bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Twitter to Educate and Engage Surgeons in Infectious Diseases and Antimicrobial Stewardship
Authors: Goff Debra A. , Jones Christian , Toney Blake , Nwomeh Benedict C. , Bauer Karri , Ellison E. Christopher
Published: September 2016

Background

As more surgeons use Twitter, it is vital to understand how to engage users. Surgeons need timely education on multidrug-resistant organisms to prescribe effective antibiotics. We evaluated Twitter as a tool to engage and educate surgeons in emerging infectious disease (ID) topics on antibiotic resistance and antimicrobial stewardship.

Methods

This was a 3-month prospective cohort study with surgeons who volunteered after attending Twitter Grand Rounds presentation and workshop. Pharmacists tweeted ID topics relevant to surgeons, and each tweet's reach, impressions, and engagement were calculated.

Results

A total of 5117 tweets were sent: 4089 by 21 surgeons and 1028 by study pharmacists. Pharmacists sent 451 ID tweets, and surgeons engaged in 72 ID tweets: 31 retweeted, 29 replied, and 12 “liked” for a potential reach of 5101, potential impressions of 38 784, and actual impressions of 15,895. The top ID tweet topics by actual impressions were antibiotic resistance (3005), global antibiotic stewardship (2257), “superbugs” (2121), and Clostridium difficile (1181). Of the 31 ID retweets by surgeons, 81% had links to articles versus 19% without links (P = 0.54). Grand Rounds evaluations identified that 81% rated the presentation topic as excellent and 77% felt Twitter was relevant to their practice. The conference hashtag #TwitterGrandRounds engaged surgeons tweeting from other institutions and generated an additional 217,317 potential impressions.

Conclusions

Twitter engaged surgeons in ID and antimicrobial stewardship topics and provided real-time education around antimicrobial resistance. Future studies should evaluate whether engagement and education via tweets impact actual antimicrobial use and the rates of antimicrobial resistance.
Role of Telomerase in Cervical Lesions as Prognostic Marker: A Comparison Between Immunohistochemistry and Fluorescence In Situ Hybridization
Authors: Ravaioli Sara , Tumedei Maria M. , Amadori Andrea , Puccetti Maurizio , Chiadini Elisa , Bravaccini Sara
Published: September 2016

Objectives

Amplification of human telomerase is known to be associated with cervical tumorigenesis, although its role in tumor progression of cervical lesions is still unclear. We aimed to evaluate the role of telomerase in predicting the evolution of cervical lesions.

Methods

A total of 50 tissue samples taken by biopsy or conization once or repeatedly from 17 patients with cervical lesions over a 14-year follow-up was analyzed using fluorescence in situ hybridization (FISH) for hTERC gene alterations and immunohistochemistry (IHC) for hTERT expression. The accuracy of the biomarkers was measured using the area under the curve.

Results

Telomerase gene amplification is highly indicative of cervical lesion evolution and seems to be a more reliable biomarker than the protein expression detected by IHC. In fact, patients with benign lesions or cervical intraepithelial lesions (CINs) showing hTERC amplification relapsed or progressed into CIN 2 and CIN 3 more frequently than those without any gene amplification. FISH and IHC assays had both 86% sensitivity on conized material and 78% and 40% specificity, respectively.

Conclusions

We demonstrated that the most accurate method to evaluate telomerase alterations as prognostic markers in cervical lesions was FISH assay on hTERC gene. The best accuracy was obtained using conized materials.
Targeting the innate repair receptor to treat neuropathy
Authors: Dahan Albert , Brines Michael , Niesters Marieke , Cerami Anthony , van Velzen Monique
Published: September 2016

The innate repair receptor (IRR) is a heteromer of the erythropoietin receptor and the β-common (CD131) receptor, which simultaneously activates anti-inflammatory and tissue repair pathways. Experimental data suggest that after peripheral nerve injury, the IRR is upregulated in the spinal cord and modulates the neurogenic inflammatory response. The recently introduced selective IRR agonist ARA290 is an 11-amino acid peptide initially tested in animal models of neuropathy. After sciatic nerve injury, ARA290 produced a rapid and long-term relief of mechanical and cold allodynia in normal mice, but not in animals with a β-common receptor knockout phenotype. In humans, ARA290 has been evaluated in patients with small fiber neuropathy associated with sarcoidosis or type 2 diabetes (T2D) mellitus. In patients with sarcoidosis, ARA290 significantly improved neuropathic and autonomic symptoms, as well as quality of life as assessed by the small fiber neuropathy screening list questionnaire. In addition, ARA290 treatment for 28 days initiated a regrowth of small nerve fibers in the cornea, but not in the epidermis. In patients with T2D, the results were similar to those observed in patients with sarcoidosis along with an improved metabolic profile. In both populations, ARA290 lacked significant adverse effects. These experimental and clinical studies show that ARA290 effectively reprograms a proinflammatory, tissue-damaging milieu into one of healing and tissue repair. Further clinical trials with long-term treatment and follow-up are needed to assess the full potential of IRR activation by ARA290 as a disease-modifying therapy in neuropathy of various etiologies.
Actigraphy in Patients With Major Depressive Disorder Undergoing Repetitive Transcranial Magnetic Stimulation
Authors: Nishida Masaki , Kikuchi Senichiro , Nisijima Koichi , Suda Shiro
Published: September 2016

Background

The effects of repetitive transcranial magnetic stimulation (rTMS) on physical activity and sleep patterns in individuals with major depressive disorder (MDD) remain unclear.

