bluuebunny/crossref_metadata_2025 huggingface dataset:
The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
Authors: Concepcion Beatrice P. , Forbes Rachel C. , Bian Aihua , Schaefer Heidi M.
Published: August 2016

Background. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions.Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identify reasons for patients being turned down and to determine the number of unnecessary tests performed. Statistical analysis was performed to estimate the association between clinical predictors and listing status.Results. 345 patients were included in the statistical analysis. 31.6% of patients were turned down: 44% due to coronary artery disease (CAD), peripheral vascular disease (PVD), or both. After adjustment for patient demographics and comorbid conditions, history of CAD, PVD, or both (OR = 1.75, 95% CI (1.20, 2.56),p=0.004), chronic obstructive pulmonary disease (OR = 8.75, 95% CI (2.81, 27.20),p=0.0002), and cancer (OR 2.59, 95% CI (1.18, 5.67),p=0.02) were associated with a higher risk of being turned down. 14.8% of patients underwent unnecessary basic testing and 9.6% underwent unnecessary supplementary testing with the charges over a 3-year period estimated at $304,337.Conclusion. A significant number of older candidates are deemed unacceptable for kidney transplantation with primary reasons cited as CAD and PVD. The overall burden of unnecessary testing is substantial and potentially avoidable.
Different Estimation Procedures for the Parameters of the Extended Exponential Geometric Distribution for Medical Data
Authors: Louzada Francisco , Ramos Pedro L. , Perdoná Gleici S. C.
Published: August 2016

We have considered different estimation procedures for the unknown parameters of the extended exponential geometric distribution. We introduce different types of estimators such as the maximum likelihood, method of moments, modified moments,L-moments, ordinary and weighted least squares, percentile, maximum product of spacings, and minimum distance estimators. The different estimators are compared by using extensive numerical simulations. We discovered that the maximum product of spacings estimator has the smallest mean square errors and mean relative estimates, nearest to one, for both parameters, proving to be the most efficient method compared to other methods. Combining these results with the good properties of the method such as consistency, asymptotic efficiency, normality, and invariance we conclude that the maximum product of spacings estimator is the best one for estimating the parameters of the extended exponential geometric distribution in comparison with its competitors. For the sake of illustration, we apply our proposed methodology in two important data sets, demonstrating that the EEG distribution is a simple alternative to be used for lifetime data.
Ischemic Gastropathic Ulcer Mimics Gastric Cancer
Authors: Daher Saleh , Lahav Ziv , Rmeileh Ayman Abu , Mizrahi Meir , Khoury Tawfik
Published: August 2016

Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.
Variability of Soil Micronutrients Concentration along the Slopes of Mount Kilimanjaro, Tanzania
Authors: Mathew Mathayo Mpanda , Majule Amos E. , Marchant Robert , Sinclair Fergus
Published: August 2016

Soil micronutrients are important elements for plant growth despite being required in small quantities. Deficiency of micronutrients can result in severe crop failure while excess levels can lead to health hazards; therefore, investigating their status in agricultural land is crucial. Fifty plots were established along an altitudinal gradient from 680 to 1696 m a.s.l. on the slopes of Mount Kilimanjaro, Tanzania. Soils were sampled at the top- (0–20 cm) and subsoils (21–50 cm) in four locations within each plot. Fourier Transform Mid-Infrared (FT-MIR) spectroscopy and wet chemistry were used for soil analysis. Results indicated that the mean concentrations of the micronutrients in the topsoil were Fe (130.4±6.9 mgkg−1), Mn (193.4±20.5 mgkg−1), Zn (2.8±0.2 mgkg−1), B (0.68±0.1 mgkg−1), and Cu (8.4±0.8 mgkg−1). Variations of the micronutrients were not statistically different by elevation (df = 41,p>0.05) and by soil depth (df = 49,p>0.05). Correlations among micronutrients were significant for FeversusMn (r=0.46,p<0.001), BversusZn (r=0.40,p=0.003), BversusCu (r=0.34,p=0.013), and CuversusZn (r=0.88,p<0.001). The correlated micronutrients implied that they were affected by similar factors. Soil pH correlated positively with B, Fe, and Mn and negatively with Cu and Zn, hence probably influencing their availability. Therefore, the need for sustaining micronutrient at sufficient levels is crucial. Management interventions may include moderating soil pH by reducing acidity through liming in the higher elevations and incorporation of organic matter in the lowlands.
Paired Exome Analysis Reveals Clonal Evolution and Potential Therapeutic Targets in Urothelial Carcinoma
Authors: Lamy Philippe , Nordentoft Iver , Birkenkamp-Demtröder Karin , Thomsen Mathilde Borg Houlberg , Villesen Palle , Vang Søren , Hedegaard Jakob , Borre Michael , Jensen Jørgen Bjerggaard , Høyer Søren , Pedersen Jakob Skou , Ørntoft Torben F. , Dyrskjøt Lars
Published: August 2016

