bluuebunny/crossref_metadata_2025 huggingface dataset:
The Long-term Outcome of Primary “Bleb-sparing, Epithelial Exchange” in Dysfunctional Filtering Blebs
Authors: Sihota Ramanjit , Angmo Dewang , Sen Seema , Gupta Viney , Dada Tanuj , Pandey Ravindra M.
Published: October 2015

Objective:

To evaluate the long-term outcome of epithelial peeling and conjunctival replacement as a primary procedure in dysfunctional filtering blebs, without excising the bleb.

Materials and Methods:

A prospective, observational case series involving 34 consecutive eyes, having prior operated trabeculectomy with a dysfunctional filtering bleb, that met the inclusion criteria and were reviewed for at least 12 months. The bleb epithelium was peeled off and replaced with the adjacent conjunctiva, without bleb excision. Patients were reviewed at 1 week, 1 and 3 months postoperatively, and thereafter every 6 months for best corrected visual acuity (BCVA), applanation tonometry, bleb morphology and leaks, the lens status, glaucoma medications, and any complications. ASOCT was performed preoperatively and at the last review. Complete success (primary outcome) was defined as an intraocular pressure (IOP) >6 and <18 mm Hg without any additional antiglaucoma medications at the last follow-up.

Results:

The average age of the patients was 36.6±20.7 years. The average time of follow-up was 23.9±6.1 months (range, 13 to 40 mo). The mean preoperative IOP was 5.8±4.2 mm Hg. Postoperatively, the IOP at 24 months was 12.6±3.9 mm Hg (P<0.0001). The bleb characteristics were graded according to the Indiana Bleb Appearance Grading Scale (IBAGS), which showed significant results in terms of the height (H), the vascularity (V), and Seidel (S) (P<0.0001). The preoperative and the postoperative BCVAs in logMAR were 0.51±0.26 and 0.37±0.21 (P=0.0001), respectively. Complete success was noted in 31/34 eyes (91.18%) and qualified success was noted in 3 eyes (8.82%). One patient developed a mild ptosis after bleb revision.

Conclusions:

Epithelial peeling of the bleb with replacement by advancement, without bleb excision, maintains bleb function and resolves bleb dysfunction in the long term.
Drug Misuse in Adolescents Presenting to the Emergency Department
Authors: Finkelstein Yaron , Goel Gautam , Hutson Janine R. , Armstrong Jeffrey , Baum Carl R. , Wax Paul , Brent Jeffrey
Published: October 2015

Objectives

Drug misuse is a disturbing, common practice among youth. One in 4 American adolescents reports consuming prescription medications without a clinical indication. We sought to explore current trends of drug misuse in adolescents.

Methods

Using the 37 participating sites of the ToxIC (Toxicology Investigators Consortium) Case Registry, a cross-country surveillance tool, we conducted an observational cohort study of all adolescents (aged 13–18 years) who presented to emergency departments with drug misuse and required a bedside medical toxicology consultation between January 2010 and June 2013.

Results

Of 3043 poisonings, 202 (7%) involved drug misuse (139 [69%] were males). Illicit drugs (primarily synthetic cannabinoids and “bath salts”) were encountered in 101 (50%), followed by prescription medications (56 [28%]) and over-the-counter (OTC) drugs (51 [25%]). Dextromethorphan was the most commonly misused legal medication (24 [12%]). Polypharmacy exposure was documented in 74 (37%). One hundred sixty-three adolescents (81%) were symptomatic; of these, 81% had central nervous system impairments: psychosis (38%), agitation (30%), coma (26%), myoclonus (11%), and seizures (10%); and 66 (41%) displayed a specific toxidrome, most commonly sedative-hypnotic. Benzodiazepines were the most frequently administered medications (46%). Antidotes were administered to 28% of adolescents, primarily naloxone, physostigmine, N-acetyl-cysteine, and flumazenil. No deaths were recorded.

Conclusions

Adolescents presenting with drug misuse may be exposed to a wide range and combinations of therapeutics or illicit substances and frequently display central nervous system abnormalities, compromising the ability to obtain a reliable history. Frontline clinicians should maintain a high index of suspicion, as routine toxicology screenings fail to detect most contemporary misused legal and designer drugs.
Nausea, Vomiting, and Weight Loss in a Young Adult Patient With a History of a Gunshot Wound
Authors: James Jessica , Fitzgibbon James , Blackford Martha
Published: October 2015

Assessing victims of gunshot wounds with retained bullets/bullet fragments for lead toxicity is not always considered until the patient develops signs and symptoms of toxicity. We discuss the case of a 19-year-old young man who received a diagnosis of chronic lead toxicity (serum lead concentration 51 μg/dL) 5 weeks after a hunting accident. Extensive wound debridement occurred following the accident; however, lead toxicity was not diagnosed until after his fourth emergency department visit. Oral chelation therapy was required for the management of his lead toxicity.
Appendicitis and Analgesia in the Pediatric Emergency Department
Authors: Delaney Kristen M. , Pankow Alexis , Avner Jeffrey R. , Rabiner Joni E.
Published: October 2015

Objectives

The primary objective of the study was to compare analgesia-prescribing practices and timing of analgesia administration between pediatric emergency medicine (PEM) and general emergency medicine (GEM) practitioners for children with appendicitis. The secondary objective was to compare analgesia administration versus triage pain score, pediatric appendicitis score (PAS), and body mass index (BMI).

