bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Onset Scoliosis: Is there an Improvement in Quality of Life With Conversion From Traditional Growing Rods to Magnetically Controlled Growing Rods?
Authors: Bauer Jennifer M. , Yorgova Petya , Neiss Geraldine , Rogers Kenneth , Sturm Peter F. , Sponseller Paul D. , Luhmann Scott , Pawelek Jeff B. , Shah Suken A.
Published: November 2018

Background:

Modern treatment of early onset scoliosis (EOS) includes implantation of traditional growing rods (TGR) or magnetically controlled growing rods (MCGR) for posterior-based distraction if nonoperative treatment plans failed. The recent MCGR innovation has largely been expected to improve patient and family burden by avoiding frequent return to the operating room. At least one study has shown no HRQoL difference between TGR and MCGR, but none have specifically investigated a cohort of conversion patients whose families have experienced both.

Methods:

An EOS database was queried for all patients treated with TGR, MCGR, and those converted from TGR to MCGR who had at least 1 pretreatment and 1 posttreatment HRQoL assessment (EOSQ-24). Data on demographics, diagnoses, and major curve size, as well as EOSQ-24 domain scores were studied.

Results:

There were 156 TGR, 114 MCGR, and 32 conversion patients, with an average of 2.0 years between first and final EOSQ-24 surveys. There was no significant difference in outcome in any EOSQ-24 domain between the converts and the other 2 treatment groups. There was a significant post-op improvement in MCGR versus TGR in transfers and energy level (P=0.01;P=0.01).

Conclusions:

Although patient families and their surgeons may subjectively report improved HRQoL after conversion from TGR lengthenings to in-office MCGR lengthenings, these improvements were seen in transfer and fatigue domains, not burden or satisfaction. Although the EOSQ-24 is a well-validated EOS metric, it may not be sensitive enough to overcome the QoL floor-effect associated with the diagnosis itself, or perhaps the improvement in QoL must be assessed over a longer interval to assess meaningful change.

Level of Evidence:

Level III—retrospective comparative study.
Using Nursing Information and Data Mining to Explore the Factors That Predict Pressure Injuries for Patients at the End of Life
Authors: Li Hsiu-Lan , Lin Shih-Wei , Hwang Yi-Ting
Published: November 2018

This study investigated the association between patient characteristics and the occurrence of pressure injuries for patients at the end of life. A retrospective study was conducted using data collected from 2062 patients at the end of life between January 2007 and October 2015. In addition to demographic data and pressure injury risk assessment scale scores, injury history, disease type, and length of hospitalization were revealed as the major independent variables for predicting the occurrence of pressure injuries. Both χ
2 tests and t tests were employed for binary variable analysis, and logistic regression was used to conduct multivariate analysis. Classification models were formulated through decision tree analysis, backpropagation neural network, and support vector machine algorithms. The rules obtained using the decision tree algorithm were analyzed and interpreted. The accuracy rate, sensitivity, and specificity of the decision tree, backpropagation neural network, and support vector machine algorithms were 77.15%, 79.54%, and 74.76%; 78.12%, 81.37%, and 74.85%; and 79.32%, 81.03%, and 78.75%, respectively. The predictive factors, ranked in order of importance, were history of pressure injuries, without cancer, excretion, activity/mobility, and skin condition/circulation. These were the primary shared risk factors among the four models used in this study.
Melatonin Attenuates Cardiac Reperfusion Stress by Improving OPA1-Related Mitochondrial Fusion in a Yap–Hippo Pathway–Dependent Manner
Authors: Ma Shuxian , Dong Zhenming
Published: November 2018

The role of OPA1-related mitochondrial fusion in cardiac reperfusion stress has remained elusive. The aim of our study is to explore whether melatonin alleviates cardiac ischemia-reperfusion (IR) injury by modulating OPA1-related mitochondrial fusion. We found that melatonin reduced infarct area, sustained myocardial function, and suppressed cardiomyocyte death during cardiac reperfusion stress. Biological studies have revealed that IR-inhibited mitochondrial fusion was largely reversed by melatonin through upregulated OPA1 expression. Knocking down OPA1 abrogated the protective effects of melatonin on mitochondrial energy metabolism and mitochondrial apoptosis. In addition, we also found that melatonin modified OPA1 expression through the Yap–Hippo pathway; blockade of the Yap–Hippo pathway induced cardiomyocyte death and mitochondrial damage despite treatment with melatonin. Altogether, our data demonstrated that cardiac IR injury is closely associated with defective OPA1-related mitochondrial fusion. Melatonin supplementation enhances OPA1-related mitochondrial fusion by activating the Yap–Hippo pathway, ultimately reducing cardiac reperfusion stress.
Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions
Authors: Allen Brandon R. , Simpson Grant G. , Zeinali Ideen , Freitas Jared T. , Chapa Jeffrey J. , Rawson Liam J. , Richter Julie A. , Payton Thomas F. , Tyndall Joseph Adrian
Published: November 2018

Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-risk chest pain decision pathway, using a retrospective observational pre/post study design with the objective of safely lowering admissions. The modified HEART score calculation tool was incorporated in our electronic medical record. A significant increase in discharges of low-risk chest pain patients (relative increase of 21%; p < 0.0001) in the postimplementation period was observed with no significant difference in the rates of major adverse cardiac events between the pre and post periods. There was a decrease in the amount of return admissions for 30 days (4.65% fewer; p = 0.009) and 60 days (3.78% fewer; p = 0.020). No significant difference in length of stay was observed for patients who were ultimately discharged. A 64% decrease in monthly coronary computed tomography angiograms was observed in the post period (p < 0.0001). These findings support the growing consensus in the literature that the adoption of the HEART pathway or similar protocols in emergency departments, including at large and high-volume medical institutions, can substantially benefit patient care and reduce associated health care costs.
Are Prior Aspirin Users With ST-Elevation Myocardial Infarction at Increased Risk of Adverse Events and Worse Angiographic Features?
Authors: Geraiely Babak , Poorhosseini Hamidreza , Sadeghian Saeed , Sattarzadeh Badkoubeh Roya , Mortazavi Seyedeh Hamideh
Published: November 2018

Despite its clinical benefits, aspirin has been considered one of the predictors of worse outcomes in patients with unstable angina/non–ST-segment-elevation myocardial infarction. Nevertheless, such association has not been demonstrated in patients with ST-elevation myocardial infarction (STEMI). Five hundred eighty-six STEMI patients undergoing primary percutaneous coronary intervention were evaluated including 116 prior aspirin users. Angiographic characteristics and 1-year major adverse cardiac events (MACE) were then compared between the 2 groups. Adjusted analysis showed that the prior aspirin users had a significantly higher rate of totally occluded infarct-related artery before primary percutaneous coronary intervention (odds ratio: 1.859; P = 0.019). Postprocedural Thrombolysis in Myocardial Infarction flow grade 3 was less often demonstrated in the prior aspirin users (odds ratio: 1.512; P = 0.059). Aspirin consumption was associated with increased long-term mortality and MACE. Prior aspirin users had higher rate of MACE and worse pre- and postprocedural angiographic features. We suppose that patients who develop STEMI despite long-term aspirin intake probably reflect more vulnerable pre-existing coronary plaques with more thrombogenicity, which could negatively affect long-term cardiovascular outcomes.
Bilateral Ulcerative Keratitis Associated With Afatinib Treatment for Non–Small-cell Lung Carcinoma
Authors: McKelvie James , McLintock Cameron , Elalfy Mohamed
Published: November 2018

Purpose:

To report a case of afatinib-related bilateral ulcerative keratitis.

Methods:

An 85-year-old female patient on treatment with afatinib for non–small-cell lung carcinoma presented with progressive redness, pain, and decreased vision in both eyes. Four weeks before the onset of symptoms, afatinib therapy had been commenced at a dose of 40 mg, once daily. Clinical examination, OCT imaging, photographs, and corneal scrapes were completed at presentation. Afatinib was discontinued. Topical and oral therapy were commenced to treat ulcerative keratitis with close monitoring for signs of progression or corneal perforation.

Results:

Significant stromal thinning was detected in the inferior cornea of both eyes with an overlying epithelial defect and no infiltrate. No organisms were identified from the corneal scrapes. The patient responded well to treatment, and her vision returned to baseline 4 months after presentation.

Conclusions:

To the best of our knowledge, this is the first case in the literature that reports afatinib-related ulcerative keratitis. Careful monitoring for signs of ocular adverse events is recommended during treatment with afatinib for non–small-cell lung carcinoma.
Pertussis Morbidity in Children 12–59 Months of Age
Authors: Staff Michael , Nyinawingeri Adelaide , Denniss Kathy , Ingleton Andrew , Jelfs Jane , Corben Paul
Published: November 2018

Background:

Pertussis continues to be a significant public health problem despite high levels of vaccination. Although hospitalizations and deaths among children greater than 12 months of age are much less frequent than among infants less than 6 months of age, only limited information is available for this age group on other measures of morbidity.

Methods:

A cross-sectional study with a 6-week follow-up component was conducted in New South Wales, Australia in 2017 to measure morbidity among children 12–59 months of age notified to health authorities. Measures used included cough duration, cough severity, constitutional symptoms and impacts on the family. Associations between these outcomes and age group, vaccination status, asthma, treatment and family structure were explored.

Results:

Three hundred and five of 472 (65%) notified cases were interviewed at baseline with approximately 20% having a severe cough with no trend in prevalence across age groups. Forty-eight percent of cases had experienced 3 or more constitutional symptoms with rates significantly higher among younger children. Children who had received an 18-month booster vaccination were significantly less likely to experience 3 or more constitutional symptoms (odds ratio: 0.46, 95% confidence interval: 0.22–0.97). Fifty-one percent of cases were still coughing at 6 weeks. One-third of carers initially reported having disrupted sleep 4 or more nights per week with substantial disruption to carers’ sleep still recorded at 6 weeks.

Conclusions:

Substantial morbidity was observed in this age group with some evidence that the reintroduction of an 18-month acellular pertussis booster lessened disease severity.
Compromised Growth Among HIV-exposed Uninfected Compared With Unexposed Children in Nigeria
Authors: Jumare Jibreel , Datong Pam , Osawe Sophia , Okolo Felicia , Mohammed Sikiratu , Inyang Bukola , Abimiku Alash’le
Published: November 2018

Background:

HIV-exposed but uninfected (HEU) children may be at an increased risk of impaired growth when compared with their HIV-unexposed and uninfected (HUU) counterparts. We compared the growth patterns of HEU to HUU children in Nigeria.