Greater knowledge concerning tumor heterogeneity and clonality is needed to determine the impact of targeted treatment in the setting of bladder cancer. In this study, we performed whole-exome, transcriptome, and deep-focused sequencing of metachronous tumors from 29 patients initially diagnosed with early-stage bladder tumors (14 with nonprogressive disease and 15 with progressive disease). Tumors from patients with progressive disease showed a higher variance of the intrapatient mutational spectrum and a higher frequency of APOBEC-related mutations. Allele-specific expression was also higher in these patients, particularly in tumor suppressor genes. Phylogenetic analysis revealed a common origin of the metachronous tumors, with a higher proportion of clonal mutations in the ancestral branch; however, 19 potential therapeutic targets were identified as both ancestral and tumor-specific alterations. Few subclones were present based on PyClone analysis. Our results illuminate tumor evolution and identify candidate therapeutic targets in bladder cancer. Cancer Res; 76(19); 5894–906. ©2016 AACR.
Skeletal Muscle Measures as Predictors of Toxicity, Hospitalization, and Survival in Patients with Metastatic Breast Cancer Receiving Taxane-Based Chemotherapy
Authors: Shachar Shlomit Strulov , Deal Allison M. , Weinberg Marc , Nyrop Kirsten A. , Williams Grant R. , Nishijima Tomohiro F. , Benbow Julia M. , Muss Hyman B.
Published: August 2016

Purpose: Severe skeletal muscle (SM) loss (sarcopenia) is associated with poor cancer outcomes, including reduced survival and increased toxicity. This study investigates SM measures in metastatic breast cancer (MBC) patients receiving first-line taxane-based chemotherapy and evaluates associations with treatment toxicity and other outcomes.

Experimental Design: Using computerized tomography (CT) images taken for the evaluation of disease burden, skeletal muscle area (SMA), and density (SMD) were measured at the third lumbar vertebrae. Sarcopenia was defined as skeletal muscle index (SMI = SMA/height2) ≤ 41. Skeletal muscle gauge (SMG) was created by multiplying SMI × SMD. Fisher exact tests, t tests, the Kaplan–Meier method, and Cox regression modeling were used.

Results: MBC patients (N = 40), median age 55 (range, 34–80), 58% sarcopenic, median SMG 1296 AU (SD, 522). Grade 3–4 toxicity was found in 57% of sarcopenic versus 18% of non-sarcopenic patients (P = 0.02). Toxicity-related hospitalizations were also higher in sarcopenic patients (39% vs. 0%, P = 0.005) as were any adverse events—defined as any grade 3–4 toxicities, hospitalizations, dose reductions, or dose delay—(74% vs. 35%, P = 0.02). Low SMG was associated with grade 3–4 toxicity (P = 0.04), hospitalization (P = 0.01), and time to treatment failure (for progression or toxicity; P = 0.03). Low SMG had a borderline significant association with any adverse event (P = 0.06) and overall survival (P = 0.07).

Conclusions: SM measures are associated with toxicity outcomes and survival in MBC patients receiving first-line taxane-based chemotherapy. Further studies are needed to explore how routinely obtained CT scans can be used to individualize dosing and improve treatment planning. Clin Cancer Res; 23(3); 658–65. ©2016 AACR.
Association of AR-V7 and Prostate-Specific Antigen RNA Levels in Blood with Efficacy of Abiraterone Acetate and Enzalutamide Treatment in Men with Prostate Cancer
Authors: Qu Fangfang , Xie Wanling , Nakabayashi Mari , Zhang Haitao , Jeong Seong Ho , Wang Xiaodong , Komura Kazumasa , Sweeney Christopher J. , Sartor Oliver , Lee Gwo-Shu Mary , Kantoff Philip W.
Published: August 2016

Purpose: We evaluated the association of PSA and androgen receptor splice variant-7 (AR-V7) transcript levels in patients' blood with time to treatment failure (TTF) and overall survival (OS) with abiraterone acetate and/or enzalutamide treatment in castration-resistant prostate cancer (CRPC) patients.

Experimental Design: RNA levels of AR-V7 and PSA in peripheral blood collected before treatment were quantified using droplet digital-PCR in retrospective cohorts treated with abiraterone acetate (N = 81) or enzalutamide (N = 51) for CRPC. Multivariable Cox regression adjusted for known prognostic factors was used for analyses.

Results: PSA transcripts were detected in 57% of abiraterone acetate–treated patients and in 63% of enzalutamide-treated patients. PSA-positive patients had a shorter TTF than PSA-negative patients [adjusted HR = 2.27 (95% confidence interval (CI) 1.26–4.10) and 2.60 (95% CI, 1.19–5.69); P = 0.006 and 0.017 in abiraterone acetate and enzalutamide cohorts, respectively]. Patients with a higher-AR-V7 transcript level had a shorter TTF with abiraterone acetate and enzalutamide in univariate analysis (median 8.0 months vs. 15.6 months, P = 0.046 in abiraterone acetate-cohort and 3.6 months vs. 5.6 months; P = 0.050 in enzalutamide cohort). In multivariable models, the association with TTF remained significant in the enzalutamide cohort (adjusted HR = 2.02; 95% CI, 1.01–4.05; P = 0.048), but statistically insignificant in the abiraterone acetate cohort. In both cohorts, we observed potential prognostic value of both PSA and AR-V7 RNA expression on OS; patients with detectable PSA transcripts and high AR-V7 predicted the poorest OS.

