bluuebunny/crossref_metadata_2025 huggingface dataset:
Practice‐related reduction of electromyographic mirroring activity depends on basal levels of interhemispheric inhibition
Authors: Bologna Matteo , Caronni Antonio , Berardelli Alfredo , Rothwell John C.
Published: October 2012

Paired‐pulse transcranial magnetic stimulation (TMS) is used to measure the excitability of interhemispheric inhibition (IHI) between the hand areas of the two motor cortices. It varies from person to person, and is highly predictive of individual differences in callosal anatomy (fractional anisotropy) and even motor behaviour, e.g. the amount of involuntary electromyographic (EMG) ‘mirroring’ in one hand during rapid contraction of the other. The present experiments tested whether it also predicts how well individuals can improve motor performance in a task involving the two hands. Healthy participants were given 100 trials to maximize the initial acceleration of a ballistic finger movement made with one hand while trying to maintain a tonic low level of EMG activity in the other hand. Initially, each movement was accompanied by additional unwanted EMG mirroring in the other hand. However, after practice, participants had on average increased acceleration by approximately one‐third without changing the amount of EMG mirroring in the contralateral hand; indeed, in some individuals EMG mirroring activity declined. TMS measures showed that there was an increase in corticospinal excitability in the trained hemisphere, but there was no change in the excitability of short‐ or long‐latency IHI from the trained to non‐trained hemisphere. Nevertheless, in each individual, the baseline (pre‐practice) excitability of short‐latency IHI was highly predictive (r = 0.65; P = 0.0019) of the change in EMG mirroring. The implication is that a physiological measure of brain excitability at rest can predict behaviour in response to training.
Positive Relationship Between a Polymorphism in Helicobacter pylori Neutrophil‐Activating Protein A Gene and Iron‐Deficiency Anemia
Authors: Yokota Shin‐ichi , Toita Nariaki , Yamamoto Soh , Fujii Nobuhiro , Konno Mutsuko
Published: October 2012

Background

Numerous studies have suggested a link between iron‐deficiency anemia (IDA) and Helicobacter pylori infection. Previously, we found that strains isolated from IDA patients showed higher levels of Fe ion uptake and Fe‐ion‐dependent rapid proliferation than those of strains derived from patients without IDA.

Materials and Methods

Twenty‐four H. pylori strains from IDA patients (IDA strains) and 25 strains from patients who had H. pylori gastritis without anemia (non‐IDA strains) were examined. Their nucleotide sequences of napA, fur, and feoB, which contribute to Fe ion uptake, were determined.

Results

Numerous polymorphisms of the three genes were found in both strains. Frequency of neutrophil‐activating protein A (NapA), which encoded by napA, with threonine at amino acid residue No. 70 (Thr70‐type NapA) was significantly higher in IDA strains than in non‐IDA strains. Strains with Thr70‐type NapA showed significantly higher levels of Fe3+ and Fe2+ uptake than did strains with other types, Ser70‐type of NapA, which is found in standard strains. Other significantly different occurrences of polymorphisms between IDA and non‐IDA groups were not observed in these genes.

Conclusion

The results suggest that H. pylori strains with Thr70‐type NapA have enhanced Fe ion uptake ability and are associated with the pathogenesis of IDA.
A design process for using normative models in shared decision making: a case study in the context of prenatal testing
Authors: Rapaport Sivan , Leshno Moshe , Fink Lior
Published: October 2012

Background

Shared decision making (SDM) encourages the patient to play a more active role in the process of medical consultation and its primary objective is to find the best treatment for a specific patient. Recent findings, however, show that patient preferences cannot be easily or accurately judged on the basis of communicative exchange during routine office visits, even for patients who seek to expand their role in medical decision making (MDM).

Objective

The objective of this study is to improve the quality of patient–physician communication by developing a novel design process for SDM and then demonstrating, through a case study, the applicability of this process in enabling the use of a normative model for a specific medical situation.

Design

Our design process goes through the following stages: definition of medical situation and decision problem, development/identification of normative model, adaptation of normative model, empirical analysis and development of decision support systems (DSS) tools that facilitate the SDM process in the specific medical situation.

Case study

This study demonstrates the applicability of the process through the implementation of the general normative theory of MDM under uncertainty for the medical–financial dilemma of choosing a physician to perform amniocentesis.

Discussion

The use of normative models in SDM raises several issues, such as the goal of the normative model, the relation between the goals of prediction and recommendation, and the general question of whether it is valid to use a normative model for people who do not behave according to the model's assumptions.
Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study
Authors: Sheridan Nicolette F , Kenealy Timothy W , Kidd Jacquie D , Schmidt‐Busby Jacqueline I G , Hand Jennifer E , Raphael Deborah L , McKillop Ann M , Rea Harold H
Published: October 2012

Background

Primary health care does not adequately respond to populations known to have high needs such as those with compounding jeopardy from chronic conditions, poverty, minority status and age; as such populations report powerlessness.

