dose. The purpose of this article is to review the literature and detail technical advances utilizing IVUS in TIPS creation.

Recent Findings

Intravascular ultrasound has been shown to be a safe and reproducible means of real-time image guidance for TIPS creation. The use of IVUS has been associated with improved procedural metrics including a decreased number of intrahepatic needle passes, shorter portal vein access times, decreased contrast usage, and a decrease in radiation dose.

Summary

Due to technical advances and real-time portal vein visualization using IVUS, TIPS creation at our institution has dramatically changed. Our institutional practice has nearly completed shifted to the sole use of IVUS for portal vein access in TIPS creation due to significantly improved procedural metrics including radiation dose and contrast usage.

http://bit.ly/2G9h3NM

Flexibility in joint coordination remains unaffected by force and balance demands in young and old adults during simple sit-to-stand tasks

Abstract

Purpose

We examined the possibility that old adults use flexibility in joint coordination as a compensatory mechanism for the age-related decline in muscle strength when performing the sit-to-stand (STS) task repeatedly under high force and balance demands.

Method

Young (n = 14, 22.4 ± 2.1) and old (n = 12, 70 ± 3.2) healthy adults performed repeated STSs under high and low force and balance demands. The balance demand was manipulated by reducing the base of support and the force demand by increasing body weight with a weight vest. Uncontrolled manifold analysis was used to quantify age differences in motor flexibility.

Results

While there were age-typical differences in kinematic STS strategies, flexibility in joint coordination was independent of age and task difficulty during repeated STSs.

Discussion

That simple manipulations of force and balance demands did not affect flexibility in joint coordination in old and young adults suggests that motor flexibility acts as a compensatory mechanism only at the limits of available muscle strength and balance abilities during STS movements. Intervention studies should identify how changes in specific neuromuscular functions affect flexibility in joint coordination during activities of daily living such as STS.

http://bit.ly/2MMEvRe

Does an increase in energy return and/or longitudinal bending stiffness shoe features reduce the energetic cost of running?

Abstract

Purpose

This study focused on the effects of shoe energy return and shoe longitudinal bending stiffness on the energetic cost and biomechanics of running.

Methods

The energetic cost of running and biomechanical variables altering running economy (ground contact times, stride frequency, vertical and leg stiffness, ground reaction force impulses, alignment between the resultant ground reaction force and the leg) were measured for nineteen male recreational runners. Participants ran overground under their ventilatory anaerobic threshold (10.8 ± 1.1 km h⁻¹ on average) using four shoe prototypes with features combining low or high magnitudes of energy return and longitudinal bending stiffness.

Results

Neither the energy return, nor the longitudinal bending stiffness, or the interaction of these shoe features altered the energetic cost of running. High energy return shoes induced significant increased ground contact time from 274.5 ± 18.3 to 277.1 ± 18.7 ms, and significant decreased stride frequency from 1.34 ± 0.05 to 1.33 ± 0.05 Hz. High bending stiffness shoes induced significant increased ground contact time from 273.8 ± 18.2 to 277.9 ± 18.7 ms, significant increased vertical stiffness from 23.2 ± 3.4 to 23.8 ± 3.0 kN m⁻¹, and significant decreased net vertical impulse from 245.4 ± 17.2 to 241.7 ± 17.5 BW ms.

Conclusions

Increased energy return and longitudinal bending stiffness induced subtle changes in the running biomechanics, but did not induce any decrease in the energetic cost of running.

http://bit.ly/2MMExZm

Cardiovascular, muscular, and skeletal adaptations to recreational team handball training: a randomized controlled trial with young adult untrained men

Abstract

Purpose

The prevalence of lifestyle diseases has escalated, and effective exercise training programmes are warranted. This study tested the hypothesis that regular participation in small-sided team handball training could provide beneficial health effects on cardiovascular, skeletal, and muscular parameters in young adult untrained men.