Conclusions: PSA and AR-V7 transcripts in blood potentially serve as biomarkers predicting TTF and OS with abiraterone acetate or enzalutamide treatment. If validated prospectively, their detection could be facilitated without isolation of circulating tumor cells. Clin Cancer Res; 23(3); 726–34. ©2016 AACR.
Systemic Ablation of MMP-9 Triggers Invasive Growth and Metastasis of Pancreatic Cancer via Deregulation of IL6 Expression in the Bone Marrow
Authors: Grünwald Barbara , Vandooren Jennifer , Gerg Michael , Ahomaa Kaarin , Hunger Annique , Berchtold Sonja , Akbareian Sophia , Schaten Susanne , Knolle Percy , Edwards Dylan R. , Opdenakker Ghislain , Krüger Achim
Published: August 2016

Matrix metalloproteinase 9 (MMP-9/Gelatinase B) is overexpressed in pancreatic ductal adenocarcinoma (PDAC) and plays a central role in tumor cell invasion and metastasis. Here we complemented mechanistic insights in the cancer biology of MMP-9 and investigated the effects of specific long-term loss-of-function, by genetic ablation, of MMP-9 on PDAC initiation and progression in the well-established KPC mouse model of spontaneous PDAC. Tumor growth and progression were analyzed by histopathology and IHC. Invasive growth of PDAC cells was analyzed by both in vitro (proliferation, survival, migration, invasion assays) and in vivo (experimental metastasis assays) methods. Retroviral shRNAi was used to knockdown target genes (MMP-9, IL6R). Gene expression was analyzed by qRT-PCR, immunoblot, ELISA, in situ hybridization, and zymography. PDAC tumors from MMP-9–deficient mice were dramatically larger, more invasive, and contained more stroma. Yet, ablation of MMP-9 in PDAC cells did not directly promote invasive growth. Interestingly, systemic ablation of MMP-9 led to increased IL6 levels resulting from abrogation of MMP-9–dependent SCF signaling in the bone marrow. IL6 levels in MMP-9−/− mice were sufficient to induce invasive growth and STAT3 activation in PDAC cells via IL6 receptor (IL6R). Interference with IL6R blocked the increased invasion and metastasis of PDAC cells in MMP-9–deficient hosts. In conclusion, ablation of systemic MMP-9 initiated fatal communication between maintenance of physiological functions of MMP-9 in the bone marrow and invasive growth of PDAC via the IL6/IL6R/STAT3 axis.

Implications: Thus, the beneficial effects of host MMP-9 on PDAC are an important caveat for the use of systemic MMP-9 inhibitors in cancer. Mol Cancer Res; 14(11); 1147–58. ©2016 AACR.
Ductal Carcinoma In situ of the Male Breast
Authors: Brents Melissa , Hancock John
Published: August 2016

Background: Ductal carcinoma in situ of the male breast is an unusual lesion and most often associated with invasive carcinoma. On rare occasions when the in situ component is present in pure form, histological grade is almost always low to intermediate. Imaging for these patients is difficult as gynecomastia is often present and can mask underlying calcifications or carcinoma. Case Report: We report a case of pure high-grade ductal carcinoma in situ of the male breast in a patient with clear nipple discharge. Breast mammography showed bilateral gynecomastia and benign calcifications. Subsequent breast ultrasound showed dilated ducts of the left breast, and a left breast ductogram showed filling defects suggestive of a papilloma. Excisional biopsy and subsequent mastectomy were consistent with high-grade ductal carcinoma in situ. Conclusion: Male breast cancer is uncommon and, although there is increasing awareness, it is less studied compared to female breast cancer. With a clinical history of nipple discharge of any kind, further evaluation with imaging should be considered. In males with gynecomastia, it is important to remember that ductal carcinoma in situ, even of high grade, is difficult to detect on mammography and may not be associated with suspicious calcifications.
Impact of reticulated platelets on antiplatelet response to thienopyridines is independent of platelet turnover
Authors: Nührenberg Thomas , Amann Michael , Cederqvist Marco , Kleiner Pascal , Valina Christian M. , Trenk Dietmar , Neumann Franz-Josef , Hochholzer Willibald , Stratz Christian
Published: August 2016

