bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors leading to overutilisation of hospital pathology testing: the junior doctor’s perspective
Authors: Ericksson William , Bothe Janine , Cheung Heidi , Zhang Kate , Kelly Simone
Published: May 2017

Objective
Pathology overutilisation is a significant issue affecting the quality and cost of health care. Because junior medical officers (JMOs) order most pathology tests in the hospital setting, the aim of the present study was to identify the main reasons for hospital pathology overutilisation from the perspective of the JMO.

Methods
A qualitative method, using focus group methodology, was undertaken. Sixteen JMOs from two hospitals participated in three focus groups. Data were analysed using thematic analysis.

Results
Three major themes contributed to overutilisation: the real and perceived expectations of senior colleagues, the level of JMO clinical experience and strategies to manage JMO workload around clinical systems. Within these themes, 12 subthemes were identified.

Conclusions
Overutilisation of hospital pathology testing occurs when there are high social costs to JMOs for underordering, with little cost for overordering. Interventions should restore this balance through reframing overutilisation as both a costly and potentially harmful activity, promoting a supportive culture with regular senior guidance, and addressing clinical systems in which missed tests create an excessive workload.

What is known about the topic?
Mean overutilisation rates of pathology testing are reported to be as high as 44%. Although numerous studies have reported successful efforts to decrease hospital pathology overutilisation, no primary research was identified that examined the JMO perspective on this subject.

What does this paper add?
Clinical need is not the primary factor guiding the pathology-ordering decisions of junior practitioners; rather, medical team culture, limited JMO experience and systems factors have a significant role.

What are the implications for practitioners?
The social and behavioural determinants of pathology ordering must be considered to achieve appropriate pathology test utilisation. These include senior medical officer engagement, the guidance of JMOs and clinical workflows.
Sperm quality, and morphology and apoptosis of germinal epithelium cells of ram lambs receiving water of different salinities
Authors: Lins T. L. B. G. , Menezes V. G. , Barberino R. S. , Costa S. A. P. , Santos N. M. S. S. , Nascimento T. V. C. , Queiroz M. A. A. , Cordeiro M. F. , Ribeiro L. B. , Araujo G. G. L. , Matos M. H. T.
Published: May 2017

The aim of the present study was to evaluate the influence of water salinity on semen quality, and on the morphology and apoptosis of germinal epithelial cells in prepubertal Morada Nova male lambs. Thirty-two lambs were allocated into four treatments with different amounts of sodium chloride (NaCl) added to the drinking water to simulate different water salinities; consequently, the concentrations of total dissolved solids (TDS) were as follows: 640 (control), 3188; 5740 and 8326 mg/L TDS. After 78 days, sperm was collected for analysis. The animals were slaughtered and histological and morphometric analyses and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL) assay were performed on the testis tissue. The thickness of the germinal epithelium and diameter of the seminiferous tubules were measured. A quadratic effect (P < 0.05) was observed in regard to semen volume and sperm abnormalities. There was an increase in the sperm count in the treatment containing 3188 mg/L TDS, compared with the control (640 mg/L TDS); however, this treatment did not differ (P > 0.05) from the other salinity treatments. Moreover, treatments with 3188 mg/L or 5740 mg/L TDS showed a higher (P < 0.05) spermatic vigour than did the other treatments. There was an increase (P < 0.05) in the number of TUNEL-positive cells in the treatment with the highest salinity (8326 mg/L TDS) compared with the control and other treatments. In conclusion, water used for drinking should contain between 3188 and 5740 mg/mL TDS so as to improve the concentration, vigour, motility and volume of semen, and to decrease sperm abnormalities in germinal cells of seminiferous tubule of Morada Nova ram lambs.
Visual lures increase camera-trap detection of the southern cassowary (Casuarius casuarius johnsonii)
Authors: McLean Wren R. , Goldingay Ross L. , Westcott David A.
Published: May 2017

Context Monitoring is a key component in managing wildlife populations and is critical for revealing long-term population trends of endangered species. Cryptic or highly mobile species that occur in low densities and in remote terrain require the development of specific monitoring methods. The southern cassowary is an Australian endangered species that poses many challenges for conducting population surveys. Aims The aims of the present study were to determine the effectiveness of camera traps in detecting cassowaries at a site, to determine whether visual lures increased detection rates, and to explore the potential of camera traps in population surveys. Methods Coloured lures (mimicking large blue and red fruit) were placed in front of a set of camera traps and compared with controls (no lures) at 29 survey sites on the Daintree coast, northern Queensland, Australia. Key results Camera traps with lures (1) detected more birds, (2) had a shorter detection latency, (3) had a marginally greater number of captures, (4) experienced a longer capture duration, (5) were more likely to have the cassowary stop in front of the camera, and (6) achieved a 95% probability of detecting cassowaries in 12 trap days, compared with 28 trap days without lures. Conclusions An increase in the number of cassowaries detected, the reduction in camera latency times and the ability to identify the birds enables a more efficient approach to estimating population sizes over existing methods. This is the first published study to use visual lures to conduct camera trapping of birds. Implications The use of camera traps with lures is a practical and cost-efficient technique for the rapid detection of cassowaries at a site and lends itself to studies of population structure, size and trends.
Melting dynamics of ice in the mesoscopic regime
Authors: Citroni Margherita , Fanetti Samuele , Falsini Naomi , Foggi Paolo , Bini Roberto
Published: May 2017