Objective

To explore what poor older adults with chronic conditions who mostly belong to ethnic minority groups say they want from clinicians.

Setting and Participants

Participants were older adults whose chronic conditions were severe enough to require hospital admission more than twice in the previous 12 months. All participants lived in poor localities inAuckland,NewZealand's largest city.

Methods

Forty‐two in‐depth interviews were conducted and analysed using qualitative description.

Results

An outward acceptance of health care belied an underlying dissatisfaction with low engagement. Participants did not feel heard and wanted information conveyed in a way that indicated clinicians understood them in the context of their lives. Powerlessness, anger, frustration and non‐concordance were frequent responses.

Discussion and Conclusions

Despite socio‐cultural and disease‐related complexity, patients pursue the (unrealised) ideal of an engaged therapeutic relationship with an understanding clinician. Powerlessness means that the onus is upon the health system and the clinician to engage. Engagement means building a relationship on the basis of social, cultural and clinical knowledge and demonstrating a shift in the way clinicians choose to think and interact in patient care. Respectful listening and questioning can deepen clinicians' awareness of patients' most important concerns. Enabling patients to direct the consultation is a way to integrate clinician expertise with what patients need and value.
Treatment of non‐alcoholic steatohepatitis with Phyllanthus urinaria: A randomized trial
Authors: Wong Vincent Wai‐Sun , Wong Grace Lai‐Hung , Chan Anthony Wing‐Hung , Chu Winnie Chiu‐Wing , Choi Paul Cheung‐Lung , Chim Angel Mei‐Ling , Yiu Karen Kar‐Lum , Yu Jun , Chan Francis Ka‐Leung , Chan Henry Lik‐Yuen
Published: October 2012

Background and Aims

Non‐alcoholic steatohepatitis (NASH) is a common liver disease that may progress to cirrhosis and hepatocellular carcinoma. There is currently no approved pharmacological treatment for NASH. Phyllanthus urinaria is a commonly used hepatoprotective herb that ameliorates NASH in animal studies. We aimed to test the hypothesis that Phyllanthus was superior to placebo in improving histological non‐alcoholic fatty liver disease (NAFLD) activity score.

Methods

This was a placebo‐controlled parallel‐group double‐blind randomized controlled trial. Patients with histology‐proven NASH were randomized to receive Phyllanthus or placebo for 24 weeks. The primary endpoint was change in NAFLD activity score from baseline to week 24. Secondary endpoints included changes in individual histological parameters, liver biochemistry and metabolic profile.

Results

We enrolled 60 patients (40 received Phyllanthus and 20 received placebo). The change in NAFLD activity score was −0.8 ± 1.4 in the Phyllanthus group and −0.3 ± 1.3 in the placebo group (P = 0.24). The change in steatosis, lobular inflammation, ballooning and fibrosis was also similar between the two groups. Within the Phyllanthus group, although there was reduction in hepatic steatosis (−0.2 ± 0.7; P = 0.039) and ballooning grades (−0.4 ± 0.5; P < 0.001), the change was small and of limited clinical significance. Furthermore, there was no significant difference in the changes in alanine aminotransferase, aspartate aminotransferase, fasting glucose and lipid profile between the two groups.

Conclusions

Phyllanthus is not superior to placebo in improving NAFLD activity score in NASH patients.
Novel splice‐site mutation in ATP8B1 results in atypical Progressive Familial Intrahepatic Cholestasis Type 1
Authors: Copeland Emily , Renault Nisa , Renault Marc , Dyack Sarah , Bulman Dennis E , Bedard Karen , Otley Anthony , Magee Fergall , Acott Philip , Greer Wenda L
Published: October 2012

Background and Aim

Our objective was to identify the molecular genetic basis of an Alagille‐like condition not linked to JAG1 or NOTCH2 in two related sibships.

Methods

Because of common ancestry, and an autosomal recessive mode of inheritance, it was hypothesized that all affected and no unaffected individuals would be homozygous for the same haplotype in the region of the causative gene. Single nucleotide polymorphism arrays were therefore used to genotype 3 affected individuals from two sibships, their mothers and four unaffected siblings, to identify regions of homozygosity. Genes within the largest regions were prioritized and sequenced for mutations. Mutant RNA transcripts were also sequenced.

Results

A novel splice acceptor site mutation in the ATP8B1 gene was identified (a G–C preceding exon 16 resulting in a 4 bp deletion and frameshift from the 5′ end of exon 16). This result was unexpected because ATP8B1 mutations are associated with Progressive Familial Intrahepatic Cholestasis Type 1 (PFIC1). Intrahepatic bile duct paucity, cardiac anomalies, renal tubular acidosis and hypothyroidism led to an initial diagnosis of Alagille Syndrome. However, in retrospect, abnormal sweat chloride, normal gamma‐glutamyl transferase, normal to low cholesterol, and an autosomal recessive mode of inheritance were consistent with PFIC1. Renal tubular acidosis, hypothyroidism and cardiac anomalies have not previously been associated with PFIC1.