Methods

This was a retrospective chart review of patients younger than 21 years who presented to either an urban pediatric emergency department (ED) or 2 general EDs and were diagnosed with appendicitis.

Results

Two hundred eighteen charts were reviewed, 153 (70%) from the pediatric ED and 65 (30%) from the general EDs. The patients seen by PEM physicians were younger than the patients seen by GEM physicians (mean age, 12.8 vs 15.4 years; P = 0.002). The patients evaluated by GEM physicians were more likely to receive analgesia in the ED (82% vs 60%, P = 0.003) and received analgesia sooner (mean, 178 vs 239 minutes; P = 0.026) than the patients evaluated by PEM physicians. The patients with triage pain scores higher than 6 of 10 were more likely to receive analgesia than the patients with pain scores lower than 6 (71% vs 51%, P = 0.015). There was no association between PAS or BMI and analgesia administration or time to analgesia (P = not significant).

Conclusions

The patients with appendicitis evaluated by GEM physicians were more likely to receive analgesia and receive analgesia quicker than the patients evaluated by PEM physicians. The patients with higher pain scores were more likely to receive analgesia, but PAS and BMI did not affect analgesia administration.
Modelling marine protected areas: insights and hurdles
Authors: Fulton Elizabeth A. , Bax Nicholas J. , Bustamante Rodrigo H. , Dambacher Jeffrey M. , Dichmont Catherine , Dunstan Piers K. , Hayes Keith R. , Hobday Alistair J. , Pitcher Roland , Plagányi Éva E. , Punt André E. , Savina-Rolland Marie , Smith Anthony D. M. , Smith David C.
Published: October 2015

Models provide useful insights into conservation and resource management issues and solutions. Their use to date has highlighted conditions under which no-take marine protected areas (MPAs) may help us to achieve the goals of ecosystem-based management by reducing pressures, and where they might fail to achieve desired goals. For example, static reserve designs are unlikely to achieve desired objectives when applied to mobile species or when compromised by climate-related ecosystem restructuring and range shifts. Modelling tools allow planners to explore a range of options, such as basing MPAs on the presence of dynamic oceanic features, and to evaluate the potential future impacts of alternative interventions compared with ‘no-action’ counterfactuals, under a range of environmental and development scenarios. The modelling environment allows the analyst to test if indicators and management strategies are robust to uncertainties in how the ecosystem (and the broader human–ecosystem combination) operates, including the direct and indirect ecological effects of protection. Moreover, modelling results can be presented at multiple spatial and temporal scales, and relative to ecological, economic and social objectives. This helps to reveal potential ‘surprises', such as regime shifts, trophic cascades and bottlenecks in human responses. Using illustrative examples, this paper briefly covers the history of the use of simulation models for evaluating MPA options, and discusses their utility and limitations for informing protected area management in the marine realm.
OX40 and 4-1BB downregulate Kaposi's sarcoma-associated herpesvirus replication in lymphatic endothelial cells, but 4-1BB and not OX40 inhibits viral replication in B-cells
Authors: Cho Min , Myoung Jinjong
Published: October 2015

Kaposi's sarcoma-associated herpesvirus (KSHV) belongs to the human gammaherpesvirus subfamily and is associated with malignancies of endothelial origin (Kaposi's sarcoma, KS) and B-cell origin [primary effusion lymphoma (PEL) and multicentric Castleman's disease (MCD)]. Viral lytic replication is known to be required for KS and MCD. As KSHV-related tumours mostly develop in human subjects when the immune system is compromised by immunosuppressive regimen, human immunodeficiency virus infection or some genetic deficiencies, KSHV-specific immune responses are believed to be important in the control of KSHV replication. However, analysis of the roles of immune cells in viral pathogenesis has been difficult due to the lack of an adequate animal model. Recently, congenital OX40 deficiency, as determined by genome-wide exome sequencing, was shown to be associated with aggressive childhood KS in a patient, suggesting that disrupted OX40–OX40L interactions might be implicated in disease development. Here, we report that interaction of recombinant OX40 protein with OX40L expressed on endothelial cells severely impaired KSHV lytic replication. Furthermore, 4-1BB–4-1BBL interactions were also capable of efficiently inhibiting viral replication in B-cells and endothelial cells. To the best of our knowledge, this is the first direct evidence that ligation of tumour necrosis factor superfamily members and their cognate receptors is important for the control of viral lytic replication. These data are likely to pave the way for the development of KSHV-specific therapies for KS and MCD, in which viral lytic replication is a disease-determining factor.
Epstein–Barr virus-infected cells release Fas ligand in exosomal fractions and induce apoptosis in recipient cells via the extrinsic pathway
Authors: Ahmed Waqar , Philip Pretty S. , Attoub Samir , Khan Gulfaraz
Published: October 2015