Methods:

Pregnant women with and without HIV infection were enrolled at the Plateau State Specialist Hospital, Jos, Nigeria. Infants born to these mothers were recruited at birth and the mother–infant pairs followed up for 18 months. Weight, length and head circumference of the infants were measured at each visit. Age- and sex-standardized Z scores were generated for each anthropometric measure using the World Health Organization Child Growth Standards. Children with length-for-age, weight-for-age and weight-for-length Z scores <−2 were classified as stunted, underweight and wasted, respectively.

Results:

Of 415 children (307 HEU and 108 HUU) recruited for this study, 117 (28.4%), 9 (2.2%) and 32 (7.8%) infants were stunted, underweight and wasted, respectively, at birth. In a multivariable longitudinal analysis, the odds of stunting were higher among HEU as compared with HUU children [adjusted odds ratio: 2.4 (95% confidence interval: 1.4–4.1)]. Similarly, odds of being underweight were higher among the HEU children [adjusted odds ratio: 1.6 (95% confidence interval: 1.1–2.2)].

Conclusions:

Linear and ponderal growth were more impaired among HEU as compared with HUU children in Nigeria during the first 18 months of life. Further studies are needed to explore the causal basis for these differences.
Prosthetic Knee Selection for Individuals with Unilateral Transfemoral Amputation: A Clinical Practice Guideline
Authors: Stevens Phillip M. , Wurdeman Shane R.
Published: November 2018

Introduction

This guideline was developed to present the evidence and provide clinical recommendations on prosthetic knee selection for unilateral amputation at the knee disarticulation or transfemoral level.

Methods

The guideline is based upon the best available evidence as it relates to prosthetic knee selection after unilateral knee disarticulation or transfemoral amputation. Recommendations are drawn from systematic review, meta-analysis, and additional published practice guidelines.

Results

Recommendation 1. Fluid knee benefits and indications: Knees with hydraulic or pneumatic swing resistance are indicated for active walkers, permitting increased walking comfort, speed, and symmetry.

Recommendation 2. Microprocessor knee benefits: Compared with nonmicroprocessor knees:

a) With respect to self-report indices and measures, microprocessor knees are indicated to reduce stumbles, falls, and associated frustrations as well as the cognitive demands of ambulation.

b) With respect to self-report indices and measures, microprocessor knees are indicated to increase confidence while walking, self-reported mobility, satisfaction, well-being, and quality of life.

c) With respect to physical performance indices and measures, microprocessor knees are indicated to increase self-selected walking speed, walking speed on uneven terrain, and metabolic efficiency during gait.

Recommendation 3. Microprocessor knee equivalence: Given the comparable values observed with the use of microprocessor and nonmicroprocessor knees with regard to daily step counts, temporal and spatial gait symmetry, self-reported general health, and total costs of prosthetic rehabilitation, these parameters may not be primary indications in prosthetic knee joint selection.

Recommendation 4. Microprocessor knees for limited community ambulators: Among limited community ambulators, microprocessor knees are indicated to enable increases in level ground walking speed and walking speed on uneven terrain while substantially reducing uncontrolled falls and increasing both measured and perceived balance.

Conclusions

These clinical practice guidelines summarize the available evidence related to prosthetic knee selection for individuals with unilateral knee disarticulation or transfemoral amputation. The noted clinical practice guidelines are meant to serve on as "guides." They may not apply to all patients and clinical situations.
Practical Management: Brief Physical Examination for Sport-Related Concussion in the Outpatient Setting
Authors: Haider Mohammad N. , Leddy John J. , Du William , J. Macfarlane Alexander , Viera Kaitlin B. , Willer Barry S.
Published: November 2018

This article presents a brief, focused physical examination [PE, the Buffalo Concussion Physical Examination (BCPE)] for sport-related concussion (SRC) to be considered for use in the outpatient setting by sports medicine physicians, pediatricians, and primary-care physicians. This companion paper describes how to perform the PE, which was derived in a separate study presented in this journal. It is envisioned for use at the initial and follow-up outpatient visits both for acute concussions and in patients with prolonged symptoms. A pertinent PE, combined with other assessments, can help identify specific treatment targets in those with persistent symptoms after SRC. The BCPE includes orthostatic vital signs and examinations of the cranial nerves, oculomotor/ophthalmologic, cervical, and vestibular systems. Supplementary tests, including testing for exercise tolerance and neurocognitive function, may be performed if indicated. It is recommended that a PE be performed at the initial visit and every 1 to 2 weeks after SRC. On return of symptoms, cognition, and the PE to baseline, as well as normalization of any supplementary tests, patients can begin a return to play program.
Central control of gastrointestinal motility
Authors: Browning Kirsteen N. , Travagli R. Alberto
Published: November 2018

Purpose of review

This review summarizes the organization and structure of vagal neurocircuits controlling the upper gastrointestinal tract, and more recent studies investigating their role in the regulation of gastric motility under physiological, as well as pathophysiological, conditions.

Recent findings

Vagal neurocircuits regulating gastric functions are highly plastic, and open to modulation by a variety of inputs, both peripheral and central. Recent research in the fields of obesity, development, stress, and neurological disorders highlight the importance of central inputs onto these brainstem neurocircuits in the regulation of gastric motility.

