bluuebunny/crossref_metadata_2025 huggingface dataset:
The perception of e-servicescape and its influence on perceived e-shopping value and customer loyalty
Authors: Tankovic Ana Cuic , Benazic Dragan
Published: August 2018

Purpose

The popularity of online shopping has grown in the recent years, enhancing the interest in identifying the factors that influence shoppers’ loyalty. The purpose of this paper is to investigate, through aesthetic appeal, layout and functionality, and financial security, the impact of customers’ perceptions of the e-servicescape in online shopping on perceived e-shopping value and customer loyalty defined as a two-component construct (attitudinal loyalty and behavioural loyalty), following the sequence of the S–O–R framework.

Design/methodology/approach

Data were gathered using an Internet survey in which 221 active online shoppers participated who had at least one online purchase in the past six months. The research model was analysed using the partial least squares approach to analyse structural equations (SEM).

Findings

Based upon empirical evidence of a web-based survey of online shoppers, this study shows that consumers’ interpretation of e-servicescape exerts a positive influence over perceived e-shopping value and loyalty. Specifically, the study finds that layout and functionality and financial security, as the salient attributes of the e-servicescape dimension, set the point of perceived e-shopping value which affects attitudinal loyalty.

Practical implications

The authors expose several practical implications how marketing management could use the dimensions of e-servicescape perceived e-shopping value. Managers are advised to incorporate the dimensions of the e-servicescape to build perceived e-shopping value and loyalty. Online shops need to invest in particular in layout and functionality and financial security, dimensions that had a stronger effect on perceived e-shopping value in order to achieve costumers’ loyalty in a fashion product context.

Originality/value

The transition from physical service locations to virtual service processes has increased the research interest of e-servicescape. This study analyses it through its aesthetic appeal, layout and functionality, and financial security connecting them with the constructs of perceived e-shopping value and customer loyalty in the application for fashion products. This work emphasises the connection between servicescape attributes in creating perceived value which affects attitudinal and behavioural loyalty. In this way, the e-servicescape is seen as stimuli, the perceived e-shopping value represents the organism and the loyalty the response of the sequence of the S–O–R framework. This research provides insight into the new effects of each dimension of e-servicescape on perceived e-shopping value and the two dimensions of loyalty, thus improving the existing knowledge in the field of servicescape and online shopping customer behaviour.
Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team
Authors: Trivedi Amal N. , Jiang Lan , Johnson Erin E. , Lima Julie C. , Flores Michael , O'Toole Thomas P.
Published: August 2018

Objective

To examine the association between reliance on VA outpatient care and hospital admissions among Medicare‐eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H‐PACT).

Data Sources/Study Setting

Registry of H‐PACT enrollees linked to VA and Medicare utilization data for 2013.

Study Design

After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA‐financed hospital admissions.

Principal Findings

Compared with higher reliance Veterans, lower reliance Veterans had an equivalent number of annual VA hospitalizations (0.63 vs. 0.50; p = .14) but substantially greater Medicare hospitalizations (0.85 vs. 0.08; p < .001). Among Veterans in the highest tertile of outpatient visits, we observed statistically similar rates of VA hospital use but over 10‐fold greater rates of Medicare‐financed hospitalizations (1.31 for lower reliance vs. 0.15 for high reliance; p < .001).

Conclusions

Among Veterans receiving integrated care in VA's H‐PACT, dual use of Medicare and VA outpatient care is strongly associated with acute hospitalizations financed by Medicare. Linking VA and non‐VA data may identify a subset of homeless Veterans with fragmented outpatient care who are at increased risk of poor outcomes.
Development of an Adverse Event Surveillance Model for Outpatient Surgery in the Veterans Health Administration
Authors: Mull Hillary J. , Itani Kamal M. F. , Pizer Steven D. , Charns Martin P. , Rivard Peter E. , McIntosh Nathalie , Hawn Mary T. , Rosen Amy K.
Published: August 2018

Objective

Develop and validate a surveillance model to identify outpatient surgical adverse events (AEs) based on previously developed electronic triggers.

Data Sources

Veterans Health Administration's Corporate Data Warehouse.

Study Design

Six surgical AE triggers, including postoperative emergency room visits and hospitalizations, were applied to FY2012–2014 outpatient surgeries (n = 744,355). We randomly sampled trigger‐flagged and unflagged cases for nurse chart review to document AEs and measured positive predictive value (PPV) for triggers. Next, we used chart review data to iteratively estimate multilevel logistic regression models to predict the probability of an AE, starting with the six triggers and adding in patient, procedure, and facility characteristics to improve model fit. We validated the final model by applying the coefficients to FY2015 outpatient surgery data (n = 256,690) and reviewing charts for cases at high and moderate probability of an AE.

Principal Findings

Of 1,730 FY2012–2014 reviewed surgeries, 350 had an AE (20 percent). The final surveillance model c‐statistic was 0.81. In FY2015 surgeries with >0.8 predicted probability of an AE (n = 405, 0.15 percent), PPV was 85 percent; in surgeries with a 0.4–0.5 predicted probability of an AE, PPV was 38 percent.

