bluuebunny/crossref_metadata_2025 huggingface dataset:
Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study
Authors: Fernandes Ana , Ribera-Sanchez Roi , Rodríguez-Carmona Ana , López-Iglesias Antía , Leite-Costa Natacha , Pérez Fontán Miguel
Published: June 2017

Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently. Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes. Main Results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics. Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.
Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans
Authors: Xue Yumei , Zhan Xianzhang , Wu Shulin , Wang Hongyue , Liu Yang , Liao Zili , Deng Hai , Duan Xuejing , Zeng Shaoying , Liang Dongpo , Elvan Arif , Fang Xianhong , Liao Hongtao , Ramdat Misier Anand R. , Smit Jaap Jan J. , Metzner Andreas , Heeger Christian-Hendrik , Liu Fangzhou , Wang Feng , Zhang Zhiwei , Kuck Karl-Heinz , Yen Ho Siew , Ouyang Feifan
Published: June 2017

Background—

Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication.

Methods and Results—

Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months.

Conclusions—

Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients.
Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing
Authors: Merchant Faisal M. , Hoskins Michael H. , Musat Dan L. , Prillinger Julie B. , Roberts Gregory J. , Nabutovsky Yelena , Mittal Suneet
Published: June 2017

Background—

Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB.

Methods and Results—

A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB. Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0–6 months) and chronic (6 months to 4 years) phases post–pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62–3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48–1.79;
P
<0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08–1.25;
P
<0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB.

Conclusions—

Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing.
Ischemic Stroke
Authors: Sporns Peter B. , Hanning Uta , Schwindt Wolfram , Velasco Aglaé , Minnerup Jens , Zoubi Tarek , Heindel Walter , Jeibmann Astrid , Niederstadt Thomas Ulrich
Published: June 2017

Background and Purpose—

The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke.

Methods—

Patients with occlusion of the carotid-T or middle cerebral artery who underwent thrombectomy at our university medical center between December 2013 and February 2016 were included. Samples were histologically analyzed (hematoxylin and eosin, Elastica van Gieson, and Prussian blue), additionally immunohistochemistry for CD3, CD20, and CD68/KiM1P was performed. These data, along with additional clinical and interventional parameters, were compared for different stroke subtypes, as defined by the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.

Results—

One hundred eighty-seven patients were included, of these, in 77 patients, cardioembolic; in 46 patients, noncardioembolic; and in 64 patients, cryptogenic pathogenesis was determined. Cardioembolic thrombi had higher proportions of fibrin/platelets (
P
=0.027), less erythrocytes (
P
=0.005), and more leucocytes (
P
=0.026) than noncardioembolic thrombi. We observed a strong overlap of cryptogenic strokes and cardioembolic strokes concerning thrombus histology. The immunohistochemical parameters CD3, CD20, and CD68/KiM1P showed no statistically noticeable differences between stroke subtypes.

Conclusions—

Histological thrombus features vary significantly according to the underlying cause and may help to differentiate between cardioembolic and noncardioembolic stroke. In addition, our study supports the hypothesis that most cryptogenic strokes have a cardioembolic cause.
Dose-Dependent Effect of Statin Pretreatment on Preventing the Periprocedural Complications of Carotid Artery Stenting
Authors: Hong Jeong-Ho , Sohn Sung-Il , Kwak Jaehyuk , Yoo Joonsang , Chang Hyuk Won , Kwon O-Ki , Jung Cheolkyu , Chung Inyoung , Bae Hee-Joon , Lee Ji Sung , Han Moon-Ku
Published: June 2017

Background and Purpose—

We investigated whether statin pretreatment can dose dependently reduce periprocedural complications in patients undergoing carotid artery stenting because of symptomatic carotid artery stenosis.

Methods—

We enrolled a consecutive series of 397 symptomatic carotid artery stenosis (≥50% stenosis on conventional angiography) treated with carotid artery stenting at 2 tertiary university hospitals over a decade. Definition of periprocedural complications included any stroke, myocardial infarction, and death within 1 month after or during the procedure. Statin pretreatment was divided into 3 categories according to the atorvastatin equivalent dose: none (n=158; 39.8%), standard dose (<40 mg of atorvastatin, n=155; 39.0%), and high dose (≥40 mg; n=84; 21.2%). A multivariable logistic regression analysis with the generalized estimating equation method was used to investigate independent factors in periprocedural complications.

