bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation and Monitoring of a Child With Hydrocarbon Pneumonitis Using Point-of-Care Lung Ultrasound in the Pediatric Emergency Department
Authors: Vazquez Michelle , Paul Audrey Z. , Tay Ee Tein , Tsung James W.
Published: February 2016

A well-appearing 3-year-old boy presented to the pediatric emergency department 2 hours after a presumed hydrocarbon ingestion. He was referred to the emergency department by his pediatrician after consultation with the local poison control center after possibly ingesting ylang ylang (Cananga odorata) fragrance oil. The child was asymptomatic with a normal physical examination. Point-of-care lung ultrasound identified focal hydrocarbon pneumonitis in the right lung and demonstrated resolution of these findings. Utilization of point-of-care ultrasound resulted in a shorter emergency department length of stay and the avoidance of radiation exposure from serial chest x-rays.
Reasons for Energy Drink Use and Reported Adverse Effects Among Adolescent Emergency Department Patients
Authors: Nordt Sean Patrick , Claudius Ilene , Rangan Cyrus , Armijo Erick , Milano Peter , Yanger Sheryl , Tomaszsewski Christian
Published: February 2016

Objectives

There is concern of energy drink use by adolescents. The objective of this study was to evaluate the energy drink consumption use, frequency, age of first use, reasons for use, influences of choice of brand, and adverse events recorded in a predominant Latino adolescent population.

Methods

Subjects between the ages of 13 and 19 years utilizing emergency department services for any reason at a large county hospital answered a questionnaire about energy drink usage.

Results

There were 192 subjects, of which 49% were male and 51% were female. Latino adolescents were 85% of the participants, although other ethnic groups participated including African American, white, and Asian. Reasons for use include 61% to increase energy, 32% as study aide, 29% to improve sports performance, and 9% to lose weight. Twenty-four percent reported using energy drinks with ethanol or illicit drugs including marijuana, cocaine, and methamphetamine. Adverse reactions were reported in 40% of the subjects including insomnia (19%), feeling “jittery” (19%), palpitations (16%), gastrointestinal upset (11%), headache (8%), chest pain (5%), shortness of breath (4%), and seizures (1%).

Conclusions

Both brand name and packaging influenced the choice of energy drink in most subjects. Forty percent reported at least 1 adverse effect. While most adverse effects were not severe, a small number are serious. In addition, we showed intentional ingestion with ethanol and illicit drugs. Of additional concern is that both brand and packaging seem to directly affect choice of energy drink consumed.
A Novel Multi-network Approach Reveals Tissue-specific Cellular Modulators of Fibrosis in Systemic Sclerosis, Pulmonary Fibrosis and Pulmonary Arterial Hypertension
Authors: Taroni Jaclyn N , Greene Casey S , Martyanov Viktor , Wood Tammara A , Christmann Romy , Farber Harrison W , Lafyatis Robert A , Denton Christopher P , Hinchcliff Monique E , Pioli Patricia A , Mahoney J. Matthew , Whitfield Michael L
Published: February 2016

We have used integrative genomics to determine if a common molecular mechanism underlies different clinical manifestations in systemic sclerosis (SSc), and the related conditions pulmonary fibrosis (PF) and pulmonary arterial hypertension (PAH). We identified a common pathogenic gene expression signature - an immune-fibrotic axis-indicative of pro-fibrotic macrophages in multiple affected tissues (skin, lung, esophagus and PBMCs) of SSc, PF, and PAH. We used this disease-associated signature to query tissue-specific functional genomic networks. This allowed us to identify common and tissue-specific pathology of SSc and related conditions. We rigorously contrasted the lung- and skin-specific gene-gene interaction networks to identify a distinct lung resident macrophage signature associated with lipid stimulation and alternative activation. In keeping with our network results, we find distinct macrophages alternative activation transcriptional programs in SSc-PF lung and in the skin of patients with an "inflammatory" SSc gene expression signature. Our results suggest that the innate immune system is central to SSc disease processes, but that subtle distinctions exist between tissues. Our approach provides a framework for examining molecular signatures of disease in fibrosis and autoimmune diseases and for leveraging publicly available data to understand common and tissue-specific disease processes in complex human diseases.
Implementation of an Open Source Software solution for Laboratory Information Management and automated RNAseq data analysis in a large-scale Cancer Genomics initiative using BASE with extension package Reggie
Authors: Häkkinen Jari , Nordborg Nicklas , Månsson Olle , Vallon-Christersson Johan
Published: February 2016

Background

Large-scale cancer genomics initiatives and next-generation sequencing for transcriptome profiling allow for detailed molecular characterization of tumors, and provide opportunities for clinical tools to improve diagnosis, prognosis, and treatment decisions. Laboratory information, data management, and data sharing in large-scale genomics projects is a challenge. Aiming to introduce such technologies in a clinical setting offer additional challenges associated with requirements of short lead-times and specialized tracking of biomaterials, data, and analysis results.