Conclusions

The surveillance model performed well, accurately identifying outpatient surgeries with a high probability of an AE.
Streamflow, Sediment Transport, and Geomorphic Change during the 2011 Flood on the Missouri River Near Bismarck–Mandan, ND
Authors: Nustad Rochelle A. , Benthem Adam J. , Skalak Katherine J. , McDonald Richard R. , Schenk Edward R. , Galloway Joel M.
Published: August 2018

Geomorphic change from extreme events in large managed rivers has implications for river management. A steady‐state, quasi‐three‐dimensional hydrodynamic model was applied to a 29‐km reach of the Missouri River using 2011 flood data. Model results for an extreme flow (500‐year recurrence interval [RI]) and an elevated managed flow (75‐year RI) were used to assess sediment mobility through examination of the spatial distribution of boundary or bed shear stress (τb) and longitudinal patterns of average τb, velocity, and kurtosis of τb. Kurtosis of τb was used as an indicator of planform channel complexity and can be applied to other river systems. From differences in longitudinal patterns of sediment mobility for the two flows we can infer: (1) under extreme flow, the channel behaves as a single‐thread channel controlled primarily by flow, which enhances the meander pattern; (2) under elevated managed flows, the channel behaves as multithread channel controlled by the interaction of flow with bed and channel topography, resulting in a more complex channel; and (3) for both flows, the model reach lacks a consistent pattern of deposition or erosion, which indicates migration of areas of erosion and deposition within the reach. Despite caveats and limitations, the analysis provides useful information about geomorphic change under extreme flow and potential implications for river management. Although a 500‐year RI is rare, extreme hydrologic events such as this are predicted to increase in frequency.
Effects of patient satisfaction and confidence on the success of treatment of combined rheumatic disease and interstitial lung disease in a multidisciplinary outpatient clinic
Authors: Jeong Shin Ok , Uh Soo‐Taek , Park Suyeon , Kim Hyun‐Sook
Published: August 2018

Objectives

Multidisciplinary discussions (MDDs) have emphasized improve medical services and outcomes. We used a multidisciplinary approach to explore whether patient emotional satisfaction and confidence affected treatment outcomes in rheumatic disease (RD)‐related interstitial lung disease (ILD).

Methods

From December 2015 to April 2017, we evaluated 23 patients with RD and ILD and 21 with idiopathic pulmonary fibrosis (IPF). Patients with RD and ILD were managed with MDDs. Patients with IPF received standardized medical care by the same pulmonologist. All patients completed brief multiple‐choice questionnaires exploring their perceptions of their illnesses and their attitudes toward medical treatment, and completed the Patient Health Questionnaire‐2.

Results

The MDD patients could more easily identify disease symptoms regardless of age stratification (under 65 age: P = 0.020, 65 years or older: P = 0.003). Among the 65 years or older group, it shows higher levels of illness perception in terms of disease timeline in the MDD group (P = 0.035). Also, the MDD group reported higher levels of satisfaction in terms of the explanations they received and their involvement in discussion, and greater satisfaction with medical staff. However, the groups did not differ significantly between treatment outcomes such as changes in forced vital capacity, the diffusion capacity of carbon monoxide, or changes in high‐resolution computed tomography.

Conclusions

MDDs afforded satisfactory management compared with standardized medical care. The MDD group felt better attention fromand satisfaction with medical staff, and had greater identification in their treatment. Further research engaging in MDDs with a comparable control group is required.
Long‐term follow‐up of 76 Iranian patients with idiopathic inflammatory myopathies
Authors: Hajialilo Mehrzad , Ghorbanihaghjo Amir , Khabbazi Alireza , Kolahi Sousan , Jafari Nakhjavani Mohammad Reza , Ebrahimi Ali Asghar , Zareh Hamid , Malek Mahdavi Aida
Published: August 2018

Aim

This study aimed to follow up patients with polymyositis (PM) and/or dermatomyositis (DM) to determine survival rate, pattern of disease, response to treatment, malignancy incidence and poor prognostic factors (PPFs).

Method

A total of 76 patients with PM (n = 47) and/or DM (n = 29) based on Bohan and Peter diagnostic criteria referred to the Imam‐Reza Hospital were followed up from 2004 to 2016. The follow‐up period was considered from diagnosis to patient′s death or last visit. All patients underwent physical examinations and data including age, sex, disease duration, disease subtype, pattern of disease, PPFs and malignancy incidence were collected.

Results

Mean age at diagnosis was 45.49 ± 10.88 years and women were predominant (84.2%). Course of disease in the majority of patients (52.6%) was polyphasic, followed by monophasic (31.6%) and chronic‐progressive (5.3%). The 1‐, 5‐ and 10‐year survival rates were 96%, 93% and 92%, respectively. Delay in treatment and dysphagia were common PPFs in the present study. The majority of patients responded to treatment (88.2%) and there were significant differences in cancer and dysphagia between responders and non‐responders to treatment (P < 0.05). The most common cause of death was cancer in four of eight deaths. There was significant difference in survival rates between patients with and without pulmonary involvement (P = 0.001). Moreover, the survival rates were significantly lower in patients with malignancy (P = 0.001).

