bluuebunny/crossref_metadata_2025 huggingface dataset:
Length‐ and Age‐Selective Fishing on Chinook Salmon of the Columbia River Basin, 2002–2012
Authors: Kendall Neala W. , Kostow Kathryn E.
Published: July 2016

Fisheries can influence the size and age of exploited stocks if they selectively remove fish. In this study, we quantified length and age selectivity of the commercial and recreational fisheries on upriver spawning stocks of Chinook Salmon Oncorhynchus tshawytscha in the lower Columbia River from 2002 to 2012. Length and age data were sampled from fish (hatchery and wild individuals together) that were caught by the fisheries and from fish that escaped and then entered a trap in a dam immediately upstream of the fisheries. We found that age‐ and length‐based standardized selection differentials (SSDs) were generally small compared with other fisheries and varied over time. Across all years, fish that were caught were, on average, 0.006 years older and 0.19 cm longer than fish in the total return. These results were consistent with the low harvest rates over the 11 years (recreational fishery harvest rate = 4.9%, commercial fishery harvest rate = 3.7%). However, in some years the SSDs during certain fishing periods or overall were larger than in other years and harvested fish were significantly older and longer than the average fish in the total return. For most years and periods, these larger SSDs appeared to be driven by higher harvest rates by recreational fishing gear (hook and line). The SSDs were influenced by how many Chinook Salmon were available to be caught when and where fisheries were occurring, the size and age distribution of those fish, and the selectivity of the gear. We conclude that the SSDs for contemporary lower Columbia River Chinook Salmon fisheries have generally been small in magnitude and variable over time, though in some years and periods the fisheries caught larger‐ and older‐than‐average fish. Thus, the 2002–2012 lower Columbia River fisheries likely had a low influence on the fitness or potential changes in length and age at maturation of upriver Chinook Salmon.

Received December 16, 2015; accepted March 30, 2016 Published online July 19, 2016
Williamson on necessitism
Authors: Goodman Jeremy
Published: July 2016

I critically discuss some of the main arguments of Modal Logic as Metaphysics, present a different way of thinking about the issues raised by those arguments, and briefly discuss some broader issues about the role of higher-order logic in metaphysics.
The Mid-Career Award Working out how working memory works: evidence from typical and atypical development
Authors: Jarrold Christopher
Published: July 2016

Working memory is an extremely influential concept within experimental psychology, with, at the time of writing, over 90 papers with this term in their title published in this journal alone since 2000. One reason for this interest is that measures of working memory tend to be strong correlates of important indices of real-world function. In addition, at first sight working memory appears to be a relatively simple concept to understand. However, despite this apparent simplicity, explaining working memory performance is not straightforward. In this paper I address this challenge, with a particular focus on the development of working memory performance in children; both children developing typically and those experiencing atypical development. I specifically highlight the multiple constraints on working memory performance, and how these constraints inter-relate. I then consider the broader theoretical implications of each of these constraints for current accounts of working memory and its development.
Analysis of a minimal Rho-GTPase circuit regulating cell shape
Authors: Holmes William R , Edelstein-Keshet Leah
Published: July 2016

Networks of Rho-family GTPases regulate eukaryotic cell polarization and motility by controlling assembly and contraction of the cytoskeleton. The mutually inhibitory Rac–Rho circuit is emerging as a central, regulatory hub that can affect the shape and motility phenotype of eukaryotic cells. Recent experimental manipulation of the amounts of Rac and Rho or their regulators (guanine nucleotide-exchange factors, GTPase-activating proteins, guanine nucleotide dissociation inhibitors) have been shown to bias the prevalence of these different states and promote transitions between them. Here we show that part of this data can be understood in terms of inherent Rac–Rho mutually inhibitory dynamics. We analyze a spatio-temporal mathematical model of Rac–Rho dynamics to produce a detailed set of predictions of how parameters such as GTPase rates of activation and total amounts affect cell decisions (such as Rho-dominated contraction, Rac-dominated spreading, and spatially segregated Rac–Rho polarization). We find that in some parameter regimes, a cell can take on any of these three fates depending on its environment or stimuli. We also predict how experimental manipulations (corresponding to parameter variations) can affect cell shapes observed. Our methods are based on local perturbation analysis (a kind of nonlinear stability analysis), and an approximation of nonlinear feedback by sharp switches. We compare the Rac–Rho model to an even simpler single-GTPase (‘wave-pinning’) model and demonstrate that the overall behavior is inherent to GTPase properties, rather than stemming solely from network topology.
Seascapes as a new vernacular for pelagic ocean monitoring, management and conservation
Authors: Kavanaugh Maria T. , Oliver Matthew J. , Chavez Francisco P. , Letelier Ricardo M. , Muller-Karger Frank E. , Doney Scott C.
Published: July 2016

