bluuebunny/crossref_metadata_2025 huggingface dataset:
S-nitrosylation of Src by NR2B-nNOS signal causes Src activation and NR2B tyrosine phosphorylation in levodopa-induced dyskinetic rat model
Authors: Ba M , Ding W , Guan L , Lv Y , Kong M
Published: October 2018

Abnormality in Src PSD-95 NR2B signaling complex assemble occurs in levodopa-induced dyskinesia (LID). N-methyl-D-aspartate receptor (NMDAR) subunit NR2B tyrosine phosphorylation mediated by Src family protein tyrosine kinases is closely associated with dyskinesia. Src autophosphorylation (p-Src) is an important part of Src-catalyzed phosphorylation of NR2B. In addition, the neuronal nitric oxide synthase (nNOS)-derived NO (nNOS/NO) signal which was also involved in dyskinesia recently was proved to participate in the regulation of Src function. Yet, the detailed signal mechanism about the interactions of NR2B, nNOS, and Src is still unknown. In the present study, we investigated the influences of nNOS on Src activation and NR2B tyrosine phosphorylation in dyskinetic rat model by immunoblotting and immunoprecipitation. The results demonstrated that chronic levodopa treatment resulted in downregulation of p-nNOS-S847, one marker of nNOS overactivation. Coinstantaneously, the S-nitrosylation (SNO-Src) and autophosphorylation (p-Src) of Src and NR2B tyrosine phosphorylation were upregulated in dyskinetic rat model. Conversely, administration of 7-NI, one nNOS inhibitor, reversed all these effects of levodopa treatment. Besides, NR2B-containing NMDAR (NR2B/NMDAR) antagonist CP-101,606 could upregulate p-nNOS-S847 and thus attenuate nNOS activation and simultaneously reduce the SNO-Src, p-Src, and NR2B tyrosine phosphorylation. Taken together, the S-nitrosylation of Src is caused by nNOS/NO signal, which is overactivated via Ca2+ influx dependent on NR2B/NMDAR, and subsequently facilitates Src auto-tyrosine phosphorylation and further phosphorylates NR2B. The “NR2B/NMDAR–nNOS/NO–SNO-Src–p-Src–NR2B/NMDAR” signaling cycle may be the molecular basis of NR2B tyrosine phosphorylation upward positive feedback, which demonstrates the possibility as one latent target for dyskinesia therapy.
Growing international evidence for urinary biomarker panels identifying lupus nephritis in children – verification within the South African Paediatric Lupus Cohort
Authors: Smith E M D , Lewandowski L B , Jorgensen A L , Phuti A , Nourse P , Scott C , Beresford M W
Published: October 2018

Background

A urinary biomarker panel including alpha-1-acid-glycoprotein (AGP), lipocalin-like-prostaglandin-D-synthase (LPGDS), transferrin and ceruloplasmin demonstrates an ‘excellent’ ability for identifying active lupus nephritis in UK/US children. This study aimed to assess whether this panel identifies active lupus nephritis within the South African Paediatric Lupus Cohort.

Methods

Juvenile-onset-systemic lupus erythematosus (JSLE) patients aged < 19 years at diagnosis and healthy controls were recruited. Patients were categorized as having active lupus nephritis (renal BILAG score; A/B and previous histological confirmation) or inactive lupus nephritis (renal BILAG score: D/E). Urinary biomarkers were quantified by ELISA. Mann–Whitney U-test compared biomarker levels between groups. Binary logistic regression and receiver operating curve analysis assessed biomarker combinations.

Results

Twenty-three juvenile-onset-systemic lupus erythematosus patients were recruited with a median age of 13.5 years (interquartile range (IQR) 12.7–14.9) and disease duration of 2.6 years (IQR 1.8–4.0). Eighteen healthy controls had a median age of 11.0 years (IQR 10.0–12.0). AGP, LPGDS, transferrin, ceruloplasmin and VCAM-1 were significantly higher in active than in inactive lupus nephritis patients (corrected p-values, all pc < 0.05), with no difference between inactive lupus nephritis patients and healthy controls (all pc = 1.0). The optimal biomarker combination included AGP, ceruloplasmin, LPGDS and transferrin (area under the curve = 1.0).

Conclusions

A urinary biomarker panel comprising AGP, ceruloplasmin, LPGDS and transferrin previously validated within UK/US cohorts also performed excellently within a racially distinct South African cohort which displayed more severe lupus nephritis.
Failure and critique in critical security studies
Authors: Sjoberg Laura
Published: October 2018

Debates imitates scholarship, which imitates debate. Using perspectives from both my policy debate career and my research career, this article argues that the enterprise of critique, whether in critical security studies or elsewhere, is always and already failing and failed. It proceeds in four sections. The first section sets up my entry into the problems of/with critique. The second section analyzes the types of dissonances inherent in the production of critical security studies scholarship. The third section theorizes those dissonances as failures – arguing that failure itself is a part of in and of critical security studies. The conclusion discusses where to go from, during, and in a world of failed critique in critical security studies.
The Effects of Exogenous Technological Change on Wage Inequality in Rural India
Authors: Banik Arindam , Bhaumik Pradip K.
Published: October 2018