Results—

The patients’ mean age was 68.7 years (81.6% men). The periprocedural complication rates across the 3 categories of statin use were 12.0%, 4.5%, and 1.2%. After adjustment, a change in the atorvastatin dose category was associated with reduction in the odds of periprocedural complications for each change in dose category (standard-dose statin: odds ratio, 0.24; 95% confidence interval, 0.07−0.81; high-dose statin: odds ratio, 0.11; 95% confidence interval, 0.01−0.96;
P
for trend=0.01). Administration of antiplatelet drugs was also an independent factor in periprocedural complications (OR, 0.18; 95% CI, 0.05−0.69).

Conclusions—

This study shows that statin pretreatment may reduce the incidence of periprocedural complications dose dependently in patients with symptomatic carotid artery stenting.
Early Reperfusion After Brain Ischemia Has Beneficial Effects Beyond Rescuing Neurons
Authors: Tachibana Masaki , Ago Tetsuro , Wakisaka Yoshinobu , Kuroda Junya , Shijo Masahiro , Yoshikawa Yoji , Komori Motohiro , Nishimura Ataru , Makihara Noriko , Nakamura Kuniyuki , Kitazono Takanari
Published: June 2017

Background and Purpose—

Recent studies show that successful endovascular thrombectomy 6 to 12 hours after stroke onset enhances functional outcomes 3 months later. In this study, we investigated the effects of reperfusion after ischemia on repair processes in the ischemic areas, as well as on functional recovery, using mouse stroke models.

Methods—

We examined time-dependent histological changes and functional recovery after transient middle cerebral artery occlusion of different durations, including permanent middle cerebral artery occlusion, using the CB-17 (CB-17/lcr-+/+Jcl) mouse strain, which has poor pial collateral blood flow.

Results—

Large microtubule-associated protein 2-negative areas of neuronal death were produced in mice subjected to ≥60 minutes of ischemia followed by reperfusion on day 1, while restricted microtubule-associated protein 2-negative regions were observed in mice subjected to a 45-minute period of ischemia. A substantial reduction in microtubule-associated protein 2-negative areas was observed on day 7 in mice given early reperfusion and was associated with better functional recovery. Klüver–Barrera staining demonstrated that white matter injury on day 1 was significantly lesser in mice with reperfusion. Immunohistochemistry and electron microscopy revealed that a greater number of endothelial cells were present in the infarct areas in mice with earlier reperfusion and were associated with a more rapid recruitment of platelet-derived growth factor receptor β-positive pericytes and subsequent intrainfarct fibrosis. Early reperfusion also resulted in a greater accumulation of glial fibrillary acidic protein–positive astrocytes in peri-infarct areas. Peri-infarct astrogliosis was attenuated in platelet-derived growth factor receptor β heterozygous knockout mice.

Conclusions—

Early reperfusion after ischemia enhances the survival of endothelial cells and pericytes within ischemic areas even after the infarct is established, resulting in efficient intrainfarct fibrosis and peri-infarct astrogliosis. These effects might be associated with efficient peri-infarct reorganization and functional recovery.
School Choice in Amsterdam: Which Schools are Chosen When School Choice is Free?
Authors: Ruijs Nienke , Oosterbeek Hessel
Published: June 2017

Using discrete choice models, this paper investigates the determinants of secondary school choice in the city of Amsterdam. In this city, there are many schools to choose from and school choice is virtually unrestricted (no catchment areas, low or no tuition fees, short distances). We find that school choice is related to exam grades and the quality of incoming students, but not to progression in lower grades, no delay in higher grades, and a composite measure of quality published by a national newspaper. Furthermore, students appear to prefer schools that are close to their home and schools that many of their former classmates in primary school attend.
Modeling the Immune System with Gestures: A Choreographic View of Embodiment in Science
Authors: Spiess Klaus , Strecker Lucie , Kimmel Michael , Martes Melanie , Pietschmann Peter
Published: June 2017

The authors describe a cross-disciplinary collaboration in which they apply both a qualitative/quantitative and a choreographic analysis to the gestures immunologists use when lecturing on immunity. They identify particular spatiotemporal features by which immunologists have mapped, embodied and blended the conceptual spaces of the molecular and cellular. The immunologists’ difficulties in integrating the differing spatiotemporal modes of observing and embodying revealed hidden policies in their concepts of immunity. The variety of modes, blending and cinematic techniques applied invite a closer cross-disciplinary look at the vivid visual scenario of gesturing in science and consideration of its potential for creating corporeal models of art and science.
The Entropic Envelope
Authors: Rodriguez Hector
Published: June 2017

This article introduces a computational model of the temporal experience of moving image sequences. The heart of the model, the concept of an entropic envelope, is based on information theoretic ideas. The concept is first described informally and then explained in a more mathematically precise manner. The article finally concludes with tentative reflections on the methodology of computation model building in cinema studies.
The larvae of the European Helicopsyche species (Trichoptera: Helicopsychidae)
Authors: WARINGER JOHANN , MALICKY HANS , ŽIVIĆ IVANA , VICENTINI HEINRICH
Published: June 2017