For terrestrial and marine benthic ecologists, landscape ecology provides a framework to address issues of complexity, patchiness, and scale—providing theory and context for ecosystem based management in a changing climate. Marine pelagic ecosystems are likewise changing in response to warming, changing chemistry, and resource exploitation. However, unlike spatial landscapes that migrate slowly with time, pelagic seascapes are embedded in a turbulent, advective ocean. Adaptations from landscape ecology to marine pelagic ecosystem management must consider the nature and scale of biophysical interactions associated with organisms ranging from microbes to whales, a hierarchical organization shaped by physical processes, and our limited capacity to observe and monitor these phenomena across global oceans. High frequency, multiscale, and synoptic characterization of the 4-D variability of seascapes are now available through improved classification methods, a maturing array of satellite remote sensing products, advances in autonomous sampling of multiple levels of biological complexity, and emergence of observational networks. Merging of oceanographic and ecological paradigms will be necessary to observe, manage, and conserve species embedded in a dynamic seascape mosaic, where the boundaries, extent, and location of features change with time.
Antibody-secreting cells in respiratory tract tissues in the absence of eosinophils as supportive partners
Authors: Sealy Robert E. , Surman Sherri L. , Vogel Peter , Hurwitz Julia L.
Published: July 2016

Antibody-secreting cells (ASCs) in respiratory tract tissues provide a first line of defense against invading pathogens. These cells often secrete IgA that is efficiently transcytosed across epithelial barriers into the airway lumen where pathogens can be blocked at their point of entry. Previous literature has reported that in the bone marrow, eosinophils are required for the maintenance of ASCs, and that eosinophils co-localize with ASCs as nearest neighbors. To determine if these rules similarly apply to the maintenance of ASCs in respiratory tract tissues, we evaluated virus-specific responses 1 month and 4 months following an intranasal virus infection of eosinophil-null (∆dblGATA-1) mice. Results showed that ASCs were fractionally reduced, but were nonetheless observed in respiratory tract tissues in the absence of eosinophils. Virus-specific antibodies were similarly observed in the airways of eosinophil-deficient mice. Respiratory tract ASCs were also present in mice lacking neutrophils (Mcl1 ∆M ). The staining of tissue sections from the upper respiratory tract of wild-type mice following viral infections demonstrated that virus-specific ASCs were most frequently situated adjacent to epithelial cells rather than eosinophils or neutrophils. Taken together, these data emphasize that rules for cell maintenance are not absolute and that ASCs can survive in the respiratory tract without eosinophils or neutrophils as their nearest neighbors.
Lessons From Rocket Science: Reframing the Concept of the Physician Health Advocate
Authors: Hubinette Maria M. , Regehr Glenn , Cristancho Sayra
Published: July 2016

Health advocacy is a prominent component of health professionals’ training internationally and is frequently discussed in the medical education literature. Despite this, it continues to be a problematic and challenging topic for medical educators, health professionals, and trainees alike. Borrowing from the field of systems engineering, the authors suggest a need to reconceptualize health advocacy using a systems mind-set rather than a physician-centric perspective. Conceptualizing health advocacy as a systemic, collective effort requires educators, practitioners, and trainees to challenge the assumption that the role of a competent physician health advocate can be fully defined without regard to the larger system or collective within which physicians function. Further, this implies a substantially more dynamic understanding of physicians’ and other participants’ parts in the collective activity.

Of course, this new way of conceptualizing physicians’ practices is not limited to health advocacy. The current education paradigm trains physicians for individual competency but expects them to practice collectively. Defining physician competen cies, or the competencies of any health care provider, in isolation from the particular system of which that individual is an integral part implicitly places that health care provider as the central focus of that system. Thus, academic medicine needs to move its educational and research efforts forward in a manner that recognizes that a systems engineering approach to health improvement will allow the various players to maximize their individual efforts to more effectively support the collective activity.
Not Too Late to Reinvigorate: How Midcareer Faculty Can Continue Growing
Authors: Bickel Janet
Published: July 2016

The continuing engagement of midcareer faculty is critical to the functioning of academic health systems (AHSs). However, despite their strong desire for ongoing meaningful work, many midcareer faculty are at a standstill, with further promotion unlikely. Drawing on more than 40 years of working closely with AHS faculty, the author describes growth-promoting strategies that midcareer faculty can tailor to individual needs, including questions for personal reflection. Research on adult devel opment and resilience indicates that reexamining commitments at this career stage is healthy and begins with individuals taking a fresh look at what they value most. When individuals shift attention from constraints to those aspects of themselves and their situations that they can modify, they often discern new possibilities and become more agile. AHSs also can do a great deal to assist faculty with adjustments inherent in this midlife stage, including incorporating into annual reviews assessment of a faculty member’s satisfaction with effort distribution; setting term limits on leadership roles to create more opportunities; and facilitating fresh ways of thinking about career success.
Perioperative Transcutaneous Electrical Acupoint Stimulation for Postoperative Pain Relief Following Laparoscopic Surgery
Authors: Sun Kai , Xing Tian , Zhang Fengjiang , Liu Yunqing , Li Wei , Zhou Zhenfeng , Fang Liangyu , Yu Lina , Yan Min
Published: July 2016

Objectives:

This trial was conducted to assess the influence of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain intensity and the optimal time of TEAS application during perioperative period in patients undergoing laparoscopic surgery.

Methods:

From July 2012 to October 2013, 380 patients scheduled for laparoscopic surgery under general anesthesia were randomly assigned to receive sham TEAS (group SSS), preoperative TEAS (group TSS), preoperative TEAS combined with intraoperative TEAS (group TTS) or preoperative TEAS combined with postoperative TEAS (group TST) (n=95 each group). Primary outcomes included resting and activity pain intensity evaluated by visual analog scale at 1, 6, 24, and 48 hours after surgery.

