bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions
Authors: Davies Sheryl , Schultz Ellen , Raven Maria , Wang Nancy Ewen , Stocks Carol L. , Delgado Mucio Kit , McDonald Kathryn M.
Published: March 2017

Objective

To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health.

Data Sources

Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008–2010 State Inpatient Databases and State Emergency Department Databases.

Study Design

Empirical analyses and structured panel reviews.

Methods

Panels of 14–17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county‐level poverty, uninsurance, and density of primary care physicians (PCPs).

Principal Findings

ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county‐level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end‐user panel separately rated the indicators as having strong face validity for most uses evaluated.

Conclusions

The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research.
They Would If They Could: Assessing the Bindingness of the Property Holding Constraints for REITs
Authors: Mühlhofer Tobias
Published: March 2017

This study examines the bindingness of the property holding constraints which Real Estate Investment Trusts (REITs) face on their portfolios (the dealer rule), and illustrates how these constraints hinder REITs from exploiting opportunities to time the property market. I first simulate a set of filter‐based market timing strategies, which outperform a buy‐and‐hold strategy out of sample, and show that imposing a four‐year (or even the newer two‐year) holding constraint significantly reduces the excess returns the strategies generate. I then analyze actual holding periods of properties in REIT portfolios and find that there seems to exist a large degree of demand for short property holding periods and that the trades generated by the filter strategy generally resemble actual REIT trading activity, validating the relevance of the simulation results. A direct test for the constraint reveals that REITs' propensity to hold a property beyond the minimum period increases, the higher the profit from the transaction, consistent with the asymmetric nature in which the rule is enforced. By contrast, this effect is insignificant for Umbrella‐Partnership REITs (UPREITs), which are not as affected by the constraint. I further show that UPREITs overall achieve significantly better ex‐post market timing performance than non‐UPREITs. I thus find that overall REITs are limited by the dealer rule.
Development of a prognosis‐prediction model incorporating genetic polymorphism with pathologic stage in stage I non‐small cell lung cancer: A multicenter study
Authors: Lee Won Kee , Lee Shin Yup , Choi Jin Eun , Seok Yangki , Lee Eung Bae , Lee Hyun Cheol , Kang Hyo‐Gyoung , Yoo Seung Soo , Lee Myung Hoon , Cho Sukki , Jheon Sanghoon , Kim Young Chul , Oh In Jae , Na Kook Joo , Jung Chi Young , Park Chang‐Kwon , Kim Mi‐Hyun , Lee Min Ki , Park Jae Yong
Published: March 2017

Background

This multicenter study was performed to develop a prognosis‐prediction model incorporating genetic polymorphism with pathologic stage for surgically treated non‐small cell lung cancer (NSCLC) patients.

Methods

A replication study including 720 patients and a panel of eight single nucleotide polymorphisms (SNPs), which predicted the prognosis of surgically treated NSCLC in our previous study, was conducted. Using the combined cohort of current and previous studies including 1534 patients, a nomogram for predicting overall survival was made using Cox proportional hazards regression.

Results

Among the eight SNPs, C3 rs2287845, GNB2L1 (alias RACK1), and rs3756585 were significantly associated with overall survival. A nomogram was constructed based on pathologic stage and the genotypes of the two SNPs, and the risk score was calculated for each patient in the combined cohort. Using the prognosis‐prediction model, we categorized patients into low, intermediate, and high‐risk groups, which had greater accuracy in predictive ability (log‐rank statistics = 54.66) than the conventional tumor node metastasis staging (log‐rank statistics = 39.56). Next, we generated a prognosis‐prediction model for stage I to identify a subgroup of potential candidates for adjuvant chemotherapy. Notably, 97 out of 499 stage IB patients were classified as high‐risk patients with a similar prognosis to stage II patients, suggesting the benefit of adjuvant chemotherapy.

Conclusions

This prognosis‐prediction model incorporating genetic polymorphism with pathologic stage may lead to more precise prognostication in surgically resected NSCLC patients. In particular, this model may be useful in selecting a subgroup of stage IB patients who may benefit from adjuvant chemotherapy.
Effect of five fungicides with different modes of action on cobweb disease (Cladobotryum mycophilum) and mushroom yield
Authors: Carrasco J. , Navarro M.J. , Santos M. , Gea F.J.
Published: March 2017