This synoptic paper gives descriptions of the hitherto unknown or poorly known larvae of Helicopsyche megalochari Malicky 1974 and H. revelieri McLachlan 1884 (Trichoptera: Helicopsychidae). We present information on the morphology of the larvae and illustrate the most important diagnostic features. This information is used for the construction of a comprehensive larval key to the five European species of family Helicopsychidae. In the context of this key, larvae can be easily diagnosed by setation patterns of the dorsal head capsule, submentum shape, and propleuron morphology. With respect to distribution, Helicopsyche megalochari has been reported from the Greek Islands of Andros, Euboea, Ikaria, and Naxos whereas H. revelieri is known from the islands of Capraia, Corsica, and Sardinia. In addition, ecological characteristics and distributions of the European species are briefly discussed.
A new species of Isthmura (Caudata: Plethodontidae) from the montane cloud forest of central Veracruz, Mexico
Authors: SANDOVAL-COMTE ADRIANA , PINEDA EDUARDO , ROVITO SEAN M. , LURÍA-MANZANO RICARDO
Published: June 2017

We describe a new plethodontid salamander species of the genus Isthmura, known only from one locality in the mountainous region of central Veracruz, Mexico. Like its congeners, Isthmura corrugata sp. nov. has a large and robust body, but it is easily distinguished from the other species in the genus by the absence of any spot or mark on the dorsum (except by dull reddish brown coloration on eyelids) and by extremely well-marked costal grooves separated by very pronounced costal folds. Based on an mtDNA phylogeny, the new species is most closely related to the geographically distant I. boneti and I. maxima but occurs very near I. naucampatepetl and I. gigantea on the eastern slope of Cofre de Perote, Veracruz. The region where I. corrugata occurs contains a high number of plethodontid salamander species and is threatened by human activity.
Trust and Patience after a Tornado
Authors: Shupp Robert , Loveridge Scott , Skidmore Mark , Lim Jungmin , Rogers Cynthia
Published: June 2017

This study examines how individuals’ trust levels and patience are affected by a tornado event. Affected and unaffected people were surveyed after a 2013 tornado in Moore, Oklahoma, that resulted in 24 fatalities. Findings suggest that those who self-identified as affected became more trusting in general as well as more trusting of police and fire authorities. Affected homeowners also exhibited less patience than their unaffected counterparts. The evaluation of differences in trust and patience enables us to learn about how underlying propensities to invest (or reinvest) in critical private and public infrastructure may be influenced by extreme events. Disasters alter trust levels and patience of affected residents, and documenting the direction and magnitude of these changes may help agencies involved in the recovery process.
Development of uni-stretch woven fabrics with zero and negative Poisson’s ratio
Authors: Zulifqar Adeel , Hua Tao , Hu Hong
Published: June 2017

Fabrics with zero or negative Poisson’s ratio are referred as auxetic fabrics, which have the unusual property of lateral expansion or zero expansion upon stretch. The use of conventional materials and machinery to produce auxetic fabrics has gained the interest of researchers in recent years. However, this approach is limited to knitted fabrics only. The development of auxetic fabric using conventional yarns and weaving technology is a research area that is still unaddressed. This paper reports a study on the development of a novel class of stretchable auxetic woven fabrics by using conventional yarns and weaving machinery. The phenomenon of differential shrinkage was successfully employed to realize auxetic geometries capable of inducing auxetic behavior in woven fabrics, and a series of auxetic woven fabrics were fabricated with elastic and non-elastic yarns and a dobby machine. The uni-axial tensile tests showed that auxetic woven fabrics developed exhibited zero or negative Poisson’s ratio over a wide range of longitudinal strain.
Pyrolysis mechanism and kinetic model of Mudanjiang oil shale in the Songliao Basin, China
Authors: Liu Dexun , Tang Shuheng , Zhao Qun , Wang Hongyan , Dong Dazhong , Wang Nan , Guo Wei , Liang Feng
Published: June 2017