Results

Using the free open-source BioArray Software Environment (BASE) and extension package Reggie we have implemented a laboratory information management system and an automated RNAseq data analysis pipeline that successfully manage a large regional cancer genomics initiative. The system manages enrolled cancer patients, tumor biopsies, extraction of nucleic acid, and whole transcriptome RNA-sequencing through to data analysis and quality control. The implementation offers integration of laboratory equipment and operating procedures, and information tracking in a module based fashion enabling efficient and flexible use of personnel resources. The system provides two-factor authentication and transaction control and seamless integration of freely available software for RNAseq analysis such as Tophat, Cufflinks, and Picard. As of February 2016 more than 8000 patients and over 6000 tumor biopsies have been successfully processed. Lead-time from biopsy arrival to summarized reports based on RNAseq data is less than 5 days, in line with regional clinical requirements. BASE and Reggie are freely available and released as open-source under the GNU General Public License and GNU Affero General Public License, respectively.

Conclusion

Using free open-source software together with BASE and a customized extension package, Reggie, we have implemented a system capable of managing large collections of quality controlled and curated material for use in research and development and tailored to meet requirements for clinical use. Featuring high degree of automation and interactivity the system allows for resource efficient laboratory procedures and short lead-times with demonstrated use of RNAseq data analyses in a clinical setting.
Convert Your Favorite Protein Modeling Program Into A Mutation Predictor: “MODICT”
Authors: Tanyalcin Ibrahim , Stouffs Katrien , Daneels Dorien , Al Assaf Carla , Lissens Willy , Jansen Anna , Gheldof Alexander
Published: February 2016

Motivation:

Predict whether a mutation is deleterious based on the custom 3D model of a protein.

Methods:

We have developed MGDIGT, a mutation prediction tool which isbased on per residuermsd(root mean square deviation) values of superimposed3D protein models. Our mathematical algorithm was tested for 42 describedmutations in multiple genes including renin, beta-tubulin, biotinidase,sphingomyelin phosphodiesterase-1, phenylalanine hydroxylase and medium chainAcyl-Coa dehydrogenase. Moreover,modictscores corresponded toexperimentally verified residual enzyme activities in mutated biotinidase,phenylalanine hydroxylase and medium chain Acyl-CoA dehydrogenase. Severalcommercially available prediction algorithms were tested and results werecompared. ThemodictPERL package and the manual can be downloaded fromhttps://github.com/MODICT/MODICT.

Conclusion:

We show here thatmodictis capable tool for mutation effectprediction at the protein level, using superimposed 3D protein models instead ofsequence based algorithms used by PGLYPHEN and SIFT.
Knowledge management in Mexican NPOs: a comparative study in organizations with a local and national presence
Authors: Zapata Cantu Laura E , Mondragon Carlota Eugenia
Published: February 2016

Purpose

– The purpose of this paper is to identify those organizational and personal elements that enable not-for-profit organizations (NPOs) to generate and transfer knowledge. NPOs are under pressure to use their financial and human resources efficiently, and to improve their activities and services constantly. Knowledge management as a strategy would ensure NPOs’ sustainability and rapid adaptation to dynamic environments.

Design/methodology/approach

– A qualitative study based on interviews, documents and questionnaires was conducted in 28 Mexican NPOs.

Findings

– Three main findings were identified: First, Mexican NPOs generate knowledge through courses and seminars based on volunteers’ personal motivation and organizational culture. Second, informal communication media are widely utilized to transfer organizational knowledge. Third, personal commitment to the organization’s mission and trust in their colleagues’ social actions are crucial for knowledge transfer effectiveness, rather than organizational elements.

Research limitations/implications

– Results scope of this study is limited to the NPOs under study. The findings expose some highlights for knowledge management process in NPOs in Mexico which would be tested in further research.

Practical implications

– Contrary to knowledge management in profit organizations, NPOs must recognize that personal motivation, commitment and trust in organization’s mission and social actions are crucial rather than organizational culture and top management support.

Social implications

– NPOs must convert their tacit knowledge to explicit knowledge, which allows NPOs to be transparent and effective, and to have access to more funding opportunities and to replicate their best practices throughout the organization.

Originality/value

– There are only few studies of knowledge management processes in NPOs. Some considerations have to be done with respect to personal motivation, commitment and trust, as well as organizational elements.
Barriers to knowledge sharing in third sector social care: a case study
Authors: Bloice Lyndsay , Burnett Simon
Published: February 2016

Purpose

– This paper aims to build on existing theory of knowledge sharing barriers (KSBs) by exploring the concept in the relatively under-researched context of social service not-for-profit organisations.

Design/methodology/approach

– In this study, case study methodology was used. Practitioner staff members took part in online questionnaires, followed by semi-structured interviews with line management and middle management staff. Secondary sources from the case study organisation were also used in the analysis. The analysis of questionnaire responses alongside responses from semi-structured interviews is compared with extant research into KSBs.

Findings

– The findings of this study highlight the need to re-examine the KSBs identified in the literature to reflect contexts beyond the private sector. Common barriers were identified, but some found in the case study organisation did not neatly fit into the existing definitions of KSBs. An updated list of KSBs to reflect this social service not-for-profit context is presented.

Research limitations/implications

– Case studies are often not generalisable; however, the KSB list developed here could be further explored and tested in other third sector organisations.