Method

We examined the effects of rTMS treatment on the rest–activity cycle and sleep disturbances in MDD. In this open-label pilot study, 14 patients with medication-resistant MDD underwent 10 rTMS sessions over the bilateral dorsolateral prefrontal cortex. In addition to Hamilton Depression Rating Scale and Pittsburgh Sleep Quality Index scores, waist actigraphy was used to evaluate alterations in the rest–activity cycle over the course of rTMS treatments. Actigraphic data were evaluated at baseline and in the first (rTMS sessions 1–3), second (rTMS sessions 4–7), and third (rTMS sessions 8–10) sections.

Results

Although Hamilton Depression Rating Scale and Pittsburgh Sleep Quality Index scores were significantly improved by rTMS, sleep variables assessed by actigraphy did not show significant changes. However, post hoc tests indicated a significant increase in mean steps per day between the baseline and first section time points (P = 0.014; t
13 = −2.316).

Conclusions

Our data indicated that a daytime physical activity response to rTMS occurred in early sessions, whereas subjective symptom improvements were consistent across all sessions. Future double-blind placebo-controlled studies assessing the effects of rTMS on the rest–activity cycle and sleep disturbances in MDD are warranted.
HiChIP: Efficient and sensitive analysis of protein-directed genome architecture
Authors: Mumbach Maxwell R. , Rubin Adam J. , Flynn Ryan A. , Dai Chao , Khavari Paul A. , Greenleaf William J. , Chang Howard Y.
Published: September 2016

Genome conformation is central to gene control but challenging to interrogate. Here we present HiChIP, a protein-centric chromatin conformation method. HiChIP improves the yield of conformation-informative reads by over 10-fold and lowers input requirement over 100-fold relative to ChIA-PET. HiChIP of cohesin reveals multi-scale genome architecture with greater signal to background thanin situHi-C. Thus, HiChIP adds to the toolbox of 3D genome structure and regulation for diverse biomedical applications.
13C metabolic flux ratio analysis by direct measurement of free metabolic intermediates in L. mexicana using gas chromatography-mass spectrometry
Authors: Ng Milica , Saunders Eleanor C. , Olshansky Moshe , McConville Malcolm J. , Likić Vladimir A.
Published: September 2016

Until recently,13C-based flux analyses have almost exclusively relied on analysis of labelled amino acids in proteins. This approach is not directly applicable toLeishmania, as these parasites scavenge most of their amino acids from the media.Leishmaniaare also unusual in that they i) share little genomic similarity with other organisms ii) constitutively express their metabolic genes and iii) display minimal changes in the enzyme levels throughout their life cycle stages. The three factors have contributed to an early development of comprehensive and reproducible13C-based metabolomics approaches in these parasites. The work presented here contributes to the creation of new13C-based metabolic flux approaches based on the isotopologue analysis of free metabolite pools inLeishmania mexicana. Namely, a new approach is presented for simultaneous calculation ofin vivofractional fluxes (or flux ratios) into two or more metabolite nodes with carbon dioxide condensation, based on isotopologue analysis of free metabolite pools. This method is used to perform the first quantitativein vivofractional flux calculation of central carbon metabolism in any human parasite.
A self-initiated two-alternative forced choice paradigm for head-fixed mice
Authors: Marbach Fred , Zador Anthony M.
Published: September 2016

Psychophysical tasks for non-human primates have been instrumental in studying circuits underlying perceptual decision-making. To obtain greater experimental flexibility, these tasks have subsequently been adapted for use in freely moving rodents. However, advances in functional imaging and genetic targeting of neuronal populations have made it critical to develop similar tasks for head-fixed mice. Although head-fixed mice have been trained in two-alternative forced choice tasks before, these tasks were not self-initiated, making it difficult to attribute error trials to perceptual or decision errors as opposed to mere lapses in task engagement. Here, we describe a paradigm for head-fixed mice with three lick spouts, analogous to the well-established 3-port paradigm for freely moving rodents. Mice readily learned to initiate trials on the center spout and performed around 200 self-initiated trials per session, reaching good psychometric performance within two weeks of training. We expect this paradigm will be useful to study the role of defined neural populations in sensory processing and decision-making.
Improving genetic diagnosis in Mendelian disease with transcriptome sequencing
Authors: Cummings Beryl B , Marshall Jamie L , Tukiainen Taru , Lek Monkol , Donkervoort Sandra , Foley A. Reghan , Bolduc Veronique , Waddell Leigh , Sandaradura Sarah , O’Grady Gina , Estrella Elicia , Reddy Hemakumar M , Zhao Fengmei , Weisburd Ben , Karczewski Konrad J , O’Donnell-Luria Anne H , Birnbaum Daniel , Sarkozy Anna , Hu Ying , Gonorazky Hernan , Claeys Kristl , Joshi Himanshu , Bournazos Adam , Oates Emily C. , Ghaoui Roula , Davis Mark , Laing Nigel , Topf Ana ,   GTEx Consortium, Kang Peter B , Beggs Alan H , North Kathryn N , Straub Volker , Dowling James , Muntoni Francesco , Clarke Nigel F , Cooper Sandra T , Bonnemann Carsten G , MacArthur Daniel G
Published: September 2016