Results:

At postoperative 6 hours, the activity pain intensity was significantly lower in groups TTS and TST compared with groups SSS and TSS (P<0.001). At postoperative 24 and 48 hours, activity pain intensity decreased in group TST compared with both groups SSS and TSS (P<0.001). The supplemental analgesic requirement was less in group TST compared with group SSS. There was no significant difference in intraoperative anesthetic consumption, postoperative nausea and vomiting and time of the first postoperative flatus or defecation among the 4 groups. The patient satisfactory rate was higher in groups TSS, TTS, and TST compared with group SSS. No side effect related to TEAS was observed during the postoperative 48 hours.

Discussion:

Combination of preoperative TEAS with intraoperative or postoperative TEAS, rather than preoperative TEAS alone, is an effective and safe adjunctive for management of postoperative pain following laparoscopic surgery.
Pediatric Hearing Aid Management: Parent-Reported Needs for Learning Support
Authors: Muñoz Karen , Rusk Stephanie E. P. , Nelson Lauri , Preston Elizabeth , White Karl R. , Barrett Tyson S. , Twohig Michael P.
Published: July 2016

Objectives:

The aim of this study was to investigate parent learning and support needs related to hearing aid management for young children, and factors that influence parent-reported hours of hearing aid use.

Design:

A cross-sectional survey design was used to collect survey data in seven states. The child’s primary caregiver completed a demographic form, a questionnaire to explore parent learning and support needs as well as their challenges with hearing aid use, and the patient health questionnaire to identify symptoms of depression. Three hundred and eighteen parents completed the questionnaires.

Results:

Responses were analyzed for 318 parents of children (M = 23.15 months; SD = 10.43; range: 3 to 51) who had been wearing hearing aids (M = 15.52; SD = 10.11; range: <1 to 50 months). Even though the majority of parents reported receiving the educational support queried, approximately one-third wanted more information on a variety of topics such as loaner hearing aids, what their child can/cannot hear, financial assistance, how to meet other parents, how to do basic hearing aid maintenance, and how to keep the hearing aids on their child. The most frequently reported challenges that interfered with hearing aid use (rated often or always) were child activities, child not wanting to wear the hearing aids, and fear of losing or damaging the hearing aids. Forty-two percent of parents reported that, on good days, their child used hearing aids all waking hours. Multiple regression was used to compare the effect on parent-reported typical hours of hearing aid use based on good days for the variables of (1) presence of depressive symptoms for the parent, (2) child age, (3) family income, (4) primary caregiver education level, (5) presence of additional disabilities for the child, (6) degree of hearing loss, and (7) length of time since the child was fitted with hearing aids. There were statistically significantly fewer hours of reported hearing aid use when parents reported mild to severe symptoms of depression, lower income, less education level, and when children had mild hearing loss or additional disabilities.

Conclusion:

Although parents reported overall that their needs for hearing aid education and support had generally been met, there were important suggestions for how audiologists and other service providers could better meet parent needs. Hearing aid use for young children was variable and influenced by a variety of factors. Understanding parent experiences and challenges can help audiologists more effectively focus support. Audiologists are more likely to meet the needs of families if they take care to provide access to thorough and comprehensive education and ongoing support that is tailored to address the unique needs of individual families.
Are Collapsed Cervical Discs Amenable to Total Disc Arthroplasty?
Authors: Patwardhan Avinash G. , Carandang Gerard , Voronov Leonard I. , Havey Robert M. , Paul Gary A. , Lauryssen Carl , Coric Domagoj , Dimmig Thomas , Musante David
Published: July 2016

Study Design.

Analysis of prospectively collected radiographic data.

Objective.

To investigate the influence of preoperative index-level range of motion (ROM) and disc height on postoperative ROM after cervical total disc arthroplasty (TDA) using compressible disc prostheses.

Summary of Background Data.

Clinical studies demonstrate benefits of motion preservation over fusion; however, questions remain unanswered as to which preoperative factors have the ability to identify patients who are most likely to have good postoperative motion, which is the primary rationale for TDA.

Methods.

We analyzed prospectively collected data from a single-arm, multicenter study with 2-year follow up of 30 patients with 48 implanted levels. All received compressible cervical disc prostheses of 6 mm-height (M6C, Spinal Kinetics, Sunnyvale, CA). The influence of index-level preoperative disc height and ROM (each with two levels: below-median and above-median) on postoperative ROM was analyzed using 2 x 2 ANOVA. We further analyzed the radiographic outcomes of a subset of discs with preoperative height less than 3 mm, the so-called “collapsed” discs.

Results.

Shorter (3.0 ± 0.4 mm) discs were significantly less mobile preoperatively than taller (4.4 ± 0.5 mm) discs (6.7° vs. 10.5°, P = 0.01). The postoperative ROM did not differ between the shorter and taller discs (5.6° vs. 5.0°, P = 0.63). Tall discs that were less mobile preoperatively had significantly smaller postoperative ROM than short discs with above-median preoperative mobility (P < 0.05). The “collapsed discs” (n = 8) were less mobile preoperatively compared with all discs combined (5.1° vs. 8.6°, P < 0.01). These discs were distracted to more than two times the preoperative height, from 2.6 to 5.7 mm, and had significantly greater postoperative ROM than all discs combined (7.6° vs. 5.3°, P < 0.05).

