bluuebunny/crossref_metadata_2025 huggingface dataset:
Soil chemical management drives structural degradation of Oxisols under a no-till cropping system
Authors: Nunes Márcio R. , da Silva Alvaro P. , Denardin José E. , Giarola Neyde F. B. , Vaz Carlos M. P. , van Es Harold M. , da Silva Anderson R.
Published: June 2017

Physical degradation of the subsurface layer of soils reduces the effectiveness of no-till (NT) as a sustainable soil management approach in crop production. Chemical factors may reduce the structural stability of Oxisols and thereby exacerbate compaction from machinery traffic. We studied the relationship between chemical management and structural degradation in Oxisols cultivated under NT at three sites in southern Brazil. The surface and subsurface layers of the soils were characterised chemically and mineralogically and three physical attributes related to soil structural stability (readily dispersible clay in water, mechanically dispersible clay in water, and water percolation) were quantified for each layer. The same characterisations were performed on Oxisols collected from adjacent non-cultivated areas, to provide reference data for non-degraded soil. The levels of dispersed clay in the cultivated soil from the surface layer matched those of the non-cultivated soil, but for the subsurface layer higher dispersed clay levels in the cultivated soil showed that it was physically degraded relative to the non-cultivated soil. Water percolation was found to be slower through the Oxisols cultivated under NT, irrespective of the soil layer. The relationships between the three indicators of soil structural stability and the measured chemical and mineralogical variables of the soils were explored through an analysis of canonical correlation. The principal variables associated with the lower stability of the cultivated vs non-cultivated Oxisols were the lower concentrations of organic carbon and exchangeable aluminium and, for the surface layer, the higher pH. It is argued that structural degradation of Oxisols cultivated under NT, observed predominantly in the subsurface layer, has been aggravated by the accumulation of amendments and fertilisers in the surface soil and reduced levels of organic matter, especially in the subsurface layer.
The Regulatory Network Controlling Ethanol-Induced Expression of Alcohol Dehydrogenase in the Endophyte Azoarcus sp. Strain BH72
Authors: Krause Andrea , Julich Henrike , Mankar Manasee , Reinhold-Hurek Barbara
Published: June 2017

The habitat of the nitrogen-fixing endophyte Azoarcus sp. strain BH72 is grass roots grown under waterlogged conditions that produce, under these conditions, ethanol. Strain BH72 is well equipped to metabolize ethanol, with eight alcohol dehydrogenases (ADHs), of which ExaA2 and ExaA3 are the most relevant ones. exaA2 and exaA3 cluster and are surrounded by genes encoding two-component regulatory systems (TCSs) termed ExaS-ExaR and ElmS-GacA. Functional genomic analyses revealed that i) expression of the corresponding genes was induced by ethanol, ii) the genes were also expressed in the rhizoplane or even inside of rice roots, iii) both TCSs were indispensable for growth on ethanol, and iv) they were important for competitiveness during rice root colonization. Both TCSs form a hierarchically organized ethanol-responsive signal transduction cascade with ExaS-ExaR as the highest level, essential for effective expression of the ethanol oxidation system based on ExaA2. Transcript and expression levels of exaA3 increased in tcs deletion mutants, suggesting no direct influence of both TCSs on its ethanol-induced expression. In conclusion, this underscores the importance of ethanol for the endophytic lifestyle of Azoarcus sp. strain BH72 and indicates a tight regulation of the ethanol oxidation system during root colonization.
Bilateral anterior shoulder dislocation
Authors: Rudy Bruce S. , Hennrikus William L.
Published: June 2017

Shoulders are the most common major joint to become disarticulated, and shoulder dislocation is a frequent patient presentation to the ED. Bilateral shoulder dislocations, however, are rare and typically caused by seizure activity or electrocution. Posterior disarticulation is most common following seizure activity. This article describes an adolescent girl who dislocated both shoulders anteriorly following seizure activity.
What do PAs need to know about prescription drug monitoring programs?
Authors: Mospan Geoffrey A. , Lucas Austin
Published: June 2017

As controlled-substance abuse continues to increase in the United States, clinicians find themselves on the front lines of this epidemic. State-operated prescription drug monitoring programs are a valuable resource that prescribers can use to see patients' controlled substance history. Despite some limitations, these programs have been shown to be an effective method in reducing overdose deaths and the supply of controlled substances in the community.
Adjuvant steroid therapy in community-acquired pneumonia
Authors: Sisson Caroline Bell
Published: June 2017

Despite medical advances, pneumonia is a leading cause of death worldwide. Because inflammation is a key defense mechanism, adjuvant corticosteroid therapy has long been considered but never widely recommended to treat pneumonia. New research is exploring potential benefits of this therapy, including reduced time to clinical stability, reduced hospital stay, reduced rates of treatment failure, and prevention of complications.
CaMKII Activation Promotes Cardiac Electrical Remodeling and Increases the Susceptibility to Arrhythmia Induction in High-fat Diet–Fed Mice With Hyperlipidemia Conditions
Authors: Zhong Peng , Quan Dajun , Huang Yan , Huang He
Published: June 2017

Background:

Obesity/hyperlipidemia is closely related to both atrial and ventricular arrhythmias. CaMKII, a multifunctional serine/threonine kinase, has been involved in cardiac arrhythmias of different etiologies. However, its role in obesity/hyperlipidemia-related cardiac arrhythmia is unexplored. The aim of this was to determine the involvement of CaMKII in the process.