Recognition of the pivotal role that the central nervous system exerts in the regulation, integration, and modulation of gastric motility should serve to encourage research into central mechanisms regulating peripheral motility disorders.
Hospital Physician Engagement
Authors: Perreira Tyrone A. , Perrier Laure , Prokopy Melissa
Published: November 2018

Background:

Literature on health system transformation highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. “Engagement” in health care is often defined as a positive, fulfilling work-related state of mind, which is characterized by vigor, dedication and absorption. The aim of this scoping review is to identify factors associated with, and tools used to measure physician engagement.

Methods:

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and gray literature were searched. Supplementary articles were obtained by searching article references. All quantitative and qualitative study designs were eligible that described factors associated with, and tools used to measure, hospital physician engagement. Quantitative and qualitative analyses were conducted. Groupings and clustering were conducted to determine dominant groups or cluster of characteristics. Conceptual mapping was then conducted to identify patterns.

Results:

A total of 15 studies fulfilled the eligibility criteria. All were published between 2012 and 2017. Studies were predominantly conducted in Germany (n=8). Factors associated with physician engagement were synthesized into individual characteristics (n=7), work environment characteristics (n=7), and work outcomes (n=5). The Utrecht Work Engagement Scale was the most commonly used tool (n=14).

Conclusions:

This scoping review provides a strong evidence-based platform to further advance knowledge in the area of physician engagement. The identification of environmental factors assists hospital administrative leaders in understanding how they might intervene to affect engagement, while the identification of individual characteristics enable identification of vulnerable physicians, permitting identification of the most pertinent targeted areas for focus.
Nursing Professional Development’s Spirit of Inquiry Focus Areas
Authors: Harper Mary G. , Warren Joan I. , Bradley Dora , Bindon Susan L. , Maloney Patsy
Published: November 2018

An Association for Nursing Professional Development (ANPD) task force was charged with redesigning the association’s small research grant process. One step in this process included identifying focus areas for the specialty’s spirit of inquiry. Using input from a round table discussion with ANPD annual convention attendees, the Journal for Nurses in Professional Development Editorial Board, and the convention evaluation query, 10 spirit of inquiry focus areas were identified that align with the Nursing Professional Development Practice Model.
Papillary Adenomas and Other Small Epithelial Tumors in the Kidney
Authors: Caliò Anna , Warfel Kathleen A. , Eble John N.
Published: November 2018

The aim of this work was to study small neoplasms of the epithelium of the renal tubules; kidneys from 402 unselected autopsies were sectioned at 1 to 2 mm intervals. All lesions were examined histologically. A total of 232 papillary adenomas were found in 76 patients (19%), ranging from 1 to 35 adenomas/patient (mean: 3, median: 2). Patients with papillary adenomas were older (range: 27 to 90 y) (P<0.0001), more commonly smokers (P=0.01), and more frequently had glomerulosclerosis (P=0.0001) than those without. Papillary adenomas ranged in size from 0.5 to 5 mm (mean: 1.4, median: 1) and were morphologically classified in 4 subtypes. Type A adenomas consisting of papillae and/or tubules covered by cells with scant cytoplasm, often with psammoma bodies, were the most common (149 adenomas). In 30, the papillae were broad with lymphocytes in the cores (type B). Thirty were more cystic lined by columnar cells and contained macrophages and psammoma bodies (type C). Sixteen were composed of large eosinophilic cells with pseudostratified nuclei, occasionally near the apical membrane (type D). Four were unclassified. Mixtures of types were observed only once (3 adenomas in one patient, each composed of a mixture of types B and D). Other epithelial lesions included 31 adrenal rests, 5 oncocytomas, 2 clear cell papillary renal cell carcinomas, 2 tubulocystic renal cell carcinomas, and 2 acquired cystic disease–associated renal cell carcinomas. In conclusion, papillary adenoma was the most common small epithelial neoplasm. The first type of papillary adenoma (type A) closely resembles papillary renal cell carcinoma, type 1, and the fourth (type D) resembles type 2. No other type of renal cell neoplasm was found (including clear cell renal cell carcinoma and chromophobe renal cell carcinoma). No nephrogenic rest was found. Angiomyolipomas and renomedullary interstitial cell tumors were found, and these findings have been reported in earlier papers.
A Diagnostic Algorithm That Combines Quantitative 18F-FDG PET Parameters and Contrast-Enhanced CT Improves Posttherapeutic Locoregional Restaging and Prognostication of Survival in Patients With Esophageal Cancer
Authors: Tamandl Dietmar , Fueger Barbara , Haug Alexander , Schmid Rainer , Stift Judith , Schoppmann Sebastian F. , Ilhan-Mutlu Aysegül , Ba-Ssalamah Ahmed
Published: November 2018

Purpose

The aim of this study was to determine whether the combination of contrast-enhanced CT (CE-CT) and quantitative 18F-FDG PET parameters improves locoregional restaging in esophageal cancer (EC) after neoadjuvant therapy.