This article develops a theoretical model that studies the economic benefits to skilled rural artisans receiving toolkits under a given poverty reduction programme. The model encompasses the frameworks for understanding the relationship between the supply of skilled labour (artisans) with improved toolkits, changes in rural economic activities and the relative incomes. Consequently, it provides a natural setting to infer their empirical relevance. The counterfactual analysis from a large sample of data reveals that once the toolkits are provided to the rural skilled artisans, the artisans as a broad social group are more likely to have benefited from the programme. Less benefit can be, but is not necessarily, associated with poor education level and other assets owned by the rural artisans. More interestingly, while the real wages of skilled workers are expected to rise due to the use of skill-biased toolkits, the wages of unskilled workers may either remain unaffected or even fall. The issue of supply of skilled labour has, therefore, become an area of immense interest largely because of the rising inequality in the relative wages of skilled and unskilled labour.
Trade union representatives from ethnic minorities. Representation revisited
Authors: Hagen Inger Marie , Jensen Ragnhild Steen
Published: October 2018

The Nordic countries have experienced major labour immigration since the EU enlargement round in 2004. Recruiting workers from ethnic minorities is a major challenge for all Nordic trade unions. Less attention has been directed towards the need also to integrate these members inside the unions, for example, by having them serve as trade union representatives at different levels in companies, as well as in the unions. A glance at the top positions in the Swedish, Danish and Norwegian trade unions reveals an almost all-white picture. There is considerable imbalance between the number of ethnic minority trade union members and the number of ethnic minority representatives. This article argues that looking into the concept of representation, and especially the features attributed to trade union representatives and how these features are perceived, enables us to investigate the mismatch between trade union density and trade union representatives among employees from different ethnic minorities.
The market dynamics of socially embedded trading
Authors: Frank Kenneth A , Lo Yun-Jia , Booth G Geoffrey , Kallunki Juha-Pekka
Published: October 2018

Social embeddedness has provided a compelling challenge to neoclassical descriptions of markets. Nevertheless, without a corresponding description of the micro-social forces that counter embeddedness, the description of embeddedness is essentially static, and does not integrate the dual forces of embeddedness and markets. In this study, we identify a sociological force counter to embeddedness residing in third parties whose presence may interrupt socially embedded informal trading partnerships. Using data from the Helsinki Stock Exchange in 1996–1997, we confirm that stock trades are socially embedded in partnerships in which trading persists from week to week and in which prices deviate from immediate trading prices. Importantly, we find that trading partnerships are more likely to be interrupted when prices deviate from immediate trading prices and when third parties are present who trade with one or both members of the partnership. Thus, third parties are a critical sociological force in the embeddedness-market dynamic.
On thermo-mechanical vibration analysis of multi-scale hybrid composite beams
Authors: Ebrahimi Farzad , Dabbagh Ali
Published: October 2018

This article is primarily organized to analyze the thermo-elastic vibrational characteristics of multi-scale hybrid composite beams according to a refined beam model. In this novel type of composites, multi-scale reinforcing elements, carbon fiber (CF) and carbon nanotube (CNT) in particular, are presumed to be dispersed in an initial resin. The homogenization process is carried out employing a mixture of the Halpin–Tsai model and the rule of mixture. The effect of temperature and its gradient on the mechanical properties of CNTs and epoxy resin is rendered to present a more reliable thermal analysis. On the other hand, a refined trigonometric shear deformable beam theory is extended to derive the kinematic relations of the beam needless of any external shear correction coefficient. On the basis of Hamilton's principle, the partial differential equations of motion are developed. Thereafter, the natural frequencies are achieved by the means of Galerkin's method for both simply supported and fully clamped edge conditions. Then, the validity of the presented model is shown by comparing these results with those of previously published researches. Finally, effects of different parameters on the natural frequency of composite beams are rendered in the framework of some numerical case studies. It can be found that multi-scale hybrid composite beams can satisfy higher frequencies once compared with each of the CF- or CNT-reinforced composite beams.
Homicides and Weapons: Examining the Covariates of Weapon Choice
Authors: Pelletier Karissa R. , Pizarro Jesenia M.
Published: October 2018

This study examines the covariates of weapon choice in homicide incidents. Two research questions are examined. The first research question is: what variables influence the use of a particular type of weapon in a homicide? The second research question asks: how does the method of weapon retrieval, or lack thereof, affect the choice of weapon? The findings suggest that firearms are more likely to be on the offender’s person and carried to the incident scene relative to other weapon types. In addition, the use of specific types of weapons is conditioned by the demographic and lifestyle characteristics of victims and offenders.
Estimation of annual probabilities of changing disability levels in Australians with relapsing-remitting multiple sclerosis
Authors: Ahmad Hasnat , van der Mei Ingrid , Taylor Bruce V , Lucas Robyn M , Ponsonby Anne-Louise , Lechner-Scott Jeannette , Dear Keith , Valery Patricia , Clarke Philip M , Simpson Steve , Palmer Andrew J
Published: October 2018

Background:

Transition probabilities are the engine within many health economics decision models. However, the probabilities of progression of disability due to multiple sclerosis (MS) have not previously been estimated in Australia.

