bluuebunny/crossref_metadata_2025 huggingface dataset:
Trait‐associated loss of frugivores in fragmented forest does not affect seed removal rates
Authors: Farwig Nina , Schabo Dana G. , Albrecht Jörg
Published: December 2016

Seed dispersal by frugivorous animals forms the basis for regeneration of numerous plant species. Habitat fragmentation has been found to be one major factor perturbing frugivore communities and dependent plant species. Yet, community‐wide consequences of fragmentation for both frugivore and plant communities are still hardly understood.

Here, we studied the effects of habitat fragmentation on the seed removal by frugivorous birds and mammals from nine fleshy‐fruited plant species in Białowieża Forest (Eastern Poland). This last relict of old‐growth lowland forest in Europe poses an exceptional reference site for studying the impact of habitat fragmentation on seed dispersal processes in temperate forest ecosystems.

In particular, (i) we tested for associations between forest fragmentation and response traits of frugivores, that is forest specialization and body mass; (ii) we studied the relationship between frugivore response and effect traits, that is centrality (number of consumed plant species) and interaction type (mutualistic vs. antagonistic); and (iii) we assessed the feedback of fragmentation‐induced changes on plant–frugivore interactions and seed removal rates.

We found that fragmentation led to shifts in the frugivore community, associated with the response traits forest specialization and body mass, with fewer forest specialists and large‐bodied frugivores in fragmented than in continuous forests. However, forest generalists and small‐bodied frugivores were more central in the plant–frugivore associations than forest specialists and large‐bodied frugivores. Therefore, the loss of vulnerable species did not result in reduced seed removal rates in fragmented compared with continuous forest.

Synthesis. These results indicate that seed removal may be relatively robust in spite of shifts in the frugivore community in forest fragments. The correlation between response and effect traits of frugivores highlights the importance of forest generalists and small‐bodied frugivores for maintaining dispersal processes in fragmented forests in temperate regions. Yet, future studies should aim at quantifying the consequences of seed disperser loss on other aspects of dispersal, such as long‐distance dispersal, spatial patterns of seed deposition, seed germination and plant regeneration.
Temporal change and determinants of maternal reproductive success in an expanding oak forest stand
Authors: Gerzabek Gabriel , Oddou‐Muratorio Sylvie , Hampe Arndt
Published: December 2016

Global change is generating widespread local‐scale expansions of tree populations. During demographic expansions, even small differences in individual reproductive success can generate large differences in the genetic composition of the resulting population. Colonizing tree populations almost invariably show highly skewed distributions of seed production, but the evolution of this reproductive skew during plant recruitment remains understudied.

We examine how recruit mortality modifies initial patterns of acorn dispersal and maternal reproductive success in a recently established, expanding Pedunculate oak (Quercus robur) forest stand and test different predictors of successful recruit establishment.

We mapped and genotyped a cohort of seedlings (n = 809) emerging within and around the stand (n = 254 adult trees), identified their habitats and monitored their fate until an age of 3 years. Their mother trees were inferred by Bayesian parentage analysis, and the number of assigned descendants was used as a proxy for tree maternal fertility. We examined temporal trends in tree fertility and patterns of dispersal, and tested effects of seed number‐quality trade‐offs, dispersal failure, dispersal distance and habitat of propagule arrival on the probability of seedling establishment.

We observed marked inequality in maternal reproductive success at the time of seedling emergence. A positive relationship between tree fertility and the proportion of non‐dispersed seedlings pointed to disperser satiation. An overall seedling mortality of 69% generated considerable reshuffling in the fertility ranking of individual trees. Non‐dispersal more than doubled seedling mortality. The establishment success of actually dispersed seedlings was independent of mother fertility and dispersal distance but strongly related to the habitat of arrival. Recruit survival was markedly higher in pine plantations or non‐forested areas than in broadleaved forest.

Synthesis. A few highly fertile trees dominated reproduction in the stand. Differential recruitment success tended to reduce their initial advantage, however, suggesting that reproductive inequality might rapidly decline as more trees start to reproduce along the expansion process. Our results also suggest that field estimates of size or seed production are unlikely to provide reliable estimates of lifetime reproductive success in trees.
Estimating contemporary migration rates: effect and joint inference of inbreeding, null alleles and mistyping
Authors: Robledo‐Arnuncio Juan J. , Gaggiotti Oscar E.
Published: December 2016

Microsatellite‐based genetic assignment is used broadly to monitor contemporary effective dispersal among populations. The need to investigate the robustness of this method to common genotyping errors was emphasized more than a decade ago, but it remains unaddressed.

