bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the quality of colonoscopy bowel preparation using a smart phone application: A randomized trial
Authors: Lorenzo‐Zúñiga Vicente , Moreno de Vega Vicente , Marín Ingrid , Barberá Marta , Boix Jaume
Published: February 2015

Background and Aim

Getting ready for a colonoscopy is difficult and involves many steps. Information given to patients is very important for adherence to treatment. We created a novel smart phone application (SPA) aimed to increase bowel preparation quality and patient satisfaction.

Methods

We carried out a prospective, endoscopist‐blinded, randomized, controlled trial. We enrolled 260 outpatient (58% female, age range 21–75 years) owners of a smartphone. Patients were allocated to two different protocols: instructions provided by SPA (SPA group; n = 108) or written instructions with visual aids (control group; n = 152). All procedures were carried out in the afternoon and patients received the same purgative regimen (2 L polyethylene glycol (PEG) solution plus ascorbic acid), in a full‐dose same‐day regimen. The study was designed to detect an improvement in quality of bowel preparation using the Harefield Cleansing Scale (HCS) scale. Effect of protocol on patient satisfaction was assessed with a specific questionnaire at the time of colonoscopy.

Results

Proportion of patients who obtained successful bowel preparation for colonoscopy (HCS A or B) was significantly higher in the SPA group than in the control group (100% vs 96.1%, respectively; P = 0.037). Mean global HCS scores were similar in both groups. Patient‐reported tolerability and overall experience with the prescribed bowel preparation were significantly higher for the SPA group than for the control group.

Conclusion

Successful cleansing and patient acceptability with the use of SPA were superior to written instructions in outpatients submitted for colonoscopy using 2 L PEG solution plus ascorbic acid.
Phylogenies support out‐of‐equilibrium models of biodiversity
Authors: Manceau Marc , Lambert Amaury , Morlon Hélène
Published: February 2015

There is a long tradition in ecology of studying models of biodiversity at equilibrium. These models, including the influential Neutral Theory of Biodiversity, have been successful at predicting major macroecological patterns, such as species abundance distributions. But they have failed to predict macroevolutionary patterns, such as those captured in phylogenetic trees. Here, we develop a model of biodiversity in which all individuals have identical demographic rates, metacommunity size is allowed to vary stochastically according to population dynamics, and speciation arises naturally from the accumulation of point mutations. We show that this model generates phylogenies matching those observed in nature if the metacommunity is out of equilibrium. We develop a likelihood inference framework that allows fitting our model to empirical phylogenies, and apply this framework to various mammalian families. Our results corroborate the hypothesis that biodiversity dynamics are out of equilibrium.
Can repetitive transcranial magnetic stimulation increase muscle strength in functional neurological paresis? A proof‐of‐principle study
Authors: Broersma M. , Koops E. A. , Vroomen P. C. , Van der Hoeven J. H. , Aleman A. , Leenders K. L. , Maurits N. M. , van Beilen M.
Published: February 2015

Background and purpose

Therapeutic options are limited in functional neurological paresis disorder. Earlier intervention studies did not control for a placebo effect, hampering assessment of effectivity. A proof‐of‐principle investigation was conducted into the therapeutic potential of repetitive transcranial magnetic stimulation (rTMS), using a single‐blind two‐period placebo‐controlled cross‐over design.

Methods

Eleven patients received active 15 Hz rTMS over the contralateral motor cortex (hand area), in two periods of 5 days, for 30 min once a day at 80% of resting motor threshold, with a train length of 2 s and an intertrain interval of 4 s. Eight of these eleven patients were also included in the placebo treatment condition. Primary outcome measure was change in muscle strength as measured by dynamometry after treatment. Secondary outcome measure was the subjective change in muscle strength after treatment.

Results

In patients who received both treatments, active rTMS induced a significantly larger median increase in objectively measured muscle strength (24%) compared to placebo rTMS (6%; P < 0.04). Subjective ratings showed no difference due to treatment, i.e. patients did not perceive these objectively measured motor improvements (P = 0.40).

Conclusions

Our findings suggest that rTMS by itself can potentially improve muscle weakness in functional neurological paresis disorder. Whereas patients' muscle strength increased as measured with dynamometry, patients did not report increased functioning of the affected hand, subjectively. The results may indicate that decreased muscle strength is not the core symptom and that rTMS should be added to behavioral approaches in functional neurological paresis.
Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage
Authors: Jabbarli R. , Reinhard M. , Niesen W.‐D. , Roelz R. , Shah M. , Kaier K. , Hippchen B. , Taschner C. , Van Velthoven V.
Published: February 2015

Background and purpose

Cerebral infarction is a frequent and serious complication of aneurysmal subarachnoid hemorrhage (SAH). This study aimed to identify independent predictors of the timing of cerebral infarction and clarify its impact on disease course and patients’ outcome.

Methods

All consecutive patients with SAH admitted to our institution from January 2005 to December 2012 were analyzed. Serial computed tomography (CT) scans were evaluated for cerebral infarctions. Demographic, clinical, laboratory and radiological data of patients during hospitalization as well as clinical follow‐ups 6 months after SAH were recorded.