Significance

The complete unfolding of the melting process, from the nucleation onset to the achievement of a bulk liquid structure, is not known to date for the timescales and the sizes of the heterogeneities involved. Here, we observe in ice the archetypal H-bonded molecular crystal, the evolution of solid/liquid interfaces generated by the absorption of a picosecond infrared pulse. The pulse delivers all of the energy needed for complete melting; therefore, the lattice is homogenously heated from within, above its melting temperature. The growth of liquid domains over distances of micrometers takes hundreds of nanoseconds and is orders of magnitude slower than vibrational dynamics.
Wild tobacco genomes reveal the evolution of nicotine biosynthesis
Authors: Xu Shuqing , Brockmöller Thomas , Navarro-Quezada Aura , Kuhl Heiner , Gase Klaus , Ling Zhihao , Zhou Wenwu , Kreitzer Christoph , Stanke Mario , Tang Haibao , Lyons Eric , Pandey Priyanka , Pandey Shree P. , Timmermann Bernd , Gaquerel Emmanuel , Baldwin Ian T.
Published: May 2017

Significance

Plants produce structurally diverse specialized metabolites, many of which have been exploited in medicine or as pest control agents, whereas some have been incorporated in our daily lives, such as nicotine. In nature, these metabolites serve complex functions for plants’ ecological adaptations to biotic and abiotic stresses. By analyzing two high-quality wild tobacco genomes, we provide an in-depth genomic study that directly associates genome evolution with the assembly and evolution of the nicotine biosynthetic machinery. These results demonstrate the importance of the interplay of gene duplications and transposable element insertions in the evolution of specialized metabolism biosynthetic pathways and illuminate how complex adaptive traits could evolve.
Can you t[æ]ll I’m from M[æ]lbourne?
Authors: Loakes Deborah , Hajek John , Fletcher Janet
Published: May 2017

This study gives an overview of the merger of the dress and trap vowels before laterals, which occurs for some
speakers of Australian English in the state of Victoria (in the south-east of the country), as well as in some other varieties of
English. Research on this phenomenon in Australian English has been preliminary to date, but has uncovered some general tendencies
in distribution, as well as possible motivators for actuation and spread of the change. The aim of this paper is to describe and
orient the phenomenon in the context of English worldwide, and while we work with some illustrative experimental data, our aim is
not to provide a detailed quantitative sociophonetic perspective here. This paper further aims to illustrate the extent of the
variability seen in the Australian English community with respect to ongoing change.
Quantifying cross-linguistic influence with a computational model
Authors: Matusevych Yevgen , Alishahi Afra , Backus Ad
Published: May 2017

Cross-linguistic influence (CLI) is one of the key phenomena in bilingual and second language learning. We propose a method for quantifying CLI in the use of linguistic constructions with the help of a computational model, which acquires constructions in two languages from bilingual input. We focus on the acquisition of case-marking cues in Russian and German and simulate two experiments that employ a picture-choice task tapping into the mechanisms of sentence interpretation. Our model yields behavioral patterns similar to human, and these patterns can be explained by the amount of CLI: the negative CLI in high amounts leads to the misinterpretation of participant roles in Russian and German object-verb-subject sentences. Finally, we make two novel predictions about the acquisition of case-marking cues in Russian and German. Most importantly, our simulations suggest that the high degree of positive CLI may facilitate the interpretation of object-verb-subject sentences.
The venturous bid for the independence of Catalonia
Authors: Colomer Josep M.
Published: May 2017

Following an ambiguous constitutional compromise for democratization, the territorial decentralization of the Spanish state developed by means of political party competition, exchanges, and bargaining. Hence, the so-calledstate of autonomieswas characterized as “non-institutional federalism” [Colomer, Josep M. 1998. “The Spanish ‘State of Autonomies': Non-institutional Federalism.”West European Politics21 (4): 40–52]. In the most recent period, competition and instability have intensified. New developments include, on one side, attempts at recentralizating the state and, on the other side, demands and mobilizations forCatexit, that is, the independence of Catalonia from Spain, which resulted in sustained inter-territorial conflict. This article addresses these recent changes with a focus on the relations between the Spanish and the Catalan governments. The political changes were analyzed as a result of opportunities and incentives offered by a loose institutional framework and the subsequent competitive strategies of extreme party leaders.
Evaluation of acceptor selectivity of Lactococcus lactis ssp. lactis trehalose 6-phosphate phosphorylase in the reverse phosphorolysis and synthesis of a new sugar phosphate
Authors: Taguchi Yodai , Saburi Wataru , Imai Ryozo , Mori Haruhide
Published: May 2017