We evaluate here for the first time the effect of mistaken and null alleles on estimates of contemporary seed and pollen migration rates obtained with genetic assignment methods. We also introduce a novel Bayesian approach to jointly estimate seed and pollen migration rates, genotyping error rates and null allele frequencies, not requiring independent reference or duplicate genotypic data.

Unaccounted‐for mistaken alleles caused positive bias and increased the root mean square error (RMSE) of pollen migration rate estimates, whereas seed migration rate estimates were weakly sensitive to mistyping. Jointly estimating mistyping rates minimized the bias and RMSE they introduce on pollen migration estimates, while yielding seed migration rate estimates with similar or slightly larger bias and RMSE than those obtained when ignoring mistyping.

Ignoring genotyping errors can be especially problematic when there is no actual migration, because it can lead to the wrong conclusion that there is statistically significant exchange of pollen and/or seeds among populations that are actually isolated.

Unaccounted‐for null alleles are problematic when among‐population pollen dispersal is present, leading to underestimation of pollen migration rates and overestimation of seed migration rates. Jointly estimating null allele frequencies minimized these two biases, reduced the RMSE of seed migration rate estimates and produced relatively small changes in the RMSE of pollen dispersal estimates.

Synthesis. Disregarding genotyping errors and null alleles can produce biased and less accurate estimates of the rates at which present‐day plant populations are exchanging seed and pollen. An approach is proposed here to minimize the effect of genotyping problems on contemporary migration rate estimates, which should help avoiding erroneous migration inference, monitoring and management, especially when dealing with low migration rates and their associated uncertainty.
Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population‐based cohort study on 7.7 million births
Authors: Schneiderman M , Czuzoj‐Shulman N , Spence AR , Abenhaim HA
Published: December 2016

Objective

To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes.

Design

Population‐based retrospective cohort study.

Setting/Population

All births in the United States’ Healthcare Cost and Utilization Project‐Nationwide Inpatient Sample from 2003 to 2011.

Methods

Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI).

Results

We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9‐year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16–1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08–1.61), have impaired wound healing (OR 4.28, 95% CI 2.55–7.18), develop infections (OR 2.44, 95% CI 1.66–3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15–12.63), require transfusions (OR 6.69, 95% CI 4.69–9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37–7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82–72.96). Congenital anomalies (OR 3.62, 95% CI 2.05–6.39) and small‐for‐gestational age infants (OR 1.78, 95% CI 1.15–2.75) were more likely in these pregnancies.

Conclusions

Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary‐care centres.

Tweetable abstract

Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes.
Lesbian and bisexual women's likelihood of becoming pregnant: a systematic review and meta‐analysis
Authors: Hodson K , Meads C , Bewley S
Published: December 2016

Background

Few data exist regarding pregnancy in lesbian and bisexual (LB) women.

Objectives

To determine the likelihood of LB women becoming pregnant, naturally or assisted, in comparison with heterosexual women

Search strategy

Systematic review of papers published 1 January 2000 to 23 June 2015.

Selection criteria

Studies contained details of pregnancy rates among LB women compared with heterosexual women. No restriction on study design.

Data collection and analysis

Inclusion decisions, data extraction and quality assessment were conducted in duplicate. Meta‐analyses were carried out, with subgroups as appropriate.

Main results

Of 6859 papers identified, 104 full‐text articles were requested, 30 papers (28 studies) were included. The odds ratio (OR) of ever being pregnant was 0.19 (95% CI 0.18–0.21) in lesbian women and 1.22 (95% CI 1.15–1.29) in bisexual women compared with heterosexual women. In the general population, the odds ratio for pregnancy was nine‐fold lower among lesbian women and over two‐fold lower among bisexual women (0.12 [95% CI 0.12–0.13] and 0.50 [95% CI 0.45–0.55], respectively). Odds ratios for pregnancy were higher for both LB adolescents (1.37 [95% CI 1.18–1.59] and 1.98 [95% CI 1.85, 2.13], respectively). There were inconsistent results regarding abortion rates. Lower rates of previous pregnancies were found in lesbian women undergoing artificial insemination (OR 0.17 [95% CI 0.11–0.26]) but there were higher assisted reproduction success rates compared with heterosexual women (OR 1.56 [95% CI 1.24–1.96]).