Epstein–Barr virus (EBV; human herpesvirus 4) is an oncogenic herpesvirus implicated in the pathogenesis of several human malignancies. A number of recent studies indicate that EBV can manipulate the local microenvironment by excreting viral and cellular components in nanovesicles called exosomes. In this study, we investigated the impact of EBV-derived exosomes on apoptosis of recipient cells and the molecular pathway involved in this process. Exosomes from EBV-infected but not from non-infected cells induced apoptosis in a number of different cell types, including B-cells, T-cells and epithelial cells. However, this phenomenon was not universal and the Burkitt's lymphoma-derived B-cell line BJAB was found to be resistant to apoptosis. Exosomes from both type I and type III EBV latently infected cells induced apoptosis in a dose- and time-dependent manner. Moreover, cells exposed to EBV exosomes did not form colonies in soft agar assays. We further show that fluorescently labelled exosomes derived from EBV-infected cells are taken up by non-infected cells and induce apoptosis via the extrinsic pathway. Inhibition of caspase-3/7/8 blocks EBV exosome-mediated apoptosis. Furthermore, our data indicate that EBV exosomes trigger apoptosis through the Fas ligand (FasL)-mediated extrinsic pathway, as FasL was present in EBV exosomal fractions and anti-FasL antibodies could block EBV exosome-mediated apoptosis. Together, these data support the notion that EBV hijacks the exosome pathway to excrete viral and cellular components that can modulate its microenvironment.
Employer of choice: does gender matter?
Authors: Bellou Victoria , Rigopoulou Irini , Kehagias John
Published: October 2015

Purpose

– This paper aims to set out to add to extant knowledge by delineating the content of employer of choice (EOC) regardless of sector and shedding light on the role of gender in the EOC profile. Becoming an employer of choice (EOC) is a strategy that can help organizations manage current and prospective employee expectations of their employment relationship.

Design/methodology/approach

– Responses were gathered from 896 working adults. The questionnaire was developed by the researchers to reflect the employment experience. Parallel analysis and factor analysis were used to analyze the content of the EOC, and t-tests compares EOC factors between male and female individuals.

Findings

– The results verify the multi-dimensionality of EOC and enrich its content. The most important facets of EOC for employees are the quality of workplace relationships, work prerequisites and satisfying work setting as the most important. With regards to how male and female employees perceive the EOC, both differences and similarities were found.

Research limitations/implications

– Key limitations pertain to its cross-sectional design, the fact that gender is examined in isolation of other forms of identity that may interact with gender, and the fact that all respondents were Greek and white-collar.

Practical implications

– The findings can support HR and marketing managers in their effort to attract talented individuals and retain and activate talented employees.

Originality/value

– Existing evidence identifies the profile of EOCs within specific sectors, while we construct an EOC profile that crosses sector boundaries. Moreover, it is the first time that research into EOC takes gender into consideration in a structured way to offer a clearer understanding of what is valued by individuals.
Extreme males – balanced females: sharing behavior in Korea
Authors: Horak Sven
Published: October 2015

Purpose

– The purpose of this paper is to examine sharing behavior among male and female subjects in Korea who had been exposed to sensitive variables derived from the Korean cultural context.

Design/methodology/approach

– Experimental research methodology was applied based on the ultimatum game and a modified variant. The subject pool consisted of participants (N= 300) from five universities based in Seoul and its vicinity as well as Busan in South Korea.

Findings

– Significant differences in sharing behavior between men and women were observed. Men significantly altered behavior from egoistic to overly altruistic when exposed to the cultural variables, whereas women did not alter their behavior and maintained a fair and balanced behavior independent of the game condition.

Practical implications

– Results positively contribute to the current debate on gender-diversified top management teams and have implications for firms that could benefit from a greater variety of problem-solving approaches to increase the overall quality of decision-making.

Originality/value

– Analyzing sharing behavior using sensitive contextual variables in an experimental framework is a new approach in gender studies. Based on this approach, novel and significant context-dependent traits of divergent decision-making behavior among men and women were found.
Releasing the grip of managerial domination
Authors: Clark Michael , Cornes Michelle , Manthorpe Jill , Hennessy Catherine , Anderson Sarah
Published: October 2015

Purpose

– The purpose of this paper is to discuss “system transformation” in the context of different workforces and organisations seeking to support people experiencing multiple exclusion homelessness (MEH). From a relational and integrated care perspective it aims to identify barriers to achieving more effective ways of working in the prevailing context of “managerial domination”. Communities of practice (COPs) are evaluated to identify their potential to overcome some of these barriers.

Design/methodology/approach

– The paper presents a theoretical and conceptual discussion of a project in which a number of COPs were established and evaluated to ascertain their value in developing more relational ways of working in the context of MEH. Case studies of COPs operating in the context of MEH are explored and discussed.

Findings

– It is concluded that COPs have the potential to deliver small-scale changes (“little miracles”) which are characteristically more subversive than transformative. Nevertheless, the authors still see these small gains as significant when compared to the inertia that is often found in local systems of care where more traditional management techniques (such as “payment by results”) prevail. The authors also draw attention to the scope for much improved service quality which flows from moving beyond the “tick box” and into the realms of what it really takes to tackle homelessness and multiple exclusion. In other words, although often requiring considerable amounts of “craft and graft” to deliver seemingly very small amounts of change, these “little miracles” may actually be more conducive in the long run to delivering the kind of tangible “real” change that is often aspired to by both workers and service users and their carers.

