bluuebunny/crossref_metadata_2025 huggingface dataset:
Key findings of the US Cystic Fibrosis Foundation's clinical practice benchmarking project
Authors: Boyle Michael P , Sabadosa Kathryn A , Quinton Hebe B , Marshall Bruce C , Schechter Michael S
Published: March 2014

Benchmarking is the process of using outcome data to identify high-performing centres and determine practices associated with their outstanding performance. The US Cystic Fibrosis Foundation (CFF) Patient Registry contains centre-specific outcomes data for all CFF-certified paediatric and adult cystic fibrosis (CF) care programmes in the USA. The CFF benchmarking project analysed these registry data, adjusting for differences in patient case mix known to influence outcomes, and identified the top-performing US paediatric and adult CF care programmes for pulmonary and nutritional outcomes. Separate multidisciplinary paediatric and adult benchmarking teams each visited 10 CF care programmes, five in the top quintile for pulmonary outcomes and five in the top quintile for nutritional outcomes. Key practice patterns and approaches present in both paediatric and adult programmes with outstanding clinical outcomes were identified and could be summarised as systems, attitudes, practices, patient/family empowerment and projects. These included: (1) the presence of strong leadership and a well-functioning care team working with a systematic approach to providing consistent care; (2) high expectations for outcomes among providers and families; (3) early and aggressive management of clinical declines, avoiding reliance on ‘rescues’; and (4) patients/families that were engaged, empowered and well informed on disease management and its rationale. In summary, assessment of practice patterns at CF care centres with top-quintile pulmonary and nutritional outcomes provides insight into characteristic practices that may aid in optimising patient outcomes.
The interdependent roles of patients, families and professionals in cystic fibrosis: a system for the coproduction of healthcare and its improvement
Authors: Sabadosa Kathryn A , Batalden Paul B
Published: March 2014

A quality healthcare system is coproduced by patients, families and healthcare professionals working interdependently to cocreate and codeliver care. Cystic fibrosis (CF) patients and families rely on healthcare professionals to provide the best possible care and timely, accurate information. They know that the care at home and in clinical settings needs to be seamless, using shared information and decisions. A parent's journey of better care begins with her son's diagnosis and moves to her involvement to improve the systems and processes of care for others. She reflects on this work and identifies five elements that contributed to the coproduction of improved care: (1) mental and emotional readiness to engage; (2) curiosity and the search for insight; (3) reframe challenges into opportunities for improvement; (4) listen and learn from everyone, bringing home what is relevant; and (5) personal participation. Joined with the reflections of an improvement scientist, they note that chronic care relies on informed, activated patients and prepared, proactive healthcare professionals working together and that it is more than ‘patient-centric’. They propose a model for the coimprovement of systems of care.
Accelerating implementation of biomedical research advances: critical elements of a successful 10 year Cystic Fibrosis Foundation healthcare delivery improvement initiative
Authors: Marshall Bruce C , Nelson Eugene C
Published: March 2014

Context: Scientific and therapeutic advances

Remarkable biomedical research advances have led to innovative and increasingly effective therapies. We highlight several scientific milestones in elucidating the pathophysiology of cystic fibrosis (CF) and review the therapies that have become available over the past 20 years.

Impact of the quality improvement initiative

In 2002, the CF Foundation launched a multifaceted quality improvement initiative to accelerate improvement in CF care. We present evidence of substantial improvement in process measures, such as more consistent outpatient follow-up, and key medical outcomes, including survival, pulmonary function and nutritional status.

Critical success factors

We offer our perspective on factors critical to the success of the quality improvement initiative, including a compelling strategic plan and the commitment of the CF Foundation to its implementation; the investment in building improvement capacity at CF care centres; the engagement of people with CF and their families as partners; and the integration of quality improvement into the existing CF care framework.

Directions for the next decade

In addition to a continued investment in building and sustaining improvement capacity at CF care centres, and deeper patient engagement, we will address the oppressive treatment burden. We will also complement the measurement of clinical outcomes with patient reported outcomes and healthcare costs for a balanced assessment of the quality and value of care.

Conclusions

Major advances in basic science and therapeutic development coupled with improvements in healthcare delivery have resulted in striking gains in medical outcomes for people with CF.
Female users of internet-based screening for rectal STIs: descriptive statistics and correlates of positivity
Authors: Ladd Jessica , Hsieh Yu-Hsiang , Barnes Mathilda , Quinn Nicole , Jett-Goheen Mary , Gaydos Charlotte A
Published: March 2014

Background

Internet-based screening for vaginal sexually transmitted infections (STI) has been shown to reach high-risk populations. Published studies of internet-based screening for rectal STIs in women are needed. Our objectives were to describe the female users of a rectal internet-based screening intervention and assess what factors correlated with rectal positivity for STIs.

Methods

The websitehttp://www.iwantthekit.orgoffers free STI testing via home self-sampling kits. Women could order vaginal and rectal kits, both containing questionnaires. Rectal and vaginal swabs were tested forChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginalisusing nucleic acid amplification tests. Data were analysed from 205 rectal kits from January 2009 through February 2011. Self-reported characteristics of participants were examined, and correlates of rectal STI positivity were analysed.