Conclusion

This work expands the phenotypic spectrum of PFIC1, and highlights the overlap in clinical phenotype between Alagille Syndrome and PFIC1. Knowledge of the causative mutation allows for carrier testing and prenatal diagnosis in this community.
High grade prostatic intraepithelial neoplasia does not display loss of heterozygosity at the mutation locus in BRCA2 mutation carriers with aggressive prostate cancer
Authors: Willems‐Jones Amber , Kavanagh Liam , Clouston David , Bolton Damien ,   kConFab Investigators, Fox Stephen , Thorne Heather
Published: October 2012

What's known on the subject? and What does the study add?

The risk of developing aggressive prostate cancer is increased for men carrying a pathogenic germline mutation in BRCA2. An earlier study by the Kathleen Cuningham Consortium for Research into Familial Breast Cancer showed that BRCA2 mutation carriers displayed a loss of heterozygosity (LOH) within their prostate cancer tissue in the majority of cases, thus implying that the prostate cancer in these men occurred as a result of LOH for BRCA2. High grade prostatic intraepithelial neoplasia (HGPIN) has been considered a precursor to prostate adenocarcinoma in some, but not all, cases of prostate adenocarcinoma.

The study found that there was no LOH for BRCA2 in HGPIN. From this small cohort of BRCA2‐positive men, we suggest HGPIN is not necessarily a precursor to their prostate cancer development. The presence of HGPIN in a TRUS biopsy in these men at risk of high risk disease is not an indication for prostatectomy.

OBJECTIVES

To determine if high grade prostatic intraepithelial neoplasia (HGPIN), which is considered a precursor to the development of prostate adenocarcinoma, displays the same genetic hallmarks as adenocarcinoma.

To identify, using molecular genetic techniques, if HGPIN is a precursor of tumour development and progression in men carrying a pathogenic germline mutation in BRCA2.

PATIENTS AND METHODS

Ten participants from the Kathleen Cuningham Consortium for Research into Familial Breast Cancer cohort of high‐risk breast cancer families were identified, with (i) a diagnosis of aggressive prostate cancer and presence of HGPIN, (ii) a pathogenic BRCA2 mutation, and (iii) access to archival prostate tissue specimens.

Loss of heterozygosity (LOH) at the BRCA2 gene was examined using mutation‐specific PCR and sequencing of DNA from laser microdissected HGPIN.

RESULTS

Within this cohort of 10 pathogenic BRCA2 carriers, no patient displayed LOH at the mutation locus within HGPIN, irrespective of whether or not corresponding adenocarcinoma DNA displayed LOH.

CONCLUSIONS

Although HGPIN is considered a precursor to cancer, as no LOH was observed, this assay does not provide a genetic marker that may be considered a positive predictor of tumorigenesis in BRCA2 carriers.

In this group of high‐risk men, early screening via prostate‐specific antigen testing, rectal examination and prostate biopsy may be prudent to permit the detection and the optimum clinical management of prostate cancer.
ASSESSING THE IMPACTS OF LABOR MARKET AND DETERRENCE VARIABLES ON CRIME RATES IN MEXICO
Authors: LIU YU , FULLERTON THOMAS M. , ASHBY NATHAN J.
Published: October 2012

Many studies examine the relationship between crime rates and various economic and/or sociodemographic variables in high income countries, but similar efforts for middle and low income countries are less common. Utilizing an 8‐year panel data sample for all 32 states in Mexico, this study assesses the impact of Mexican labor market and deterrence variables on various Mexican crime rates. The principal results indicate that: (1) State gross domestic product (GDP) per capita has ambiguous effect on crime rates under different conditions. Both wages and unemployment rates are negatively linked with crime rates. (2) Although the Mexican judicial and public security systems are widely believed to be ineffective, increased federal police forces and incarceration rates are associated with lower crime rates, but higher public security expenditure per capita is associated with higher crime rates. (3) The impacts from labor market and deterrence variables presented in (1) and (2) continue to hold under the Fox administration as well as for non‐border states. Their respective impacts diminish, however, under the Calderon administration as well as for border states because of the small number of observations. Overall, the results indicate that increasing average wages, federal police forces, and incarceration rates would have significant impacts on reducing crime rates in Mexican states. (JEL O54, K42)
Globalization Lived Locally: Investigating Kerala's Local Labour Control Regimes
Authors: Neethi P.
Published: October 2012