Results

Of the 632 analyzed patients, 320 (51%) developed cerebral infarction on CT scans. 136 patients (21.5%) with early cerebral infarction (occurring within 3 days after SAH) had a significantly higher risk of unfavorable outcome than patients with late infarction [odds ratio (OR) 2.94; P = 0.008], a higher in‐hospital mortality (OR 3.14; P = 0.0002) and poorer clinical outcome after 6 months (OR 0.54; P < 0.0001). The rates of decompressive craniectomy (OR 1.96, P = 0.0265), tracheostomy (OR 1.87, P = 0.0446), the duration of intensive care unit stay and mechanical ventilation were significantly higher in patients with early infarction. In multivariate analysis, Hunt and Hess grades 4 and 5 (OR 2.06, P = 0.008), Fisher grades 3 and 4 (OR 3.99, P = 0.014), sustained elevations of intracranial pressure >20 mmHg (OR 5.95, P < 0.0001) and early vasospasm on diagnostic angiograms (OR 3.01, P = 0.008) were predictors of early cerebral infarction.

Conclusion

Early cerebral infarction after SAH is associated with severe clinical course and unfavorable outcome and can be reliably predicted by poor initial clinical condition, thick subarachnoid clot, early angiographic vasospasm and sustained elevations of intracranial pressure.
Anemia in young patients with ischaemic stroke
Authors: Kellert L. , Kloss M. , Pezzini A. , Metso T. M. , Metso A. J. , Debette S. , Leys D. , Caso V. , Thijs V. , Bersano A. , Touzé E. , Tatlisumak T. , Gensicke H. , Lyrer P. A. , Bösel J. , Engelter S. T. , Grond‐Ginsbach C. ,   the Cervical Artery Dissection Ischaemic Stroke Patients (CADISP) study group
Published: February 2015

Background and purpose

To investigate the association of anemia on admission with ischaemic stroke (IS), stroke severity and early functional outcome in patients with cervical artery dissection (CeAD) or with IS of other causes (non‐CeAD‐IS patients).

Methods

The study sample comprised all patients from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) study without pre‐existing disability and with documentation of stroke severity and hemoglobin (Hb) concentration on admission. Anemia was classified as mild (Hb < 12 g/dl in women and Hb < 13 g/dl in men) or moderate to severe (Hb < 10 g/dl in women and Hb < 11 g/dl in men). Stroke severity on admission was assessed with the National Institutes of Health Stroke Scale (NIHSS). Outcome after 3 months was assessed with the modified Rankin Scale (mRS‐3mo). Unfavorable outcome was defined as mRS‐3mo ≥ 3.

Results

Amongst 1206 study patients (691 CeAD and 515 non‐CeAD), 87 (7.2%) had anemia, which was moderate to severe in 18 (1.5%) patients. Anemia was associated with female sex in both study samples, but no further associations with risk factors or comorbidities were observed. In CeAD patients, anemia was associated with occurrence of stroke (P = 0.042). In both study samples, anemic patients had more severe strokes (CeAD, P = 0.023; non‐CeAD, P = 0.005). Functional outcome was not associated with anemia in general, but moderate to severe anemia was significantly associated with unfavorable outcome (P = 0.004).

Conclusion

Anemia on admission was associated with stroke in CeAD patients and with more severe strokes in both study samples. Moderate to severe anemia may predict unfavorable outcome.
Staphylococcal α‐toxin induces a functional upregulation of TLR‐2 on human peripheral blood monocytes
Authors: Niebuhr Margarete , Schorling Kartinka , Heratizadeh Annice , Werfel Thomas
Published: February 2015

Resistance to bacterial skin infections, for example with Staphylococcus aureus (S. aureus), is based on the function of intact innate immune mechanisms. Toll‐like receptor (TLR)‐2 recognizes components of S. aureus and is known to be expressed on monocytes. Staphylococcal exotoxins such as staphylococcal enterotoxin B (SEB) or α‐toxin are produced by many S. aureus strains. To investigate TLR‐2 regulation and function on human monocytes upon stimulation with staphylococcal exotoxins to elucidate a putative feedback loop between different staphylococcal components. Monocytes were stimulated with α‐toxin or SEB, respectively. TLR‐2 expression and regulation as well as functional effects of TLR‐2 stimulation with Pam3Cys (TLR‐2/TLR‐1), lipoteichoic acid (LTA) (TLR‐2/TLR‐6) and peptidoglycan (PGN) (TLR‐2 and Nod) were then investigated both at the mRNA and protein level and compared to monocytes from patients with psoriasis. α‐toxin significantly upregulated TLR‐2 expression. TLR‐2 mediated IL‐1β, IL‐6 and IL‐8 secretion was significantly augmented after upregulation with staphylococcal exotoxins. CD36 expression was significantly more downregulated after TLR‐2 upregulation with SEB and consecutive LTA stimulation and TLR‐2 upregulation with α‐toxin following LTA and PGN stimulation, respectively. PGN enhanced CD54 expression after upregulation of the receptor with α‐toxin. Expression of HLA‐DR was unaffected. However, no differences were observed in monocytes from psoriasis patients compared to healthy controls. Together, our findings provide a new link between staphylococcal α‐toxin and TLR‐2 signalling in monocytes which may have implications for skin diseases where skin colonization with S. aureus and dysregulation of TLR‐2 have been described.
The topical corticosteroid classification called into question: towards a new approach
Authors: Humbert Philippe , Guichard Alexandre
Published: February 2015