Conclusion.

We observed a significant interaction between preoperative index-level disc height and ROM in influencing postoperative ROM. Although limited by small sample size, the results suggest discs with preoperative height less than 3 mm may be amenable to disc arthroplasty using compressible disc prostheses.

Level of Evidence: 2
Mild Cognitive Impairment and Risk of Critical Illness*
Authors: Teeters D. Alex , Moua Teng , Li Guangxi , Kashyap Rahul , Biehl Michelle , Kaur Rupinder , Gajic Ognjen , Boeve Bradley F. , St Louis Erik K. , Petersen Ronald C. , Caples Sean M.
Published: July 2016

Objectives:

Approximately half of ICU admissions are comprised of patients older than 65 years old. Mild cognitive impairment is a common disorder affecting 10–20% of patients in the same age group. A need exists for exploring mild cognitive impairment and risk of critical illness. As mild cognitive impairment may be a contributor to poorer overall health or be a result of it, we sought to determine whether the presence of mild cognitive impairment independently increases the risk of critical illness admissions.

Design:

Data from the Mayo Clinic Study of Aging were analyzed. All study participants underwent prospective comprehensive cognitive testing and expert panel consensus diagnosis of both cognitive function and clinical state at baseline and subsequent visits. Comparisons were made between those with normal cognitive function and mild cognitive impairment regarding baseline health and frequency of critical illness.

Setting:

Single-center population-based cohort out of Olmsted County, MN.

Participants:

All individuals 70–89 years old were screened for prospective enrollment in the Mayo Clinic Study of Aging. Patients with preexisting dementia and ICU admission within 3 years of entry to the study were excluded from this analysis.

Interventions:

None.

Measurements and Main Results:

Of 2,425 patients analyzed from the Mayo Clinic Study of Aging, 1,734 patients (71%) were included in the current study. Clinical factors associated with baseline mild cognitive impairment included age, male gender, stroke, and poorer health self-rating. Using a Cox regression model adjusting for these and a priori variables of baseline health, the presence of mild cognitive impairment remained a significant predictor of ICU admission (hazard ratio, 1.50 [1.15–1.96]; p = 0.003).

Conclusions and Relevance:

The presence of mild cognitive impairment is independently associated with increased critical illness admission. Further prospective studies are needed to analyze the impact of critical illness on cognitive function.
Quality of Life and Recommendations for Further Care*
Authors: Putman Michael S. , Tak Hyo Jung , Curlin Farr A. , Yoon John D.
Published: July 2016

Objectives:

Physician recommendations for further medical treatment or palliative treatment only at the end of life may influence patient decisions. Little is known about the patient characteristics that affect physician-assessed quality of life or how such assessments are related to subsequent recommendations.

Design, Setting, and Subjects:

A 2010 mailed survey of practicing U.S. physicians (1,156/1,878 or 62% of eligible physicians responded).

Measurements and Main Results:

Measures included an end of life vignette with five experimentally varied patient characteristics: setting, alimentation, pain, cognition, and communication. Physicians rated vignette patient quality of life on a scale from 0 to 100 and indicated whether they would recommend continuing full medical treatment or palliative treatment only. Cognitive deficits and alimentation had the greatest impacts on recommendations for further care, but pain and communication were also significant (all p < 0.001). Physicians who recommended continuing full medical treatment rated quality of life three times higher than those recommending palliative treatment only (40.41 vs 12.19; p < 0.01). Religious physicians were more likely to assess quality of life higher and to recommend full medical treatment.

Conclusions:

Physician judgments about quality of life are highly correlated with recommendations for further care. Patients and family members might consider these biases when negotiating medical decisions.
Neutrophil Fluorescence: A New Indicator of Cell Activation During Septic Shock–Induced Disseminated Intravascular Coagulation
Authors: Stiel Laure , Delabranche Xavier , Galoisy Anne-Cécile , Severac François , Toti Florence , Mauvieux Laurent , Meziani Ferhat , Boisramé-Helms Julie
Published: July 2016

Objective:

To investigate the contribution of neutrophil activation as innate immune cells during septic shock–induced disseminated intravascular coagulation.

Design:

Prospective study.

Setting:

One University Hospital ICU.

Participants:

Hundred patients with septic shock. Thirty-five patients had disseminated intravascular coagulation according to Japanese Association for Acute Medicine 2006 score.

Intervention:

None.

Measurements and Main Results:

Neutrophil chromatin decondensation was assessed by measuring neutrophil fluorescence (NEUT-side-fluorescence light) labeled by a fluorochrome-based polymethine reagent using a routine automated flow cytometer Sysmex XN20 (Sysmex, Kobe, Japan) and neutrophil-derived CD66b microparticles by prothrombinase assay. Measurements in disseminated intravascular coagulation and no disseminated intravascular coagulation patients showed that a mean value of NEUT-side-fluorescence light above 57.3 arbitrary units had a sensitivity of 90.91% and a specificity of 80.60% for disseminated intravascular coagulation diagnosis. NEUT-side-fluorescence light was correlated to the CD66b microparticles/neutrophil count, a surrogate of neutrophil activation associated with septic shock–induced disseminated intravascular coagulation.

