bluuebunny/crossref_metadata_2025 huggingface dataset:
Aortic Waveform Analysis to Individualize Treatment in Heart Failure
Authors: Wohlfahrt Peter , Melenovsky Vojtech , Redfield Margaret M. , Olson Thomas P. , Lin Grace , Abdelmoneim Sahar S. , Hametner Bernhard , Wassertheurer Siegfried , Borlaug Barry A.
Published: February 2017

Background—

Afterload reduction is a cornerstone in the management of patients with heart failure (HF) and reduced ejection fraction. However, arterial load and the effect of HF therapies on afterload might vary between individuals. Tailoring vasoactive medicines to patients with HF based upon better understanding of arterial afterload may enable better individualization of therapy.

Methods and Results—

Subjects with HF and reduced ejection fraction underwent aggressive titration of vasoactive HF therapies with assessment of central aortic waveforms analyzed using pulse wave, wave separation, and arterial reservoir models. Clinical response to treatment was assessed using the 6-minute walk test distance, which increased in 25 subjects and decreased or remained unchanged in 13. Subjects with improvement on therapy displayed higher aortic pressure wave pulsatility (central pulse pressure [PP], reflected pressure wave, and reservoir pressure) at study entry compared with subjects without improvement (all
P
<0.05). Parameters derived by the arterial analysis methods were strongly correlated with one another and displayed similar ability to predict improvement. Aortic pressure pulsatility significantly decreased in subjects with functional improvement, whereas no change was observed in patients without functional improvement (
P
for interaction <0.05). These differences in arterial load at baseline and on therapy were not apparent from conventional brachial artery cuff pressure assessments.

Conclusions—

Increased aortic pressure wave pulsatility and greater decrease in pulsatility on treatment are associated with functional improvement in patients with HF and reduced ejection fraction receiving aggressive vasodilator titration. These differences are not identifiable using brachial cuff pressures. Central aortic waveform analysis may enable better individualization of vasoactive therapies in chronic HF and reduced ejection fraction.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00588692.
Surgical Indication for Chronic Aortic Dissection in Descending Thoracic and Thoracoabdominal Aorta
Authors: Oda Tatsuya , Minatoya Kenji , Sasaki Hiroaki , Tanaka Hiroshi , Seike Yoshimasa , Itonaga Tatsuya , Inoue Yosuke , Higashi Masahiro , Nishimura Kunihiro , Kobayashi Junjiro
Published: February 2017

Background—

To address the lack of information about the size of ruptures associated with chronic dissection in the descending and thoracoabdominal aorta, we evaluated the natural history of this pathology.

Methods and Results—

We analyzed data from 571 patients (mean age, 69.4±11.6 years) with unrepaired chronic aortic dissection in the descending or thoracoabdominal aorta with a maximal aortic diameter of ≥3.5 cm from 2007 to 2014. This was a cross-sectional study. Data on the timing of computed tomographic scan were as follows: for ruptured cases: at the time of rupture; for nonruptured cases: the initial aortic diameter. Patients with connective tissue disorders were excluded. The primary end point was evidence of aortic rupture on computed tomographic images. The median maximal diameter was 4.3 cm (limits, 3.5–9.0 cm) for all aortas and 5.6 cm (n=31; limits, 3.6–8.0 cm) for ruptured aortas. For aortic diameters of 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, 5.5 to 5.9, and 6.0 to 6.4 cm, the incidence of rupture was 0%, 3.3%, 15.3%, 18.8%, and 28.6%, respectively. The risk factors for rupture were absence of hypertension, chronic heart failure, chronic-phase dissection, and Yale index.

Conclusions—

The risk of aortic rupture increased with an aortic diameter of ≥5.0 cm in patients with chronic aortic dissection in the descending or thoracoabdominal aorta. We would recommend 5.0 cm as an acceptable size for elective resection of subacute or chronic aortic dissection in the descending or thoracoabdominal aorta.
High-Sensitive Cardiac Troponin T as an Early Biochemical Signature for Clinical and Subclinical Heart Failure
Authors: Seliger Stephen L. , Hong Susie N. , Christenson Robert H. , Kronmal Richard , Daniels Lori B. , Lima Joao A.C. , de Lemos James A. , Bertoni Alain , deFilippi Christopher R.
Published: February 2017

Background:

Although small elevations of high-sensitive cardiac troponin T (hs-cTnT) are associated with incident heart failure (HF) in the general population, the underlying mechanisms are not well defined. Evaluating the association of hs-cTnT with replacement fibrosis and progression of structural heart disease before symptoms is fundamental to understanding the potential of this biomarker in a HF prevention strategy.

Methods:

We measured hs-cTnT at baseline among 4986 participants in MESA (Multi-Ethnic Study of Atherosclerosis), a cohort initially free of overt cardiovascular disease (CVD). Cardiac magnetic resonance imaging was performed at baseline. Repeat cardiac magnetic resonance was performed 10 years later among 2831 participants who remained free of interim CVD events; of these, 1723 received gadolinium-enhanced cardiac magnetic resonance for characterization of replacement fibrosis by late gadolinium enhancement. Progression of subclinical CVD was defined by 10-year change in left ventricular structure and function. Associations of hs-cTnT with incident HF, CV-related mortality, and coronary heart disease were estimated using Cox regression models.