Conclusions

Heterosexuality must not be assumed in adolescents, as LB adolescents are at greater risk of unwanted pregnancies and terminations. Clinicians should provide appropriate information to all women, without assumptions about LB patients’ desire for, or rejection of, fertility and childbearing.

Tweetable abstract

Review of likelihood of LB women becoming pregnant: LB teenagers at greater risk of unwanted pregnancies.
Microfinance and Ethnic Diversity
Authors: Awaworyi Churchill Sefa
Published: December 2016

We argue that understanding why the levels of success vary across microfinance institutions (MFIs) requires not only an understanding of the interplay between MFIs, MFI‐specific practices and macroeconomic factors, but also what role ethnic diversity plays. Thus, this study hypothesises a relationship between ethnic diversity and MFI performance. We measure ethnic diversity using indices of fractionalisation. We find that fractionalisation is associated with poorer MFI financial performance and leads to MFI mission drift. Trust and strong social networks are important mechanisms of influence; they are lower in more fractionalised countries. Results are robust to several sensitivity checks.
Examining Interobserver Reliability of Metric and Morphoscopic Characteristics of the Mandible
Authors: Byrnes Jennifer F. , Kenyhercz Michael W. , Berg Gregory E.
Published: December 2016

Mandibular metric and morphological characteristics have long been used for sex and ancestry estimation. Currently, there are no large‐scale studies examining interobserver agreement, particularly examining the role of observer experience. This study examines the interobserver agreement of six morphoscopic and eleven metric mandibular variables. Four observers with varied levels of experience scored 183 mandibles from the William M. Bass Donated Skeletal Collection. Absolute agreement and consistency were evaluated with the intraclass correlation coefficient (ICC). Additionally, technical error of measurement (TEM) and relative TEM (%TEM) were calculated for each metric variable. All analyses were conducted twice—once with all observers and again with only experienced observers. Results show mean morphoscopic agreement of 0.543 among all observers and 0.615 for experienced observers, and mean metric agreement of 0.886 among all observers and 0.911 for experienced observers. Further, no TEM exceeded 2 mm. All results were significant (p < 0.001).
Efficacy and safety of high‐dose dual therapy for Helicobacter pylori rescue therapy: A systematic review and meta‐analysis
Authors: Gao Cai Ping , Zhou Zhou , Wang Jia Zhen , Han Sheng Xi , Li Liang Ping , Lu Hong
Published: December 2016

Objective

Although some studies have reported >90% success with high‐dose dual proton pump inhibitor (PPI)–amoxicillin dual therapy for Helicobacter pylori (H. pylori) eradication, the efficacy of this therapy remains controversial. We aimed to re‐evaluate the efficacy and safety of high‐dose dual therapy on H. pylori eradication.

Methods

We searched PubMed, the Cochrane Library, and EMBASE for randomized clinical trials (RCTs) evaluating the efficacy of high‐dose PPI–amoxicillin dual therapy as the rescue therapy on H. pylori eradication. Treatment effect was determined with a fixed‐effect model using the inverse variance method and was expressed as risk ratio (RR) with 95% confidence interval (CI).

Results

Because of significant statistical heterogeneity (χ2 15.98, I2 = 69%) among the six studies that qualified, four RCTs that included 473 patients with H. pylori infection after eradication failure were assessed. The meta‐analysis showed that high‐dose dual therapy and guideline‐recommended rescue therapies achieved similar efficacy (81.3% vs 81.5%, RR 1.00 [95% CI 0.93–1.08], intention‐to‐treat analysis), compliance (95.3% vs 95.4%, RR 1.00 [95% CI 0.97–1.03]), and side effects (17.9% vs 19.7%, RR 0.88 [95% CI 0.62–1.25]).

