bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of cariprazine in bipolar I depression: A double‐blind, placebo‐controlled phase 3 study
Authors: Earley Willie R. , Burgess Maria V. , Khan Barbara , Rekeda Ludmyla , Suppes Trisha , Tohen Mauricio , Calabrese Joseph R.
Published: October 2019

Objective

To assess the efficacy, safety, and tolerability of cariprazine in the treatment of the depressed phase of bipolar I disorder in adults (NCT02670538).

Methods

In this phase 3 double‐blind placebo‐controlled study, adult patients with bipolar I disorder according to the Diagnostic and Statistical Manual — 5th Edition criteria and a current depressive episode were randomized to placebo (n = 167), cariprazine 1.5 mg/day (n = 168) or cariprazine 3.0 mg/day (n = 158). Efficacy parameters were changes in the Montgomery‐Åsberg Depression Rating Scale (MADRS) total scores (primary) and Clinical Global Impressions — Severity (CGI‐S) scores (secondary) from baseline to Week 6 compared to placebo. A mixed‐model for repeated measures was used to estimate the least‐squares mean differences (LSMD); P‐values were adjusted for multiplicity. Adverse events (AEs), laboratory results, vital signs, and suicide risk were monitored.

Results

Cariprazine 1.5 mg/day significantly reduced depressive symptoms on the primary (MADRS LSMD = −2.5; adjusted P = .0417) and secondary (CGI‐S LSMD = −0.3; adjusted P = .0417) efficacy parameters vs placebo; differences were not statistically significant for cariprazine 3.0 mg/day. Common treatment‐emergent AEs (≥5% in either cariprazine group and at least twice the incidence of placebo) were akathisia, restlessness, nausea, and fatigue. Mean metabolic parameter changes were low and generally comparable among groups; mean weight increases were ≤0.5 kg for all groups.

Conclusions

Cariprazine 1.5 mg/day significantly reduced depressive symptoms in adults with bipolar I depression compared to placebo, but differences were not significant for cariprazine 3.0 mg/day. The safety and tolerability profiles were similar to previous studies of cariprazine.
Relationship between serum lithium concentration and kidney damage in a preclinical model
Authors: Ossani Georgina P. , Uceda Ana M. , Lago Néstor R. , Martino Diego J.
Published: October 2019

Objectives

The aim of the present study was to assess whether there is a relationship between serum lithium concentrations and the magnitude of kidney damage in a preclinical model.

Methods

Thirty Wistar male rats were randomized into three groups: control group fed ad libitum powered standard diet for 3 months; and experimental groups fed ad libitum the same diet supplemented with 30 or 60 mmol/kg diet for 3 months (LowLi and HighLi groups respectively). Laboratory parameters were assessed at months 1 and 3 and histopathological changes were evaluated after 3 months.

Results

Serum lithium levels in experimental rats were within therapeutic range used in humans throughout the entire experiment. After 3 months of treatment, lithium levels were statistically higher in HighLi group. Rats of the LowLi group showed dilation of cortical tubules although with similar clearance of creatinine. Rats from the HighLi group had greater histopathological damage in addition to lower creatinine clearance than the other two groups.

Conclusions

Our study suggests that during long‐term treatments, even with serum lithium levels within the therapeutic range used in humans, the risk of kidney damage could increase proportionally to the serum lithium concentration.
HIV‐1 Vpr inhibits autophagy during the early steps of infection of CD4 T cells
Authors: Alfaisal Jamal , Machado Alice , Galais Mathilde , Robert‐Hebmann Véronique , Arnauné‐Pelloquin Laetitia , Espert Lucile , Biard‐Piechaczyk Martine
Published: October 2019

Background information

Autophagy is induced during HIV‐1 entry into CD4 T cells by the fusion of the membranes triggered by the gp41 envelope glycoprotein. This anti‐HIV‐1 mechanism is inhibited by the viral infectivity factor (Vif) neosynthesized after HIV‐1 integration to allow viral replication. However, autophagy is very rapidly controlled after HIV‐1 entry by a still unknown mechanism. As HIV‐1 viral protein R (Vpr) is the only auxiliary protein found within the virion in substantial amount, we studied its capability to control the early steps of HIV‐1 envelope‐mediated autophagy.

Results

We demonstrated that ectopic Vpr inhibits autophagy in both the Jurkat CD4 T cell line and HEK.293T cells. Interestingly, Vpr coming from the virus also blocks autophagy in CD4 T cells, the main cell target of HIV‐1. Furthermore, Vpr decreases the expression level of two essential autophagy proteins (ATG), LC3B and Beclin‐1, and an important autophagy‐related protein, BNIP3 as well as the level of their mRNA. We also demonstrated in HEK.293T cells that Vpr degrades the FOXO3a transcription factor through the ubiquitin proteasome system.

Conclusion

Vpr, the only well‐expressed HIV‐1 auxiliary protein incorporated into viruses, is able to negatively control autophagy induced during HIV‐1 entry into CD4 T cells.