Conclusion

Presence of dysphagia and cancer were associated with poor response to treatment. Pulmonary involvement and cancer incidence significantly affect survival rate. Furthermore, since cancer is the most common cause of death, so this study emphasizes the importance of careful cancer screening in these patients.
Emerging role of metabolomics in rheumatology
Authors: Gupta Latika , Ahmed Sakir , Jain Avinash , Misra Ramnath
Published: August 2018

The pursuit for understanding disease pathogenesis, in this age of rapid laboratory diagnostics and fast‐paced research, has led scientists worldwide to take recourse in hypothesis‐free approaches for molecular diagnosis. Metabolomics is one such powerful tool that explores comprehensibly the metabolic alternations in human diseases. It involves study of small molecules of less than 1 kD in size by either LSMS or nuclear magnetic resonance. Unlike genomics, which tells us what may have happened, metabolomics reflects what did happen. The NMR technique has an advantage of analyzing metabolites without sample preparation, thereby diminishing artifacts, is less cumbersome and with the latest database on Metabolome; about 30 000 metabolites can be identified. The study of metabolomics for several rheumatic diseases, including rheumatoid arthritis, lupus, osteoarthritis and vasculitis, has revealed distinctive metabolic signatures. Thus, metabolomics is a technique that promises precision medicine with better biomarkers, robust predictors of drug response and of disease outcome, discovery of newer metabolites and pathways in disease pathogenesis, and finally, targeted drug development. This review intends to decipher its relevance in common rheumatic diseases.
Apigenin and apigeninidin isolates from theSorghum bicolorleaf targets inflammation via cyclo‐oxygenase‐2 and prostaglandin‐E2blockade
Authors: Makanjuola Samira B. L. , Ogundaini Abiodun O. , Ajonuma Louis C. , Dosunmu Adedoyin
Published: August 2018

Aim

This study evaluated the anti‐inflammatory properties of a species ofSorghum bicolorleaf (SBL) grown in West Africa.

Method

Cyclo‐oxygenase (COX)‐2:COX‐1 selectivity assay was carried out by plating isolated peripheral blood mononuclear cells in culture medium with specific SBL fractions: crude extract (J), ethyl‐acetate (JE) and aqueous (JA); secondary compounds from JE (JE5, JE6, JE7 and JE8); purified (P9) and semi‐purified (P8) compounds from JE5 at 5‐200 μg/mL for 1 hour. Test compounds and controls ibuprofen (50 μmol/L) and CAY10404 (1 μmol/L; 10 μmol/L) were added to two sets of plates, one without lipopolyshaccharide (LPS) and the other with LPS (1 μg/mL) for 24 hour. COX‐2IC50:COX‐1IC50ratio represented 50% inhibition of the activity of COX‐2 to that of COX‐1 using ibuprofen as control. In separate experiments the supernatant of P8 and P9‐treated fractions of SBL and controls were plated with RAW 264.7 macrophage cells to measure prostaglandin (PG)‐E2production and cell proliferation activity.

Results

JA fraction of SBL had the highest ratio of COX‐2IC50:COX‐1IC5041.214whereas JE had the lowest ratio COX‐2IC50:COX‐1IC501.161. Interestingly, JE5 derived from JE showed a ratio of COX‐2IC50:COX‐1IC500.495while P8 derived from JE5 showed a dose‐dependent reduction in COX‐2IC50:COX‐1IC50ratio and in PG‐E2production, which was more effective compared to ibuprofen. A dose‐dependent reduction in RAW 264.7 macrophage cell proliferation was also observed in P8‐treated cells. The phenolic compounds identified in P8 include apigenin and apigeninidin adducts which may explain the exceptional anti‐inflammatory activity and efficacy in COX‐2 targeting.
Pretreatment hematological markers predict clinical outcome in cancer patients receiving immune checkpoint inhibitors: A meta‐analysis
Authors: Tan Qiaoyun , Liu Shuxia , Liang Caixia , Han Xiaohong , Shi Yuankai
Published: August 2018

Background

Immune checkpoint inhibitors (ICIs) have revolutionized the clinical treatment of multiple cancers. Recent studies revealed the potential prognostic value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients receiving ICIs; however, the results were inconsistent. We conducted a meta‐analysis to identify the prognostic significance of baseline NLR and PLR in cancer patients treated with ICIs.

Methods

We conducted a thorough literature search of PubMed, Embase, and Cochrane databases for studies dealing with the prognostic impact of pretreatment NLR and/or PLR levels in cancer patients treated with ICIs. The clinical outcomes were progression‐free survival (PFS) and overall survival (OS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated, and sensitivity and subgroup analyses were performed to investigate heterogeneity.

Results

Seventeen articles involving 2092 patients were included in the final analysis. The pooled HRs of PFS and OS for NLR were 1.81(95% CI 1.36–2.41) and 2.26 (95% CI 1.68–3.03), respectively, suggesting that patients with higher baseline NLRs had significantly poorer PFS and OS. Similar results were detected in sensitivity and subgroup analyses. However, no significant relevance was found between PLR and clinical endpoints in patients treated with ICIs (HR = 1.14, 95% CI 0.88–1.48 for PFS; HR = 1.35, 95% CI 0.86–2.12 for OS).