Methods:

Adult male APOE−/− mice were fed a high-fat diet (HFD), administrated with KN93 (10 mg·kg−1·2d−1), a specific inhibitor of CaMKII. Serum lipid and glucose profile, cardiac function, and surface electrocardiogram were determined. Electrophysiological study and epicardial activation mapping were performed in Langendorff-perfused heart. Expression of cardiac ion channels, gap junction proteins, Ca2+ handling proteins, and CaMKII were evaluated, coupled with histological analysis.

Results:

A hyperlipidemia condition was induced by HFD in the APOE−/− mice, which was associated with increased expression and activity of CaMKII in the hearts. In Langendorff-perfused hearts, HFD-induced heart showed increased arrhythmia inducibility, prolonged action potential duration, and decreased action potential duration alternans thresholds, coupled with slow ventricular conduction, connexin-43 upregulation, and interstitial fibrosis. Downregulation of ion channels including Cav1.2 and Kv4.2/Kv4.3 and disturbed Ca2+ handling proteins were also observed in HFD-induced heart. Interestingly, all these alterations were significantly inhibited by KN93 treatment.

Conclusion:

Our results demonstrated an adverse effect of metabolic components on cardiac electrophysiology and implicated an important role of CaMKII underlying this process.
Can the Early Introduction of Palliative Care Alleviate the Disease Burden in Adolescents and Young Adults With Cancer?
Authors: Daunov Katherine A. , Cornett Sydney E.
Published: June 2017

As a result of oncology research and technology, great improvements in cancer treatment and survival have occurred in the past 2 decades. However, adolescents and young adults (AYAs) who received a diagnosis of cancer have not witnessed the same improvements in survival as children or older adults. Adolescent and young adult oncology is an emerging field that focuses on the physical and psychosocial treatment of patients between the ages of 15 and 39 years. Adolescent and young adult oncology patients experience high burden of psychological distress, in addition to physical symptoms, which affect their quality of life. Cancer is the leading disease-related cause of death in AYAs; it is imperative that healthcare professionals work to improve the high morbidity and mortality within this age group. Adolescent and young adult oncology patients would benefit from earlier implementation of palliative care. Incorporating palliative care alongside early cancer treatment regimens is beneficial in helping to relieve psychosocial and symptom burden, increase quality of life, and identify the patient's goals of care throughout the treatment process. Initiating palliative care at the beginning of treatment helps build therapeutic relationships between the patient and caregiver. When there are changes in goals of care, having an established relationship with palliative care eases the transition between active disease treatment and end-of-life care. Despite research indicating benefits to patients and increased growth of clinical and academic palliative care programs, many barriers still exist in incorporating palliative care alongside standard oncology care. Palliative care is not routinely incorporated into AYA oncology despite the high symptom burden and unique psychosocial needs of this population. This literature review discusses unique challenges that AYAs face throughout the diagnosis of cancer, identifies the unmet needs of this population, and advocates for an earlier introduction of palliative care throughout the treatment process.
A Microbiological and Ultrastructural Comparison of Aseptic versus Sterile Acellular Dermal Matrix as a Reconstructive Material and a Scaffold for Stem Cell Ingrowth
Authors: Mendenhall Shaun D. , Schmucker Ryan W. , Daugherty Timothy H. F. , Kottwitz Katherine M. , Reichensperger Joel D. , Koirala Janak , Cederna Paul S. , Neumeister Michael W.
Published: June 2017

Background:

Recent data suggest an increased risk for infection when acellular dermal matrix is used in breast reconstruction. This may be because some acellular dermal matrices are actually not terminally sterilized but are instead “aseptically processed.” This study evaluates aseptic and sterile matrices for evidence of bacterial contamination and whether or not terminal sterilization affects matrix collagen architecture and stem cell ingrowth.

Methods:

Five separate samples of 14 different matrices were analyzed by fluorescent in situ hybridization using a bacterial DNA probe to detect bacterial DNA on the matrices. Separate samples were incubated for bacteria, acid-fast bacilli, and fungi for 2 to 6 weeks to detect living organisms. The impact of terminal sterilization on the collagen network and stem cell ingrowth on the matrices was then assessed.

Results:

Traces of bacterial DNA were encountered on all matrices, with more bacteria in the aseptic group compared with the sterile group (3.4 versus 1.6; p = 0.003). The number of positive cultures was the same between groups (3.8 percent). Electron microscopy demonstrated decreased collagen organization in the sterile group. Stem cell seeding on the matrices displayed a wide variation of cellular ingrowth between matrices, with no difference between aseptic and sterile groups (p = 0.2).

