bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal triangular alopecia: significance of trichoscopy in differential diagnosis
Authors: Karadağ Köse Ö. , Güleç A.T.
Published: September 2014

Background

There are only two case reports in literature regarding the trichoscopic features of temporal triangular alopecia (TTA). Differential diagnosis of other types of localized alopecia such as alopecia areata is necessary in some cases.

Objective

To evaluate the potential benefit of trichoscopy in the clinical diagnosis of TTA.

Methods

Nine patients with a clinical diagnosis of TTA were included in the study. Trichoscopic examination was performed by a polarized‐light handheld dermatoscope with a 10‐fold magnification. The images were obtained by a digital camera that produced imagery with a 3‐fold optical zoom.

Results

Short vellus hairs, vellus hair length diversity and white hairs were encountered in all subjects, while white dots, honeycomb pigment pattern, arborising red lines and epidermal scale were noted in 22%–33% of them. None of the cases showed trichoscopic features such as tapering hairs, yellow dots or loss of follicular openings.

Conclusion

We suggest that it seems possible to differentiate TTA by a handheld dermatoscope. Short vellus hairs with length diversity and white hairs in the absence of diagnostic features of other types of localized alopecia should be considered in favour of TTA.
Paradigms, Processes, and Values in Family Research
Authors: Barton Allen W. , Bishop Robert C.
Published: September 2014

In research on the family, considerable amounts of scholarship have occurred with respect to central domains of theory, methodology, and substantive content. In contrast, attention to philosophy, another domain whose influence is arguably just as central, appears noticeably scant. Considering philosophical issues reveals important yet frequently unrecognized values, beliefs, and modes of inquiry that underlie and inform research endeavors. The present article offers an accessible overview of important philosophical and paradigmatic issues that arise in family research, specifically describing different modes of social inquiry as well as cultural ideals and values embedded in family research. In doing so, implications for current and future family research are highlighted and discussed.
THE EUROPE–U.S. PRODUCTIVITY GAP IN A REAR‐VIEW MIRROR: WILL MEASUREMENT DIFFERENCES IN THE SERVICES SECTOR OUTPUT PLEASE RISE?
Authors: Harchaoui Tarek M.
Published: September 2014

The deterioration in 1995 of Europe's productivity performance relative to the U.S. coincided with the ‘renaissance’ of the U.S. statistical system, which can be regarded, by now, as the frontier in official statistics. This paper raises the natural question whether the European statistical system was ‘left at the station’ while its U.S. counterpart ‘departed’, making it possible for measurement differences to become the primary suspect for the existing productivity gap. My retrospective review of the development path in the services sector productivity statistics suggests that Europe lags significantly behind the U.S. in the services producer price index program, both in terms of scope and timing of its implementation. Accordingly, the role of these measurement differences in the post‐1995 Europe–U.S. productivity story cannot reasonably be ruled out. The paper concludes with a ‘structured guess’ that provides a circumstantial evidence on the benefits generated by the upgrades in the U.S. services sector statistics. The results show that these enhancements led to two kinds of benefits during the post‐1995 period – a considerable reduction in the contribution of industries that traditionally dampened the aggregate productivity trend combined with a larger contribution of those that generally lifted it. This contrasts markedly with Europe where the contribution of these two sources remained unchanged in the meantime.
END‐OF‐LIFE CARE IN ADVANCED KIDNEY DISEASE: ETHICAL AND LEGAL ISSUES AND KEY CHALLENGES FOR BLACK AND MINORITY ETHNIC GROUPS
Authors: Cronin Antonia J.
Published: September 2014

Advances in modern medical technology have gone so far that it is now possible for machinery to keep people alive. To some extent this has led to a misperception in society that death can almost always be postponed because life‐sustaining extracorporeal machinery of some sort or another, for example a dialysis machine, can prevent it. However, for some, being kept alive connected to a dialysis machine for four hours three times a week does not represent or even come close to an existence or quality of life they consider valuable. It may even cause unnecessary distress. This may be because they have reached a point at the end of their lives where they would like the focus of their treatment or care to become that which enables them to live as well as possible until they die. In these circumstances treatment and care should properly be that which enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. Identifying and acknowledging the importance of such a paradigm shift in the delivery of healthcare, and above all facilitating it, includes taking on the responsibility, incumbent upon us all, to address the ethical issues that are brought into focus. In this paper, I examine some of these issues. I consider the ways in which underlying theoretical ethical principles have informed the development of professional guidance and highlight the dynamic relationship this guidance has with the law. Finally, I demonstrate the ways in which it can be usefully applied to inform and assist clinical decision‐making. Key challenges for BAME groups are addressed.
Daytime physical activity and sleep in pre‐schoolers with developmental disorders
Authors: Tatsumi Yukako , Mohri Ikuko , Shimizu Sachiko , Tachibana Masaya , Ohno Yuko , Taniike Masako
Published: September 2014

Aim

This study aims to investigate the association between daytime physical activity (PA) and sleep in pre‐schoolers with or without autism spectrum disorders (ASDs).