Conclusion

These results indicate that high pretreatment NLR but not PLR level, as a routinely obtained hematological parameter, is a potential prognostic predictor for poor PFS and OS in cancer patients receiving ICIs.
Population‐level patterns and mental health and substance use correlates of alcohol, marijuana, and tobacco use and co‐use in US young adults and adults: Results from the population assessment for tobacco and health
Authors: Cohn Amy M. , Johnson Amanda L. , Rose Shyanika W. , Pearson Jennifer L. , Villanti Andrea C. , Stanton Cassandra
Published: August 2018

Background and Objectives

This study identified the most common patterns of current alcohol and marijuana use with the spectrum of tobacco products (cigarettes, hookah, e‐cigarettes, cigars/little cigars, and other products), among US young adults and older adults and examined associations of mental health and substance use problems with each pattern.

Methods

Wave 1 adult dataset (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses estimated the prevalence of the top 10 patterns of current alcohol, marijuana, and tobacco use and co‐use separately by young adults aged 18–24 (n = 9,112) and adults 25+ years (n = 23,208). Multivariable models examined associations of substance use and mental health problems to patterns of use, adjusting for demographics.

Results

Across both age groups, alcohol‐only use was the most popular use pattern (20.7% for young adults and 32.2% older adults) however poly‐substance use patterns were more frequent than single use patterns. Cigarettes were the only tobacco product used exclusively; all other tobacco products were used with together, or with alcohol or marijuana. Only one young adult pattern emerged containing e‐cigarettes, and this pattern included co‐use with alcohol and cigarettes (1.3%). Mental health and substance use problems were most strongly correlated with dual and poly‐substance use patterns, regardless of age.

Scientific Significance

Prevention and intervention campaigns should focus on multiple product use, as single substance use is uncommon. Alcohol is common in all patterns, suggesting it should also gain more focus in marijuana and tobacco prevention and intervention programs. (Am J Addict 2018;27:491–500)
The association of time of emergency surgery – day, evening or night – with postoperative 30‐day hospital mortality
Authors: Tessler M. J. , Charland L. , Wang N. N. , Correa J. A.
Published: August 2018

It is unclear whether the time of day for emergency surgery is associated with postoperative mortality. We assessed this association in 9319 patients who had emergency surgery as their first surgery at the Jewish General Hospital, Montreal, QC, Canada from April 2010 to March 2015. Of the 7362 (80%) patients with complete data, 168 (2.3%) died within 30 postoperative days. There was no significant association of time of day with postoperative mortality, with adjusted OR (95%CI) of 1.61 (0.96–2.72) for night vs. day, p = 0.07; 1.29 (0.78–2.13) for night vs. evening, p = 0.33; and 1.26 (0.89–1.78) for evening vs. day, p = 0.20. Studies of more patients and more factors, with longer follow‐up, should be carried out to exclude important associations of time of emergency surgery with postoperative mortality and morbidity.
A Foundation Programme educational placement in peri‐operative medicine for older people: mixed methods evaluation
Authors: Rogerson A. , Partridge J. S. L. , Dhesi J. K.
Published: August 2018

We established an innovative Foundation placement in peri‐operative medicine for older patients in response to the need for training in ‘whole patient’ medicine and the challenge of fewer Foundation doctors in acute surgical roles. The placement and underpinning curriculum were co‐designed with junior doctors and other clinical stakeholders. This resulted in a modular design offering acute and community experience and dedicated quality improvement project time. To evaluate the placement we used a mixed methods study based on Kirkpatrick's model of workplace learning. Level 1 (trainee reaction) was evaluated using Job Evaluation Study Tool questionnaires and nominal group technique. Levels 2 and 3 (trainee learning/behaviour) were assessed using a Likert‐style survey mapped to curriculum objectives, e‐portfolio completion, nominal group technique and documentation of completed quality improvement projects and oral/poster presentations. Sixty‐eight foundation trainees underwent the new placement. A similar‐sized ‘control’ sample (n = 57) of surgical Foundation trainees within the same Trust was recruited. The trainees in the peri‐operative placement attained both generic Foundation and specific peri‐operative curriculum competencies, and gave higher job satisfaction scores than trainees in standard surgical placements. The top three ranked advantages from the nominal group sessions were senior support, clinical variety and project opportunities. Universal project completion resulted in high rates of poster and platform presentations, and in sustained service changes at hospital level.
Surgical outcomes of oesophagectomy or gastrectomy due to cancer for patients ≥75 years of age: a single‐centre cohort study
Authors: Klevebro Fredrik , Garritano Stefano , Scandavini Chiara M. , Shetye Alysha , Coppola Alessandro , Kamiya Satoshi , Nilsson Magnus , Lundell Lars , Rouvelas Ioannis
Published: August 2018

Background

The increasing age of the population and prolonged life expectancy result in a widening of age limit criteria for a variety of surgical procedures. Oesophagectomy and total gastrectomy are complex operations associated with significant risks of post‐operative complications.

Methods

This is a single‐centre cohort study of patients operated with curative intent due to oesophageal or gastric cancer.