The fungicides chlorothalonil, metrafenone, prochloraz‐Mn, thiabendazole and thiophanate‐methyl were tested in vitro and in vivo for their effect on Cladobotryum mycophilum, the mycoparasite that causes cobweb disease in white button mushroom. In vitro experiments showed that metrafenone (EC50= 0.025 mg L−1) and prochloraz‐Mn (EC50= 0.045 mg L−1) were the most effective fungicides for inhibiting the mycelial growth of C. mycophilum. Selectivity indexes of the tested fungicides on both C. mycophilum and Agaricus bisporus indicated that metrafenone was also the most selective fungicide, while chlorothalonil was the most toxic fungicide against A. bisporus mycelium. The in vivo efficacy of fungicides for controlling cobweb was evaluated in three mushroom cropping trials, which were artificially inoculated with C. mycophilum (106 conidia m−2). Prochloraz‐Mn provided good control, although the surface colonised by cobweb reached 12% by the end of the crop cycles. None of the inoculated cropping trials treated with metrafenone showed any cobweb disease symptoms, and neither were any significant phytotoxic effects on mushroom yield recorded. These results indicated that metrafenone can be used as an alternative to prochloraz‐Mn in the control of cobweb disease.
Comparison of cost of care for tethered versus non‐tethered ureteric stents in the management of uncomplicated upper urinary tract stones
Authors: Okullo Alfin , Yuminaga Yuigi , Ziaziaris William , Ende David , Lau Howard , Brooks Andrew , Patel Manish I. , Bariol Simon
Published: March 2017

Background

Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short‐term stenting purposes, a surgeon has the choice of either a tethered or a non‐tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL.

Methods

We retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent‐related emergency department presentations, re‐admissions and stent removal.

Results

A total of 113 patients had tethered stents and 21 had non‐tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P = 0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P = 0.096), mean cost of out‐patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P < 0.001) for endoscopic stent removal, overall mean cost of care was A$3603.6 ± A$1896.7 versus A$4468.1 ± A$820.8 (P = 0.042) for tethered and non‐tethered stents, respectively.

Conclusion

It is cheaper to use a tethered ureteric stent compared with non‐tethered stents for short‐term stenting after uncomplicated URSL, with a mean cost saving of A$864.5.
Cohort study on emergency general surgery patients and an observation unit
Authors: Dickfos Marilla , Ibrahim Hany , Evans Andrew , Franz Robert
Published: March 2017

Background

Medium‐sized, non‐trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients.

Methods

To assess the unit's effect, a prospective analysis was completed of the patients who came through the RAMS unit over a 6‐month period and compared with a retrospective analysis of patients presenting in the same 6‐month period the year prior to the unit's instigation.

Results

The RAMS unit was effective in providing an avenue for faster review by the surgical team. This resulted in patients leaving the emergency department faster, decreased the number of patients that breached emergency department time‐targets and increased the number of patients discharged after a period of observation or basic treatments.

Conclusion

General surgery patients were managed more efficiently with the RAMS unit in place. However, a full cost analysis is required to determine if such units are cost‐effective.
Development of a 22q11DS psycho‐educational programme: exploration of the views, concerns and educational needs of parents caring for children or adolescents with 22q11DS in relation to mental health issues
Authors: Alugo T. , Malone H. , Sheehan A. , Coyne I. , Lawlor A. , McNicholas F.
Published: March 2017

Background

22q11.2 deletion syndrome (22q11DS) is a multisystem genetic condition with a broad phenotype. It is associated with a high prevalence of depression and anxiety during childhood and increased risk of schizophrenia in adulthood. Despite this, studies report that families may receive inadequate information of mental health (MH) risks at diagnosis. Therefore, this study investigated parents' experiences of caring for a child with 22q11DS, investigated their knowledge regarding the risk of MH problems and assessed the need for a psycho‐educational programme.

Methods

A qualitative design and purposeful sampling was utilized. Parents registered with the ‘22q11 Ireland’ support group, and parents listed on the cleft palate database in a children's hospital in Ireland were invited to participate. Focus groups were held with 22 parents. Data were thematically analysed using Burnard's method of analysis.

Results

Most parents had some knowledge of the relationship between 22q11DS and an increased risk of MH issues. Parents reported that MH information relating to 22q11DS was mainly obtained from 22q11DS conferences, the ‘22q11 Ireland’ support group and the Internet. Parents expressed a need for information to prevent or cope with their child's MH issues. Parents suggested that the following topics would be quite useful in a psycho‐educational programme. These included information on the early warning signs of MH issues and guidance on when and how to tell the child about the condition and how to manage the child or young person's anxiety, obsessive behaviour or hearing voices.

Conclusions

The findings indicated parental support for a psycho‐educational programme that would provide relevant, accurate and timely information on how to effectively care for a child with 22q11DS MH needs.
Clinical instruments and methods for assessing physical oral health: A systematic review
Authors: Pauli L.‐K. , Aarabi G. , Kriston L. , Jansen A. , Heydecke G. , Reissmann D.R.
Published: March 2017

Objective

This study aimed at exploring available clinical instruments and methods for assessing physical oral health, and at identifying those with sufficient diagnostic performance.