Vasoconstrictor assay described in 1962 was an interesting assessment of potency of topical corticosteroids at the beginning of these new therapies, however knowledge and technology have evolved and the classification should follow. A topical corticosteroids with a strong vasoconstrictor effect, as determined by vasoconstrictor assay, has not necessary a strong anti‐inflammatory effect. Therefore a specific classification adapted to the therapeutic target is needed to be more efficient and thus reduce side effects and corticophobia.
The yeast ζ‐crystallin/NADPH:quinone oxidoreductase (Zta1p) is under nutritional control by the target of rapamycin pathway and is involved in the regulation of argininosuccinate lyase mRNA half‐life
Authors: Crosas Eva , Sumoy Lauro , González Eva , Díaz Maykelis , Bartolomé Salvador , Farrés Jaume , Parés Xavier , Biosca Josep Antoni , Fernández María Rosario
Published: February 2015

The yeast ζ‐crystallin (Zta1p) is a quinone oxidoreductase belonging to the ζ‐crystallin family, with activity in the reduction of alkenal/alkenone compounds. Various biological functions have been ascribed to the members of this protein family, such as their ability to interact specifically with AU‐rich sequences in mRNA, and thus they have been proposed to act as AU‐rich element‐binding proteins (AREBPs). In this study, we evaluated the specificity of Zta1p for RNA versus DNA by means of a novel nonisotopic method for the in vitro quantitative detection of protein·RNA complexes. Through comparative transcriptomic analysis, we found that the lack of Zta1p negatively affects the expression of a group of genes involved in amino acid biosynthesis, the argininosuccinate lyase (ARG4) gene being one of them. Here, we propose that Zta1p participates in the post‐transcriptional regulation of ARG4 expression by increasing the ARG4 mRNA half‐life. In addition, expression of the ζ‐crystallin gene (ZTA1) is itself regulated by nutrient availability through the general amino acid control and target of rapamycin pathways. Our results shed new light on the ζ‐crystallin family members from yeast to humans as stress response proteins with a bifunctional role in the detoxification of alkenal and alkenone compounds, and the regulation of gene expression.
Anthropogenic nitrogen deposition enhances carbon sequestration in boreal soils
Authors: Maaroufi Nadia I. , Nordin Annika , Hasselquist Niles J. , Bach Lisbet H. , Palmqvist Kristin , Gundale Michael J.
Published: February 2015

It is proposed that carbon (C) sequestration in response to reactive nitrogen (Nr) deposition in boreal forests accounts for a large portion of the terrestrial sink for anthropogenic CO2 emissions. While studies have helped clarify the magnitude by which Nr deposition enhances C sequestration by forest vegetation, there remains a paucity of long‐term experimental studies evaluating how soil C pools respond. We conducted a long‐term experiment, maintained since 1996, consisting of three N addition levels (0, 12.5, and 50 kg N ha−1 yr−1) in the boreal zone of northern Sweden to understand how atmospheric Nr deposition affects soil C accumulation, soil microbial communities, and soil respiration. We hypothesized that soil C sequestration will increase, and soil microbial biomass and soil respiration will decrease, with disproportionately large changes expected compared to low levels of N addition. Our data showed that the low N addition treatment caused a non‐significant increase in the organic horizon C pool of ~15% and a significant increase of ~30% in response to the high N treatment relative to the control. The relationship between C sequestration and N addition in the organic horizon was linear, with a slope of 10 kg C kg−1 N. We also found a concomitant decrease in total microbial and fungal biomasses and a ~11% reduction in soil respiration in response to the high N treatment. Our data complement previous data from the same study system describing aboveground C sequestration, indicating a total ecosystem sequestration rate of 26 kg C kg−1 N. These estimates are far lower than suggested by some previous modeling studies, and thus will help improve and validate current modeling efforts aimed at separating the effect of multiple global change factors on the C balance of the boreal region.
Application of a process‐based model for predicting the productivity of Eucalyptus nitens bioenergy plantations in Spain
Authors: González‐García Marta , Almeida Auro C. , Hevia Andrea , Majada Juan , Beadle Chris
Published: February 2015

The feasibility of using plantation‐grown biomass to fuel bioenergy plants is in part dependent on the ability to predict the capacity of surrounding forests to maintain a sustainable supply. In this study, the potential productivity of Eucalyptus nitens (Deane and Maiden) Maiden plantations grown for bioenergy in a region of north‐west Spain was quantified using the 3‐PG process‐based model. The model was calibrated using detailed measurements from five permanent sample plots and validated using data from thirty‐five additional permanent sample plots; both sets represented the variability of climate and soils of the region. Plot scale analysis showed that the model was able to reasonably estimate above‐ground biomass and water use when compared with the observed data. Using a representative loam soil characteristic, a spatial analysis was then carried out to predict the potential productivity of E. nitens for bioenergy across a potential area for plantation establishment of 2550 km2 and to evaluate different management scenarios related to rotation length and stocking. An increase of only 1.9% in mean annual increment (MAI) of above‐ground biomass (WAGB) was found between stockings of 3000 and 5000 trees ha−1; for the lower stocking, MAI of WAGB increased 4% for rotation lengths between 6 and 8 years. Production was reduced by low summer rainfall and to a lesser extent by high summer and low winter temperatures, and vapour pressure deficit. Above‐ground biomass production was higher by around 12% when average rather than actual climate data were applied. The information from this study can be used to optimize forest management, determine regional relative potential productivity and contribute to decision‐making for bioenergy production from E. nitens plantations in north‐west Spain.
Can argillaceous formations isolate nuclear waste? Insights from isotopic, noble gas, and geochemical profiles
Authors: Hendry M. J. , Solomon D. K. , Person M. , Wassenaar L. I. , Gardner W. P. , Clark I. D. , Mayer K. U. , Kunimaru T. , Nakata K. , Hasegawa T.
Published: February 2015