Conclusions:

Although there was more evidence of prior bacterial contamination on aseptically processed matrices compared with sterile matrices; clinical cultures did not differ between groups. Terminal sterilization does not appear to affect stem cell ingrowth but may come at the cost of damaging the collagen network.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Is Maintenance Electroconvulsive Therapy Always an Elective Procedure?
Authors: Rosenthal Isobel A. , Kellner Charles H.
Published: June 2017

Because of the severe nature of psychiatric illness, electroconvulsive therapy (ECT) is not always an “elective procedure.” The pre-ECT medical evaluation, although important, should not be an impediment to timely ECT. We argue that an arbitrary regulation requiring new assessments every 30 days may be unduly burdensome and unnecessary. The small medical risk of treatment should be weighed against the potential psychiatric risk (including suicide) of delayed treatment.
MELD: Mixed Effects for Large Datasets
Authors: Nielson Dylan M. , Sederberg Per B.
Published: June 2017

Mixed effects models provide significant advantages in sensitivity and flexibility over typical statistical approaches to neural data analysis, but mass univariate application of mixed effects models to large neural datasets is computationally intensive. Threshold free cluster enhancement also provides a significant increase in sensitivity, but requires computationally-intensive permutation-based significance testing. Not surprisingly, the combination of mixed effects models with threshold free cluster enhancement and nonparametric permutation-based significance testing is currently completely impractical. With mixed effects for large datasets (MELD) we circumvent this impasse by means of a singular value decomposition to reduce the dimensionality of neural data while maximizing signal. Singular value decompositions become unstable when there are large numbers of noise features, so we precede it with a bootstrap-based feature selection step employing threshold free cluster enhancement to identify stable features across subjects. By projecting the dependent data into the reduced space of the singular value decomposition we gain the power of a multivariate approach and we can greatly reduce the number of mixed effects models that need to be run, making it feasible to use permutation testing to determine feature level significance. Due to these innovations, MELD is much faster than an element-wise mixed effects analysis, and on simulated data MELD was more sensitive than standard techniques, such as element-wise t-tests combined with threshold-free cluster enhancement. When evaluated on an EEG dataset, MELD identified more significant features than the t-tests with threshold free cluster enhancement in a comparable amount of time.
Following Snowden: an international survey
Authors: Adams Andrew A. , Murata Kiyoshi , Lara Palma Ana María
Published: June 2017

Purpose

This paper aims to present the baseline English survey used in the other papers in this special issue.

Design/methodology/approach

The survey includes yes/no, Likert scale and free text responses, which were analysed quantitatively and qualitatively.

Findings

Respondents to the survey expressed divergent views of whether they would emulate Snowden, even though most in all countries believed he had helped rather than harmed society.

Originality/value

This is the only such broad survey on attitudes to Snowden of which the authors are aware.
Few youngsters would follow Snowden’s lead in Japan
Authors: Murata Kiyoshi , Fukuta Yasunori , Orito Yohko , Adams Andrew A.
Published: June 2017

Purpose

This paper aims to deal with the attitudes towards and social impact of Edward Snowden’s revelations in Japan, taking the Japanese socio-cultural and political environment surrounding privacy and state surveillance into account.

Design/methodology/approach

A questionnaire survey of 1,820 university students and semi-structured follow-up interviews with 56 respondents were conducted, in addition to reviews of the literature on privacy and state surveillance in Japan. The outcomes of the survey were statistically analysed, and qualitative analyses of the interview results were also performed.

Findings

Snowden’s revelations have had little influence over Japanese youngsters’ attitudes towards privacy and state surveillance, mainly due to their low level of awareness of the revelations and high level of confidence in government agencies.

Practical implications

The study results imply a need for reviewing educational programmes for civic education in lower and upper secondary education.

Social implications

The results of this study based on a large-scale questionnaire survey indicate an urgent necessity for providing Japanese youngsters with opportunities to learn more about privacy, liberty, individual autonomy and national security.

Originality/value

This study is the first attempt to investigate the social impact of Snowden’s revelations on Japanese youngsters’ attitudes towards privacy and state surveillance as part of cross-cultural analyses between eight countries.
Surveillance following Snowden: a major challenge in Spain
Authors: Adams Andrew A. , Arias-Oliva Mario , Lara Palma Ana María , Murata Kiyoshi
Published: June 2017

Purpose

This study aims to analyse the impacts of Edward Snowden’s revelations in Spain focusing on issues of privacy and state surveillance. This research takes into consideration the Spanish context from a multidimensional perspective: social, cultural, legal and political.

Design/methodology/approach

The paper reviews the Spanish privacy and state surveillance situation. Responses to a questionnaire were collected from 207 university students studying at Universitat Rovira i Virgili or Burgos University. The quantitative responses to the survey were statistically analysed as well as qualitative considerations of free-text answers.

Findings

The survey outcomes demonstrate that a majority of respondents are aware of Snowden’s revelations, but only a few have even considered taking serious actions to improve their online privacy. One of the most relevant findings is that Spanish citizens find it acceptable to lose privacy and be subject to state surveillance if that provides a benefit in security.

Practical implications

The research points out the importance of privacy in a multicultural environment. A sensitised society is a keystone for the healthy and balanced development of state surveillance policy and practice.

Social implications

Training programmes are a critical dimension to ensure awareness across society regarding privacy and digital technologies. Suitable educational policies and curricula at all levels should be fostered.