Results

Of the 205 rectal samples returned and eligible for testing, 38 (18.5%) were positive for at least one STI. The women were young (mean age 25.8 years), mostly African–American (50.0%), and only 14.0% always used condoms. After adjusting for age and race, Black race (AOR=3.06) and vaginal STI positivity (AOR=40.6) were significantly correlated with rectal STI positivity. Of women testing positive for rectal STIs who also submitted vaginal swabs, 29.4% were negative in the vaginal sample.

Conclusions

Internet-based rectal screening can reach populations that appear to be at high risk for rectal STIs (18.5% prevalence) and led to the diagnosis of STIs in women who would not have been diagnosed vaginally. Black race and vaginal STI positivity were highly correlated with rectal STI positivity.
Horseshoes, Entropy, Homoclinic Trajectories, and Lyapunov Stability
Authors: Kočan Zdeněk , Kurková Veronika , Málek Michal
Published: March 2014

We consider six properties of continuous maps, such as the existence of an arc horseshoe, the positivity of topological entropy, the existence of a homoclinic trajectory, or Lyapunov instability on the set of periodic points. The relations between the considered properties are provided in the case of graph maps, dendrite maps and maps on compact metric spaces. For example, by [Llibre & Misiurewicz, 1993] in the case of graph maps, the existence of an arc horseshoe implies the positivity of topological entropy, but we construct a continuous map on a Peano continuum with an arc horseshoe and zero topological entropy. We also formulate one open problem.
Population Dynamics with Nonlinear Delayed Carrying Capacity
Authors: Yukalov V. I. , Yukalova E. P. , Sornette D.
Published: March 2014

We consider a class of evolution equations describing the population dynamics in the presence of a carrying capacity depending on the population with delay. In an earlier work, we presented an exhaustive classification of the logistic equation where the carrying capacity is linearly dependent on the population with a time delay, which we refer to as the "linear delayed carrying capacity" model. Here, we generalize it to the case of a nonlinear delayed carrying capacity. The nonlinear functional form of the carrying capacity characterizes the delayed feedback of the evolving population on the capacity of their surrounding by either creating additional means for survival or destroying the available resources. The previously studied linear approximation for the capacity assumed weak feedback, while the nonlinear form is applicable to arbitrarily strong feedback. The nonlinearity essentially changes the behavior of solutions to the evolution equation, as compared to the linear case. All admissible dynamical regimes are analyzed, which can be of the following types: punctuated unbounded growth, punctuated increase or punctuated degradation to a stationary state, convergence to a stationary state with sharp reversals of plateaus, oscillatory attenuation, everlasting fluctuations, everlasting up–down plateau reversals, and divergence in finite time. The theorem is proved that, for the case characterizing the evolution under gain and competition, solutions are always bounded, if the feedback is destructive. We find that even a small noise level profoundly affects the position of the finite-time singularities. Finally, we demonstrate the feasibility of predicting the critical time of solutions having finite-time singularities from the knowledge of a simple quadratic approximation of the early time dynamics.
Codimension-2 Border Collision, Bifurcations in One-Dimensional, Discontinuous Piecewise Smooth Maps
Authors: Gardini Laura , Avrutin Viktor , Sushko Irina
Published: March 2014

We consider a two-parametric family of one-dimensional piecewise smooth maps with one discontinuity point. The bifurcation structures in a parameter plane of the map are investigated, related to codimension-2 bifurcation points defined by the intersections of two border collision bifurcation curves. We describe the case of the collision of two stable cycles of any period and any symbolic sequences. For this case, we prove that the local monotonicity of the functions constituting the first return map defined in a neighborhood of the border point at the parameter values related to the codimension-2 bifurcation point determines, under suitable conditions, the kind of bifurcation structure originating from this point; this can be either a period adding structure, or a period incrementing structure, or simply associated with the coupling of colliding cycles.
Impact of a Biospecimen Collection Seminar on Willingness to Donate Biospecimens among Chinese Americans: Results from a Randomized, Controlled Community-Based Trial
Authors: Tong Elisa K. , Fung Lei-Chun , Stewart Susan L. , Paterniti Debora A. , Dang Julie H.T. , Chen Moon S.
Published: March 2014

Background: Biospecimen collection from diverse populations can advance cancer disparities research, but is currently underrepresented.

Methods: We partnered with a community-based clinic serving Cantonese-speaking Chinese Americans to develop and revise an educational seminar on biospecimen collection. Through a randomized controlled trial (n = 395), the intervention seminar was compared with a control seminar (cancer prevention) on change in willingness to donate biospecimens.

Results: At baseline, many were willing to donate a biospecimen (saliva, urine, hair, toenails, blood, unused cancerous tissue) whether healthy or hypothetically had cancer. Also, many would donate because future generations would benefit, and few had concerns about donation. In logistic regression analyses, there was an intervention effect for willingness to donate: urine if had cancer [OR, 2.2; 95% confidence interval (CI), 1.3–3.7], toenails if healthy (OR, 2.1; 95% CI, 1.4–3.2) or had cancer (OR, 2.3; 95% CI, 2.0–2.7), hair if healthy (OR, 1.8; 95% CI, 1.3–2.5) or had cancer (OR, 2.8; 95% CI, 1.9–4.0), and unused cancerous tissue (OR, 1.8; 95% CI, 1.2–2.9). There was also an intervention effect for donating because future generations would benefit (OR, 2.0; 95% CI, 1.4–3.0), and this attitude was a strong independent predictor for willingness to donate all biospecimens, whether healthy or had cancer (OR, 2.9–4.2).