Method

Thirty‐one pre‐school children with ASD and 16 age‐matched controls were recruited. Sleep and PA patterns were measured with an Actiwatch for 7 days. After average PA values were calculated for three periods (morning, afternoon and evening) of each day for each child, the days with maximum (active) and minimum (inactive) PA values for these three periods were determined. The Wilcoxon signed‐rank test was used to compare sleep following active mornings, afternoons and evenings with that following inactive time periods.

Results

In control children, sleep onset time following active mornings/afternoons did not differ from that following inactive mornings/afternoons. In contrast, sleep onset following the most inactive morning (median sleep onset time: 9:57 pm) and the most inactive afternoon (median sleep onset time: 10:24 pm) began significantly later than that following the most active mornings (median sleep onset time: 9:21 pm) and the most active afternoons (median sleep onset time: 9:39 pm) in children with ASD. The percentage of sleep for control children following active mornings was significantly higher (median: 93.2%) than that following inactive ones (median: 91.7%). Significant associations were not found between evening PA and sleep in either ASD or control children.

Conclusions

A high level of morning and afternoon PA can advance the sleep phase in children with ASD.
Context‐dependent stress responses and their connections to fitness in a landscape of fear
Authors: Jaatinen K. , Seltmann M. W. , Öst M.
Published: September 2014

The acute glucocorticoid stress response is presumed to facilitate escape from life‐threatening situations such as predation and thus it is assumed to be linked to fitness. However, the fitness effects of glucocorticoid reactivity remain controversial, as these effects may be context‐dependent. Individuals differing in their emphasis on current versus future reproduction may differ in their risk‐taking under threat of predation; this variation in risk‐taking may be mediated by variations in stress reactivity. We set out to test whether predation risk (island‐ and year‐specific proportion of depredated nests) modified the relationships between stress responsiveness and current reproductive investment (clutch weight) and between stress responsiveness and reproductive success (viable proportion of the clutch) in the long‐lived female eider Somateria mollissima. This study system shows large spatial and annual fluctuations in predation risk, indexed by the annual island‐specific proportion of depredated nests. The capture stress‐related corticosterone output was attenuated with increasing clutch weight under low predation pressure but elevated under severe predation pressure, and females in well‐concealed nests had lower stress responsiveness. The viable proportion of the clutch decreased with increasing corticosterone reactivity under low to moderate predation pressure, but slightly increased under severe predation pressure. The acute stress response may thus mediate adaptive plasticity; dampened stress reactivity may ensure successful reproduction under low predation threat or in nest sites reducing detection by visual predators, whereas preparing for potential attacks may be favoured under elevated predation risk.
AFTERWORD: PUBLIC SECTOR ANTHROPOLOGISTS AND NEW DIRECTIONS FOR A PUBLIC ANTHROPOLOGY
Authors: Ono Sarah S. , Solimeo Samantha L.
Published: September 2014

In this final contribution in the edited volume on anthropologists working in the Veterans Health Administration within the Department of Veterans Affairs (VA), the authors reflect on how developments in recent years have brought us to this moment in time from the “insider” perspective of VA anthropologists. These collected papers provide ethnographic evidence for the innovative ways in which anthropologists employed in the public sector constitute a public anthropology that is theoretically informed, actionable, and cognizant of its role in the production of authoritative knowledge. The “afterword” makes connections between the chapters, with their varied topics, and addresses how this volume points to new destinations for engaged and ethical research in the growing field of public sector anthropology.
EMPOWERING VETERANS WITH PTSD IN THE RECOVERY ERA: ADVANCING DIALOGUE AND INTEGRATING SERVICES
Authors: Finley Erin P.
Published: September 2014

As highly effective treatments for posttraumatic stress disorder (PTSD) become increasingly available, how will the VA (Department of Veterans Affairs) and other public institutions navigate complex questions around appropriate services for Veterans with PTSD? This and related questions will be examined in this article in light of epidemiological, clinical, and ethnographic data on combat PTSD in the 21st century.
EVALUATING SECURE MESSAGING FROM THE VETERAN PERSPECTIVE: INFORMING THE ADOPTION AND SUSTAINED USE OF A PATIENT‐DRIVEN COMMUNICATION PLATFORM
Authors: Haun Jolie N. , Lind Jason D. , Shimada Stephanie L. , Simon Steven R.
Published: September 2014

Secure messaging (SM) is a secured asynchronous electronic e‐mail system within the Veterans Health Administration web‐based patient portal, My Health eVet. This electronic tool is part of a national transformation initiative to create new models of care to support patient‐provider communication and promote self‐care management. SM is designed to empower patients to communicate with their providers, but to date little research has evaluated Veterans’ perspectives on using SM as a communication tool. This article provides an overview of a qualitative mixed‐methods study with 33 Veterans who opted‐in to use SM. We used a combination of in‐depth interviews, user‐testing, three‐month review of secondary SM data, and three‐month follow‐up phone interviews to understand Veterans’ experiences using SM. Synthesizing these data, we identified high‐ and low‐volume users and characterized their reasons for using or not using SM. These profiles illustrate the Veteran perspective, enabling clinicians, administrators, and other stakeholders to understand how to adapt marketing and educational strategies and make system changes to promote and facilitate Veteran adoption and sustained use of SM as a communication tool.
OBSERVERS OBSERVED: EXPLORING THE PRACTICE OF ANTHROPOLOGY IN THE VA
Authors: McCullough Megan B. , Hahm Bridget , Ono Sarah
Published: September 2014