Trehalose 6-phosphate phosphorylase (TrePP), a member of glycoside hydrolase family 65, catalyzes the reversible phosphorolysis of trehalose 6-phosphate (Tre6P) with inversion of the anomeric configuration to produce β-d-glucose 1-phosphate (β-Glc1P) and d-glucose 6-phosphate (Glc6P). TrePP in Lactococcus lactis ssp. lactis (LlTrePP) is, alongside the phosphotransferase system, involved in the metabolism of trehalose. In this study, recombinant LlTrePP was produced and characterized. It showed its highest reverse phosphorolytic activity at pH 4.8 and 40°C, and was stable in the pH range 5.0–8.0 and at up to 30°C. Kinetic analyses indicated that reverse phosphorolysis of Tre6P proceeded through a sequential bi bi mechanism involving the formation of a ternary complex of the enzyme, β-Glc1P, and Glc6P. Suitable acceptor substrates were Glc6P, and, at a low level, d-mannose 6-phosphate (Man6P). From β-Glc1P and Man6P, a novel sugar phosphate, α-d-Glcp-(1↔1)-α-d-Manp6P, was synthesized with 51% yield.
Embedded 𝐻-planes in hyperbolic 3-space
Authors: Coskunuzer Baris
Published: May 2017

We show that for any

C

0

\mathcal {C}^0

Jordan curve

Γ
\Gamma

in

S

∞

2

(

H

3

)

S^2_{\infty }(\mathbf {H}^3)

, there exists an embedded

H
H

-plane

P

H

\mathcal {P}_H

in

H

3

\mathbf {H}^3

with

∂

∞

P

H

=
Γ

\partial _{\infty } \mathcal {P}_H =\Gamma

for any

H
∈
(
−
1
,
1
)

H\in (-1,1)

. As a corollary, we prove that any quasi-Fuchsian hyperbolic

3
3

-manifold

M
≃
Σ
×

R

M\simeq \Sigma \times \mathbb {R}

contains an

H
H

-surface

Σ
H

\Sigma _H

in the homotopy class of the core surface

Σ
\Sigma

for any

H
∈
(
−
1
,
1
)

H\in (-1,1)

. We also prove that for any

C
1

C^1

Jordan curve in

S

∞

2

(

H

3

)

S^2_{\infty }(\mathbf {H}^3)

, there exists a unique minimizing

H
H

-plane

P

H

\mathcal {P}_H

with

∂

∞

P

H

=
Γ

\partial _{\infty } \mathcal {P}_H =\Gamma

for a generic

H
∈
(
−
1
,
1
)

H\in (-1,1)

.
Back Against the Wall
Authors: Roessler Philip , Verhoeven Harry
Published: May 2017

Through the testimonies of civil administrators and security hawks, this chapter demonstrates the repatriation of nearly a million Rwandans from the camps was not the exorcism Paul Kagame had hoped for, but rather how the opposite was true. The failure to organize screening at the border meant that within months of the return of the refugees the RPF had to confront an insurgency that engulfed the country. With thousands of soldiers deployed in Congo, it could barely stave off the existential menace of the resurgent génocidaires. This context informed how the RPF responded to Kabila’s Katangization. For Kigali, its shrinking influence in Kinshasa was a disaster, as it came just when Kabarebe needed his authority as chief of staff to send Congolese troops to destroy the resurfaced rear bases of the génocidaires in North and South Kivu. The actual divorce was accelerated when intelligence reports began showing the unthinkable was happening: in Kabila’s attempts at escaping Kabarebe’s embrace, his advisors forged links with the génocidaires and supplied them with weapons. This was a point of no return in the security dilemma facing the liberation coalition. Paul Kagame gave the green light to proceed with a regime change strategy in Congo.
Rotation and toroidal magnetic field effects on the stability of two-component jets
Authors: Millas Dimitrios , Keppens Rony , Meliani Zakaria
Published: May 2017

Several observations of astrophysical jets show evidence of a structure in the direction perpendicular to the jet axis, leading to the development of ‘spine and sheath' models of jets. Most studies focus on a two-component jet consisting of a highly relativistic inner jet and a slower – but still relativistic – outer jet surrounded by an unmagnetized environment. These jets are believed to be susceptible to a relativistic Rayleigh–Taylor-type instability, depending on the effective inertia ratio of the two components. We extend previous studies by taking into account the presence of a non-zero toroidal magnetic field. Different values of magnetization are examined to detect possible differences in the evolution and stability of the jet. We find that the toroidal field, above a certain level of magnetization σ, roughly equal to 0.01, can stabilize the jet against the previously mentioned instabilities and that there is a clear trend in the behaviour of the average Lorentz factor and the effective radius of the jet when we continuously increase the magnetization. The simulations are performed using the relativistic MHD module from the open source, parallel, grid adaptive, mpi-amrvac code.
The first Baade–Wesselink analysis of Blazhko RR Lyrae stars: discrepancies between photometrically and spectroscopically determined radius variations
Authors: Jurcsik J. , Hajdu G.
Published: May 2017