Methods

Eighty-eight consecutive patients with locally advanced esophageal cancer, who underwent restaging after neoadjuvant chemotherapy or chemoradiotherapy before esophagectomy, were included in this retrospective study. The diagnostic accuracy of CE-CT, visual 18F-FDG PET/CT (vPET/CT), and quantitative PET parameters was assessed for T and N staging. Histopathology was used as the reference standard. The prognostic value for recurrence-free survival, cancer-specific survival, and overall survival was assessed using Cox regression analysis.

Results

Sensitivity, positive predictive value, and accuracy were 78.8%, 70.2%, and 59.0% (CE-CT), and 81.1%, 81.1%, and 68.2% (vPET/CT) for T staging as well as 59.5%, 75.9%, and 50.0% (CE-CT), and 70.2%, 93.7%, and 67.0% (vPET/CT) for N staging, respectively. Tumor length and metabolic tumor volume (MTV) exhibited an incremental increase with advancing T stages (P = 0.002 and 0.038). Contrast-enhanced CT had the highest sensitivity to differentiate advanced T stages (T3/4 vs 0–2; area under the receiver operating curve [AUC], 0.86; P < 0.001), whereas MTV at a threshold of 5.8 mL had the highest sensitivity to detect complete response (T0 vs 1–4; AUC, 0.77; P = 0.002). Contrast-enhanced CT and MTV combined had an even superior accuracy to predict complete response (AUC, 0.82; P < 0.001). The imaging American Joint Committee on Cancer stage provided a better prognostication of recurrence-free survival, cancer-specific survival, and overall survival than either T stage, N stage derived from CE-CT or vPET/CT, or quantitative PET parameters alone.

Conclusions

Combined CE-CT and MTV had the highest diagnostic accuracy to identify the posttherapeutic T stage, allowing for robust prediction of recurrence and survival.
An Easy and Sensitive Method to Profile the Antibody Specificities of HLA–specific Memory B Cells
Authors: Karahan Gonca E. , Krop Juliette , Wehmeier Caroline , de Vaal Yvonne J.H. , Langerak–Langerak Janneke , Roelen Dave L. , Lardy Neubury M. , Bemelman Frederike J. , ten Berge Ineke J.M. , Reinders Marlies E.J. , van Kooten Cees , Claas Frans H.J. , Heidt Sebastiaan
Published: November 2018

Background.

Pretransplant immunological risk assessment is currently based on donor–specific HLA antibodies in serum. Despite being an excellent source for antibodies produced by bone marrow–residing plasma cells, serum analysis does not provide information on the memory B–cell compartment. Although B–cell culture supernatants can be used to detect memory B cell–derived HLA antibodies, low IgG concentrations can preclude detectability of HLA antibodies in luminex single–antigen bead (SAB) assays.

Methods.

Culture supernatants of polyclonally activated B cells from alloantigen exposed (n = 13) or nonexposed (n = 10) individuals were either concentrated 10–fold, or IgG was isolated by using a protein G affinity purification method to increase the IgG concentration. These processed culture supernatants, as well as paired serum samples were tested for the presence of HLA antibodies using luminex SAB analysis.

Results.

In immunized individuals, 64% were found to have HLA–specific B–cell memory in concentrated supernatants, whereas 82% showed HLA–specific B–cell memory when IgG isolated supernatants were used for HLA antibody detection. IgG–isolated supernatants showed higher mean fluorescence intensity values compared with concentrated supernatants without increased background. In some individuals, HLA–specific B–cell memory was detected in the absence of accompanying serum antibody specificities.

Conclusions.

We developed a novel, highly sensitive method to assess the HLA–specific memory B–cell compartment using luminex SAB technology. This assay allows direct comparison to the serum compartment and may therefore provide a more complete picture of the humoral alloimmune response in patients with a history of alloantigen exposure.
Update on obstructive sleep apnea for neuro-ophthalmology
Authors: Fraser Clare L.
Published: November 2018

Purpose of review

Obstructive sleep apnea (OSA) is increasing in prevalence. The intermittent hypoxia of OSA has wide-ranging effects on a patient's general health outcomes. However, gold-standard investigations and treatment are expensive and a significant burden on patients. Therefore, OSA research remains focused on improving the means of diagnosing and treating OSA, in high-risk-associated conditions. This review is to provide an update on the advances in the field of OSA.

Recent findings

There has been recent debate about the best practice for diagnosis and treatment of OSA. Further work has been done on conditions associated with OSA including hypertension, atherosclerosis, various types of dementia and intracranial aneurysms. Inflammatory and vascular risk factors associated with OSA increase stroke risk and alter outcomes for recovery. OSA should definitely be considered in patients presenting with nonarteritic anterior ischemic optic neuropathy, and perhaps those with intracranial hypertension.

Newer home-based sleep-apnea testing can be implemented via physician clinics, with oversight by a certified sleep physician. Although continuous positive airway pressure (CPAP) is the gold-standard, management should include diet and exercise. It is important to test for, and treat OSA in patients with a range of neurological diseases. However, further studies into the long-term impact of CPAP on health outcomes are still needed.
Analysis of Movement-Related Beta Oscillations in the Off-Medication State During Subthalamic Nucleus Deep Brain Stimulation Surgery
Authors: Kochanski Ryan B. , Shils Jay , Verhagen Metman Leo , Pal Gian , Sani Sepehr
Published: November 2018

Purpose:

Local field potential recordings from deep brain stimulation (DBS) leads provide insight into the pathophysiology of Parkinson disease (PD). We recorded local field potential activity from DBS leads within the subthalamic nucleus in patients with PD undergoing DBS surgery to identify reproducible pathophysiological signatures of the disease.