Exome and whole-genome sequencing are becoming increasingly routine approaches in Mendelian disease diagnosis. Despite their success, the current diagnostic rate for genomic analyses across a variety of rare diseases is approximately 25-50%. Here, we explore the utility of transcriptome sequencing (RNA-seq) as a complementary diagnostic tool in a cohort of 50 patients with genetically undiagnosed rare muscle disorders. We describe an integrated approach to analyze patient muscle RNA-seq, leveraging an analysis framework focused on the detection of transcript-level changes that are unique to the patient compared to over 180 control skeletal muscle samples. We demonstrate the power of RNA-seq to validate candidate splice-disrupting mutations and to identify splice-altering variants in both exonic and deep intronic regions, yielding an overall diagnosis rate of 35%. We also report the discovery of a highly recurrentde novointronic mutation inCOL6A1that results in a dominantly acting splice-gain event, disrupting the critical glycine repeat motif of the triple helical domain. We identify this pathogenic variant in a total of 27 genetically unsolved patients in an external collagen VI-like dystrophy cohort, thus explaining approximately 25% of patients clinically suggestive of collagen VI dystrophy in whom prior genetic analysis is negative. Overall, this study represents a large systematic application of transcriptome sequencing to rare disease diagnosis and highlights its utility for the detection and interpretation of variants missed by current standard diagnostic approaches.

One Sentence Summary

Transcriptome sequencing improves the diagnostic rate for Mendelian disease in patients for whom genetic analysis has not returned a diagnosis.
Understanding the absence of renewable electricity imports to the European Union
Authors: Lilliestam Johan , Ellenbeck Saskia , Karakosta Charikleia , Caldés Natàlia
Published: September 2016

Purpose

This paper aims to analyse reasons for the absence of renewable electricity (RE) imports to the European Union, for which the authors develop a multi-level heuristic.

Design/methodology/approach

The heuristic covers three sequential acceptance levels: political attractiveness (macro-level), the “business case” (micro-level) and civil society perspectives (public discourse level).

Findings

Numerous factors on all three levels determine the success/demise of renewables trade. So far, trade has failed on the macro-level, because European policymakers perceive that targets can be achieved domestically with significant co-benefits and because exporter countries have rapidly increasing electricity demand, limiting the realisable exports. As policymakers deemed it unattractive, they have not implemented policy-supported business cases. Public opposition against trade has not been an issue as no concrete plans or projects have been proposed.

Research limitations/implications

The authors show that the factors determining whether a RE programme is successful are plentiful and extend far beyond potential cost savings. This suggests that future research and the energy policy debate should better account for how cost savings are weighed against other policy aims and explicitly include the perspectives of investors and the public.

Originality/value

This paper adds the first holistic analysis of success/failure factors for RE trade to Europe. The three-level, sequential framework is new to energy policy analysis.
Renewable energy cooperation between the EU and North Africa
Authors: Beneking Andreas , Ellenbeck Saskia , Battaglini Antonella
Published: September 2016

Purpose

Following the issuance of the Renewable Energy Directive in 2009, the European Union (EU) is explicitly pushing for member states to cooperate with third countries to meet their EU 2020 targets. So far, no single joint project is planned or in place yet. This paper aims to look at the opportunities for and barriers to possible RE exports from North Africa into the EU through the concept of a SWOT (strengths, weaknesses, opportunities and threats) analysis.

Design/methodology/approach

Thus, the SWOT for a possible implementation of Article 9 projects are analyzed using expert and stakeholder knowledge. A qualitative assessment was undertaken using data collected through one stakeholder workshop in North Africa, in-depth interviews and a qualitative literature review. The analysis was structured within a three-tier analyzing concept distinguishing between macro, micro and acceptance parameters.

Findings

From the SWOT analysis, some lessons are drawn, future possible measures are identified and conclusions for policymakers are discussed. The authors find that no easy solutions exist as most parameters can be both a strength and a weakness or a threat and an opportunity at the same time depending on future developments and the specific ideological perspective.

Originality/value

This paper provides new information and analysis of renewable energy sources projects in North Africa – application of the SWOT method on Article 9 cooperation projects – application of a three-tier analysis to cope with the complexity of the topic – taking into account often neglected socio-political aspects such as public acceptance.
Congruency as a mediator in an IKEA retail setting
Authors: Helmefalk Miralem
Published: September 2016

Purpose

The purpose of this paper is to analyse and discuss how sensory cues are preferred in relation to products, service and store image in a retail context and why retailers should consider the importance of congruence in a retail setting.

Design/methodology/approach

Four qualitative focus group discussions were conducted, following a semi-structured interview guide. A total of 24 participants discussed how and why a lighting department in an IKEA store in Sweden could be regarded as more appealing than the traditional layout.

Findings

The findings indicate that congruency works as a mediator between a retail setting, sensory cues, products, service and store image. Consumers prefer, compare and categorize sensory cues in relation to the specific product in the department, the service offered by the firm and the store image.