In recent years, a lot of work on the development of oil shale has been done with regard to the Chinese oil shales. However, the research is mainly with respect to the processing aspects of oil shale. The pyrolysis mechanism of oil shale has been limited, to some extent, by instrumentation and analytical techniques. In this paper, pyrolysis kinetics characteristics of oil shale samples obtained from Mudanjiang were investigated by Rock-Eval analysis. The weight loss data, pyrolysis mechanism, and properties of oil shale were analyzed at different heating rates (10, 15, 20, 25, 30℃/min) in the temperature range from 200 to 600℃. In this paper, a distribution function of apparent activation energy and a relationship equation of apparent energy with frequency factor have been obtained. A special kinetic model was developed, fully suitable for the pyrolysis characteristics of oil shale. This model was also verified by experiment. Throughout the analysis of pyrolysis kinetics, it was observed that the pyrolysis reaction mechanism at different temperatures could be explained. The results may provide the theoretical basis for further effective and economical exploitation of oil shale.
Institutions, place leadership and public entrepreneurship: Reinterpreting the economic development of Nottingham
Authors: Rossiter Will , Smith David J
Published: June 2017

This paper develops a conceptual framework that draws on three discrete bodies of research: institutional perspectives on economic development, place leadership and public entrepreneurship. This framework is used to reinterpret the recent economic development of Nottingham (a second-tier regional city in the UK) with a particular focus on attempts to respond to the challenges of economic restructuring and deindustrialisation over the long term. Examples of public entrepreneurship are seen as forms of recursive agency through which institutions are established and reconstituted in ways that may facilitate adaptation and path creation in local economic development.
Sport as a complex adaptive system for place-based leadership: Comparing five European cities with different administrative and socio-cultural traditions
Authors: Budd Leslie , Sancino Alessandro , Pagani Michela , Kristmundsson Ómar , Roncevic Borut , Steiner Michael
Published: June 2017

This paper compares place-based leadership patterns of five European cities that have different administrative and socio-cultural traditions in order to understand the role that context plays in shaping city leadership patterns in the policy domain of sport. This paper uses an exploratory approach to analyse the city as a complex adaptive system. In pursuing this research, we investigate the main actors, structures, processes and followership patterns across different forms of city leadership (political, managerial, business and civic). Our findings show the similarities and the differences across the five cities that lead us to a two-part conclusion. First, context may or may not influence city leadership patterns but it remains an essential parameter in comparative analysis. Second, the main challenges for place-based leadership in the policy domain of sport appear generalisable and specifically we observe that civic leadership as praxis can reinforce the transformative nature of place-based leadership in developing and sustaining socio-economic resilience.
Shear-lag solution for excitation, sensing, and time reversal of Lamb waves for structural health monitoring
Authors: Kapuria Santosh , Agrahari Jitendra Kumar
Published: June 2017

An analytical solution is presented for excitation, forward propagation, sensing, and time reversal of Lamb waves, considering the shear-lag effect of the bonding layer between the piezoelectric patch transducers and the plate. Consistent shear-lag solutions for actuator–plate and plate–sensor interactions are developed, considering plane strain condition. The Lamb wave solution is obtained by transforming the interfacial shear stress distribution and wave equations into the wavenumber domain by applying the spatial Fourier transform and converting the same to the physical domain using the inverse Fourier transform and residue theorem. The time-domain response for an arbitrary excitation is obtained by applying the temporal Fourier transform to the excitation and using convolution integral. The solution is compared with the experimental and numerical results for both forward and time-reversal responses and also for the best reconstruction frequency. The effect of transducer mass on the accuracy of the response is investigated. Finally, the shear-lag effect on the time reversibility of the reconstructed signal is studied for varying adhesive layer thickness, transducer thickness, host plate thickness, and the tone burst count. The solution will be useful for designing structural health monitoring systems using both baseline-based and baseline-free methods.
Do checkpoint inhibitors rely on gut microbiota to fight cancer?
Authors: Firwana Belal , Avaritt Nathan , Shields Bradley , Ravilla Rahul , Makhoul Issam , Hutchins Laura , Tackett Alan J , Mahmoud Fade
Published: June 2017

The field of gut microbiota is of growing interest, especially in the recent discoveries of its interaction with host immune responses, which when disrupted, can further alter immunity. It also plays a role in cancer development, its microenvironment and response to anticancer therapeutics. Several recently published experimental studies had explored the efficacy of modifying microbiota to enhance the response of checkpoint inhibitors, suggesting its beneﬁcial function in cancer management and potential to be targeted as a therapeutic agent to enhance efficacy of checkpoint inhibitors. Here we review available evidence, mechanisms and hypotheses of its use to enhance cancer response.
Stereotype threat, anxiety, instructor gender, and underperformance in women
Authors: Kapitanoff Susan , Pandey Carol
Published: June 2017