The simultaneous photometric and spectroscopic observations of the RR Lyrae variables in the globular cluster, M3, published in Jurcsik et al. (2017, Paper I) made it possible to perform Baade–Wesselink (BW) analysis of a large sample of Blazhko stars for the first time. The BW distances of Blazhko stars turned out to be unreliable, as significantly different distances were obtained for the stars of the Blazhko sample and also for the same star in different modulation phases. Even the results of small modulation–amplitude Blazhko stars may be doubtful. This result warns that the application of the BW method to Blazhko stars is not trustworthy. Keeping the distance fixed for each Blazhko star in each modulation phase, a significant difference between the spectroscopic and the photometric radius (Rsp, Rph) variations is detected. The phase and amplitude variations of Rsp follow the changes of the light curve during the Blazhko cycle but the Rph curve seems to be not (or only marginally) affected by the modulation. The asynchronous behaviour of Rsp and Rph supports the interpretation of the Blazhko effect as a depth-dependent phenomenon, as the spectroscopic radius variation reflects the radial displacement of the line-forming region high in the atmosphere, while the photospheric radius variation is derived from the information of the observed visual-band light emitted mostly by the lower photosphere. The stability of Rph may be interpreted as a strong argument against the non-radial-mode explanation of the Blazhko phenomenon.
Practice Patterns for Neurosurgical Utilization and Outcome in Acute Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials 1 and 2 Studies
Authors: Guo Rui , Blacker David J. , Wang Xia , Arima Hisatomi , Lavados Pablo M. , Lindley Richard I. , Chalmers John , Anderson Craig S. , Robinson Thompson ,   INTERACT Investigators
Published: May 2017

BACKGROUND

The prognosis in acute spontaneous intracerebral hemorrhage (ICH) is related to hematoma volume, where >30 mL is commonly used to define large ICH as a threshold for neurosurgical decompression but without clear supporting evidence.

OBJECTIVES

To determine the factors associated with large ICH and neurosurgical intervention among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT).

METHODS

We performed pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2839) studies of ICH patients (<6 h of onset) with elevated systolic blood pressure (SBP, 150-220 mm Hg) who were randomized to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-recommended (target SBP < 180 mm Hg) management. Neurosurgical intervention data were collected at 7 d postrandomization. Multivariable logistic regression was used to determine associations.

RESULTS

There were 372 (13%) patients with large ICH volume (>30 mL), which was associated with nonresiding in China, nondiabetic status, severe neurological deficit (National Institutes of Health stroke scale [NIHSS] score ≥ 15), lobar location, intraventricular hemorrhage extension, raised leucocyte count, and hyponatremia. Significant predictors of those patients who underwent surgery (226 of 3233 patients overall; 83 of 372 patients with large ICH) were younger age, severe neurological deficit (lower Glasgow coma scale score, and NIHSS score ≥ 15), baseline ICH volume > 30 mL, and intraventricular hemorrhage.

CONCLUSIONS

Early identification of severe ICH, based on age and clinical and imaging parameters, may facilitate neurosurgery and intensive monitoring of patients.
Early Venous Thromboembolism Chemoprophylaxis After Traumatic Intracranial Hemorrhage
Authors: Frisoli Fabio A , Shinseki Matthew , Nwabuobi Lynda , Zeng Xiaopei L , Adrados Murillo , Kanter Carolyn , Frangos Spiros G , Huang Paul P
Published: May 2017

BACKGROUND

Venous thromboembolism is a common complication of traumatic brain injury with an estimated incidence of 25% when chemoprophylaxis is delayed. The timing of initiating prophylaxis is controversial given the concern for hemorrhage expansion.

OBJECTIVE

To determine the safety of initiating venous thromboembolic event (VTE) chemoprophylaxis within 24 h of presentation.

METHODS

We performed a retrospective analysis of patients with traumatic intracranial hemorrhage presenting to a level I trauma center. Patients receiving early chemoprophylaxis (<24 h) were compared to the matched cohort of patients who received heparin in a delayed fashion (>48 h). The primary outcome of the study was radiographic expansion of the intracranial hemorrhage. Secondary outcomes included VTE, use of intracranial pressure (ICP) monitoring, delayed decompressive surgery, and all-cause mortality.

RESULTS

Of 282 patients, 94 (33%) received chemoprophylaxis within 24 h of admission. The cohorts were evenly matched across all variables. The primary outcome occurred in 18% of patients in the early cohort compared to 17% in the delayed cohort (P = .83). Fifteen patients (16%) in the early cohort underwent an invasive procedure in a delayed fashion; this compares to 35 patients (19%) in the delayed cohort (P = .38). Five patients (1.7%) in our study had a VTE during their hospitalization; 2 of these patients received early chemoprophylaxis (P = .75). The rate of mortality from all causes was similar in both groups.

CONCLUSION

Early (<24 h) initiation of VTE chemoprophylaxis in patients with traumatic intracranial hemorrhage appears to be safe. Further prospective studies are needed to validate this finding.
Early Postoperative Complications for Elderly Patients Undergoing Single-Level Decompression for Lumbar Disc Herniation, Ligamentous Hypertrophy, or Neuroforaminal Stenosis
Authors: Prabhu Arpan V , Lieber Bryan A , Henry Jenson K , Agarwal Nitin , Tabbosha Monir , Okonkwo David O
Published: May 2017

BACKGROUND

Lumbar decompression for disc herniation is frequently performed on elderly patients, and this trend will continue as the population ages. Clinical reports on the complications of lumbar discectomy show good results and cost effectiveness in young or middle-aged patients.

OBJECTIVE

To assess and compare the morbidity of single-level lumbar disc surgery for radicular pain in a cohort of patients greater than 80 yr of age to that of a middle-aged cohort.