From our position as publicly funded anthropologists in the Veterans Affairs, we discuss how anthropological research on Veterans health care offers an opportunity to critically engage with ideas about what constitutes public anthropology. As public sector anthropologists, we are conducting theoretically and ethnographically innovative work. In this chapter, we discuss the implications of this work in regard to anthropological theory and practice.
“YOU NEVER HEARD JESUS SAY TO MAKE SURE YOU TAKE TIME OUT FOR YOURSELF”: MILITARY CHAPLAINS AND THE STIGMA OF MENTAL ILLNESS
Authors: Besterman‐Dahan Karen , Lind Jason D. , Crocker Theresa
Published: September 2014

The wars in Iraq and Afghanistan have taken a toll on military chaplains (MCs) who often return from deployment with high levels of stress, yet are expected to counsel on a daily basis without decompression of their own, potentially exacerbating any personal trauma. MC with posttraumatic stress disorder (PTSD) who have had deployments abridged due to their positive PTSD screen have reported shame due to leaving service members in their unit in danger while they went to safety. Many MCs report compassion fatigue, PTSD, reintegration issues, and adverse effects to their personal energy, motivation, and mental and spiritual well‐being postdeployment, related to stressors from deployment and combat exposure. Only 23–40 percent of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) service members with a psychiatric disorder seek mental health care, citing stigma as a primary barrier. For MCs, stigma is compounded by a culture in which military health care providers, including MCs, are encouraged to deny their own needs to provide the necessary support to beneficiaries. This paper reviews a pilot study, which explored the impact of operational stress on the psychosocial health and reintegration of MCs, focusing on findings related to mental health and stigma within the military chaplaincy.
THE ROLE OF SOCIAL NETWORKS FOR VETERANS WITH SPINAL CORD INJURY IN OBTAINING EMPLOYMENT
Authors: Cotner Bridget A. , Keleher Jennie , O'Connor Danielle R. , Trainor John K. , Ottomanelli Lisa
Published: September 2014

The purpose of this article is to demonstrate the use of ethnographic methods to explore the types of social support provided to Veterans with spinal cord injuries (SCIs) who are participating in an employment program. Interview data with Veterans and their social support members along with employment narratives written after a job was secured are used to document the types of support provided to Veterans with SCI to facilitate obtaining and maintaining employment. The impact of social support on mental and physical health is well documented in the literature; however, there is a need for research on the influence of social support on employment. As applied in VA spinal cord care, the “individual placement and support (IPS)” model of supported employment for vocational rehabilitation integrates vocational services into clinical treatment, and includes social support members in the pursuit of employment goals. Guided by theories of social capital, the types of social support provided to Veterans were classified into three types: instrumental, informational, and emotional. Analysis of data showed that for all Veterans with SCI, some form of social support was needed to aid in finding and maintaining employment, demonstrating the need for evidence‐based supported employment (EBSE) services in the VA spinal cord system of care.
Distribution across tissue layers of extrinsic nerves innervating the mouse colorectum – An in vitro anterograde tracing study
Authors: Brumovsky Pablo R. , La Jun‐Ho , Gebhart Gerald F.
Published: September 2014

Background

Anterograde in vitro tracing of the pelvic nerve (PN) and visualization in the horizontal plane in whole mount preparations has been fundamental in the analysis of distribution of peripheral nerves innervating the colorectum. Here, we performed a similar analysis, but in cryostat sections of the mouse colorectum, allowing for a more direct visualization of nerve distribution in all tissue layers.

Methods

Colorectum with attached PNs was dissected from adult male BalbC mice. Presence of active afferents was certified by single fiber recording of fine PN fibers. This was followed by ‘bulk’ (all fibers) anterograde tracing using biotinamide (BTA). Histo‐ and immunohistochemical techniques were used for visualization of BTA‐positive nerves, and evaluation of co‐localization with calcitonin gene‐related peptide (CGRP), respectively. Tissue was analyzed using confocal microscopy on transverse or longitudinal colorectum sections.

Key Results

Abundant BTA‐positive nerves spanning all layers of the mouse colorectum and contacting myenteric plexus neurons, distributing within the muscle layer, penetrating deeper into the organ and contacting blood vessels, submucosal plexus neurons or even penetrating the mucosa, were regularly detected. Several traced axons co‐localized CGRP, supporting their afferent nature. Finally, anterograde tracing of the PN also exposed abundant BTA‐positive nerves in the major pelvic ganglion.