Results

From 2007 to 2017, 548 patients underwent surgery with curative intent, with 122 patients (22.3%) classified as elderly (≥75 years). There was no difference in total complication rates between the groups. The adjusted odds ratio for 90‐day mortality after oesophageal resection in the elderly group was 3.65 (95% confidence interval (CI): 1.33–10.03) and after gastrectomy was 1.62 (95% CI: 0.55–4.79). The adjusted hazard ratio for 1‐year mortality after oesophagectomy was 2.29 (95% CI: 1.25–4.19), and after gastrectomy the adjusted hazard ratio was 1.48 (95% CI: 0.75–2.92). In the event of a complication with Clavien–Dindo score IIIb or higher, there was a statistically significant increase of 90‐day mortality to over 50% among elderly patients both after oesophagectomy and gastrectomy (50.0% versus 19.8%; P = 0.005 and 57.1% versus 17.4%; P = 0.012, respectively).

Conclusion

There is a statistically significant increase in 90‐day mortality after oesophageal and gastric cancer surgery in elderly compared with younger patients. Post‐operative complications with high Clavien–Dindo score in patients undergoing oesophagectomy or gastrectomy, with age ≥75 years, are a dramatic risk factor for post‐operative death.
Use of regional administration of prophylactic antibiotics in total knee arthroplasty
Authors: Symonds Tristan , Parkinson Ben , Hazratwala Kaushik , McEwen Peter , Wilkinson Matthew , Grant Andrea
Published: August 2018

Prosthetic joint infection after total knee arthroplasty is an infrequent, yet serious complication. Antimicrobial prophylaxis plays an important role in reducing the rate of surgical site infections. To be effective as an antimicrobial prophylaxis, the serum, tissue and bone concentrations of the antibiotic must be greater than the target organism's minimum inhibitory concentration. As antibiotic resistance increases current intravenous prophylactic dosing has been shown to be subtherapeutic for some patients. Intravenous regional administration and intraosseous regional administration of prophylactic antibiotics are novel methods used to increase the antibiotic tissue concentrations, which may enhance the efficacy of prophylactic antibiotics in total knee arthroplasty. Currently, literature has shown both intravenous regional administration and intraosseous regional administration to be safe and effective techniques. However, there is no clinical evidence to show that it results in a reduction of prosthetic joint infection rates. This study summarizes the current knowledge base on the use of regional administration of prophylactic antibiotics in total knee arthroplasty.
Bacteriological profile of community‐acquired musculoskeletal infections: a study from Queensland
Authors: Matthews Justin , Bamal Rahul , McLean Andrew , Bindra Randy
Published: August 2018

Background

The purpose of this study was to determine bacteriology of community‐acquired musculoskeletal infections requiring hospitalization and to compare this with published national and international data. This will help treating physicians select the appropriate antibiotic.

Methods

All patients who underwent surgical procedures for community‐acquired musculoskeletal infections over a period of 22 months were included in the study. Hospital acquired infections, post‐operative infections and infections involving prosthetic joints were excluded. Patient characteristics, treatment details, cultured organisms and their antibiotic sensitivity were recorded.

Results

Forty‐five patients with 46 cases met the inclusion criteria. Ten patients were from paediatric age group. Soft tissue infections were the most common diagnosis and accounted for 20 cases. The remainder were septic arthritis (n = 17) and osteomyelitis (n = 9). Thirteen patients (28.3%) had negative cultures from the operative samples. Staphylococcus aureus was the most common isolated organism overall accounting for 23 cases (69.7%). Methicillin‐resistant S. aureus (MRSA) sensitive to vancomycin was cultured in four adult cases (12.1%), of which three were hand infections (50%). For the entire cohort, 67.7% and 61.3% isolates that were tested were sensitive to cefazolin and flucloxacillin, respectively.

Conclusion

The bacteriological profile in this study is consistent with European and Australian data. While the overall MRSA infection rate was low, it was much higher among hand infections and is comparable to reports from the USA. Flucloxacillin and cefazolin should be considered as the first line of antibiotic therapy for all cases. Vancomycin should be considered when MRSA is suspected.
Associations of maternal oestradiol, cortisol, and TGF‐β1 plasma concentrations with thyroid autoantibodies during pregnancy and postpartum
Authors: Sakkas Evangelos G. , Paltoglou George , Linardi Anastasia , Gryparis Alexandros , Nteka Eleni , Chalarakis Nikos , Mantzou Aimilia , Vrachnis Nikolaos , Iliodromiti Zoe , Koukkou Eftychia , Deligeoroglou Efthymios , Sakkas Grigorios E. , Mastorakos George
Published: August 2018

Background

Thyroid physiology and autoimmunity are altered in pregnancy. While oestradiol, cortisol, and TGF‐β1 are implicated in these phenomena outside pregnancy, their associations with thyroid autoantibodies during pregnancy and postpartum are not thoroughly examined. This study aimed to unravel their eventual associations during pregnancy and postpartum in the same cohort of 93 pregnant women studied prospectively from 2015 to 2017.

Methods

Blood samples were drawn at the 24th and the 36th gestational week and at the 1st postpartum week for measurements of thyroid hormones, TSH, anti‐TPO, anti‐Tg, oestradiol, cortisol, and TGF‐β1.

Results

Serum anti‐TPO was greater (P < 0.05) at the 1st postpartum than at the 24th and 36th gestational weeks. At the 36th gestational week, cortisol was greater (P < 0.05) and TGF‐β1 lower (P < 0.05) than at the 24th gestational and the 1st postpartum weeks. At the 1st postpartum week, cortisol correlated negatively with anti‐Tg (r = −0.419) (P < 0.05). ΔTGF‐β1 was the best negative and Δoestradiol the best positive predictor of the 1st postpartum week anti‐TPO (P < 0.05, b = −0.509; P < 0.05, b = 0.459 respectively).