Significance

We provide insights of how HIV‐1 controls autophagy very early after its entry into CD4 T cells and discovered a new function of Vpr. These results open the route to a better understanding of the roles of Vpr during HIV‐1 infection through FOXO3a degradation and could be important to consider additional therapies that counteract the role of Vpr on autophagy.
Maize‐field complexity and farming system influence insectivorous birds’ contribution to arthropod herbivore regulation
Authors: Otieno Nickson E. , Jacobs Shayne M. , Pryke James S.
Published: October 2019

The contribution of insectivorous birds to reducing crop damage through suppression of herbivory remains underappreciated, despite their role as cropland arthropod predators. We examined the roles of farming system, crop cover pattern, and structural configuration in influencing assemblage composition of insectivorous birds and their herbivorous arthropod prey across maize fields, and determined how bird exclusion affects crop herbivory levels. To achieve these objectives, we collected data across a sample of organic and conventional small‐scale non‐Bt maize farms in western Kenya. Assessments of abundance, diversity, and richness of insectivorous birds and abundance of their arthropod prey were compared between organic and conventional small‐scale non‐Bt maize on monocultured and inter‐cropped farms. We also employed bird exclusion experiments to assess impacts of bird predation on herbivorous arthropod abundance. Results showed that higher structural heterogeneity supported higher insectivorous bird richness, particularly under organic systems, dense trees, large woodlots, and thick hedgerows. Bird abundance further increased with crop diversity but not in relation to cropping method, hedgerow type, or percent maize cover per se. Conversely, herbivorous arthropod abundance and richness increased on conventional farms and those with higher percent maize cover, but were unaffected by cropping methods, tree, or hedgerow characteristics. Birds’ arthropod prey was more abundant under completely closed experimental plots compared with open or semi‐closed plots, confirming a significant linkage between birds and herbivorous arthropod suppression. In this study, we demonstrate importance of structural heterogeneity in agricultural landscapes, including diverse croplands and on‐farm trees to maximize insectivorous birds’ contribution to reducing crop arthropod herbivory.

Abstract in Swahili is available with online material.
Contributions of bats to the local economy through durian pollination in Sulawesi, Indonesia
Authors: Sheherazade  , Ober Holly K. , Tsang Susan M.
Published: October 2019

Durian is economically important for local livelihoods in Indonesia. Our study investigated the identity of pollinators of semi‐wild durian and subsequently estimated the economic contribution of these pollination services. We conducted pollination exclusion experiments and deployed camera traps at durian trees from October 2017 to January 2018 in an area where the local economy depends on durian production in West Sulawesi, Indonesia. Durian flowers in the experiment that were accessible to bats had significantly higher fruit set compared with flowers that were completely closed to animal visitors or those that could only be visited by insects, suggesting that bats were the primary durian pollinator. The small, highly nectarivorous cave nectar bat (Eonycteris spelaea) visited more inflorescences (n = 25) and had visits of much longer duration ( = 116.87 sec/visit) than the two species of flying foxes: Pteropus alecto (n = 7 inflorescences visited,  = 11.07 sec/visit) and Acerodon celebensis (n = 6 inflorescences visited,  = 11.60 sec/visit). Visits by large and small bats were influential in differentiating successful durian fruit production from unsuccessful. Using a bioeconomic approach, we conservatively estimate that bat pollination services are valued at ~$ 117/ha/fruiting season. By demonstrating an ecological link between bats and the local economy, this research provides an urgent message for Southeast Asian governments regarding the need to promote bat conservation in order to increase the production of durian grown under semi‐wild conditions.

Abstract in Indonesia is available with online material.
The Evolution of Acculturation and Development Models for Understanding Immigrant Children and Youth Adjustment
Authors: Juang Linda P. , Syed Moin
Published: October 2019

Acculturation and developmental theories and frameworks have merged steadily to portray the development and adaptation of immigrant children more comprehensively. In this article, we trace this evolution to show how research has increasingly provided greater specificity in identifying the domains, dimensions, and contexts of acculturation processes, as integrated with greater concern for developmental principles. Although models have become more complex and comprehensive, we still need well‐formulated theoretical explanations for the many processes that link development with acculturation and subsequent adjustment. We argue that novel developmental and acculturation concepts could advance specific lines of research situated in these complex models. By continuing to integrate developmental science and acculturation research more explicitly, we can arrive at a clearer and more complete understanding of how immigrant children and youth adapt across the lifespan.
The Development of the Counterfactual Imagination
Authors: Nyhout Angela , Ganea Patricia A.
Published: October 2019

When reasoning counterfactually, we think of alternative possibilities to what we know to be true about the world by imagining what would have happened had a situation been different. Research has yielded mixed findings and substantial debate over when this ability develops, how it is best conceptualized, and what functions it serves. In this article, we propose a framework of counterfactual reasoning in development. We argue that counterfactual reasoning is best understood by looking both at the representations of reality children manipulate counterfactually, and the cognitive processes that make up and contribute to counterfactual reasoning. In so doing, we highlight the fact that many of the component skills are present in early childhood. This framework yields testable predictions about children’s counterfactual reasoning across a range of situations. We also discuss recent work that examines the contribution of counterfactual reasoning to learning in childhood.
Immunological tolerance of low-risk HPV in recurrent respiratory papillomatosis
Authors: Ivancic R , Iqbal H , deSilva B , Pan Q , Matrka L
Published: October 2019