This article uses the case study of a prominent electronics manufacturer in Kerala, southern India, to illuminate an approach to labour studies which focuses on local labour control regimes. Kerala was chosen for this study because of certain unusual characteristics of its labour market. Building on the theoretical base of local labour control regimes, empirical evidence from the case study reveals that local labour markets develop their own forms of labour control and worker response patterns. These are not always clearly visible and may require something more than superficial enquiry to bring their salient features into view. In this case, the Church is shown to play an unexpected role in local labour control regimes.
Problems of doing research at home: research on child witches in London (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: La Fontaine J. S.
Published: October 2012

In this narrative, Jean La Fontaine recounts her experiences trying to do fieldwork in London on the topic of witchcraft accusations involving children.
Ageing and long‐term CD4 cell count trends in HIV‐positive patients with 5 years or more combination antiretroviral therapy experience
Authors: Wright ST , Petoumenos K , Boyd M , Carr A , Downing S , O'Connor CC , Grotowski M , Law MG ,   Australian HIV Observational Database study group
Published: October 2012

Objectives

The aim of this study was to describe the long‐term changes in CD4 cell counts beyond 5 years of combination antiretroviral therapy (cART). If natural ageing leads to a long‐term decline in the immune system via low‐grade chronic immune activation/inflammation, then one might expect to see a greater or earlier decline in CD4 counts in older HIV‐positive patients with increasing duration of cART.

Methods

Retrospective and prospective data were examined from long‐term virologically stable HIV‐positive adults from the Australian HIV Observational Database. We estimated mean CD4 cell count changes following the completion of 5 years of cART using linear mixed models.

Results

A total of 37 916 CD4 measurements were observed for 892 patients over a combined total of 9753 patient‐years. Older patients (> 50 years old) at cART initiation had estimated mean (95% confidence interval) changes in CD4 counts by year‐5 CD4 count strata (< 500, 500–750 and > 750 cells/μL) of 14 (7 to 21), 3 (–5 to 11) and –6 (–17 to 4) cells/μL/year. Of the CD4 cell count rates of change estimated, none were indicative of long‐term declines in CD4 cell counts.

Conclusions

Our results suggest that duration of cART and increasing age do not result in decreasing mean changes in CD4 cell counts for long‐term virologically suppressed patients, indicating that the level of immune recovery achieved during the first 5 years of treatment is sustained through long‐term cART.
Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study
Authors: Rist P. M. , Buring J. E. , Kase C. S. , Ridker P. M , Kurth T.
Published: October 2012

Background and purpose

Several biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women.

Methods

Prospective cohort study of 27 728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0–1, 2–3, or 4–6.

Results

After a mean follow‐up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4–6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18–3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C‐reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes.

Conclusions

Whilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.
Historical and modern neutral genetic variability in Mednyi Arctic foxes passed through a severe bottleneck
Authors: Ploshnitsa A. I. , Goltsman M. E. , Happ G. M. , Macdonald D. W. , Kennedy L. J.
Published: October 2012

Small isolated populations often show lower genetic variability. Demographic bottlenecks lead to loss of genetic variation too. Arctic foxes (Vulpes lagopus) have been isolated since the Pleistocene on Mednyi and Bering Islands (Commander Islands). In 1970–1980, the Mednyi population passed through a severe bottleneck due to a mange outbreak. Previous studies showed lack of genetic diversity in the contemporary Mednyi population that could be due to the long history of isolation and/or the recent bottleneck. To test both factors, we analyzed the mtDNA D‐loop fragment and five microsatellites in pre‐bottleneck Mednyi museum samples. Also, contemporary Mednyi, Bering and mainland Alaskan Arctic foxes were analyzed. Registered genetic variability in historical Mednyi was higher than in contemporary Mednyi Arctic foxes, but lower than in contemporary the Bering population. Our data confirms that the bottleneck reduced an already depleted polymorphism in Mednyi Arctic foxes. Lack of genetic variability could be a reason why the Mednyi population did not recover following the outbreak of mange.
Patients and ICU nurses' perspectives of non‐pharmacological interventions for pain management
Authors: Gélinas Céline , Arbour Caroline , Michaud Cécile , Robar Lauren , Côté José
Published: October 2012

Background

Pain is a major stressor for critically ill patients. To maximize pain relief, non‐pharmacological interventions are an interesting avenue to explore.

Aims and Objectives

The study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non‐pharmacological interventions for pain management in the intensive care unit (ICU).

Design

A qualitative descriptive design was used.

Methods

Patients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi‐structured discussion guide, participants were asked to share their perspective about non‐pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive‐behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment.

Results

A total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non‐pharmacological interventions were discussed. The top four non‐pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive‐behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning.

Conclusions

Four non‐pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. Relevance to clinical practice: While more evidence is required to conclude to their effectiveness, ICU nurses can use non‐pharmacological interventions complementary to pharmacological treatment of pain as they are low cost and safe.
Postacute Rehabilitation Care for Hip Fracture: Who Gets the Most Care?
Authors: Freburger Janet K. , Holmes George M. , Ku Li‐Jung E.
Published: October 2012

Objectives

To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture.