Originality/value

Privacy and state surveillance based on information and communication technologies is an emerging research topic with important consequences for social values and ethics. This study provides an overview of Spanish higher education students’ attitudes in these areas.
Reverse logistics for the end-of-life and end-of-use products in the pharmaceutical industry: a systematic literature review
Authors: Campos Elaine Aparecida Regiani de , Paula Istefani Carisio de , Pagani Regina Negri , Guarnieri Patricia
Published: June 2017

Purpose

The aim of this paper is to develop a systematic literature review (SLR) aiming to identify reverse logistics (RL) concepts and practices applied to the end-of-life (EOL) and end-of-use (EOU) of pharmaceuticals and to identify and synthesize, through bibliometric indicators, research opportunities on RL, considering the analysis of publications in the periodical Supply Chain Management: An International Journal (SCMij).

Design/methodology/approach

The SLR followed two steps, namely, search for articles on the subject and content analysis of selected material and bibliometric analysis of publications using VOSviewer®.

Findings

The SLR allowed the compilation of evidences regarding pharmaceutical RL in the groups: environmental risk, the RL evolution and regulatory and stakeholder’s educational perspective. Despite the timid specific literature on pharmaceutical RL, it was also possible to point out research gaps and opportunities. Pharmaceutical RL seems to be influenced by studies from traditional RL including mathematical modeling, managerial strategies and technologies but prescind of a systemic solution. Besides reducing environmental impact, the motivation to implement pharmaceutical RL resides in its potential for revenue. Considering integrated logistics as a trend and an emerging issue, RL for the pharmaceutical industry needs to be addressed more thorough and broadly.

Research limitations/implications

The limited number of papers returned in this SLR of pharmaceutical RL impaired the bibliometric analysis of them, leading to the inclusion of papers on general RL.

Originality/value

This study provides an overview of the evolution of RL in the pharmaceutical industry, it also clarifies concepts and EOL/EOU practices, particularly directed to the pharmaceutical industry RL.
Towards a classification of supply chain relationships: a routine based perspective
Authors: Ahmed Muhammad Usman , Kristal Mehmet Murat , Pagell Mark , Gattiker Thomas F.
Published: June 2017

Purpose

This paper studies buyer–supplier relationships (BSRs) by taking a routine-based approach and develops a taxonomy of BSRs. Recent advances in the BSR literature have shown that firms implement a host of diverse routines, called integrative practices, with their supply chain partners. Relationships differ based on what integrative practices are present in them. This paper aims to develop a taxonomy of supply chain relationships based on integrative practices measured at the relationship level.

Design/methodology/approach

The authors use survey data collected from North American manufacturers to establish the measurement properties of new relationship level constructs that represent different aspects of integration. Cluster analysis is used with these new constructs to develop a taxonomy of supply chain relationships. Regression and bootstrapping techniques are used to establish the predictive validity and stability of the taxonomy.

Findings

The results show four distinct types of relationships. On comparison, the authors find salient differences between their results and past classifications. As a result of taking a routine-based multidimensional view of integration, the authors find two types of relationships that have not been discovered by past taxonomies.

Originality/value

The new relationship level constructs will allow academics to have greater precision in their research questions on BSRs, as not all aspects of integration behave in the same manner. The four types of relationships identified by this study provide a useful framework to manage supply chain relationships for practitioners.
Variation in leaf anatomical traits from tropical to cold‐temperate forests and linkage to ecosystem functions
Authors: He Nianpeng , Liu Congcong , Tian Miao , Li Meiling , Yang Hao , Yu Guirui , Guo Dali , Smith Melinda D. , Yu Qiang , Hou Jihua
Published: June 2017

Leaf anatomical traits may reflect plants adaption to environmental changes and influence ecosystem functions, as they regulate light absorption and gas exchange to some extent. Here, we hypothesized that leaf anatomical traits were closely related to gross primary productivity (GPP) because photosynthesis commonly occurs in the chloroplasts of palisade and spongy tissues in leaf.

Eight leaf anatomical traits were measured in 916 plant species inhabiting from tropical to cold‐temperate forests in eastern China: adaxial epidermis thickness (AD), abaxial epidermis thickness (AB), leaf thickness (LT), palisade tissue thickness (PT), and spongy tissue thickness (ST), palisade–spongy tissue ratio (PT/ST), palisade tissue–leaf thickness ratio (PT/LT), and spongy tissue–leaf thickness ratio (ST/LT).

Leaf anatomical traits showed significant latitudinal patterns at species, plant functional group (PFG), and community levels (p < .05), and they differed between PFG and community. Temperature and precipitation were the main factors influencing AD, AB, PT/ST, and PT/LT, explaining 33–72% of the total variation at large scale. Furthermore, AB, LT, PT/ST, and PT/LT were significantly correlated with the aridity index.

Our findings filled the data gap of plant anatomical traits at regional scales, and broadened current knowledge on the adaptation strategies of plant anatomical traits, which also provided new evidence for linkages of plant traits and functioning across natural communities.