Results:

Late gadolinium enhancement for replacement fibrosis was detectable in 6.3% participants without interim CVD events by follow-up cardiac magnetic resonance. A graded association was observed between higher baseline hs-cTnT categories and late gadolinium enhancement (≥7.42 ng/L versus <limit of detection [<3 ng/L]; adjusted odds ratio, 2.87; 95% confidence interval, 1.38–5.94). Higher hs-cTnT was also associated with a greater probability of an increase in LV mass >12% (highest category versus <limit of detection; odds ratio, 1.50; 95% confidence interval, 1.09–2.07), but not with decline in left ventricular ejection fraction. The risk of incident HF was greater for higher hs-cTnT (≥8.81 ng/L versus <limit of detection; adjusted hazards ratio, 5.59; 95% CI, 2.97–10.68).

Conclusions:

hs-cTnT levels are associated with replacement fibrosis and progressive changes in left ventricular structure in CVD-free adults, findings that may precede HF symptoms by years. Minor elevations of hs-cTnT may represent a biochemical signature of early subclinical cardiac disease, providing an opportunity for targeted preventive interventions.
Thoracic Aortic Aneurysm Growth: Role of Sex and Aneurysm Etiology
Authors: Cheung Katie , Boodhwani Munir , Chan Kwan‐Leung , Beauchesne Luc , Dick Alexander , Coutinho Thais
Published: February 2017

Background

Thoracic aortic aneurysm (
TAA
) outcomes are worse in women than men, although reasons for sex differences are unknown. Because faster
TAA
growth is a risk factor for acute aortic syndromes, we sought to determine the role of sex and aneurysm etiology on
TAA
growth.

Methods and Results

Eighty‐two consecutive unoperated subjects with
TAA
who had serial aneurysm measurements were recruited. In multivariable linear regression the association of female sex with aneurysm growth rate was assessed after adjustment for potential confounders. We also tested the interaction term sex×aneurysm etiology in the prediction of
TAA
growth. Seventy‐four percent of subjects were men; mean±
SD
age was 62.4±11.9 years in men and 67.7±10.7 years in women (
P
=0.06). Forty‐seven (57%) subjects had degenerative
TAA
s, and the remainder had heritable
TAA
s. Absolute baseline aneurysm size and follow‐up time were not different between men and women. Aneurysm growth rate was 1.19±1.15 mm/y in women and 0.59±0.66 mm/y in men (
P
=0.02). Female sex remained significantly associated with greater aneurysm growth in multivariable analyses (β±
SE
: 0.35±0.12,
P
=0.005). In addition, female sex was associated with faster
TAA
growth only among those with degenerative
TAA
(β±
SE
: 0.33±0.08,
P
=0.0002) and not among those with heritable
TAA
(
P
=0.79), with a significant sex×etiology interaction (
P
=0.001).

Conclusions

TAA
growth rates are greater in women than men, and this difference is specific to women with degenerative
TAA
s. Our findings may explain sex differences in
TAA
outcomes and provide a foundation for future investigations of this topic.
Tissue Transglutaminase Modulates Vascular Stiffness and Function Through Crosslinking‐Dependent and Crosslinking‐Independent Functions
Authors: Steppan Jochen , Bergman Yehudit , Viegas Kayla , Armstrong Dinani , Tan Siqi , Wang Huilei , Melucci Sean , Hori Daijiro , Park Sung Yong , Barreto Sebastian F. , Isak Abraham , Jandu Sandeep , Flavahan Nicholas , Butlin Mark , An Steven S. , Avolio Alberto , Berkowitz Dan E. , Halushka Marc K. , Santhanam Lakshmi
Published: February 2017

Background

The structural elements of the vascular wall, namely, extracellular matrix and smooth muscle cells (
SMC
s), contribute to the overall stiffness of the vessel. In this study, we examined the crosslinking‐dependent and crosslinking‐independent roles of tissue transglutaminase (
TG
2) in vascular function and stiffness.

Methods and Results

SMC
s were isolated from the aortae of
TG
2−/− and wild‐type (
WT
) mice. Cell adhesion was examined by using electrical cell–substrate impedance sensing and PicoGreen assay. Cell motility was examined using a Boyden chamber assay. Cell proliferation was examined by electrical cell–substrate impedance sensing and EdU incorporation assays. Cell micromechanics were studied using magnetic torsion cytometry and spontaneous nanobead tracer motions. Aortic mechanics were examined by tensile testing. Vasoreactivity was studied by wire myography.
SMC
s from
TG
2−/− mice had delayed adhesion, reduced motility, and accelerated de‐adhesion and proliferation rates compared with those from
WT
.
TG
2−/−
SMC
s were stiffer and displayed fewer cytoskeletal remodeling events than
WT
. Collagen assembly was delayed in
TG
2−/−
SMC
s and recovered with adenoviral transduction of
TG
2. Aortic rings from
TG
2−/− mice were less stiff than those from
WT
; stiffness was partly recovered by incubation with guinea pig liver
TG
2 independent of crosslinking function.
TG
2−/− rings showed augmented response to phenylephrine‐mediated vasoconstriction when compared with
WT
. In human coronary arteries, vascular media and plaque, high abundance of fibronectin expression, and colocalization with
TG
2 were observed.