Objectives:

To estimate annual probabilities of changing disability levels in Australians with relapsing-remitting MS (RRMS).

Methods:

Combining data from Ausimmune/Ausimmune Longitudinal (2003–2011) and Tasmanian MS Longitudinal (2002–2005) studies ( n = 330), annual transition probabilities were obtained between no/mild (Expanded Disability Status Scale (EDSS) levels 0–3.5), moderate (EDSS 4–6.0) and severe (EDSS 6.5–9.5) disability.

Results:

From no/mild disability, 6.4% (95% confidence interval (CI): 4.7–8.4) and 0.1% (0.0–0.2) progressed to moderate and severe disability annually, respectively. From moderate disability, 6.9% (1.0–11.4) improved (to no/mild state) and 2.6% (1.1–4.5) worsened. From severe disability, 0.0% improved to moderate and no/mild disability. Male sex, age at onset, longer disease duration, not using immunotherapies greater than 3 months and a history of relapse were related to higher probabilities of worsening.

Conclusion:

We have estimated probabilities of changing disability levels in Australians with RRMS. Probabilities differed between various subgroups, but due to small sample sizes, results should be interpreted with caution. Our findings will be helpful in predicting long-term disease outcomes and in health economic evaluations of MS.
‘In the therapist’s head and heart’: An investigation into the profound impact that motherhood has on the work of a music therapist
Authors: Dindoyal Lucy
Published: October 2018

This essay, based on a qualitative research project undertaken by the author while training at Roehampton University, explores the profound impact motherhood can have on the work of a music therapist. Motivated by the close parallels between the roles of mother and therapist as described in psychodynamic theory, the study involved three interviews with music therapist-mothers, and used Interpretative Phenomenological Analysis to analyse the data. Three superordinate themes emerged: Conflict and Growth; Drawing from Motherhood ‘Toolkit’; and Therapist Boundaries. Findings highlighted the multifaceted nature of the participants’ experiences, revealing both the positive and negative impact being a mother has on the work of a music therapist and the complex ways in which these roles intertwined with each other. During the research process, a broader picture emerged, placing the participants’ experiences within the context of Western culture’s idealised expectations of motherhood, which appeared to exert a powerful influence. It also drew attention to the limitations inherent in the ‘maternal metaphor’ which parallels the roles of mother and therapist, questioning its gender-specificity and the impact this has on music therapist-mothers. This small study provides a starting point for discussion regarding the challenges music therapist-mothers – as well as music therapists who are not mothers – face in a profession in which women make up the majority of the workforce.
The principle of discrimination: Investigating perceptions of soldiers
Authors: Watkins Hanne M. , Laham Simon M.
Published: October 2018

The principle of discrimination states that soldiers are legitimate targets of violence in war, whereas civilians are not. Is this prescriptive rule reflected in the descriptive judgments of laypeople? In two studies ( Ns = 300, 229), U.S. Mechanical Turk workers were asked to evaluate the character traits of either a soldier or a civilian. Participants also made moral judgments about scenarios in which the target individual (soldier or civilian) killed or was killed by the enemy in war. Soldiers were consistently viewed as more dangerous and more courageous than civilians (Study 1). Participants also viewed killing by (and of) soldiers as more permissible than killing by (and of) civilians, in line with the principle of discrimination (Study 1). Altering the war context to involve a clearly just and unjust side (in Study 2) did not appear to moderate the principle of discrimination in moral judgment, although soldiers and civilians on the just side were evaluated more positively overall. However, the soldiers on the unjust side of the war were not attributed greater courage than were civilians on the unjust side. Theoretical and practical implications of these descriptive findings are discussed.
Where does the time go? An experimental test of what social media displaces and displaced activities’ associations with affective well-being and quality of day
Authors: Hall Jeffrey A , Johnson Rebecca M , Ross Elaina M
Published: October 2018

Drawing from media displacement theory, this article explores which activities are displaced when individuals spend time on social media. Community and undergraduate participants ( N = 135) were randomly assigned to five conditions: no change in social media use, or abstinence from social media for 1 week, 2 weeks, 3 weeks, or 4 weeks. Participants completed a daily diary measuring how they spent time each day, affective well-being, and quality of day for 28 days. The results indicate that abstinence from social media increased time spent engaged in seven activities, primarily browsing the Internet, working, childcare, and cooking/cleaning. In addition, associations among psychosocial outcomes and the displaced activities were examined. Time spent working, sleeping, and cooking/cleaning were negatively associated with affective well-being and quality of day. On days participants used social media, minutes of use were negatively associated with quality of day. The results suggest that social media primarily displaces unpleasant or neutral activities.
Dealing with numbers: Nurses informing doctors and patients about test results
Authors: Kurhila Salla , Lehtimaja Inkeri
Published: October 2018