Recurrent respiratory papillomatosis (RRP) is characterized by benign exophytic lesions of the respiratory tract caused by the human papillomavirus (HPV), in particular low-risk HPV6 and HPV11. Aggressiveness varies greatly among patients. Surgical excision is the current standard of care for RRP, with adjuvant therapy used when surgery cannot control disease recurrence. Numerous adjuvant therapies have been used to control RRP with some success, but none are curative. Current literature supports a polarization of the adaptive immune response to a T helper type 2 (Th2)-like or T regulatory phenotype, driven by a complex interplay between innate immunity, adaptive immunity and HPV6/11 proteins. Additionally, certain immunogenetic polymorphisms can predispose individuals to an HPV6/11-tolerant microenvironment. As a result, immunomodulatory efforts are being made to restore the host immune system to a more balanced T cell phenotype and clear viral infection. Literature has shown exciting evidence for the role of HPV vaccination with Gardasil or Gardasil-9 as both primary prevention, by decreasing incidence through childhood vaccinations, and secondary prevention, by treating active RRP disease. Multi-institution randomized clinical trials are needed to better assess their efficacy as treatment for active disease. Interestingly, a DNA vaccine has recently shown in-vitro success in generating a more robust CD8+ T cell response. Furthermore, clinical trials for programmed death 1 (PD-1) inhibitors are under investigation for RRP management. Molecular insights into RRP, in particular the interplay between RRP and the immune system, are needed to advance our understanding of this disease and may lead to the identification of immunomodulatory agents to better manage RRP.
Immoral Professors and Malfunctioning Tools: Counterfactual Relevance Accounts Explain the Effect of Norm Violations on Causal Selection
Authors: Kominsky Jonathan F. , Phillips Jonathan
Published: October 2019

Causal judgments are widely known to be sensitive to violations of both prescriptive norms (e.g., immoral events) and statistical norms (e.g., improbable events). There is ongoing discussion as to whether both effects are best explained in a unified way through changes in the relevance of counterfactual possibilities, or whether these two effects arise from unrelated cognitive mechanisms. Recent work has shown that moral norm violations affect causal judgments of agents, but not inanimate artifacts used by those agents. These results have been interpreted as showing that prescriptive norm violations only affect causal reasoning about intentional agents, but not the use of inanimate artifacts, thereby providing evidence that the effect of prescriptive norm violations arises from mechanisms specific to reasoning about intentional agents, and thus casting doubt on a unified counterfactual analysis of causal reasoning. Four experiments explore this recent finding and provide clear support for a unified counterfactual analysis. Experiment 1 demonstrates that these newly observed patterns in causal judgments are closely mirrored by judgments of counterfactual relevance. Experiment 2 shows that the relationship between causal and counterfactual judgments is moderated by causal structure, as uniquely predicted by counterfactual accounts. Experiment 3 directly manipulates the relevance of counterfactual alternatives and finds that causal judgments of intentional agents and inanimate artifacts are similarly affected. Finally, Experiment 4 shows that prescriptive norm violations (in which artifacts malfunction) affect causal judgments of inanimate artifacts in much the same way that prescriptive norm violations (in which agents act immorally) affect causal judgments of intentional agents.
Bone mineral density in emphysema and chronic bronchitis phenotypes in hospitalized male chronic obstructive pulmonary disease patients
Authors: Yormaz Burcu , Cebeci Hakan , Yılmaz Farise , Süerdem Mecit
Published: October 2019

Introduction

Risk of osteoporosis known to increase in chronic obstructive pulmonary disease (COPD), but is usually overlooked, especially in male patients.

Objectives

The present study compares the bone mineral density (BMD) measurements of male COPD patients with emphysema and the chronic bronchitis phenotype, and evaluates the association between density of emphysema and osteoporosis.

Methods

Ninety‐four patients with COPD, and with emphysema and the chronic bronchitis phenotype, were included in the prospective study. A high‐resolution computed tomography (HRCT) was used for the diagnosis of emphysema, and a dual X‐ray absorptiometry was used to measure the BMD of the lumbar vertebrae and neck of the femur.

Results

Emphysema phenotype 45.75% and chronic bronchitis phenotype 54.25%, based on their clinical findings and a quantitative volumetric analysis by HRCT. Osteoporosis was found 60.47% and 17.65% of patients with emphysema and bronchitis, while osteopenia was detected 27.91% and 41.18% of patients with emphysema and bronchitis, respectively. A negative correlation was found between HRCT emphysema density and the bone densitometer t‐score in patients with osteoporosis. Among the patients with osteoporosis, a positive correlation was found between Body Mass Index (BMI) and the bone densitometer t‐score. Only BMI and emphysema score were found to be independent risk factors for a low BMD. One unit drop in BMI increased the risk of osteoporosis by 28% (OR = 1.28, 95% CI 1.14‐1.45) (P < 0.001). One unit increase in emphysema score increased the risk of osteoporosis by 6% (OR = 1.06, 95% CI 1.03‐1.09) (P < 0.001).