Methods

A systematic literature search was conducted in Embase and MEDLINE. Identified instruments and methods were critically appraised, and quality of diagnostic performance was rated by two independent reviewers as A (sufficient diagnostic performance), B (either sufficient reliability or validity) or C (insufficient quality, or empirical results unsatisfactory and/or inconsistent). For all A‐rated instruments and methods, an in‐depth literature search was conducted to supplement and verify their effectiveness and accuracy.

Results

A total of 141 instruments and methods were identified. Only 12 methods with sufficient diagnostic performance could be rated as A, 72 were rated as B, and 34 received a C‐rating. Further 23 instruments and methods could not be rated due to lack of available information on diagnostic performance. Of all A‐rated instruments, six were designed for tooth structure, two for periodontium, one for endodontium and three for temporomandibular joints and muscles.

Conclusion

Even though some instruments and methods exhibited good to excellent reliability and validity and can be recommended for research and clinical practice, they do not allow assessing all components of physical oral health. There is a need to identify and define standard instruments, and for components of physical oral health where methods with sufficient diagnostic performance are lacking, further research is required.
Are school and home environmental characteristics associated with oral health‐related quality of life in Brazilian adolescents and young adults?
Authors: Alwadi Maram Ali M. , Vettore Mario Vianna
Published: March 2017

Objectives

The aim of this study was to test the association of contextual school and home environmental characteristics and individual factors with oral health‐related quality of life (OHRQoL) in a representative sample of Brazilian adolescents and young adults.

Methods

Individual‐level data from 3854 fifteen‐ to nineteen‐year‐olds who participated in the Brazilian Oral Health Survey were pooled with contextual city‐level data. The dependent variable was the frequency of impacts of oral disorders on daily performances (OIDP extent), as a measure of OHRQoL. Contextual school and home environmental characteristics were categorized into three equal groups according to tertiles of the contextual variable's scores (low, moderate and high). Individual demographic, socioeconomic and oral clinical measures were the covariates. The association between contextual and individual characteristics and OIDP extent was estimated using multilevel Poisson regression models.

Results

The mean of OIDP extent was 0.9 (standard error 0.1). Adolescents and young adults living in the cities with high levels of lack of security at school (RR 1.33; 95% CI=1.02‐1.74), moderate levels of bullying at school (RR 1.56; 95% CI=1.20‐2.03) and moderate levels of low maternal schooling (RR 1.43; 95% CI=1.06‐1.92) had a higher mean OIDP extent. Male sex, higher age, skin colour, poor individual socioeconomic status and worse oral clinical measures were also associated with higher mean of OIDP extent.

Conclusions

Poor school and home environmental characteristics were independently associated with poor OHRQoL in individuals aged between 15 and 19 years. Our findings suggest the place where they study and the maternal level of education are meaningful aspects for their oral health.
The association of subjective orthodontic treatment need with oral health‐related quality of life
Authors: Kragt Lea , Jaddoe Vincent , Wolvius Eppo , Ongkosuwito Edwin
Published: March 2017

Objectives

The existing body of evidence reports an inconsistent association between subjective and objective orthodontic treatment need. The concept of oral health‐related quality of life (OHRQoL) might help to explain the differences in subjective and objective orthodontic treatment need. Our aim was to investigate the association of subjective orthodontic treatment with OHRQoL in children.

Methods

This cross‐sectional study was embedded in the Generation R Study, a population‐based prospective cohort study. OHRQoL and subjective orthodontic treatment need were assessed by parental questionnaires. Questionnaire items were individually compared among children with no, borderline and definite subjective orthodontic need. The association between subjective orthodontic treatment need and OHRQoL was investigated in multivariate regression analysis with weighted least squares. Differences by sex and levels of objective orthodontic treatment need were evaluated.

Results

In total, 3774 children were included in the analysis. Children with borderline subjective orthodontic treatment need and those with definite subjective orthodontic treatment need had significantly poorer OHRQoL based on the fully adjusted model (adjusted regression coefficient (aβ)=−0.49, 95% CI: −0.75, −0.30; (aβ)=−1.58, 95% CI: −1.81, −1.58, respectively). The association between subjective orthodontic treatment need and OHRQoL was stronger in girls than in boys and stronger in children with objective orthodontic treatment need than in those with none.