Practical implications

– The research raises the question of applicability of current knowledge management (KM) theory and lexicon in the third sector and social care environment.

Originality/value

– This study provides an insight into KM applicability in a third sector context, which is a relatively under-developed research area.
Increase of interleukin‐10‐producing B cells associated with long‐term remission after i.v. immunoglobulin treatment for pemphigus
Authors: Kabuto Miho , Fujimoto Noriki , Tanaka Toshihiro
Published: February 2016

We present a refractory case of pemphigus vulgaris that achieved long‐term remission after i.v. immunoglobulin treatment (IVIG). We evaluated the fluctuation of circulating interleukin‐10‐producing B cells (B10 cells) during the course in our case and other three patients with pemphigus treated with IVIG without clinical remission. B10 cells were observed predominantly in CD1d–, CD5–, CD9– and CD27+ populations among CD19+ cells in healthy controls, as well as in patients with pemphigus. The frequency of B10 cells among CD19+ cells increased in our case, but not in the other three patients without clinical remission, which leads to speculation on the association between the increase of B10 cells and the achievement of long‐term remission after IVIG treatment.
Families dealing with the uncertainty of genetic disorders: the case of Neurofibromatosis Type 1
Authors: Carrieri Daniele , Farrimond Hannah , Kelly Susan , Turnpenny Peter
Published: February 2016

Some scholars contend that genetic medicine is transforming the experience of illness and the social category of the family – bringing future risks into the present, and potentially strengthening familial biological bonds in light of these shared genetic risks. However, research has shown that genetic information is interpreted and acted upon through a rich repertoire of adaptable social, cultural and familial factors which pre‐exist and interact with biomedical knowledge. This paper reports research into families living with Neurofibromatosis Type 1 (NF1), a highly uncertain condition the manifestation of which can vary considerably also within the same family and, for this reason, has been defined as a ‘condition without parameters’. These characteristics makeNF1 a particularly informative condition for the examination of family dynamics around genetic information. The study and the methodology are based on the exploration of family networks and allow us to investigate the interrelation of individual and familial constructions of the uncertainty ofNF1. This also allows both theoretical and policy claims to be made about the danger of reductionist thinking about the transformative potential of genetic technologies.
Choosing a Nursing Home: What Do Consumers Want to Know, and Do Preferences Vary across Race/Ethnicity?
Authors: Hefele Jennifer Gaudet , Acevedo Andrea , Nsiah‐Jefferson Laurie , Bishop Christine , Abbas Yasmin , Damien Ecaterina , Ramos Candi
Published: February 2016

Objective

To identify what consumers want to know about nursing homes (NHs) before choosing one and to determine whether information preferences vary across race/ethnicity.

Data Sources/Study Setting

Primary data were collected in Greater Boston (January 2013–February 2014) from community‐dwelling, white, black, and Latino adults aged 65+ and 40–64 years, who had personal/familial experience with a NH admission or concerns about one.

Study Design

Eleven focus groups and 30 interviews were conducted separately by race/ethnicity and age group.

Principal Findings

Participants wanted detailed information on the facility, policies, staff, and residents, such as location, staff treatment of residents, and resident conditions. They wanted a sense of the NH gestalt and were interested in feedback/reviews from residents/families. Black and Latino participants were especially interested in resident and staff racial/ethnic concordance and facility cultural sensitivity. Latino participants wanted information on staff and resident language concordance.

Conclusions

Consumers want more information about NHs than what is currently available from resources like Nursing Home Compare. Report card makers can use these results to enhance their websites, and they should consider the distinct needs of different racial/ethnic groups. Future research should test methods for collecting and reporting resident and family feedback/reviews.
An Approach to Speaker Identification
Authors: Hollien Harry
Published: February 2016

This presentation will provide standards upon which any attempts to meet the challenge of identifying speakers by voice should be based. It is organized into a model based on (i) application of a rigorous research program validating the system, (ii) an upgrading of the organization of theSIarea, and (iii) exploitation of new technology. The second part of the presentation will describe an illustrative speech/voice approach toSIdevelopment. This effort is also based on an extensive corpus of research. It is suggested that application of the cited standards, plus the illustrative model, will permit reasonable progress to be made. Finally, a number of procedural recommendations are made; they should enhance the efficacy of the proposed approach.
Blood glucose screening among elderly Malaysians: Who to target?
Authors: Cheah Yong Kang , Goh Kim‐Leng
Published: February 2016

Background

Early detection of raised blood glucose can reduce the risk of developing diabetes. Despite being a high‐risk group, a significant proportion of the elderly population does not undergo blood glucose screening. The aim of the present study was to examine the factors affecting blood glucose screening among the elderly.

Methods

Data from a sample of 2463 respondents in the National Health and Morbidity Survey 2011 were used. Pearson Chi‐squared tests were conducted to find factors associated with screening behavior. A logit model was used to analyze the likelihood of screening.

Results

Income, age, education, ethnicity, employment status, availability of medical coverage, and smoking behavior were significantly associated with blood glucose screening. The likelihood of blood glucose screening was positively correlated with available monthly income and was higher in those aged 60–69 years, those attaining higher education, Malays, and elderly who are medically covered.