Conclusions

High‐dose PPI–amoxicillin dual therapy is comparable to recommended rescue therapies for H. pylori infection. More researches are needed to determine the efficacy of high‐dose dual therapy as a first‐line therapy.
In‐gantry MRI guided prostate biopsy diagnosis of prostatitis and its relationship with PIRADS V.2 based score
Authors: Jyoti Rajeev , Jina Noel Hamesh , Haxhimolla Hodo Z
Published: December 2016

Introduction

The recent literature has focussed predominantly on prostate cancer detection which has been revolutionized by multiparametric magnetic resonance imaging (mpMRI). Due to an overlap of features, prostatitis may mimic prostate cancer on MRI, especially in patients with chronic prostatitis. We retrospectively analysed our in‐gantry MRI‐guided biopsy (MRGB) results to determine incidental detection rate of prostatitis in Prostate Imaging Reporting and Data System (PIRADS) 3, 4 and 5 foci reported on diagnostic MRI of the prostate.

Methods

About 137 patients underwent in‐gantry MRGB for lesions with PIRADS score of 3 or above. All the biopsies were performed utilizing the dynaTRIM™ system (Invio Inc, Germany) on a three‐tesla MRI scanner (Ingenia 3.0T, Philips, Netherlands) by a Radiologist and a Urologist.

Results

We biopsied 228 lesions in 137 patients. There were 55 lesions that returned positive for prostate cancer with a Gleason Score of 3 + 3 = 6 or above. There were 62 lesions that showed inflammation. The distribution of these lesions was 3 (5%) in the central zone, 32 (52%) in the transitional zone and 27 (43%) in the peripheral zone. Inflammation was found in 36 (58%) PIRADS 3 lesions, 24 (39%) PIRADS 4 lesions and 2 (3%) PIRADS 5 lesions on pre biopsy MRI evaluation.

Conclusion

In our series, biopsies which showed inflammation had a radiological appearance on mpMRI more likely of a PIRADS 3 or 4 lesions with only 3% of PIRADS 5 biopsies showing inflammation. This would suggest that a higher PIRADS score can more reliably differentiate between prostate cancer and prostatitis.
Breast interest group faculty of radiation oncology: Australian and New Zealand patterns of practice survey on breast radiotherapy
Authors: Nguyen Kimberley , Mackenzie Penny , Allen Angela , Dreosti Marcus , Morgia Marita , Zissiadis Yvonne , Lamoury Gilian , Windsor Apsara
Published: December 2016

Introduction

This patterns of practice study was conducted on behalf of the RANZCR Breast Interest Group in order to document current radiotherapy practices for breast cancer in Australia and New Zealand. The survey identifies variations and highlights potential contentious aspects of radiotherapy management of breast cancer.

Methods

A fifty‐eight question survey was disseminated via the Survey Monkey digital platform to 388 Radiation Oncologists in Australia and New Zealand.

Results

In total, 156 responses were received and collated. Areas of notable consensus among respondents included hypofractionation (77.3% of respondents would ‘always’ or ‘sometimes’ consider hypofractionation in the management of ductal carcinoma in‐situ and 99.3% in early invasive breast cancer); margin status in early breast cancer (73.8% believe a clear inked margin is sufficient and does not require further surgery) and use of bolus in post‐mastectomy radiotherapy (PMRT) (91.1% of participants use bolus in PMRT). Areas with a wider degree of variability amongst respondents included regional nodal irradiation and components of radiotherapy planning and delivery (examples include the technique used for delivery of boost and frequency of bolus application for PMRT).

Conclusion

The results of these patterns of practice survey informs radiation oncologists in Australia and New Zealand of the current clinical practices being implemented by their peers. The survey identifies areas of consensus and contention, the latter of which may lead to a development of research trials and/or educational activities to address these areas of uncertainty.
Level of genetic differentiation affects relative performances of expressed sequence tag and genomic SSRs
Authors: Khimoun Aurélie , Ollivier Anthony , Faivre Bruno , Garnier Stéphane
Published: December 2016