Methods:

Local field potentials were recorded in 11 hemispheres from patients with PD undergoing subthalamic nucleus-DBS. Bipolar recordings were performed off medication for 2 minutes at rest and another 2 minutes with continuous repetitive opening–closing of the contralateral hand. Spectral analysis and bicoherence were performed and compared between the two testing conditions.

Results:

In all hemispheres, predominance of the beta band frequency (13–30 Hz) was observed at rest and during movement. Beta peak energy was significantly (P < 0.05) increased during movement compared with rest in 6 of 10 hemispheres. Significant beta bicoherence was observed at rest and during movement in 5 of 10 hemispheres. The most robust local field potential recordings were observed at the DBS contact(s) independently chosen for programming in 9 of the 10 hemispheres.

Conclusions:

In patients with PD, beta activity that increases with repetitive movement may be a signature of the “off” medication state. These findings provide new data on beta oscillatory activity during the Parkinsonian “off” state that may help further define the local field potential signatures of PD.
Inverse Bayesian inference in swarming behaviour of soldier crabs
Authors: Gunji Yukio-Pegio , Murakami Hisashi , Tomaru Takenori , Basios Vasileios
Published: November 2018

Animals making a group sometimes approach and sometimes avoid a dense area of group mates, and that reveals the ambiguity of density preference. Although the ambiguity is not expressed by a simple deterministic local rule, it seems to be implemented by probabilistic inference that is based on Bayesian and inverse Bayesian inference. In particular, the inverse Bayesian process refers to perpetual changing of hypotheses. We here analyse a time series of swarming soldier crabs and show that they are employed to Bayesian and inverse Bayesian inference. Comparing simulation results with data of the real swarm, we show that the interpretation of the movement of soldier crabs which can be based on the inference can lead to the identification of a drastic phase shift-like transition of gathering and dispersing.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
Spatially localized structures in the Gray–Scott model
Authors: Gandhi Punit , Zelnik Yuval R. , Knobloch Edgar
Published: November 2018

Spatially localized structures in the one-dimensional Gray–Scott reaction–diffusion model are studied using a combination of numerical continuation techniques and weakly nonlinear theory, focusing on the regime in which the activator and substrate diffusivities are different but comparable. Localized states arise in three different ways: in a subcritical Turing instability present in this regime, and from folds in the branch of spatially periodic Turing states. They also arise from the fold of spatially uniform states. These three solution branches interconnect in complex ways. We use numerical continuation techniques to explore their global behaviour within a formulation of the model that has been used to describe dryland vegetation patterns on a flat terrain.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
Spiral wave initiation in excitable media
Authors: Zykov V. S.
Published: November 2018

Spiral waves represent an important example of dissipative structures observed in many distributed systems in chemistry, biology and physics. By definition, excitable media occupy a stationary resting state in the absence of external perturbations. However, a perturbation exceeding a threshold results in the initiation of an excitation wave propagating through the medium. These waves, in contrast to acoustic and optical ones, disappear at the medium's boundary or after a mutual collision, and the medium returns to the resting state. Nevertheless, an initiation of a rotating spiral wave results in a self-sustained activity. Such activity unexpectedly appearing in cardiac or neuronal tissues usually destroys their dynamics which results in life-threatening diseases. In this context, an understanding of possible scenarios of spiral wave initiation is of great theoretical importance with many practical applications.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
Numerical path integral calculation of the probability function and exit time: an application to non-gradient drift forces
Authors: Mora Fernando , Coullet Pierre , Rica Sergio , Tirapegui Enrique
Published: November 2018

We provide numerical solutions based on the path integral representation of stochastic processes for non-gradient drift Langevin forces in the presence of noise, to follow the temporal evolution of the probability density function and to compute exit times even for arbitrary noise. We compare the results with theoretical calculations, obtaining excellent agreement in the weak noise limit.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
From the Lugiato–Lefever equation to microresonator-based soliton Kerr frequency combs
Authors: Lugiato L. A. , Prati F. , Gorodetsky M. L. , Kippenberg T. J.
Published: November 2018

The model, that is usually called the Lugiato–Lefever equation (LLE), was introduced in 1987 with the aim of providing a paradigm for dissipative structure and pattern formation in nonlinear optics. This model, describing a driven, detuned and damped nonlinear Schroedinger equation, gives rise to dissipative spatial and temporal solitons. Recently, the rather idealized conditions, assumed in the LLE, have materialized in the form of continuous wave driven optical microresonators, with the discovery of temporal dissipative Kerr solitons (DKS). These experiments have revealed that the LLE is a perfect and exact description of Kerr frequency combs—first observed in 2007, i.e. 20 years after the original formulation of the LLE—and in particular describe soliton states. Observed to spontaneously form in Kerr frequency combs in crystalline microresonators in 2013, such DKS are preferred state of operation, offering coherent and broadband optical frequency combs, whose bandwidth can be extended exploiting soliton-induced broadening phenomena. Combined with the ability to miniaturize and integrate on-chip, microresonator-based soliton Kerr frequency combs have already found applications in self-referenced frequency combs, dual-comb spectroscopy, frequency synthesis, low noise microwave generation, laser frequency ranging, and astrophysical spectrometer calibration, and have the potential to make comb technology ubiquitous. As such, pattern formation in driven, dissipative nonlinear optical systems is becoming the central Physics of soliton micro-comb technology.