A plain language summary is available for this article.
Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma/hyperplasia in primary hyperparathyroidism
Authors: Goroshi Manjunath , Lila Anurag R. , Jadhav Swati S. , Sonawane Sushil , Hira Priya , Goroshi Shetteppa , Garle Mahadev N. , Dalvi Abhay , Sathe Pragati , Bandgar Tushar R. , Shah Nalini S.
Published: June 2017

Background

Radiation exposure to neck by four‐dimensional computerized tomography (4DCT) is relatively high and limits its use as a first‐line investigation in evaluation of primary hyperparathyroidism (PHPT). Radiation exposure can be reduced by restricting the number of CT phases. Our aim was to study the performance of 4DCT in cohort of surgery‐naïve PHPT patients, and to evaluate percentage enhancement as an objective radiological index to discriminate parathyroid lesions (adenoma/hyperplasia) from thyroid tissue and lymph nodes.

Materials and method

Retrospective study of 49 PHPT patients {(44 single‐gland diseases (SGD) and five multiple‐gland disease (MGD)} who underwent 4DCT (unenhanced, early arterial, early venous and delayed venous phase) pre‐operatively. Two radiologists who were blinded to surgical location of parathyroid lesions examined the scans. Attenuation values were recorded for parathyroid lesions (n=50), thyroid gland (n=50) and lymph nodes (n=12) in different phases. Percentage enhancement for different phases was calculated as “(HU in a specific enhanced phase‐HU in unenhanced phase)/HU in unenhanced phase” ×100.

Results

Inter‐rater reliability between the two radiologists was 0.83 (Cohen's kappa). In SGD, sensitivity and PPV were 93.18% and 98.8% for lateralization, and 89.77% and 95.18% for quadrant localization, respectively. In MGD, 4DCT showed 50% sensitivity and 100% PPV. Percentage arterial enhancement showed highest area under curve (AUC=0.992) for differentiation of parathyroid lesions from thyroid tissue and lymph nodes. A cut‐off value of 128.9% showed 95.8% sensitivity and 100% specificity for the identification of parathyroid lesions.

Conclusions

We propose that percentage arterial enhancement can be used as an objective radiological index for accurate identification of parathyroid adenoma/hyperplasia.
Enhanced Visualization of Detected 3D Geometric Differences
Authors: Palma Gianpaolo , Sabbadin Manuele , Corsini Massimiliano , Cignoni Paolo
Published: June 2017

The wide availability of 3D acquisition devices makes viable their use for shape monitoring. The current techniques for the analysis of time‐varying data can efficiently detect actual significant geometric changes and rule out differences due to irrelevant variations (such as sampling, lighting and coverage). On the other hand, the effective visualization of such detected changes can be challenging when we want to show at the same time the original appearance of the 3D model. In this paper, we propose a dynamic technique for the effective visualization of detected differences between two 3D scenes. The presented approach, while retaining the original appearance, allows the user to switch between the two models in a way that enhances the geometric differences that have been detected as significant. Additionally, the same technique is able to visually hides the other negligible, yet visible, variations. The main idea is to use two distinct screen space time‐based interpolation functions for the significant 3D differences and for the small variations to hide. We have validated the proposed approach in a user study on a different class of datasets, proving the objective and subjective effectiveness of the method.
Early clearance vs persistence of de novo donor‐specific antibodies following lung transplantation
Authors: Islam Ana K. , Sinha Neeraj , DeVos Jennifer M. , Kaleekal Thomas S. , Jyothula Soma S. , Teeter Larry D. , Nguyen Duc T. M. , Eagar Todd N. , Moore Linda W. , Puppala Mamta , Wong Stephen T. C. , Knight Richard J. , Frost Adaani E. , Graviss Edward A. , Osama Gaber A.
Published: June 2017

Background

The natural history of de novo donor‐specific antibodies (dnDSA) after lung transplantation is not well‐described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation.

Methods

A single‐center review of all lung transplants from 1/2009‐7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure.

Results

Median follow‐up was 18 months (range: 1‐61 months), and 24.6% of 333 first‐time lung‐only transplant recipients developed a dnDSA. Ethnicity, HLA‐DQ mismatches, post‐transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA‐positive vs negative recipients (P=.025). Of 323 recipients with 1‐year follow‐up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007).

Conclusions

Early post‐lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri‐transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one‐third of recipients, was associated with a lower risk of acute rejection.
Hypoxia–ischemia is not an antecedent of most preterm brain damage: the illusion of validity
Authors: Gilles Floyd , Gressens Pierre , Dammann Olaf , Leviton Alan
Published: June 2017

Brain injury in preterm newborn infants is often attributed to hypoxia–ischemia even when neither hypoxia nor ischemia is documented, and many causative speculations are based on the same assumption. We review human and animal study contributions with their strengths and limitations, and conclude that – despite all the work done in human fetal neuropathology and developmental models in animals – the evidence remains unconvincing that hypoxemia, in the fetus or newborn infant, contributes appreciably to any encephalopathy of prematurity. Giving an inappropriate causal name to a disorder potentially limits the options for change, should our understanding of the etiologies advance. The only observationally‐based title we think appropriate is ‘encephalopathy of prematurity’. Future pathophysiological research should probably include appropriately designed epidemiology studies, highly active developmental processes, infection and other inflammatory stimuli, the immature immune system, long chain fatty acids and their transporters, and growth (neurotrophic) factors.