Conclusion: Cantonese-speaking Chinese American participants of an educational seminar on biospecimen collection showed greater increases in willingness to donate biospecimens and donating for the benefit of future generations, than participants who attended a control seminar.

Impact: Donating for the benefit of future generations is a theme that should be incorporated in messages that encourage biospecimen donation for Chinese Americans.

See all articles in this CEBP Focus section, “Community Network Program Centers.”

Cancer Epidemiol Biomarkers Prev; 23(3); 392–401. ©2014 AACR.
Development and Validation of the Biobanking Attitudes and Knowledge Survey (BANKS)
Authors: Wells Kristen J. , Arevalo Mariana , Meade Cathy D. , Gwede Clement K. , Quinn Gwendolyn P. , Luque John S. , San Miguel Gloria , Watson Dale , Phillips Rebecca , Reyes Carmen , Romo Margarita , West Jim , Jacobsen Paul B.
Published: March 2014

Background: No validated multiscale instruments exist that measure community members' views on biobanking and biospecimen donation. This study describes the development and psychometric properties of the English-language BANKS (Biobanking Attitudes and Knowledge Survey).

Methods: The BANKS was created by item generation through review of scientific literature, focus groups with community members, and input from a community advisory board. Items were refined through cognitive interviews. Content validity was assessed through an expert panel review. Psychometric properties of the BANKS were assessed in a sample of 85 community members.

Results: The final BANKS includes three scales: attitudes, knowledge, and self-efficacy; as well as three single items, which evaluated receptivity and intention to donate a biospecimen for research. Cronbach α coefficients for two scales that use Likert response format indicated high internal consistency (attitudes: α, 0.88; self-efficacy: α, 0.95). Content validity indices were moderate, ranging from 0.69 to 0.89. Intention to donate blood and intention to donate urine were positively correlated with attitudes, knowledge, self-efficacy, and receptivity to learning more about biobanking (P values range from 0.029 to <0.001).

Conclusions: The final BANKS shows evidence of satisfactory reliability and validity, is easy to administer, and is a promising tool to inform biospecimen research. Additional studies should be conducted with larger samples considering biospecimen donation to further assess the reliability and validity of the instrument.

Impact: A valid and reliable instrument measuring community members' views about biobanking may help researchers evaluate relevant communication interventions to enhance understanding, intention, and actual biospecimen donation. A Spanish-language BANKS is under development.

See all articles in this CEBP Focus section, “Community Network Program Centers.”

Cancer Epidemiol Biomarkers Prev; 23(3); 374–82. ©2014 AACR.
Effective Recruitment Strategies and Community-Based Participatory Research: Community Networks Program Centers' Recruitment in Cancer Prevention Studies
Authors: Greiner K. Allen , Friedman Daniela B. , Adams Swann Arp , Gwede Clement K. , Cupertino Paula , Engelman Kimberly K. , Meade Cathy D. , Hébert James R.
Published: March 2014

Background: Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research.

Methods: Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)–funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement.

Results: Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community–academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%–100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%–11%).

Conclusions: Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations.

Impact: CBPR strategies should be more widely implemented to enhance study recruitment.

See all articles in this CEBP Focus section, “Community Network Program Centers.”

Cancer Epidemiol Biomarkers Prev; 23(3); 416–23. ©2014 AACR.
Clinic Type and Patient Characteristics Affecting Time to Resolution After an Abnormal Cancer-Screening Exam
Authors: Krok JL , Kurta ML , Weier RC , Young GS , Carey AB , Tatum CM , Paskett ED
Published: March 2014

Research shows that multilevel factors influence health care delivery and patient outcomes. The goal of this study was to examine how clinic type (primary care clinic within an academic medical center (AMC) or federally-qualified health center (FQHC)) and patient characteristics influence time to resolution (TTR) among individuals enrolled in a patient navigation (PN) intervention. Data were obtained from the Ohio Patient Navigation Research Project, a group randomized trial in which 862 patients from 18 clinics in Columbus, OH participated. Patient's TTR after an abnormal breast, cervical, or colorectal test and the clinics' patient and provider characteristics were obtained. Descriptive statistics and Cox shared frailty proportional hazards regression models of TTR were used to analyze the data. The mean patient age was 44.8 years and 71% of patients were White. In models adjusted for study arm, the interaction between time and study arm and a clinic random effect, FQHC patients had a 39% lower rate of resolution than AMC patients (HR = 0.61, p = 0.004); college educated patients had an 87% higher rate of resolution than patients with less than a high school education (HR = 1.87, p = 0.0007); privately insured patients had a 79% higher rate of resolution than uninsured patients (HR = 1.79, p < 0.0001); patients with annual incomes ≥ $50,000 had a 51% higher rate of resolution than patients with annual incomes < $10,000 (HR = 1.51, p = 0.02); and there was a 4% increase in the rate of resolution for each five year increase in patient age (HR = 1.04, p = 0.004). After using multiple imputation to impute income and insurance status where missing, factors that potentially confounded the effect of clinic type on TTR were assessed using forward selection. After adjustment for patient insurance status, education level and age, clinic type was not significantly associated with TTR. Controlling for clinic type, patient insurance status and age were significantly associated with TTR (p = 0.005 and p = 0.01, respectively) and patient education level was marginally significant (p = 0.06). These results suggest that TTR among individuals participating in PN programs is influenced by multiple socioeconomic (SES) patient-level factors rather than clinic type. Consequently, PN interventions should be tailored to address SES factors that influence TTR within patient populations.
Collagen Fiber Alignment in Relation to Prognostic Markers for Ductal Carcinoma In Situ of the Breast
Authors: Trentham-Dietz A , Sprague BL , Conklin MW , Hampton JM , Gangnon RE , Eliceiri KW , Newcomb PA , Friedl A , Kelly PJ
Published: March 2014