Originality/value

A model is developed that conceptualizes congruency as a mediator in a retail setting, which provides an opportunity to further explore external influences on congruency in retail settings, both conceptually and empirically.
Does urban form influence grocery shopping frequency? A study from Seattle, Washington, USA
Authors: Jiao Junfeng , Vernez Moudon Anne , Drewnowski Adam
Published: September 2016

Purpose

The purpose of this paper is to ascertain how elements of the built environment may or may not influence the frequency of grocery shopping.

Design/methodology/approach

Using data from the 2009 Seattle Obesity Study, the research investigated the effect of the urban built environment on grocery shopping travel frequency in the Seattle-King County area. Binary and ordered logit models served to estimate the impact of individual characteristics and built environments on grocery shopping travel frequency.

Findings

The results showed that the respondents’ attitude towards food, travel mode, and the network distance between homes and stores exerted the strongest influence on the travel frequency while urban form variables only had a modest influence. The study showed that frequent shoppers were more likely to use alternative transportation modes and shopped closer to their homes and infrequent shoppers tended to drive longer distances to their stores and spent more time and money per visit.

Practical implications

This research has implications for urban planners and policy makers as well as grocery retailers, as the seemingly disparate groups both have an interest in food shopping frequency.

Originality/value

Few studies in the planning or retail literature investigate the influence of the urban built environment and the insights from the planning field. This study uses GIS and a planning framework to provide information that is relevant for grocery retailers and those invested in food distribution.
Investigating the effects of shyness and sociability on customer impulse buying tendencies
Authors: Dhaundiyal Mayank , Coughlan Joseph
Published: September 2016

Purpose

The effect of personality traits on impulse purchase is not well understood. The purpose of this paper is to investigate how two such traits, shyness and sociability, impact on impulse buying tendency. Understanding drivers of impulse purchase, a significant source of retail sales, is important to succeed in the challenging environment that store-based retailers face.

Design/methodology/approach

A customer intercept approach was taken to collect 194 responses from two locations in a busy city centre shopping street in Dublin, Ireland, and the hypotheses were tested using covariance-based structural equation modelling.

Findings

Sociability has a significant positive effect on both affective and cognitive impulse buying tendencies whereas shyness has a positive effect on cognitive impulse buying tendencies only. Age was found to be a significant moderator of these effects.

Research limitations/implications

This study uses an in vivo street-intercept approach and hence the results may differ for other data collection approaches. The lack of discriminant validity of the sub-scales for impulse buying tendencies has implications for future research.

Practical implications

The findings suggest that retailers should factor customers’ psychological traits into their decision making. Individuals with high levels of sociability and shyness are prone to buying on impulse but in different ways. Younger people are more likely to exhibit these behaviours.

Originality/value

This paper meets a need for research on how customers’ traits affect their impulse purchase tendencies, and offers retailers advice on how to attract and serve customers with these traits.
Once again: selecting foils as similar to the suspect, or matching the description of the culprit?
Authors: Levi Avraham
Published: September 2016

Purpose

The purpose of this paper is to examine Clark et al.’s (2013) claim that, contrary to the white paper produced by the American Psychological Association (Wells et al., 1998), the match-to-description method of choosing foils is inferior to the similarity-to-suspect method.

Design/methodology/approach

Examining the existing empirical evidence.

Findings

There is no difference between the two methods in rate of identifications. Sometimes, however, the rate of false identifications is larger when the similarity-to-suspect method is used.

Practical implications

The white paper’s recommendation should remain in place.

Originality/value

Keeping the white paper’s recommendation is important to prevent false identifications.
The construct validity of theh-index
Authors: Barnes Cameron Stewart
Published: September 2016

Purpose

The purpose of this paper is to show how bibliometrics would benefit from a stronger programme of construct validity.

Design/methodology/approach

The value of the construct validity concept is demonstrated by applying this approach to the evaluation of theh-index, a widely used metric.

Findings

The paper demonstrates that theh-index comprehensively fails any test of construct validity. In simple terms, the metric does not measure what it purports to measure. This conclusion suggests that the current popularity of theh-index as a topic for bibliometric research represents wasted effort, which might have been avoided if researchers had adopted the approach suggested in this paper.

Research limitations/implications

This study is based on the analysis of a single bibliometric concept.

Practical implications

The conclusion that theh-index fails any test in terms of construct validity implies that the widespread use of this metric within the higher education sector as a management tool represents poor practice, and almost certainly results in the misallocation of resources.

Social implications

This paper suggests that the current enthusiasm for theh-index within the higher education sector is misplaced. The implication is that universities, grant funding bodies and faculty administrators should abandon the use of theh-index as a management tool. Such a change would have a significant effect on current hiring, promotion and tenure practices within the sector, as well as current attitudes towards the measurement of academic performance.

Originality/value

The originality of the paper lies in the systematic application of the concept of construct validity to bibliometric enquiry.
The use of distinction in the process of communication
Authors: Adriaenssen Daniel Joh. , Johannessen Dagny , Johannessen Jon-Arild
Published: September 2016

Purpose

The purpose of this paper is to improve the theoretical understanding of the communicative processes in social systems.

Design/methodology/approach

Conceptual generalisation.

Findings

Aspects of a communications theory with three assumptions and ten propositions.