Design

Cross‐sectional analysis of 2 years (2005–06) of population‐based hospital discharge data.

Setting

All short‐term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI).

Participants

Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black.

Measurements

Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use.

Results

Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18–0.30) and to receive HH (OR = 0.46, 95% CI = 0.30–0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36–3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62–0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC.

Conclusion

Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.
The Role of Energetic Cost in the Age‐Related Slowing of Gait Speed
Authors: Schrack Jennifer A. , Simonsick Eleanor M. , Chaves Paulo H.M. , Ferrucci Luigi
Published: October 2012

Objectives

To determine whether slow gait represents a compensatory strategy to reduce the energetic cost of walking with age.

Design

Cross‐sectional analysis.

Setting

Community‐dwelling volunteers from the Baltimore Longitudinal Study of Aging (BLSA).

Participants

Four hundred twenty community‐dwelling persons aged 32 to 96 (mean 68.1 ± 12.5) who underwent a physical examination, physical function testing, and energy expenditure assessment.

Measurements

Energy expenditure per minute (mL/kg/min) and per meter (mL/kg/m) during 2.5 minutes of overground walking at customary speed and usual gait speed over 6 m (m/s) were examined. General linear regression models were used to assess the relationship between customary walking energy expenditure and usual gait speed, adjusted for potential confounders including smoking, medical diagnoses, walking‐related pain, and balance difficulty.

Results

Usual gait speed was slower with increasing age after age 65. Energy expenditure per minute during customary walking averaged 13.0 ± 2.8 mL/kg/min and was independent of age (ρ < 0.01, P = .88). In contrast, energy expenditure per meter walked was progressively higher after age 65 (ρ = 0.35, P < .001) and heightened after age 80 (r = 0.57, P < .001), mirroring the observed pattern of usual gait speed. This relationship remained significant after adjusting for multiple impairments and comorbidities.

Conclusion

These observations support the hypothesis that slower gait at older ages may reflect a compensatory action to offset the greater energetic cost of walking associated with aging and chronic conditions. Future studies should evaluate the specific mechanisms that contribute to this phenomenon as novel targets for clinical intervention.
Patterns of Multimorbidity in Elderly Veterans
Authors: Steinman Michael A. , Lee Sei J. , John Boscardin W. , Miao Yinghui , Fung Kathy Z. , Moore Kelly L. , Schwartz Janice B.
Published: October 2012

Objectives

To determine patterns of co‐occurring diseases in older adults and the extent to which these patterns vary between the young‐old and the old‐old.

Design

Observational study.

Setting

Department of Veterans Affairs.

Participants

Veterans aged 65 years and older (1.9 million male, mean age 76 ± 7; 39,000 female, mean age 77 ± 8) with two or more visits to Department of Veterans Affairs (VA) or Medicare settings in 2007 and 2008.

Measurements

The presence of 23 common conditions was assessed using hospital discharge diagnoses and outpatient encounter diagnoses from the VA and Medicare.

Results

The mean number of chronic conditions (out of 23 possible) was 5.5 ± 2.6 for men and 5.1 ± 2.6 for women. The prevalence of most conditions increased with advancing age, although diabetes mellitus and hyperlipidemia were 11% to 13% less prevalent in men and women aged 85 and older than in those aged 65 to 74 (P < .001 for each). In men, the most common three‐way combination of conditions was hypertension, hyperlipidemia, and coronary heart disease, which together were present in 37% of men. For women, the most common combination was hypertension, hyperlipidemia, and arthritis, which co‐occurred in 25% of women. Reflecting their high population prevalence, hypertension and hyperlipidemia were both present in 9 of the 15 most common three‐way disease combinations in men and in 11 of the 15 most common combinations in women. The prevalence of many disease combinations varied substantially between young‐old and old‐old adults.

Conclusions

Specific combinations of diseases are highly prevalent in older adults and inform the development of guidelines that account for the simultaneous presence of multiple chronic conditions.
Activity Participation and Cognitive Aging from Age 50 to 80 in theGlostrup 1914Cohort
Authors: Gow Alan J. , Mortensen Erik L. , Avlund Kirsten
Published: October 2012

Objectives

To examine the cognitively protective effect of leisure and physical activities while accounting for prior cognitive ability, a rarely considered confounder of the previously reported associations between activity and cognitive aging.

Design

Longitudinal cohort study.

Setting

Glostrup,Denmark.

Participants

Community‐dwelling sample of adults recruited into theGlostrup 1914Cohort (baselineN = 802). All were born in 1914 and were assessed at ages 50, 60, 70, and 80. New participants were recruited during the study to counter attrition.