Almost 20% of new diagnoses of breast cancer are ductal carcinoma in situ (DCIS). DCIS increases risk for invasive breast cancer, and new prognostic markers of disease-free survival are needed to complement the few that are known. Limited studies have investigated the prognostic value of the tumor microenvironment, which is increasingly recognized as potentially playing a key role in tumor invasion and progression. Collagen is the most abundant component of the stroma surrounding the breast ducts, and laboratory studies suggest that collagen alignment facilitates cancer cell invasion and migration. Here we examined whether collagen alignment patterns in human DCIS specimens correlate with known prognostic markers. We evaluated collagen fiber alignment in 235 Wisconsin women diagnosed with DCIS in 1997–2000 who participated in a clinicopathologic cohort study. Fiber alignment was evaluated from routine H&E tissue slides prepared at the time of diagnosis using second harmonic generation (SHG) microscopy, a label-free multiphoton laser scanning technique that selectively images collagen. Images were evaluated for the presence of collagen fibers arranged in a radial pattern (approximately 75- to 90-degree angles) with respect to the DCIS lesion/stroma boundary, a phenotype termed TACS (Tumor Associated Collagen Signature). Chi-square tests were used to compare presence or absence of TACS with prognostic factors from a central review of pathology reports and slides, and analysis of tissue for ER, PR, Ki-67, and HER2. Overall, slides for about half (49.8%) of DCIS cases showed the TACS phenotype. TACS was not associated with age of the cases (P = 0.29), size of the lesion (P = 0.76), grade (P = 0.61), or margin size (P = 0.77). However, results suggested that TACS was more common (63.1%) among DCIS cases detected symptomatically than by mammography (47.3%, P = 0.09). TACS was more common among cases that were ER-negative (P = 0.002), PR-negative (P = 0.02), Ki-67 positive (P = 0.06), and HER2-positive (P = 0.002). This study underscores the relevance of the tumor microenvironment, in particular the arrangement of the collagen fiber matrix. On-going analysis will examine disease-free survival among DCIS cases according to patterns of collagen fiber alignment.
Contribution of MC1R Genotype and Novel Common Genomic Variants to Melanoma Risk Prediction
Authors: Cust AE , Bui M , Goumas C , Jenkins MA ,   Australian Melanoma Family Study Investigators
Published: March 2014

Genome-wide association studies have identified numerous common genomic variants associated with increased susceptibility to melanoma, but there is limited knowledge about the utility of adding them to risk prediction models for melanoma. Individuals diagnosed at a young age might have an underlying genetic susceptibility to melanoma, and young adulthood is a key age period for targeting primary prevention strategies for melanoma. Aim: To evaluate the contribution of melanocortin-1 receptor (MC1R) gene variants and novel common genomic variants to melanoma risk prediction, among young Australian adults. Methods: The sample included 552 cases with invasive cutaneous melanoma diagnosed between ages 18–39 years and 405 controls from an Australian population-based, case-control-family study. MC1R genotype was sequenced, and through a genome-wide association study we obtained genotype data for single nucleotide polymorphisms from 18 selected gene regions. Measures of discriminatory accuracy included the area under receiver operating characteristic curves (AUC) and net reclassification improvement (NRI), calculated based on predicted probabilities of melanoma from unconditional logistic regression models. We used 10-fold cross-validation and bootstrap methods to assess internal validation. Results: The AUC increased from 0.76 (95% CI 0.73–0.79) for the non-genetic multivariate model containing demographic and self-reported risk factors (UV exposure, phenotype, nevi, etc), to 0.81 (95% CI 0.78–0.84) for the genetic model that additionally included MC1R genotype and novel common genomic variants. The combined contribution to the AUC of the novel common genomic variants identified through genome-wide association studies was similar to that contributed from the known common variants in MC1R and CDKN2A. Inclusion of genomic variants in the multivariate model improved the quartile classification of predicted risk (NRI) by a net 17% (95% CI 9–24) compared to the non-genetic model. Conclusions: Our results suggest that MC1R and other common genomic variants could considerably improve risk prediction models for early-onset melanoma, and may have a role in primary prevention of melanoma.
Quality of Life and Comorbidities Impact Education and Employment for Survivors of Adolescent and Young Adult Cancers
Authors: Kirchhoff AC , McFadden M , Warner EL , Kinney AY
Published: March 2014