Conclusions & Inferences

We present the patterns of innervation of extrinsic axons across layers in the mouse colorectum, including the labile mucosal layer. The proposed approach could also be useful in the analysis of associations between morphology and physiology of peripheral nerves targeting the different layers of the colorectum.
New insights into plant salt acclimation: the roles of vesicle trafficking and reactive oxygen species signalling in mitochondria and the endomembrane system
Authors: Garcia de la Garma Jesus , Fernandez‐Garcia Nieves , Bardisi Enas , Pallol Beatriz , Asensio‐Rubio Jose Salvador , Bru Roque , Olmos Enrique
Published: September 2014

In this study, we investigated the cellular and molecular mechanisms that regulate salt acclimation. The main objective was to obtain new insights into the molecular mechanisms that control salt acclimation. Therefore, we carried out a multidisciplinary study using proteomic, transcriptomic, subcellular and physiological techniques.

We obtained a Nicotiana tabacum BY‐2 cell line acclimated to be grown at 258 mM NaCl as a model for this study. The proteomic and transcriptomic data indicate that the molecular response to stress (chaperones, defence proteins, etc.) is highly induced in these salt‐acclimated cells.

The subcellular results show that salt induces sodium compartmentalization in the cell vacuoles and seems to be mediated by vesicle trafficking in tobacco salt‐acclimated cells. Our results demonstrate that abscisic acid (ABA) and proline metabolism are crucial in the cellular signalling of salt acclimation, probably regulating reactive oxygen species (ROS) production in the mitochondria. ROS may act as a retrograde signal, regulating the cell response.

The network of endoplasmic reticulum and Golgi apparatus is highly altered in salt‐acclimated cells. The molecular and subcellular analysis suggests that the unfolded protein response is induced in salt‐acclimated cells. Finally, we propose that this mechanism may mediate cell death in salt‐acclimated cells.
The relative importance of color signaling for plant generalization in pollination networks
Authors: Renoult Julien P. , Blüthgen Nico , Binkenstein Julia , Weiner Christiane N. , Werner Michael , Schaefer H. Martin
Published: September 2014

Plant strategies frequently vary from opportunistic pollination to specialization to single pollinators within the same community. Unraveling the proximate mechanisms that determine the degree of plant generalization to pollinators has become a primary goal of pollination ecology. Color signaling is a potentially important mechanism because it is well established that many pollinators use color stimuli to locate food items. Until now, studies on the importance of color signaling in structuring pollination networks have not considered floral coloration as it is perceived by pollinators. Here, we use a framework recently developed for network analyses to compare the relative importance of color matching (i.e. the degree of phenotypic matching between flower coloration and pollinators’ visual system) and other variables (phylogeny, co‐abundance and spatiotemporal overlap between plants and pollinators) for plant generalization. We analyzed 25 000 visits in three temperate regions. We show that color matching in combination with spatiotemporal overlap or co‐abundance significantly influences plant generalization in one of the three regions. We suggest that intense human activities in two regions have decreased the mean level of color matching, potentially disrupting the communication between plants and pollinators. This study illuminates how the sensory ecology of pollinators contributes to structure a highly diversified pollination network.
Life‐history traits and climatic responsiveness in noctuid moths
Authors: Végvári Zsolt , Juhász Edit , Tóth János Pál , Barta Zoltán , Boldogh Sándor , Szabó Sándor , Varga Zoltán
Published: September 2014

Emergence phenology has been shown to advance considerably in the past decades in many lepidopterans. Noctuid moths (Noctuidae) constitute a species‐rich family of lepidopterans with a large diversity of life history traits presumably driving climatic responsiveness. In our study we aim to assess the role of life‐history and ecological traits in climatic responsiveness of noctuid moths, whilst controlling for phylogenetic dependence. We used a long‐term dataset of European noctuid moths collected from a light‐trap in northeastern Hungary. As the study site is located at the intersection of several biogeographical zones harbouring a large number of noctuid moth species, our dataset provides a unique possibility to investigate the moths’ climatic sensitivity. To estimate the role of life‐history traits and ecological factors in driving lepidopterans’ response to climatic trends, we employed three proxies related to the species’ ecology (habitat affinity, food plant specialization and food type) and two robust types of life‐history traits (migration strategy and hibernation form). The degree of temporal shifts of various measures of emergence phenology was related to hibernation stage, food type and migration strategy. Large‐scale phylogenetic relatedness exerted little constraint in all models fitted on each measure of phenology. Our results imply that noctuid moths overwintering as adults exhibited greater degrees of phenological shifts than species hibernating as larvae or pupae. It implies that moths hibernating as adults are forced to suspend activity in our climate and the prolongation of autumn activity might be the result of increased plasticity in flight periods.
Corticobasal degeneration initially developing motor versus non‐motor symptoms: a comparative clinicopathological study
Authors: Ikeda Chikako , Yokota Osamu , Nagao Shigeto , Ishizu Hideki , Morisada Yumi , Terada Seishi , Nakashima Yoshihiko , Akiyama Haruhiko , Uchitomi Yosuke
Published: September 2014

Background

Clinical presentations of pathologically confirmed corticobasal degeneration (CBD) vary, and the heterogeneity makes its clinical diagnosis difficult, especially when a patient lacks any motor disturbance in the early stage.