What this paper adds

Fetal hypoxemia is rarely documented in brain injury studies.

Animal studies fail to consider human–animal fetal anatomical differences.

Putative treatments from animal models have not found clinical use.

Observational studies constitute the only approach to etiological understanding.

No convincing evidence yet that hypoxemia injures preterm brain. Encephalopathy of prematurity is preferable to hypoxia‐ischemia as a term for this disorder.

Encephalopathy of prematurity is preferable to hypoxia‐ischemia as a term for this disorder.
Therapeutic inertia in patients treated with two or more antidiabetics in primary care: Factors predicting intensification of treatment
Authors: Mata‐Cases Manel , Franch‐Nadal Josep , Real Jordi , Gratacòs Mònica , López‐Simarro Flora , Khunti Kamlesh , Mauricio Dídac
Published: June 2017

Aims

To determine the patterns and predictors of treatment intensification in patients with type 2 diabetes on ≥2 non‐insulin antidiabetic drugs (NIADs) and inadequate glycaemic control in primary care in Catalonia, Spain.

Material and Methods

This was a retrospective analysis using electronic medical records from patients with HbA1c ≥ 7% and a first prescription for a new NIAD or insulin recorded from January 2010 to December 2014. Therapeutic inertia was defined as no intensification if HbA1c was ≥8% at baseline or during follow‐up. Time to first intensification was evaluated by time‐to‐event analysis, and factors predicting intensification through a competing‐risk regression model.

Results

Among 23 678 patients with HbA1c ≥ 7%, 26.2% were censored without treatment intensification after a median follow up of 4.2 years. Among the 12 730 patients in the subgroup with HbA1c ≥ 8% at baseline or during follow‐up, therapeutic inertia was present in 18.1% of cases. In the overall cohort, mean HbA1c at initiation of insulin and NIAD were 9.4% ± 1.5% and 8.7% ± 1.3%, respectively. Median time to first intensification was 17.1 months in patients with HbA1c 8.0% to 9.9%, and 10.1 months in those with HbA1c > 10%. Variables strongly associated with intensification were HbA1c values 8.0% to 9.9% (subhazard ratio [SHR], 1.7; 95% CI, 1.65‐1.78) and >10% (SHR, 2.5; 95% CI, 2.37‐2.68); diabetes duration ≥20 years (SHR, 1.25; 95% CI, 1.11‐1.41) and, to a lesser extent, female gender, presence of comorbidities, chronic kidney disease and microvascular complications.

Conclusions

Intensification was not undertaken in 1 in 5 patients. Both HbA1c thresholds and time until therapy intensification exceeded current recommendations.
Pleistocene megafaunal extinctions and the functional loss of long‐distance seed‐dispersal services
Authors: Pires Mathias M. , Guimarães Paulo R. , Galetti Mauro , Jordano Pedro
Published: June 2017

Pleistocene extinctions affected mainly large‐bodied animals, determining the loss or changes in numerous ecological functions. Evidence points to a central role of many extinct megafauna herbivores as seed dispersers. An important step in understanding the legacy of extinct mutualistic interactions is to evaluate the roles and effectiveness of megafauna herbivores in seed dispersal. Here we use morphological and ecophysiological allometries to estimate both quantitative and qualitative aspects of seed‐dispersal services likely provided by extinct megafauna. We developed a mechanistic model that encompasses four stages of seed dispersal – seed ingestion, gut retention, animal movement, and seed deposition. We estimate seed‐dispersal kernels through simulations to infer the role of Pleistocene megafauna in promoting long‐distance dispersal and examine how seed dispersal was affected by extinctions. Simulations suggest extinct large‐bodied frugivores would frequently disperse large seeds over a thousand meters, whereas smaller‐bodied frugivores are more likely to deposit the seeds over a few hundred meters. Moreover, events of long‐distance seed dispersal by the extinct megafauna would be up to ten times longer than long‐distance dispersal by smaller‐sized extant mammals. By estimating the combined distribution of seed dispersal distances considering all large‐bodied mammalian frugivores in specific South American Pleistocene assemblages we found that long‐distance dispersal contracted by at least two thirds after the megafauna died out. The disruption of long‐distance dispersal is expected to have consequences for recruitment, spatial and genetic structure of plant populations, population persistence and community composition. Promoting long‐distance seed dispersal was one among other salient features of extinct Pleistocene megafauna that reveal their influence on natural ecosystems. Modeling the consequences of megafaunal extinctions can offer quantitative predictions on the consequences of ongoing defaunation to plant populations and ecological communities.
Projections of climate‐driven changes in tuna vertical habitat based on species‐specific differences in blood oxygen affinity
Authors: Mislan K. A. S. , Deutsch Curtis A. , Brill Richard W. , Dunne John P. , Sarmiento Jorge L.
Published: June 2017