METHODS

A total of 9451 patients who received a single-level lumbar decompression procedure for disc displacement without myelopathy were retrospectively selected from a multicenter validated surgical database from the American College of Surgeons National Surgical Quality Improvement Program. A cohort with 485 patients greater than 80 yr of age (80+) was compared with a middle-aged cohort with 8966 patients between 45 and 65 yr. Preoperative comorbidity and postoperative outcome variables observed included mortality, myocardial infarction, return to the operating room, sepsis, deep vein thrombosis, transfusions, cardiac arrest necessitating cardiopulmonary resuscitation, coma greater than 24 h, urinary tract infection, acute renal failure, use of ventilator greater than 24 h, pulmonary embolism, pneumonia, wound dehiscence, and postoperative infection.

RESULTS

The preoperative comorbidities and characteristics were significantly different between the middle-aged and the 80+ cohorts, with the older cohort having many more preoperative comorbidities. There was statistically significantly greater postoperative morbidity among the 80+ cohort regarding pulmonary embolism (0.8% vs 0.2%, P = .037), intra/postoperative transfusion requirement (1.9% vs 0.7%, P = .01), urinary tract infection (1.2% vs 0.3%, P = .011), and 30-d mortality (0.4% vs 0.1%, P = .046).

CONCLUSION

In this large sample of patients who received a single-level lumbar decompression procedure for disc displacement without myelopathy, elderly patients, particularly with American Society of Anesthesiologists class 3 and 4, had a statistically significant increase in morbidity and mortality, but the overall risk of complications remains low.
Extreme Weather and Climate
Authors: Otto Friederike
Published: May 2017

Natural disasters and extreme weather events have been of great societal importance throughout history and often brought everyday life to a catastrophic halt, in a way sometimes comparable to wars and epidemics, only without the lead time. Extreme weather events with large impacts serve as an anchor point of the collective memory of the population in the affected area. Every northern German of the right age remembers the storm surge of 1962 and where they were at the time and has friends or family effected by the event. The “dust bowl” of the 1930s with extensive droughts and heat waves shaped the life of a generation in the United States, and the Sahel droughts in the 1960s and 1970s led to famine and dislocation of population on a massive scale the region arguably never quite recovered from. Hurricane Hyian in 2013 is said to have directly influenced the outcome of the annual Conference of the Parties (COP) United Nation Framework Convention for Climate Change Negotiations in Warsaw, leading to the inclusion of a mechanism to deal with loss and damage from climate-related disasters. Though earthquakes are still fairly unpredictable on short timescales, this is not the case for weather events. Weather forecasts today are so good that we normally know the time and location of the landfall of a hurricane within a 100-mile radius days in advance. Improvements in the prediction of slow-onset events such as droughts (which depend on the rainfall over a large region and whole season) are less striking but have still improved dramatically in the late 20th and early 21st centuries. One of the major reasons for the large increase in the accuracy of weather forecasts is the exponential increase in computing power, which allows scientists to predict and study extreme weather events using complex computer models, simulating possible weather events under certain conditions to understand the statistics of and physical mechanisms behind extreme events. Extreme events are by definition rare and thus impossible to understand from historical records of weather observation alone. Despite the progress on our understanding of and ability to predict extreme weather events, substantial uncertainties remain. Two aspects are of particular importance. Firstly, we know that the climate is changing, having observed almost a one-degree increase in global mean temperature. However, global mean temperature doesn’t kill anyone, extreme weather events do. Their frequency and intensity is changing and will continue to change, but the extent of these changes depends on a host of both global and local factors. Secondly, whether or not a rare weather event leads to extreme impacts depends largely on the vulnerability and exposure of the affected societies. If these are high, even a perfectly forecasted weather event leads to disaster.
Parts of a Whole
Authors: Champollion Lucas
Published: May 2017

Why can I tell you that I ran for five minutes but not that I *ran all the way to the store for five minutes? Why can you say that there are five pounds of books in this package if it contains several books, but not *five pounds of book if it contains only one? What keeps you from using *sixty degrees of water to tell me the temperature of the water in your pool when you can use sixty inches of water to tell me its height? And what goes wrong when I complain that *all the ants in my kitchen are numerous? The constraints on these constructions involve concepts that are generally studied separately: aspect, plural and mass reference, measurement, and distributivity. This work provides a unified perspective on these domains, connects them formally within the framework of algebraic semantics and mereology, and uses this connection to transfer insights across unrelated bodies of literature and formulate a single constraint that explains each of the judgments above. This provides a starting point from which various linguistic applications of mereology are developed and explored. The main foundational issues, relevant data, and choice points are introduced in an accessible format.
Rice black-streaked dwarf virus Genome in China: Diversification, Phylogeny, and Selection
Authors: Zhou Yu , Zhang Lin , Zhang Xiaoming , Zu Hongyue , Di Hong , Dong Ling , Liu Xianjun , Zeng Xing , Weng Jianfeng , Wang Zhenhua , Li Xinhai
Published: May 2017