Reticulated platelets are associated with impaired antiplatelet response to thienopyridines. It is uncertain whether this interaction is caused by a decreased drug exposure due to high platelet turnover reflected by elevated levels of reticulated platelets or by intrinsic properties of reticulated platelets. This study sought to investigate if the impact of reticulated platelets on early antiplatelet response to thienopyridines is mainly caused by platelet turnover as previously suggested. Elective patients undergoing coronary intervention were randomised to loading with clopidogrel 600 mg or prasugrel 60 mg (n=200). Adenosine diphosphate (ADP)-induced platelet reactivity was determined by impedance aggregometry before, at 30, 60, 90, and 120 minutes and at day 1 after loading. Immature platelet count was assessed as marker of reticulated platelets by flow cytometry. Platelet reactivity increased with rising levels of immature platelet count in both groups. This effect was more distinctive in patients on clopidogrel as compared to patients on prasugrel. Overall, immature platelet count correlated well with on-treatment platelet reactivity at all timepoints (p < 0.001). These correlations did not change over time in the entire cohort as well as in patients treated with clopidogrel or prasugrel indicating an effect independent of platelet turnover (comparison of correlations 120 minutes/day 1: p = 0.64). In conclusion, the association of immature platelet count with impaired antiplatelet response to thienopyridines is similar early and late after loading. This finding suggests as main underlying mechanism another effect of reticulated platelets on thienopyridines than platelet turnover.

Supplementary Material to this article is available online at www.thrombosis-online.com.
A new Otocinclus (Siluriformes: Loricariidae: Hypoptopomatinae) from the Rio Juruena Basin, central Brazil
Authors: RIBEIRO ALEXANDRE CUNHA , LEHMANN PABLO A.
Published: August 2016

A new species of Otocinclus (Loricariidae) is described from the Rio Juruena, a right bank tributary of the Rio Tapajós system in Mato Grosso State, central Brazil. The new taxon can be distinguished from its congeners by the possession of an ocular operculum and by a complete lateral line. Additionally, the new species is distinguished by having a dorsal trunk coloration composed of a set of distinct oval dark blotches and by a caudal spot.
Taxonomic revision of the crab spider genus Epicadus Simon, 1895 (Arachnida: Araneae: Thomisidae) with notes on related genera of Stephanopinae Simon, 1895
Authors: SILVA-MOREIRA THIAGO DA , MACHADO MIGUEL
Published: August 2016

All species of Epicadus Simon, 1895 are reviewed and redescribed, including the previously unknown males of E. rubripes Mello-Leitão, 1924 and E. planus Mello-Leitão, 1932. A new diagnosis based on morphological characters is proposed for the genus. Three valid species of Epicadus are recognized: E. heterogaster (Guérin-Méneville, 1829); E. rubripes and E. planus. The following taxonomic changes are proposed: E. granulatus Banks, 1909 is considered incertae sedis, most likely belonging to a new genus; E. h. scholagriculae Piza, 1933 is considered a junior subjective synonym of E. heterogaster; E. pallidus Mello-Leitão, 1929 is considered a junior subjective synonym of E. rubripes Mello-Leitão, 1924; E. nigronotatus Mello-Leitão, 1940 is considered junior subjective synonym of E. planus Mello-Leitão, 1932. Species distributions were updated with new records in the Neotropics, including Bolivia, Colombia, Ecuador, Mexico, Panama, Paraguay, Peru and Venezuela, which makes Epicadus a genus of Neotropical distribution.
The History and Future of Neoliberal Health Reform
Authors: Waitzkin Howard , Hellander Ida
Published: August 2016

The Colombian reform of 1994, through a strange historical sequence, became a model for health reform in Latin America, Europe, and the United States. Officially, the reform aimed to improve access for the uninsured and underinsured, in collaboration with the private, for-profit insurance industry. After several historical attempts at health reform adhering to the neoliberal pattern, favored by international financial institutions and multinational insurance corporations, the Affordable Care Act (ACA) similarly enhanced access by corporations to public-sector trust funds. An ideology favoring for-profit corporations in the marketplace justified these reforms through unproven claims about the efficiency of the private sector and enhanced quality of care under principles of competition and business management. The ACA maintains this historical continuity by dealing with health care as a commodity bought and sold in a marketplace, rather than a fundamental human right to be guaranteed according to principles of social solidarity. As the ACA heads toward probable failure, a space finally will open for a U.S. national health program that does not follow same historical patterns of the neoliberal model.
Pursuing equal pay: The perspectives of female engineers and potential policy interventions
Authors: McGregor Judy , Davies Sharyn Graham , Giddings Lynne S , Pringle Judith
Published: August 2016

The gender pay gap of higher paid women working in traditionally male-dominated sectors has received less analysis in equal pay research than low paid, female-dominated and undervalued women’s work. This article explores equal pay from the perspectives of female engineers, well paid women working in a Science, Technology, Engineering and Mathematics (STEM) sector in New Zealand, who perform work of the same or like nature to male engineers but who are paid less for doing so. It explores the gender pay gap against the complex intersections of labour market de-regulation, family demands, work and the ‘cost of being female’ that women in engineering must constantly navigate. The research uses quantitative pay data in the sector disaggregated by gender, and new qualitative data from focus groups and interviews with 22 female engineers. It finds a surprising lack of transparency around pay and remuneration in the sector at the individual level which negatively impacts on women. The article concludes by recommending new public policy initiatives for equal pay in sectors like engineering, where individualised negotiation and bargaining is embedded in neo-liberalism.
Sense of Community and Its Impact on the Life Satisfaction of Adults With Brain Injury
Authors: Ditchman Nicole M. , Keegan John P. , Batchos Elisabeth J. , Haak Christopher L. , Johnson Kristina S.
Published: August 2016