Nurses need to adapt to various interactional situations and design their talk for different recipients. One essential communicative task for nurses is to transmit information on test and measurement results both to the patient and to the physician. This article examines how nurses design their talk on numerical values according to the recipient and the activity. The nurse can deliver the information either plainly through numbers or by formulating some type of qualitative description of the value. The data consist of 7.5 hours of video-recorded interaction in a Finnish hospital. Using conversation analysis, we demonstrate how the institutional roles and the ongoing activity sequence affect how nurses formulate their talk. When nurses discuss results with their patients, they typically use qualitative descriptions, whereas when they talk with doctors, the typical turn involves numeric information. It will be demonstrated that nurses construct their professional identity involving both care and medical expertise through their linguistic-interactional choices.
Image-Based Profiling of Patient-Derived Pancreatic Tumor–Stromal Cell Interactions Within a Micropatterned Tumor Model
Authors: Mukundan Shilpaa , Sharma Kriti , Honselmann Kim , Singleton Amy , Liss Andrew , Parekkadan Biju
Published: October 2018

Pancreatic cancer is one of the most aggressive cancers with a 5-year patient survival rate of 8.2% and limited availability of therapeutic agents to target metastatic disease. Pancreatic cancer is characterized by a dense stromal cell population with unknown contribution to the progression or suppression of tumor growth. In this study, we describe a microengineered tumor stromal assay of patient-derived pancreatic cancer cells to study the heterotypic interactions of patient pancreatic cancer cells with different types of stromal fibroblasts under basal and drug-treated conditions. The population dynamics of tumor cells in terms of migration and viability were visualized as a functional end point. Coculture with cancer-associated fibroblasts increased the migration of cancer cells when compared to dermal fibroblasts. Finally, we imaged the response of a bromodomain and extraterminal inhibitor on the viability of pancreatic cancer clusters surrounding by stroma in microengineered tumor stromal assay. We visualized a codynamic reduction in both cancer and stromal cells with bromodomain and extraterminal treatment compared to the dimethyl sulfoxide-treated group. This study demonstrates the ability to engineer tumor–stromal assays with patient-derived cells, study the role of diverse types of stromal cells on cancer progression, and precisely visualize a coculture during the screening of therapeutic compounds.
Apoptotic PET Imaging of Rat Pulmonary Fibrosis With [18F]ML-8
Authors: Xiong Ying , Nie Dahong , Liu Shaoyu , Ma Hui , Su Shu , Sun Aixia , Zhao Jing , Zhang Zhanwen , Xiang Xianhong , Tang Ganghua
Published: October 2018

Objective:

To investigate the value of 2-(3-[18F]fluoropropyl)-2-methyl-malonic acid ([18F]ML-8) positron emission tomography (PET) imaging of rat pulmonary fibrosis.

Methods:

Male Sprague-Dawley rats were divided into 2 groups, including pulmonary fibrosis model group and control group. The rat model was established by an intratracheal instillation of bleomycin (BLM). Control rats were treated with saline. Positron emission tomography/computed tomography (CT) with [18F]ML-8 or 18F-fluorodeoxyglucose ([18F]FDG) was performed on 2 groups. After PET/CT imaging, lung tissues were collected for histologic examination. Data were analyzed and comparisons between 2 groups were performed using Student t test.

Results:

Bleomycin-treated rats showed a higher lung uptake of [18F]ML-8 than control rats ( P < .05). In BLM-treated rats, the lung to muscle relative uptake ratio of [18F]ML-8 was also higher than that of [18F]FDG ( P < .05). Pathological examination showed overproliferation of fibroblasts and deposition of collagen in lungs from BLM-treated rats. Compared to control rats, BLM-treated rats had higher lung hydroxyproline content ( P < .05). Immunofluorescence staining indicated more apoptotic cells in BLM-treated rats than those in control rats. Moreover, the apoptosis rate of lung tissues obtained from BLM-treated rats was higher than that from control rats ( P < .05).

Conclusions:

2-(3-[18F]fluoropropyl)-2-methyl-malonic acid PET/CT could be used for noninvasive diagnosis of pulmonary fibrosis in a rat model.
Examining the Relationship Between Race and Juvenile Court Decision-Making: A Counterfactual Approach
Authors: Gann Shaun M.
Published: October 2018

Prior research has found that disproportionate minority contact (DMC) is a problem at various decision-making points in the juvenile justice system. This study addresses two limitations often found in prior DMC research: (1) a focus on a single court and/or a single stage of the juvenile court process and (2) methodological problems in comparing youth of different races who are otherwise similarly situated. Nearest neighbor matching is used to examine the relationship between race and five juvenile court outcomes—pre-adjudication detention, case dismissal, adjudication, secure confinement, and waiver to criminal court—in a sample of over 50,000 youth referred to seven juvenile courts. After matching youth on multiple legal and extralegal variables, results indicate that non-White youth were significantly more likely than White youth to be detained prior to adjudication, placed in a secure confinement facility postadjudication, and waived to criminal court.
Enlivening a Community of Authentic Scholarship
Authors: West Christina H. , Rieger Kendra L. , Chooniedass Rishma , Adekoya Adebusola A. , Isse Anisa A. R. , Karpa Jane V. , Waldman Celeste , Peters-Watral Brenda , Chernomas Wanda M. , Scruby Lynn S. , Martin Donna E.
Published: October 2018

Background:

Critical and engaged qualitative scholarship depends on high-quality graduate training. The need to reexamine graduate student mentorship has become particularly pressing, given the high level of mental health distress experienced by students. It is unclear whether mentorship emerging within the student–advisor relationship is sufficient to ensure comprehensive mentorship. Innovative, experiential pedagogical approaches that integrate emotional and intellectual aspects are limited but may play a vital role in mentorship. There is a critical need to develop and study creative mentorship initiatives for emerging qualitative scholars.