Conclusions

At postpartum, increased TGF‐β1 is related to a less pronounced anti‐TPO increase as compared to the 3rd trimester, suggesting an immunosuppressive role for TGF‐β1. During pregnancy and postpartum, oestradiol, cortisol, and TGF‐β1 are associated with suppression of thyroid autoantibodies.
Sonic hedgehog signalling regulates the self‐renewal and proliferation of skin‐derived precursor cells in mice
Authors: Park Sangkyu , Kim Hyewon , Kim Kichul , Roh Sangho
Published: August 2018

Objectives

The sonic hedgehog (Shh) signalling pathway has an important role in the maintenance of various stem cells and organogenesis during development. However, the effect of Shh in skin‐derived precursors (SKPs), which have the capacity for multipotency and self‐renewal, is not yet clear. The present study investigated the effects of the Shh signalling pathway on the proliferation and self‐renewal of murine SKPs (mSKPs).

Methods

The Shh signalling pathway was activated by treatment with purmorphamine (Shh agonist) or recombinant Shh in mSKPs. Cyclopamine (Shh antagonist) or GANT‐61 (Gli inhibitor) was used to inhibit the pathway. Western blot, qPCR, and immunofluorescence were used to analyse the expression of genes related to self‐renewal, stemness, epithelial‐mesenchymal transition (EMT) and the Shh signalling pathway. In addition, cell proliferation and apoptosis were examined.

Results

Inhibiting the Shh signalling pathway reduced mSKP proliferation and sphere formation, but increased apoptosis. Activating this signalling pathway produced opposite results. The Shh signalling pathway also controlled the EMT phenotype in mSKPs. Moreover, purmorphamine recovered the self‐renewal and proliferation of aged mSKPs.

Conclusion

Our results suggest that the Shh signalling pathway has an important role in the proliferation, self‐renewal and apoptosis of mSKPs. These findings also provide a better understanding of the cellular mechanisms underlying SKP self‐renewal and apoptosis that allow more efficient expansion of SKPs.
Muscle volume alterations after first botulinum neurotoxin A treatment in children with cerebral palsy: a 6‐month prospective cohort study
Authors: Alexander Caroline , Elliott Catherine , Valentine Jane , Stannage Katherine , Bear Natasha , Donnelly Cyril J , Shipman Peter , Reid Siobhan
Published: August 2018

Aim

This study aimed to track alterations in muscle volume for 6 months in children with cerebral palsy (CP) after the first exposure to botulinum neurotoxin A (BoNT‐A), a commonly used focal spasticity treatment.

Method

Eleven ambulant children (eight males, three females) with spastic CP, mean age 8 years 10 months (SD 3y 1mo) participated. Participants received injections to the affected gastrocnemius. The muscle volume of the gastrocnemius, soleus, tibialis anterior, and hamstrings was measured using magnetic resonance imaging. Muscle volume was normalized to bone length, and changes analysed relative to baseline. Assessments were conducted 1 week before, and 4 weeks, 13 weeks, and 25 weeks after BoNT‐A treatment.

Results

All children demonstrated positive clinical and functional gains. Muscle volume of the injected gastrocnemius was found to be significantly reduced at 4 weeks (−5.9%), 13 weeks (−9.4%), and 25 weeks (−6.8%). Significant increases in normalized soleus muscle volume were identified at each follow‐up, while hamstrings showed significant increase at 4 weeks only.

Interpretation

Absolute and normalized muscle volume of the injected muscle reduces after first BoNT‐A exposure, and does not return to baseline volume by 25 weeks. Hypertrophy is seen in the soleus up to 25 weeks; the volume of the plantar flexor compartment is stable.

What this paper adds

Muscle atrophy after first botulinum neurotoxin A (BoNT‐A) exposure in children with cerebral palsy is noted.

Mild BoNT‐A‐induced muscle atrophy is still apparent 6 months after BoNT‐A exposure.

Hypertrophy is evident in soleus after gastrocnemius BoNT‐A exposure.

Total plantarflexor volume is unchanged.
Validation of Dodd's Model for Differential Diagnosis of childhood speech sound disorders: a longitudinal community cohort study
Authors: Ttofari Eecen Kyriaki , Eadie Patricia , Morgan Angela T , Reilly Sheena
Published: August 2018

Aim

Dodd's Model for Differential Diagnosis is one of the available clinical diagnostic classification systems of childhood speech sound disorders. Yet we do not understand the validity of this system beyond clinical samples, precluding its application in epidemiological or population‐based research. This study aimed to determine the prevalence of subgroups of speech sound disorders in a community sample, relative to past clinical samples, in children speaking standard Australian English.

Method

We examined speech development in a community‐ascertained sample of children at 4 years (n=1607). Inclusion for speech sound disorder was a score of less than or equal to 1 standard deviation on a standardized speech test, and/or research assistant concern, and/or three or more speech errors on sounds typically acquired by 4 years. Dodd's model was then applied to 126 children.