Survivors of adolescent and young adult (AYA) cancers have a high risk of chronic conditions such as cardiovascular disease and asthma. These conditions may affect their ability to attend school or to work. We examined the impact of quality of life (QOL) and comorbidities on educational attainment and employment status for survivors of AYA cancers relative to a non-cancer comparison group. Methods: Using data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS), we identified 7,471 individuals who were diagnosed with cancer between ages 15 and 39 and were ≥5 years from diagnosis and 326,821 controls without a history of cancer. Participants were ≥25 years of age. QOL was measured by a general health measure (excellent/very good/good/fair/poor). Comorbidities included self-reported cardiovascular disease, hypertension, asthma, and diabetes. Multivariable regressions using BRFSS survey weights were adjusted for sex, race/ethnicity and age, and compared the effects of QOL and comorbidities on educational attainment (college graduate or more vs. less education) and being employed or unable to work (compared to out of work or not in labor force) among the survivor and control groups. Results: Compared to controls, survivors in fair-poor health were less likely to be college graduates or more (survivors 18.5% vs. controls 37.9%, p < 0.01) and less likely to be employed (survivors 31.7% vs. controls 61.6%, p < 0.001), whereas survivors in good-excellent health did not differ from controls for either outcome. In addition, survivors in fair-poor health self-reported being unable to work more often than controls (31.4% vs. 5.4%, respectively; p < 0.001). For comorbidities, inability to work ranged from 14.9% of survivors with hypertension to 27.9% of survivors with cardiovascular conditions compared to 5.4% of controls (all p < 0.001), while survivors with no comorbidities did not differ from controls. Conclusions: AYA cancer survivors with ongoing health problems may face educational or work-related limitations. Early detection and management of health problems could help AYA cancer survivors control health problems before their ability to attend school or employment is disrupted.
Vaginal Lactoferrin Administration before Genetic Amniocentesis Decreases Amniotic Interleukin-6 Levels
Authors: Vesce Fortunato , Giugliano Emilio , Bignardi Stefania , Cagnazzo Elisa , Colamussi Cecilia , Marci Roberto , Valente Nicoletta , Seraceni Silvia , Maritati Martina , Contini Carlo
Published: March 2014

Aim: To verify the eventual efficacy of lactoferrin (LF), an iron-binding glycoprotein, to decrease the amniotic concentration of interleukin-6 (IL-6). Methods: We prospectively enrolled 60 Caucasian patients at the 16th week of their singleton physiological gestation. A vaginal compound containing 300 mg of LF was administered randomly 4 or 12 h prior to amniocentesis, as to obtain 3 groups: A, 20 untreated patients; B, 20 treated 4 h before amniocentesis; C, 20 treated 12 h before amniocentesis. Results: A normal karyotype was registered in all cases. The comparison of the distribution of IL-6 among the 3 groups showed a highly significant difference (p = 0.001). The difference between mean values of group B and both groups C and A was shown to be highly significant (p = 0.006 and p = 0.03, respectively). In contrast, there was no significant difference between mean values of groups A and C. Conclusion: Vaginal LF administration decreases amniotic IL-6 concentration. We therefore suggest that the glycoprotein may exert a protective role against ominous pregnancy complications linked to an increased level of the cytokine, such as abortion secondary to amniocentesis.
Increased Calcification in Osteoprotegerin-Deficient Smooth Muscle Cells: Dependence on Receptor Activator of NF-κB Ligand and Interleukin 6
Authors: Callegari Andrea , Coons Matthew L. , Ricks Jerry L. , Rosenfeld Michael E. , Scatena Marta
Published: March 2014

Objective: Vascular calcification is highly correlated with cardiovascular disease morbidity and mortality. Osteoprotegerin (OPG) is a secreted decoy receptor for receptor activator of NF-κB ligand (RANKL). Inactivation of OPG in apolipoprotein E-deficient (ApoE-/-) mice increases lesion size and calcification. The mechanism(s) by which OPG is atheroprotective and anticalcific have not been entirely determined. We investigated whether OPG-deficient vascular smooth muscle cells (VSMCs) are more susceptible to mineralization and whether RANKL mediates this process. Results: Lesion-free aortas from 12-week-old ApoE-/-OPG-/- mice had spotty calcification, an appearance of osteochondrogenic factors and a decrease of smooth muscle markers when compared to ApoE-/-OPG+/+ aortas. In osteogenic conditions, VSMCs isolated from ApoE-/-OPG-/- (KO-VSMC) mice deposited more calcium than VSMCs isolated from ApoE-/-OPG+/+ (WT-VSMC) mice. Gene expression and biochemical analysis indicated accelerated osteochondrogenic differentiation. Ablation of RANKL signaling in KO-VSMCs rescued the accelerated calcification. While WT-VSMCs did not respond to RANKL treatment, KO-VSMCs responded with enhanced calcification and the upregulation of osteochondrogenic genes. RANKL strongly induced interleukin 6 (IL-6), which partially mediated RANKL-dependent calcification and gene expression in KO-VSMCs. Conclusions: OPG inhibits vascular calcification by regulating the procalcific effects of RANKL on VSMCs and is thus a possible target for therapeutic intervention.
Predictors of Outcome following Stroke due to Isolated M2 Occlusions
Authors: Khan Muhib , Goddeau Jr. Richard P. , Zhang Jayne , Moonis Majaz , Henninger Nils
Published: March 2014