Conclusions

TG
2 modulates vascular function/tone by altering
SMC
contractility independent of its crosslinking function and contributes to vascular stiffness by regulating
SMC
proliferation and matrix remodeling.
Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Agarwal Rajiv
Published: February 2017

Background

Cardiovascular morbidity and mortality was reduced by 25% when blood pressure (
BP
) was targeted to 120 mm Hg systolic compared with 140 mm Hg systolic in Systolic Blood Pressure Intervention Trial (SPRINT); however,
BP
was measured using a research technique.
SPRINT
specified 5 minutes of seated rest in a quiet room followed by 3 oscillometric measurements without an observer in the room. The relationship of this research‐grade methodology to routine
BP
measurements is not known.

Methods and Results

Among 275 people with chronic kidney disease who had
BP
<140/90 mm Hg when they came to the clinic, we measured
BP
as in
SPRINT
and recorded
BP
on the same day without specification of seated rest. Compared with routine measurement, the research‐grade systolic
BP
was 12.7 mm Hg lower with wide limits of agreement (−46.1 to 20.7 mm Hg). Research grade systolic
BP
was 7.9 mm Hg lower than daytime ambulatory systolic
BP
and had wide agreement limits (−33.2 to 17.4 mm Hg). Whereas the routine, research‐grade, and daytime ambulatory systolic
BP
were all related to echocardiographic left ventricular hypertrophy, the strength of the relationship between research‐grade and daytime ambulatory systolic
BP
to left ventricular hypertrophy was similar and stronger than the strength of the relationship between routine systolic
BP
and left ventricular hypertrophy.

Conclusions

Taken together, these results suggest that translation of the
SPRINT
results will require measurement of
BP
as performed in that trial. Instead of an algebraic manipulation of routine clinic measurements, the
SPRINT
methodology of
BP
measurement would be needed at minimum if implementation of the
SPRINT
results were to be deployed in the population at large.
Beta‐Blocker Use Is Associated With Impaired Left Atrial Function in Hypertension
Authors: Sardana Mayank , Syed Amer Ahmed , Hashmath Zeba , Phan Timothy S. , Koppula Maheswara R. , Kewan Uzma , Ahmed Zoubair , Chandamuri Ravikantha , Varakantam Swapna , Shah Ejaz , Gorz Ryan , Akers Scott R. , Chirinos Julio A.
Published: February 2017

Background

Impaired left atrial (
LA
) mechanical function is present in hypertension and likely contributes to various complications, including atrial arrhythmias, stroke, and heart failure. Various antihypertensive drug classes exert differential effects on central hemodynamics and left ventricular function. However, little is known about their effects on
LA
function.

Methods and Results

We studied 212 subjects with hypertension and without heart failure or atrial fibrillation.
LA
strain was measured from cine steady‐state free‐precession cardiac
MRI
images using feature‐tracking algorithms. In multivariable models adjusted for age, sex, race, body mass index, blood pressure, diabetes mellitus,
LA
volume, left ventricular mass, and left ventricular ejection fraction, beta‐blocker use was associated with a lower total longitudinal strain (standardized β=−0.21;
P
=0.008), and lower
LA
expansion index (standardized β=−0.30;
P
<0.001), indicating impaired
LA
reservoir function. Beta‐blocker use was also associated with a lower positive strain (standardized β=−0.19;
P
=0.012) and early diastolic strain rate (standardized β=0.15;
P
=0.039), indicating impaired
LA
conduit function. Finally, beta‐blocker use was associated with a lower (less negative) late‐diastolic strain (standardized β=0.15;
P
=0.049), strain rate (standardized β=0.18;
P
=0.019), and a lower active
LA
emptying fraction (standardized β=−0.27;
P
<0.001), indicating impaired booster pump function. Use of other antihypertensive agents was not associated with
LA
function.

Conclusions

Beta‐blocker use is significantly associated with impaired
LA
function in hypertension. This association could underlie the increased risk of atrial fibrillation and stroke seen with the use of beta‐blockers (as opposed to other antihypertensive agents) demonstrated in recent trials.
Currencies, Constraints and Contradictions of South Africa’s Soft Power
Authors: Tella Oluwaseun
Published: February 2017

Despite increasing interest in South Africa’s soft power in recent years, little analysis is offered on the factors that hinder the projection of such soft power. Most studies have focused on the sources and the optimization of South Africa’s soft power. While this article gives a synoptic account of these sources, it offers a different perspective by engaging the constraints and contradictions that hinder and circumscribe its soft power projection. The article concludes that, in order to maximize its soft power projection, Pretoria must address the impediments that continue to undermine its power of attraction.
A Preliminary Investigation of the Psychological Inventory of Criminal Thinking Styles–Layperson Edition–Short Form
Authors: Mitchell Sean M. , Bartholomew Nicole R. , Morgan Robert D. , Cukrowicz Kelly C.
Published: February 2017