Conclusion

Especially male patients with emphysema, high dyspnea score, low BMI and frequent exacerbations should be evaluated for osteoporosis.
Outcomes after simultaneous kidney‐pancreas versus pancreas after kidney transplantation in the current era
Authors: Parajuli Sandesh , Arunachalam Annamalai , Swanson Kurtis J. , Aziz Fahad , Garg Neetika , Redfield Robert R. , Kaufman Dixon , Djamali Arjang , Odorico Jon , Mandelbrot Didier A.
Published: October 2019

Simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplant are both potential options for diabetic ESRD patients. Historically, PAK pancreas graft outcomes were felt to be inferior to SPK pancreas graft outcomes. Little is known about outcomes in the modern era of transplantation. We analyzed our SPK and PAK recipients transplanted between 01/2000 and 12/2016. There were a total of 635 pancreas and kidney transplant recipients during the study period, 611 SPK and 24 PAK. Twelve of the PAK patients received a living donor kidney. There were no significant differences between the two groups in kidney or pancreas graft rejection at 1 year. Similarly, 1‐year graft survival for both organs was not different. At last follow‐up, uncensored and death‐censored graft survival was not statistically different for kidney or pancreas grafts. In addition, in Cox regression analysis SPK and PAK were associated with similar graft survival. Although the majority of pancreas transplants are in the form of SPK, PAK is an acceptable alternative. Simultaneous pancreas and kidney avoids donor risks associated with live donation, so may be preferable in regions with short wait times, but PAK with a living donor kidney may be the best alternative in regions with long SPK wait times.
Contrast‐enhanced ultrasound of the transplant pancreas in the post‐operative setting
Authors: Swensson Jordan , Nagaraju Santosh , O'Brien Daniel , Tann Mark , Shah Angela , Mangus Richard , Powelson John , Fridell Jonathan
Published: October 2019

Background/Objectives

Vascular thrombosis is the most common cause of early graft loss after transplantation. Routine grayscale and Doppler ultrasound frequently fail to adequately visualize vascular compromise. Contrast‐enhanced ultrasound is a novel approach to identifying these complications.

Methods

This was a prospective study of 22 consecutive patients who received pancreas transplant at our institution between 2017 and 2018. All allografts were implanted with systemic venous and enteric exocrine drainage. Perfusion was assessed in the immediate post‐operative period using grayscale, Doppler, and contrast‐enhanced ultrasound. Imaging findings were compared between those who required surgical re‐intervention and those who did not in order to evaluate for differences in perfusion.

Results

Of the 22 transplants, 15 did not require surgical re‐intervention and were considered normal. These allografts demonstrated prompt and uniform enhancement, with washout usually by 90 seconds. All patients who had abnormal CEUS underwent re‐exploration. Perfusion was acceptable or restored in all cases. Two patients ultimately required allograft pancreatectomy. Two patients had normal glands, and the remaining 3 grafts were salvaged following intervention.

Conclusions

Contrast‐enhanced ultrasound provides rapid evaluation of allograft perfusion following pancreas transplantation. The differences in perfusion provide a novel way of evaluating for complications in the immediate post‐transplant period.
The association of pregnane X receptor activation with outcomes after liver transplantation—A retrospective study
Authors: Amer Aimen , McColl Kirsty , Bouayyad Sarah , Kanwar Aditya , Sen Gourab , French Jeremy J. , Wilson Colin H. , Manas Derek M. , Wright Matthew C. , White Steve A.
Published: October 2019

Background

Many complications following liver transplantation are linked to ischemia‐reperfusion injury. Activation of the pregnane X receptor (PXR) has been shown to alleviate this process in animal models. The aim of this retrospective study was to investigate the effect of early activation of human PXR (hPXR) on postoperative complications and survival following liver transplantation.

Methods

The study included deceased donor liver transplants at a single center over 6 years. Estimated hPXR activation value on day 7 (EPAV7) was calculated per patient based on potency/total dose of known hPXR‐activating drugs administered in the first week post‐transplantation. Patients were divided into low and high hPXR activation groups based on EPAV7.

Results

Overall, 240 liver transplants were included. Average EPAV7 was significantly lower in patients who developed anastomotic biliary strictures (17.7 ± 5.5 vs 35.1 ± 5.7 in stricture‐free patients; P = .03) and sepsis (16.4 ± 7.1 vs 34.9 ± 5.5; P = .04). Patient survival was significantly improved in the high hPXR group (5‐year survival: 88.7% ± 3.8% versus 70.7% ± 5.8% [low hPXR]; P = .023). Regression analysis identified EPAV7 as a significant independent predictor of patient survival.

Conclusion

hPXR activation within the first week of liver transplantation is a prognostic indicator of patient survival, possibly due to the associated lower biliary stricture and infection rates.
Assessing cardiovascular risk in the prerenal transplant population: Comparison of myocardial perfusion imaging and coronary angiography with risk factor stratification
Authors: Wilson Ryan S. , Lin Tony , Chambers Charles E. , Kadry Zakiyah , Jain Ashokkumar B.
Published: October 2019

Introduction

Patients with end‐stage renal disease (ESRD) have a higher incidence of coronary artery disease (CAD). Hence, it is crucial to evaluate CAD before renal transplantation. This study compares the utility of pharmacologic single‐photon emission computed‐tomography (SPECT) imaging directly to coronary angiography for diagnosis of CAD with correlation to cardiovascular risk factors.