Measurements

On each occasion, cognitive ability was assessed using four tests, which defined a general cognitive ability score. Self‐reported participation in leisure and physical activities was also collected. In general, physical activity was summarized on a 3‐ or 4‐point scale, and leisure activity as none versus some (ages 50 and 60) or according to participation in a list of common activities (age 70). The effect of activity—leisure and physical—on the level of cognitive ability and cognitive change over time from age 60 to 80 was examined in growth curve models.

Results

Greater activity (leisure or physical) was consistently associated with a higher level of cognitive ability. Adjusting for baseline cognitive ability (age 50) attenuated these associations, suggesting that associations between activity and cognition reported in old age are largely a consequence of preserved differentiation. A small but significant association remained between greater physical activity at age 60 or 70 and less cognitive decline.

Conclusion

The association between more‐frequent leisure activity and less cognitive decline mainly reflects the positive cross‐sectional association between activity and cognition, although the link that remains between greater physical activity and a more‐successful cognitive aging trajectory is of particular relevance to those who are developing interventions.
Stability of Coxiella burnetii in stored human blood
Authors: Kersh Gilbert J. , Priestley Rachael , Massung Robert F.
Published: October 2012

Background

Coxiella burnetii, an obligate intracellular organism, is the causative agent of the zoonotic disease Q fever. The seroprevalence rate for Q fever in the United States is 3.1%, suggesting a high number of infections each year. However, fewer than 200 cases of Q fever are reported to the CDC annually. This discrepancy is likely the result of underutilized diagnostics and a high percentage (>50%) of asymptomatic infections. The detection of C. burnetii in patient blood during the first 2 to 3 weeks of infection raises the possibility that the organism could be present in donated human blood. The purpose of this study was to determine if extracellular C. burnetii would be stable in blood under normal storage conditions.

Study Design and Methods

Donated human blood was separated into whole blood, leukoreduced whole blood, red blood cells, and plasma. Each component was spiked with purified, extracellular C. burnetii strain Nine Mile Phase 1, and the viability and infectivity of the organisms were tested weekly.

Results

C. burnetii did not decrease in viability or the ability to infect cells after storage in any of the blood products, even after 6 weeks of storage at 1 to 6°C.

Conclusions

Extracellular C. burnetii can survive and remain infectious in donated blood products.
Association between antimicrobial locks for hemodialysis central venous catheters and antibiotic resistance
Authors: Wolley Martin J. , Taylor Susan L. , Hossain Firoz , Abbas Saib A. , Marshall Mark R.
Published: October 2012

Antimicrobial locks (AMLs) are effective in preventing catheter‐associated bloodstream infections (CABSI) in hemodialysis (HD) patients, but may increase antibiotic resistance. In our center, gentamicin‐heparin locks have been used for all HD central venous catheters since July 1, 2004. We previously reported a significant reduction in CABSI rates, but a short‐term trend to increased gentamicin resistance among coagulase‐negative staphylococci (CNS). We present a further 3‐year follow‐up study of bacterial resistance in our dialysis center. We examined the susceptibility of bacterial isolates from CABSI from July 1, 2006 to July 31, 2009, restricting analyses to CNS, gram‐negative bacilli, and Staphylococcus aureus. We compared the frequency of gentamicin resistance in these isolates between four groups: CABSI in HD patients, non‐CABSI in HD patients, peritonitis in peritoneal dialysis (PD) patients, and bloodstream infection in the non–end‐stage kidney failure general population. For CNS isolates, the frequency of gentamicin resistance was similar between the CABSI and PD peritonitis groups, but higher in both groups than the general population. The pattern was similar for S. aureus although the differences were of borderline statistical significance. The frequency of gentamicin resistance among gram‐negative bacilli isolates did not differ between groups. Gentamicin resistance was more common than expected in CNS and possibly S. aureus isolates from CABSI, although this resistance may be part of a generally higher frequency of antibiotic resistance in the dialysis population, rather than a direct result of AML use. AMLs remain a valuable clinical tool although surveillance is needed to ensure that benefits continue to outweigh risks.
Effect of sterilization on solute transport performances of super high‐flux dialyzers
Authors: Yamashita Akihiro C. , Fujita Ryoichiro , Hosoi Nobuyuki
Published: October 2012