Methods:

This study used interpretive description methodology and a community of practice theoretical framework to describe a faculty-mentored experience for graduate nursing students at the 2016 Qualitative Health Research Conference (FM-QHR) hosted by the International Institute for Qualitative Methodology. Participants completed written journals elucidating their experiences throughout FM-QHR. The textual data were analyzed using a constant comparative group analysis process, leading to the development of salient and interconnected themes.

Results:

Six graduate students and four faculty mentors submitted journals. Three interrelated themes articulate how this FM-QHR initiative enlivened a community of authentic scholarship: Questioning the Academic Self: Unvoiced Experiences of Angst, Uncertainty, and Fear; Cocreating Authentic Community through Shared Vulnerability; and Generative and Emergent Empowerment.

Conclusion:

These findings provide compelling insights into the importance of assisting students to navigate the emotional experiences that are a part of qualitative graduate training. Relational, mentorship initiatives hold potential to not only alleviate emotional distress but also support student empowerment, socialization, and entrance into a community of international qualitative researchers.
Adaptive recurrent neural network motion control for observation class remotely operated vehicle manipulator system with modeling uncertainty
Authors: Huang Hai , Li Jiyong , Zhang Guocheng , Tang Qirong , Wan Lei
Published: October 2018

Precise motion control of remotely operated vehicles plays an important role in a great number of submarine missions. However, the high-performance operations are difficult to realize due to the uncertainty in system modeling with self-disturbance. On the basis of the multibody system dynamics, self-disturbances from the tether and manipulator have been systematically analyzed in order to transform them into observed forces. A novel S surface–based adaptive recurrent wavelet neural network control system has been proposed on the nonlinear control of underwater vehicles, with its recurrent wavelet neural network structure designed for the approximation of the uncertain dynamics. Moreover, a robust function has been proposed to improve system robustness and convergence. The comparison shows that the remotely operated vehicle operation performance including the three-dimensional path following and vehicle-manipulator coordinate control has been greatly improved.
Three non-Newtonian fluids flow considering thin film over an unsteady stretching surface with variable fluid properties
Authors: Khan Waris , Idress Muhammad , Gul Taza , Khan Muhammad Altaf , Bonyah Ebenezer
Published: October 2018

This research examines the features of liquid film of non-Newtonian fluids under the influence of thermophoresis. For this study, we proposed a mathematical model for Jeffrey, Maxwell, and Oldroyd-B fluids and concluded the unsteady stretched surface in the existence of a magnetic field and also the thermal conductivity was measured which is directly related to the temperature whereas the viscosity inversely related to the temperature. Inserting the thermophoretic effect which improved the thermal conductivity of Jeffrey fluid over the Oldroyd-B and Maxwell fluids. The model is helpful for the liquid flow of Jeffrey, Maxwell, and Oldroyd-B fluid including the Brownian motion parameter effect. The results have been obtained through optimal approach compared with numerical (ND-Solve) method. Study mainly focused to understand the physical appearance of the embedded parameters based on the characteristic length of the liquid flow. The behavior of skin friction, local Nusselt number, and Sherwood number has been described numerically for the dynamic constraints of the problem. The obtained results are drafted graphically and discussed.
The implementation of performance analysis and feedback within Olympic sport: The performance analyst's perspective
Authors: Nicholls Scott B , James Nic , Bryant Elizabeth , Wells Julia
Published: October 2018

The study considered performance analysis and feedback from the perspective of the performance analyst through the investigation of the ‘what’, ‘how’ and ‘when’ of practice within a selection of Olympic sports. Twenty-three performance analysts (experience 6.4 ± 4.1 years) engaged in a structured interview (85 ± 15 min) regarding their processes within applied practice. Likert scales (All the time, Often, Sometimes, Rarely and Never) were used to facilitate cross-sport and environment comparison. The performance analysts highlighted the experience of their coaches as the most prominent feature influencing analysis direction, and time had the greatest impact upon feedback provision. The main analysis techniques used were video, profiling and performance reports. Feedback was delivered primarily either, (1) < 1-h post-performance within sessions lasting < 10-min or (2) the following day within sessions lasting 25 + min. Video feedback was usually coach led; however, data delivery was more evenly distributed between coach and analyst. Very similar processes across the participants were identified, despite a wide variety of sports and participant experience levels. The findings have begun to illustrate practice within elite sport whilst highlighting the importance and need for further practitioner-based investigation regarding the use of performance analysis and feedback within applied contexts.
Cardiac arrest and pulmonary hypertension in scurvy: a case report
Authors: Dean Terry , Kaushik Neeru , Williams Sharron , Zinter Matthew , Kim Paul
Published: October 2018