Method

Twenty-six untrained 20–30-year-old men were randomly allocated to either a team handball training group (HG; n = 14), which completed 1.9 ± 0.3 training sessions per week over 12 weeks, or an inactive control group (CG; n = 12). Physiological training adaptations were assessed pre- and post interventions by DXA scans, blood samples, muscle biopsies, and physical tests.

Results

The average heart rate during training was equivalent to 84 ± 4% of maximal heart rate. Compared to CG, HG displayed significant increases in VO_2max (11 ± 6%), proximal femur bone mineral density (2 ± 1%), whole-body bone mineral content (2 ± 1%), intermittent endurance performance (32 ± 16%), incremental treadmill test performance (16 ± 7%) and muscle citrate synthase activity (22 ± 28%) as well as decreases in total fat mass (7 ± 7%) and total fat percentage (6 ± 7%) (all p < 0.05). There were no significant changes in muscle mass, blood pressure, resting heart rate, muscle hydroxyl-acyl-dehydrogenase activity, or blood lipids (all p > 0.05).

Conclusion

Participation in regular recreational team handball training was associated with positive cardiovascular, skeletal, and muscular adaptations, including increased maximal oxygen uptake, increased muscle enzymatic activity, and improved bone mineralization as well as lower fat percentage. These findings suggest that recreational team handball training may be an effective health-promoting activity for young adult men.

http://bit.ly/2DU9zMh

Pulmonary and respiratory muscle function in response to 10 marathons in 10 days

Abstract

Purpose

Marathon and ultramarathon provoke respiratory muscle fatigue and pulmonary dysfunction; nevertheless, it is unknown how the respiratory system responds to multiple, consecutive days of endurance exercise.

Methods

Nine trained individuals (six male) contested 10 marathons in 10 consecutive days. Respiratory muscle strength (maximum static inspiratory and expiratory mouth-pressures), pulmonary function (spirometry), perceptual ratings of respiratory muscle soreness (Visual Analogue Scale), breathlessness (dyspnea, modified Borg CR10 scale), and symptoms of Upper Respiratory Tract Infection (URTI), were assessed before and after marathons on days 1, 4, 7, and 10.

Results

Group mean time for 10 marathons was 276 ± 35 min. Relative to pre-challenge baseline (159 ± 32 cmH₂O), MEP was reduced after day 1 (136 ± 31 cmH₂O, p = 0.017), day 7 (138 ± 42 cmH₂O, p = 0.035), and day 10 (130 ± 41 cmH₂O, p = 0.008). There was no change in pre-marathon MEP across days 1, 4, 7, or 10 (p > 0.05). Pre-marathon forced vital capacity was significantly diminished at day 4 (4.74 ± 1.09 versus 4.56 ± 1.09 L, p = 0.035), remaining below baseline at day 7 (p = 0.045) and day 10 (p = 0.015). There were no changes in FEV₁, FEV₁/FVC, PEF, MIP, or respiratory perceptions during the course of the challenge (p > 0.05). In the 15-day post-challenge period, 5/9 (56%) runners reported symptoms of URTI, relative to 1/9 (11%) pre-challenge.

Conclusions

Single-stage marathon provokes acute expiratory muscle fatigue which may have implications for health and/or performance, but 10 consecutive days of marathon running does not elicit cumulative (chronic) changes in respiratory function or perceptions of dyspnea. These data allude to the robustness of the healthy respiratory system.

http://bit.ly/2DRUUkv

Cardiovascular and autonomic responses to passive arm or leg movement in men and women

Abstract

Purpose

Women display an attenuated mechanoreflex during leg movement; however, sex differences in the response to arm movement are unknown.

Methods

Men (n = 12) and women (n = 10) performed passive arm or leg movement where either the right elbow or right knee was passively flexed/extended for 3 min at 30 times/min. Mean arterial pressure (MAP), cardiac output index (Qi), and heart rate (HR) were continuously measured and 1-min averages along with peak values were obtained. Heart rate variability was measured at baseline and throughout 3 min of passive movement.