The effect of sterilization was quantitatively evaluated for modern super high‐flux dialyzers in terms of solute transport performances for autoclave sterilization (AC), gamma ray sterilization (G‐ray), combination of these two and no sterilization (NS) as reference. A commercial polysulfone dialyzer (Kawasumi Laboratory Co., Tokyo, Japan) was chosen for investigation with six different sterilization processes, i.e., sterilization with AC one time and two times, that with G‐ray using either no additives or an additive, that with AC one time followed by G‐ray using no additive and that with NS. In vitro dialysis and ultrafiltration experiments were performed with aqueous test solution as pseudo blood, varying QB, QD, and QF. Creatinine (MW113), vitamin B12 (MW1355), and α‐chymotrypsin (MW25000) were chosen as test solutes for dialysis experiments. Clearances (CL) calculated from dialysis experiments and the sieving coefficient for albumin (MW66000) from ultrafiltration experiments were compared among six models. A dialyzer with NS showed much lower clearances for all three solutes than those with sterile. Therefore, the sterilization increases the solute transfer performances. Although no significant changes in clearances for creatinine and vitamin B12 were found among five sterile models, much higher clearances for α‐chymotrypsin were found in AC sterile models. Then, the effect of sterilization may become greater with the increase of molecular weight of solutes. According to the results of the sieving coefficient for albumin, AC may have enlarged the pore size of the membrane that could increase clearances for large solutes without changing those for relatively small solutes. The sterilization increases the solute clearance even in so‐called super high‐flux dialyzers and the effect of sterilization may be greater in larger solutes.
Physiologic volume of phosphorus during hemodialysis: Predictions from a pseudo one‐compartment model
Authors: Leypoldt John K. , Akonur Alp , Agar Baris U. , Culleton Bruce F.
Published: October 2012

The kinetics of plasma phosphorus concentrations during hemodialysis (HD) are complex and cannot be described by conventional one‐ or two‐compartment kinetic models. It has recently been shown by others that the physiologic (or apparent distribution) volume for phosphorus (Vr‐P) increases with increasing treatment time and shows a large variation among patients treated by thrice weekly and daily HD. Here, we describe the dependence of Vr‐P on treatment time and predialysis plasma phosphorus concentration as predicted by a novel pseudo one‐compartment model. The kinetics of plasma phosphorus during conventional and six times per week daily HD were simulated as a function of treatment time per session for various dialyzer phosphate clearances and patient‐specific phosphorus mobilization clearances (KM). Vr‐P normalized to extracellular volume from these simulations were reported and compared with previously published empirical findings. Simulated results were relatively independent of dialyzer phosphate clearance and treatment frequency. In contrast, Vr‐P was strongly dependent on treatment time per session; the increase in Vr‐P with treatment time was larger for higher values of KM. Vr‐P was inversely dependent on predialysis plasma phosphorus concentration. There was significant variation among predicted Vr‐P values, depending largely on the value of KM. We conclude that a pseudo one‐compartment model can describe the empirical dependence of the physiologic volume of phosphorus on treatment time and predialysis plasma phosphorus concentration. Further, the variation in physiologic volume of phosphorus among HD patients is largely due to differences in patient‐specific phosphorus mobilization clearance.
Piperacillin‐induced thrombocytopenia reversed by high‐flux hemodialysis in an uremic patient
Authors: Lin Shang‐Yi , Huang Jiun‐Chi , Shen Mei‐Chiou , Chuang Shu‐Hui , Lee Mei‐Hsuan , Chen Huang‐Chi
Published: October 2012

Drug‐induced thrombocytopenia in an infected patient often is overlooked. We present a 74‐year‐old uremic female with continuous renal replacement therapy developed severe thrombocytopenia during the treatment course of piperacillin/tazobactam. Platelet counts recovered rapidly after discontinuing piperacillin/tazobactam and receiving high‐flux hemodialysis. The George criteria indicates piperacillin/tazobactam as the probable cause of thrombocytopenia in this patient. Immediate withdrawal of the causative drug is important for drug‐induced thrombocytopenia. Prompt high‐flux hemodialysis may be an adjunctive management for uremic patients.
Isolated pleural effusion as a presentation of high cardiac output heart failure in a hemodialysis patient
Authors: Dhawan Vibhu , Ariyamuthu Venkatesh , Malhotra Kunal , Dalal Pranav , Bichu Prasad , Dorairajan Smrita
Published: October 2012

Congestive heart failure is a well‐recognized complication of hemodialysis arteriovenous fistula. Symptoms of dyspnea are usually associated with signs of congestive heart failure including pulmonary edema, pleural effusions, lower extremity edema, and liver enlargement, to name a few. We present a case of a gentleman with end‐stage renal disease on chronic hemodialysis, which developed acute bilateral transudative pleural effusions in the absence of other signs of systemic venous congestion, associated with pulmonary venous congestion. We also discuss the pathogenesis and role of hemodialysis in management of this patient.
Bath salt intoxication causing acute kidney injury requiring hemodialysis
Authors: Regunath Hariharan , Ariyamuthu Venkatesh Kumar , Dalal Pranavkumar , Misra Madhukar
Published: October 2012

Traditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of “bath salts.” They are beta‐ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the “khat” plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. Serious adverse effects reported with intoxication included cardiac, psychiatric, and neurological signs and symptoms. Not much is known about the toxicology and metabolism of these compounds. They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4‐methylenedioxy‐N‐methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of “bath salt” pills that improved with hemodialysis.
Factors Associated With High Levels of Patient Satisfaction With Pain Management
Authors: Shill Jessica , Taylor David McD. , Ngui Bryan , Taylor Simone E. , Ugoni Antony M. , Yeoh Michael , Richardson Joanna
Published: October 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:1212–1215 © 2012 by the Society for Academic Emergency Medicine

Objectives:  The objective was to determine, among emergency department (ED) patients, the factors associated with a high level of satisfaction with pain management.