Research limitations/implications

– The COPs project was limited in terms of time and scale and, hence, further research would be needed to, for example, ascertain their longer-term potential.

Practical implications

– There is merit in the theoretical perspectives discussed and, from these, of understanding how best to establish and operate COPs as a vehicle for achieving better outcomes through integrated or collaborative working.

Social implications

– There is much scope for better integrated or more collaborative working in the context of MEH and this paper draws attention to how COPs could be one means of achieving better outcomes for people experiencing MEH.

Originality/value

– This is the first paper to set out the theoretical analysis of COPs as a means of achieving better integrated or collaborative working.
Working together to identify child maltreatment: social work and acute healthcare
Authors: Lewis Jane , Greenstock Jane , Caldwell Kim , Anderson Beth
Published: October 2015

Purpose

– The wider research literature indicates that health professionals’ ability to identify possible child maltreatment varies, and that this can lead to under-reporting of possible maltreatment to local authority (LA) statutory child protection agencies. The purpose of this paper is to understand how acute trust paediatric and LA services work together in suspected cases of child maltreatment, and what is viewed locally as good practice.

Design/methodology/approach

– A mixed-method approach, consisting of an online survey, qualitative case studies and good practice examples, was used to describe key features of current practice in joint working between acute trusts and LA services, and to generate insights that could help improve practice.

Findings

– Holistic assessment and information gathering, supported by training and expert input, were identified as being critical to a comprehensive approach to identifying maltreatment. Both in-hospital and community-based social work arrangements can be effective bases for joint working in respect of child maltreatment. Effective joint working relies on shared vision and values, and investment in, and commitment to, collaborative working.

Research limitations/implications

– This study covered arrangements in emergency departments (EDs) and maternity departments only, so future research could usefully look more broadly within acute care settings. Study respondents were also limited to safeguarding leads so, in future, there would be real value in exploring the experiences, practices and views of frontline practitioners.

Practical implications

– The study includes practical implications for hospital and social work teams working to safeguard children.

Originality/value

– The study highlights the characteristics of effective liaison between acute trust maternity and EDS and social work teams.
Implementation aspects of attenuation compensation in reverse‐time migration
Authors: Zhu Tieyuan
Published: October 2015

Attenuation compensation in reverse‐time migration has been shown to improve the resolution of the seismic image. In this paper, three essential aspects of implementing attenuation compensation in reverse‐time migration are studied: the physical justification of attenuation compensation, the choice of imaging condition, and the choice of a low‐pass filter. The physical illustration of attenuation compensation supports the mathematical implementation by reversing the sign of the absorption operator and leaving the sign of the dispersion operator unchanged in the decoupled viscoacoustic wave equation. Further theoretical analysis shows that attenuation compensation in reverse‐time migration using the two imaging conditions (cross‐correlation and source‐normalized cross‐correlation) is able to effectively mitigate attenuation effects. In numerical experiments using a simple‐layered model, the source‐normalized cross‐correlation imaging condition may be preferable based on the criteria of amplitude corrections. The amplitude and phase recovery to some degree depend on the choice of a low‐pass filter. In an application to a realistic Marmousi model with added Q, high‐resolution seismic images with correct amplitude and kinematic phase are obtained by compensating for both absorption and dispersion effects. Compensating for absorption only can amplify the image amplitude but with a shifted phase.
Smart averaging interpolation algorithm comparative test
Authors: Krilov D. , Vaniarho Ya. , Basaev D.
Published: October 2015

In many practical cases, it is necessary to characterize the explored area with a regular set of geodata. Regular matrix data (e.g., ordinary maps) are calculated via existing data interpolation and extrapolation. For low frequency (oversampled) data acquired within a dense profile net (e.g., seismic three‐dimensional structural or gravity mapping), this procedure is mathematically more or less stable and, to a certain extent, unique since we might neglect discrepancies resulting from different interpolations. The situation is quite different for high‐resolution and high‐frequency contaminated data (e.g., raw seismic attributes or geochemistry measurements) represented by sparse profiling. Considering the variety of exploration cases, the investigation of different interpolation algorithm efficiency seems very important. Since it is impossible to compare all algorithms by means of formal mathematics, we have designed a test program. A representative set of seismic attribute maps has been artificially destroyed by introducing blank values (from 20% up to 95%) and then restored by different interpolation algorithms— bicubic, bilinear, nearest neighbor, and “smart averaging.” Smart averaging interpolation is done in a “live” window. The position, form, and size of the window are determined by some mathematical criterion on a trial‐and‐error basis. Discrepancies between restored and initial (true) data have been assessed and analysed. It is shown that the total (absolute) efficiency and comparative (relative) efficiency of the algorithms depend mostly upon the initial interpolant data characteristics. Identifying the best interpolation algorithm for all interpretive cases seems impossible. Some aspects of data processing are discussed in connection with interpolation accuracy.
Grassland birds demonstrate delayed response to large‐scale tree removal in central North America
Authors: Thompson Sarah J. , Arnold Todd W. , Fieberg John , Granfors Diane A. , Vacek Sara , Palaia Nick
Published: October 2015

Maintenance of early successional and open habitats often requires active removal of encroaching vegetation. In many cases, fire or other historically applied methods can no longer maintain or create open or early‐successional habitat. In these situations, managers must employ mechanical or chemical treatments to control vegetation and improve habitat quality for wildlife that depend on open habitats.