Background: Factors influencing outcome after cerebral artery occlusion are not completely understood. Although it is well accepted that the site of arterial occlusion critically influences outcome, the majority of studies investigating this issue has focused on proximal large artery occlusion. To gain a better understanding of factors influencing outcome after distal large artery occlusion, we sought to assess predictors of outcome following isolated M2 middle cerebral artery occlusion infarcts. Methods: We retrospectively analyzed patients with isolated acute M2 occlusion admitted to a single academic center from January 2010 to August 2012. Baseline clinical, laboratory imaging, and outcome data were assessed from a prospectively collected database. Factors associated with a modified Rankin Scale (mRS) score ≤2 in univariable analyses (p < 0.05) were entered into multivariable logistic regression analysis. The Admission National Institutes of Health Stroke Scale (aNIHSS) score, age, and infarct volume were also entered as dichotomized variables. Receiver operating characteristic curves were plotted to determine the optimal aNIHSS score, infarct volume, and age cut points predicting an mRS score ≤2. Optimal thresholds were determined by maximizing the Youden index. Respective multivariable logistic regression analyses were used to identify independent predictors of a good 90-day outcome (mRS score ≤2; primary analysis) as well as 90-day mortality (secondary outcome). Results: 90 patients with isolated M2 occlusion were included in the final analyses. Of these, 69% had a good 90-day outcome which was associated with age <80 years (p = 0.007), aNIHSS <10 (p = 0.002), and infarct volume ≤26 ml (p < 0.001). Notably, 20% of patients (64% of those with a poor outcome) had died by 90 days. Secondary analysis for 90-day mortality was performed. This analysis indicated that infarct volume >28 ml (OR 11.874, 95% CI 2.630-53.604, p = 0.001), age >80 years (OR 4.953, 95% CI 1.087-22.563, p = 0.039), need for intubation (OR 7.788, 95% CI 1.072-56.604), and history of congestive heart failure (OR 5.819, 95% CI 1.140-29.695) were independent predictors of 90-day mortality (20% of all included patients). Conclusion: While the majority of patients with isolated M2 occlusion stroke has a good 90-day outcome, a substantial proportion of subjects dies by 90 days, as identified by a unique subset of predictors. The knowledge gained from our study may lead to an improvement in the prognostic accuracy, clinical management, and resource utilization in this patient population.
Anatomic Pattern of Intracerebral Hemorrhage Expansion
Authors: Boulouis Grégoire , Dumas Andrew , Betensky Rebecca A. , Brouwers H. Bart , Fotiadis Panagiotis , Vashkevich Anastasia , Ayres Alison , Schwab Kristin , Romero Javier M. , Smith Eric E. , Viswanathan Anand , Goldstein Joshua N. , Rosand Jonathan , Gurol M. Edip , Greenberg Steven M.
Published: March 2014

Background and Purpose—

We sought to identify baseline determinants of the anatomic pattern of hematoma expansion in patients with intracerebral hemorrhage and spot sign.

Methods—

We coregistered baseline and follow-up CT scans from 15 intracerebral hemorrhage patients and measured growth at each surface node from baseline to follow-up hematoma. We analyzed the effects of proximity to the spot sign or hematoma center on distance of expansion, controlling for covariates.

Results—

There was substantial node-to-node variation in the extent of expansion around each hematoma surface (mean coefficient of variation for expansion distance, 0.43; 95% confidence interval, 0.39–0.48), indicating nonuniform expansion. Closer proximity to the hematoma center was independently associated with increased expansion (0.185 mm greater expansion for each 1 mm closer to the center;
P
<0.0001). Closer proximity to the spot sign was not independently associated with increased expansion in models including both terms.

Conclusions—

Hemorrhages expand nonuniformly around their surface with a tendency for greater expansion closer to their center. These findings provide a novel framework for analyzing mechanisms underlying hemorrhage growth and response to treatment.
Plato on Pure Pleasure and the Best Life
Authors: Fletcher Emily
Published: March 2014

Abstract

In thePhilebus, Socrates maintains two theses about the relationship between pleasure and the good life: (1) the mixed life of pleasure and intelligence is better than the unmixed life of intelligence, and: (2) the unmixed life of intelligence is the most divine. Taken together, these two claims lead to the paradoxical conclusion that the best human life is better than the life of a god. A popular strategy for avoiding this conclusion is to distinguish human from divine goods; on such a reading, pleasure has merely instrumental value, and it benefits human beings only as a result of their imperfect nature. I argue that certain ‘pure’ pleasures are full-fledged, intrinsic goods in thePhilebus, which are even worthy of the gods (thus Socrates ultimately rejects thesis 2). This positive evaluation of pure pleasure results from a detailed examination of pleasure, which reveals that different types of pleasures have fundamentally different natures.
Two new feather mite species of the family Pteronyssidae (Acarina: Analgoidea) from Meghalaya (Northeast India)
Authors: CONSTANTINESCU IOANA CRISTINA , CHIŞAMERA GABRIEL , MUKHIM KHLUR B. , ADAM COSTICĂ
Published: March 2014