Conclusions

The findings of the present study provide insights for health policy formulation for the elderly. As part of their efforts to reduce national health costs, governments should pay particular attention to the elderly, who are likely to be unscreened for blood glucose levels, because they face even larger risk exposure.
Is internal jugular vein extensibility associated with indices of fluid responsiveness in ventilated patients?
Authors: Thudium M. , Klaschik S. , Ellerkmann R. K. , Putensen C. , Hilbert T.
Published: February 2016

Background

Ultrasound of the inferior vena cava provides rapid and non‐invasive assessment of fluid responsiveness. We hypothesized that the extensibility of the internal jugular vein (IJV) as well reflects intravascular volume state. We assessedIJVdimensions together with pulse pressure variation (PPV) as dynamic index for fluid responsiveness in mechanically ventilated patients.

Methods

Of 50 patients after cardiac surgery were assessed. Ultrasound ofIJVdimensions as well as collection of hemodynamic data were performed in 30° and horizontal (0°) position, and the ventilator‐ and position‐inducedIJVextensibilities (E‐IJV) were calculated.

Results

Mean ventilator‐induced E‐IJVin 30° position was 56%, and meanPPVin 30° position was 13.7%. Changing the patient's position from 30° to 0° significantly reduced ventilator‐induced E‐IJVas well asPPV. Pearson's correlation test revealed significant association between ventilator‐induced E‐IJVand fluid responsiveness deduced fromPPVin 0° position (r= 0.43,P< 0.005). An E‐IJVthreshold >5% identified patients with significantly elevatedPPVvalues.

Conclusion

Ultrasound of theIJVandPPVas a dynamic index for fluid responsiveness can be associated under certain defined conditions. Whether or not ultrasound of theIJVcan be useful to predict patient intravascular volume state should be further studied using invasive cardiac output monitoring.
Habitat selection in a reintroduced population: social effects differ between natal and post‐release dispersal
Authors: Richardson K. M. , Ewen J. G.
Published: February 2016

Understanding the factors driving dispersal behaviour and habitat selection in reintroduced populations can be critical to reintroduction success. Social factors in particular can influence habitat selection, for example through conspecific attraction, and this can have both positive and negative effects on reintroduction success, particularly where multiple releases occur. In addition, little is known about how habitat selection differs between natal and post‐release dispersal within species. Often it is assumed that information from a species’ natal dispersal preferences and patterns can act as a guide for predicting post‐release dispersal behaviour, but no studies to date have examined this. We examine the factors influencing habitat selection during both natal and post‐release dispersal in a reintroduced hihi (stitchbird, Notiomystis cincta) population using species distribution models. We demonstrate a strong social effect in habitat selection of natal dispersers bred at the release area (largely the offspring of founders), yet find no social effect in habitat selection of juveniles translocated 2 years after the first releases occurred. In addition, we establish that environmental variables are important in habitat selection in both groups. We suggest (1) that consideration of social effects and conspecific attraction should play a role in planning reintroduction release strategies, especially if reinforcement releases are considered necessary, and (2) that it may not always be appropriate to assume post‐release dispersal in reintroduced populations will be driven by the same factors that influence natal dispersal.
‘As long as you're easy on the eye’: reflecting on issues of positionality and researcher safety during farmer interviews
Authors: Chiswell Hannah M , Wheeler Rebecca
Published: February 2016

This reflective paper explores gendered experiences of fieldwork encounters with farmers. Specifically, the paper considers how the particularities of farmer interviews – including the geographical remoteness of many farm holdings, the strength of tradition in farm families and the male‐dominated nature of the industry – pose a unique and challenging prospect for the young and relatively inexperienced female researcher. Drawing on a number of the authors’ own fieldwork experiences, we consider some of the ethical and safety challenges we have faced, and offer some practical strategies for addressing these. The paper also reflects on the implications of our positionality – specifically the intersection of our age, gender and non‐farming status – on our own, and participants’ interview performances. Although, as we discuss, we found these aspects of our identity broadly advantageous in securing and conducting successful farmer interviews, we also recount how they invited a number of unwelcomed behaviours, and often left us vulnerable to emotional risk. In sharing such experiences, we raise a number of questions concerning the ethical responsibility of negotiating or conforming to the identities conferred on us during farmer interviews and hope to prompt further discussion around these challenges. The paper concludes that young female researchers face a number of ethical and safety challenges during fieldwork in the rural and farming context and highlights the need to consider the impact of researcher positionality on the researcher, the participant(s) and the overall research process. By stimulating such a debate, we aim to bring the issue of gendered experiences of rural research to the fore, and hope to provide some reassurance and support to others working in similar areas.
The role of nutraceuticals for the treatment of non‐alcoholic fatty liver disease
Authors: Del Ben Maria , Polimeni Licia , Baratta Francesco , Pastori Daniele , Angelico Francesco
Published: February 2016