Whatever their major, students are often required to take at least one course in statistics. After graduation, statistics is a key skill in numerous workplace settings. However, for many, it is a particularly difficult course. One factor that may play a role is the lingering misconception that women are not as good as men in mathematics subjects such as statistics. Belief in this gender stereotype can lead women to avoid taking this class and ultimately could contribute to their underrepresentation in many professions. Instructor gender may also be a factor that affects student performance. This study examined whether a female role model would reduce the detrimental effects of a gender/mathematics stereotype threat in women and improve their academic performance and retention rate. Several types of anxiety were measured to determine what aspects of anxiety might be most relevant to stereotype threat. For men, anxiety and performance were not related to the gender of their instructor or endorsement of the gender/mathematics stereotype. For women, mathematics anxiety and anxiety-about-the-specific-class were related to their endorsement of the stereotype. Having a female instructor initially led to higher rates of underperformance on the first examination among women as compared to men. Continued interaction with a female role model, however, reduced this deficit for women by the end of the semester. Understanding this process may help educators better prepare women for success in both academia and the professional world.
‘You just can’t do it all’: a secondary analysis of nurses' perceptions of teamwork, staffing and workload
Authors: Yanchus Nancy J , Ohler Lindsey , Crowe Emily , Teclaw Robert , Osatuke Katerine
Published: June 2017

The purpose of this study was to re-examine data to explore connections between nurses’ perceptions of teamwork, staffing and workload, focusing on salient aspects and connections, from the nurses’ perspective. Insufficient staffing levels and imbalanced workload distributions are prominent challenges in contemporary healthcare which can cause increased incident reports, medical errors and lower patient satisfaction. Using a novel form of secondary analysis – an original qualitative analysis followed by a quantification of the qualitative data, we found themes of teamwork, staffing and workload were interrelated in the data. When facing workload challenges created by understaffing, participants directly attributed their units’ ability to meet the needs of patient care to levels of teamwork on the unit. We suggest that teamwork in healthcare needs targeted organisational support. In other words, healthcare organisations must systematically approach and monitor the status of nursing teamwork, e.g. implement programmes to develop it as needed, particularly when faced with staffing and workload challenges. Healthcare leaders can learn from and the healthcare delivery workplace can be shaped by listening to teamwork perceptions of nurses.
Impact of age at diagnosis on disease progression in patients with primary sclerosing cholangitis
Authors: Rupp Christian , Rössler Alexander , Zhou Taotao , Rauber Conrad , Friedrich Kilian , Wannhoff Andreas , Weiss Karl‐Heinz , Sauer Peter , Schirmacher Peter , Süsal Caner , Stremmel Wolfgang , Gotthardt Daniel N
Published: June 2017

Background

The median age of diagnosis of primary sclerosing cholangitis (PSC) is ∼30–40 years.

Objective

We aimed to analyse disease progression and liver‐dependent survival in patients diagnosed with PSC after 50 years of age.

Methods

Patients with PSC were analysed with regard to their age at diagnosis. Patients with a first diagnosis of PSC after the age of 50 years were considered as the late‐onset group.

Results

A total of 32/215 (14.9%) patients were diagnosed with PSC after 50 years of age. The proportion of females was significantly higher among patients with late‐onset PSC (48.4 vs. 27.3%; p  = 0.02). Patients with later diagnosis required dilatation therapy more often due to dominant stenosis (84.2 vs. 53.1%; p  = 0.01) and suffered from recurrent cholangitis more often (48.3 vs. 21.0%; p  = 0.003). Patients with late‐onset PSC had reduced transplantation‐free survival (10.5 ± 0.6 years vs. 20.8 ± 1.7 years, p  < 0.0001), with progredient liver failure and cholangiocarcinoma as the leading causes of death.

Conclusions

Patients with later age at diagnosis of PSC displayed a different clinical phenotype with a different sex ratio, immune status and an increased risk for progressive liver failure and biliary malignancies.
The stability of the rare sodium antimonate, brizziite, and it's role in Sb mobility
Authors: Roper Adam J. , Leverett Peter , Murphy Timothy D. , Williams Peter A.
Published: June 2017

Synthesis and solubility studies of brizziite, NaSbO3, have been undertaken to determine the possible role of this rare secondary phase in the immobilization of Sb under supergene conditions and the conditions responsible for its formation in the supergene zone. Solubility studies were undertaken atT= 298.15 K. A value of ΔGfө) (NaSbO3, s, 298.15 K) = –806.66 ± 1.4 kJ mol–1was derived. Calculations involving tripuhyite, FeSbO4, byströmite, MgSb2O6, ordoñezite, ZnSb2O6and rosiaite, PbSb2O6, show that brizziite is a thermodynamically stable phase only at negligible activities of Pb2+(aq) at high pH and high salinity. Calculations involving mopungite Na[Sb(OH)6] combined with reported mineral associations suggest that mopungite is the thermodynamically unstable precursor to brizziite and its presence in natural settings must be due to kinetic stability. This explains why brizziite is such a rare secondary phase and therefore why it cannot exert any significant influence on the dispersion of Sb in the supergene environment.
Deposition conditions for the indium-bearing polymetallic quartz veins at Sarvlaxviken, south-eastern Finland
Authors: Broman C. , Sundblad K. , Valkama M. , Villar A.
Published: June 2017