Methods

We compared clinical and pathological features of four pathologically confirmed CBD cases that initially developed non‐motor symptoms, including behavioural and psychiatric symptoms but without motor disturbance (CBD‐NM), and five CBD cases that initially developed parkinsonism and/or falls (CBD‐M). The age range at death for the CBD‐NM and CBD‐M subjects (58–85 years vs 45–67 years) and the range of disease duration (2–18 years vs 2–6 years) did not significantly differ between the groups.

Results

Prominent symptoms in the early stage of CBD‐NM cases included self‐centred behaviours such as frontotemporal dementia (n = 1), apathy with and without auditory hallucination (n = 2), and aggressive behaviours with delusion and visual hallucination (n = 1). Among the four CBD‐NM cases, only one developed asymmetric motor disturbance, and two could walk without support throughout the course. Final clinical diagnoses of the CBD‐NM cases were frontotemporal dementia (n = 2), senile psychosis with delirium (n = 1), and schizophrenia (n = 1). Neuronal loss was significantly less severe in the subthalamic nucleus and substantia nigra in the CBD‐NM cases than in the CBD‐M cases. The severity of tau pathology in all regions examined was comparable in the two groups.

Conclusion

CBD cases that initially develop psychiatric and behavioural changes without motor symptoms may have less severe degenerative changes in the subthalamic nucleus and substantia nigra, and some CBD cases can lack motor disturbance not only in the early stage but also in the last stage of the course.
The Boston Marathon Bombings: Who's to Blame and Why It Matters for Public Administration
Authors: Marvel John D.
Published: September 2014

This article examines how elite attributions of blame—statements from politicians and high‐level public administrators assigning responsibility for failure to prevent the Boston Marathon bombings—affect citizens’ beliefs regarding which government organizations, if any, are culpable for failing to prevent the bombings. The primary hypothesis is that public administrators, owing to their greater credibility relative to politicians, will more strongly influence citizens’ notions of who is to blame. Findings show that public administrators are viewed as significantly more credible among Democrats, and this credibility advantage translates into influence. Additionally, blame statements implicating the Federal Bureau of Investigation for failing to prevent the Boston Marathon bombings are particularly influential among Republicans, and exculpatory statements are particularly influential among Democrats. As discussed in the context of the Boston Marathon bombings, the public process of attributing blame for a perceived governmental failure has important implications for public administration.
Multi‐Peer Disagreement and the Preface Paradox
Authors: Boyce Kenneth , Hazlett Allan
Published: September 2014

The problem of multi‐peer disagreement concerns the reasonable response to a situation in which you believeP1…Pnand disagree with a group of ‘epistemic peers’ of yours, who believe ∼P1… ∼Pn, respectively. However, the problem of multi‐peer disagreement is a variant on the preface paradox; because of this the problem poses no challenge to the so‐called ‘steadfast view’ in the epistemology of disagreement, on which it is sometimes reasonable to believePin the face of peer disagreement aboutP. After some terminology is defined (§1), Peter vanInwagen's challenge to the steadfast view will be presented (§2). The preface paradox will then be presented and diagnosed (§3), and it will be argued that vanInwagen's challenge relies on the same principle that generates the preface paradox (§4). The reasonable response to multi‐peer disagreement will be discussed (§5), and an objection addressed (§6).
A Decomposition Analysis of the Relationship Between Parental Income and Multiple Child Outcomes
Authors: Washbrook Elizabeth , Gregg Paul , Propper Carol
Published: September 2014

The paper explores the relationship between family income and a range of cognitive, socioemotional and health outcomes in mid-childhood. Child developmental outcomes are conceptualized as the result of an underlying set of associations or pathways running from distal factors (broad indicators of family characteristics and resources) to proximal factors (parental behaviours and aspects of the child's lived environment). We use a decomposition framework to compare the associations underpinning the raw income gradients in the different outcomes systematically. We find considerable variation in the extent of the income gradients, and in the factors that can account for them, across developmental domains.
Bayesian Estimation of Long-Term Health Consequences for Obese and Normal-Weight Elderly People
Authors: Hong Hyokyoung Grace , Yue Yu , Ghosh Pulak
Published: September 2014

Obesity is a rapidly growing public health problem even among the elderly. Understanding the disabling consequences of obesity in the elderly will help us to design better effective intervention management guidelines for the elderly obese. To examine the long-term health consequences of the obese elderly, we present a joint model consisting of two bivariate ordered responses observed at successive time points. The bivariate ordered response model corresponds to the subject's self-reporting health status outcomes including self-rated health and functional status. Although the joint model that we propose is generally suited for use in health and disease research, where the ordered value responses are observed at successive time points, we further extend it by addressing some of the challenges by incorporating the semiparametric features in the ordinal logistic model, by modelling the underlying latent states of health that are associated with self-rated health, by jointly modelling the bivariate ordinal outcomes to mitigate the variability of the single response and by accounting for the non-ignorable missing data due to different reasons through a multinomial logit model. The motivating data were obtained from the Second Longitudinal Study of Aging, which are longitudinal survey data from 1994–2000 providing various useful information on the health status of elderly people. Parameter estimation of our joint model was performed in a Bayesian framework via Markov chain Monte Carlo methods. Analytical results demonstrate the difference in longitudinal patterns of the health outcomes between the two weight groups, validating our hypothesis that different management strategies for the obese elderly should be employed.
Choice, Competition and Care – Developments in English Social Care and the Impacts on Providers and Older Users of Home Care Services
Authors: Rodrigues Ricardo , Glendinning Caroline
Published: September 2014