Conclusion:

NEUT-side-fluorescence light, routinely available, could prove an accurate biomarker of neutrophil activation.
Elevated Plasma Angiopoietin-2 Levels Are Associated With Fluid Overload, Organ Dysfunction, and Mortality in Human Septic Shock
Authors: Fisher Jane , Douglas James J. , Linder Adam , Boyd John H. , Walley Keith R. , Russell James A.
Published: July 2016

Objectives:

Angiopoietins modulate endothelial permeability via endothelial cell junctions. Angiopoietin-2 blocks the angiopoietin-1/Tie-2 interaction that stabilizes these junctions, and elevated plasma angiopoietin-2 levels are associated with vascular leakage. We hypothesized that plasma angiopoietin-1 and angiopoietin-2 levels are associated with indirect markers of increased vascular permeability, organ dysfunction, mortality, and plasma proinflammatory cytokine levels in human septic shock.

Design:

Multicenter observational cohort study derived from a randomized controlled trial (Vasopressin and Septic Shock Trial of vasopressin versus norepinephrine in septic shock).

Setting:

ICUs of hospitals in Canada, Australia, and the United States.

Patients:

Three hundred forty-one patients in the randomized, controlled Vasopressin and Septic Shock Trial trial of vasopressin versus norepinephrine in septic shock.

Interventions:

None.

Measurement and Main Results:

We measured plasma levels of angiopoietin-1 and angiopoietin-2 at study baseline and determined their association with percent fluid overload and acute organ dysfunction and generated a receiver operating characteristic curve for plasma angiopoietin-2 levels versus acute kidney injury. We also determined the association of angiopoietin-1 and angiopoietin-2 levels with hemodynamics, mortality, and plasma cytokine levels. Plasma angiopoietin-2 levels were directly associated with percent fluid overload at baseline (r
s = 0.18; p = 0.0008) and at 6 hours (r
s = 0.13; p = 0.023), but not at 24 hours (r
s = 0.041; p = 0.46). Plasma angiopoietin-2 levels were associated with the development of hepatic (p < 0.0001) and coagulation (p < 0.0001) dysfunction and acute kidney injury (p < 0.0001). Receiver operating characteristic curve had an area under the curve of 0.73 for acute kidney injury. angiopoietin-2 levels were also inversely associated with days alive (r = –0.24; p = 0.010) and positively associated with increased 7-day (log-rank trend chi-square = 5.9; p = 0.015) and 28-day (log-rank chi square = 4.9; p = 0.027) mortality. A threshold of angiopoietin-2 levels above the first quartile (> 5,807 pg/mL) was observed to be associated with increased mortality risk, which aligns with prior studies. Plasma angiopoietin-2 levels were positively associated with plasma cytokine levels, including tumor necrosis factor-α and interleukin-6 at baseline (r
s = 0.39; p < 0.0001 and r
s = 0.51; p < 0.0001) and at 24 hours (r
s = 0.29; p < 0.0001 and r
s = 0.41; p < 0.0001).

Conclusions:

Increased plasma angiopoietin-2 levels are associated with increased fluid overload, hepatic and coagulation dysfunction, acute kidney injury, mortality, and plasma cytokines in human septic shock. angiopoietin-2 activation may increase vascular leakage leading to increased fluid requirements, organ dysfunction, and death from septic shock.
An Algorithm for Systemic Inflammatory Response Syndrome Criteria–Based Prediction of Sepsis in a Polytrauma Cohort*
Authors: Lindner Holger A. , Balaban Ümniye , Sturm Timo , Weiϐ Christel , Thiel Manfred , Schneider-Lindner Verena
Published: July 2016

Objectives:

Lifesaving early distinction of infectious systemic inflammatory response syndrome, known as “sepsis,” from noninfectious systemic inflammatory response syndrome is challenging in the ICU because of high systemic inflammatory response syndrome prevalence and lack of specific biomarkers. The purpose of this study was to use an automatic algorithm to detect systemic inflammatory response syndrome criteria (tachycardia, tachypnea, leukocytosis, and fever) in surgical ICU patients for ICU-wide systemic inflammatory response syndrome prevalence determination and evaluation of algorithm-derived systemic inflammatory response syndrome descriptors for sepsis prediction and diagnosis in a polytrauma cohort.

Design:

Cross-sectional descriptive study and retrospective cohort study.

Setting:

Electronic medical records of a tertiary care center’s surgical ICU, 2006–2011.

Patients:

All ICU admissions and consecutive polytrauma admissions.

Interventions:

None.

Measurements and Main Results:

Average prevalence of conventional systemic inflammatory response syndrome (≥ 2 criteria met concomitantly) from cross-sectional application of the algorithm to all ICU patients and each minute of the study period was 43.3%. Of 256 validated polytrauma patients, 85 developed sepsis (33.2%). Three systemic inflammatory response syndrome descriptors summarized the 24 hours after admission and before therapy initiation: 1) systemic inflammatory response syndrome criteria average for systemic inflammatory response syndrome quantification over time, 2) first-to-last minute difference for trend detection, and 3) change count reflecting systemic inflammatory response syndrome criteria fluctuation. Conventional systemic inflammatory response syndrome for greater than or equal to 1 minute had 91% sensitivity and 19% specificity, whereas a systemic inflammatory response syndrome criteria average cutoff value of 1.72 had 51% sensitivity and 77% specificity for sepsis prediction. For sepsis diagnosis, systemic inflammatory response syndrome criteria average and first-to-last minute difference combined yielded 82% sensitivity and 71% specificity compared with 99% sensitivity and only 31% specificity of conventional systemic inflammatory response syndrome from a nested case-control analysis.