We report a case of a six‐year‐old boy who presented after a cardiac arrest, likely due to a pulmonary hypertensive crisis in the setting of vitamin C deficiency. After initially presenting with subacute multifocal bone lesions of unknown etiology, he experienced a pulseless electrical activity cardiac arrest while undergoing a diagnostic procedure under sedation. During his post‐arrest convalescence, he developed persistent tachycardia and peripheral edema. An echocardiogram revealed findings consistent with significant pulmonary arterial hypertension, which was found to be responsive to inhaled nitric oxide. Laboratory investigation revealed undetectable levels of vitamin C, resulting in disclosure of a history of severe restrictive eating behavior. With ascorbate supplementation, the patient’s pulmonary vasodilators were weaned and discontinued. Given his complete recovery, we suspect that the cardiac arrest and pulmonary hypertension were the consequence of a rare, but reversible, complication of scurvy.
Sex-related response to bivalirudin and unfractionated heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial
Authors: Venetsanos D , Sederholm Lawesson S , Fröbert O , Omerovic E , Henareh L , Robertsson L , Linder R , Götberg M , James S , Alfredsson J , Erlinge D , Swahn E
Published: October 2018

Aims:

Our aim was to study the impact of sex on anticoagulant treatment outcomes during percutaneous coronary intervention in acute myocardial infarction patients.

Methods:

This study was a prespecified analysis of the Bivalirudin versus Heparin in ST-Segment and Non ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART) trial, in which patients with myocardial infarction were randomised to bivalirudin or unfractionated heparin during percutaneous coronary intervention. The primary outcome was the composite of death, myocardial infarction or major bleeding at 180 days.

Results:

There was a lower risk of the primary outcome in women assigned to bivalirudin than to unfractionated heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval (0.60–1.00)) with no significant difference in men (11.8% vs 11.2%, hazard ratio 1.06 (0.89–1.26), p for interaction 0.05). The observed difference was primarily due to lower risk of major bleeding (Bleeding Academic Research Consortium definition 2, 3 or 5) associated with bivalirudin in women (8.9% vs 11.8%, hazard ratio 0.74 (0.54–1.01)) but not in men (8.5% vs 7.3%, hazard ratio 1.16 (0.94–1.43) in men, p for interaction 0.02). Conversely, no significant difference in the risk of Bleeding Academic Research Consortium 3 or 5 bleeding, associated with bivalirudin, was found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54–1.31)) or men 2.9% vs 2.1% (hazard ratio 1.36 (0.93–1.99)). Bleeding Academic Research Consortium 2 bleeding occurred significantly less often in women assigned to bivalirudin than to unfractionated heparin. The risk of death or myocardial infarction did not significantly differ between randomised treatments in men or women.

Conclusion:

In women, bivalirudin was associated with a lower risk of adverse outcomes, compared to unfractionated heparin, primarily due to a significant reduction in Bleeding Academic Research Consortium 2 bleeds.
Comparison of early postoperative pain after partial tumour nephrectomy by flank, transabdominal or laparoscopic access
Authors: Hager Boris , Herzog Sereina A , Hager Barbara , Sandner-Kiesling Andreas , Zigeuner Richard , Pummer Karl
Published: October 2018

Aim:

To explore whether the total pain experience differs after (partial) kidney tumour nephrectomies via flank, transabdominal or laparoscopic access.

Materials and methods:

We analyzed retrospectively 107 patients with flank, 12 with transabdominal and 21 with laparoscopic interventions. For pain treatment, conventional analgesics (A) or intravenous patient-controlled analgesia (PCIA) or thoracic peridural analgesia (tPDA) were used. Self-reported pain was measured with a Visual Analogue Scale three times daily. The area under the curve (AUC) at rest (R) and during a standardized body movement (M) were calculated from the intervention till the end of the second T(0–2) and seventh postoperative day T(0–7), respectively.

Results:

The median AUC for T(0–2) at R was more intense for laparoscopy (13) than for flank incision (A, 9) and approximately the same during M. For flank incisions (A), the median AUC at R rises from 9 for T(0–2) to 22 for T(0–7) and at M the median AUC increases from 18 to 37. In contrast, laparoscopy did not cause further pain after the second postoperative day. Furthermore, with flank incision for T(0–2), at R, tPDA was superior to A (median AUC: 5 versus 9, p = 0.02) and at M again tPDA (median AUC: 12) had a better pain-control as A (18) or even as PCIA (19, p = 0.005).