We conducted a large‐scale study of tree removal from 2005 to 2011 on 14 grassland sites in central North America. Beginning in the autumn of 2005, shrubs, scattered trees, shelterbelts and woodlots were removed from six of fourteen study sites with cutting and burning treatments. Trees and shrubs accounted for 7–21% of pre‐treatment ground cover. We conducted vegetation and bird surveys on each site for one year before and six years after initiating tree removal treatments.

Treatments effectively removed larger woody vegetation (>6 m in height), but effects of shrub removal were less consistent due to rapid regrowth. Tree removal sites also experienced reductions in grassy litter as a result of prescribed fires that were used to discourage shrub and tree regrowth.

On untreated sites, abundance of all grassland birds declined throughout the study, on average declining by 62%. On tree removal sites, we estimated that grassland bird abundance dropped from 2·04 (birds per count) before treatment to a low of 0·90 in the second year after initiating treatments, but recovered in the final three years of study with a weak, but significant positive response six years after initiating treatment, with an estimated 1·42 birds per count. Waterfowl and wetland birds increased following tree removal, whereas woodland birds, particularly those that nest in cavities, declined on treated sites.

Synthesis and applications. Tree removal did appear to improve habitat suitability for grassland birds, but a positive response was weak and delayed, and treatments caused short‐term habitat disturbances that significantly reduced abundance of target species. When planning large‐scale tree removal, it may be beneficial to allow undisturbed habitat in the surrounding landscape to ameliorate potential short‐term displacement of wildlife in early phases of treatment. In addition, managers should expect site recovery to require repeated treatments over multiple years.
A Test of the Passalacqua Age at Death Estimation Method Using the Sacrum
Authors: Colarusso Tara
Published: October 2015

A test of the accuracy of the Passalacqua (J Forensic Sci, 5, 2009, 255) sacrum method in a forensic context was performed on a sample of 153 individuals from the J.C.B. Grant Skeletal Collection. The Passalacqua (J Forensic Sci, 5, 2009, 255) method assesses seven traits of the sacrum using a 7‐digit coding system. An accuracy of 97.3% was achieved using the Passalacqua (J Forensic Sci, 5, 2009, 255) method to estimate adult skeletal age. On average each age estimate differed by 12.87 years from the known age. The method underestimated the age of individuals by an average of 4.3 years. An intra‐observer error of 6.6% suggests that the method can be performed with precision. Correlation and regression analysis found that the sacral traits used in the Passalacqua (J Forensic Sci, 5, 2009, 255) method did not have a strong relationship with age or an ability to strongly predict age. Overall, the method was not practical for use in a forensic context due to the broad age ranges, despite the high accuracy and low intra‐observer error.
Targeting an Alcohol Intervention Cost‐Effectively to Persons Living with HIV/AIDS in East Africa
Authors: Kessler Jason , Ruggles Kelly , Patel Anik , Nucifora Kimberly , Li Lingfeng , Roberts Mark S. , Bryant Kendall , Braithwaite R. Scott
Published: October 2015

Background

In the current report, we ask if targeting a cognitive behavioral therapy (CBT)‐based intervention aimed at reducing hazardous alcohol consumption to HIV‐infected persons in East Africa would have a favorable value at costs that are feasible for scale‐up.

Methods

Using a computer simulation to inform HIV prevention decisions in East Africa, we compared 4 different strategies for targeting a CBT intervention—(i) all HIV‐infected persons attending clinic; (ii) only those patients in the pre‐antiretroviral therapy (ART) stages of care; (iii) only those patients receiving ART; and (iv) only those patients with detectable viral loads (VLs) regardless of disease stage. We define targeting as screening for hazardous alcohol consumption (e.g., using the Alcohol Use Disorders Identification Test and offering the CBT intervention to those who screen positive). We compared these targeting strategies to a null strategy (no intervention) or a hypothetical scenario where an alcohol intervention was delivered to all adults regardless of HIV status.

Results

An intervention targeted to HIV‐infected patients could prevent 18,000 new infections, add 46,000 quality‐adjusted life years (QALYs), and yield an incremental cost‐effectiveness ratio of $600/QALY compared to the null scenario. Narrowing the prioritized population to only HIV‐infected patients in pre‐ART phases of care results in 15,000 infections averted, the addition of 21,000 QALYs and would be cost‐saving, while prioritizing based on an unsuppressed HIV‐1 VL test results in 8,300 new infections averted, adds 6,000 additional QALYs, and would be cost‐saving as well.