Methods:  This was a prospective cohort study in a single ED. Consecutive adult patients, with triage pain scores of ≥4 (numerical rating scale = 0 to 10), were enrolled. Variables examined included demographics, presenting complaint, pain scores, nurse‐initiated analgesia, analgesia administered, time to first analgesia, specific pain communication, and whether “adequate analgesia” was provided (defined as a decrease in pain score to <4 and a decrease from the triage pain score of ≥2). The level of patient satisfaction with their pain management (six‐point scale: very unsatisfied to very satisfied) was determined by a blinded investigator 48 hours post discharge. Logistic regression analyses were undertaken.

Results:  Data were complete for 476 patients: mean (±standard deviation [SD]) age was 43.6 (±17.2) years, and 237 were males (49.8%, 95% confidence interval [CI] = 45.2% to 54.4%). A total of 190 (39.9%, 95% CI = 35.5% to 44.5%) patients were “very satisfied” with their pain management, and 207 (43.5%, 95% CI = 39.0% to 48.1%) patients received adequate analgesia. Three variables were associated with the patient being very satisfied: the provision of adequate analgesia (odds ratio [OR] = 7.8, 95% CI = 4.9 to 12.4), specific pain communication (OR = 2.3, 95% CI = 1.3 to 4.1), and oral opioid administration (OR = 2.0, 95% CI = 1.1 to 3.4). Notably, the provision of nurse‐initiated analgesia to 211 patients (44.3%, 95% CI = 39.8% to 48.9%) and the short time to analgesia (median = 11.5 minutes; interquartile range [IQR] = 2.0 to 85.8 minutes) were not associated with being very satisfied.

Conclusions:  The receipt of adequate analgesia (as defined) is highly associated with patient satisfaction. This variable may serve as a clinically relevant and achievable target in the pursuit of best‐practice pain management.
Spore rain in relation to regional sources and beyond
Authors: Sundberg Sebastian
Published: October 2012

While patterns of spore dispersal from single sources at short distances are fairly well known, information about ‘spore rain’ from numerous sources and at larger spatial scales is generally lacking. In this study, I sampled spore rain using a novel method consisting of 0.25–0.5 m2 cotton cloth traps at nine sites in the boreo‐nemoral vegetation zone in eastern Sweden during two seasons, using Sphagnum spores as a model. Traps were located in various landscapes (mainland, islands). Additional trapping was done in an arctic area (Svalbard) without spore production. Spore densities were tested against distance from the nearest source and area of sources (open peatlands) within different radii around each site (5, 10, 20, 50, 100, 200, 300, 400 km). The cloth method appeared reliable when accounting for precipitation losses, retaining approximately 20–60% of the spores under the recorded amounts of precipitation. Estimated spore densities ranged from 6 million m−2 and season within a large area source, via regional deposition of 50 000–240 000 spores m−2, down to 1000 m−2 at Svalbard. Spore rain for all sites was strongly related to distance from the nearest source, but when excluding samples taken within a source peatland, the amount of sources within 200 km was most important. Spores were larger at isolated island sites, indicating that a higher proportion originated from distant, humid areas. Immense amounts of Sphagnum spores are dispersed across regional distances annually in boreal areas, explaining the success of the genus to colonise nutrient poor wetlands. The detectable deposition at Svalbard indicates that about 1% of the regional spore rain has a trans‐ or intercontinental origin. The regional spore rain, originating from numerous sources in the landscape, is probably valid for most organisms with small diaspores and provides a useful insight in ecology, habitat restoration and conservation planning.
Dental age in patients with neurofibromatosis 1
Authors: Jääsaari Päivi , Visnapuu Vivian , Nyström Marjatta , Peltonen Sirkku , Peltonen Juha , Happonen Risto‐Pekka
Published: October 2012

Neurofibromatosis type 1 (NF1) is a common, hereditary, neurocutaneous skeletal condition with a variety of osseous manifestations. Although NF1 also affects craniofacial structures, the literature has only limited information related to the effect of NF1 on dental development. In this study the dental age of 34 Finnish NF1 patients, 8–17 yr of age, was estimated using the Demirjian & Goldstein method. The dental age of children with NF1 was similar to that of a Finnish control population. The findings suggest that NF1 does not affect the timing of tooth development.