This article is part of the theme issue ‘Dissipative structures in matter out of equilibrium: from chemistry, photonics and biology (part 2)’.
Restoring memory by optogenetic synchronization of hippocampal oscillations in an Alzheimer’s disease mouse model
Authors: Giovannetti Eleonora Ambrad , Poll Stefanie , Justus Daniel , Kaneko Hiroshi , Fuhrmann Falko , Steffen Julia , Remy Stefan , Fuhrmann Martin
Published: November 2018

Disrupted neural oscillations are a feature of Alzheimer’s disease (AD). We observed reduced frequency of theta oscillations in the hippocampal local field potential (LFP) in a mouse model of beta-amyloidosis. By restoring the temporal organization of theta oscillations using LFP-guided closed-loop optogenetic stimulation of parvalbumin-positive interneurons, we could rescue memory deficits of APP/PS1 mice in the novel object recognition test.
A comprehensive study of metabolite genetics reveals strong pleiotropy and heterogeneity across time and context
Authors: Gallois Apolline , Mefford Joel , Ko Arthur , Vaysse Amaury , Laakso Markku , Zaitlen Noah , Pajukanta Päivi , Aschard Hugues
Published: November 2018

Genetic studies of metabolites have identified thousands of variants many of which are associated with downstream metabolic and obesogenic disorders. However, these studies have relied on univariate analyses, reducing power and limiting context specific understanding. Here we aim to provide an integrated perspective of the genetic basis of metabolites by leveraging the Finnish Metabolic Syndrome In Men (METSIM) cohort, a unique genetic resource which contains metabolic measurements across distinct timepoints as well as detailed information on statin usage. We increase effective sample size by an average of two-fold by applying the Covariates for Multi-phenotype Studies (CMS) approach, identifying 588 significant SNP-metabolite associations, including 248 novel associations. We further show that many of these SNPs are master metabolic regulators, balancing the relative proportion of dozens of metabolite levels. We then identify the first associations to changes in metabolic levels across time as well as evidence of genetic interaction with statin use. Finally, we show an overall decrease in genetic control of metabolic processes with age.
Prevalence of Soil Transmitted Helminthes (STHs)Among Pupils of Community Primary Schools in Nkpor and Mgbodohia, Obio/Akpor Local Government Area, Rivers State, Nigeria
Authors: Gboeloh LeBari Barine , Ndamzi Ike-Ihunwo Chikaire
Published: November 2018

Soil transmitted helminthes (STHs) are common public health concern among children in Sub saharan Africa. A study to determine the prevalence and intensity of these parasites among pupils of two primary schools in Nkpor and Mgbodohia communities, Obio/Akpor Local Government Area, Rivers State, Nigeria was conducted. The formo-ether concentration technique was used to concentrate and separate the eggs and cysts from the faeces. Out of 107 pupils (56males and 51 females) investigated, 81 (75.7 %) were positive for at least one gastrointestinal helminth. The parasites identified included Ascaris lumbricoide(58.0%), Hookworms(28.4%), Trichirus trichiura(13.6%) and A.lumbricoide + T. trichiura (6.3%). Ascaris lumbricoide was significantly (P<0.05) higher in prevalence than other parasites. Although more females (54.3%) were infected than males (45.7%), there was no significance(P>0.05) difference in the prevalence in relation to sex. Of the 44 males infected, 24(54.5%), 5 (11.4%), 13(29.5%) and 2(4.5%) haboured A. lumbricoide, T. trichiura, Hookworms and mixed infection (A. lumbricoide + T. trichiura) repectively. Out of the 37 females infected, 21 (56.8%), 3(8.1%), 10(27.0%) and 3(8.1%) haboured A. lumbricoide, T. trichiura, Hookworms and mixed infection (A. lumbricoide + T. trichiura) repectively. There was no significance difference in the prevalence of A. lumbricoide and Hookworms between males (54.5%) and females (56.8%). There was significant difference in prevalence among two major age groups (5-10years-45% and 11-15years-41.9%). Children within the age group of 16-20years had the least infection (9.9%). The intensities of A.lumbricoide, T.trichiura and hookworm were 246.5, 107.5 and 187 Epg respectively. The intensity of A. lumbricoide was significantly difference than other parasites identified.Soil transmited helminthes remain a public health concern among children in the study area. Provision of portable water, toilet facilities, good education on the epidemiology of STHs and regular de-worming will enhance control measures.
The association between weight at birth and breast cancer risk revisited using Mendelian randomisation
Authors: Kar Siddhartha P. , Andrulis Irene L. , Brenner Hermann , Burgess Stephen , Chang-Claude Jenny , Considine Daniel , Dörk Thilo , Evans D. Gareth R. , Gago-Domínguez Manuela , Giles Graham G. , Hartman Mikael , Huo Dezheng , Kaaks Rudolf , Li Jingmei , Lophatananon Artitaya , Margolin Sara , Milne Roger L. , Muir Kenneth R. , Olsson Håkan , Punie Kevin , Radice Paolo , Simard Jacques , Tamimi Rulla M. , Nieuwenhuysen Els Van , Wendt Camilla , Zheng Wei , Pharoah Paul D. P.
Published: November 2018