Method

Retrospective review of asymptomatic renal failure patients who underwent both SPECT and coronary angiography to identify obstructive CAD between the years 2008‐2016. Ninety‐four ESRD subjects were evaluated.

Results

Myocardial perfusion SPECT study found, when compared to coronary angiography demonstrated for CAD, the sensitivity of 93.3% with a specificity of 73.4%. Importantly, the negative predictive value for coronary artery disease was 96%. With seven or more cardiac risk factors, 66.7% of patients had obstructive coronary artery disease. Among all the risk factors examined, patients with a previous history of coronary artery disease had a 68% risk of obstructive coronary artery disease.

Conclusion

Comparing myocardial perfusion imaging SPECT findings with coronary angiography in patients with ESRD, a sensitivity of 93.3% and a specificity of 73% were observed. Of all the risk factors examined, patient with the previous history of CAD was the single most significant risk factor for CAD in 68% of cases.
Skin cancer in transplant recipients: Scientific retreat of the international immunosuppression and transplant skin cancer collaborative and skin care in organ transplant patients—Europe
Authors: Stevenson Mary L. , Carucci John , Colegio Oscar R.
Published: October 2019

The International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 500 physicians and scientists focused on the treatment of cutaneous malignancies following solid organ transplantation and in other forms of immunosuppression. It is well known that solid organ transplant recipients (SOTRs) have an approximate 100‐fold increase in the risk of developing skin cancer with consensus guidelines recommending these patients be managed as high risk for local recurrence and metastasis associated with poor outcomes. In September 2018, ITSCC and its European counterpart, the Skin Care in Organ Transplant Patients—Europe (SCOPE), held their biennial scientific retreat in Essex, MA to discuss novel findings in the pathogenesis of cutaneous malignancy including new treatment and prevention strategies in this at‐risk population for significant morbidity and mortality from their cutaneous disease. This meeting report is a summary of the novel findings discussed.
Infrared thermography and ulcer prevention in the high‐risk diabetic foot: data from a single‐blind multicentre controlled clinical trial
Authors: Petrova N. L. , Donaldson N. K. , Tang W. , MacDonald A. , Allen J. , Lomas C. , Leech N. , Ainarkar S. , Bevans J. , Plassmann P. , Kluwe B. , Ring F. , Whittam A. , Rogers L. , McMillan J. , Simpson R. , Donaldson A. N. A. , Machin G. , Edmonds M. E.
Published: October 2019

Aim

To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence.

Methods

People with diabetes (n = 110), neuropathy and history of ≥ 1 foot ulcer participated in a single‐blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature ≥ 2.2°C higher than the corresponding contralateral site) and acted upon as per local standards.

Results

After 12 months, 62% of participants were ulcer‐free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively.

Conclusions

Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer‐free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow‐up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.
An image fusion tool for echo‐guided left ventricular lead placement in cardiac resynchronization therapy: Performance and workflow integration analysis
Authors: Babić Aleksandar , Odland Hans Henrik , Lyseggen Erik , Holm Torbjørn , Ross Stian , Hopp Einar , Haugaa Kristina H. , Kongsgård Erik , Edvardsen Thor , Gérard Olivier , Samset Eigil
Published: October 2019

Background

The response rate to cardiac resynchronization therapy (CRT) may be improved if echocardiographic‐derived parameters are used to guide the left ventricular (LV) lead deployment. Tools to visually integrate deformation imaging and fluoroscopy to take advantage of the combined information are lacking.

Methods

An image fusion tool for echo‐guided LV lead placement in CRT was developed. A personalized average 3D cardiac model aided visualization of patient‐specific LV function in fluoroscopy. A set of coronary venography‐derived landmarks facilitated registration of the 3D model with fluoroscopy into a single multimodality image. The fusion was both performed and analyzed retrospectively in 30 cases. Baseline time‐to‐peak values from echocardiography speckle‐tracking radial strain traces were color‐coded onto the fused LV. LV segments with suspected scar tissue were excluded by cardiac magnetic resonance imaging. The postoperative augmented image was used to investigate: (a) registration accuracy and (b) agreement between LV pacing lead location, echo‐defined target segments, and CRT response.

Results

Registration time (264 ± 25 seconds) and accuracy (4.3 ± 2.3 mm) were found clinically acceptable. A good agreement between pacing location and echo‐suggested segments was found in 20 (out of 21) CRT responders. Perioperative integration of the proposed workflow was successfully tested in 2 patients. No additional radiation, compared with the existing workflow, was required.