Microsatellites, also called simple sequence repeats (SSRs), are markers of choice to estimate relevant parameters for conservation genetics, such as migration rates, effective population size and kinship. Cross‐amplification of SSRs is the simplest way to obtain sets of markers, and highly conserved SSRs have recently been developed from expressed sequence tags (EST) to improve SSR cross‐species utility. As EST‐SSRs are located in coding regions, the higher stability of their flanking regions reduces the frequency of null alleles and improves cross‐species amplification. However, EST‐SSRs have generally less allelic variability than genomic SSRs, potentially leading to differences in estimates of population genetic parameters such as genetic differentiation. To assess the potential of EST‐SSRs in studies of within‐species genetic diversity, we compared the relative performance of EST‐ and genomic SSRs following a multispecies approach on passerine birds. We tested whether patterns and levels of genetic diversity within and between populations assessed from EST‐ and from genomic SSRs are congruent, and we investigated how the relative efficiency of EST‐ and genomic SSRs is influenced by levels of differentiation. EST‐ and genomic SSRs ensured comparable inferences of population genetic structure in cases of strong genetic differentiation, and genomic SSRs performed slightly better than EST‐SSRs when differentiation is moderate. However and interestingly, EST‐SSRs had a higher power to detect weak genetic structure compared to genomic SSRs. Our study attests that EST‐SSRs may be valuable molecular markers for conservation genetic studies in taxa such as birds, where the development of genomic SSRs is impeded by their low frequency.
Molecular sexing applicable in 4000 species of lizards and snakes? From dream to real possibility
Authors: Rovatsos Michail , Kratochvíl Lukáš
Published: December 2016

While the stability of sex chromosomes is widely accepted in viviparous mammals and birds, ectothermic vertebrates are still largely viewed as having frequent turnovers in sex‐determining systems. Frequent changes in sex‐determining systems in ectotherms could be problematic for field ecological studies as well as for breeding programs, as molecular sexing across a phylogenetically widespread spectrum of ectothermic vertebrates would not be possible. However, we recently documented that sex‐determining systems in three important reptile lineages (caenophidian snakes, iguanas and lacertid lizards) are in fact highly conserved.

We applied a new molecular procedure to identify sex within each of these three lineages (encompassing altogether around 4000 species, i.e. nearly 50% of the recent species of reptiles). This technique uses quantitative PCR (qPCR) to compare copy numbers of genes specific for their respective Z (in caenophidian snakes and lacertids) and X (in iguanas) chromosomes between male and female genomes. The DNA samples required can be collected relatively non‐invasively. Unlike molecular sexing based on repetitive elements, this technique can be easily applied to previously unstudied species of these lineages, as the number of copies of protein‐coding genes linked to the differentiated sex chromosomes is evolutionarily highly conserved in each.

We suggest that qPCR‐based molecular sexing using the comparison of gene copy number is a practical choice for non‐model species of caenophidian snakes, iguanas and lacertids. Moreover, it should also soon be available for other reptile lineages with differentiated sex chromosomes.
Studying the Safety and Performance of Rapid Sequence Intubation: Data Collection Method Matters
Authors: Rinderknecht Andrea S. , Dyas Jenna R. , Kerrey Benjamin T. , Geis Gary L. , Ho Mona H. , Mittiga Matthew R.
Published: December 2016

Objective

We sought to describe and compare chart and video review as data collection sources for the study of emergency department (ED) rapid sequence intubation (RSI).

Methods

This retrospective cohort study compares the availability and content of key RSI outcome and process data from two sources: chart and video data from 12 months of pediatric ED RSI. Key outcomes included adverse effects (oxyhemoglobin desaturation, physiologic changes, inadequate paralysis, vomiting), process components (number of laryngoscopy attempts, end‐tidal CO2 detection), and timing data (duration of preoxygenation and laryngoscopy attempts).

Results

We reviewed 566 documents from 114 cases with video data. Video review detected higher rates of adverse effects (67%) than did chart review (46%, p < 0.0001), identifying almost twice the rate of desaturation noted in the chart (34% vs. 18%, p = 0.0002). The performance and timing of key RSI processes were significantly more reliably available via video review (timing and duration of preoxygenation, as well as timing, duration, and number of laryngoscopy attempts, all p < 0.05). Video review identified 221 laryngoscopy attempts, whereas chart review only identified 187.