Non‐alcoholic fatty liver disease (NAFLD) represents the most common chronic liver disease. It is characterized by a wide spectrum of hepatic changes, which may progress to liver fibrosis and to cirrhosis. NAFLD is considered as the hepatic component of the metabolic syndrome but mechanisms underlying the onset and progression of NAFLD are still under investigation. The traditional ‘two hit hypothesis’ has been developed within a more complex ‘multiple parallel hit hypothesis’ which comprises a wide spectrum of parallel hits. Many therapeutic approaches have been proposed so far and several types of nutraceuticals have been suggested for the treatment of NAFLD and non‐alcoholic steatohepatitis (NASH), the most promising of which are those with antioxidant effects. In particular, vitamin E appears to be effective for the treatment of nondiabetic subjects with more advanced NASH, although the high suggested daily dosages are a matter of concern. Moreover, polyphenols reduce liver fat accumulation, mainly by inhibiting lipogenesis. At present, there are insufficient data to support the use of vitamin C supplements in patients with NAFLD. Data on polyunsaturated fatty acid (PUFA) supplementation are heterogeneous, and no well‐designed randomized controlled studies (RCTs) of adequate size, with histological assessment of steatosis, have been conducted. Based on the available data, silymarin supplementation for the treatment of NAFLD seems to have a favourable effect. The results with anti‐inflammatory agents, such as vitamin D and carnitine are uncertain. In conclusion, there are insufficient data either to support or refute the use of nutraceuticals for subjects with NAFLD. Further RTCs, with histological changes as an outcome measure, are needed.
Pooled population pharmacokinetic model of imipenem in plasma and the lung epithelial lining fluid
Authors: van Hasselt J. G. Coen , Rizk Matthew L. , Lala Mallika , Chavez‐Eng Cynthia , Visser Sandra A. G. , Kerbusch Thomas , Danhof Meindert , Rao Gauri , van der Graaf Piet H.
Published: February 2016

Aims

Several clinical trials have confirmed the therapeutic benefit of imipenem for treatment of lung infections. There is however no knowledge of the penetration of imipenem into the lung epithelial lining fluid (ELF), the site of action relevant for lung infections. Furthermore, although the plasma pharmacokinetics (PK) of imipenem has been widely studied, most studies have been based on selected patient groups. The aim of this analysis was to characterize imipenem plasma PK across populations and to quantify imipenem ELF penetration.

Methods

A population model for imipenem plasma PK was developed using data obtained from healthy volunteers, elderly subjects and subjects with renal impairment, in order to identify predictors for inter‐individual variability (IIV) of imipenem PK. Subsequently, a clinical study which measured plasma and ELF concentrations of imipenem was included in order to quantify lung penetration.

Results

A two compartmental model best described the plasma PK of imipenem. Creatinine clearance and body weight were included as subject characteristics predictive for IIV on clearance. Typical estimates for clearance, central and peripheral volume, and inter‐compartmental clearance were 11.5 l h–1, 9.37 l, 6.41 l, 13.7 l h–1, respectively (relative standard error (RSE) <8%). The distribution of imipenem into ELF was described using a time‐independent penetration coefficient of 0.44 (RSE 14%).

Conclusion

The identified lung penetration coefficient confirms the clinical relevance of imipenem for treatment of lung infections, while the population PK model provided insights into predictors of IIV for imipenem PK and may be of relevance to support dose optimization in various subject groups.
Nutraceuticals with a clinically detectable blood pressure‐lowering effect: a review of available randomized clinical trials and their meta‐analyses
Authors: Borghi Claudio , Cicero Arrigo F G
Published: February 2016

AIMS

The aim of the present study was to review and comment on the available evidence on nutraceuticals with a clinically demonstrable blood pressure (BP)‐lowering effect.

METHODS

We reviewed studies published in the English language from 1990 to 2015 on dietary supplements or nutraceuticals claiming to show an effect on human BP. An initial list of possibly effective agents and studies was obtained from the online reference, the Natural Medicine Comprehensive Database. Using PubMed, we searched agents identified from this list using the MeSH terms ‘hypertension’, ‘blood pressure’, ‘dietary supplement’ and ‘nutraceuticals’, alone and in combination. We then focused our attention on meta‐analyses and randomized clinical trials.

RESULTS

Beyond the well‐known effects on BP of the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, a large number of studies have investigated the possible BP‐lowering effect of different dietary supplements and nutraceuticals, most of which are antioxidant agents with a high tolerability and safety profile. In particular, a relatively large body of evidence supports the use of potassium, magnesium, L‐arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled‐release melatonin and aged garlic extract. The antihypertensive effect of all these nutraceuticals seems to be dose related and the overall tolerability is good.

CONCLUSION

Some nutraceuticals might have a positive impact on BP in humans. Further clinical research is needed, to identify from the available active nutraceuticals those with the best cost‐effectiveness and risk–benefit ratio for widespread and long‐term use in the general population with a low‐added cardiovascular risk related to uncomplicated hypertension.
Long‐term outcome of insulin pump therapy: reduction of hypoglycaemia and impact on glycaemic control
Authors: Quirós C. , Giménez M. , Ríos P. , Careaga M. , Roca D. , Vidal M. , Conget I.
Published: February 2016

Aims

To determine the long‐term outcome of continuous subcutaneous insulin infusion (CSII) in Type 1 diabetes according to Catalan National Health Service indications.