Conclusions

Oral health‐related quality of life is poorer in children with subjective orthodontic treatment need. This has not been investigated before in such a large‐population‐based study and clearly offers an explanation for the lack of concurrence between objective and subjective orthodontic treatment need.
Adjuvant psychological therapy in long‐term endocrine conditions
Authors: Daniels J. , Turner‐Cobb J. M.
Published: March 2017

Consideration of psychological distress in long‐term endocrine conditions is of vital importance given the prevalence of anxiety and depression in such disorders. Poor mental health can lead to compromised self‐care, higher utilization of health services, lower rates of adherence, reduced quality of life and ultimately poorer outcomes. Adjuvant psychological therapy offers an effective resource to reduce distress in endocrine conditions. While the vast majority of work in this area has focused on psychological screening and intervention in diabetes, identification and recognition of psychological distress are equally important in other endocrinological conditions, with supportive evidence in polycystic ovary syndrome and Addison's disease. Referral pathways and recommendations set out by UK guidelines and the Department of Health mandate requires greater attention across a wider range of long‐term endocrine conditions to facilitate improved quality of life and health outcome.
Dose‐response effects of sex hormone concentrations on body composition and adipokines in medically castrated healthy men administered graded doses of testosterone gel
Authors: Thirumalai Arthi , Rubinow Katya B. , Cooper Lori A. , Amory John K. , Marck Brett T. , Matsumoto Alvin M. , Page Stephanie T.
Published: March 2017

Objective

Serum sex steroid concentrations may alter body composition and glucose homoeostasis in men in a dose‐response manner. We evaluated these end‐points in healthy men rendered medically castrate through use of a gonadotrophin‐releasing hormone antagonist (acyline) with incremental doses of exogenous testosterone (T) gel.

Design

Subjects (n=6‐9 per group) were randomly assigned to injections of acyline every 2 weeks plus transdermal T gel (1.25 g, 2.5 g, 5.0 g, 10 g or 15 g) daily or double placebo (injections and gel) for 12 weeks.

Patients

Healthy men, ages 25‐55 years, with normal serum total T concentrations.

Measurements

Serum T, dihydrotestosterone (DHT) and oestradiol (E2) were measured at baseline and every 2 weeks. Body composition was analysed by dual‐energy X‐ray absorptiometry at baseline and week 12. Fasting serum adiponectin, leptin, glucose and insulin concentrations were measured at baseline and week 10.

Results

Forty‐eight men completed the study. A significant treatment effect was observed for change in lean mass (ANOVAP=.01) but not fat mass (P=.14). Lean mass increased in the 15 g T group relative to all lower dose groups, except the 10 g T group. When all subjects were analysed together, changes in lean mass correlated directly and changes in fat mass correlated inversely with serum T, E2 and DHT. No changes were noted in serum glucose, insulin or adipokine levels.

Conclusions

In healthy men, higher serum concentrations of T, DHT and E2 were associated with greater increases in lean mass and decreases in fat mass but not with changes in serum glucose, insulin or adipokines.
New EPCAM founder deletion in Polish population
Authors: Dymerska D. , Gołębiewska K. , Kuświk M. , Rudnicka H. , Scott R.J. , Billings R. , Pławski A. , Boruń P. , Siołek M. , Kozak‐Klonowska B. , Szwiec M. , Kilar E. , Huzarski T. , Byrski T. , Lubiński J. , Kurzawski G.
Published: March 2017

It is well known that founder mutations associated with cancer risk have useful implications for molecular diagnostics. We report the presence of a founder mutation in EPCAM involved in the etiology of Lynch syndrome (LS). The mutation extends nearly 8.7 kb (c.858 + 2478_*4507del) and is shared by 8 Polish families. Family members suffered almost exclusively from colorectal cancer; however, pancreatic and gastric cancers were also apparent. Next to mutations c. 2041G>A in MLH1 gene and c.942+3A>T in MSH2, the deletion mutation encompassing EPCAM is one of the most common causative changes responsible for LS in Poland.
LIFETIME TAXPAYER CONTRIBUTIONS AND BENEFITS OF MEDICARE AND SOCIAL SECURITY
Authors: Guo Jing , Moon Marilyn
Published: March 2017

Many criticisms of Medicare and Social Security have suggested that beneficiaries get more than they paid into the system over their lifetimes and these entitlement programs may be unsustainable if they are insufficiently funded. But studies do not always use appropriate assumptions for estimating lifetime values. Our simulation model properly aligns the financing sources with the benefits received by making consistent comparisons and using a more appropriate inflation adjustment. Our study suggests that using different assumptions can dramatically change the balance between contributions and benefits as compared with other analyses. Choosing the appropriate assumptions is essential for a reasoned debate on the important issues about the future and financing of Medicare and Social Security. (JEL I13, H5, H24)
Effect of dental pulp stem cells in MPTP‐induced old‐aged mice model
Authors: Gnanasegaran Nareshwaran , Govindasamy Vijayendran , Simon Christopher , Gan Quan Fu , Vincent‐Chong Vui King , Mani Vasudevan , Krishnan Selvarajan Kesavanarayanan , Subramaniam Vellayan , Musa Sabri , Abu Kasim Noor Hayaty
Published: March 2017

Background

Parkinson's disease (PD) is a neurodegenerative disease caused by the loss of dopaminergic (DA‐ergic) neurons in the substantia nigra (SN) and represented as a huge threat to the geriatric population. Cell replacement therapies (CRTs) have been proposed as a promising strategy to slow down or replace neuronal loss. Among the widely available cell sources, dental pulp stem cells (DPSCs) portray as an attractive source primarily due to their neural crest origin, ease of tissue procurement and less ethical hurdles.