Conclusions:

Dynamic systemic inflammatory response syndrome descriptors improved specificity of sepsis prediction and particularly diagnosis, rivaling established biomarkers, in a polytrauma cohort. They may enhance electronic sepsis surveillance once evaluated in other patient populations.
Factors associated with the utilization of mammographic screening in Greece
Authors: Naoum Panagiota , Skroumpelos Anastasis , Athanasakis Kostas , Kyriopoulos John
Published: July 2016

Breast cancer is the most commonly diagnosed type of cancer in women and the primary cause of death by cancer in women globally. Early diagnosis and treatment can be achieved through screening, mainly mammographic; however, international experience has shown that women do not attend mammographic screening adequately. The aim of the present study was to investigate and assess the factors that affect demand for mammography by women to improve and enhance the use of mammography by women in Greece, especially those in the 50–70 age group. The data used in the analysis were extracted from the National Health Survey of 2009, conducted by the Hellenic Statistical Authority. The sample for the analysis included 2294 women aged 30–70 years. To investigate the factors that affect mammography use, binary logistic regression models were constructed for women in the 30–39, 40–49 and 50–70 age groups. 61.70% of the sample had ever undergone a mammogram, 46.80% of which were during the last 12 months. Factors associated with mammography use in at least one of the binary logistic regression models were pap-test, blood cholesterol test, level of education, income level and country of birth. In the 50–70 age group, income level [odds ratio (OR)=1.164; 95% confidence interval (CI)=1.038, 1.305], blood cholesterol test ever (OR=6.096; 95% CI=2.498, 14.872) and pap-test (OR=20.148; 95% CI=11.264, 36.040) were found to be statistically significant predictors of mammography uptake. As mammography utilization in Greece is mostly opportunistic, it is necessary to organize screening provision to cover the majority of the population through nationally organized screening programmes, with a focus on women 50–70 years of age.
Radiation Therapy in the Management of Soft Tissue Sarcoma
Authors: Shah Chirag , Verma Vivek , Takiar Radhika , Vajapey Ramya , Amarnath Sudha , Murphy Erin , Mesko Nathan W. , Lietman Steven , Joyce Michael , Anderson Peter , Shepard Dale , Budd Thomas
Published: July 2016

Radiation therapy represents a vital component in the multidisciplinary management of soft tissue sarcomas. Combined with limb-preserving surgery, radiation therapy represents a standard of care treatment option for patients with high-grade sarcomas. Radiation therapy for soft tissue sarcoma continues to evolve with changes in timing, techniques, and targets. Over the past 2 decades, increasing data have supported the role of preoperative radiotherapy with the potential for lower total doses of radiation and improved long-term function coming at the cost of increased wound complications for certain locations. Retroperitoneal sarcomas represent a location where preoperative treatment is becoming the standard of care based on anatomic constraints and challenges with delivering postoperative radiotherapy. Multiple radiation therapy techniques exist to deliver treatment; currently both 3-dimensional conformal radiotherapy and intensity-modulated radiation therapy (IMRT) are appropriate options, although increasing data support the role of IMRT in reducing dose to critical structures (bone, bowel, kidneys, vessels) while maintaining target coverage. Traditional target volumes have included larger fields; however, recent prospective data have demonstrated that image guidance in conjunction with smaller treatment volumes may reduce toxicity while not increasing marginal failures, although follow-up is short. Because of the toxicity associated with treatment, novel radiotherapy strategies are being used such as stereotactic radiotherapy as well as the use of tumor genetics to identify patients most likely to benefit most from radiotherapy.
A Phase II Study to Prevent Radiation-induced Rectal Injury With Lovastatin
Authors: Anscher Mitchell S. , Chang Michael G. , Moghanaki Drew , Rosu Mihaela , Mikkelsen Ross B. , Holdford Diane , Skinner Vicki , Grob Baruch M. , Sanyal Arun , Wang Aiping , Mukhopadhyay Nitai D.
Published: July 2016

Purpose:

Physician reported symptomatic late rectal injury occurs in about 5% to 25% of patients treated with radiation therapy for prostate cancer, depending on the treatment technique. Patients, however, report clinically meaningful declines in bowel/rectal function regardless of the technique used. Lovastatin has been shown to protect mice from late radiation injury. This study was designed to determine if lovastatin might reduce the incidence of late rectal injury in patients receiving radiation therapy for prostate cancer.

Materials and Methods:

Patients with adenocarcinoma of the prostate receiving radiotherapy with curative intent were eligible. A portion of the rectum had to receive at least 60 Gy. Gastrointestinal functioning was assessed using both physician-reported and patient-reported instruments at baseline and at prescribed intervals during and after treatment. Lovastatin (20 to 80 mg/d) was started on day 1 of radiation and continued for 12 months. Patients were followed for an additional 12 months. The primary endpoint was physician-reported rectal toxicity ≥grade 2 during the first 2 years after treatment.

Results:

A total of 20/53 (38%) patients developed grade 2 or higher toxicity during the 2-year follow-up period. Seventeen patients had 1 or more unresolved gastrointestinal symptom at the end of 2 years, 3 (6%) of which were grade 2 and none were of higher grade.