The Psychological Inventory of Criminal Thinking Styles (PICTS) is commonly used to assess criminal thinking (thoughts related to criminal behavior); however, the item wording may not be an appropriate assessment for individuals without a criminal history (laypersons) who still may be at risk of engaging in crime. Therefore, a layperson version of the PICTS may more accurately assess criminal thinking among this group. This study examined the psychometric properties of the PICTS–Layperson–Short Form (PICTS-L-SF). Participants were 619 college students without a criminal justice involvement history. Analyses of the PICTS-L-SF indicated that a bifactor model fit the data better than a one- and two-factor model (general criminal thinking; proactive and reactive criminal thinking). Results provide strong evidence for the reliability and validity of the PICTS-L-SF, suggesting it can be used with individuals who are not criminal justice involved to assess criminal thinking.
Psychometric Properties of the Reactive-Proactive Aggression Questionnaire Among a Sample of Detained and Community Girls
Authors: Pechorro Pedro , Kahn Rachel E. , Ray James V. , Raine Adrian , Gonçalves Rui Abrunhosa
Published: February 2017

Research on adolescent aggression often distinguishes between reactive and proactive aggression, but there is limited knowledge regarding the application or measurement of these subtypes of aggression among female youth, especially forensic samples of female youth. Drawing on 377 girls (103 selected from forensic settings and 274 selected from school settings) from Portugal, the current study is the first to simultaneously examine the psychometric properties of the Reactive-Proactive Aggression Questionnaire (RPQ) in incarcerated girls and community girls. The results support the use of the RPQ in terms of its two-factor structure, measurement invariance, internal consistency, convergent validity, discriminant validity, and known-groups validity. Significant associations were found with several criterion-related variables such as age of criminal onset, age of first problem with the law, conduct disorder, crime severity, violent crimes, and alcohol and drug use. Findings are discussed in terms of the use of the RPQ among incarcerated girls and community girls.
Community Perceptions of Police Body-Worn Cameras
Authors: Crow Matthew S. , Snyder Jamie A. , Crichlow Vaughn J. , Smykla John Ortiz
Published: February 2017

Despite relatively little extant research, efforts to expand the use of body-worn cameras (BWCs) in policing are increasing. Although recent research suggests positive impacts of BWCs on reducing police use-of-force and citizen complaints, little is known about community members’ perceptions of BWCs. The current study examined perceptions of residents of two Florida counties and found a large majority of respondents supported the use of BWCs. Structural equation modeling was utilized to examine factors that influence views of BWCs. Findings indicate that positive perceptions of police performance and more police interaction were associated with greater perceived benefits of BWCs, whereas concerns about the privacy reduced perceived BWC benefits. Respondents’ views of procedural fairness and crime concern were indirectly related to perceptions BWC benefits. Non-White and younger respondents were indirectly less likely to perceive benefits. Implications of these findings and future directions for research are discussed.
Technology and Economic Development: The Schumpeterian Legacy
Authors: Evangelista Rinaldo
Published: February 2017

The main argument put forward in the paper is that the recent neo-Schumpeterian literature, while providing fundamental contributions to our understanding of innovation, has contributed to the emergence of an optimistic reading of the relationship between technology, economy, and society, with technology able to guarantee strong economic growth and social welfare. It is also argued that such an “optimistic bias” has been associated with a dominant supply-side and micro-based view of the technology–economy relationships.

JEL Classification: B52; O10; O30
A Psychometric Evaluation of the Pleasant Events Schedule–Alzheimer’s Disease (Short Version): Among a Veteran Population
Authors: Amspoker Amber B. , Hersch Gayle , Snow A. Lynn , Wilson Nancy , Morgan Robert O. , Sansgiry Shubhada , Kunik Mark E.
Published: February 2017

Alzheimer’s disease and other dementias are often associated with a gradual loss of the ability to participate in rewarding activities. Caregivers may struggle with spending quality time with the person with dementia (PWD) when the demands of caregiving dominate. However, the importance of activity participation among PWDs is internationally recognized. The Pleasant Events Schedule–Alzheimer’s Disease (PES-AD) Short Form measures frequency of engagement in pleasant events. It has been used to assess overall frequency of engagement in 20 activities. The current study involves a psychometric evaluation of the PES-AD Short Form and reveals two separate activity domains: active and social events, each with preliminary evidence of reliability and construct validity. Furthermore, the frequency with which the PWD enjoys social and active events are not uniformly related to PWD and caregiver characteristics and well-being, which has measure- and practice-focused implications that should be considered when engaging PWDs.
Investigation on temperature distribution in form grinding of 9Mn2V thread gauge
Authors: Qiu Kunxian , Guo Guoqiang , Yang Changqi , Dong Dapeng , Chen Ming
Published: February 2017

Accurate simulation about the grinding temperature distribution helps to decrease the thermal damage and microcracks during the grinding process. In this article, the grinding heat transfer process of form grinding was analyzed and a temperature distribution model was derived in form grinding of 9Mn2V thread gauge. Considering the characteristics of form grinding, the temperature rise of the intersection region can be affected by two kinds of heat sources, and the impact between the two heat sources has been investigated. Also, the influence of the grinding depth on the temperature rise was analyzed. Depending on the analysis, an improved heat partition model has been derived, which is based on single-grain energy partition model. A series of experiments were carried out to investigate the grinding performance of 9Mn2V. The grinding force was obtained, the specific grinding energy was discussed, and the experimental temperature was measured by infrared imager. It is shown that the experiment results correspond well to the theoretical temperature calculated by the prediction model. This temperature model can be used to optimize the grinding conditions and the critical depth in form grinding of 9Mn2V thread gauge.
The Impacts of Medicaid Expansion on Rural Low-Income Adults: Lessons From the Oregon Health Insurance Experiment
Authors: Allen Heidi , Wright Bill , Broffman Lauren
Published: February 2017

Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and newly insured rural populations.
Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents With ADHD
Authors: Langberg Joshua M. , Molitor Stephen J. , Oddo Lauren E. , Eadeh Hana-May , Dvorsky Melissa R. , Becker Stephen P.
Published: February 2017

Objective: The primary objective of this study was to evaluate the prevalence of multiple types of sleep problems in young adolescents with ADHD. Method: Adolescents comprehensively diagnosed with ADHD (N = 262) and their caregivers completed well-validated measures of sleep problems and daytime sleepiness. Participants also completed measures related to medication use, comorbidities, and other factors that could predict sleep problems. Results: Daytime sleepiness was by far the most common sleep problem, with 37% of adolescents meeting the clinical threshold according to parent report and 42% according to adolescent report. In contrast, prevalence rates for specific nighttime sleep problems ranged from 1.5% to 7.6%. Time spent in bed, bedtime resistance, ADHD inattentive symptoms, and Sluggish Cognitive Tempo (SCT) symptoms were significant in the final model predicting daytime sleepiness. Conclusion: Adolescents with ADHD commonly experience problems with daytime sleepiness that may significantly affect their functioning, but this may not be directly attributable to specific sleep problems.
Management and resistance in the digital newsroom
Authors: Bunce Mel
Published: February 2017

What happens when there is conflict between the profit motivations of a news outlet and the professional values of its journalists? Questions of managerial influence and journalistic autonomy have interested media scholars from the seminal work of Warren Breed onwards. However, there have only been a handful of studies since the introduction of audience metrics which, this research suggests, allow managers to more efficiently monitor and discipline their journalists. This article presents an ethnographic case study of a Reuters newswire bureau during a time of conflict between the management and journalists. The article outlines the strategies that management used to incentivize their journalists to change their reporting priorities. These included the strategic dissemination of audience metrics and praise, and the hiring and promotion of ‘appropriate’ journalists to positions of influence. These interventions changed who was considered a ‘good journalist’ at the newswire, disrupting existing hierarchies, and eventually changing the culture of the newsroom. The article draws on the insights of Pierre Bourdieu’s field theory to help explain how managerial power operates, and the role that individual journalists play producing and reinforcing newsroom norms.
High-Density Electroencephalographic Recordings During Sleep in Children and Adolescents With Acquired Brain Injury
Authors: Mouthon Anne-Laure , Meyer-Heim Andreas , Kurth Salome , Ringli Maya , Pugin Fiona , van Hedel Hubertus J. A. , Huber Reto
Published: February 2017

Background. Acquired brain injuries (ABI) such as traumatic brain injury (TBI) or stroke can result in motor, language, or cognitive impairments. Although a considerable number of studies have investigated functional recovery, underlying brain reorganization remains poorly understood. Accumulating evidence indicates that plastic processes in the brain are linked to changes in electroencephalographic (EEG) slow wave activity (SWA) during deep sleep (EEG spectral power 1-4.5 Hz). Objective. We investigated sleep SWA in children and adolescents with ABI. Methods. We used high-density EEG (128 electrodes) to record sleep in 22 young patients with ABI (age range = 4-16 years). We compared patients to 52 previously measured typically developing children and adolescents (age range = 4-16 years). Results. The pattern of alterations in SWA differed between particular patient groups. In patients with bilateral stroke, SWA was globally reduced across the entire scalp. Patients with unilateral stroke showed a local reduction in SWA over lesion areas and an increase over perilesional and contralateral brain areas. In patients with severe TBI, we found a reduction in SWA over the midline and an increase over lateral brain areas. We found no consistent pattern in patients with mild to moderate TBI. Conclusions. Sleep SWA seems to be a sensitive measure to assess individual alterations in neural activity after ABI. Deviations from age norms might indirectly indicate plastic processes that have occurred since injury. Improving our understanding of neural activity after ABI could optimize clinical prognosis and guide the development of novel therapeutic interventions.
Managing screening and diagnosis of Zika in the Emergency Department
Authors: de Tantillo Lila , Gonzalez Juan M. , Ortega Johis
Published: February 2017

Zika has emerged as a rapidly spreading infection worldwide. Clinicians in many parts of the world must be prepared to screen for symptoms and diagnose patients with this disease. In particular, pregnant women who may have experienced exposure to Zika must be treated with care and sensitivity due to serious risk for pregnancy complications among those who contract the infection. In response to the outbreak, patient management guidelines have been established for all who may be symptomatic or potentially at risk of infection with Zika. Clinicians globally can prepare to implement such protocols to help contain this disease.
Factor Structure and Basic Psychometric Properties of the Transition Assessment and Goal Generator
Authors: Hennessey Maeghan N. , Terry Robert , Martin James E. , McConnell Amber E. , Willis Donna M.
Published: February 2017

We examined the theoretical factor structure fit and psychometric properties of the Transition Assessment and Goal Generator (TAGG). In the first study, 349 transition-aged students with disabilities, their special educators, and family members completed TAGG assessments, and using exploratory factor analysis (EFA)/confirmatory factor analysis (CFA), a simple eight-factor structure emerged. In 2 subsequent years, independent samples of students with disabilities (Study II, N = 257; Study III, N = 846), their special educators, and family members completed the TAGG, and the TAGG structure replicated in both years across all versions using CFAs. The results provide evidence of construct validity and reliability. We discuss implications of the results and identify future research needs.
Stem and progenitor cell alterations in myelodysplastic syndromes
Authors: Shastri Aditi , Will Britta , Steidl Ulrich , Verma Amit
Published: February 2017