Results

Data revealed proportions of children across Dodd's diagnostic subgroups as follows: suspected atypical speech motor control (10%); inconsistent phonological disorder (15%); consistent atypical phonological disorder (20%); phonological delay (55%); and articulation disorder alone (0%). The findings are in line with known prevalence of these subgroups in clinical populations.

Interpretation

Our findings provide additional support for speech‐language pathologists to use this system in clinical practice for differential diagnosis and targeted intervention of speech sound disorders in children.

What this paper adds

Dodd's Model for Differential Diagnosis is the first classification system of speech sound disorders to be applicable to both clinical and community cohorts.
Integrin β1 activity is required for cardiovascular formation in zebrafish
Authors: Iida Atsuo , Wang Zi , Hirata Hiromi , Sehara‐Fujisawa Atsuko
Published: August 2018

Integrins are transmembrane molecules that facilitate cell‐to‐cell and cell‐to‐extracellular matrix (ECM) interactions. Integrin molecules are heterodimers that consist of α‐ and β‐subunits. The integrin β1 gene is widely expressed in vivo and is the major β molecule in many tissues; however, tissue‐specific roles of integrin β1 are still elusive. In this study, we investigated integrin β1 function in endothelial cells of zebrafish. An integrin β1b mutant zebrafish exhibited morphological abnormalities in blood vessel formation, cephalic hemorrhage and a decreased responsiveness to tactile stimulation during development. To determine the role of integrin β1b in vascular formation, we developed a Gal4/UAS‐mediated conditional inactivation of integrin β1 by expressing the cytoplasmic region of integrin β1 that acts as a dominant‐negative (DN) isoform. Expression of integrin β1 DN in endothelial cells induced blood vessel abnormalities as in integrin β1b mutants. These results show that endothelial cells require integrin activity for the formation and/or maintenance of blood vessels in zebrafish. Furthermore, our time‐lapse recording visualized the breakpoint of cephalic vessels and the hemorrhage onset. Taken together, our tissue‐specific inactivation of integrin β1 in zebrafish is powerful tools for functional analysis of integrin β1 in developing tissues.
Horizontal Direction‐Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV
Authors: Beh Shin C.
Published: August 2018

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31‐month clinical course of a 41‐year‐old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left‐beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.
The physical and mental health of acute psychiatric ward staff, and its relationship to experience of physical violence
Authors: Renwick Laoise , Lavelle Mary , James Karen , Stewart Duncan , Richardson Michelle , Bowers Len
Published: August 2018

To evaluate and describe the physical and mental health of staff on acute psychiatric wards and examine whether violence exposure is linked with health status. We undertook a cross‐sectional survey with 564 nursing staff and healthcare assistants from 31 psychiatric wards in nine NHS Trusts using the SF‐36, a reliable and valid measure of health status and compared summary scores with national normative data. Additional violence exposure data were collated simultaneously and also compared with health status. The physical health of staff was worse, and their mental health was better than the general population. Physical health data were skewed and showed a small number of staff in relatively poor health while the majority were above average. Better physical health was associated with less time in the current post, a higher pay grade, and less exposure to mild physical violence in the past year. Better mental health was associated with being older and from an ethnic minority background. Violence exposure influenced physical health but not mental health when possible confounders were considered. Mental health was strongly influenced by ethnicity, and further research might highlight the impact on own‐group ethnic density on the quality of care. The impact of staff whom are physically unwell or impaired in the workplace needs to be considered as the quality of care may be compromised despite this being an example of inclusiveness, equal opportunities employment, and positive staff motivation.
Reproductive biology and recruitment in an amphidromous prawn Macrobrachium australe in Reunion Island
Authors: Hoarau Pierre E. , Treilhes Camille R.M. , Valade Pierre B.
Published: August 2018

Macrobrachium australe is a widespread, medium‐sized amphidromous prawn which like many other species within this genus is exploited by fisheries. As such, they are vulnerable to overexploitation as well as to environmental modifications that impact connectivity between spawning and rearing habitats. An informed understanding of reproductive biology is essential for a responsible management of stocks in species with such a complex life circle. This study reports the results of a 1‐year investigation of the reproductive biology of M. australe in the Langevin River, Reunion Island, southwest Indian Ocean. Males attained a larger size than females. The smallest ovigerous female recorded during the study was 36 mm, and females >42 mm in length were ≥50% more likely to be ovigerous. Although reproduction occurred throughout the year, there was an increase in the reproductive activity from November to May. The highest rates of ovigerous females were observed from December to March, corresponding to elevated water temperatures and, to a lesser extent, elevated river flow. Recruitment mainly occurred in the months after high female reproductive activity (January to April).
Family perceptions of the impacts of a home and community based services autism waiver: Making family life possible
Authors: Eskow Karen Goldrich , Summers Jean Ann
Published: August 2018

Background

An important mechanism that provides support and services for families with a child/youth with autism spectrum disorder is the home‐ and community‐based services (HCBS) Waiver authorized by Section 1915(c) of the Social Security Act or Medicaid.

Methods

This study used qualitative research methods to explore parent perspectives about the impact of HCBS Waiver services on the child/youth with autism and their family. In‐depth interviews focused on aspects of the programme they valued, identification of barriers and general issues they experienced.

Results

Results of the qualitative study indicated that improved outcomes could be explained by providers of services who were well‐trained, flexible and allowed parents’ opportunities for choice regarding provision of services to meet child/youth and family needs.