Conclusions

The fusion tool facilitates understanding of the spatial relationship between the coronary veins and the LV function and may help targeted LV lead delivery.
“Echo pause” for postoperative transthoracic echocardiographic surveillance
Authors: Cox Kelly , Arunamata Alisa , Krawczeski Catherine D. , Reddy Charitha , Kipps Alaina K. , Long Jin , Roth Stephen J. , Axelrod David M. , Hanley Frank , Shin Andrew , Selamet Tierney Elif Seda
Published: October 2019

Background

No guidelines exist for inpatient postoperative transthoracic echocardiographic (TTE) surveillance in congenital heart disease. We prospectively evaluated indications for postoperative TTEs in patients with congenital heart disease to identify areas to improve upon (Phase 1) and then assessed the impact of a simple pilot intervention (Phase 2).

Methods

We included patients with RACHS‐1 (Risk Adjustment for Congenital Heart Surgery) scores of 2 and 3 to keep the cohort homogenous. During Phase 1, we collected data prospectively to identify postoperative TTEs for which there were no new findings and no associated clinical management decisions (“potentially redundant” TTEs). During Phase 2, prior to placement of a TTE order, an “Echo Pause” was performed during rounds to prompt review of prior TTE results and indication for the current order. The number of “potentially redundant” TTEs during Phase 1 vs. Phase 2 was compared.

Results

During Phase 1, 98 postoperative TTEs were performed on 51 patients. Potentially “redundant” TTEs were identified in two main areas: (a) TTEs ordered to evaluate pericardial effusion and (b) TTEs ordered with the indication of “postoperative,” “follow‐up,” or “discharge” in the setting of a prior complete postoperative TTE and no apparent change in clinical status. During Phase 2, 101 TTEs were performed on 63 patients. The number of “potentially redundant” TTEs decreased from 14/98 (14%) to 5/101 (5%) (P = .026).

Conclusion

Our results suggest that the number of “potentially redundant” TTEs during inpatient postoperative surveillance of patients with congenital heart disease can be decreased by a simple intervention during rounds such as an “Echo Pause.”
Tricuspid regurgitation due to blood cyst
Authors: Aydın Cihan , Engin Mesut , Kul Selim
Published: October 2019

Cardiac blood cysts are confirmed by autopsies in stillbirths but rarely detected in adults. Although cardiac blood cysts are common in newborns, they disappear within a few months after birth. These cysts are blood‐filled diverticula surrounded by endothelium. Their possible etiology is invaginations of atrial endothelium into the stroma of atrioventricular valves. Most blood cysts originate from the left side of the heart and are located on the atrioventricular valves. Complication is followed in very little cases, such as embolic stroke, valvular dysfunction, and ventricular outflow system obstruction. The blood cysts leading to complications should be removed surgically.
Temperature, deltamethrin‐resistance status and performance measures of Plutella xylostella: complex responses of insects to environmental variables
Authors: Wang Leyun , Walter Gimme H. , Furlong Michael J.
Published: October 2019

1. Worldwide, the excessive use of insecticides has resulted in field‐evolved insecticide‐resistant populations of diamondback moth (DBM), Plutella xylostella. A deltamethrin‐resistant DBM population from the field was divided into two subpopulations in the laboratory. One population (S‐strain) was maintained with no further exposure to insecticides, whereas the other population (R‐strain) was maintained under a regime of intermittent selection with deltamethrin.

2. Individuals from both strains were reared at constant temperatures in the range 10–35 °C in the absence of deltamethrin, and the effects of rearing temperature on various traits were investigated. At the time of experimentation, the R‐strain was 20‐fold more resistant to deltamethrin than the S‐strain.

3. Temperature differentially affected developmental time, adult life span, pupal weight, and fecundity of both strains. Although both strains laid eggs after being reared at 10 °C, few of these eggs were fertile. The R‐strain developed significantly faster than the S‐strain. The integrated performance of the S‐strain and R‐strain was greatest at 25 and 15 °C, respectively.

4. The present study provides important information on the complexities of the outcomes of the interactions between ectotherms and temperature. Specifically, temperature‐trait relationships may not be unimodal, and ectotherm genotypes (in this case insecticide‐resistance status) and abiotic stresses can interact with unpredictable outcomes.

5. Current models predicting DBM population dynamics and relative abundance in different locations do not consider different thermal biologies of different genotypes. The present study shows the dramatic effects of environment on many parameters used in these models and will help to enhance their accuracy, and thus their utility.
Exposure to potentially cannibalistic conspecifics induces an increased immune response
Authors: Murray Rosalind L. , Tah Sunanda , Koprivnikar Janet , Rowe Locke , McCauley Shannon J.
Published: October 2019

1. Within‐population infectious disease dynamics depend on multiple factors, including the ability of hosts to mount an effective immune response. These immune responses can be highly plastic, responding to pathogen risk, as well as the ecological context in which pathogens are encountered.

2. High conspecific density can stimulate immune activity, and recent research suggests that predators can cause indirect protective effects in their prey through the induction of increased immune responses. Comparatively little work, however, has investigated whether exposure to potentially cannibalistic conspecifics, representing both increased density and predatory pressures, will have similar effects on immune expression.

3. Using dragonfly larvae, the present study investigated whether exposure to potentially cannibalistic conspecifics altered the melanisation of simulated parasites.

4. Increased levels of melanisation were found in larvae regardless of whether that conspecific had recently engaged in cannibalism or not. Melanisation also increased as conspecific density increased, even if the conspecifics present were small, and therefore unlikely to pose a cannibalism threat.