Recent studies have demonstrated that myelodysplastic syndromes (MDSs) arise from a small population of disease-initiating hematopoietic stem cells (HSCs) that persist and expand through conventional therapies and are major contributors to disease progression and relapse. MDS stem and progenitor cells are characterized by key founder and driver mutations and are enriched for cytogenetic alterations. Quantitative alterations in hematopoietic stem and progenitor cell (HSPC) numbers are also seen in a stage-specific manner in human MDS samples as well as in murine models of the disease. Overexpression of several markers such as interleukin-1 (IL-1) receptor accessory protein (IL1RAP), CD99, T-cell immunoglobulin mucin-3, and CD123 have begun to differentiate MDS HSPCs from healthy counterparts. Overactivation of innate immune components such as Toll-like receptors, IL-1 receptor–associated kinase/tumor necrosis factor receptor–associated factor-6, IL8/CXCR2, and IL1RAP signaling pathways has been demonstrated in MDS HSPCs and is being targeted therapeutically in preclinical and early clinical studies. Other dysregulated pathways such as signal transducer and activator of transcription 3, tyrosine kinase with immunoglobulinlike and EGF-like domains 1/angiopoietin-1, p21-activated kinase, microRNA 21, and transforming growth factor β are also being explored as therapeutic targets against MDS HSPCs. Taken together, these studies have demonstrated that MDS stem cells are functionally critical for the initiation, transformation, and relapse of disease and need to be targeted therapeutically for future curative strategies in MDSs.
The Bony Bankart Lesion: How to Measure the Glenoid Bone Loss
Authors: Skupiński Jarosław , Piechota Małgorzata Zofia , Wawrzynek Wojciech , Maczuch Jarosław , Babińska Anna
Published: February 2017

An osseous Bankart lesion is commonly seen in patients with an anterior shoulder dislocation. It is defined as a detachment of the anteroinferior labrum associated with a glenoid rim fracture. Radiological studies are crucial not only for detecting glenoid bone defects but also for measuring the amount of bone loss. The precise quantification of the bony defect is crucial for the therapeutic desicion-making and clinical outcomes. Although we know that major glenoid bone loss requires surgical intervention, none of the studies performed so far answered the question what size of the defect should be an indication for open surgery procedures. Moreover, there is still no consensus on the exact percentage of glenoid loss that results in a higher risk of re-dislocations. In our opinion, there is a strong need for a consensus on universally accepted measuring techniques of the glenoid defect as well as on algorithms with validated glenoid bone loss threshold values for therapeutic decision-making. In this study, we review the techniques described so far in the literature and try to assess if any of these techniques should be treated as a leading method of detecting and quantifying osseous glenoid lesions.
Cost of Acute Kidney Injury in Hospitalized Patients
Authors: Silver Samuel A. , Long Jin , Zheng Yuanchao , Chertow Glenn M.
Published: February 2017

BACKGROUND

The economic burden of acute kidney injury (AKI) is not well understood.

OBJECTIVE

To estimate the effects of AKI on hospitalization costs and length of stay (LOS).

DESIGN

Using data from the 2012 National Inpatient Sample, we compared hospitalization costs and LOS with and without AKI. We used a generalized linear model with a gamma distribution and a log link fitted to AKI to adjust for demographics, hospital differences, and comorbidities.

SETTING

United States

PATIENTS

29,763,649 adult hospitalizations without endstage renal disease.

EXPOSURE

AKI determined using International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9‐CM) diagnosis codes.

MEASUREMENTS

Hospitalization costs and LOS.

RESULTS

AKI was associated with an increase in hospitalization costs of $7933 (95% confidence interval [CI], $7608‐$8258) and an increase in LOS of 3.2 (95% CI, 3.2‐3.3) days compared to patients without AKI. When adjusted for patient and hospital characteristics, the associated increase in costs was $1795 (95% CI, $1692‐$1899) and in LOS, it was 1.1 (95% CI, 1.1‐1.1) days. Corresponding results among patients hospitalized with AKI requiring dialysis were $42,077 (95% CI, $39,820‐$44,335) and 11.5 (95% CI, 11.2‐11.8) days and $11,016 (95% CI, $10,468‐$11,564) and 3.9 (95% CI, 3.8‐4.1) days. AKI was associated with higher hospitalization costs than myocardial infarction and gastrointestinal bleeding, and costs were comparable to those for stroke, pancreatitis, and pneumonia.

CONCLUSIONS

In the United States, AKI is associated with excess hospitalization costs and prolonged LOS. The economic burden of AKI warrants further attention from hospitals and policymakers to enhance processes of care and develop novel treatment strategies.
The Association of Geriatric Syndromes with Hospital Outcomes
Authors: Romero‐Ortuno Roman , Forsyth Duncan R. , Wilson Kathryn Jane , Cameron Ewen , Wallis Stephen , Biram Richard , Keevil Victoria
Published: February 2017

BACKGROUND

Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital.

OBJECTIVE

To study the association of frailty (≥6 points in the Clinical Frailty Scale [CFS]), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery).