Results

Men had a greater average HR (P = 0.006) and Qi (P = 0.05) responses to passive limb movement compared to women. Men also had a greater (P = 0.02) and faster (P = 0.04) peak Qi response compared to women. During arm movement, men exhibited a greater change of average MAP compared to both women (P = 0.002) and leg movement (P = 0.05). Movement of either limb in both sexes decreased low-frequency power (LF; P = 0.04), decreased low-frequency to high-frequency ratio (LF/HF; P = 0.03), and increased high-frequency power (HF; P = 0.01) of heart rate variability. Women had lower pulse wave velocity (P = 0.02), higher root mean square of the successive differences (RMSSD; P = 0.04), lower LF power (P = 0.04), higher HF power (P = 0.03), and higher cardiovagal baroreceptor sensitivity (P = 0.003) compared to men at all time points.

Conclusions

We have found sex- and limb-dependent responses where men exhibit higher blood pressure in response to passive arm movement compared to women and compared to leg movement.

http://bit.ly/2MMxkZv

Local high-frequency vibration therapy following eccentric exercises reduces muscle soreness perception and posture alterations in elite athletes

Abstract

Purpose

Exercise-induced muscle damage produces painful sensations (delayed onset of muscle soreness, DOMS). DOMS causes compensatory postural adaptations, which in turn affect athletes' walking and running gait biomechanics. It is still debated whether the postural changes are due to impaired proprioception or pain perception. To disambiguate between these two contrasting hypotheses, we designed a study that tested post-exercise postural adjustments in two groups of athletes: a group who was administered a vibration therapy (VT), to attenuate pain perception, and a control group.

Methods

Thirty professional futsal players were tested on five different occasions: baseline, eccentric exercises (EE) session day, 24, 48 and 72 h after EE. Vibration therapy (120 Hz) was applied on legs muscles for 15 min in the experimental group, while no vibration was applied in the control group. The measurements included: isokinetic evaluation, stabilometric test, perceived soreness evaluation and serum levels of creatine kinase, and lactate dehydrogenase.

Results

48 h after EE, the control group showed changes in biomechanical parameters (antero-rotations of pelvis, p < 0.05). A substantial alteration in the hip kinematics was found, associated to a reduced contractile force (p < 0.01) and soreness perception. On the contrary, the VT group did not show any change in posture and pain perception. High-intensity VT decreases EE effects on muscle strength and DOMS.

Conclusions

DOMS significantly changes athletes' posture; but postural changes disappear following a VT therapy that decreases pain perception. It is concluded that soreness perception is the main cause of postural changes and that its effects can be counteracted using VT therapy.

http://bit.ly/2DTnpyn

Effect of different knee flexion angles with a constant hip and knee torque on the muscle forces and neuromuscular activities of hamstrings and gluteus maximus muscles

Abstract

Purpose

This study examined the effect of different knee flexion angles with a constant hip and knee torque on the muscle force and neuromuscular activity of the hamstrings and gluteus maximus.

Methods

Twenty healthy males lay in prone position and held their lower limb with hip flexion at 45° and knee flexion at either 10° or 80°. At these angles, the hip and knee torques are identical. Under three load conditions: passive (referred to as Unloaded), active (Loaded), and active with 3-kg weight added to the shank (Loaded + 3 kg), the muscle stiffness (i.e., an indicator of muscle force) and neuromuscular activity of the hamstrings and gluteus maximus were measured using shear wave elastography and surface electromyography.

Results

The muscle stiffness and neuromuscular activity of the hamstrings and gluteus maximus increased significantly with the load. Muscle stiffness in the hamstrings was significantly lower at knee flexion of 80° than at 10° for Unloaded, but not for either Loaded or Loaded + 3 kg. The neuromuscular activity of the hamstrings was significantly greater at knee flexion of 80° than at 10° for both Loaded and Loaded + 3 kg. The muscle stiffness or neuromuscular activity of the gluteus maximus showed no significant differences between knee angles.