Polymetallic quartz veins, with up to 1500 ppm indium, have been discovered recently in the Sarvlaxviken area within the 1.64 Ga anorogenic multiphase Wiborg rapakivi batholith and adjacent 1.90 Ga Svecofennian crust in SE Finland. Evidence from primary fluid inclusions in the Sarvlaxviken area provides new information on the hydrothermal transport and depositional processes of metals in anorogenic granites. Fluid inclusions with variable aqueous liquid and vapour proportions (5–90 vol.% vapour) occur in quartz, cassiterite and fluorite belonging to three generations of polymetallic quartz veins. Microthermometry indicates that the veins were deposited at temperatures that range from ~500°C down to <100°C and salinities from 0 to 16 eq. mass% NaCl. Fluid inclusion data show that the depositional conditions were similar regardless of vein generation. The interpreted depositional processes involve phase separation with a combination of condensation, cooling and boiling of an initially low-salinity (<3 eq. mass% NaCl) aqueous magmatic vapour phase enriched in CO2-F-Cl-S and metals. Fluid inclusions with low salinities dominate, but higher salinities are recorded in metal-rich parts of the veins. The turbulent fluid flow, with complex geometry and temperature-salinity patterns, may explain why sulfide and/or oxide opaque minerals occur irregularly, and are locally the dominating vein minerals, but disappear completely into barren parts of the quartz veins. All fluids are considered to have been generated by the F-rich Marviken granite (and related granite dykes), which show all geochemical criteria for an ore-fertile granite. The quartz veins investigated in the adjacent Svecofennian country rocks are considered to represent the very last stage of a fluid with similar characteristics to the fluid responsible for the ore formation in the Sarvlaxviken area, but that had cooled to <100°C.
Best proximity points for proximal contractive type mappings with C-class functions in S-metric spaces
Authors: Ansari Arslan Hojat , Nantadilok Jamnian
Published: June 2017

In this paper, we use the concept of C-class functions to establish the best proximity point results for a certain class of proximal contractive mappings in S-metric spaces. Our results extend and improve some known results in the literature. We give examples to analyze and support our main results.
Biofluid lipidome: a source for potential diagnostic biomarkers
Authors: Ghosh Arkasubhra , Nishtala Krishnatej
Published: June 2017

Lipidomics is the identification and quantitation of changes in the lipidome of a cell, tissue, organ or biofluid in health and disease using high resolution mass spectrometry. Lipidome of a particular organism has relevance to the disease manifestation as it reflects the metabolic changes which can be a consequence of the disease. Hence these changes in the molecules can be considered as potential markers for screening and early detection of the disease. Biological fluids as blood/serum/plasma, urine, saliva, tear and cerebrospinal fluid, due to their accessibility, offer ease of collection with minimal or no discomfort to the patient and provide a ready footprint of the metabolic changes occurring during disease. This review provides a brief introduction to lipidomics and its role in understanding the metabolic changes in health and disease followed by discussion on the chemical diversity of the lipid species and their biological role, mammalian lipids and their metabolism and role of lipids in pathogens and the immune response before dwelling further into importance of studying lipidome in various biological fluids. The challenges in performing a lipidomic analysis at the experimental and data analysis stages are discussed.
Assessing explanatory models and health beliefs: An essential but overlooked competency for clinicians
Authors: Dinos Sokratis , Ascoli Micol , Owiti John A. , Bhui Kamaldeep
Published: June 2017

Explanatory models of illness – the way people perceive, interpret and respond to it – are mediated not only by the illness itself, but also by cultural and social contexts. This article discusses recent evidence showing how the exploration of explanatory models can help to shape treatment and outcomes for some of the most common categories of mental illness, and presents case studies illustrating dilemmas clinicians face when their explanatory models differ from those of their patients. It concludes with recommendations on how a culturally sensitive clinical approach based on the exploration of explanatory models during assessment and treatment can be used as an effective way of dealing with the complexity of patients' and families' needs.