Conclusions:

The primary endpoint of the study was not met. Lovastatin, as administered in this trial, did not reduce the incidence of grade 2 or higher rectal toxicity compared with historical controls.
Hormone therapy and clinical and surrogate cardiovascular endpoints in women with chronic kidney disease: a systematic review and meta-analysis
Authors: Ramesh Sharanya , Mann Michelle C. , Holroyd-Leduc Jayna M. , Wilton Stephen B. , James Matthew T. , Seely Ellen W. , Ahmed Sofia B.
Published: July 2016

Objective:

Women with chronic kidney disease (CKD) experience kidney dysfunction-mediated premature menopause. The role of postmenopausal hormone therapy (HT) in this population is unclear. We sought to summarize current knowledge regarding use of postmenopausal HT and cardiovascular (CV) outcomes, and established surrogate measures of CV risk in women with CKD.

Methods:

This is a systematic review and meta-analysis of adult women with CKD. We searched electronic bibliographic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) (inception to 2014 December), relevant conference proceedings, tables of contents of journals, and review articles. Randomized controlled trials and observational studies examining postmenopausal HT compared with either placebo or untreated control groups were included. The intervention of interest was postmenopausal HT, and the outcome measures were all-cause and CV mortality, nonfatal CV event (myocardial infarction, stroke), and surrogate measures of CV risk (serum lipids, blood pressure).

Results:

Of 12,482 references retrieved, four randomized controlled trials and two cohort studies (N = 1,666 participants) were identified. No studies reported on CV outcomes or mortality. Compared with placebo, postmenopausal HT was associated with decreased low-density lipoprotein cholesterol (−13.2 mg/dL [95% CI, −23.32 to −3.00 mg/dL]), and increased high-density lipoprotein (8.73 mg/dL [95% CI, 4.72-12.73 mg/dL]) and total cholesterol (7.96 mg/dL [95% CI, 0.07-15.84 mg/dL]). No associations were observed between postmenopausal HT triglyceride levels and blood pressure.

Conclusions:

Studies examining the effect of postmenopausal HT on CV outcomes in women with CKD are lacking. Further prospective study of the role of postmenopausal HT in this high-risk group is required.
Relationship between changes in vasomotor symptoms and changes in menopause-specific quality of life and sleep parameters
Authors: Pinkerton JoAnn V. , Abraham Lucy , Bushmakin Andrew G. , Cappelleri Joseph C. , Komm Barry S.
Published: July 2016

Objective:

This study characterizes and quantifies the relationship of vasomotor symptoms (VMS) of menopause with menopause-specific quality of life (MSQOL) and sleep parameters to help predict treatment outcomes and inform treatment decision-making.

Methods:

Data were derived from a 12-week randomized, double-blind, placebo-controlled phase 3 trial that evaluated effects of two doses of conjugated estrogens/bazedoxifene on VMS in nonhysterectomized postmenopausal women (N = 318, mean age = 53.39) experiencing at least seven moderate to severe hot flushes (HFs) per day or at least 50 per week. Repeated measures models were used to determine relationships between HF frequency and severity and outcomes on the Menopause-Specific Quality of Life questionnaire and the Medical Outcomes Study sleep scale. Sensitivity analyses were performed to check assumptions of linearity between VMS and outcomes.

Results:

Frequency and severity of HFs showed approximately linear relationships with MSQOL and sleep parameters. Sensitivity analyses supported assumptions of linearity. The largest changes associated with a reduction of five HFs and a 0.5-point decrease in severity occurred in the Menopause-Specific Quality of Life vasomotor functioning domain (0.78 for number of HFs and 0.98 for severity) and the Medical Outcomes Study sleep disturbance (7.38 and 4.86) and sleep adequacy (−5.60 and −4.66) domains and the two overall sleep problems indices (SPI: 5.17 and 3.63; SPII: 5.82 and 3.83).

Conclusions:

Frequency and severity of HFs have an approximately linear relationship with MSQOL and sleep parameters—that is, improvements in HFs are associated with improvements in MSQOL and sleep. Such relationships may enable clinicians to predict changes in sleep and MSQOL expected from various VMS treatments.
Measuring hot flash phenomenonology using ambulatory prospective digital diaries
Authors: Fisher William I. , Thurston Rebecca C.
Published: July 2016

Objective:

This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary.

Methods:

This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of three consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred.

Results:

Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the face (78.9%), neck (74.7%), and chest (61.3%). Of all reported hot flashes, 32% occurred concurrently with prickly skin, 7% with anxiety, and 5% with nausea. A novel finding from the study was that 38% of hot flashes were accompanied by a premonitory aura.

Conclusions:

A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly used retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci, and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience.
Anthropometric and cardiovascular responses to hypertrophic resistance training in postmenopausal women
Authors: Shaw Brandon S. , Gouveia Monique , McIntyre Shannon , Shaw Ina
Published: July 2016

Objective:

Menopause induces a phase of decreased physical fitness and altered body composition characterized by increased total and abdominal fat and reduced lean mass. It is, however, inconclusive which specific resistance training (RT) subtypes can reverse these deleterious changes in postmenopausal women.