Originality/value

The method used and the findings.
Trauma-informed mental healthcare in the UK: what is it and how can we further its development?
Authors: Sweeney Angela , Clement Sarah , Filson Beth , Kennedy Angela
Published: September 2016

Purpose

The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.

Design/methodology/approach

The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.

Findings

There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.

Originality/value

This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.
Maternal protein restriction induced‐hypertension is associated to oxidative disruption at transcriptional and functional levels in the medulla oblongata
Authors: de Brito Alves José L , de Oliveira Jéssica M D , Ferreira Diorginis J S , Barros Monique A de V , Nogueira Viviane O , Alves Débora S , Vidal Hubert , Leandro Carol G , Lagranha Cláudia J , Pirola Luciano , da Costa‐Silva João H
Published: September 2016

Maternal protein restriction during pregnancy and lactation predisposes the adult offspring to sympathetic overactivity and arterial hypertension. Although the underlying mechanisms are poorly understood, dysregulation of the oxidative balance has been proposed as a putative trigger of neural‐induced hypertension. The aim of the study was to evaluate the association between the oxidative status at transcriptional and functional levels in the medulla oblongata and maternal protein restriction induced‐hypertension. Wistar rat dams were fed a control (normal protein; 17% protein) or a low protein ((Lp); 8% protein) diet during pregnancy and lactation, and male offspring was studied at 90 days of age. Direct measurements of baseline arterial blood pressure (ABP) and heart rate (HR) were recorded in awakened offspring. In addition, quantitative RT‐PCR was used to assess the mRNA expression of superoxide dismutase 1 (SOD1) and 2 (SOD2), catalase (CAT), glutathione peroxidase (GPx), Glutamatergic receptors (Grin1, Gria1 and Grm1) and GABA(A)‐receptor‐associated protein like 1 (Gabarapl1). Malondialdehyde (MDA) levels, CAT and SOD activities were examined in ventral and dorsal medulla. Lp rats exhibited higher ABP. The mRNA expression levels of SOD2, GPx and Gabarapl1 were down regulated in medullary tissue of Lp rats (P<.05, t test). In addition, we observed that higher MDA levels were associated to decreased SOD (approximately 45%) and CAT (approximately 50%) activities in ventral medulla. Taken together, our data suggest that maternal protein restriction induced‐hypertension is associated with medullary oxidative dysfunction at transcriptional level and with impaired antioxidant capacity in the ventral medulla.
Right‐wing populist party supporters: Dissatisfied but not direct democrats
Authors: BOWLER SHAUN , DENEMARK DAVID , DONOVAN TODD , McDONNELL DUNCAN
Published: September 2016

Right‐wing populist parties tend to combine criticism of how liberal democracy functions with calls for greater direct democracy. But do their voters share that support for direct democracy? In this article, survey data is used to examine, first, whether right‐wing populist candidates in Australia, Canada and New Zealand were more supportive of direct democracy than candidates of other parties. Second, the views of right‐wing populist voters about the functioning of democracy and direct democracy are investigated. While right‐wing populist candidates turned out to be far more likely to support direct democracy, right‐wing populist supporters did not mirror the candidates. Although these were among the most dissatisfied with how democracy worked, they did not necessarily favour referendums more than other voters. The findings have implications both for how we conceive of the relationship between populism and direct democracy and the remedies proposed for redressing populist discontent.
The Effects of Distance to Dentists and Dentist Supply on Children's Use of Dental Care
Authors: Wehby George L. , Shane Dan M. , Joshi Adweta , Momany Elizabeth , Chi Donald L. , Kuthy Raymond A. , Damiano Peter C.
Published: September 2016

Objective

To examine the effects of distance to dentists and dentist supply on dental services use among children with Medicaid coverage in Iowa.

Data Source

Iowa Medicaid claims for enrolled children between 2000 and 2009.

Study Design

The study sample included 41,554 children (providing 158,942 child‐year observations) who were born in Iowa between 2000 and 2006 and enrolled from birth in the Iowa Medicaid program. Children were followed through 2009. We used logistic regression to simultaneously examine the effects of distance (miles to nearest dentist) and county‐level dentist supply on a broad range of dental services controlling for key confounders. Additional models only used within‐child variation over time to remove unobservable time‐invariant confounders.

Principal Findings

Distance was related to lower utilization of comprehensive dental exams (2 percent lower odds per 1 mile increase in distance), an effect that also held in models using within‐child variation only. Dentist supply was positively related to comprehensive exams and other preventive services and negatively related to major dental treatments; however, these associations became smaller and insignificant when examining within‐child changes except for other preventive services.

Conclusions

Longer distance to dentists is a barrier for use of comprehensive dental exams, conditional on dentist supply.
Predicting Early Rapid Response Team Activation in Patients Admitted From the Emergency Department: The PeRRT Score
Authors: Bellew Shawna D. , Cabrera Daniel , Lohse Christine M. , Bellolio M. Fernanda
Published: September 2016

Objectives

Rapid response teams (RRTs) respond to signs of deterioration to avoid morbidity and mortality. Early RRT activation (eRRT) in patients admitted from the emergency department (ED) is associated with significantly increased mortality. Predicting these events may represent an opportunity to identify patients who would benefit from further resuscitation, aid disposition decision‐making, or improve communication between ED and inpatient providers. We aimed to create a clinical prediction instrument to quantify the risk of eRRT.