Rice black-streaked dwarf virus (RBSDV), a Fijivirus, causes maize rough dwarf disease and rice black-streaked dwarf disease in the summer maize-growing regions of the Yellow and Huai rivers, respectively, in China. Nevertheless, the diversification and selection of the entire genome from S1 to S10 have not been illuminated. Molecular variation, evolution, conserved regions, and other genomic properties were analyzed in 21 RBSDV isolates from maize (Zea mays L.) and rice (Oryza sativa) hosts sampled from nine geographic locations in China. Low codon adaptation index values ranging from 0.1878 to 0.2918 indicated a low degree of codon-usage bias and low potential expression for all 13 RBSDV open reading frames (ORFs). ORF9-2 showed a stronger effect of codon usage bias than did other ORFs, as the majority of points for this ORF lay close to the standard curve in the Nc plot (the effective number of codons [Nc] versus the frequency of G+C at synonymous third-base positions [GC3]). A 9-bp deletion mutation was detected in the RBSDV genome in the 3′ UTR of S8. Nucleotide diversity analysis indicated that the structural proteins of RBSDV, such as S2 and S4, were all more conserved than nonstructural proteins such as S9. Nucleotide diversity (π) was highest among S9 sequences (0.0656), and was significantly higher than among S4 sequences (0.0225, P < 0.01). The number of conserved regions among the 10 segments varied substantially. The highest number of conserved regions (5) was found in S5, whereas no conserved regions were identified in S9. Nucleotide diversity and the number of conserved regions were independent of the lengths of segments. Nucleotide diversity was also not correlated with the number of conserved regions in segments. Ten recombination events in 21 isolates were found in seven segments with breakpoint positions in UTRs, intergenic spacer regions, and gene coding regions. The number of recombination events was also independent of the lengths of segments. RBSDV isolates from China could be phylogenetically classified into two groups using either 10 segment sequences or the concatenated sequence of S1 through S10, regardless of host or geographical location. The phylogenetic tree generated from pairwise nucleotide identities of individual RBSDV segments such as S9 and S3, with nucleotide identity values of 93.74% and 95.86%, respectively, is similar to the tree constructed from the concatenated sequences of the entire RBSDV genome. The 13 RBSDV ORFs were under negative and purifying selection (Ka/Ks < 1). ORF5-2 was under the greatest selection pressure; however, ORF2, which encodes the core protein of RBSDV, was under the lowest selection pressure.
A young man with recurrent paralysis
Authors: Chavez Magdalena , Williams Jeffrey
Published: May 2017

Hypokalemia can cause reactions from mild muscular cramping to life-threatening paralysis and cardiac dysrhythmias. This article describes a patient whose unusual, recurrent muscular symptoms and electrolyte abnormalities were eventually identified as Gitelman syndrome, a rare genetic disorder resulting in severe refractory hypokalemia.
Immunotherapy for lung cancer
Authors: Vafadar Sam
Published: May 2017

Lung cancer is the third most common cancer in the United States and the top cause of cancer-related mortality in men and women. Despite advances in chemotherapy, molecular therapies, and CT screening, overall survival remains dismal. Additional options and a new treatment paradigm are needed. This article focuses on immunotherapy, a promising new approach targeted at the PD-1 inhibition pathway.
Brief Psychological Screening Questions Can be Useful for Ruling Out Psychological Conditions in Patients With Chronic Pain
Authors: Vaegter Henrik B. , Handberg Gitte , Kent Peter
Published: May 2017

Objectives:

Psychological symptoms are highly prevalent in chronic pain patients. Timely and accurate identification may enable individualized treatment and improve outcomes. The aims of this study were to (1) investigate the concurrent validity of brief psychological screening questions assessing anxiety, fear of movement, stress, pain catastrophization, and depression in chronic pain patients, and (2) to determine screening question cut-points at which the likely probability of having these psychological states was <10%.

Materials and Methods:

Responses to 1-item or 2-item screening questions within each of these 5 psychological constructs were compared with those of validated full-length questionnaires in 894 patients with diverse chronic pain conditions.

Results:

Compared with scores from full-length questionnaires, brief screening question scores had correlations between 0.54 and 0.66, and area under the curve between 0.79 and 0.83. At the dichotomized threshold scores that we chose, the posttest probability after a negative test result ranged from 6.5% to 8.6% for all these psychological constructs, except fear of movement. The pretest probability was so high (70%) for fear of movement that no threshold resulted in a posttest probability (negative test result) that was below 10%.

Discussion:

Use of these screening tests and scoring thresholds would have correctly identified that between 38.5% and 60.5% of the sample were unlikely to have these psychological states (true negatives), with a false-negative rate between 3.4% and 5.3%. This would allow clinicians to focus on whether there are other patient attributes in those patients requiring more thorough investigation using comprehensive validated questionnaires or structured clinical interviews.
Physical activity, sedentary time, and risk of colorectal cancer: the Singapore Chinese Health Study
Authors: Eaglehouse Yvonne L. , Koh Woon-Puay , Wang Renwei , Aizhen Jin , Yuan Jian-Min , Butler Lesley M.
Published: May 2017