This article critically examines recent changes in markets for home (domiciliary) care services in England. During the 1990s, the introduction of competition between private (for‐profit and charitable) organizations and local authority providers of long‐term care services aimed to create a ‘mixed economy’ of supply. More recently, care markets have undergone further reforms through the introduction of direct payments and personal budgets. Underpinned by discourses of user choice, these mechanisms aim to offer older people increased control over the public resources for their care, thereby introducing further competitive pressures within local care markets.

The article presents early evidence of these changes on:

The commissioning and contracting of home care services by local authorities and individual older people.

The experiences and outcomes for individual older people using home care services.

Drawing on evidence from two recent empirical studies, the article describes how the new emphasis on choice and competition is being operationalized within six local care markets. There are suggestions of small increases in user agency and in opportunities for older people to receive more personalized home care, in which the quality of care‐giving relationships can also be optimized. However, the article also presents early evidence of increases in risk and costs associated with the expansion of competition and choice, both for organizations providing home care services and for individual older service users.
Spatial variability of volcanic features in early‐stage rift settings: the case of the Tanzania Divergence, East African rift system
Authors: Isola Ilaria , Mazzarini Francesco , Bonini Marco , Corti Giacomo
Published: September 2014

Close relationships between deformation and volcanism are well documented in relatively late evolutionary stages of continental rifting, whereas these are poorly constrained in less mature rifting stages. To investigate the control of inherited structures on faulting and volcanism, we present a statistical analysis of volcanic features, faults and pre‐rift fabric in the Tanzania Divergence, where volcanic features occur extensively in in‐rift and off‐rift areas. Our results show that in mature rift sectors (Natron), magma uprising is mostly controlled by fractures/faults responding to the far‐field stress, whereas the distribution of volcanism during initial rifting (Eyasi) is controlled by inherited structures oblique to the regional extension direction. Off‐rift sectors show a marked control of pre‐rift structures on magma emplacement, which may not respond to the regional stress field. Thus, the use of off‐rift magmatic features as stress indicators should take into account the role of pre‐existing structures.
Evaluation of acid–base disorders in dogs and cats presenting to an emergency room. Part 1: Comparison of three methods of acid–base analysis
Authors: Hopper Kate , Epstein Steven E. , Kass Philip H. , Mellema Matthew S.
Published: September 2014

Objective

To compare the diagnostic performance of the traditional approach to acid–base analysis with the Stewart approach and a semiquantitative approach.

Design

Prospective cohort study.

Setting

University teaching hospital.

Animals

A total number of 84 dogs and 14 cats presenting to a university teaching hospital emergency room.

Procedures

All dogs and cats in which venous blood samples for acid–base, lactate, and serum biochemical analysis were all collected within 60 minutes of each other, over a 5‐month enrollment period. Acid–base analysis was performed using the traditional approach, Stewart approach, and a semiquantitative approach.

Results

Traditional acid–base analysis identified respiratory acid–base abnormalities in 14/98 animals and metabolic acid–base abnormalities in 67/98. A mixed disorder of metabolic acidosis and respiratory alkalosis was most common occurring in 29/98 patients. The Stewart approach identified metabolic abnormalities in 82/98 patients; strong ion difference abnormalities were evident in 68/98 cases; an increased strong ion gap acidosis was identified in 49/98 cases; and changes in the quantity of weak acids in 25/98 cases. The semiquantitative approach identified abnormalities in all cases evaluated. Of the 14 patients with a primary respiratory acid–base abnormality, the Stewart approach identified metabolic abnormalities in 9 and the semiquantitative approach found abnormalities in all animals.

Conclusions and Clinical Relevance

The physicochemical approaches diagnosed more acid–base abnormalities in this population than the traditional approach although many of the abnormalities identified were small and of unknown clinical relevance. The physicochemical approaches may provide greater insight as to the underlying etiology of abnormalities, which maybe of particular relevance to cases with changes in albumin and/or phosphorus concentration.
FEASIBILITY OF ULTRASOUND‐GUIDED EPIDURAL ACCESS AT THE LUMBO‐SACRAL SPACE IN DOGS
Authors: Liotta Annalisa , Busoni Valeria , Carrozzo Maria Valentina , Sandersen Charlotte , Gabriel Annick , Bolen Géraldine
Published: September 2014