Learning Objectives

• Appreciate the use of explanatory models in clinical practice

• Understand the relevance of explanatory models in relation to specific diagnostic categories of mental illness

• Recognise that dilemmas may arise if the explanatory models of the clinician and the patient differ, and be able to manage this tension
Parity of esteem: Addressing the inequalities between mental and physical healthcare
Authors: Mitchell Alex J. , Hardy Sheila , Shiers David
Published: June 2017

Parity of esteem means valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care. There is clear evidence that patients with mental illness receive inferior medical, surgical and preventive care. This further exacerbated by low help-seeking, high stigma, medication side-effects and relatively low resources in mental healthcare. As a result, patients with severe mental illness die 10–20 years prematurely and have a high rate of cardiometabolic complications and other physical illnesses. Many physical healthcare guidelines and policy recommendations address parity of esteem, but their implementation to date has been poor. All clinicians should be aware that inequalities in care are adversely influencing mental health outcomes, and managers, healthcare organisations and politicians should provide resources and education to address this gap.

Learning Objectives

• Understand the concept of parity of esteem

• Be aware of the current inequalities in mental healthcare

• Appreciate how parity of esteem may be improved
Clinical formulation: Where it came from, what it is and why it matters
Authors: Baird John , Hyslop Alan , Macfie Marjorie , Stocks Ruth , Van der Kleij Tessa
Published: June 2017

Clinical formulation was introduced in its present form a little over 30 years ago and is, in essence, a concise summary of the origins and nature of a person's problems, together with opinion on what may go wrong in the future and what steps should be taken to improve matters. In our article we discuss how, in recent times, the task of preparing a clinical formulation has rightly become a multidisciplinary exercise involving the whole clinical team and, even more important, that nowadays the patient – the subject of the clinical formulation – together with their carers should also be actively involved in the process and feel some ownership of the conclusions and decisions. In addition, we compare these developments in clinical formulation with similar developments, arising for the same reasons, in clinical teaching and education.

Learning Objectives

• Understand the core principles of formulation

• Know how to prepare a formulation within a clinical team

• Understand the role that formulation plays in the effective management of patients
Malingering mental disorders: Medicolegal reporting
Authors: Rix Keith J. B. , Tracy Derek K.
Published: June 2017

In this second part of a two-article review on malingering we consider the challenges of presenting clinical and psychometric findings. Numerous clinical and demographic factors are statistically associated with malingering but applying them to an individual case risks challenges to the expert psychiatric witness's evidence. Although psychometric data can usefully help strengthen or challenge a diagnosis, expert witnesses must recognise and report the limitations of these tests. We recommend that psychiatric expert witnesses do not try to look for or to link any external incentives with clinical findings, and indeed we suggest that they should, other than exceptionally, avoid using the term ‘malingering’. It is the job of the court, not the expert witness, to ascertain an individual's credibility and motives. We suggest a framework for presenting expert psychiatric evidence in this area.

Learning Objectives

• Appreciate clinical and sociodemographic factors associated with malingering, and the challenges to applying these in individual cases

• Understand the legal scrutiny to which the reporting of psychometric data might be exposed

• Appreciate the roles of the expert witness and the court, and have a suitable framework for reporting expert psychiatric evidence in such cases
Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin: A Systematic Review of Spinal Epidural Hematoma
Authors: Leffert Lisa R. , Dubois Heloise M. , Butwick Alexander J. , Carvalho Brendan , Houle Timothy T. , Landau Ruth
Published: June 2017

Venous thromboembolism remains a major source of morbidity and mortality in obstetrics with an incidence of 29.8/100,000 vaginal delivery hospitalizations; cesarean delivery confers a 4-fold increased risk of thromboembolism when compared with vaginal delivery. Revised national guidelines now stipulate that the majority of women delivering via cesarean and women at risk for ante- or postpartum venous thromboembolism receive mechanical or pharmacological thromboprophylaxis. This practice change has important implications for obstetric anesthesiologists concerned about the risk of spinal epidural hematoma (SEH) among anticoagulated women receiving neuraxial anesthesia. We conducted a systematic review of published English language studies (1952–2016) and of the US Anesthesia Closed Claims Project Database (1990–2013) to identify cases of SEH associated with neuraxial anesthesia and thromboprophylaxis. We also report on SEH in obstetric patients receiving thromboprophylaxis and neuraxial anesthesia without adherence to the American Society of Regional Anesthesia (ASRA) recommendations. In our review, we initially identified 736 publications of which 10 met inclusion criteria; these were combined with the 5 cases of SEH identified in 546 obstetric Anesthesia Closed Claims reviews. None of these publications revealed SEH associated with neuraxial anesthesia and thromboprophylaxis with unfractionated heparin or low-molecular-weight heparin in obstetric patients. Based on data from 6 reports, 28 parturients had their neuraxial blockade before the minimum ASRA recommended time interval between the last anticoagulant dose and the neuraxial procedure. Based on data from 2 reports, 52 parturients received neuraxial anesthesia without their low-molecular-weight heparin dose being discontinued during the intrapartum period. Although the very low level of evidence and high heterogeneity in these reports make it difficult to draw quantitative conclusions from this systematic review, it is encouraging that this comprehensive search did not identify a single case of SEH in an obstetric patient receiving thromboprophylaxis and neuraxial anesthesia. Analysis of large-scale registries (eg, the Anesthesia Incident Reporting System of the Anesthesia Quality Institute) with more granular clinical and pharmacological data is needed to assess the impact of these practice changes on obstetric SEH incidence. In the interim, optimal care of obstetric patients depends on multidisciplinary planning of anticoagulation dosing to facilitate neuraxial anesthesia and thoughtful weighing of the relative risks and benefits of providing versus withholding neuraxial in favor of general anesthesia.
Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery
Authors: Karhausen Jörn A. , Smeltz Alan M. , Akushevich Igor , Cooter Mary , Podgoreanu Mihai V. , Stafford-Smith Mark , Martinelli Susan M. , Fontes Manuel L. , Kertai Miklos D.
Published: June 2017