There is considerable interest in the use of thick argillaceous geologic formations to contain nuclear waste. Here, we show that diffusion can be the controlling transport process in these formations and diffusional time scales for δ18O and δ2H in water, dissolved He, and Cl transport in shale‐dominated aquitards are typically over 106 years, well exceeding the regulatory requirements for isolation in most countries. Our scientific understanding of diffusive solute transport processes through argillaceous formations would benefit from the application of additional isotopic tracers (e.g., using new 4He sampling technology), multidimensional diffusive‐dispersive modeling of groundwater flow and diffusive‐dispersive solute transport over long geologic time scales, and an improved understanding of spatial heterogeneity as well as time‐dependent changes in the subsurface conditions and properties of argillaceous formations in response to events such as glaciation. Based on our current isotopic and geochemical understanding of transport, we argue that argillaceous formations can provide favorable long‐term conditions for isolating nuclear wastes.
Deep venous thrombosis was not detected after total knee arthroplasty in Japanese patients with haemophilia
Authors: Takedani H. , Ohnuma K. , Hirose J.
Published: February 2015

Combined thrombo‐prophylaxis with mechanical and pharmacological methods is recommended in patients undergoing total knee or hip arthroplasty. As patients with ‘untreated inherited bleeding disorders such as haemophilia’ are at risk of bleeding, no prophylaxis has been prescribed for these patients. However, a retrospective study reported subclinical deep venous thrombosis (DVT) in 10% of patients with haemophilia undergoing major orthopaedic surgery. In this study, we aimed to evaluate the risk of DVT after total knee arthroplasty (TKA). We examined 38 TKA in 33 Japanese patients with haemophilia using ultrasonography. We did not detect DVT. The risk of DVT in patients with haemophilia after TKA may be lower than that in the general population. However, as patients with haemophilia progress in age, venous thromboembolism should be considered as a potential problem.
High incidence of Epstein–Barr virus (EBV)‐positive Hodgkin lymphoma and Hodgkin lymphoma‐like B‐cell lymphoproliferations with EBV latency profile 2 in children with interleukin‐2‐inducible T‐cell kinase deficiency
Authors: Bienemann Kirsten , Borkhardt Arndt , Klapper Wolfram , Oschlies Ilske
Published: February 2015

Aims

Interleukin‐2‐inducible T‐cell kinase (ITK) deficiency is an inherited T‐cell deficiency characterized by the development of Epstein–Barr virus (EBV)‐associated lymphoproliferations. We aimed to describe the histopathological features of lymphoproliferative processes arising in ITK deficiency, and to compare them with lymphoproliferations in otherwise immunocompromised patients.

Methods and results

We revised the histopathological diagnoses of 12 biopsies of lymphoproliferations from seven ITK‐deficient children according to the World Health Organization criteria, and determined the EBV latency types and lytic activity by staining for EBV‐encoded small RNA, latent membrane protein 1, EBV nuclear antigen 2, and ZEBRA. We found polymorphic and borderline polymorphic to monomorphic B‐cell lymphoproliferations with variable contents in large cells (five cases), a Hodgkin‐like B‐cell proliferation (one case), and classic mixed‐cellularity Hodgkin lymphoma (six cases). All cases (12/12) were EBV‐positive. The Hodgkin lymphoma‐like and Hodgkin lymphoma, and all but one polymorphic B‐cell lymphoproliferation, showed EBV latency type 2, as observed in classic EBV‐positive Hodgkin lymphoma.

Conclusions

The 100% EBV association, the high percentage of EBV‐positive classic Hodgkin lymphoma and Hodgkin‐like B‐cell proliferations and the predominance of EBV latency type 2 even in polymorphic lesions are the main features of lymphoproliferations in patients with ITK deficiency, and suggest a unique pathomechanism of lymphomagenesis in this T‐cell immunodeficiency.
Phosphohistone H3 outperforms Ki67 as a marker of outcome for breast cancer patients
Authors: Gerring Zac , Pearson John F , Morrin Helen R , Robinson Bridget A , Harris Gavin C , Walker Logan C
Published: February 2015

Aims

The proliferation marker Ki67 has been extensively investigated as a prognostic factor in breast cancer, but has not gained widespread clinical acceptance. Phosphohistone H3 is a new immunohistochemical marker for quantifying mitoses; however, there is limited information on its prognostic value in breast cancer. In this study, we performed a head‐to‐head comparison of Ki67 and phosphohistone H3 to establish the marker with the greatest prognostic value.