Singapore has experienced a marked increase in colorectal cancer incidence over the past 40 years. Evidence from prospective studies in Western Europe and the USA suggests that low physical activity and high amounts of sedentary time are associated with increased colorectal cancer risk. The aim of this study is to evaluate these relationships in an Asian population. The Singapore Chinese Health Study enrolled 63 257 adults between 1993 and 1998. At enrollment, participants reported past year physical activity and time spent sitting. Incident colorectal cancers (n=1994) were identified through 31 December 2014. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for potential confounders. Any strenuous–vigorous or moderate physical activity was reported by 13.7 and 22.1% of the cohort, respectively. Strenuous–vigorous physical activity was associated with statistically significant reduced colorectal cancer risk (HR=0.85; 95% CI: 0.74–0.99 for ≥0.5 h/week vs. none), but moderate was not. In analysis stratified by time spent watching television, an inverse relationship between moderate physical activity and colorectal cancer risk (HR=0.86; 95% CI: 0.72–1.01 for ≥0.5 h/week vs. none) was observed for those who reported at least 3 h/day sitting watching television (P
interaction=0.042). Participation in strenuous–vigorous physical activity, such as jogging, swimming, or heavy manual labor, was associated with reduced colorectal cancer risk among Singapore Chinese. Further research on physical activity and sedentary behaviors, independently and in combination, and colorectal cancer risk in Asian populations is needed.
Prevention of Trastuzumab and Anthracycline-induced Cardiotoxicity Using Angiotensin-converting Enzyme Inhibitors or β-blockers in Older Adults With Breast Cancer
Authors: Wittayanukorn Saranrat , Qian Jingjing , Westrick Salisa C. , Billor Nedret , Johnson Brandon , Hansen Richard A.
Published: May 2017

Purpose:

Although clinical trials have provided some data on the benefit of angiotensin-converting enzyme inhibitors (ACEIs) or β-blockers (BBs) in patients with chemotherapy-induced cardiotoxicity, evidence of ACEIs/BBs on prevention of trastuzumab and/or anthracycline-induced cardiotoxicity outside trials is limited.

Materials and Methods:

A cohort study of 142,990 women (66 y and above) newly diagnosed with breast cancer from 2001 to 2009 was conducted using the Surveillance, Epidemiology, and End Results-Medicare–linked database. The ACEI/BB exposure was defined as filled prescription(s) before or after the initiation of trastuzumab/anthracyclines. The nonexposed group was defined as those who had never been prescribed ACEIs/BBs. Cumulative rates of cardiotoxicity and all-cause mortality were estimated and marginal structural Cox models were used to determine factors associated with cardiotoxicity and all-cause mortality adjusting for baseline covariates and use of chemotherapy. All statistical tests were 2 sided.

Results:

The final sample included 6542 women. Adjusted hazard ratio for cardiotoxicity and all-cause mortality for the ACEI/BB exposed group were 0.77 (95% confidence interval, 0.62-0.95) and 0.79 (95% confidence interval, 0.70-0.90) compared with the nonexposed group, respectively. Starting ACEIs/BBs≤6 months after the initiation of trastuzumab/anthracyclines and having exposed duration≥6 months were also associated with decreased risk of cardiotoxicity and all-cause mortality. Baseline characteristics, including age, non-Hispanic black, advanced cancer, region, comorbidity, preexisting cardiovascular conditions, lower socioeconomic status, and concomitant treatment were significantly associated with an elevated risk of all-cause mortality and/or cardiotoxicity (all P<0.05).

Conclusions:

ACEIs/BBs show favorable effects on preventing cardiotoxicity and improving survival in female breast cancer patients undergoing trastuzumab/anthracycline treatment.
Nitric oxide pathway presumably does not contribute to antianxiety and memory retrieval effects of losartan
Authors: Aghaei Iraj , Arjmand Shokouh , Yousefzadeh Chabok Shahrokh , Tondar Mahdi , Shabani Mohammad
Published: May 2017

Nitric oxide (NO) and angiotensin (AT) receptors have demonstrated well-established interactions in various physiological phenomena. AT1 receptors can play a part in stress-induced activation of the hypothalamic–pituitary–adrenal axis; also, angiotensinergic neurotransmission plays a pivotal role in stress-evoked physiological responses. On the basis of the stress-modulating characteristics of NO, AT1, and AT2 receptors, the present study evaluated the roles of NO and AT1 receptors in the attenuation of stress-induced anxiety-like behaviors after administration of losartan, an AT1 antagonist. Male Wistar rats were exposed to the communication stress box, using a novel method to induce physical or emotional stress, and losartan (10 mg/kg), losartan+l-NG-nitroargininemethyl ester (l-NAME), l-NAME (1, 10, and 100 mg/kg), and normal saline-treated groups were compared. Losartan had reduced behavioral changes induced by both types of stressor and enhanced memory retrieval. Anxiety-like behaviors were significantly attenuated by administration of losartan, to a greater extent in the emotional rather than physical stress group. None of the injected dosages of l-NAME reversed the antianxiety and memory retrieval effects of losartan. Our results indicate that losartan probably improves memory retrieval and lessens anxiety-like behaviors through mechanisms other than the NO pathway.
Interbrachial Pinch by Trapezius Transfer in Amyoplasia Congenita: A Case Report
Authors: Thione Alessandro , Cavadas Pedro C. , Espadero Alberto Perez , Rubi Carlo G.
Published: May 2017

Amyoplasia congenita, or “classic distal arthrogryposis,” is the most common disorder among the congenital, non-progressive, multiple joint contractural conditions named arthrogryposis. The cause remains unknown, and it occurs sporadically. Abnormal neurological examination indicates that movement in utero was diminished as a result of an abnormality of the central or peripheral nervous system, the motor end plate, or muscle. The absence of central neural pathology indicates the origin in akinetic fetal condition. Three weeks are enough to cause muscle weakness and joint fibrosis. Joint contractures in amyoplasia are often rigid and refractory to nonoperative treatment such as passive stretching. Surgery is focused on each patient's need respecting adaptive maneuvers to accomplish daily tasks. We present a case in which pectoral major muscle had no strength for pinching; a trapezius muscle transfer was planned to obtain an interbrachial pinch useful for grasping.
Exposure to oral contraceptives increases the risk for development of inflammatory bowel disease: a meta-analysis of case-controlled and cohort studies
Authors: Ortizo Ronald , Lee Stephanie Y. , Nguyen Emily T. , Jamal Mohammad Mazen , Bechtold Matthew M. , Nguyen Douglas L.
Published: May 2017