BACKGROUND:

Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated with stroke.

METHODS:

We evaluated 6130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild versus moderate to severe) predictors of stroke. Extended Cox proportional hazard regression analysis with a time-varying covariate for daily minimum postoperative platelet count assessed the association of day-to-day variations in postoperative platelet count with time to stroke. Competing risks proportional hazard regression models examined associations between day-to-day variations in postoperative platelet counts with timing of stroke (early: 0–1 days; delayed: ≥2 days).

RESULTS:

Median (interquartile range) postoperative nadir platelet counts were 123.0 (98.0–155.0) × 109/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts >150 × 109/L, 100 to 150 × 109/L, and <100 × 109/L, respectively. The risk for stroke increased by 12% on a given postoperative day for every 30 × 109/L decrease in platelet counts (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.01–1.24;P= .0255). On a given day, patients with moderate to severe thrombocytopenia were almost twice as likely to develop stroke (adjusted HR, 1.89; 95% CI, 1.13–3.16;P= .0155) as patients with nadir platelet counts >150 × 109/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (≥2 days after surgery; adjusted HR, 2.83; 95% CI, 1.48–5.41;P= .0017) but not early postoperative stroke.

CONCLUSIONS:

Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery.
Você tem fome de quê? Uma reflexão sobre patrimônio, legitimidade e novas perspectivas analíticas
Authors: Souza Luciana Christina Cruz
Published: June 2017

Partindo de uma provocação sore o universo simbólico e a necessidade de considerá-lo como elemento primordial à vida humana, o presente artigo trata sobre o patrimônio e as escolhas, os juízos, que envolvem a seleção e a preservação de bens culturais. Recorre, portanto, à importância atribuída à figura do técnico-especialista no trato com o patrimônio, seja na esfera do Estado ou no museu, enquanto agente que parece reunir a capacidade/legitimidade de nomear e tratar o patrimônio. Partindo do pressuposto que há uma concentração de agentes provenientes de específicas disciplinas que se revelam responsáveis, ou se consideram exclusivamente aptos, à condução da seleção de bens culturais e das práticas de preservação desses bens, o artigo, em formato de ensaio de natureza teórica, reflete sobre as relações de colonialidade que parecem atravessar as dinâmicas do campo do patrimônio a partir da figura dos técnicos-especialistas. Palavras-chave: Patrimônio, Preservação, Colonialidade.
A decoração interna do palácio Nova Friburgo: reapropriações do passado monárquico na nova casa da República
Authors: Mendes Isabella do Amaral
Published: June 2017

Este artigo apresenta uma investigação preliminar acerca da decoração interna do Palácio Nova Friburgo, onde funciona desde 1960 o Museu da República, na cidade do Rio de Janeiro. Identificamos a possibilidade de, por meio da análise da decoração interna do palácio - pertencente ao acervo do museu - discutir como se resolveu a disputa simbólica sobre o imaginário coletivo iniciada pelos republicanos à época da transição de governos. Os ambientes do palácio apresentam a sobrevivência de quase todos os elementos decorativos remanescente do segundo reinado, mas, simultaneamente, tentam passar a ideia de superação com o passado a partir do acréscimo de símbolos republicanos. Teremos como enfoque a análise da sobrevivência estética destes símbolos, a fim de problematizarmos a ocupação deste espaço pelos republicanos.Palavras-chave: Museu, Imaginário, Iconografia