Methods and results

Tissue microarrays from 108 breast cancer patients were immunohistochemically stained for Ki67 and phosphohistone H3. Our results showed that phosphohistone H3 had a greater prognostic value than Ki67 in a multivariable model that adjusted for traditional prognostic variables in breast cancer. Phosphohistone H3 staining was a stronger predictor of survival at 5 years after diagnosis [hazard ratio (HR) 4.35, P < 10−5] than Ki67 (HR 2.44, P = 0.004), and better separated the risk of death in patients aged >45 years. Importantly, phosphohistone H3 consistently showed strong unequivocal staining, in contrast to the variable staining intensities associated with Ki67.

Conclusions

Our study suggests that phosphohistone H3 staining is a stronger and more robust prognostic indicator than Ki67 staining in breast cancer patients, and has the potential for use in routine diagnostic laboratories.
Oral Direct Thrombin Inhibitor as an Alternative in the Management of Cerebral Venous Thrombosis: A Series of 15 Patients
Authors: Mendonça Marcelo D. , Barbosa Raquel , Cruz-e-Silva Vera , Calado Sofia , Viana-Baptista Miguel
Published: February 2015

Background

Cerebral vein thrombosis is a rare cause of stroke with significant risk of death and long-term dependency. Anticoagulation has been associated with better long-term prognosis, and vitamin K antagonists are usually prescribed in this setting.

Aim

The aim of this study was to present a series of 15 cerebral vein thrombosis patients treated with dabigatran.

Methods

Retrospective study of clinical, imaging, and follow-up characterization of all patients admitted with cerebral vein thrombosis and treated with dabigatran in a tertiary neurology department between June 2011 and December 2013 was conducted. Complications and adverse effects were recorded. Modified Rankin Scale was used to assess clinical severity; excellent outcome was defined as modified Rankin Scale at six-months of 0 to 1. Recanalization was assessed with an angiographic method (computer tomography, magnetic resonance imaging, or digital subtraction angiography).

Results

Eighteen patients were admitted for cerebral vein thrombosis. Dabigatran was started in 11 patients, and warfarin was started in 7. Four patients on warfarin were switched to dabigatran because of adverse effects at 0·5, 1, 3·5, and 4 months. A total of 15 patients were treated with dabigatran with median follow-up time of 19 months. Excellent outcome was observed in 87% of patients and recanalization in 80%.

Conclusions

We report the largest series of cerebral vein thrombosis patients treated with dabigatran. Clinical outcome was excellent in most patients and not different from other studies. Dabigatran could possibly be considered an alternative to warfarin; nevertheless, further prospective assessment with randomized controlled studies is warranted.
Gut immune deficits in LEW.1AR1‐iddm rats partially overcome by feeding a diabetes‐protective diet
Authors: Crookshank Jennifer A. , Patrick Christopher , Wang Gen‐Sheng , Ariana Noel J. , Scott Fraser W.
Published: February 2015

The gut immune system and its modification by diet have been implicated in the pathogenesis of type 1 diabetes (T1D). Therefore, we investigated gut immune status in non‐diabetes‐prone LEW.1AR1 and diabetes‐prone LEW.1AR1‐iddm rats and evaluated the effect of a low antigen, hydrolysed casein (HC)‐based diet on gut immunity and T1D. Rats were weaned onto a cereal‐based or HC‐based diet and monitored for T1D. Strain and dietary effects on immune homeostasis were assessed in non‐diabetic rats (50–60 days old) and rats with recent‐onset diabetes using flow cytometry and immunohistochemistry. Immune gene expression was analysed in mesenteric lymph nodes (MLN) and jejunum using quantitative RT‐PCR and PCR arrays. T1D was prevented in LEW.1AR1‐iddm rats by feeding an HC diet. Diabetic LEW.1AR1‐iddm rats had fewer lymphoid tissue T cells compared with LEW.1AR1 rats. The percentage of CD4+ Foxp3+ regulatory T (Treg) cells was decreased in pancreatic lymph nodes (PLN) of diabetic rats. The jejunum of 50‐day LEW.1AR1‐iddm rats contained fewer CD3+ T cells, CD163+ M2 macrophages and Foxp3+ Treg cells. Ifng expression was increased in MLN and Foxp3 expression was decreased in the jejunum of LEW.1AR1‐iddm rats; Ifng/Il4 was decreased in jejunum of LEW.1AR1‐iddm rats fed HC. PCR arrays revealed decreased expression of M2‐associated macrophage factors in 50‐day LEW.1AR1‐iddm rats. Wheat peptides stimulated T‐cell proliferation and activation in MLN and PLN cells from diabetic LEW.1AR1‐iddm rats. LEW.1AR1‐iddm rats displayed gut immune cell deficits and decreased immunoregulatory capacity, which were partially corrected in animals fed a low antigen, protective HC diet consistent with other models of T1D.
Impact sourcing ventures and local communities: a frame alignment perspective
Authors: Sandeep M. S. , Ravishankar M. N.
Published: February 2015