Two new species of the feather mite family Pteronyssidae (Acariformes: Analgoidea) from passerines of the families Leiothrichidae and Pycnonotidae in India (Meghalaya, East Jaintia Hills District) are described: Timalinyssus actinodurae Constantinescu sp. nov. from Actinodura cyanouroptera (Hodgson) (Leiothrichidae) and Pteroherpus meghalayensis Constantinescu sp. nov. from Hemixos flavala Blyth (Pycnonotidae). Timalinyssus actinodurae differs from all of the other species of the genus due to a particular shape of the opisthosomal lobes in both sexes and having a strong sclerotised band in postero-median area of the hysteronotal shield in male. The male of Pteroherpus meghalayensis differs due to a very long genital apparatus and unusual length of the tips of epiandrum that extend the level of the genital apparatus.
Cyrts in the city: A new Bent-toed Gecko (Genus Cyrtodactylus) is the only endemic species of vertebrate from Batu Caves, Selangor, Peninsular Malaysia
Authors: GRISMER L. LEE , WOOD PERRY JR. L. , ONN CHAN KIN , ANUAR SHAHRUL , MUIN MOHD ABDUL
Published: March 2014

Cyrtodactylus metropolis sp. nov. from Batu Caves massif, Selangor, Peninsular Malaysia is differentiated from all congeners by having a unique suite of morphological and color pattern characteristics. Remarkably, this species has been overlooked despite a plethora of field studies at Batu Caves from 1898 to the present and no specimens had ever been examined until now. As with all other limestone forest-adapted Cyrtodactylus in Peninsular Malaysia, C. metropolis sp. nov. is not a cave-adapted species but is far more common on the exterior surfaces of the Batu Caves limestone massif and its surrounding limestone vegetation. We suggest that researchers devote time exploring the exterior surfaces of limestone massifs as well the interiors of their caves.
Metformin decreases glycated albumin to glycated haemoglobin ratio in patients with newly diagnosed type 2 diabetes
Authors: Sumitani Satoru , Morita Shinya , Deguchi Reiko , Hirai Koichi , Mukai Kosuke , Utsu Yoshihiko , Miki Shunji , Sato Bunzo , Nakamura Hideji , Kasayama Soji , Koga Masafumi
Published: March 2014

Background

To know whether metformin improves postprandial hyperglycaemia, we examined the effect of metformin on the glycated albumin (GA) to glycated haemoglobin (HbA1c) ratio (GA/HbA1c ratio) in patients with newly diagnosed type 2 diabetes.

Methods

Metformin and lifestyle interventions were initiated in 18 patients with newly diagnosed type 2 diabetes. Metformin was titrated to 1500 mg/day or maximum-tolerated dose. HbA1c and GA were measured every four weeks up to 24 weeks.

Results

HbA1c decreased significantly from 9.0 ± 2.1% at baseline to 6.5 ± 0.9% at week 24, and GA decreased significantly from 24.3 ± 8.2% to 16.2 ± 3.1%. The GA/HbA1c ratio decreased significantly from 2.66 ± 0.37 at baseline to 2.47 ± 0.29 at week 24 ( P < 0.01), despite that the GA/HbA1c ratio reached a plateau value at week 16. The change in the GA/HbA1c ratio during 24 weeks (ΔGA/HbA1c ratio) was significantly correlated with both baseline HbA1c and GA. Moreover, the ΔGA/HbA1c ratio was significantly correlated with the change in GA during 24 weeks but not with the change in HbA1c.

Conclusions

Metformin decreased the GA/HbA1c ratio in patients with newly diagnosed type 2 diabetes. This suggests that metformin improves postprandial hyperglycaemia in patients with newly diagnosed type 2 diabetes.
Morphology, mechanical properties, and shape memory effects of poly(lactic acid)/ thermoplastic polyurethane blend scaffolds prepared by thermally induced phase separation
Authors: Jing Xin , Mi Hao-Yang , Salick Max R , Cordie Travis , Crone Wendy C , Peng Xiang-Fang , Turng Lih-Sheng
Published: March 2014

Novel blended scaffolds combining biobased polylactic acid (PLA) and thermoplastic polyurethane (TPU) were fabricated by thermally induced phase separation (TIPS) using two different solvents. Pure PLA and TPU polymer scaffolds using 1,4-dioxane as the sole solvent exhibited typical ladder-like structures, while blended PLA/TPU scaffolds using the same solvent showed a more uniform microstructure. When de-ionized water was added to the solution as a non-solvent, scaffolds with the mixed solvent showed more open cells and greater interconnectivity. In compression tests, it was found that specimens, including pure PLA, TPU, and blended scaffolds with the mixed solvent, showed a higher compressive modulus than their counterparts that used dioxane as the single solvent. Dynamic mechanical analysis (DMA) was employed to characterize the shape memory properties of the scaffolds. DMA indicated that the shape fixing ratio was highest in the PLA scaffolds, while the shape recovery ratio of the TPU scaffolds was the greatest among the specimens. More interestingly, when the mixed solvent was used, the shape memory property of the blended scaffolds displayed a similar deformation curve to the TPU scaffold. This was due to the presence of the TPU phase and similarity in structure between PLA/TPU and TPU scaffolds when mixed solvent was used. In the degradation test, the blended scaffolds showed a balanced degradation behavior in-between the more easily degraded PLA and the more stable TPU in the phosphate-buffered saline (PBS), and the addition of water to the systems accelerated the degradation process of the specimens. Cell culture results showed that all of the scaffolds had good biocompatibility.
Peace research – Just the study of war?
Authors: Gleditsch Nils Petter , Nordkvelle Jonas , Strand Håvard
Published: March 2014