Methods

We performed an observational cohort study of patients admitted to a non–intensive care unit (ICU) setting who triggered eRRT from January 2009 to December of 2012 compared to those who did not trigger eRRT. Age, sex, ED vital sign measurements, and final ED diagnosis by ICD‐9 code were evaluated in a multivariable logistic regression model. The performance of prediction models was assessed using discrimination summarized by area under a receiver operating curve (AUC) and calibration with the Hosmer and Lemeshow goodness‐of‐fit test. The final model was used to create a simplified scoring system.

Results

The eRRT group consisted of 474 patients who were compared to 2,575 patients in the reference group. Age and sex did not add significant discrimination to the model and were eliminated from the simplified, final model. This model, which included vital signs and diagnosis category, was found to have an AUC of 0.754 (95% confidence interval [CI] = 0.730 to 0.778) and was used to create a simplified scoring system. The odds ratio for the association of a 1‐unit increase in risk score with eRRT was 1.37 (95% CI = 1.32 to 1.41; p < 0.001). When internally validated, the score was found to have an AUC of 0.759 (95% CI = 0.735 to 0.753). Calculated scores ranged from −3 to 18, which corresponded to predicted probabilities of eRRT ranging from 5.1% to 72.2%.

Conclusions

In summary, the PeRRT score is a simple tool that can be referenced by emergency providers at the bedside to quantify the risk of early RRT activation and potential deterioration, helping to answer the question, “How likely is my patient to trigger an RRT activation in the next twelve hours?” Given that patients who trigger eRRT have an elevated risk of morbidity and mortality, higher scores should result in resuscitative intervention, further observation in the ED, consideration of ICU admission, or direct enhanced communication between ED and inpatient providers. A prospective multicenter study is required to further validate this instrument.
Emergency Department Management of Patients With Febrile Neutropenia: Guideline Concordant or Overly Aggressive?
Authors: Baugh Christopher W. , Wang Thomas J. , Caterino Jeffrey M. , Baker Olesya N. , Brooks Gabriel A. , Reust Audrey C. , Pallin Daniel J.
Published: September 2016

Objectives

The Infectious Diseases Society of America and the American Society of Clinical Oncology recommend risk stratification of patients with febrile neutropenia (FN) and discharge with oral antibiotics for low‐risk patients. We studied guideline concordance and clinical outcomes of FN management in our emergency department (ED).

Methods

Our urban, tertiary care teaching hospital provides all emergency and inpatient services to a large comprehensive cancer center. We performed a structured chart review of all FN patients seen in our ED from January 2010 to December 2014. Using electronic medical records, we identified all visits by patients with fever and an absolute neutrophil count of <1000 cells/mm3 and then included only patients without a clear source of infection. Following national guidelines, we classified patients as low or high risk and assessed guideline concordance in disposition and parenteral versus oral antibiotic therapy by risk category as our main outcome measure.

Results

Of 173 qualifying visits, we classified 44 (25%) as low risk and 129 (75%) as high risk. Management was guideline concordant in 121 (70%, 95% confidence interval [CI] = 63% to 77%). Management was guideline discordant in 43 (98%, 95% CI = 88% to 100%) of low‐risk patients versus 9 (7%, 95% CI = 3% to 13%) of high‐risk patients (relative risk [RR] = 14, 95% CI = 7.5 to 26). Of 52 guideline‐discordant cases, 36 (83%, 95% CI = 72% to 93%) involved low‐risk cases with treatment that was more aggressive than recommended.

Conclusions

Guideline concordance was low among low‐risk patients, with management tending to be more aggressive than recommended. Unless data emerge that undermine the guidelines, we believe that many of these hospitalizations and parenteral antibiotic regimens can be avoided, decreasing the risks associated with hospitalization, while improving antibiotic stewardship and patient comfort.
Abnormal white matter structural connectivity in treatment‐naïve young adults with borderline personality disorder
Authors: Gan J. , Yi J. , Zhong M. , Cao X. , Jin X. , Liu W. , Zhu X.
Published: September 2016

Objective

The pathogenesis of borderline personality disorder (BPD) is not well understood. We examined the microstructure of white matter in patients with BPD.

Method

Treatment‐naïve young adult with BPD (N = 30) and young‐adult healthy controls (HCs; N = 31) were subjected diffusion tensor imaging (DTI). Microstructural parameters were analyzed via tract‐based spatial statistics (TBSS) and post hoc tractography.

Results

TBSS analysis revealed that, relative to the HC group, the BPD group had significantly lower fractional anisotropy (FA) values in the genu and body of the corpus callosum (CC), right superior corona radiate, right anterior corona radiate, as well as higher radial diffusivity (RD) in the left anterior thalamic radiation. Tractography showed that FA values of fiber bundles passing through the fornix were significantly reduced in BPD group relative to HCs. No significant correlations were observed between clinical symptom and DTI indices in BPD group (FDR corrected).