Conclusions

Our results suggest that targeting a cognitive‐based treatment aimed at reducing hazardous alcohol consumption to subgroups of HIV‐infected patients provides favorable value in comparison with other beneficial strategies for HIV prevention and control in this region. It may even be cost‐saving under certain circumstances.
House dust mite sublingual immunotherapy is safe in patients with mild‐to‐moderate, persistent asthma: a clinical trial
Authors: Devillier P. , Fadel R. , de Beaumont O.
Published: October 2015

Background

The safety of allergen immunotherapy (AIT) in asthma has not always been sufficiently documented; accordingly, fear of asthma exacerbations has made physicians somewhat reluctant to prescribe AIT in this context. In a double‐blind, placebo‐controlled, randomized clinical trial, house dust mite (HDM) sublingual AIT was found to be efficacious in moderate, persistent asthma. The trial's safety results are now reported in detail.

Methods

Asthmatic adults were randomized 2 : 1 to twelve months of daily treatment with a sublingual solution of Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts or a placebo. Adverse events (AEs) at least possibly related to the investigational product were classified by the investigators as adverse drug reactions (ADRs).

Results

Overall, the patients in the safety analysis set (n = 484; active treatment: n = 322; placebo: n = 162) had mostly well‐controlled, persistent asthma [mild in 290 patients (59.9%), moderate in 183 (37.8%) and severe in 11 (2.3%)]. No treatment‐related serious AEs were reported. A total of 87.0% and 75.9% of the patients in the active and placebo groups, respectively, experienced at least one AE (mostly mild), and 78.9% and 48.1% experienced an ADR (mostly mild or moderate oral reactions). The incidence of asthma exacerbations (symptoms requiring a short course of oral corticosteroids) during the study was similar in the active treatment group (3.7%) and the placebo group (4.3%). There were no significant intergroup differences or intragroup changes over time in respiratory AEs, lung function or asthma‐related quality of life.

Conclusions

HDM sublingual AIT was safe and well tolerated in adult patients with mild‐to‐moderate, persistent asthma (ClinicalTrials.gov: NCT00660452).
Is meat quality from Longissimus lumborum samples correlated with other cuts in horse meat?
Authors: De Palo Pasquale , Maggiolino Aristide , Centoducati Pasquale , Milella Paola , Calzaretti Giovanna , Tateo Alessandra
Published: October 2015

The present work aims to investigate if the variation of each parameter in Longissimus lumborum muscle could correspond to the same or to a similar variation of the parameter in the other muscles. The work presents results of Pearson's correlations between Longissimus lumborum samples and other muscle samples, such as Biceps femoris, Rectus femoris, Semimembranosus, Supraspinatus and Semitendinosus in horse meat. A total of 27 male IHDH (Italian Heavy Draught Horse) breed foals were employed. They were slaughtered at 11 months of age and the above‐mentioned muscles were sampled. The Longissimus lumborum muscle showed to be representative of other muscles and of the whole carcass for some chemical parameters (moisture, protein and ash) and for some fatty acids profile patterns such as C12:0, C14:0, total monounsaturated fatty acid and polyunsaturated fatty acid, but poor correlations were recorded for intramuscular fat concentration, rheological and colorimetric parameters. Although almost all the qualitative parameters in meat are affected by the anatomical site and by the muscle, the Longissimus lumborum is often not representative in horse meat with regard to modifications of this parameters.
NET amyloidogenic backbone in human activated neutrophils
Authors: Pulze L , Bassani B , Gini E , D'Antona P , Grimaldi A , Luini A , Marino F , Noonan D M , Tettamanti G , Valvassori R , de Eguileor M
Published: October 2015

Activated human neutrophils produce a fibrillar DNA network [neutrophil extracellular traps (NETs)] for entrapping and killing bacteria, fungi, protozoa and viruses. Our results suggest that the neutrophil extracellular traps show a resistant amyloidogenic backbone utilized for addressing reputed proteins and DNA against the non-self. The formation of amyloid fibrils in neutrophils is regulated by the imbalance of reactive oxygen species (ROS) in the cytoplasm. The intensity and source of the ROS signal is determinant for promoting stress-associated responses such as amyloidogenesis and closely related events: autophagy, exosome release, activation of the adrenocorticotrophin hormone/α-melanocyte-stimulating hormone (ACTH/α-MSH) loop and synthesis of specific cytokines. These interconnected responses in human activated neutrophils, that have been evaluated from a morphofunctional and quantitative viewpoint, represent primitive, but potent, innate defence mechanisms. In invertebrates, circulating phagocytic immune cells, when activated, show responses similar to those described previously for activated human neutrophils. Invertebrate cells within endoplasmic reticulum cisternae produce a fibrillar material which is then assembled into an amyloidogenic scaffold utilized to convey melanin close to the invader. These findings, in consideration to the critical role played by NET in the development of several pathologies, could explain the structural resistance of these scaffolds and could provide the basis for developing new diagnostic and therapeutic approaches in immunomediated diseases in which the innate branch of the immune system has a pivotal role.
Differential expression of key regulators of Toll-like receptors in ulcerative colitis and Crohn's disease: a role for Tollip and peroxisome proliferator-activated receptor gamma?
Authors: Fernandes P , MacSharry J , Darby T , Fanning A , Shanahan F , Houston A , Brint E
Published: October 2015