Oxygen concentrations are hypothesized to decrease in many areas of the ocean as a result of anthropogenically driven climate change, resulting in habitat compression for pelagic animals. The oxygen partial pressure,pO2, at which blood is 50% saturated (P50) is a measure of blood oxygen affinity and a gauge of the tolerance of animals for low ambient oxygen. Tuna species display a wide range of blood oxygen affinities (i.e., P50values) and therefore may be differentially impacted by habitat compression as they make extensive vertical movements to forage on subdaily time scales. To project the effects of end‐of‐the‐century climate change on tuna habitat, we calculate tuna P50depths (i.e., the vertical position in the water column at which ambientpO2is equal to species‐specific blood P50values) from 21st century Earth System Model (ESM) projections included in the fifth phase of the Climate Model Intercomparison Project (CMIP5). Overall, we project P50depths to shoal, indicating likely habitat compression for tuna species due to climate change. Tunas that will be most impacted by shoaling are Pacific and southern bluefin tunas—habitat compression is projected for the entire geographic range of Pacific bluefin tuna and for the spawning region of southern bluefin tuna. Vertical shifts in P50depths will potentially influence resource partitioning among Pacific bluefin, bigeye, yellowfin, and skipjack tunas in the northern subtropical and eastern tropical Pacific Ocean, the Arabian Sea, and the Bay of Bengal. By establishing linkages between tuna physiology and environmental conditions, we provide a mechanistic basis to project the effects of anthropogenic climate change on tuna habitats.
Poor adherence to chronic obstructive pulmonary disease medications in primary care: Role of age, disease burden and polypharmacy
Authors: Vetrano Davide L. , Bianchini Elisa , Onder Graziano , Cricelli Iacopo , Cricelli Claudio , Bernabei Roberto , Bettoncelli Germano , Lapi Francesco
Published: June 2017

Aim

The aim of the present study was to assess the occurrence and determinants of poor adherence to pharmacological treatment in a cohort of primary care patients with chronic obstructive pulmonary disease (COPD), paying special attention to the role of age, comorbidity and polypharmacy.

Methods

We identified a cohort of COPD patients using the primary care Italian Health Search – IMS Longitudinal Patient Database. We assessed 1‐year adherence to COPD maintenance pharmacotherapy (encompassing inhaled corticosteroids, long‐acting beta agonists and long‐acting anticholinergics). Poor adherence was defined as <80% of proportion of days covered by pharmacological treatment over a 1‐year period.

Results

Of 22 505 patients (mean age 67.3 ± 13.2; 41.3% women) entering the study, 17 486 (77.7%) were poorly adherent. According to multivariate analysis, poor adherence is less likely in older adults (OR 0.51, 95% CI 0.40–0.66), in non‐smokers (OR 0.77, 95% CI 0.69–0.86) and in those with a history of alcohol abuse (OR 0.74, 95% CI 0.58–0.94). Higher comorbidity (OR 1.43, 95% CI 1.13–1.80) was positively associated with poor adherence. Polypharmacy was associated with poor adherence only in patients aged ≥65 years (OR 1.34, 95% CI 1.13–1.59). Finally, COPD severity was associated with a reduced likelihood of poor adherence (OR 0.20, 95% CI 0.07–0.61 for stage IV).

Conclusions

The present findings show that poor medication adherence is common in patients with COPD receiving long‐term treatment. The interaction between age and polypharmacy, and the role of comorbidity suggest a pivotal role of biological age as a steering determinant of poor adherence. Geriatr Gerontol Int 2017; 17: 2500–2506.
Chromosomal abnormalities of high‐grade mucinous tubular and spindle cell carcinoma of the kidney
Authors: Sadimin Evita T , Chen Ying‐Bei , Wang Lu , Argani Pedram , Epstein Jonathan I
Published: June 2017

Aims

Mucinous tubular and spindle cell carcinoma (MTSC) of the kidney is a distinct entity characterized by bland tightly packed elongated tubules and spindle cells with low nucleolar grade in a basophilic mucinous stroma. Several case studies have reported MTSC with high‐grade features and have brought into question whether they represented MTSC or a variant of papillary renal cell carcinoma.

Methods and results

We searched our pathology database and identified seven cases: six MTSC with high International Society of Urological Pathology (ISUP) nucleolar grade and one MTSC with overall low nucleolar grade but extensive necrosis. DNA samples were extracted from paraffin blocks and analysed using a single nucleotide polymorphism (SNP) array platform. Six of seven patients were female, aged between 46 and 82 years. Tumour sizes ranged from 3 to 7.5 cm. One case showed involvement of renal sinus fat and a second case showed involvement of the perinephric fat. All cases shared common chromosomal abnormalities observed with the more typical MTSC, with monosomy of chromosomes 1, 4, 6, 8, 9, 13, 14, 15 and 22. Trisomy of chromosomes 7, 17 and loss of Y chromosome were not observed in any of the cases. None of the patients showed evidence of recurrence or metastasis.