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound‐guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound‐guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid‐shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal–caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound‐guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.
Evaluation of Meropenem Regimens Suppressing Emergence of Resistance in Acinetobacter baumannii with Human Simulated Exposure in an
In Vitro
Intravenous-Infusion Hollow-Fiber Infection Model
Authors: Li Xin , Wang Lin , Zhang Xian-Jia , Yang Yang , Gong Wei-Tao , Xu Bin , Zhu Ying-Qun , Liu Wei
Published: September 2014

The emergence of resistance to carbapenems in
Pseudomonas aeruginosa
can be suppressed by optimizing the administration of meropenem. However, whether the same is true for
Acinetobacter baumannii
is not fully understood. We assessed the bactericidal activity of meropenem and its potency to suppress the emergence of resistance in
A. baumannii
with human simulated exposure in an
in vitro
intravenous-infusion hollow-fiber infection model (HFIM). Two clinical strains of carbapenem-susceptible multidrug-resistant
A. baumannii
(CS-MDRAB), CSRA24 and CSRA91, were used, and their MICs and mutant prevention concentrations (MPCs) were determined. Six meropenem dosage regimens (0.5, 1.0, or 2.0 g given every 8 h [q8h] with a 0.5-h or 3-h infusion for seven consecutive days) were simulated and then evaluated in the HFIM. Both the total population and resistant subpopulations of the two strains were quantified. Drug concentrations were measured by high-performance liquid chromatography. All dosage regimens, except for the lowest dosage (0.5 g for both the 0.5-h and 3-h infusions), showed 3-log CFU/ml bacterial killing. Dosage regimens of 2.0 g with 0.5-h and 3-h infusions exhibited an obvious bactericidal effect and suppressed resistance. Selective amplification of subpopulations with reduced susceptibility to meropenem was suppressed with a percentage of the dosage interval in which meropenem concentrations exceeded the MPC (
T
>MPC) of ≥20% or with a ratio of
T
>MPC to the percentage of the dosage interval in which drug concentrations are within the mutant selection window of ≥0.25. Our
in vitro
data support the use of a high dosage of meropenem (2.0 g q8h) for the treatment of severe infection caused by CS-MDRAB.
Impact of Hypoalbuminemia on Voriconazole Pharmacokinetics in Critically Ill Adult Patients
Authors: Vanstraelen Kim , Wauters Joost , Vercammen Ine , de Loor Henriette , Maertens Johan , Lagrou Katrien , Annaert Pieter , Spriet Isabel
Published: September 2014

Setting the adequate dose for voriconazole is challenging due to its variable pharmacokinetics. We investigated the impact of hypoalbuminemia (<35 g/liter) on voriconazole pharmacokinetics in adult intensive care unit (ICU) patients treated with voriconazole (20 samples in 13 patients) as well as in plasma samples from ICU patients that had been spiked with voriconazole at concentrations of 1.5 mg/liter, 2.9 mg/liter, and 9.0 mg/liter (66 samples from 22 patients). Plasma albumin concentrations ranged from 13.8 to 38.7 g/liter. Total voriconazole concentrations in adult ICU patients treated with voriconazole ranged from 0.5 to 8.7 mg/liter. Unbound and bound voriconazole concentrations were separated using high-throughput equilibrium dialysis followed by liquid chromatography-tandem mass spectrometry (LC-MSMS). Multivariate analysis revealed a positive relationship between voriconazole plasma protein binding and plasma albumin concentrations (
P
< 0.001), indicating higher unbound voriconazole concentrations with decreasing albumin concentrations. The correlation is more pronounced in the presence of elevated bilirubin concentrations (
P
= 0.05). We therefore propose to adjust the measured total voriconazole concentrations in patients with abnormal plasma albumin and total serum bilirubin plasma concentrations who show adverse events potentially related to voriconazole via a formula that we developed. Assuming 50% protein binding on average and an upper limit of 5.5 mg/liter for total voriconazole concentrations, the upper limit for unbound voriconazole concentrations is 2.75 mg/liter. Alterations in voriconazole unbound concentrations caused by hypoalbuminemia and/or elevated bilirubin plasma concentrations cannot be countered immediately, due to the adult saturated hepatic metabolism. Consequently, increased unbound voriconazole concentrations can possibly cause adverse events, even when total voriconazole concentrations are within the reference range.
Enterococcus faecium PBP5-S/R, the Missing Link between PBP5-S and PBP5-R
Authors: Pietta Ester , Montealegre Maria Camila , Roh Jung Hyeob , Cocconcelli Pier Sandro , Murray Barbara E.
Published: September 2014

During a study to investigate the evolution of ampicillin resistance in
Enterococcus faecium
, we observed that a number of
E. faecium
strains, mainly from the recently described subclade A2, showed PBP5 sequences in between PBP5-S and PBP5-R. These hybrid PBP5-S/R patterns reveal a progression of amino acid changes from the S form to the R form of this protein; however, these changes do not strictly correlate with changes in ampicillin MICs.
Mutation-Driven β-Lactam Resistance Mechanisms among Contemporary Ceftazidime-Nonsusceptible Pseudomonas aeruginosa Isolates from U.S. Hospitals
Authors: Castanheira Mariana , Mills Janet C. , Farrell David J. , Jones Ronald N.
Published: September 2014