Methods

Retrospective observational study including 178 patients with Type 1 diabetes who started CSII treatment in our centre (2003–2008). All patients were followed in our CSII programme for outpatients for at least 5 years. Data on annual HbA1c levels were collected, and the main indication for starting CSII was analysed.

Results

Twenty‐seven of 178 patients were excluded because of loss to follow‐up or withdrawal from CSII, thus 151 patients (aged 37.4 ± 10.5 years, 64% women) were analysed. The main indications for starting CSII were suboptimal metabolic control (60.9%), severe hypoglycaemia/hypoglycaemia unawareness (25.5%) and others (13.6%). HbA1c was 64 ± 13 mmol/mol (8.0 ± 1.2%) at the start of CSII and 62 ± 13 mmol/mol (7.8 ± 1.2%) after 5 years in the total cohort (P = 0.1). The severe hypoglycaemia rates were 0.66 ± 1.61 and 0.17 ± 0.42 episodes/patient/year (P < 0.001). In patients with suboptimal metabolic control, HbA1c decreased from 68 ± 12 mmol/mol (8.4 ± 1.1%) to 64 ± 14 mmol/mol (8.0 ± 1.3%) (P = 0.016), with 37.4% of those in this group having an HbA1c ≤ 58 mmol/mol (7.5%) after 5 years. In patients starting CSII due to severe hypoglycaemia the problem was considered resolved in 93%, and in 64% of those starting CSII because of suboptimal glycaemic control, HbA1c improved significantly.

Conclusions

CSII therapy achieves and maintains its efficacy mainly in terms of reducing severe hypoglycaemia. In the whole group of patients, the reduction in HbA1c is transient and disappears after 5 years.
Urinary C–peptide analysis in an intervention study: experience from the DEFEND–2 otelixizumab trial
Authors: Ambery P. , Donaldson J. , Parkin J. , Austin D. J.
Published: February 2016

Aims

To demonstrate that analysis of urinary C–peptide across multiple study sites in the context of an intervention trial (DEFEND–2) is a viable alternative to mixed meal testing and delivers results that correlate to mixed meal testing estimation of endogenous insulin production.

Methods

Second morning void urine was collected for analysis and was available from 161 subjects at baseline (55 placebo, 106 otelixizumab), and 146 subjects (47 placebo, 99 otelixizumab) at month 12. Urinary C–peptide concentration was corrected for urinary creatinine [urinary C–peptide/creatinine ratio (UCPCR)] and serum C–peptide from the mixed meal tolerance test was calculated using area under the plasma concentration–time curve (AUC) normalized over 120 min. The correlation between mixed meal stimulated C–peptide AUC (mmol/l/min) and UCPCR (nmol/mmol), as well as the correlation between insulin use (IU/kg), and HbA1c (%) with UCPCR, was determined.

Results

UCPCR and mixed meal testing C–peptide AUC were correlated, with a correlation coefficient of 0.4172. UCPCR was not correlated with exogenous insulin use (r = –0.089) or with HbA1c (r = –0.032).

Conclusions

Urinary C–peptide estimation should be considered as a measure of endogenous insulin production in future Type 1 diabetes mellitus outcome trials. A change in the timing for urine collection (to 120 min post standard meal) may provide a tighter correlation to C–peptide measured via a traditional mixed meal test.
Network burst dynamics under heterogeneous cholinergic modulation of neural firing properties and heterogeneous synaptic connectivity
Authors: Knudstrup Scott , Zochowski Michal , Booth Victoria
Published: February 2016

The characteristics of neural network activity depend on intrinsic neural properties and synaptic connectivity in the network. In brain networks, both of these properties are critically affected by the type and levels of neuromodulators present. The expression of many of the most powerful neuromodulators, including acetylcholine (ACh), varies tonically and phasically with behavioural state, leading to dynamic, heterogeneous changes in intrinsic neural properties and synaptic connectivity properties. Namely, ACh significantly alters neural firing properties as measured by the phase response curve in a manner that has been shown to alter the propensity for network synchronization. The aim of this simulation study was to build an understanding of how heterogeneity in cholinergic modulation of neural firing properties and heterogeneity in synaptic connectivity affect the initiation and maintenance of synchronous network bursting in excitatory networks. We show that cells that display different levels of ACh modulation have differential roles in generating network activity: weakly modulated cells are necessary for burst initiation and provide synchronizing drive to the rest of the network, whereas strongly modulated cells provide the overall activity level necessary to sustain burst firing. By applying several quantitative measures of network activity, we further show that the existence of network bursting and its characteristics, such as burst duration and intraburst synchrony, are dependent on the fraction of cell types providing the synaptic connections in the network. These results suggest mechanisms underlying ACh modulation of brain oscillations and the modulation of seizure activity during sleep states.
Patients' expectations and experiences of epilepsy surgery—A population‐based long‐term qualitative study
Authors: Ozanne Anneli , Graneheim Ulla H. , Ekstedt Gerd , Malmgren Kristina
Published: February 2016

Objective

The aim of this prospective and population‐based longitudinal study was to explore patients' expectations before surgery and their experiences both short and long term after epilepsy surgery.