Conclusions

When compared with video review for retrospective study of RSI in a pediatric ED, chart review significantly underestimated adverse effects, inconsistently contained data on important RSI process elements, rarely provided time data, and often conflicted with observations made on video review. Interpretation of and design of future studies of RSI should take into consideration the quality of the data source.
Point‐of‐care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient‐centered Outcomes
Authors: Poonai Naveen , Myslik Frank , Joubert Gary , Fan Josiah , Misir Amita , Istasy Victor , Columbus Melanie , Soegtrop Robert , Goldfarb Alex , Thompson Drew , Dubrovsky Alexander Sasha
Published: December 2016

Objectives

Distal forearm fractures are the most common fracture type in children. Point‐of‐care‐ultrasound (POCUS) is increasingly being used, and preliminary studies suggest that it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for nonangulated distal forearm injuries in children and compare POCUS to x‐ray with respect to pain, caregiver satisfaction, and procedure duration.

Methods

We conducted a cross‐sectional study involving children aged 4–17 years with a suspected nonangulated distal forearm fracture. Participants underwent both x‐ray and POCUS assessment. The primary outcome was sensitivity between POCUS and x‐ray, the reference standard. Secondary outcomes included self‐reported pain using the Faces Pain Scale–Revised, caregiver satisfaction using a five‐item Likert scale, and procedure duration.

Results

POCUS was performed in 169 children of whom 76 were diagnosed with a fracture including 61 buckle fractures. Sensitivity of POCUS for distal forearm fractures was 94.7% (95% confidence interval [CI] = 89.7–99.8) and specificity was 93.5% (95% CI = 88.6–98.5). POCUS was associated with a significantly lower median (interquartile range [IQR]) pain score compared to x‐ray: 1 (0–2) versus 2 (1–3), respectively (median difference = 0.5; 95% CI = 0.5–1; p < 0.001) and no significant difference in median (IQR) caregiver satisfaction score: 5 (0) versus 5 (4–5), respectively (median difference = 0, 95% CI = 0, p = 1.0). POCUS was associated with a significantly lower median (IQR) procedure duration versus x‐ray: 1.5 (0.8–2.2) minutes versus 27 (15–58) minutes, respectively (median difference = 34.1, 95% CI = 26.8–41.5, p < 0.001).

Conclusions

Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction.
Risk, Benefit, and Cost Thresholds for Emergency Department Testing: A Cross‐sectional, Scenario‐based Study
Authors: Meka Arjun Prasad , Porath Jonathan Douglas , Iyengar Rahul , Morrow Chelsea , Fagerlin Angela , Meurer William J.
Published: December 2016

Background

While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing.

Methods

A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low‐risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0.1, 1, 5, and 10% for benefit and risk and $0, $100, $500, and $1,000 for the individual's personal cost for receiving the test). Benefit was defined as the probability of finding the target disease (traumatic intracranial hemorrhage or acute coronary syndrome).

Results

One‐thousand unique respondents completed the survey. With an increased benefit from 0.1% to 10%, the percentage of respondents who accepted a diagnostic test went from 28.4% to 53.1%. (odds ratio [OR] = 3.42; 95% confidence interval [CI] = 2.57–4.54). As risk increased from 0.1% to 10%, this number decreased from 52.5% to 28.5%. (OR = 0.33; 95% CI = 0.25–0.44). Increasing cost from $0 to $1,000 had the greatest change of those accepting the test from 61.1% to 21.4%, respectively (OR = 0.15; 95% CI = 0.11–0.2).

Conclusions

The desire for testing was strongly sensitive to the benefits, risks, and costs. Many participants wanted a test when there was no added cost, regardless of benefit or risk levels, but far fewer elected to receive the test as cost increased incrementally. This suggests that out‐of‐pocket costs may deter patients from undergoing diagnostic testing with low potential benefit.
Composition of Unrecorded Distilled Alcohol (bai jiu) Produced in Small Rural Factories in Central China
Authors: Newman Ian , Qian Ling , Tamrakar Niran , Feng Yonghua , Xu Ganrong
Published: December 2016

Background

Unrecorded traditional distilled spirits (bai jiu, 白酒) are made and used throughout rural China for everyday use and special occasions. Nearly every town or village has a distiller to supply the demand. In rural China, distilling bai jiu is legal and regulated lightly or not at all. The World Health Organization estimates that as much as 25% of all alcohol consumed in China is unrecorded alcohol, of which an unknown portion is unrecorded bai jiu. Little is known about the composition of unrecorded Chinese spirits from rural parts of the country. This study focused on white spirits because the high ethanol (EtOH) concentration makes them more likely to contribute to health risks compared to other types of lower alcohol by volume (ABV) Chinese unrecorded alcohol.