Materials and methods

We first demonstrated the in vitro differentiation ability of DPSCs towards DA‐ergic‐like cells before evaluating their neuro‐protection/neuro‐restoration capacities in MPTP‐induced mice. Transplantation via intrathecal was performed with behavioural assessments being evaluated every fortnight. Subsequent analysis investigating their immuno‐modulatory behaviour was conducted using neuronal and microglial cell lines.

Results

It was apparent that the behavioural parameters began to improve corresponding to tyrosine hydroxylase (TH), dopamine transporter (DAT) and dopamine decarboxylase (AADC) immunostaining in SN and striatum as early as 8‐week post‐transplantation (P < 0·05). About 60% restoration of DA‐ergic neurons was observed at SN in MPTP‐treated mice after 12‐week post‐transplantation. Similarly, their ability to reduce toxic effects of MPTP (DNA damages, reactive oxygen species and nitric oxide release) and regulate cytokine levels was distinctly noted (P < 0·05) upon exposure in in vitro model.

Conclusions

Our results suggest that DPSCs may provide a therapeutic benefit in the old‐aged PD mice model and may be explored in stem cell‐based CRTs especially in geriatric population as an attempt towards ‘personalized medicine’.
Development and optimisation of a sex pheromone lure for monitoring populations of saddle gall midge, Haplodiplosis marginata
Authors: Rowley Charlotte , Pope Tom W. , Cherrill Andrew , Leather Simon R. , Fernández‐Grandon G. Mandela , Hall David R.
Published: March 2017

Saddle gall midge, Haplodiplosis marginata (von Roser) (Diptera: Cecidomyiidae), is a sporadic pest of cereals in Northern and Central Europe and is of increasing importance in the UK. Recently, the major component of the sex pheromone produced by adult female H. marginata was reported to be 2‐nonyl butyrate. The importance of absolute configuration on attractiveness, the effects on trap catches of the addition of minor pheromone components, dispenser type, and pheromone loading are described in the development of an optimised pheromone lure with which to trap H. marginata males. In analyses of volatiles collected from virgin female H. marginata by gas chromatography (GC) coupled with electroantennographic recording (EAG) from the antenna of a male H. marginata, two EAG responses were observed. Analyses by coupled GC‐mass spectrometry (MS) indicated these were due to 2‐nonyl butyrate and a trace amount (1%) of 2‐heptyl butyrate. A similar trace amount of 2‐nonanol was detected in GC‐MS analyses but this compound did not elicit an EAG response when the synthetic compound was tested, whereas the other two compounds did. These three compounds were not observed in collections of volatiles made from male H. marginata. The 2‐nonyl butyrate was shown to be the (R)‐enantiomer. In field trapping tests (R)‐2‐nonyl butyrate was at least 10× more attractive to male H. marginata than the racemic compound, and the (S)‐enantiomer was unattractive. Addition of the potential minor components individually or together at the naturally occurring ratios did not increase or reduce the attractiveness of the lure. Polyethylene vials and rubber septa were equally effective as pheromone dispensers, lasting for at least 5 weeks in the field in the UK, although laboratory tests indicated release from the former was more uniform and more likely to last longer in the field. Increasing loading of pheromone in the dispenser increased attractiveness. Traps baited with polyethylene vials containing 0.5 mg of (R)‐2‐nonyl butyrate are recommended for monitoring H. marginata and these are far more sensitive than water or sticky traps currently used for monitoring this pest.
There is no functional small‐fibre neuropathy in prurigo nodularis despite neuroanatomical alterations
Authors: Pereira Manuel P. , Pogatzki‐Zahn Esther , Snels Chantal , Vu Thai‐Ha , Üçeyler Nurcan , Loser Karin , Sommer Claudia , Evers Andrea Walburga Maria , van Laarhoven Antoinette I. M. , Agelopoulos Konstantin , Ständer Sonja
Published: March 2017

Prurigo nodularis (PN) is a pruritic condition with altered epidermal neuroanatomy as demonstrated previously. Here we elucidated neuroimmunological mechanisms by combining functional, morphological and gene expression experiments in twelve subjects with PN and eight healthy controls. Subjects with PN showed a reduced intra‐epidermal nerve fibre density (IENFD) in lesional skin. Quantitative sensory testing indicated maintenance of somatosensory function compared to controls. None of the tested molecular markers including the neuron‐distracting SEMA3A and neuron‐attracting NGF were altered in lesional vs non‐lesional skin in PN subjects. Accordingly, we speculate that scratching may contribute to reduced IENFD rather than an authentic endogenous neuropathy.
RARα/RXR synergism potentiates retinoid responsiveness in cutaneous T‐cell lymphoma cell lines
Authors: Wang Lei , DeMarco Sebastian S. , Peaks Mary Stuart , Maiorana‐Boutilier Abigail L. , Chen JianMing , Crouch Miranda J. , Shewchuk Brian M. , Shaikh Saame Raza , Phillips Charles M. , Bridges Lance C.
Published: March 2017