Conclusion

Focal microstructural alterations were found in BPD group, mainly in the limbic system and CC. The present findings support the fronto‐limbic disconnectivity hypothesis and suggest that abnormal maturation of white matter structures may play an important role in mechanism of BPD.
The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness
Authors: Vöhringer P. A. , Barroilhet S. A. , Alvear K. , Medina S. , Espinosa C. , Alexandrovich K. , Riumallo P. , Leiva F. , Hurtado M. E. , Cabrera J. , Sullivan M. , Holtzman N. , Ghaemi S. N.
Published: September 2016

Objective

The differential diagnosis of bipolar illness vs. borderline personality is controversial. Both conditions manifest impulsive behavior, unstable interpersonal relationships, and mood symptoms. This study examines whether and which mood clinical features can differentiate between both conditions.

Method

A total of 260 patients (mean ± standard deviation age 41 ± 13 years, 68% female) attending to a mood clinic were examined for diagnosis of bipolar illness and borderline personality disorder using SCID‐I, SCID‐II, and clinical mood criteria extracted from Mood Disorder Questionnaire (MDQ). They were analyzed using diagnoses as dependent variables. Predictors of bipolar and borderline diagnoses were identified by multivariable logistic regressions, and predictive validity of models was assessed using ROC curve analysis.

Results

Bipolar illness was strongly predicted by elevated mood (OR = 4.02, 95% CI: 1.80–9.15), increased goal‐directed activities (OR = 3.90, 95% CI: 1.73–8.96), and episodicity of mood symptoms (OR = 3.48, 95% CI 1.49–8.39). This triad model predicted bipolar illness with 88.7% sensitivity, 81.4% specificity, and obtained an auROC of 0.91 (95% CI: 0.76–0.96) and a positive predictive value of 85.1%. For borderline personality disorder, only female gender was a statistically significant predictor (OR = 3.41, 95% CI: 1.29–13.7), and the predictive model obtained an auROC of 0.67 (95% CI: 0.53–0.74).

Conclusion

In a mood disorder clinic setting, manic criteria and episodic mood course distinguished bipolar illness from borderline personality disorder.
White matter integrity between left basal ganglia and left prefrontal cortex is compromised in gambling disorder
Authors: van Timmeren Tim , Jansen Jochem M. , Caan Matthan W. A. , Goudriaan Anna E. , van Holst Ruth J.
Published: September 2016

Pathological gambling (PG) is a behavioral addiction characterized by an inability to stop gambling despite the negative consequences, which may be mediated by cognitive flexibility deficits. Indeed, impaired cognitive flexibility has previously been linked to PG and also to reduced integrity of white matter connections between the basal ganglia and the prefrontal cortex. It remains unclear, however, how white matter integrity problems relate to cognitive inflexibility seen in PG. We used a cognitive switch paradigm during functional magnetic resonance imaging in pathological gamblers (PGs; n = 26) and healthy controls (HCs; n = 26). Cognitive flexibility performance was measured behaviorally by accuracy and reaction time on the switch task, while brain activity was measured in terms of blood oxygen level‐dependent responses. We also used diffusion tensor imaging on a subset of data (PGs = 21; HCs = 21) in combination with tract‐based spatial statistics and probabilistic fiber tracking to assess white matter integrity between the basal ganglia and the dorsolateral prefrontal cortex. Although there were no significant group differences in either task performance, related neural activity or tract‐based spatial statistics, PGs did show decreased white matter integrity between the left basal ganglia and prefrontal cortex. Our results complement and expand similar findings from a previous study in alcohol‐dependent patients. Although we found no association between white matter integrity and task performance here, decreased white matter connections may contribute to a diminished ability to recruit prefrontal networks needed for regulating behavior in PG. Hence, our findings could resonate an underlying risk factor for PG, and we speculate that these findings may extend to addiction in general.
Gross Osteology, Radiographic and Computed Tomographic Morphology of the Axial Skeleton of the Nine‐Banded Armadillo (Dasypus novemcinctus)
Authors: Alves L. S. , Midon M. , Filadelpho A. L. , Vulcano L. C.
Published: September 2016

This study used 20 nine‐banded armadillo, four in vivo and 16 cadavers, to describe the osteoarticular anatomy of the axial skeleton by means of digital radiography and computed tomography. Vertebral formula obtained in this sample specimens was seven cervical, 10 thoracic, five lumbar, nine vertebrae related to the synsacrum and 20–27 free caudal vertebrae. Peculiar features of this species were noted as the presence of xenarthrous processes in the caudal thoracic vertebra to the last lumbar vertebra, with prominent mammillary processes in the thoracolumbar segment, fused cervical vertebra from the second to fourth vertebra and the presence of synsacrum related to sacral and caudal vertebra fused to the pelvis. They are homodont animals presenting only molariform teeth with formula of 8/8, totalling 32 teeth. There was no complexity in the execution of radiographic and tomographic examinations, concluding that execution can be carried out in nine‐banded armadillos during the clinical routine for wild animals.
A review of superior vena cava flow measurement in the neonate by functional echocardiography
Authors: McGovern Matthew , Miletin Jan
Published: September 2016

Neonatologists have begun using superior vena cava flow as assessed by functional echocardiography to facilitate real‐time decision‐making on cardiovascular care. This review aims to describe the basis of the technique, summarise the evidence for its use and compare the technique to existing clinical, biochemical and radiological techniques for assessing neonatal circulatory status.