Conclusions

When the passive force in the hamstrings decreases with knee flexion, sufficient muscle force to maintain the hip and knee torques against an external load is generated by preferentially increasing the neuromuscular activity of the hamstrings, rather than increasing the synergetic muscle force.

http://bit.ly/2MMDUis

Effect of growth hormone treatment on energy expenditure and its relation to first-year growth response in children

Abstract

Purpose

The effects of growth hormone (GH) treatment on linear growth and body composition have been studied extensively. Little is known about the GH effect on energy expenditure (EE). The aim of this study was to investigate the effects of GH treatment on EE in children, and to study whether the changes in EE can predict the height gain after 1 year.

Methods

Total EE (TEE), basal metabolic rate (BMR), and physical activity level (PAL) measurements before and after 6 weeks of GH treatment were performed in 18 prepubertal children (5 girls, 13 boys) born small for gestational age (n = 14) or with growth hormone deficiency (n = 4) who were eligible for GH treatment. TEE was measured with the doubly labelled water method, BMR was measured with an open-circuit ventilated hood system, PAL was assessed using an accelerometer for movement registration and calculated (PAL = TEE/BMR), activity related EE (AEE) was calculated [AEE = (0.9 × TEE) − BMR]. Height measurements at start and after 1 year of GH treatment were analysed. This is a 1-year longitudinal intervention study, without a control group for comparison.

Results

BMR and TEE increased significantly (resp. 5% and 7%). Physical activity (counts/day), PAL, and AEE did not change. 11 out of 13 patients (85%) with an increased TEE after 6 weeks of GH treatment had a good first-year growth response (∆height SDS > 0.5).

Conclusions

GH treatment showed a positive effect on EE in prepubertal children after 6 weeks. No effect on physical activity was observed. The increase in TEE appeared to be valuable for the prediction of good first-year growth responders to GH treatment.

http://bit.ly/2DS738Y

Effects of a cyborg-type robot suit HAL on cardiopulmonary burden during exercise in normal subjects

Abstract

Background

The hybrid assistive limb (HAL) is the world's first cyborg-type robot suit that provides motion assistance to physically challenged patients. HAL is expected to expand the possibilities of exercise therapy for severe cardiac patients who have difficulty in moving on their own legs. As a first step, we examined whether or not the motion assistance provided by HAL during exercise could effectively reduce the cardiopulmonary burden in healthy subjects.

Methods

A total of ten healthy male adults (35 ± 12 years) underwent cardiopulmonary exercise testing (CPX) on a cycle ergometer with or without assistance from HAL. The CPX protocol consisted of four 3-min stages performed in a continuous sequence: rest, 0 W, 40 W, and 80 W. The heart rate (HR), blood pressure, oxygen uptake (VO₂), minute ventilation (VE), and gas exchange ratio (R) were monitored during the CPX.

Results

At 0 W, the HR, VO₂, and VE were significantly higher when HAL was used. At 80 W, however, the HR (107 ± 14 vs 114 ± 14 beats/min, p < 0.01), systolic blood pressure (141 ± 15 vs 155 ± 20 mmHg, p < 0.01), VO₂ (17.6 ± 2.4 vs 19.0 ± 2.5 mL/min/kg, p < 0.05), and R (0.88 ± 0.04 vs 0.95 ± 0.09, p < 0.05) were significantly lower when HAL was used.