Sense of community (SOC) refers to feelings of belonging and attachment one has for a community. Despite a growing focus on adjustment and community outcomes following disability, this construct has received little attention in the rehabilitation literature. The primary aim of this study was to examine the extent to which SOC and social identification with one’s town contribute to life satisfaction outcomes among adults with brain injury, controlling for demographic, disability, and other related social constructs (e.g., social support and social integration). Members from brain injury associations across the United States ( N = 177) participated in a survey-based study. Results from hierarchical regression analysis indicated that the final model accounted for 45% of the variance in life satisfaction, with SOC variables contributing 11%. Symptom severity, perceived emotional support, and the SOC dimension reinforcement of needs were significant independent predictors of life satisfaction. Findings from this study highlight the importance of examining SOC variables among clients with brain injury to enhance subjective well-being.
“But now my eye sees you”
Authors: Carson Jordan
Published: August 2016

This article argues Thomas Pynchon’s The Crying of Lot 49 is a postsecular retelling of the book of Job. The novel not only alludes directly to Job, but shares plot, structure, and theme. Both texts explore religious meaning; divining the nature of the transcendent is the primary task of both protagonists. Further, both texts detail an education in uncertainty: as the voice from the whirlwind “answers” neither Oedipa nor Job according to expectations, each comes to understand the innate uncertainty of life and gains the self-knowledge and wisdom to live fully in spite of and according to this ambiguity.
“How good it is to be a monkey”: Conversion and spiritual formation in Gene Luen Yang’s American Born Chinese
Authors: Stratman Jacob
Published: August 2016

For me, the most complex and nuanced intersection of theology and spiritual formation written in literature for young people is contained in the work of Gene Luen Yang. The scope of this article is to explore the Christian belief of Yang’s major work to date, American Born Chinese, with the hope that more scholar-teachers will include Yang’s work in their curriculum, and more scholar-parents will include more of Yang’s work on their bookshelves. More specifically, this article argues that a theological approach to the graphic novel reveals spiritual formation to be as much a part of the narrative’s focus on teenage identity as its already recognized and emphasized racial formation.
Mechanisms and states of self-stress of planar trusses using graphic statics, part II: Applications and extensions
Authors: McRobie Allan , Baker William , Mitchell Toby , Konstantatou Marina
Published: August 2016

This article extends the overview relating graphic statics and reciprocal diagrams to linear algebra-based matrix structural analysis. Focus is placed on infinitesimal mechanisms, both in-plane (linkage) and out-of-plane (polyhedral Airy stress functions). Each self-stress in the original diagram corresponds to an out-of-plane polyhedral mechanism. Decomposition into sub-polyhedra leads to a basis set of reciprocal figures which may then be linearly combined. This leads to an intuitively appealing approach to the identification of states of self-stress for use in structural design and to a natural ‘structural algebra’ for use in structural optimisation. A 90° rotation of the sub-reciprocal generated by any sub-polyhedron leads to the displacement diagram of an in-plane mechanism. Any self-stress in the original thus corresponds to an in-plane mechanism of the reciprocal, summarised by the equation s =  M* (where s is the number of states of self-stress in one figure, and M* is the number of in-plane mechanisms, including rigid body rotation, in the other). Since states of self-stress correspond to out-of-plane polyhedral mechanisms, this leads to a form of ‘conservation of mechanisms’ under reciprocity. It is also shown how external forces may be treated via a triple-layer Airy stress function, consisting of a structural layer, a load layer and a layer formed by coordinate vectors of the structural perimeter.
Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study
Authors: Seng Elizabeth K , Robbins Matthew S , Nicholson Robert A
Published: August 2016

Objective

To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction.

Methods

Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication.

Results

Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p < .001] and highest acute medication satisfaction [medication × pain at dosing F (4, 3867.36) = 24.00, p < .001].

Conclusion

Using an MSM (triptan or ergot) first was associated with the lowest migraine disability and highest acute medication satisfaction.
Tavaborole, Efinaconazole, and Luliconazole: Three New Antimycotic Agents for the Treatment of Dermatophytic Fungi
Authors: Saunders Jacqueline , Maki Kayla , Koski Renee , Nybo S. Eric
Published: August 2016