Using qualitative methods, this paper explores how impact sourcing (ImS) ventures frame their activities to marginalized communities. In doing so, the paper attempts to unearth the social–psychological processes undergirding ImS strategies. The findings highlight the difficulties faced by ImS ventures in operationalizing their strategic intent. More specifically, the paper provides insights into how different and diverse framings are used by ImS ventures to influence the local community. From a strategic perspective, the paper suggests that framings related to progress, family, material benefit and egalitarianism can help overcome the inevitable tensions and misunderstandings with the community. Drawing on the findings, we develop a process model that describes how competing framings of an ImS venture and the community could eventually align. Theoretically, the paper illuminates the day to day micro‐processes of reality negotiation between socially driven information technology – business process outsourcing businesses and the local communities they seek to impact.
Good habits gone bad: Explaining negative consequences associated with the use of mobile phones from a dual‐systems perspective
Authors: Soror Amr A. , Hammer Bryan I. , Steelman Zachary R. , Davis Fred D. , Limayem Moez M.
Published: February 2015

Information technology use is typically assumed to have positive effects for users, yet information technology use may also lead to negative consequences with various degrees of gravity. In the current work, we build on dual‐systems theories to investigate negative consequences associated with mobile phones use (MPU), defined as the extent to which the use of mobile phones is perceived to create problems in managing one's personal and social life. According to dual‐system theories, human behaviour is guided by two systems: reflexive (automatic) and reflective (control), which most of the time work in harmony. But when the two systems come into conflict, they will both complete to exert their influences over behaviour. Thus, we view the negative consequences associated with MPU as an outcome of the tug‐of‐war between the two systems influencing our day‐to‐day behaviours, where reflexive system is represented in our study by MPU habits and reflective system is represented by self‐regulation. We hypothesise that the influence of habit and self‐regulation on these negative consequences will be mediated through MPU. A partial least square analysis of 266 responses was used to validate and test our model. The study results generally support our model. The theoretical and practical implications of our study are discussed.
The sustainability of healthcare innovations: a concept analysis
Authors: Fleiszer Andrea R. , Semenic Sonia E. , Ritchie Judith A. , Richer Marie‐Claire , Denis Jean‐Louis
Published: February 2015

Aim

To report on an analysis of the concept of the sustainability of healthcare innovations.

Background

While there have been significant empirical, theoretical and practical contributions made towards the development and implementation of healthcare innovations, there has been less attention paid to their sustainability. Yet many desired healthcare innovations are not sustained over the long term. There is a need to increase clarity around the concept of innovation sustainability to guide the advancement of knowledge on this topic.

Design

Concept analysis.

Data sources

We included literature reviews, theoretical and empirical articles, books and grey literature obtained through database searching (ABI/INFORM, Academic Search Complete, Business Source Complete, CINAHL, Embase, MEDLINE and Web of Science) from 1996–May 2014, reference harvesting and citation searching.

Methods

We examined sources according to terms and definitions, characteristics, preconditions, outcomes and boundaries to evaluate the maturity of the concept.

Results

This concept is partially mature. Healthcare innovation sustainability remains a multi‐dimensional, multi‐factorial notion that is used inconsistently or ambiguously and takes on different meanings at different times in different contexts. We propose a broad conceptualization that consists of three characteristics: benefits, routinization or institutionalization, and development. We also suggest that sustained innovations are influenced by a variety of preconditions or factors, which are innovation‐, context‐, leadership‐ and process‐related.

Conclusion

Further conceptual development is essential to continue advancing our understanding of the sustainability of healthcare innovations, especially in nursing where this topic remains largely unexplored.
The interplay of spatial and climatic landscapes in the genetic distribution of a South American parrot
Authors: Masello Juan F. , Montano Valeria , Quillfeldt Petra , Nuhlíčková Soňa , Wikelski Martin , Moodley Yoshan
Published: February 2015

Aim

Our aim was to understand the interplay of heterogeneous climatic and spatial landscapes in shaping the distribution of nuclear microsatellite variation in burrowing parrots, Cyanoliseus patagonus. Given the marked phenotypic differences between populations of burrowing parrots we hypothesized an important role of geographical as well climatic heterogeneity in the population structure of this species.

Location

Southern South America.

Methods

We applied a landscape genetics approach to investigate the explicit patterns of genetic spatial autocorrelation based on both geography and climate using spatial principal component analysis (sPCA). This necessitated a novel statistical estimation of the species climatic landscape, considering temperature‐ and precipitation‐based variables separately to evaluate their weight in shaping the distribution of genetic variation in our model system.

Results

Geographical and climatic heterogeneity successfully explained molecular variance in burrowing parrots. sPCA divided the species distribution into two main areas, Patagonia and the pre‐Andes, which were connected by an area of geographical and climatic transition. Moreover, sPCA revealed cryptic and conservation‐relevant genetic structure: the pre‐Andean populations and the transition localities were each divided into two groups, each management units for conservation.