Conclusion

The findings of this study provide guideposts for further research about factors that contribute to satisfaction of families receiving waiver services for quality of life and child progress.
Long‐Term Weight Trajectory and Risk of Hip Fracture, Falls, Impaired Physical Function, and Death
Authors: LeBlanc Erin S. , Rizzo Joanne H. , Pedula Kathryn L. , Yaffe Kristine , Ensrud Kristine E. , Cauley Jane A. , Cawthon Peggy M. , Cummings Steven R. , Hillier Teresa A. ,   for the Study of Osteoporotic Fractures Research Group
Published: August 2018

Objectives

To determine the association between weight trajectory, health status, and mortality in older women.

Design

Cohort study.

Setting

Study of Osteoporotic Fractures.

Participants

Older community‐dwelling women (age: baseline (1986–88), mean 68, range 65–81; Year 20 (2006–08), mean 88, range 83–102 (N = 1,323)).

Measurements

Body weight measured repeatedly over 20 years (mean 8 times). Logistic and Cox proportional hazard models were used to evaluate whether 20‐year weight trajectory measures were associated with hip fracture, falls, physical performance, and mortality.

Results

In models adjusted for age, clinic, calcium use, Year 20 weight, walking speed, comorbidity score, smoking, self‐reported health, and walking for exercise, women with moderate weight loss (>9.0 kg) over 20 years had a 74% greater risk of death (hazard ratio (HR) = 1.74, 95% confidence interval (CI) = 1.37–2.20) in the 5 years after the Year 20 visit than those with no weight loss and more than twice the risk of hip fracture (HR = 2.56, 95% CI = 1.39–4.70). They were 3.6 times (odds ratio (OR) = 3.60, 95% CI = 1.86–6.95) as likely to have poor physical function at the Year 20 visit as women with no weight loss but no greater risk of 2 or more falls in the 1.5 years after the Year 20 visit. Weight variability and abrupt weight decline were not associated with adverse health oucomes (falls, fractures, mortality), but those in the highest quartile of variability were 2.3 times (OR = 2.26, 95% CI = 1.34–3.80) as likely to have poor physical function scores.

Conclusion

In women surviving past 80 years of age, moderate weight loss over 20 years was associated with greater risk of hip fracture, poor physical function, and mortality but not of falls. Future work should separate voluntary from involuntary weight loss.
Manganese causes neurotoxic iron accumulation via translational repression of amyloid precursor protein and H‐Ferritin
Authors: Venkataramani Vivek , Doeppner Thorsten R. , Willkommen Desiree , Cahill Catherine M. , Xin Yongjuan , Ye Guilin , Liu Yanyan , Southon Adam , Aron Allegra , Au‐Yeung Ho Yu , Huang Xudong , Lahiri Debomoy K. , Wang Fudi , Bush Ashley I. , Wulf Gerald G. , Ströbel Philipp , Michalke Bernhard , Rogers Jack T.
Published: August 2018

For more than 150 years, it is known that occupational overexposure of manganese (Mn) causes movement disorders resembling Parkinson's disease (PD) and PD‐like syndromes. However, the mechanisms of Mn toxicity are still poorly understood. Here, we demonstrate that Mn dose‐ and time‐dependently blocks the protein translation of amyloid precursor protein (APP) and heavy‐chain Ferritin (H‐Ferritin), both iron homeostatic proteins with neuroprotective features. APP and H‐Ferritin are post‐transcriptionally regulated by iron responsive proteins, which bind to homologous iron responsive elements (IREs) located in the 5′‐untranslated regions (5′‐UTRs) within their mRNA transcripts. Using reporter assays, we demonstrate that Mn exposure repressed the 5′‐UTR‐activity of APP and H‐Ferritin, presumably via increased iron responsive proteins‐iron responsive elements binding, ultimately blocking their protein translation. Using two specific Fe2+‐specific probes (RhoNox‐1 and IP‐1) and ion chromatography inductively coupled plasma mass spectrometry (IC‐ICP‐MS), we show that loss of the protective axis of APP and H‐Ferritin resulted in unchecked accumulation of redox‐active ferrous iron (Fe2+) fueling neurotoxic oxidative stress. Enforced APP expression partially attenuated Mn‐induced generation of cellular and lipid reactive oxygen species and neurotoxicity. Lastly, we could validate the Mn‐mediated suppression of APP and H‐Ferritin in two rodent in vivo models (C57BL6/N mice and RjHan:SD rats) mimicking acute and chronic Mn exposure. Together, these results suggest that Mn‐induced neurotoxicity is partly attributable to the translational inhibition of APP and H‐Ferritin resulting in impaired iron metabolism and exacerbated neurotoxic oxidative stress.

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Presidential Address: Pension Policy and the Financial System
Authors: SCHARFSTEIN DAVID S.
Published: August 2018

In this paper, I examine the effect of pension policy on the structure of financial systems around the world. In particular, I explore the hypothesis that policies that promote pension savings also promote the development of capital markets. I present a model that endogenizes the extent to which savings are intermediated through banks or capital markets, and derive implications for corporate finance, household finance, banking, and the size of the financial sector. I then present a number of facts that are broadly consistent with the theory and examine a variety of alternative explanations of my findings.