Conclusion:

Laparoscopic nephrectomies cause a relatively intense mean cumulative pain for T(0–2) and a subsequent absence of pain. However, flank incisions went on to increased pain levels until the seventh postoperative day with tPDA as most effective therapy.
Does past religion have a past? Habermas, religion, and the sacred complex
Authors: MacKendrick Kenneth
Published: October 2018

This article argues for a rethinking of Jürgen Habermas's understanding of religion. Taking into consideration some of Habermas’s recent writings on the topic, it is argued that his conception of religion is untenable. Recent critical studies on the discourse of religion and its historical context have rendered the classic conception of religion suspect. Instead of describing a unique sphere of life, religion can and should be redescribed as something ordinary, embedded, and conceptually inseparable from a larger array of social imaginary institutions and networks.
Histological and immunohistochemical evaluation of mandibular bone tissue regeneration
Authors: Di Carlo S , De Angelis F , Brauner E , Rosella D , Papi P , Pompa G , Saptefrati L , Cimpean AM , Ciobanu G
Published: October 2018

The purpose of the study was to perform an immunohistochemical and histological evaluation of samples taken from different bone regeneration procedures in atrophic human mandible. 30 patients (15 men and 15 women, age range of 35–60 years), non-smokers, with good general and oral health were recruited in this study and divided into three groups. The first group included patients who were treated with blood Concentration Growth Factors (bCGF), the second group included patients who were treated with a mixture of bCGF and autologous bone, while the third group of patients was treated with bCGF and tricalcium phosphate/hydroxyapatite (TCP-HA). Six months after the regenerative procedures, all patients undergone implant surgery, and a bone biopsy was carried out in the site of implant insertion. Each sample was histologically and immunohistochemically examined. Histological evaluation showed a complete bone formation for group II, partial ossification for group I, and moderate ossification for group III. Immunohistochemical analysis demonstrated a statistically significant difference between the three groups, and the best clinical result was obtained with a mixture of bCGF and autologous bone.
Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update
Authors: Casale Manuele , Moffa Antonio , Cassano Michele , Carinci Francesco , Lopez Michele Antonio , Trecca Eleonora Maria Consiglia , Torretta Sara , Rinaldi Vittorio , Pignataro Lorenzo
Published: October 2018

Saline nasal irrigations (SNIs) are often recommended as an additional non-pharmacological treatment for adults with chronic rhinosinusitis (CRS), for which it could even be considered a first-line treatment. However, there is a wide range of different SNI protocols. The aim of this article is to review the published literature regarding all of the potential therapeutic effects of SNIs in adult CRS patients who had not undergone sinus surgery and clarify the role of the various saline nasal solutions and protocols (particularly the volume, frequency and duration of treatment), and describe the nasal devices used. A search was made of the PubMed, Google Scholar and Ovid databases using the key words ‘saline nasal irrigation’ and ‘chronic rhinosinusitis’, or medical subject headings. The search identified 11 studies involving 663 patients. There was no consensus about but substantial agreement concerning the frequency and duration of treatment, the type of device, and the amount of solution to be used when managing CRS. A hypertonic solution with the addition of the natural minerals and oligo-elements found in seawater and some thermal waters may be associated with greater clinical benefit in terms of endoscopic scores and mucociliary clearance than isotonic solutions. Further studies are required to compare the different forms of SNI and define SNI protocols and nasal devices, while considering patient compliance.
Domestic mite–induced allergy: Causes, diagnosis, and future prospects
Authors: Li Ling , Qian Jun , Zhou Ying , Cui Yubao
Published: October 2018

Allergies to various environmental factors, in particular mite species, represent a considerable healthcare burden with lost productivity resulting from symptoms including asthma, conjunctivitis, rhinitis, and atopic dermatitis. The complexity of mite species and the allergens that they produce complicates diagnosis and treatment; however, the advent of recombinant DNA technologies now allows clinicians to better pinpoint the specific sensitizing agents and creates new opportunities for avoidance or immunotherapy. Here we discuss the advantages and disadvantages of traditional and novel diagnostic and therapeutic platforms, with particular consideration given to multiplex tests able to generate patient-specific allergen profiles. Immunotherapies tailored to such profiles may be safer and more effective than generalized treatments, but many hurdles, including the costs associated with identifying the protein or protein combinations able to exert the safest and most beneficial effects, must be overcome before such therapies can be globally applied.
A Regional Analysis of Hepatitis C Virus Collaborative Care With Pharmacists in Indian Health Service Facilities
Authors: Geiger Rebecca , Steinert Jessica , McElwee Grant , Carver Jennifer , Montanez Robert , Niewoehner Julie , Clark Cassandra , Reilley Brigg
Published: October 2018