Methods

A national sample of adult patients answered open‐ended questions preoperatively, 2 years after surgery and at a cross‐sectional long‐term follow‐up (mean 13 years, standard deviation [SD] 1.85). The answers were analyzed by qualitative content analysis.

Results

Eighty patients participated in the study. Before surgery, patients experienced a belief in a “normal” life; they hoped for reduction of seizures and medication, a richer social life, and more self‐confidence. However, they also experienced anxiety of the unknown. They were afraid of the operation, of continued seizures, and of complications. At both postoperative follow‐ups patients experienced increased independence. They had symptom reduction, felt relief from worries and fears, and felt that they had a new life. However, some patients experienced that the operation had changed their life to the worse due to both psychological and neurologic adverse effects, regardless of whether they had obtained seizure freedom or improvement.

Significance

Positive experiences of epilepsy surgery dominated, both in the short and long term. However, attention must be paid to negative expectations before and negative experiences after surgery in order to provide individual support and information. This should increase the possibility for patients to have realistic hopes before surgery and to find coping strategies in the new life situation after surgery.
Interacting effects of atmospheric CO2 enrichment and solar radiation on growth of the aquatic fern Azolla filiculoides
Authors: van Kempen Monique M. L. , Smolders Alfons J. P. , Bögemann Gerard M. , Lamers Leon P. M. , Roelofs Jan G. M.
Published: February 2016

Azolla spp. rank among the fastest growing plants in the world. Increased atmospheric CO2 concentrations can be expected to have a strong impact on the biomass production of this fast growing floating fern, especially at northern latitudes.

We investigated the growth of the northernmost occurring species, A. filiculoides, under past (Eocene), present and predicted future CO2 levels. To study the interacting effects of temperature and solar radiation, we performed the atmospheric CO2 fertilisation experiments in spring, summer and autumn.

Azolla filiculoides grown at 1600 ppm CO2 produced twice as much biomass as when grown at 400 ppm CO2 in spring and autumn. However, high summer temperature and solar radiation seemed to significantly lower its maximum growth potential, presumably as a result of a metabolic shift as indicated by water loss.

Nutrient availability became more important at higher atmospheric CO2 concentration. In addition, high temperature and solar radiation affected the nitrogen concentrations in A. filiculoides, most likely by inducing photorespiration and photoinhibition.

Our results indicate that temperate Azolla may become more productive in temperate regions as a result of rising atmospheric carbon dioxide concentrations. In addition, our results can help to explain the reported massive Azolla event in the Eocene.
Winter precipitation and snow accumulation drive the methane sink or source strength of Arctic tussock tundra
Authors: Blanc‐Betes Elena , Welker Jeffrey M. , Sturchio Neil C. , Chanton Jeffrey P. , Gonzalez‐Meler Miquel A.
Published: February 2016

Arctic winter precipitation is projected to increase with global warming, but some areas will experience decreases in snow accumulation. Although Arctic CH4 emissions may represent a significant climate forcing feedback, long‐term impacts of changes in snow accumulation on CH4 fluxes remain uncertain. We measured ecosystem CH4 fluxes and soil CH4 and CO2 concentrations and 13C composition to investigate the metabolic pathways and transport mechanisms driving moist acidic tundra CH4 flux over the growing season (Jun–Aug) after 18 years of experimental snow depth increases and decreases. Deeper snow increased soil wetness and warming, reducing soil %O2 levels and increasing thaw depth. Soil moisture, through changes in soil %O2 saturation, determined predominance of methanotrophy or methanogenesis, with soil temperature regulating the ecosystem CH4 sink or source strength. Reduced snow (RS) increased the fraction of oxidized CH4 (Fox) by 75–120% compared to Ambient, switching the system from a small source to a net CH4 sink (21 ± 2 and −31 ± 1 mg CH4 m−2 season−1 at Ambient and RS). Deeper snow reduced Fox by 35–40% and 90–100% in medium‐ (MS) and high‐ (HS) snow additions relative to Ambient, contributing to increasing the CH4 source strength of moist acidic tundra (464 ± 15 and 3561 ± 97 mg CH4 m−2 season−1 at MS and HS). Decreases in Fox with deeper snow were partly due to increases in plant‐mediated CH4 transport associated with the expansion of tall graminoids. Deeper snow enhanced CH4 production within newly thawed soils, responding mainly to soil warming rather than to increases in acetate fermentation expected from thaw‐induced increases in SOC availability. Our results suggest that increased winter precipitation will increase the CH4 source strength of Arctic tundra, but the resulting positive feedback on climate change will depend on the balance between areas with more or less snow accumulation than they are currently facing.
Alteplase vs. urokinase for occluded hemodialysis catheter: A randomized trial
Authors: Pollo Viviane , Dionízio Danielle , Bucuvic Edwa Maria , Castro João Henrique , Ponce Daniela
Published: February 2016