Methods:

Thirty-seven postmenopausal women were randomized to a 6-week nonexercising control group (n = 18) or hypertrophic RT group (n = 19) that engaged in two 40-minute sessions weekly using three sets of 12 repetitions at 67% to 85% one-repetition maximum for 10 whole-body exercises.

Results:

RT significantly improved resting heart rate (69.05 ± 11.19-63.80 ± 4.94 bpm, P = 0.017), systolic blood pressure (125.85 ± 4.86-124.05 ± 3.98 mm Hg, P < 0.0001), diastolic blood pressure (81.20 ± 7.50-77.90 ± 6.85 mm Hg, P < 0.0001), rate-pressure product (8,712.40 ± 1,408.21-7,952.90 ± 782.72, P = 0.003), blood glucose concentration (6.06 ± 0.52-5.70 ± 0.52 mmol/L, P = 0.009), fat mass (21.53 ± 7.07-19.75 ± 6.40 kg, P = 0.001), percentage body fat (30.66% ± 5.08%-25.49% ± 9.89%, P = 0.026), body mass index (24.50 ± 3.85-24.27 ± 4.04 kg/m2, P = 0.050), waist circumference (80.04 ± 8.57-73.19 ± 18.44 cm, P = 0.045), sum of skinfolds (22.91 ± 6.05-20.72 ± 5.26 mm, P < 0.0001), upper-body muscle strength (20.12 ± 5.65-23.77 ± 7.10 kg, P < 0.0001), and lower-body (16.28 ± 5.47-16.44 ± 5.62 kg, P = 0.001) muscle strength.

Conclusions:

A 6-week hypertrophic RT program, performed even twice weekly, produces substantial simultaneous improvements in multiple anthropometric, cardiovascular, and muscle strength variables in postmenopausal women. This program can be recommended for inclusion in any exercise training regime or as an adjunct lifestyle approach in combination with other treatments in postmenopausal women.
Timing and persistence of effect of conjugated estrogens/bazedoxifene in postmenopausal women
Authors: Kagan Risa , Komm Barry S. , Ryan Kelly A. , Lavenberg Joanne , Yu Ching-Ray , Pinkerton JoAnn V.
Published: July 2016

Objective:

The aim of the study was to determine the time course of effect with conjugated estrogens/bazedoxifene (CE/BZA) in nonhysterectomized postmenopausal women in five phase 3 trials.

Methods:

This post hoc analysis identified when CE 0.45 mg/BZA 20 mg and CE 0.625 mg/BZA 20 mg first achieved a statistically significant difference (P < 0.05) versus placebo in individual trials and the duration the difference persisted for prespecified efficacy endpoints.

Results:

CE/BZA significantly reduced hot flush frequency beginning at weeks 2 to 4 and severity at weeks 3 to 6; benefits were maintained through month 24. Significant improvements in lumbar spine, total hip, femoral neck, and femoral trochanter bone mineral density were evident at month 6 or 12 and changes in bone turnover markers at month 3 or 6; benefits were maintained throughout the studies (12 or 24 mo). In symptomatic women with less than 5% vaginal superficial cells at baseline, vaginal maturation index was significantly improved by week 4. Reductions in parabasal cells were maintained throughout the studies (through months 3 and 24), but superficial cell count changes persisted only with the higher CE/BZA dose. Menopause-Specific Quality of Life total and vasomotor domain scores were improved at all assessments, from months 3 through 24. Some measures of sleep, especially quality and time to fall asleep, improved during weeks 4 to 8 and were maintained in a majority of weeks thereafter.

Conclusions:

In the context of studies designed primarily to evaluate efficacy at final study endpoints, both doses of CE/BZA achieved significance versus placebo at early assessments for most outcomes, and benefits were well maintained.
Age at menarche, androgen concentrations, and midlife obesity: findings from the Midlife Women's Health Study
Authors: Gallicchio Lisa , Flaws Jodi A. , Smith Rebecca L.
Published: July 2016

Objective:

Studies have shown that earlier age at menarche is associated with a higher risk of midlife obesity; however, the mechanism underlying this association is not known. The purpose of this study was to examine whether the association between age at menarche and midlife obesity is due to variation in circulating androgen concentrations.

Methods:

Baseline data were analyzed from 748 women aged 45 to 54 years enrolled in the Midlife Women's Health Study, a prospective cohort study conducted in the Baltimore, MD region. Information on age at menarche was collected through a self-administered questionnaire. Body mass index (BMI) was calculated using height and weight measured at a clinic visit. Obesity was defined as a BMI between 30 and 34.9 kg/m2; super obesity was defined as a BMI greater than 35 kg/m2. Testosterone, estradiol, and sex hormone-binding globulin were measured in blood samples using enzyme-linked immunosorbent assays. The free androgen index (FAI) was calculated using the formula: (testosterone × 3.467)/sex hormone-binding globulin × 100.

Results:

After adjustment for covariates, for each year increase in age at menarche, the odds of obesity and super obesity decreased by 31% (odds ratio (OR) 0.69; 95% confidence limits (CL) 0.59, 0.81) and 34% (OR 0.66; 95% CL 0.52, 0.83), respectively. Addition of the FAI into the models did not attenuate the observed estimates.

Conclusions:

The results of this study indicate that age at menarche is associated with midlife obesity independent of free testosterone concentrations measured in adulthood.