Background: American Indian/Alaska Natives (AI/ANs) are disproportionately affected by hepatitis C virus (HCV), with more than double the national rate of HCV-related mortality as well as the highest rates of acute HCV. The “cascade of care” for HCV consists of screening, confirmation, treatment, and sustained virologic clearance (SVR)/cure. At each stage of this process, patients can be lost to follow-up. Federal health care facilities in an administrative area of the Indian Health Service conducted a review to identify and address gaps in HCV treatment. Facilities generally treated HCV with a strong pharmacy component using a collaborative practice agreement and HCV telehealth services to external specialists. Methods: All facilities had a pharmacist HCV program point of contact. Each pharmacist conducted a chart review of HCV patients and submitted aggregate results on HCV antibody status, HCV confirmation testing, stage of liver disease, initiation of treatment, and SVR/cure. Each facility also ranked current barriers to scaling up HCV treatment services from a defined list of options. Results: Of 1789 HCV antibody positive patients, 77% (1381) had a confirmation test, of which 67% (929) were positive. Of these patients, 62% (576) had their liver fibrosis scored, and 58% (335) had initiated treatment. Of patients with an SVR/cure test, all (274/274) were negative. Discussion: These data indicate that rural clinics can be successful providing HCV diagnosis and treatment. Pharmacists can play a key role in HCV clinical services. The outcomes of each step in the treatment process at the facility level can vary widely due to local factors. The barriers to HCV care that persist are nonclinical.
Deferoxamine-Soaked Suture Improves Angiogenesis and Repair Potential After Acute Injury of the Chicken Achilles Tendon
Authors: Efird William M. , Fletcher Alex G. , Draeger Reid W. , Spang Jeffrey T. , Dahners Laurence E. , Weinhold Paul S.
Published: October 2018

Background:

A major obstacle to the treatment of soft tissue injuries is the hypovascular nature of the tissues. Deferoxamine (DFO) has been shown to stimulate angiogenesis by limiting the degradation of intracellular hypoxia-inducible factor 1–alpha.

Hypothesis:

DFO-saturated suture would induce angiogenesis and improve the markers of early healing in an Achilles tendon repair model.

Study Design:

Controlled laboratory study.

Methods:

Broiler hens were randomly assigned to the control (CTL) group or DFO group (n = 9 per group). The right Achilles tendon was partially transected at its middle third. The defect was surgically repaired using 3-0 Vicryl suture soaked in either sterile water (CTL group) or 324 mM DFO solution (DFO group). All animals were euthanized 2 weeks after the injury, and the tendon was harvested. Half of the tendon was used to evaluate angiogenesis via hemoglobin content and tissue repair via DNA content and proteoglycan (PG) content. The other half of the tendon was sectioned and stained with hematoxylin and eosin, safranin O, and lectin to evaluate vessel density.

Results:

Hemoglobin content (percentage of wet tissue weight) was significantly increased in the DFO group compared with the CTL group (0.081 ± 0.012 vs 0.063 ± 0.016, respectively; P = .046). DNA content (percentage of wet tissue weight) was also significantly increased in the DFO group compared with the CTL group (0.31 ± 0.05 vs 0.23 ± 0.03, respectively; P = .024). PG content (percentage of wet tissue weight) was significantly decreased in the DFO group compared with the CTL group (0.26 ± 0.02 vs 0.33 ± 0.08, respectively; P = .035). Total chondroid area (number of vessels per mm2 of tissue area evaluated) was significantly decreased in the DFO group compared with the CTL group (17.2 ± 6.6 vs 24.6 ± 5.1, respectively; P = .038). Articular zone vessel density (vessels/mm2) was significantly increased in the DFO group compared with the CTL group (7.1 ± 2.5 vs 2.1 ± 0.9, respectively; P = .026).

Conclusion:

The significant increase in hemoglobin content as well as articular zone vessel density in the DFO group compared with the CTL group is evidence of increased angiogenesis in the fibrocartilaginous region of the tendon exposed to DFO. The DFO group also displayed a significantly greater level of DNA and significantly lower level of PG, suggesting enhanced early healing by fibrous tissue formation.

Clinical Relevance:

Stimulating angiogenesis by DFO-saturated suture may be clinically useful to improve healing of poorly vascularized tissues.
Patients’ Health Information Practices and Perceptions of Provider Knowledge in the Case of the Newly Discovered Alpha-gal Food Allergy
Authors: Flaherty Mary Grace , Threats Megan , Kaplan Samantha J.
Published: October 2018

Background:

Alpha-gal food allergy is a life-threatening, newly discovered condition with limited presence in authoritative information sources. Sufferers seeking diagnosis are likely to encounter clinicians unfamiliar with the condition.

Objective:

To understand information practices of individuals diagnosed with alpha-gal allergy, how they obtained diagnosis, and their perceptions of health-care providers’ awareness of the condition.

Methods:

Semistructured interviews with open- and closed-ended questions were completed with a chronological systematic sample of 28 adults (11% of alpha-gal clinic patients at the time) diagnosed with alpha-gal allergy and treated at University of North Carolina Allergy and Immunology Clinic.

Results:

The majority of patients determined they had alpha-gal allergy through nontraditional health information channels. Three-quarters of patients rated their primary care provider as having little to no knowledge. In 25 specialists’ encounters, 23 were rated as having little to no knowledge.

Conclusion:

With new conditions, information is often available through informal networks before appearing in the vetted medical literature. In this study, social connections were the primary pathway to successful diagnosis. Health practitioners need to develop mechanisms to understand that process.
Visualizing Income Inequality and Mobility Together
Authors: Lawrence Matthew
Published: October 2018

Research and public conversations about income inequality and intergenerational mobility will benefit from a new approach that jointly visualizes these two measures. The new mobility table proposed addresses this concern by scaling each quintile by the spread of income it represents. Implications of this approach for future analyses of inequality and mobility are discussed.