5. The findings obtained in the present study indicate that conspecific presence is sufficient to affect immune responses in these insects even though they are relatively solitary compared with the phase‐polyphenic taxa typically associated with density‐dependent prophylaxis. Because melanisation is also important for wound healing, we suggest that the increased melanin response observed with increased conspecific density might act to induce heightened immunity when faced with potentially increased risk of infection, and also facilitate wound healing under threat of predation/cannibalism.
Prey size and predator density modify impacts by natural enemies towards mosquitoes
Authors: Dalal Arpita , Cuthbert Ross N. , Dick Jaimie T.A. , Sentis Arnaud , Laverty Ciaran , Barrios‐O'Neill Daniel , Perea Natali O. , Callaghan Amanda , Gupta Susmita
Published: October 2019

1. Interactions between multiple predators can modify prey risk and profoundly alter ecological community dynamics. Further, ontogenic prey size changes are known to mediate prey risk through refuge effects. Understandings of these biotic factors is important for robust quantifications of natural enemy effects on target species, yet their combined influence lacks investigation.

2. Functional responses were used to quantify the predatory impacts ofNotonecta glauca(water boatman;Ng) andGammarus pulex(river shrimp;Gp) towards four different larval instars ofCulex pipiensin container‐style habitats. Using conspecific pairs of predators, multiple predator effects (MPEs) of both predator species were examined across larval prey sizes, and prey preference tests were applied to examine prey selectivity across predator–prey body size ratios.

3. Both predators were able to feed onC. pipiensacross their larval ontogeny; however,Ngconsumed significantly more larvae thanGp. Functional responses ofNgwere typically Type IIs, whereasGptrended towards sigmoidal Type IIIs. Predation by pairs ofNgandGpshowed independent MPEs towards first‐, third‐, and fourth‐instar stages (except predation byGpat higher densities of fourth‐instar) stages, whereas, for second‐instar stages,Ngshowed synergistic MPEs andGpshowed antagonistic MPEs. Both predators preferred late instar mosquitoes (Ng: fourth instar;Gp: third instar). These preferences reflected predator:prey weight–length ratios, showing that relative sizes of predators and prey are important factors in prey selectivity.

4. The results obtained in the present study demonstrate that MPEs, combined with intraspecific prey preferences, may modulate trophic interactions within ecosystems. Therefore, such effects should be increasingly considered to further the understanding of agent efficacies.
Accurate forest projections require long‐term wood decay experiments because plant trait effects change through time
Authors: Oberle Brad , Lee Marissa R. , Myers Jonathan A. , Osazuwa‐Peters Oyomoare L. , Spasojevic Marko J. , Walton Maranda L. , Young Darcy F. , Zanne Amy E.
Published: October 2019

Whether global change will drive changing forests from net carbon (C) sinks to sources relates to how quickly deadwood decomposes. Because complete wood mineralization takes years, most experiments focus on how traits, environments and decomposer communities interact as wood decay begins. Few experiments last long enough to test whether drivers change with decay rates through time, with unknown consequences for scaling short‐term results up to long‐term forest ecosystem projections. Using a 7 year experiment that captured complete mineralization among 21 temperate tree species, we demonstrate that trait effects fade with advancing decay. However, wood density and vessel diameter, which may influence permeability, control how decay rates change through time. Denser wood loses mass more slowly at first but more quickly with advancing decay, which resolves ambiguity about the after‐life consequences of this key plant functional trait by demonstrating that its effect on decay depends on experiment duration and sampling frequency. Only long‐term data and a time‐varying model yielded accurate predictions of both mass loss in a concurrent experiment and naturally recruited deadwood structure in a 32‐year‐old forest plot. Given the importance of forests in the carbon cycle, and the pivotal role for wood decay, accurate ecosystem projections are critical and they require experiments that go beyond enumerating potential mechanisms by identifying the temporal scale for their effects.
Exploring the research culture in the health information management profession in Australia
Authors: Kemp Trixie , Finlayson Lara , Chan Jaclyn , Lackey Gavin , Richards Dwayne , Rupnik Cassandra , White Heather , Butler‐Henderson Kerryn , Low Sarah
Published: October 2019

Background

Research is an important activity that informs knowledge and practice. The research culture within the Australian Health Information Management (HIM) profession has not been previously reported.

Objective

This study explored the perceptions of HIM practitioners about research in their role to establish if there is a research culture in the Australian HIM profession.

Method

An online survey was distributed to the HIM community using a snowball recruitment strategy.

Results

Of the 149 respondents, more than half (54%) identified they possessed research skills from prior education, whilst 40% considered they had a strong knowledgebase in conducting research. However, only a quarter of respondents indicated that they should undertake research in their role. Barriers to undertaking research included recognition, organisational support and time.

Discussion

The findings from this study reflected other studies within clinical workforces. The lack of recognition and support to incorporate research into practitioner roles has implications for the profession and its body of knowledge.