Conclusions

HAL has the potential to reduce cardiopulmonary burden during moderate-intensity exercise and can, therefore, be used as a support for exercise therapy. Further studies on cardiac patients are expected to contribute to the establishment of a new exercise therapy program using HAL.

http://bit.ly/2MV4Ixj

A three-tier risk assessment process for climate change adaptation at a local scale

Abstract

Formal structures for evaluating climate change risk are important components of adaptation decision-making. In this paper, we present an accessible, cost-effective and user-tested climate change risk assessment framework which allows organisations to systematically apply a risk management process aligned with international standards to identify and manage their climate change risks. It is delivered through 'CoastAdapt', a resource supporting climate change adaptation in Australia. This three-tier framework offers four benefits to the adaptation process. First, it allows organisations to identify climate change risks and integrate them with their mainstream risk management process. Second, it makes optimal use of an organisation's limited adaptation resources by taking a tiered approach, so allowing an organisation to start from a low knowledge base using minimal resources and, only if required, then move to more complex and resource-intensive risk assessment processes. Third, it introduces a time-dependent vulnerability rating which recognises the particular characteristics of climate change risks—that they are long term and associated with a considerable degree of uncertainty. Finally, it takes into account business inter-dependencies that can exacerbate impacts but be overlooked in a sector-based impacts evaluation. In this paper, we highlight the appropriate context in which to use each risk assessment tier, explore key technical differences among the three tiers, describe performance testing and present one case study of application. We discuss the benefits of this tiered risk assessment approach in the context of broader adaptation planning.

http://bit.ly/2MNVgLZ

Modified interpretation criteria significantly improve performance of commercially available confirmatory assays for the serodiagnosis of Lyme borreliosis: a case-control study with clinically defined serum samples

Abstract

Case-control study for the evaluation of innovative test formats for second-tier testing for the serodiagnosis of Lyme borreliosis (LB). A head-to-head comparison was performed with the test systems ViraStripe, SeraSpot, ViraChip, and recomBead. Serum samples from 62 patients (21 erythema migrans, 33 Lyme neuroborreliosis, 8 late LB) and 91 controls (including 29 potentially cross-reacting sera) were tested. For ViraChip and recomBead, optimised interpretation criteria were developed for both IgG and IgM. The most important modification for the proposed interpretation criteria for ViraChip is the interpretation of strong (> 2.5-fold above cutoff) singular IgG reactions against VlsE as positive. This significantly improves sensitivity (32 to 85%, p < 0.0001) without significant changes in specificity (borderline reactions interpreted as negative). By application of our modified rules, specificity of ViraChip IgM is significantly increased (89 to 97%, p < 0.05; borderline results included to negatives), and sensitivities of recomBead IgG and IgM are also significantly improved (69 to 87%, p < 0.01, and 57 to 74%, p < 0.01, respectively; borderline results included to positives). Further improvement of sensitivity by the rating of strong singular IgG reactions against VlsE as positive can also be shown for recomBead. IgG/IgM result combinations must be interpreted as a function of the assumed disease stage, and the best combinations differ for the various assays. Application of our proposed interpretation criteria significantly improve the discriminatory abilities of two assays; however, this must be confirmed with other data sets. Recommendations from Scientific Societies should be updated as may be necessary.

http://bit.ly/2DTkshh

Multi-step optimization of the filtration method for the isolation of Campylobacter species from stool samples

Abstract

The filtration method (FM) is the most effective isolation technique for Epsilobacteriaceae from stool samples. FM's different adaptations make it difficult to compare data between studies. This study was performed in three phases to optimize FM from a routine laboratory perspective. In July–September 2014 (part I), FM was performed on Mueller–Hinton agar containing 5% sheep blood and Columbia agar containing 5% sheep blood. In July 2016 (part II), FM was performed using 0.60-μm pore size polycarbonate filters (0.6-PC filter) and 0.45-μm pore size cellulose acetate filters (0.45-AC filter); in January 2018 (part III), the addition of hydrogen to incubators was studied. On 1146 stools analyzed in part I, the positive samples that showed no growth on the Butzler medium (n = 22/72, 30.6%) had improved growth of Epsilobacteriaceae when using the Columbia instead of the Mueller–Hinton medium (21/22 strains vs. 11/22, p < 0.05). In part II, on 718 stools, 91 strains grew with FM (12.7%), more with 0.6-PC filter (90/91) than with 0.45-AC filter (44/91) (p < 0.05). In part III, 578 stools were cultured, 98 Epsilobacteriaceae strains grew with FM, and 7% hydrogen finding significantly more Epsilobacteriaceae than without hydrogen (90/98, 91.8%, vs. 72/98, 73.5%; p < 0.05). The use of a Columbia medium containing 5% sheep blood with 0.6-PC filters incubated at 37 °C in a 7% hydrogen-enriched atmosphere led to an almost fourfold increase in the isolation rate of Epsilobacteriaceae among the studied combinations. Reference centers for Campylobacter should use standardized protocols to enable the comparison of prevalence in space and time.