DESIGN

Retrospective observational study.

SETTING

Large university hospital in England.

PATIENTS

We analyzed 8202 first nonelective inpatient episodes of people aged 75 years and older between October 2014 and October 2015.

MEASUREMENTS

The outcomes studied were prolonged length of stay (LOS ≥10 days), inpatient mortality, delayed discharge, institutionalization, and 30‐day readmission. Statistical analyses were based on multivariate regression models.

RESULTS

Independently of controlling variables, prolonged LOS was predicted by CFS ≥6: odds ratio (OR) =1.55; 95% confidence interval [CI], 1.36‐1.77; P < 0.001; HoD: OR = 2.16; 95% CI, 1.79‐2.61; P < 0.001; and ACS: OR = 3.31; 95% CI, 2.64‐4.15; P < 0.001. Inpatient mortality was predicted by CFS ≥6: OR = 2.29; 95% CI, 1.79‐2.94; P < 0.001. Delayed discharge was predicted by CFS ≥6: OR = 1.46; 95% CI, 1.27‐1.67; P < 0.001; HoD: OR = 2.17; 95% CI, 1.80‐2.62; P < 0.001; and ACS: OR = 2.29; 95% CI: 1.83‐2.85; P < 0.001. Institutionalization was predicted by CFS ≥6: OR = 2.56; 95% CI, 2.09‐3.14; P < 0.001; HoD: OR = 2.51; 95% CI, 2.00‐3.14; P < 0.001; and ACS: OR 1.93; 95% CI, 1.46‐2.56; P < 0.001. Readmission was predicted by ACS: OR = 1.36; 95% CI, 1.09‐1.71; P = 0.006.

CONCLUSIONS

Routine screening for frailty, HoD, and ACS in hospitals may aid the development of acute care pathways for older adults.
Patient‐Level Exclusions from mHealth in a Safety‐Net Health System
Authors: Hinami Keiki , Harris Bhrandon A. , Uriostegui Ricardo , Jasmin Wilnise , Lopez Mario , Trick William E.
Published: February 2017

Excitement about mobile health (mHealth) for improving care transitions is fueled by widespread adoption of smartphones across all social segments, but new disparities can emerge around nonadopters of technology‐based communications. We conducted a cross‐sectional survey of urban low‐income adults to assess inadequate reading health literacy and limited English proficiency as factors affecting access to and engagement with mHealth. Although the proportion owning smartphones were comparable to national figures, adjusted analysis showed fewer patients with inadequate reading health literacy having Internet access (odds ratio [95% confidence interval]: 0.50 [0.26‐0.95]), e‐mail (0.43 [0.24‐0.79]), and interest in using e‐mail (0.34 [0.18‐0.65]) for healthcare communications. Fewer patients with limited English proficiency were interested in using mobile apps (0.2 [0.09‐0.46]). Inpatient status was independently associated with less interest in text messaging (0.46 [0.25‐0.87]). mHealth exclusions around literacy and language proficiency threaten equity, and innovative solutions are needed to realize mHealth's potential for reducing disparities.
Assessment of Readability, Understandability, and Completeness of Pediatric Hospital Medicine Discharge Instructions
Authors: Unaka Ndidi I. , Statile Angela , Haney Julianne , Beck Andrew F. , Brady Patrick W. , Jerardi Karen E.
Published: February 2017

The average American adult reads at an 8th‐grade level. Discharge instructions written above this level might increase the risk of adverse outcomes for children as they transition from hospital to home. We conducted a cross‐sectional study at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. Two hundred charts for patients discharged from the hospital medicine service were randomly selected for review. Written discharge instructions were extracted and scored for readability (Fry Readability Scale [FRS]), understandability (Patient Education Materials Assessment Tool [PEMAT]), and completeness (5 criteria determined by consensus). Descriptive statistics enumerated the distribution of readability, understandability, and completeness of written discharge instructions. Of the patients included in the study, 51% were publicly insured. Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th‐grade reading level (interquartile range, 8‐12; range, 1‐13). Median PEMAT score was 73% (interquartile range, 64%‐82%; range, 45%‐100%); 36% of instructions scored below 70%, correlating with suboptimal understandability. The diagnosis was described in only 33% of the instructions. Although explicit warning signs were listed in most instructions, 38% of the instructions did not include information on the person to contact if warning signs developed. Overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home.
Impact of Patient‐Centered Discharge Tools: A Systematic Review
Authors: Okrainec Karen , Lau Davina , Abrams Howard B. , Hahn‐Goldberg Shoshanna , Brahmbhatt Ronak , Huynh Tai , Lam Kenneth , Bell Chaim M.
Published: February 2017

BACKGROUND

Patient‐centered discharge tools provide an opportunity to engage patients, enhance patient understanding, and improve capacity for self‐care and postdischarge outcomes.

PURPOSE

To review studies that engaged patients in the design or delivery of discharge instruction tools and that tested their effect among hospitalized patients.

DATA SOURCES

We conducted a search of 12 databases and journals from January 1994 through May 2014, and references of retrieved studies.

STUDY SELECTION

English‐language studies that tested discharge tools meant to engage patients were selected. Studies that measured outcomes after 3 months or without a control group or period were excluded.

DATA EXTRACTION

Two independent reviewers assessed the full‐text papers and extracted data on features of patient engagement.