Fungal diseases of the nail bed (onychomycosis) and epidermis are recurrent illnesses in the elderly and immunocompromised patients, which have few efficacious treatment options. Current treatment options for onychomycosis are limited to topical agents, laser treatment, and oral antifungals. Previous generations of topical agents were not efficacious, owing to poor penetration of the nail bed. Oral antifungal drugs, such as itraconazole, terbinafine, and fluconazole, not only give better response rates but also inhibit a host of CYP450 enzymes. Oral antifungals can exacerbate drug–drug interactions for patients taking other medications concurrently. Newer topical agents might recognize improved efficacy and provide therapeutic alternatives when the use of oral antifungal agents is contraindicated. Recently, the Food and Drug Administration (FDA) approved efinaconazole and tavaborole for the treatment of onychomycosis. Additionally, the FDA approved luliconazole for the treatment of tinea pedis, tinea cruris, and tinea corporis. This review examines the mechanism of action, spectrum of activity, pharmacokinetics, and clinical trials data and considers the place in therapy for these 3 new antimycotic agents.
Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa
Authors: Lewandowski L B , Schanberg L E , Thielman N , Phuti A , Kalla A A , Okpechi I , Nourse P , Gajjar P , Faller G , Ambaram P , Reuter H , Spittal G , Scott C
Published: August 2016

Background

Systemic lupus erythematosus (SLE) is a life-threatening multisystem autoimmune disease that is more severe in patients of African ancestry and children, yet pediatric SLE on the African continent has been understudied. This study describes a cohort of pediatric SLE (PULSE) patients in South Africa.

Methods

Patients with a diagnosis of SLE (1997 American College of Rheumatology criteria) diagnosed prior to age 19 years in Cape Town, South Africa, were enrolled in this cross-sectional study from September 2013 to December 2014. Information on clinical and serological characteristics was extracted from medical records. Results were compared to a well-described North American pediatric SLE cohort.

Results

Seventy-two South African patients were enrolled in the study; mean age 11.5 years; 82% were girls. The racial distribution was 68% Coloured, 24% Black, 5% White and 3% Asian/Indian. Most patients presented with severe lupus nephritis documented by renal biopsy (61%). Of patients with lupus nephritis, 63% presented with International Society of Nephrology/Renal Pathology Society class III or IV. Patients in the PULSE cohort were more likely to be treated with cyclophosphamide, methotrexate and azathioprine. The PULSE cohort had high disease activity at diagnosis (mean Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K) 20.6). The SLEDAI-2K at enrolment in the PULSE cohort (5.0) did not differ from the North American pediatric SLE cohort (4.8). Sixty-three per cent of the PULSE cohort had end organ damage with Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) score >0 (mean SLICC-DI 1.9), compared to 23% in a previously reported US cohort. Within the PULSE cohort, nine (13%) developed end-stage renal disease with six (8%) requiring transplant, strikingly higher than North American peers (transplant rate <1%).

Conclusions

The PULSE cohort had highly active multiorgan disease at diagnosis and significant disease damage at enrolment in the South African registry. South African patients have severe lupus nephritis and poor renal outcomes compared to North American peers. Our study revealed a severe disease phenotype in the PULSE cohort resulting in poor outcomes in this high-risk population.
An extension of generalized pairwise comparisons for prioritized outcomes in the presence of censoring
Authors: Péron Julien , Buyse Marc , Ozenne Brice , Roche Laurent , Roy Pascal
Published: August 2016

Generalized pairwise comparisons have been proposed to permit a comprehensive assessment of several prioritized outcomes between two groups of observations. This procedure estimates Δ, the net chance of a better outcome with treatment than with control by comparing the patients outcomes among all possible pairs taking one patient from the treatment group and one patient from the control group. For time to event outcomes, the standard procedure of generalized pairwise comparisons is analogous to the Gehan’s modification of the Mann-Whitney test which is biased in presence of censored observation and less powerful than Efron’s modification of this test. We adapt Efron’s modification to generalized pairwise comparisons. We show how a pairwise contribution to Δ can be calculated from the estimates of the survival function in the presence of right-censored data. We performed a simulation study to assess the bias, the type I error and the power of the new procedure. The estimate of Δ with the new procedure is only slightly biased even in presence of heavy censoring. We also show how this bias can be corrected when only one time-to-event outcome is analyzed. The new procedure has higher power in most cases compared to the standard procedure.
When Terminal Illness Is Worse Than Death: A Multicenter Study of Health-Care Providers’ Resuscitation Desires
Authors: Chavez Luis O. , Einav Sharon , Varon Joseph
Published: August 2016

Purpose:

To investigate how a terminal illness may affect the health-care providers’ resuscitation preferences.

Methods:

We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ2 test for the presence of associations ( P < 0.05 being significant) and Cramer V for the strength of the association. The main outcome measured the correlation between the respondents’ present code status and their preference for cardiopulmonary resuscitation (CPR) in case of terminal illness.

Results:

A total of 852 surveys were completed. Among the respondents, 21% (n = 180) were physicians, 36.9% (n = 317) were nurses, 10.5% (n = 90) were medical students, and 265 participants were other staff members of the institutions. Most respondents (58.3%; n = 500) desired “definitely full code” (physicians 73.2%; n = 131), only 13.8% of the respondents (physicians 8.33%; n = 15) desired “definitely no code” or “partial support,” and 20.9% of the respondents (n = 179; among physicians 18.4%; n = 33) had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness ( P < .001), but this association was overall quite weak (Cramer V = 0.180). Subgroup analysis revealed no association between current code status and terminal illness code preference among physicians ( P = .290) and nurses ( P = .316), whereupon other hospital workers were more consistent ( P < .01, Cramer V = .291).