The concept of peace has been under discussion in peace research from its start over 50 years ago. This article reviews the debate on broader and narrower conceptions of peace and investigates empirical patterns in the first 49 volumes of Journal of Peace Research, with some comparisons with Journal of Conflict Resolution. Negative peace, in the sense of reducing war, was the main focus in peace research from the inception. But positive peace, in the sense of cooperation or integration, has also always been on the peace research agenda, as reflected in the contents of both journals. Over time, a larger share of the articles in JPR has ‘violence’ or related terms in the title, while the incidence of the word ‘peace’ is fairly stable. Furthermore, articles on peace generally have fewer citations than those with violence-related terms. A broad concept of peace, as encouraged by the definition of positive peace as the reversal of structural violence, was popular in peace research for a decade or so, but has largely evaporated. To some extent, peace research has returned to its original agenda, although the main attention has shifted from interstate war to civil war and to some extent to one-sided and non-state violence. Articles dealing with patterns of cooperation, the traditional meaning of positive peace, now tend to address the liberal agenda and ask how they can foster a reduced probability of violence. Despite the ‘gender gap’, the increasing share of female authors in the journal appears to have had little influence on these developments although it may well have had other effects.
Compensatory Advantage as a Mechanism of Educational Inequality
Authors: Bernardi Fabrizio
Published: March 2014

Compensatory advantage is a mechanism of social stratification that complements cumulative advantage and path dependence. In this article, I first discuss the theoretical foundations of the compensatory advantage and path dependence mechanisms and the methodological challenges that complicate identification of their effects. Next, I present a practical demonstration of the use of the compensatory advantage theoretical framework, with a regression discontinuity design estimating the probability of being continuously promoted throughout primary education in France. Results indicate that students born just before the cutoff date for primary school entry, who are consequently the youngest in the class when starting school, face a larger risk of grade repetition. In line with theoretical predictions of the compensatory advantage model, the risk is much smaller for students born to highly educated parents compared to students whose parents have lower educational attainment.
Alternative medicine use at Vila Central Hospital: a survey of ‘custom medicine’ use in patients and staff a decade later
Authors: Lai Yan , Grace Robert
Published: March 2014

A structured questionnaire was administered to 50 medical patients, 50 surgical patients and 50 staff members at Vila Central Hospital, Vanuatu. A similar study was conducted 10 years earlier. In the intervening decade, Vanuatu has seen unprecedented population growth, increasing expatriate numbers, and the introduction of mobile phone and Internet networks. Given these social transformations, this study aimed to identify changes in custom medicine use over this period. Fifty-nine percent of interviewees had used custom medicine at least once, compared to 86% reported in the 2003 study. Thirty-two percent had used custom medicine in the last 12 months, a significant decline from 60% in the previous study. Collectively, rates of custom medicine use have declined but especially in the physical therapies such as bone setting. We believe this declining custom medicine use reflects an overall weakening traditional culture within Vanuatu and believe that within a generation, custom medicine knowledge will likely be lost.
Taurolidine Lock in Home Parenteral Nutrition in Adults
Authors: Klek Stanislaw , Szczepanek Kinga , Hermanowicz Adam , Galas Aleksander
Published: March 2014

Background and Aim: Many techniques have been tested to reduce the incidence of catheter‐relater bloodstream infections (CRBSIs) during home parenteral nutrition (HPN). One of these methods, taurolidine lock, has shown some potential in several studies, but it has been studied primarily in patients with a relatively high CRBSI rate. Therefore, the aim of this study was to analyze the clinical value of taurolidine in patients receiving HPN who have a low infection rate. Methods: The CRBSI ratio at the Skawina HPN center has remained at 0.3–0.4 episodes/patient/y for the past 7 years. In November 2012, 30 patients (17 men, 13 women, mean age 52.3 years) were randomized to 1 of 3 groups: 2% taurolidine lock (group A), 1.35% taurolidine + citrate lock (B), and control—saline flush (C). Patients were observed for 12 consecutive months for catheter‐related complications. Blood cultures were collected in each case in which an infection was suspected. Results: The total number of catheter days reached 10,968, with the following number of days per group: group A, 3658; group B, 3650; and group C, 3660. No complications were observed in the control group, while patients in the study groups had 1 catheter infection (group A) and 1 occlusion (group B). The CRBSIs were treated successfully with antibiotics. The cost of treatment in groups A and B was significantly higher than that in group C (P < .05). Conclusion: The study did not observe any additional clinical value of taurolidine in patients receiving HPN who have a low infection rate and found low cost‐effectiveness. Taurolidine should most likely be used only in patients with a high CRBSI rate.