DATA SYNTHESIS

Thirty articles met inclusion criteria, 28 of which examined educational tools. Of these, 13 articles involved patients in content creation or tool delivery, with only 6 studies involving patients in both. While many of these studies (10 studies) demonstrated an improvement in patient comprehension, few studies found improvement in patient adherence despite their engagement. A few studies demonstrated an improvement in self‐efficacy (2 studies) and a reduction in unplanned visits (3 studies).

CONCLUSIONS

Improving patient engagement through the use of media, visual aids, or by involving patients when creating or delivering a discharge tool improves comprehension. However, further studies are needed to clarify the effect on patient experience, adherence, and healthcare utilization postdischarge. Better characterization of the level of patient engagement when designing discharge tools is needed given the heterogeneity found in current studies.
A Refined Approach for Non-Negative Entire Solutions of Δ u + up = 0 with Subcritical Sobolev Growth
Authors: Villavert John
Published: February 2017

Let

N
≥
2

{N\geq 2}

and

1
<
p
<

(

N
+
2

)

/

(

N
-
2

)

+

{1<p<(N+2)/(N-2)_{+}}

. Consider the Lane–Emden equation

Δ
⁢
u

+

u
p

=
0

{\Delta u+u^{p}=0}

in

ℝ
N

{\mathbb{R}^{N}}

and recall the classical Liouville type theorem: if u is a non-negative classical solution of the Lane–Emden equation, then

u
≡
0

{u\equiv 0}

.

The method of moving planes combined with the Kelvin transform provides an elegant proof of this theorem. A classical approach of Serrin and Zou, originally used for the Lane–Emden system, yields another proof but only in lower dimensions. Motivated by this, we further refine this approach to find an alternative proof of the Liouville type theorem in all dimensions.
Acid-Sensing Ion Channels Activated by Evoked Released Protons Modulate Synaptic Transmission at the Mouse Calyx of Held Synapse
Authors: González-Inchauspe Carlota , Urbano Francisco J. , Di Guilmi Mariano N. , Uchitel Osvaldo D.
Published: February 2017

Acid-sensing ion channels (ASICs) regulate synaptic activities and play important roles in neurodegenerative diseases. We found that these channels can be activated in neurons of the medial nucleus of the trapezoid body (MNTB) of the auditory system in the CNS. A drop in extracellular pH induces transient inward ASIC currents (IASICs) in postsynaptic MNTB neurons from wild-type mice. The inhibition of IASICs by psalmotoxin-1 (PcTx1) and the absence of these currents in knock-out mice for ASIC-1a subunit (ASIC1a−/−) suggest that homomeric ASIC-1as are mediating these currents in MNTB neurons. Furthermore, we detect ASIC1a-dependent currents during synaptic transmission, suggesting an acidification of the synaptic cleft due to the corelease of neurotransmitter and H+from synaptic vesicles. These currents are capable of eliciting action potentials in the absence of glutamatergic currents. A significant characteristic of these homomeric ASIC-1as is their permeability to Ca2+. Activation of ASIC-1a in MNTB neurons by exogenous H+induces an increase in intracellular Ca2+. Furthermore, the activation of postsynaptic ASIC-1as during high-frequency stimulation (HFS) of the presynaptic nerve terminal leads to a PcTx1-sensitive increase in intracellular Ca2+in MNTB neurons, which is independent of glutamate receptors and is absent in neurons from ASIC1a−/−mice. During HFS, the lack of functional ASICs in synaptic transmission results in an enhanced short-term depression of glutamatergic EPSCs. These results strongly support the hypothesis of protons as neurotransmitters and demonstrate that presynaptic released protons modulate synaptic transmission by activating ASIC-1as at the calyx of Held–MNTB synapse.

SIGNIFICANCE STATEMENTThe manuscript demonstrates that postsynaptic neurons of the medial nucleus of the trapezoid body at the mouse calyx of Held synapse express functional homomeric Acid-sensing ion channel-1a (ASIC-1as) that can be activated by protons (coreleased with neurotransmitter from acidified synaptic vesicles). These ASIC-1as contribute to the generation of postsynaptic currents and, more relevant, to calcium influx, which could be involved in the modulation of presynaptic transmitter release. Inhibition or deletion of ASIC-1a leads to enhanced short-term depression, demonstrating that they are concerned with short-term plasticity of the synapse. ASICs represent a widespread communication system with unique properties. We expect that our experiments will have an impact in the neurobiology field and will spread in areas related to neuronal plasticity.
Need Analysis of Lesson Planning to Teach Education Value of Sulawesi Ethnic Dance Teaching in Primary School
Authors: Wahira Wahira
Published: February 2017

This study aims to find out need analysis of lesson planning to teach education value of Sulawesi ethnic dance which comprises learning material, teaching method and learning model, learning media, as well as an assessment instrument. A method implemented in this study was research and development (R&D) with three main stages, namely, preliminary study, developmental research, and evaluation. This study, however, will only implement the first stage of study which is the preliminary study. This is implemented to perform need and content analysis. Results showed that need of lesson planning to teach education value of Sulawesi ethnic dance comprises learning material, teaching method and learning model, learning media, as well as an assessment instrument belongs to the category of “very important” and that the planning is needed by teachers in teaching Sulawesi ethnic dance value for students in primary school.