Retinoids, natural and synthetic derivatives of vitamin A, induce cellular changes by activating nuclear retinoic acid receptors (RAR) and retinoid X receptors (RXR). Although the ability of retinoids to govern gene expression is exploited clinically for cancer therapeutics, the full benefit of retinoid‐based strategies is unrealized due to detrimental side effects. Delineating the receptors that prompt cellular outcomes is critical to advancing retinoid‐based approaches. Here, we identify the receptors that evoke multiple responses in cutaneous T‐cell lymphoma (CTCL). The data demonstrate that RARα drives integrin β7‐dependent adhesion and CCR9‐mediated chemotaxis in CTCL cells. Of note, concomitant activation of RARα and RXR nuclear receptors yielded synergistic increases in adhesion and migration at concentrations where single agents were ineffective. As the established paradigm of retinoid action in CTCL is apoptosis and growth arrest, the role of RARα/RXR in these events was studied. As with adhesion and migration, RARα/RXR synergism prompted apoptosis and dampened CTCL cell proliferation. Strikingly, RARα/RXR synergism induced responses from CTCL cell lines previously reported to be unresponsive to retinoids. These data provide a novel framework that may further refine a proven CTCL therapy.
A global meta‐analysis of exotic versus native leaf decay in stream ecosystems
Authors: Kennedy Kimberly T. M. , El‐Sabaawi Rana W.
Published: March 2017

Streams are reliant on streamside plants for allochthonous inputs that form the base of the stream food web. The impact of exotic leaves on stream ecosystems has been investigated regionally, but not assessed globally. In this study, we conducted a global meta‐analysis contrasting native and exotic aquatic litter decay.

We used a linear mixed effects model to identify how the site‐specific factors and experimental treatments of latitude, temperature, pH, conductivity and the exclusion of invertebrates (via mesh size) cause relative differences in exotic and native decay rates. Subsequently, we assessed whether differences in native and exotic litter decay rates were driven by the intrinsic factors of leaf litter quality.

We found that overall leaf litter decay rates were similar for native and exotic leaves on a global scale. However, we also found that exotic leaves decayed faster than native leaves at higher stream temperatures and in larger mesh sizes (allowing macroinvertebrate access); yet, those differences disappeared at lower temperatures and in finer mesh sizes which excluded macroinvertebrates.

Post hoc analysis of leaf quality suggested that differences between higher native and lower exotic leaf C:N ratios might explain differences in decomposition rates observed at high temperature, and differences between lower native and higher exotic leaf C:P ratios associated with differences in decomposition rates observed at coarse mesh sizes.

Our study suggests that exotic leaf litter is likely to have the most impact in high‐temperature stream ecosystems and that the nature of the impact is potentially related to the C:N ratio differences between native and exotic leaves. This might indicate that higher temperature stream ecosystems are more vulnerable to changes in litter decay rates due to invasion by exotic plant species than lower temperature stream ecosystems, and should be monitored accordingly. We recommend that future leaf litter decay studies include stream discharge measurements and leaf litter quality information so that both intrinsic and extrinsic factors that impact litter decay can be fully accounted for when assessing the factors that drive differences in leaf litter decay rates.
The role of functional uniqueness and spatial aggregation in explaining rarity in trees
Authors: Umaña María Natalia , Mi Xiangcheng , Cao Min , Enquist Brian J. , Hao Zhanqing , Howe Robert , Iida Yoshiko , Johnson Daniel , Lin Luxiang , Liu Xiaojuan , Ma Keping , Sun I‐Fang , Thompson Jill , Uriarte Maria , Wang Xugao , Wolf Amy , Yang Jie , Zimmerman Jess K. , Swenson Nathan G.
Published: March 2017

Aim

Determining the drivers of species rarity is fundamental for understanding and conserving biodiversity. Rarity of a given species within its community may arise due to exclusion by other ecologically similar species. Conversely, rare species may occupy habitats that are rare in the landscape or they may be ill‐suited to all available habitats. The first mechanism would lead to common and rare species occupying similar ecological space defined by functional traits. The second mechanism would result in common and rare species occupying dissimilar ecological space and spatial aggregation of rare species, either because they are specialists in rare habitats or because rare species tend to be dispersal limited. Here, we quantified the contribution of locally rare species to community functional richness and the spatial aggregation of species across tree communities world‐wide to address these hypotheses.