OprD loss and hyperexpression of AmpC, MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM were evaluated among 120
Pseudomonas aeruginosa
isolates collected during 2012 in U.S. hospitals and selected based on ceftazidime MIC values (1 to >32 μg/ml). AmpC derepression (10-fold greater than that with the control) and OprD loss (decreased/no band) were the most prevalent resistance mechanisms: 47.5 and 45.8% of the isolates were considered positive, respectively. Elevated expression of the efflux pumps MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM was observed in 32.5, 8.3, 0.0, and 28.4% of the isolates, respectively. A total of 21 different combinations of resistance mechanisms were noted, and the most prevalent included AmpC derepression with OprD loss with and without efflux hyperexpression (38 and 10 isolates, respectively). A total of 26 isolates had no changes in the resistance mechanisms tested and had lower MIC values for all β-lactams or β-lactam/β-lactamase inhibitor combinations analyzed. OprD loss had a strong correlation with elevated MIC results for imipenem and meropenem (median MIC values of 8 and 4 μg/ml, respectively), with all combinations displaying OprD loss also displaying elevated median MIC values for these carbapenems (4 to >8 μg/ml). AmpC expression levels were greater in isolates displaying elevated cefepime, ceftazidime, or piperacillin-tazobactam MIC values (≥4, ≥4, and ≥16 μg/ml, respectively). Isolates displaying derepressed AmpC had ceftolozane-tazobactam MIC values ranging from 1 to 16 μg/ml. No strong correlation was noticed with MIC values for this β-lactam/β-lactamase inhibitor combination and OprD loss or hyperexpression of efflux systems. Two KPC-producing isolates were detected among 16 isolates displaying ceftolozane-tazobactam MIC values of ≥8 μg/ml.
The Type III Secretion Effector NleF of Enteropathogenic Escherichia coli Activates NF-κB Early during Infection
Authors: Pallett Mitchell A. , Berger Cedric N. , Pearson Jaclyn S. , Hartland Elizabeth L. , Frankel Gad
Published: September 2014

The enteric pathogens enteropathogenic
Escherichia coli
(EPEC) and enterohemorrhagic
E. coli
employ a type 3 secretion system (T3SS) to manipulate the host inflammatory response during infection. Previously, it has been reported that EPEC, in a T3SS-dependent manner, induces an early proinflammatory response through activation of NF-κB via extracellular signal-regulated kinases 1 and 2 (ERK1/2) and protein kinase Cζ (PKCζ). However, the activation of NF-κB during infection has not yet been attributed to an effector. At later time points postinfection, NF-κB signaling is inhibited through the translocation of multiple effectors, including NleE and NleC. Here we report that the highly conserved non-LEE (locus of enterocyte effacement)-encoded effector F (NleF) shows both diffuse and mitochondrial localization during ectopic expression. Moreover, NleF induces the nuclear translocation of NF-κB p65 and the expression of interleukin 8 (IL-8) following ectopic expression and during EPEC infection. Furthermore, the proinflammatory activity and localization of NleF were dependent on the C-terminal amino acids LQCG. While the C-terminal domain of NleF has previously been shown to be essential for interaction with caspase-4, caspase-8, and caspase-9, the proinflammatory activity of NleF was independent of interaction with caspase-4, -8, or -9. In conclusion, EPEC, through the T3SS-dependent translocation of NleF, induces a proinflammatory response in an NF-κB-dependent manner in the early stages of infection.
Cross-Species Comparison of the Burkholderia pseudomallei, Burkholderia thailandensis, and Burkholderia mallei Quorum-Sensing Regulons
Authors: Majerczyk Charlotte D. , Brittnacher Mitchell J. , Jacobs Michael A. , Armour Christopher D. , Radey Matthew C. , Bunt Richard , Hayden Hillary S. , Bydalek Ryland , Greenberg E. Peter
Published: September 2014

Burkholderia pseudomallei
,
Burkholderia thailandensis
, and
Burkholderia mallei
(the
Bptm
group) are close relatives with very different lifestyles:
B. pseudomallei
is an opportunistic pathogen,
B. thailandensis
is a nonpathogenic saprophyte, and
B. mallei
is a host-restricted pathogen. The acyl-homoserine lactone quorum-sensing (QS) systems of these three species show a high level of conservation. We used transcriptome sequencing (RNA-seq) to define the quorum-sensing regulon in each species, and we performed a cross-species analysis of the QS-controlled orthologs. Our analysis revealed a core set of QS-regulated genes in all three species, as well as QS-controlled factors shared by only two species or unique to a given species. This global survey of the QS regulons of
B. pseudomallei
,
B. thailandensis
, and
B. mallei
serves as a platform for predicting which QS-controlled processes might be important in different bacterial niches and contribute to the pathogenesis of
B. pseudomallei
and
B. mallei
.