The innate immune system is currently seen as the probable initiator of events which culminate in the development of inflammatory bowel disease (IBD) with Toll-like receptors (TLRs) known to be involved in this disease process. Many regulators of TLRs have been described, and dysregulation of these may also be important in the pathogenesis of IBD. The aim of this study was to perform a co-ordinated analysis of the expression levels of both key intestinal TLRs and their inhibitory proteins in the same IBD cohorts, both ulcerative colitis (UC) and Crohn's disease (CD), in order to evaluate the potential roles of these proteins in the pathogenesis of IBD. Of the six TLRs (TLRs 1, 2, 4, 5, 6 and 9) examined, only TLR-4 was increased significantly in IBD, specifically in active UC. In contrast, differential alterations in expression of TLR inhibitory proteins were observed. A20 and suppressor of cytokine signalling 1 (SOCS1) were increased only in active UC while interleukin-1 receptor-associated kinase 1 (IRAK-m) and B cell lymphoma 3 protein (Bcl-3) were increased in both active UC and CD. In contrast, expression of both peroxisome proliferator-activated receptor gamma (PPARγ) and Toll interacting protein (Tollip) was decreased in both active and inactive UC and CD and at both mRNA and protein levels. In addition, expression of both PPARγ and A20 expression was increased by stimulation of a colonic epithelial cell line Caco-2 with both TLR ligands and commensal bacterial strains. These data suggest that IBD may be associated with distinctive changes in TLR-4 and TLR inhibitory proteins, implying that alterations in these may contribute to the pathogenesis of IBD.
Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours: presentation and long‐term outcomes
Authors: Chemaitilly Wassim , Merchant Thomas E. , Li Zhenghong , Barnes Nicole , Armstrong Gregory T. , Ness Kirsten K. , Pui Ching‐Hon , Kun Larry E. , Robison Leslie L. , Hudson Melissa M. , Sklar Charles A. , Gajjar Amar
Published: October 2015

Objectives

To estimate the prevalence of central precocious puberty (CPP) after treatment for tumours and malignancies involving the central nervous system (CNS) and examine repercussions on growth and pubertal outcomes.

Design

Retrospective study of patients with tumours near and/or exposed to radiotherapy to the hypothalamus/pituitary axis (HPA).

Patients and Measurements

Patients with CPP were evaluated at puberty onset, completion of GnRH agonist treatment (GnRHa) and last follow‐up. Multivariable analysis was used to test associations between tumour location, sex, age at CPP, GnRHa duration and a diagnosis of CPP with final height <‐2SD score (SDS), gonadotropin deficiency (LH/FSHD) and obesity, respectively.

Results

Eighty patients (47 females) had CPP and were followed for 11·4 ± 5·0 years (mean ± SD). The prevalence of CPP was 15·2% overall, 29·2% following HPA tumours and 6·6% after radiotherapy for non‐HPA tumours. Height <‐2SDS was more common at the last follow‐up than at the puberty onset (21·4% vs 2·4%, P = 0·005). Obesity was more prevalent at the last follow‐up than at the completion of GnRHa or the puberty onset (37·7%, 22·6% and 20·8%, respectively, P = 0·03). Longer duration of GnRHa was associated with increased odds of final height <‐2SDS (OR = 2·1, 95% CI 1·0–4·3) and longer follow‐up with obesity (OR = 1·3, 95% CI 1·1–1·6). LH/FSHD was diagnosed in 32·6%. There was no independent association between CPP and final height <‐2SDS, and LH/FSHD and obesity in the subset of patients with HPA low‐grade gliomas.

Conclusions

Patients with organic CPP experience an incomplete recovery of growth and a high prevalence of LH/FSHD and obesity. Early diagnosis and treatment of CPP may limit further deterioration of final height prospects.
The effect of ofloxacin otic drops on the regeneration of human traumatic tympanic membrane perforations
Authors: Lou Z. , Lou Z. , Tang Y. , Xiao J.
Published: October 2015

Objective

To investigate the effects of direct application of ofloxacin otic drops on human traumatic tympanic membrane perforations (TMPs).

Study design

Prospective, sequential allocation, controlled clinical study.

Setting

Tertiary university hospital.

Participants

In total, 149 patients with traumatic TMPs were recruited. They were allocated sequentially to two groups: a conservative observation group (n = 75) and a ofloxacin drops‐treated group (n = 74).

Main outcome measures

The closure rate, closure time and rate of otorrhoea were compared between the groups at 6 months.

Results

In total, 145 patients were analysed. The closure rates of medium perforations between the groups were not significantly different (P = 0.35); however, the ofloxacin drops‐treated group had a significantly shorter closure time for medium perforations than the observation group (P < 0.01). Additionally, the ofloxacin drops‐treated group showed improvement in the closure rate of large perforations (P = 0.02) and a significantly shorter mean closure time (P < 0.01) than the observation group. However, purulent otorrhoea was not significantly different between the groups (P = 0.37).