Conclusion:

Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo CPR may change when facing a terminal illness.
Failure path-independent methodology for structural damage evolution and failure mode analysis of framed structures
Authors: Yang LuFeng , Liu JingMin , Yu Bo , Ju JW
Published: August 2016

Traditional methods for structural damage evolution and failure mode analysis usually depend on specific failure path analysis, which is inefficient and time-consuming to implement for complex structures. In this paper, an efficient failure path-independent methodology for structural damage evolution and failure mode analysis of framed structures is proposed based on the elastic modulus reduction method. The element bearing ratio, uniformity of element bearing ratio and reference element bearing ratio are defined in terms of the homogeneous generalized yield function of spatial beam element, while a dynamic criterion is presented to identify the highly stressed elements. Subsequently, a self-adaptive strategy of elastic modulus adjustment is developed to reduce the elastic moduli of the highly stressed elements for simulation of structural damage evolution. Finally, the reduction rate of elastic moduli of the highly stressed elements is presented to determine the failed sections among the failure elements in the last iteration, based on which the potential failure mode is identified. The applicability, computational accuracy and efficiency of the proposed methodology are validated by comparing with the elasto-plastic methods through two numerical examples.
Serum activity of angiotensin converting enzyme 2 is decreased in patients with acute ischemic stroke
Authors: Bennion Douglas M , Rosado Christian A , Haltigan Emily A , Regenhardt Robert W , Sumners Colin , Waters Michael F
Published: August 2016

Levels of angiotensin converting enzyme 2 (ACE2), a cardio and neuro-protective carboxypeptidase, are dynamically altered after stroke in preclinical models. We sought to characterize the previously unexplored changes in serum ACE2 activity of stroke patients and the mechanism of these changes. Serum samples were obtained from patients during acute ischemic stroke ( n=39), conditions mimicking stroke (stroke-alert, n=23), or from control participants ( n=20). Enzyme activity levels were analyzed by fluorometric assay and correlated with clinical variables by regression analyses. Serum ACE2 activity was significantly lower in acute ischemic stroke as compared to both control and stroke-alert patients, followed by an increase to control levels at three days. Serum ACE2 activity significantly correlated with the presence of ischemic stroke after controlling for other factors ( P=0.01). Additional associations with ACE2 activity included a positive correlation with systolic blood pressure at presentation in stroke-alert ( R2=0.24, P=0.03), while stroke levels showed no correlation ( R2=0.01, P=0.50). ACE2 sheddase activity was unchanged between groups. These dynamic changes in serum ACE2 activity in stroke, which concur with preclinical studies, are not likely to be driven primarily by acute changes in blood pressure or sheddase activity. These findings provide new insight for developing therapies targeting this protective system in ischemic stroke.
Fate of Enlarged Iliac Arteries After Endovascular or Open Abdominal Aortic Aneurysm Repair
Authors: Dube Bhekifa , Ünlü Çağdaş , de Vries Jean-Paul P. M.
Published: August 2016

Purpose: To examine the fate of untreated ectatic and aneurysmal common iliac arteries (CIAs) after open treatment and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: Databases of scientific literature were searched between January 1980 and February 2016 to identify publications on the follow-up of ectatic and aneurysmal CIAs after open or endovascular AAA repair. The primary outcome measure was the increase of iliac artery diameter during follow-up. The secondary outcome was the subsequent reintervention rate during follow-up. Results: Only 3 open AAA and 3 EVAR studies containing 1239 patients met the inclusion criteria for analysis. In the open AAA group, ectatic iliac arteries (defined as 12–18 mm) had a diameter progression of 1.7 to 1.8 mm during a follow-up period of 51.6 to 85.2 months. The aneurysmal iliac arteries (>18 mm) in the open repair group showed a faster growth (2.3–3.0 mm) in a follow-up period of 50.4 to 85.2 months. The pooled assessment of arteries ≥18 mm had a mean growth of 2.56 mm at 60 months of follow-up. In the entire open AAA cohort, the reintervention rate for CIA transformation was <1%. In the EVAR studies, arbitrary cutoff sizes of 16 to 20 mm for ectatic arteries and >20 mm for aneurysmal arteries were used. During a follow-up of 39.2 to 60 months, the diameter progression was 1.5 mm for the 16-mm iliac arteries and 2.7 mm for the 20-mm iliac arteries. The need for endovascular reinterventions was similar in patients with previously normal or enlarged CIAs. Conclusion: After open AAA repair, the overall size of CIA aneurysms grows slowly, but enlarged CIAs >20 mm in EVAR patients show faster growth during follow-up. However, the need for secondary interventions was similar in patients with normal or enlarged CIAs post EVAR.
The role of approximate morphisms in multiresolution modeling: Can we relax the strict lumpability requirements?
Authors: Zeigler Bernard P
Published: August 2016