Observational studies suggest that higher birth weight (BW) is associated with increased risk of breast cancer in adult life. We conducted a two-sample Mendelian randomisation (MR) study to assess whether this association is causal. Sixty independent single nucleotide polymorphisms (SNPs) known to be associated at P < 5 × 10-8 with BW were used to construct (1) a 41-SNP instrumental variable (IV) for univariable MR after removing SNPs with pleiotropic associations with other breast cancer risk factors and (2) a 49-SNP IV for multivariable MR after filtering SNPs for data availability. BW predicted by the 41-SNP IV was not associated with overall breast cancer risk in inverse-variance weighted (IVW) univariable MR analysis of genetic association data from 122,977 breast cancer cases and 105,974 controls (odds ratio = 0.86 per 500 g higher BW; 95% confidence interval: 0.73—1.01). Sensitivity analyses using four alternative methods and three alternative IVs, including an IV with 59 of the 60 BW-associated SNPs, yielded similar results. Multivariable MR adjusting for the effects of the 49-SNP IV on birth length, adult height, adult body mass index, age at menarche, and age at menopause using IVW and MR-Egger methods provided estimates consistent with univariable analyses. Results were also similar when all analyses were repeated after restricting to estrogen receptor-positive or -negative breast cancer cases. Point estimates of the odds ratios from most analyses performed indicated an inverse relationship between genetically-predicted BW and breast cancer. Thus, there is little evidence from MR to suggest that the previously observed association between higher BW and increased risk of breast cancer in adult life is causal.
High-Resolution, Long-Term Trends in Relative Abundance from Spatial Modeling of Continent-Wide Bird Counts
Authors: Meehan Timothy D. , Michel Nicole L. , Rue Håvard
Published: November 2018

Continent-wide bird counts by community volunteers provide valuable information about the conservation needs of many bird species. The statistical modeling techniques commonly used to analyze these counts provide robust long-term trend estimates from heterogeneous community science data at regional, national, and continental scales. Here we present a novel modeling framework that increases the spatial resolution of trend estimates, and reduces the computational burden of trend estimation, each by an order of magnitude. We demonstrate the approach with data for the American Robin (Turdus migratorius) from Audubon Christmas Bird Counts conducted between 1966 and 2017, and show that aggregate regional trend estimates from the proposed method align well with those from the current standard method. Thus, it appears that the proposed technique can provide reasonable large-scale trend estimates for users concerned with general patterns, while also providing higher resolution estimates for others examining correlates of abundance trends at finer spatial scales.
A Phylogenomic Framework, Evolutionary Timeline, and Genomic Resources for Comparative Studies of Decapod Crustaceans
Authors: Wolfe Joanna M. , Breinholt Jesse W. , Crandall Keith A. , Lemmon Alan R. , Lemmon Emily Moriarty , Timm Laura E. , Siddall Mark E. , Bracken-Grissom Heather D.
Published: November 2018

Comprising over 15,000 living species, decapods (crabs, shrimp, and lobsters) are the most instantly recognizable crustaceans, representing a considerable global food source. Although decapod systematics have received much study, limitations of morphological and Sanger sequence data have yet to produce a consensus for higher-level relationships. Here we introduce a new anchored hybrid enrichment kit for decapod phylogenetics designed from genomic and transcriptomic sequences that we used to capture new high-throughput sequence data from 94 species, including 58 of 179 extant decapod families, and 11 of 12 major lineages. The enrichment kit yields 410 loci (>86,000 bp) conserved across all lineages of Decapoda, eight times more molecular data than any prior study. Phylogenomic analyses recover a robust decapod tree of life strongly supporting the monophyly of all infraorders, and monophyly of each of the reptant, ‘lobster’, and ‘crab’ groups, with some results supporting pleocyemate monophyly. We show that crown decapods diverged in the Late Ordovician and most crown lineages diverged in the Triassic-Jurassic, highlighting a cryptic Paleozoic history, and post-extinction diversification. New insights into decapod relationships provide a phylogenomic window into morphology and behavior, and a basis to rapidly and cheaply expand sampling in this economically and ecologically significant invertebrate clade.
Confidence predicts speed-accuracy tradeoff for subsequent decisions
Authors: Desender Kobe , Boldt Annika , Verguts Tom , Donner Tobias H.
Published: November 2018

When external feedback about decision outcomes is lacking, agents need to adapt their decision policies based on an internal estimate of the correctness of their choices (i.e., decision confidence). We hypothesized that agents use confidence to continuously update the tradeoff between the speed and accuracy of their decisions: When confidence is low in one decision, the agent needs more evidence before committing to a choice in the next decision, leading to slower but more accurate decisions. We tested this hypothesis by fitting a bounded accumulation decision model to behavioral data from three different perceptual choice tasks. Decision bounds indeed depended on the reported confidence on the previous trial, independent of objective accuracy. This increase in decision bound was predicted by a centro-parietal EEG component sensitive to confidence. We conclude that the brain uses internally computed confidence signals for the ongoing adjustment of decision policies.