http://bit.ly/2MNx6kG

Compartment pressures in children with normal and fractured lower extremities

Abstract

Purpose

Needle manometry is a tool to confirm suspected acute compartment syndrome (ACS). There is scarce evidence of normal pressure values of the lower extremities in children. The aim of this study is to assess the normal compartment pressures in non-injured lower extremities of children.

Methods

This prospective study included children up to the age of 16 years with lower extremity fractures that needed reduction. Between June 2009 and August 2015, 20 children were included. We used needle manometry to measure the pressures in the superficial (SPC), deep posterior (DPC) and in the anterior compartments (AC) on both the lower legs.

Results

On the healthy leg, the mean compartment pressure was 15.15 mmHg in the AC (range 7–30 mmHg), 14.32 mmHg in the SPC (range 8–24 mmHg) and 13.00 mmHg in the DPC (range 4–21 mmHg). On the injured leg, the mean compartment pressure was 24.07 mmHg in the AC (range 5–40 mmHg), 17.21 mmHg in the SPC (range 7–29 mmHg) and 17.13 mmHg in the DPC (range 6–37 mmHg). We found a perfusion gradient (diastolic blood pressure—compartment pressure) < 30 mmHg in at least one compartment of the fractured and healthy leg in 13 patients. Five patients underwent fasciotomy for suspected ACS and their data was excluded for the injured leg.

Conclusion

We could show that children have higher normal compartment pressures than adults in the lower leg. They seem to be able to tolerate higher absolute compartment pressures and lower pressure gradients before ACS occurs. More studies are needed to make a final statement on tolerable compartment pressures in children.

http://bit.ly/2Bktdz5

Die Entwicklung virtueller Realität als Expositionsverfahren

Zusammenfassung

Hintergrund

Virtuelle Realität (VR) wird seit 20 Jahren als Expositionsverfahren in der Verhaltenstherapie von Angststörungen untersucht. Inzwischen liegen mehrere Metaanalysen mit überzeugenden Wirksamkeitsbelegen vor.

Fragestellung

In den letzten Jahren hat eine enorme Weiterentwicklung der VR-Technologie und der damit verbundenen Möglichkeiten stattgefunden, die weiterhin andauert. Vor diesem Hintergrund wird der aktuelle Stand von VR als Expositionsmethode dargestellt.

Material und Methoden

Wir bieten einen narrativen Überblick über aktuelle Forschung zu VR-Expositionstherapie bei Angststörungen und die wichtigsten Entwicklungen in diesem Bereich.

Ergebnisse

Nach einem anfangs fast ausschließlichen Fokus auf spezifische Phobien nimmt die Zahl der Arbeiten zu komplexeren Angststörungen (v. a. soziale Angststörung) zu. Zudem hat sich VR inzwischen als experimentelle Methode etabliert, um psychopathologische Prozesse zu erforschen und die Wirkmechanismen von (VR-)Exposition zu erhellen.