Conclusion

Although echocardiographic measurements of superior vena cava flow, like other measures of perfusion, are not perfect, their noninvasive nature and ability to facilitate real‐time decision‐making means that at present, they remain the best available methodology of monitoring central perfusion in the neonatal population.
Real‐world effectiveness and safety of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin in hepatitis C: AMBER study
Authors: Flisiak R. , Janczewska E. , Wawrzynowicz‐Syczewska M. , Jaroszewicz J. , Zarębska‐Michaluk D. , Nazzal K. , Bolewska B. , Bialkowska J. , Berak H. , Fleischer‐Stępniewska K. , Tomasiewicz K. , Karwowska K. , Rostkowska K. , Piekarska A. , Tronina O. , Madej G. , Garlicki A. , Lucejko M. , Pisula A. , Karpińska E. , Kryczka W. , Wiercińska‐Drapało A. , Mozer‐Lisewska I. , Jabłkowski M. , Horban A. , Knysz B. , Tudrujek M. , Halota W. , Simon K.
Published: September 2016

Background

Virologic and safety outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin (OBV/PTV/r ± DSV ± RBV) therapy have shown high sustained virologic response (SVR) rates and good tolerability in most patient populations in pre‐registration studies.

Aim

To confirm these clinical trial findings in the treatment of genotype 1 and 4 hepatitis C under real‐world conditions.

Methods

Patients enrolled for treatment with OBV/PTV/r ± DSV ± RBV based on therapeutic guidelines were included, and the regimen was administered according to product characteristics. Clinical and laboratory data, including virologic response, were collected at baseline, end of treatment (EOT) and 12 weeks after EOT.

Results

A total of 209 patients with chronic hepatitis C were enrolled, most were genotype 1b‐infected (84.2%) and 119 (56.9%) had liver cirrhosis. Among these, 150 (71.7%) had failed previous anti‐viral therapies and 84 (40.2%) were null‐responders. At 12 weeks after EOT, SVR was achieved by 207 (99.0%) patients, ranging from 96.4% to 100.0% across subgroups. All Child–Pugh B and post‐orthotopic liver transplantation patients achieved SVR. Adverse events occurred in 151 (72.2%) patients and were mostly mild and associated with the use of RBV. Serious adverse events, including hepatic decompensation, renal insufficiency, anaemia, hepatotoxicity and diarrhoea, were reported in eight (3.8%) patients. In five (2.4%) patients, adverse events led to treatment discontinuation. On‐treatment decompensation was experienced by seven (3.3%) patients.

Conclusions

The results of our study confirm previous findings. They demonstrate excellent effectiveness and a good safety profile of OBV/PTV/r± DSV±RBV in HCV genotype 1‐infected patients treated in the real‐world setting.
Effects of mycoplasmal pneumonia of swine (MPS) lung lesion‐selected Landrace pigs on MPS resistance and immune competence in three‐way crossbred pigs
Authors: Borjigin Liushiqi , Shimazu Tomoyuki , Katayama Yuki , Watanabe Kouichi , Kitazawa Haruki , Roh Sang‐gun , Aso Hisashi , Katoh Kazuo , Satoh Masahiro , Suda Yoshihito , Sakuma Akiko , Nakajo Mituru , Suzuki Keiichi
Published: September 2016

To clarify the genetic influence of mycoplasmal pneumonia of swine (MPS) lesion‐selected Landrace (La) on MPS resistance and immune characteristics in three‐way crossbred pigs (LaWaDa), the LaWaDa pigs were compared with the non‐selected crossbred (LbWbDb) and purebred (La) pigs. The MPS lesion score in the three lines was as follows: La line < LaWaDa line < LbWbDb line, with significant differences among the lines. The proportions of myeloid cells and T cells were lower and higher, respectively, in the LaWaDa pigs compared with those in the other two lines. Messenger RNA (mRNA) expression of interleukin (IL)‐6, IL‐10, transforming growth factor‐β, and interferon‐γ in peripheral blood was significantly increased after vaccination in the La and LaWaDa lines. IL‐4 mRNA expression in the LaWaDa line was intermediate to the La and LbWbDb lines. Furthermore, principal component analysis for immune traits and MPS lesions was executed to clarify the characteristics of each pig line. These findings suggest that the immune responses in the three pig lines are genetically distinct and that MPS resistance and some immunity characteristics from the La line were transmitted to the three‐way crossbred pigs.
Self‐Euthanasia, the Dutch Experience: In Search for the Meaning of a Good Death or Eu Thanatos
Authors: Vink Ton
Published: September 2016

My main purpose in this article is to establish the meaning of a ‘good death’ when death is self‐chosen. I will take as my point of departure the new notion of ‘self‐euthanasia’ and the corresponding practice that has evolved in the Netherlands in recent years. Both physician‐euthanasia and self‐euthanasia refer to an ideal process of a good death, the first being ultimately the physician's responsibility, while the second is definitely the responsibility of the individual choosing to die. However, if we also accept the existence of a fundamental moral difference between ending another person's life and ending your own life, and if we accept this moral difference to be also relevant to the normatively laden good death, then this difference represents a strong reason for preferring self‐euthanasia to physician‐euthanasia.