Discussion

The molecular analysis performed in this study supports that MTSC of the kidney can have high nucleolar grade or extensive necrosis, and that they are not papillary renal cell carcinoma. We support modifying the definition of MTSC to include those with higher nucleolar grade.
Interplay between barrier epithelial cells and dendritic cells in allergic sensitization through the lung and the skin
Authors: Deckers Julie , De Bosscher Karolien , Lambrecht Bart N , Hammad Hamida
Published: June 2017

The prevalence of asthma is increasing over the years and it has become obvious that a thorough understanding of mechanisms leading to Th2 sensitization and to asthma is urgently needed to provide better ways to treat the disease. This articles reviews the different players involved in the initiation of allergic reactions in the lung and in the skin, and highlights the importance of a crosstalk between antigen‐presenting dendritic cells and structural cell‐derived signals in this process. Our increasing understanding of these mechanisms indicates that structural cells, such as airway epithelial cells and skin keratinocytes, need to be considered as more than a simple physical barrier since they are very upstream of the entire Th2 cascade and therefore might represent crucial targets for new therapies.
Modeling TH2 responses and airway inflammation to understand fundamental mechanisms regulating the pathogenesis of asthma
Authors: Foster Paul S. , Maltby Steven , Rosenberg Helene F. , Tay Hock L. , Hogan Simon P. , Collison Adam M. , Yang Ming , Kaiko Gerard E. , Hansbro Philip M. , Kumar Rakesh K. , Mattes Joerg
Published: June 2017

In this review, we highlight experiments conducted in our laboratories that have elucidated functional roles for CD4+ T‐helper type‐2 lymphocytes (TH2 cells), their associated cytokines, and eosinophils in the regulation of hallmark features of allergic asthma. Notably, we consider the complexity of type‐2 responses and studies that have explored integrated signaling among classical TH2 cytokines (IL‐4, IL‐5, and IL‐13), which together with CCL11 (eotaxin‐1) regulate critical aspects of eosinophil recruitment, allergic inflammation, and airway hyper‐responsiveness (AHR). Among our most important findings, we have provided evidence that the initiation of TH2 responses is regulated by airway epithelial cell‐derived factors, including TRAIL and MID1, which promote TH2 cell development via STAT6‐dependent pathways. Further, we highlight studies demonstrating that microRNAs are key regulators of allergic inflammation and potential targets for anti‐inflammatory therapy. On the background of TH2 inflammation, we have demonstrated that innate immune cells (notably, airway macrophages) play essential roles in the generation of steroid‐resistant inflammation and AHR secondary to allergen‐ and pathogen‐induced exacerbations. Our work clearly indicates that understanding the diversity and spatiotemporal role of the inflammatory response and its interactions with resident airway cells is critical to advancing knowledge on asthma pathogenesis and the development of new therapeutic approaches.
Crucial role for CD69 in allergic inflammatory responses: CD69‐Myl9 system in the pathogenesis of airway inflammation
Authors: Kimura Motoko Y. , Hayashizaki Koji , Tokoyoda Koji , Takamura Shiki , Motohashi Shinichiro , Nakayama Toshinori
Published: June 2017

CD69 has been known as an early activation marker of lymphocytes; whereas, recent studies demonstrate that CD69 also has critical functions in immune responses. Early studies using human samples revealed the involvement of CD69 in various inflammatory diseases including asthma. Moreover, murine disease models using Cd69−/− mice and/or anti‐CD69 antibody (Ab) treatment have revealed crucial roles for CD69 in inflammatory responses. However, it had not been clear how the CD69 molecule contributes to the pathogenesis of inflammatory diseases. We recently elucidated a novel mechanism, in which the interaction between CD69 and its ligands, myosin light chain 9, 12a and 12b (Myl9/12) play a critical role in the recruitment of activated T cells into the inflammatory lung. In this review, we first summarize CD69 function based on its structure and then introduce the evidence for the involvement of CD69 in human diseases and murine disease models. Then, we will describe how we discovered CD69 ligands, Myl9 and Myl12, and how the CD69‐Myl9 system regulates airway inflammation. Finally, we will discuss possible therapeutic usages of the blocking Ab to the CD69‐Myl9 system.
An examination of advanced practice nurses’ job satisfaction internationally
Authors: Steinke M.K. , Rogers M. , Lehwaldt D. , Lamarche K.
Published: June 2017

Aim

To examine the level of job satisfaction of nurse practitioners/advanced practice nurses in developing and developed countries.

Background

The nurse practitioner/advanced practice nurse has the advanced, complex skills and experience to play an important role in providing equitable health care across all nations.

Introduction

Key factors that contribute to health disparities include lack of access to global health human resources, the right skill mix of healthcare providers and the satisfaction and retention of quality workers.

Methods

The study utilized a descriptive analysis and cross‐sectional survey methodology with quantitative and qualitative sections of 1419 job satisfaction survey respondents from an online survey.

Results

Age, number of hours worked in a week and length of time that nurse practitioners/advanced practice nurses worked in their current jobs were statistically significant in job satisfaction. A key barrier was the lack of respect from supervisors and physicians.

Discussion

It was clear from the number of comments in the qualitative section of the survey that having a wide scope of practice is rewarding and challenging to the nurse practitioner and advanced practice nurse.

Conclusion and implications for health policy

The challenges to transform healthcare gaps of access into a better distribution of health care in all countries would constitute a systematic change in policy including providing education and training for doctors and nurses that will match the skills needed in the workplace; emphasizing the right skill mix for the healthcare team; supporting advanced practice nurses in the workplace; and utilizing all healthcare providers to the fullest extent of their abilities.