Main conclusions

sPCA, a method originally developed for spatial genetics, allowed us to unravel the genetic structure related to spatial and climatic landscapes and to visualize these patterns in landscape space. These novel climatic inferences underscore the importance of our modified sPCA approach in revealing how climatic variables can drive cryptic patterns of genetic structure, making the approach potentially useful in the study of any species distributed over a climatically heterogeneous landscape.
Surface ECG f Wave Analysis of Dofetilide Drug Effect in the Atrium
Authors: RAYGOR VIRAJ P. , NG JASON , GOLDBERGER JEFFREY J.
Published: February 2015

Dofetilide Effect on f Waves in AF

Introduction

The electrocardiogram (ECG) fibrillatory (f) wave characteristics in atrial fibrillation (AF) could provide important information regarding the efficacy of antiarrhythmic drug therapy.

Methods and Results

To measure the effects of dofetilide on the surface ECG f wave characteristics in patients with persistent AF, baseline and post‐drug (2 hours after first dose and after multiple doses) ECGs in 31 patients with persistent AF admitted for dofetilide loading were evaluated. A QRST template subtraction algorithm was used to yield an atrial ECG. Fast Fourier transform analysis was performed to evaluate the maximum organizational index (OI), the dominant frequency (DF) in the lead with max OI, the median DF for all leads, and the vector magnitude f wave amplitude. Dofetilide reduced DF in the lead with the max OI (6.32 ± 0.98 Hz at baseline vs. 4.83 ± 0.63 Hz after final dose, P < 0.0001) and median DF (6.46 ± 0.87 Hz vs. 4.92 ± 0.62 Hz, P < 0.0001). Dofetilide also increased the maximum OI from 0.52 ± 0.11 at baseline to 0.59 ± 0.11 after final dose (P = 0.02). Of the 29 patients with long‐term follow‐up, the 22 (76%) with recurrent AF on dofetilide had a lower baseline DF in the lead with the max OI (6.01 ± 1.08 vs. 6.89 ± 0.46; P = 0.05). The change in DF after dofetilide did not correlate with the change in QTc interval.

Conclusions

The standard ECG can be used to assess atrial rate in AF. This may be useful to assess antiarrhythmic drug effects for treatment of AF.
Adherence to self‐care behavior and glycemic effects using structured education
Authors: Yang Yi‐Sun , Wu Yueh‐Chu , Lu Ying‐Li , Kornelius Edy , Lin Yu‐Tze , Chen Yu‐Ju , Li Ching‐Lu , Hsiao Hui‐Wen , Peng Chiung‐Huei , Huang Chien‐Ning
Published: February 2015

Aims/Introduction

The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university‐based hospital primary care clinic.

Materials and Methods

This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self‐behavioral changes.

Results

A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = −0.59% and Δ = −1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = −0.43% and Δ = −0.49%), based on an intention‐to‐treat analysis. A per‐protocol analysis showed the significant change was maintained at 12 months (Δ = −0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self‐Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem‐solving, reducing risk and health coping.

Conclusions

In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self‐care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care.
Stent under‐expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction
Authors: Hori Yasuki , Naitoh Itaru , Ban Tesshin , Narita Kei , Nakazawa Takahiro , Hayashi Kazuki , Miyabe Katsuyuki , Shimizu Shuya , Kondo Hiromu , Nishi Yuji , Yoshida Michihiro , Umemura Shuichiro , Kato Akihisa , Yamada Tomonori , Ando Tomoaki , Joh Takashi
Published: February 2015

Background and Aim

Self‐expandable metallic stents (SEMS) have been widely accepted as palliation therapy for malignant gastric outlet obstruction (GOO). However, the factors predictive of poor oral intake after SEMS placement have not been elucidated sufficiently. We aimed to clarify both the patient and stent‐related predictive factors.

Methods

We retrospectively reviewed 126 consecutive patients who underwent uncovered SEMS placement for malignant GOO between April 2010 and March 2013 at a university hospital and two tertiary care referral centers.

Results

Technical success of SEMS placement was achieved in all 126 (100%) patients. Improved oral intake was observed in 111 (88.1%) patients. A Karnofsky performance status ≤ 40 (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.02–1.28; P = 0.041), peritoneal dissemination (OR, 1.20; 95% CI, 1.01–1.26; P = 0.038), and under‐expansion of the SEMS on the procedure day (OR, 1.55; 95% CI, 1.26–1.62; P < 0.001) were independent predictive factors for poor improvement on the GOO scoring system, according to multivariate analysis.

Conclusions

SEMS under‐expansion was a stent related, while poor performance status and peritoneal dissemination were patient related, predictive factors for poor oral intake after SEMS placement for malignant GOO.
Association of colonic regulatory T cells with hepatitis C virus pathogenesis and liver pathology
Authors: Hetta Helal F , Mekky Mohamed A , Khalil Nasr K , Mohamed Wegdan A , El‐Feky Mohamed A , Ahmed Shabaan H , Daef Enas A , Nassar Mahmoud I , Medhat Ahmed , Sherman Kenneth E , Shata Mohamed Tarek M
Published: February 2015

Background and Aim

Forkhead box protein P3 (FoxP3)+ regulatory T (Treg) cells play a fundamental role in maintaining the balance between the tissue‐damaging and protective immune response to chronic hepatitis C (CHC) infection. Herein, we investigated the frequency of Treg cells in the colon and their potential relationship to the various CHC outcomes and hepatic histopathology.