Conclusions

The present findings indicate that the moist eardrum environment resulting from topical application of ofloxacin drops shortened the closure time and improved the closure rate, but did not affect hearing improvement or increase the rate of middle ear infection of large traumatic TMPs. Thus, although traumatic TMPs tend to heal spontaneously, moist therapy can be considered for traumatic, large TMPs in the clinic.
IN‐SEASON HEAD‐COACH DISMISSALS AND THE PERFORMANCE OF PROFESSIONAL FOOTBALL TEAMS
Authors: van Ours Jan C. , van Tuijl Martin A.
Published: October 2015

This paper studies the causes and consequences of in‐season changes of the head‐coach of association football teams. We exploit data from the highest level of Dutch professional football during 14 successive seasons. An in‐season change of the head‐coach depends on recent match results and the difference between actual results and expectations as measured using bookmaker data. We find that, after the head‐coach has been replaced, teams perform better than before. However, the performance is also better than before for a control group of coach replacements that did not occur. From this we conclude that replacement of head‐coaches does not improve team performance. (JEL J44, L83)
Syringometaplasia: variants and underlying mechanisms
Authors: Abbas Ossama , Bhawan Jag
Published: October 2015

Syringometaplasia is an adaptive, benign, metaplastic cellular process that affects the eccrine ducts and glands in response to a variety of physiological or pathological stimuli. Different subtypes of syringometaplasia have been described, including the squamous, mucinous, and adenomatous types. These metaplastic changes have been reported in association with chemotherapeutic agents, as well as with a variety of skin disorders including multiple infectious, neoplastic, and inflammatory skin diseases. In this review, we attempt to shed light on the different patterns of syringometaplasia, its pathogenesis, the plethora of skin conditions in which it may be observed, and the differential diagnoses that should be considered.
Trends in state/territorial obesity prevalence by race/ethnicity among U.S. low‐income, preschool‐aged children
Authors: Pan L. , Grummer‐Strawn L. M. , McGuire L. C. , Park S. , Blanck H. M.
Published: October 2015

Background

Understanding state/territorial trends in obesity by race/ethnicity helps focus resources on populations at risk.

Objective

This study aimed to examine trends in obesity prevalence among low‐income, preschool‐aged children from 2008 through 2011 in U.S. states and territories by race/ethnicity.

Methods

We used measured weight and height records of 11.1 million children aged 2–4 years who participated in federally funded health and nutrition programmes in 40 states, the District of Columbia and two U.S. territories. We used logistic regression to examine obesity prevalence trends, controlling for age and sex.

Results

From 2008 through 2011, the aggregated obesity prevalence declined among all racial/ethnic groups (decreased by 0.4–0.9%) except American Indians/Alaska Natives (AI/ANs); the largest decrease was among Asians/Pacific Islanders (A/PIs). Declines were significant among non‐Hispanic whites in 14 states, non‐Hispanic blacks in seven states/territories, Hispanics in 13 states, A/PIs in five states and AI/ANs in one state. Increases were significant among non‐Hispanic whites in four states, non‐Hispanic blacks in three states, Hispanics in two states and A/PIs in one state. The majority of the states/territories had no change in obesity prevalence.

Conclusions

Our findings indicate slight reductions in obesity prevalence and variations in obesity trends, but disparities exist for some states and racial/ethnic groups.
Pressure injury risk assessment in intensive care: comparison of inter‐rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales
Authors: Fulbrook Paul , Anderson Alissa
Published: October 2015

Aim

To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index.

Background

Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients.

Design

Instrument development.

Methods

A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter‐rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales.

Results

Inter‐rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales.

Conclusion

Inter‐rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs.
A trial examining an advanced practice nurse intervention to promote medication adherence and symptom management in adult cancer patients prescribed oral anti‐cancer agents: study protocol
Authors: Spoelstra Sandra L. , Burhenn Peggy S. , DeKoekkoek Tracy , Schueller Monica
Published: October 2015

Aim

To report a study protocol that refines then examines feasibility, preliminary efficacy and satisfaction of ADHERE, an intervention using motivational interviewing and brief cognitive behaviorial therapy as a mechanism for goal‐oriented systematic patient education to promote symptom management and adherence among cancer patients prescribed oral anti‐cancer agents.

Background

Cancer treatment with oral anti‐cancer agents shifts responsibility for managing treatment from clinicians in supervised cancer centres to patients and their caregivers. Thus, a need exists to standardize start‐of‐care to support patient self‐management of care at home.

Design

A two‐phase quasi‐experimental sequential design with repeated measures.

Methods

Sixty‐five adult patients newly prescribed an oral anti‐cancer agent will be recruited from three community cancer centres. Phase 1 will enrol five patients to refine the ADHERE intervention prior to testing. After completion, Phase 2 will enrol 30 patients who receive usual care. Advanced practice nurses will then be trained. Thirty patients will be then enrolled in the intervention group and provided ADHERE, a 4‐week intervention using semi‐structured interactions (initial face‐to‐face session and once a week phone sessions over 3 weeks) and a Toolkit to promote self‐management of care. Outcome measures include: oral anti‐cancer agents adherence rate, symptom presence and severity, feasibility and satisfaction with ADHERE. This protocol was approved January 2014.

Discussion

This nurse‐led intervention has the potential to standardize the start‐of‐care training for the patients to self‐manage when oral anti‐cancer agents for treatment were prescribed.