Conclusion

Advocating for research to be incorporated into practitioner roles is required to inform knowledge and practice. Increased professional development opportunities may create a stronger research culture within the HIM profession in Australia and strengthen the position of the profession within health.
Validation for Brazilian Portuguese language of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT‐P)
Authors: Firmino Ramon Targino , Granville‐Garcia Ana Flávia , McGrath Colman P. , Bendo Cristiane Baccin , Ferreira Fernanda Morais , Paiva Saul Martins
Published: October 2019

Background

Oral health literacy (OHL) is associated with oral health outcomes.

Aim

To validate the Brazilian Portuguese version of the Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT‐P).

Design

We performed cross‐cultural adaptation of the HKOHLAT‐P. A sample of 200 pre‐schoolers and caregivers from Campina Grande, Brazil completed the Brazilian HKOHLAT‐P (BOHLAT‐P), sociodemographic questionnaire, the Brazilian Early Childhood Oral Health Impact Scale (B‐ECOHIS), and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD‐30). Child dental caries was assessed. Instrument reliability was measured by internal consistency (Cronbach's alpha) and test‐retest (ICC). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) evaluated dimensionality. Regression models tested associations between BOHLAT‐P and exploratory variables (P < .05).

Results

BOHLAT‐P demonstrated excellent reliability (Cronbach's alpha = 0.92; ICC = 0.95). BOHLAT‐P and BREALD‐30 scores (r = .71), number of schooling years (r = .60), and reading hours (r = .34) were positively correlated. BOHLAT‐P and B‐ECOHIS scores (r = −.22), and BOHLAT‐P scores and number of cavitated teeth (r = −.15) were negatively correlated. After controlling for confounding variables, BOHLAT‐P scores were not associated with caries or number of teeth with cavitated caries.

Conclusion

BOHLAT‐P is a valid and reliable instrument to assess the OHL of Brazilian parents.
A novel single‐chain enzyme complex with chain reaction properties rapidly producing thromboxane A2 and exhibiting powerful anti‐bleeding functions
Authors: Li Yan , Li Qun‐Ying , Ling Qing‐Lan , So Shui‐Ping , Ruan Ke‐He
Published: October 2019

Uncontrollable bleeding is still a worldwide killer. In this study, we aimed to investigate a novel approach to exhibit effective haemostatic properties, which could possibly save lives in various bleeding emergencies. According to the structure‐based enzymatic design, we have engineered a novel single‐chain hybrid enzyme complex (SCHEC), COX‐1‐10aa‐TXAS. We linked the C‐terminus of cyclooxygenase‐1 (COX‐1) to the N‐terminus of the thromboxane A2 (TXA2) synthase (TXAS), through a 10‐amino acid residue linker. This recombinant COX‐1‐10aa‐TXAS can effectively pass COX‐1–derived intermediate prostaglandin (PG) H2 (PGH2) to the active site of TXAS, resulting in an effective chain reaction property to produce the haemostatic prostanoid, TXA2, rapidly. Advantageously, COX‐1‐10aa‐TXAS constrains the production of other pro‐bleeding prostanoids, such as prostacyclin (PGI2) and prostaglandin E2 (PGE2), through reducing the common substrate, PGH2 being passed to synthases which produce aforementioned prostanoids. Therefore, based on these multiple properties, this novel COX‐1‐10aa‐TXAS indicated a powerful anti‐bleeding ability, which could be used to treat a variety of bleeding situations and could even be useful for bleeding prone situations, including nonsteroidal anti‐inflammatory drugs (NSAIDs)‐resulted TXA2‐deficient and PGI2‐mediated bleeding disorders. This novel SCHEC has a great potential to be developed into a biological haemostatic agent to treat severe haemorrhage emergencies, which will prevent the complications of blood loss and save lives.
Dental status of the Iranian elderly: A systematic review and meta‐analysis
Authors: Rabiei Maryam , Masoudi Rad Hossein , Homaie Rad Enayatollah , Ashourizadeh Shooka
Published: October 2019

Tooth loss is an important health dilemma. The aim of the present study was to perform a systematic review and meta‐analysis of dental status and edentulism in the elderly residing in Iran. An electronic search of the literature was carried out on Farsi and English databases using the following keywords: edentulism, dental caries, elderly, oral and dental health, edentulous, geriatric, caries, dentate, Iran, and prevalence. Articles that met the eligibility criteria according to the STROBE (Strengthening the Reporting of Observational Studies In Epidemiology) checklist were selected and entered into the meta‐analysis. Data were analyzed using Stata 13.1 software, and the metan and metareg packages for used for the meta‐regression and meta‐analysis. Of the 172 articles retrieved, 154 were used after eliminating the duplicates, and their full texts were read. Of the 4574 participants evaluated in 13 studies, 2227 (48.7%) were completely edentulous (95% confidence interval [CI]: .49‐.49). Of the 4423 participants evaluated in 12 studies, 2286 (51.7%) were dentate (95% CI: .52‐.52). The mean number of remaining teeth was 5.73 (95% CI: 5.73‐5.73) in six studies conducted on 2782 participants. Approximately 50% of the elderly in Iran are completely edentulous. Efforts should be made to improve dental care instruction, provision of dental care services in the public sector, and dental insurance coverage to promote the dental status of elderly Iranians.