Methods

Colonic biopsies were collected from three groups with CHC: treatment naïve (TN; n = 20), non‐responders (NR; n = 20), sustained virologic response (SVR; n = 20), and a fourth healthy control group (n = 10). The plasma viral loads and cytokines levels were determined by quantitative real‐time polymerase chain reaction, and ELISA, respectively. Liver biopsies were examined to assess inflammatory score and fibrosis stage. Colonic Treg frequency was estimated by immunohistochemistry using confocal microscopy.

Results

A significant increase in the frequency of colonic Treg was found in TN, and NR groups compared with the control and SVR group. The frequency of colonic Treg, plasma interleukin (IL)‐10 and IL‐4 levels were significantly positively correlated with viral load and negatively correlated with METAVIR inflammatory score, and fibrosis stages.

Conclusion

Colonic Treg cells are negatively correlated with liver inflammation and hepatitis C virus (HCV) viral load, which suggests a strong linkage between gut‐derived Treg cell populations and HCV infection.
An observational study of older patients’ participation in hospital admission and discharge – exploring patient and next of kin perspectives
Authors: Dyrstad Dagrunn N , Laugaland Kristin A , Storm Marianne
Published: February 2015

Aims and objectives

To explore older patients’ participation during hospital admission and discharge.

Background

Patient participation is suggested as a means to improve the quality of transitional healthcare. Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer from primary to hospital healthcare and vice versa.

Design

This study adopts a participant observational research design.

Methods

Participant observations of 41 older patients (over 75 years of age) during hospital admission and discharge were conducted in two hospitals in Norway (in 2012). The observations included short conversations with the patient and their next of kin to capture their participation experiences. Systematic text condensation was used to analyse the data material from the field notes.

Results

Varying degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision‐making (in admission and discharge) were observed and experienced by patients and their next of kin. The next of kin appeared to be important advocates for the patients in admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influenced by time constraints and the heavy workloads of healthcare professionals. Patients’ health conditions and preferences also influence participation.

Conclusions

Several issues influence the participation of the older patients during hospital admission and discharge. Participation of the older patients needs continuous support from healthcare professionals that acknowledges both the individual patient's preferences and their capacity to participate.

Relevance to clinical practice

Study findings report discrepancies in the involvement of older people and their next of kin. There is a need to increase and support older patients’ participation in hospital admission and discharge.
The Effect of Providing Peer Information on Retirement Savings Decisions
Authors: BESHEARS JOHN , CHOI JAMES J. , LAIBSON DAVID , MADRIAN BRIGITTE C. , MILKMAN KATHERINE L.
Published: February 2015

Using a field experiment in a 401(k) plan, we measure the effect of disseminating information about peer behavior on savings. Low‐saving employees received simplified plan enrollment or contribution increase forms. A randomized subset of forms stated the fraction of age‐matched coworkers participating in the plan or age‐matched participants contributing at least 6% of pay to the plan. We document an oppositional reaction: the presence of peer information decreased the savings of nonparticipants who were ineligible for 401(k) automatic enrollment, and higher observed peer savings rates also decreased savings. Discouragement from upward social comparisons seems to drive this reaction.
Self‐Insurance, Self‐Protection, and Saving: On Consumption Smoothing and Risk Management
Authors: Hofmann Annette , Peter Richard
Published: February 2015

This article studies the effect of risk preferences on self‐insurance and self‐protection in a two‐period expected utility framework. Here the investment to reduce risk precedes its effect. In contrast to single‐period models, self‐insurance and self‐protection react similarly when the agent's utility function becomes more concave. Effort is increased if and only if current consumption is sufficiently large. However, if we introduce endogenous saving, an agent with more concave utility always selects more self‐insurance, but will select more self‐protection if and only if the probability of loss is small enough. These latter results concur with those in standard monoperiodic models with no saving.
The Sluggish and Asymmetric Reaction of Life Annuity Prices to Changes in Interest Rates
Authors: Charupat Narat , Kamstra Mark J. , Milevsky Moshe A.
Published: February 2015

Many assume that in the short run, annuity prices promptly and efficiently respond to changes in interest rates. Using a unique database of quotes, we show this is not the case. Prices are less sensitive to changes in rates than expected, and responses are asymmetric. Prices react more rapidly and with greater sensitivity to an increase than to a decrease in rates. The results are robust, but there is a small degree of heterogeneity in the responses of different insurance companies. When rates increase, larger firms are slightly quicker to improve prices. The opposite is true when rates decline. In sum, we show that the microstructure of annuity dynamics is more complicated than (simply) adding mortality credits to bond yields.
Yes, No, Perhaps? Premium Risk and Guaranteed Renewable Insurance Contracts With Heterogeneous Incomplete Private Information
Authors: Peter Richard , Richter Andreas , Steinorth Petra
Published: February 2015

The article shows that heterogeneous incomplete private information can explain the limited existence of guaranteed renewable health insurance (GR) contracts in an otherwise frictionless markets. We derive a unique equilibrium that can be of the form that either only a portion of the population or none will cover themselves against premium risk with a GR contract. Increased risk aversion, increased premium risk, and first‐order stochastic improvements of the distribution of private information increase the likelihood of positive take‐up. In case GR contracts are in demand, increased risk aversion and first‐order stochastic improvements of the distribution of private information lead to more individuals purchasing the GR contract.