Introduction Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. To compare the efficacy of alteplase vs. urokinase in reestablishing adequate blood flow through completely occluded vascular catheters. Methods In this randomized study, patients with completely occluded tunneled HD catheters received 40 minutes intracatheter dwell with alteplase (1 mg/mL) or urokinase (5000 IU/mL). Primary endpoint was the proportion of patients with occluded catheters achieving post‐thrombolytic blood flow of ≥250 mL/min. Safety endpoints included the incidence of hemorrhagic and infectious complications. Findings Eligible adult patients (n = 100) were treated with alteplase (n = 44) or urokinase (n = 56). The two groups were similar in gender (male: 51.8% vs. 56.8%, P = 0.35), age (60 ± 12 vs. 59 ± 13 years, P = 0.71), time on dialysis (678 ± 203 vs. 548 ± 189 days, P = 0.77), diabetes and cardiovascular disease (55.6% vs. 70.4%, P = 0.08 and 17.8% vs. 22.7%, P = 0.38, respectively), jugular vein as main vascular access (54.8% vs. 62.5%, P = 0.57), and time of CVC (278 ± 63 vs. 218 ± 59 days, P = 0.67). Primary success with alteplase and urokinase occurred in 42/44 (95%) vs. 46/56 (82%), P = 0.06. Success was not achieved after the second dose of alteplase and urokinase in 1 and 7 cases, respectively (2% vs. 12%, P = 0.075). Serious adverse effects were not observed in both groups. There was no difference between the two groups in infectious complications (P = 0.94). Discussion Alteplase and urokinase are effective thrombolytic agents for restoring HD catheter patency. Our study has revealed a likely slight superiority of alteplase over urokinase for unblocking central lines, but which has enrolled too few patients to be able to detect a difference of this size.
Three Tales of Obsession: Crosscutting Boundaries in Middle Eastern Film
Authors: Gordon Joel
Published: February 2016

By examining three classic neo‐realist films directed by three cineastes from three different countries between 1958 and 1970, I attempt to engage a dialogue across boundaries of Middle Eastern film. Each film has been discussed in contexts of national cinema traditions with references to Western and Third World film, but rarely if ever in the context of regional, multi‐lingual cinemas with which they share most in terms of theme and content. Representative of a national moment, the intersections of modernity and social dislocation, and centered on who loses his sanity, they constitute a not‐so‐accidental trilogy that blurs boundaries between realism and melodrama.
Vaccination, Fear and Historical Relevance
Authors: Boddice Rob
Published: February 2016

Fears about vaccination are tenacious, despite an overwhelming weight of evidence in favour of immunisation and despite the potentially dangerous consequences of falling rates of immunity against once common diseases. Drawing on recent developments in the history of emotions and an extensive historiography on the history of vaccination, this article argues that fear of vaccination has become culturally idiomatic and highly resistant to fact‐based education campaigns. A role is envisaged for historians to present, in accessible media, narratives of successful public‐health campaigns and, at the same time, to demonstrate the contextual underpinnings of social fear in order to allay such fears in the present.
Recent Approaches in Understanding Evangelization in New Spain
Authors: Christensen Mark
Published: February 2016

This article surveys scholarship on the evangelization of the natives of New Spain that challenge the myths and assumptions behind a “spiritual conquest.” Aided by native‐language sources and armed with a more critical reading of those Spanish, contemporary works debunk many myths associated with the spiritual conquest including those advocating a complete and finished conversion, the dominant role of the Spanish clergy, and a monolithic view of the Church, its institutions, and its implementation throughout New Spain. Recent scholars view conversion as a negotiated and fluid state that moved beyond syncretism and expose the major role native assistants played in evangelization. Furthermore, scholars increasingly illustrate the various versions of Catholicism, its apparatuses, and its participants as they continue to challenge a spiritual conquest.
INFLATION TARGETING WITH IMPERFECT INFORMATION*
Authors: Araujo Aloisio , Berriel Tiago , Santos Rafael
Published: February 2016

In a global games setup with imperfect commitment technology, we show that low targets—the ones close to the optimal inflation under perfect commitment—are unattainable, leading to a trade‐off between low and credible targets. Moreover, since noisy public information helps to coordinate expectations around the announced target, our article supports unconventional policy prescriptions. First, weaker countries need to impose higher targets. Second, less transparency helps to make the announced target credible and then reduces the optimally announced target. Results are based on a general central bank loss function encompassing models traditionally used to discuss central bank decisions.
POLLUTION PERMIT SYSTEMS AND FIRM DYNAMICS: HOW DOES THE ALLOCATION SCHEME MATTER?*
Authors: Dardati Evangelina
Published: February 2016

I use a firm dynamics model to compare two permit allocation schemes commonly used in pollution permit systems. In the first, closing plants keep their permits, and new entrants do not get them, whereas in the second, closing plants lose their permits, and new entrants get free allowances. Calibrating the model with data from power plants participating in the U.S.program, I find that, compared to the first scheme, in the second arrangement, (i) plants stay, on average, 3.6 years longer and (ii) although the aggregate emission rate is lower, the plant distribution displays more dirty and low‐productivity plants.