Location

Asia and the Americas.

Time period

2002 to 2012 (period that considers the censuses for the plots used).

Major taxa studied

Angiosperm and Gymnosperm trees.

Methods

We compiled a dataset of functional traits from all the species present in eight tree plots around the world to evaluate the contribution of locally rare species to tree community functional richness using multi‐ and univariate approaches. We also quantified the spatial aggregation of individuals within species at several spatial scales as it relates to abundance.

Results

Locally rare tree species in temperate and tropical forests tended to be functionally unique and are consistently spatially clustered. Furthermore, there is no evidence that this pattern is driven by pioneer species being locally rare.

Main conclusions

This evidence shows that locally rare tree species disproportionately contribute to community functional richness, and we can therefore reject the hypothesis that locally rare species are suppressed by ecologically similar, but numerically dominant, species. Rather, locally rare species are likely to be specialists on spatially rare habitats or they may be ill‐suited to the locally available environments.
Repeat prescribing of medications: A system‐centred risk management model for primary care organisations
Authors: Price Julie , Man Shu Ling , Bartlett Stephen , Taylor Kate , Dinwoodie Mark , Bowie Paul
Published: March 2017

Rationale, aims and objectives

Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care.

Methods

All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web‐based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses.

Results

Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1‐33; SD = 7.13). Seven hundred sixty‐seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0‐34; SD = 8.0).

Conclusions

The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System‐wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally.
The struggle of translating science into action: Foundational concepts of implementation science
Authors: Rapport Frances , Clay‐Williams Robyn , Churruca Kate , Shih Patti , Hogden Anne , Braithwaite Jeffrey
Published: March 2017

Rationale, aims, and objectives

“Implementation science,” the scientific study of methods translating research findings into practical, useful outcomes, is contested and complex, with unpredictable use of results from routine clinical practice and different levels of continuing assessment of implementable interventions. The authors aim to reveal how implementation science is presented and understood in health services research contexts and clarify the foundational concepts: diffusion, dissemination, implementation, adoption, and sustainability, to progress knowledge in the field.

Method

Implementation science models, theories, and frameworks are critiqued, and their value for laying the groundwork from which to implement a study's findings is emphasised. The paper highlights the challenges of turning research findings into practical outcomes that can be successfully implemented and the need for support from change agents, to ensure improvements to health care provision, health systems, and policy. The paper examines how researchers create implementation plans and what needs to be considered for study outputs to lead to sustainable interventions. This aspect needs clear planning, underpinned by appropriate theoretical paradigms that rigorously respond to a study's aims and objectives.

Conclusion

Researchers might benefit from a return to first principles in implementation science, whereby applications that result from research endeavours are both effective and readily disseminated and where interventions can be supported by appropriate health care personnel. These should be people specifically identified to promote change in service organisation, delivery, and policy that can be systematically evaluated over time, to ensure high‐quality, long‐term improvements to patients' health.
Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans
Authors: Garcia Marc A. , Valderrama‐Hinds Luis M. , Chiu Chi‐Tsun , Mutambudzi Miriam S. , Chen Nai‐Wei , Raji Mukaila
Published: March 2017

The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later‐life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican‐American population. The results indicate that early‐life and late‐life migrant women spend more years with Performance‐Oriented Mobility Assessment limitations than U.S.‐born women. Conversely, midlife migrant women were not statistically different from U.S.‐born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability‐free years than U.S.‐born men. For morbidity, late‐life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.‐born women, but late‐life migrant men spent more years with morbidity than U.S.‐born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.
Do‐Not‐Hospitalize Orders in Nursing Homes: “Call the Family Instead of Calling the Ambulance”
Authors: Cohen Andrew B. , Knobf M. Tish , Fried Terri R.
Published: March 2017

Objectives

To determine how do‐not‐hospitalize (DNH) orders are interpreted and used in nursing homes (NHs) once they are in place.

Design

Qualitative study using in‐depth semi‐structured interviews performed from December 2013 to April 2014.

Setting

Eight skilled nursing facilities in Connecticut that ranked in the top 10% or bottom 10% in hospitalization rates from 2008 to 2010.

Participants

Nursing facility staff members (N = 31).

Measurements

A multidisciplinary team performed qualitative content analysis. The constant comparative method was used to develop a coding structure and identify themes.

Results

DNH orders were uncommon at low‐ and high‐hospitalizing facilities. Participants reported that they did not interpret these orders literally. A DNH order was not a prohibition against hospitalization but was understood to have a variety of exceptions. These orders functioned primarily as a signal that hospitalization should be questioned and discussed with the family when an acute event occurred.