To become the core development methodology of major defense-related simulation projects, multiresolution modeling needs more advances in basic theory and practice. In this note, we illustrate an approach to addressing issues relating to approximate morphisms (structure/behavior preservation relations) between pairs of models. Such issues include metrics for departure from strict lumpability, tying approximate satisfaction of structural conditions to the resulting behavioral error, and how to enhance the probability of creating good approximate morphisms by humans and artificial modelers.
The Correlation Between a Numerical Rating Scale of Patient Satisfaction With Current Management of an Upper Extremity Disorder and a General Measure of Satisfaction With the Medical Visit
Authors: van Berckel Marijn M. G. , Bosma Niels H. , Hageman Michiel G. J. S. , Ring David , Vranceanu Ana-Maria
Published: August 2016

Background: Patient satisfaction is used as an indicator of quality of care, but the measures currently available are lengthy and cumbersome and may not be feasible in orthopedic surgical practices. We set out to assess the relationship between the Medical Interview Satisfaction Scale (MISS-21) and a numerical rating scale (NRS) of patient satisfaction with current management of an orthopedic upper extremity condition. Methods: In this cross-sectional study, 86 patients from the practices of 2 hand surgeons were included during an initial or follow-up visit. Questionnaires assessing demographics, upper extremity specific disability, pain during rest and activity, satisfaction with the medical visits (MISS-21), and satisfaction with current management of an orthopedic upper extremity condition (NRS satisfaction) were completed. Results: Eighty-six patients completed all questionnaires. A small correlation of .21 ( P = .050) was found between the MISS-21 and the NRS satisfaction. In bivariate analysis, NRS pain at rest and during activity had small correlations with the MISS-21 (−.29, P = .05 and −.23, P = .034) and with NRS satisfaction (−.27, P = .011 and −0.27, P = 0.012). Quick Disability of Arm, Shoulder and Hand (QuickDASH) had a small correlation with NRS satisfaction (−0.023, P ≤ 0.001), but did not correlate with MISS-21. Conclusions: Although there is small overlap about the 2 satisfaction measures, a complex patient satisfaction questionnaire consisting of multiple facets of patient satisfaction like MISS-21 is not replaceable by 1 simple NRS patient satisfaction question.
Dynamic modeling and simulation of a two-stage series-parallel vibration isolation system
Authors: Guo Rong , Zhou Sheng-qi , Wang Meng-jia , Qiu Shan
Published: August 2016

A two-stage series-parallel vibration isolation system is already widely used in various industrial fields. However, when the researchers analyze the vibration characteristics of a mechanical system, the system is usually regarded as a single-stage one composed of two substructures. The dynamic modeling of a two-stage series-parallel vibration isolation system using frequency response function–based substructuring method has not been studied. Therefore, this article presents the source-path-receiver model and the substructure property identification model of such a system. These two models make up the transfer path model of the system. And the model is programmed by MATLAB. To verify the proposed transfer path model, a finite element model simulating a vehicle system, which is a typical two-stage series-parallel vibration isolation system, is developed. The substructure frequency response functions and system level frequency response functions can be obtained by MSC Patran/Nastran and LMS Virtual.lab based on the finite element model. Next, the system level frequency response functions are substituted into the transfer path model to predict the substructural frequency response functions and the system response of the coupled structure can then be further calculated. By comparing the predicted results and exact value, the model proves to be correct. Finally, the random noise is introduced into several relevant system level frequency response functions for error sensitivity analysis. The system level frequency response functions that are most sensitive to the random error are found. Since a two-stage series-parallel system has not been well studied, the proposed transfer path model improves the dynamic theory of the multi-stage vibration isolation system. Moreover, the validation process of the model here actually provides an example for acoustic and vibration transfer path analysis based on the proposed model. And it is worth noting that the proposed model can be widely applicable in mechanical systems.
Integrated Framework for Patient Safety and Energy Efficiency in Healthcare Facilities Retrofit Projects
Authors: Mohammadpour Atefeh , Anumba Chimay J. , Messner John I.
Published: August 2016

There is a growing focus on enhancing energy efficiency in healthcare facilities, many of which are decades old. Since replacement of all aging healthcare facilities is not economically feasible, the retrofitting of these facilities is an appropriate path, which also provides an opportunity to incorporate energy efficiency measures. In undertaking energy efficiency retrofits, it is vital that the safety of the patients in these facilities is maintained or enhanced. However, the interactions between patient safety and energy efficiency have not been adequately addressed to realize the full benefits of retrofitting healthcare facilities. To address this, an innovative integrated framework, the Patient Safety and Energy Efficiency (PATSiE) framework, was developed to simultaneously enhance patient safety and energy efficiency. The framework includes a step-by-step procedure for enhancing both patient safety and energy efficiency. It provides a structured overview of the different stages involved in retrofitting healthcare facilities and improves understanding of the intricacies associated with integrating patient safety improvements with energy efficiency enhancements. Evaluation of the PATSiE framework was conducted through focus groups with the key stakeholders in two case study healthcare facilities. The feedback from these stakeholders was generally positive, as they considered the framework useful and applicable to retrofit projects in the healthcare industry.