Diskussion

Nach wie vor besteht Forschungsbedarf zur VR-Expositionstherapie, v. a. bei komplexen Angststörungen (z. B. Panikstörung und Agoraphobie, soziale Phobie) und Traumafolgestörungen. Darüber hinaus hat sich VR als Forschungsmethode inzwischen etabliert. Die rasche technische Entwicklung im VR-Bereich lässt eine weitere Zunahme der Forschungsaktivitäten zu VR erwarten – sowohl in der klinischen als auch in der Grundlagenforschung.

http://bit.ly/2MMqdjL

A histocytological and radiological overview of the natural history of intervertebral disk: from embryonic formation to age-related degeneration

Abstract

Purpose

To elucidate the natural history of intervertebral disk (IVD) and characterize its embryonic beginnings and age-related degeneration.

Methods

Coronal sections of embryonic (E13.5-neonatal) and postnatal (4–60-week-old) Sprague–Dawley rat IVD were stained by a series of histological stainings (hematoxylin and eosin, Alcian blue, Picrosirius red, Masson, Periodic acid–Schiff). Growth kinetics within embryonic IVD were evaluated by immunohistochemical staining of Ki67 and proliferating cell nuclear antigen. Postnatal maturation and degeneration of IVD were visualized on radiology by X-ray, CT, and MR imaging.

Results

During the formation of rat IVD, inner annulus fibrosus (AF) and cartilaginous endplate (CEP) shared similar cell density, extracellular matrix, and potential of growth kinetics; notochord provided increased and enlarged cytoplasmic vacuoles to generate nucleus pulposus (NP), part of which was retained within CEP. Postnatally, vacuolated notochord cells were reduced by devacuolation, while chondrocytic NP cells increased; cartilaginous layers of CEP were narrowed by vertebrae growth and secondary ossification; fibrotic portion of AF decreased as cartilaginous matrix accumulated and infiltrated outward. In aged and degenerated IVD, large longitudinal fissures were detected near the boundaries between inner and outer AF, whereas both reduced cellularity and accumulated cell clusters were evident within the dehydrated NP; only part of these histocytological changes could be reported on radiology.

Conclusions

By showing that the natural history of IVD is orchestrated by a dynamic histocytological regulation, our study may facilitate better understanding of the developmental defects, cellular heterogeneity, age-related degenerative mechanisms, and biological regeneration of IVD.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2DTkgyx

Correction to: Measuring nanoparticles in the size range to 2000 nm

The original version of this article unfortunately contained mistakes.

http://bit.ly/2BjcbkO

Gait abnormalities following slipped capital femoral epiphysis treated with in situ fixation

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Brice Henry, Christine Detrembleur, Philippe Mahaudens, Sophie Boulet, Pierre-Louis Docquier

Abstract

Background

Slipped capital femoral epiphysis (SCFE) is a common disorder in adolescent for which no consensus exists regarding management. The aim of the present study was to analyze gait modifications following SCFE treated with in situ fixation (ISF) and to relate it to radiologic stage. Research question. To verify if gait biomechanics are impaired in patients with SCFE and to try to determine a degree of slippage from which gait modifications would appear.

Methods

We evaluated 16 patients treated by ISF for SCFE with slippage ranging from 11° to 61°. Gait variables were compared to normal population according to age and walking speed and were normalized in Z-scores.

Results

Spatiotemporal parameters, mechanical and energetic variables were inferior to |1.5| Z-scores and considered as normal. Kinematics showed increase of pelvic tilt and hip adduction. Kinetic variables showed modifications with increased hip extension moment. There was also a strong increase in power of hip extensor. Hip extension moment and power of hip extensors were significantly correlated to radiologic stage. Analysis of ROC curves showed a cut-off value of slippage about 25°–30° affecting kinematics of pelvis and hip and kinetic variables.

Conclusion

The gait variables were close to normal values. Main modifications were observed in kinematic and kinetic data with a significant increase in extension moment and power generated at the operated hip. This could participate to long-term joint degradation observed in SCFE, even in mild slips. The clinical message is to control regularly SCFE with initial slippage greater than >25–30° to allow for early diagnosis of premature hip osteoarthritis.

from #Audiology via ola Kala on Inoreader http://bit.ly/2DQRaQ9