Conclusion

In‐the‐moment discussions about hospitalization are still necessary even when a DNH order is in place. Work to reduce potentially burdensome NH–hospital transfers needs to focus not just on eliciting preferences in advance, but also on preparing residents and their families to make the best decisions about hospitalization when the time comes.
Use of an Early Labor Lounge to Promote Admission in Active Labor
Authors: Paul Julie A. , Yount Susan M. , Breman Rachel Blankstein , LeClair Melissa , Keiran Diane M. , Landry Nannette , Dever Kimberly
Published: March 2017

Professional maternity care organizations within the United States are aligned in the goal to prevent the first cesarean birth in nulliparous women with a term, singleton, vertex fetus. Currently, one in 3 women are at risk for having a cesarean birth. The most common reason for cesarean in the United States is labor dystocia. The evidence supports delaying admission to the birthing unit until active labor is established, thereby minimizing the inadvertent diagnosis of labor dystocia. Providers are familiar with the rationale supporting delayed admission to the birthing unit until active labor is established; however, there is very little evidence on how to effectively promote this delay. Provider apprehension and the lack of early labor support are challenges to sending women home to await the onset of active labor. Maternal anxiety, fear, pain, and unpreparedness also play a part in this reluctance. To address these obstacles, South Shore Hospital created an early labor lounge with stations aimed at instilling confidence in the birth team, promoting teamwork, facilitating relaxation, and reducing anxiety for laboring women. A literature review focusing on women's perceptions of promoting admission in active labor, maternal anxiety, and nonpharmacologic strategies for managing early labor are discussed within the context of the creation, implementation, and evaluation of an early labor lounge.
Environmental and hormonal regulation of epigenetic enzymes in the hypothalamus
Authors: Stevenson T. J.
Published: March 2017

Neuroendocrine structures integrate a vast range of external cues and internal signals that, in turn, result in adaptive physiological responses. Emerging data indicate that light, social cues, stress and energy balance stimulate relatively short‐ and long‐term genomic modifications in discrete neuroendocrine structures, which are mediated by epigenetic mechanisms. Moreover, environmentally‐induced fluctuations in the synthesis of local hypothalamic and circulating hormones provide an internal signal that contributes to the extensive neuroendocrine genomic plasticity. This review examines the impact of environmental stimuli and endogenous hormonal signals on the regulation of epigenetic enzymes in key neuroendocrine structures. The data discussed are predominantly derived from studies in the neuroendocrine control of seasonal reproduction and the impact of social stress in rodent models. The perspective presented considers the role of oestrogen and glucocorticoids as the primary catalysts for inducing epigenetic modifications (eg, DNA methylation) in specific neuroendocrine structures. Oestrogen and glucocorticoid actions suggest: (i) a preferential action for specific epigenetic enzymes and (ii) nucleus‐ and cell‐specific modifications. Untangling the complex web of hormonal regulation of methylation and acetylation will enhance our understanding of short‐ and long‐term changes in epigenetic enzymes that generate adaptive and pathological neuroendocrine responses.
Three urocortins in medaka: identification and spatial expression in the central nervous system
Authors: Hosono K. , Yamashita J. , Kikuchi Y. , Hiraki‐Kajiyama T. , Okubo K.
Published: March 2017

The urocortin (UCN) group of neuropeptides includes urocortin 1/sauvagine/urotensin 1 (UTS1), urocortin 2 (UCN2) and urocortin 3 (UCN3). In recent years, evidence has accumulated showing that UCNs play pivotal roles in mediating stress response and anxiety in mammals. Evidence has also emerged regarding the evolutionary conservation of UCNs in vertebrates, but very little information is available about UCNs in non‐mammalian vertebrates. Indeed, at present, there are no reports of the empirical identification of ucn2 in non‐mammalian vertebrates or of the distribution of ucn2 and ucn3 expression in the adult central nervous system (CNS) of these animals. To gain insight into the evolutionary nature of UCNs in vertebrates, we cloned uts1, ucn2 and ucn3 in a teleost fish, medaka and examined the spatial expression of these genes in the adult brain and spinal cord. Although all known UCN2 genes except those in rodents have been reported to likely lack the necessary structural features to produce a functional pre‐pro‐protein, all three UCN genes in medaka, including ucn2, displayed all of these features, suggesting their functionality. The three UCN genes exhibited distinct spatial expression patterns in the medaka brain: uts1 was primarily expressed in broad regions of the dorsal telencephalon, ucn2 was expressed in restricted regions of the thalamus and brainstem and ucn3 was expressed in discrete nuclei throughout many regions of the brain. We also found that these genes were all expressed throughout the medaka spinal cord, each with a distinct spatial pattern. Given that many of these regions have been implicated in stress responses and anxiety, the three UCNs may serve distinct physiological roles in the medaka CNS, including those involved in stress and anxiety, as shown in the mammalian CNS.