Background

The oral contraceptive pill (OCP) is a widely used method of contraception. There have been conflicting studies linking the use of OCPs to the development of inflammatory bowel disease (IBD). The intent of this meta-analysis is to better define the association between OCP exposure and the risk for development of IBD.

Methods

A thorough search of multiple databases, including Scopus, Cochrane, MEDLINE/PubMed, and CINAHL, and abstracts from major gastroenterology meetings was performed (October, 2016). Studies reporting the development of IBD in patients with or without previous exposure to OCP, compared with healthy controls, were included. A meta-analysis was completed using the Mantel–Haenszel model to evaluate the risk of developing IBD in the setting of previous OCP exposure.

Results

In a complete analysis of 20 studies, there appeared to be over a 30% increased risk for the development of IBD in patients exposed to OCP compared with patients not exposed to OCP [odds ratio (OR): 1.32, 95% confidence interval (CI): 1.17–1.49, P<0.001, I
2=14%]. More specifically, there was a 24% higher risk for developing Crohn’s disease (OR: 1.24, 95% CI: 1.09–1.40, P<0.001; I
2=38%) and a 30% higher risk for developing ulcerative colitis (OR: 1.30, 95% CI: 1.13–1.49, I
2=26%) in patients exposed to OCP compared with those not exposed to the medication.

Conclusion

The use of OCP is associated with an increased risk for development of Crohn’s disease and ulcerative colitis in the genetically susceptible host. The total duration, dose of OCP exposure, and the risk for development of IBD need to be better characterized.
Late Effects in Pediatric High-risk Neuroblastoma Survivors After Intensive Induction Chemotherapy Followed by Myeloablative Consolidation Chemotherapy and Triple Autologous Stem Cell Transplants
Authors: Armstrong Amy E. , Danner-Koptik Karina , Golden Shannon , Schneiderman Jennifer , Kletzel Morris , Reichek Jennifer , Gosiengfiao Yasmin
Published: May 2017

Multimodal treatment in high-risk neuroblastoma has modestly improved survival; limited data exist on the late effects from these regimens. We report the sequelae of treatment incorporating 3 consecutive cycles of high-dose therapy and autologous stem cell transplants (ASCTs) without the use of total body irradiation (TBI). We reviewed the medical records of 61 patients treated on or following the Chicago Pilot 2 protocol between 1991 and 2008. Of the 25 patients who are alive (41%), 19 had near complete data to report. Specific treatment modalities and therapy-related side effects were collected. Fourteen of these 19 patients (74%) received 3 cycles of high-dose therapy with ASCT; follow-up occurred over a median of 13.9 years (range, 5.8 to 18.8 y). The majority of late effects were endocrine-related, including growth failure, hypothyroidism, and hypogonadism. Patients also developed secondary neoplasms and skeletal deformities. The most frequent sequela was hearing loss, seen in 17/19 patients. We found a high prevalence of various late effects in survivors of high-risk neuroblastoma using a non–TBI-based regimen including 3 cycles of high-dose therapy with ASCTs. As current treatment regimens recommend tandem ASCT without TBI, it is imperative that we understand and monitor for the sequelae from these modalities.
Central Hematocrit Levels in Fetal Malnourished Term Infants
Authors: Ertaş Kerem , Salihoğlu Özgül , Can Emrah , Hatipoğlu Sami , Hamilçikan Şahin
Published: May 2017

Backround:

Fetal malnutrition is especially important for common chronic diseases in adult life. They could potentially be prevented by achieving optimal fetal nutrition.

Objective:

The aim of this study was to investigate hematocrit levels of malnourished, term, appropriate for gestational age (AGA) neonates.

Subjects and Methods:

A total of 80 AGA neonates (between 10% and 90% percentiles interval according to birth week), born with spontaneous vaginal delivery between 37 and 42 weeks of gestation, detected by both last menstrual period and ultrasonography measurements, were included in the study. Neonates with fetal malnutrition constituted the study group and the control group consisted of well-nourished neonates. We analyzed central venous hematocrit levels obtained 4 hours after birth and maternal risk factors for both groups.

Results:

Although there were no differences in gestational age, head circumference, maternal factors (gravidity, parity, abortions and curettage counts, maternal tobacco use, preeclampsia, hypertension, diabetes mellitus, gestational diabetes mellitus, and history of urinary tract infections), first minute APGAR scores, and sex, Clinical Assessment of Nutritional Status score was lower (29.91±2.87 vs. 21.25±1.65) and hematocrit levels were higher (51.33±2.740 vs. 59.53±5.094) in the fetal malnutrition group (P<0.0001).

Conclusions:

Central hematocrit levels in malnourished term AGA neonates were found significantly higher than well-nourished term AGA newborns.