Methods

Researchers purchased samples of Chinese white spirits from small‐factory distillers in central China. An independent laboratory conducted the analysis. Alcohol strength (ABV) was determined by hydrometer. Gas chromatography was used to determine the concentration of volatile organic compounds: EtOH, methanol, acetaldehyde, ethyl acetate, and higher alcohols. Samples were tested for 3 heavy metals—arsenic, cadmium, and lead. We used the guidelines developed by the Alcohol Measures for Public Health Research Alliance (AMPHORA) of the European Commission to assess risk.

Results

ABV ranged from 35.7 to 61.4%, and 58 of the 61 samples exceeded 40% ABV. The concentration of methanol, ethyl acetate, lead, arsenic, and cadmium was below AMPHORA guideline. The sum of higher alcohols exceeded the AMPHORA maximum in just 1 sample. Forty of the 61 samples had acetaldehyde levels beyond the AMPHORA guideline.

Conclusions

The unrecorded Chinese alcohols we analyzed had a high EtOH concentration—a public health concern that is also presented by recorded alcohols. The high percentage of samples (65.5%) that had elevated acetaldehyde suggests the need to investigate the causes for this result and the need for steps to reduce acetaldehyde levels. The cumulative long‐term risks of using high EtOH and high acetaldehyde Chinese spirits are heightened by the percentage of people in China who have a genetic trait for impaired acetaldehyde metabolism.
The effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes and laryngotracheal morbidity in children: a randomised, controlled trial
Authors: Soares S. M. F. , Arantes V. M. , Módolo M. P. , dos Santos V. J. B. , Vane L. A. , Navarro e Lima L. H. , Braz L. G. , do Nascimento P. , Módolo N. S. P.
Published: December 2016

We studied the effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes during tracheal extubation and postoperative laryngotracheal morbidity in children. We randomly allocated 164 children aged 3–13 years undergoing general anaesthesia to one of four groups; tracheal tube cuffs filled with air (n = 41); saline (n = 41); alkalinised lidocaine 0.5% (n = 41); or alkalinised lidocaine 1% (n = 41). Intracuff pressure was monitored and maintained below 20 cmH2O. The mean (SD) increases in systolic blood pressure after tracheal extubation compared with before extubation were 10.9 (10.8) mmHg, 7.3 (17.7) mmHg, 4.1 (10.5) mmHg and 1.9 (9.5) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.021). The mean (SD) increases in diastolic blood pressure after tracheal extubation compared with before extubation were 3.9 (9.7) mmHg, 7.9 (14.6) mmHg, 0.7 (10.4) mmHg and 3.6 (6.9) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.019). The mean (SD) increases in heart rate after tracheal extubation compared with before extubation were 14.2 (7.6) beats.min−1, 15.5 (13.1) beats.min−1, 5.2 (9.6) beats.min−1 and 4.1 (6.6) beats.min−1 in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p < 0.001). The incidence of sore throat 8 h after tracheal extubation was 22.0% in the air‐filled group, 9.8% in the saline group, 4.9% in the 0.5% alkalinised lidocaine group and 2.4% in the 1% alkalinised lidocaine group, p = 0.015. We conclude that filling the tracheal tube cuff with alkalinised lidocaine‐filled reduces the haemodynamic response to tracheal extubation and postoperative laryngotracheal morbidity in children.
When alternative female Kangaroo care is provided by other immediate postpartum mothers, it reduces postprocedural pain in preterm babies more than swaddling
Authors: Murmu Jitendranath , Venkatnarayan Kannan , Thapar Rajeev Kumar , Shaw Subhash Chandra , Dalal Shamsher Singh
Published: December 2016

Aim

Research on alternative female Kangaroo care (KC) has been hampered by high maternal refusal rates. We assessed the efficacy of Kangaroo mother care (KMC), alternative KC provided by other postpartum mothers and swaddling for postprocedural pain relief in preterm babies.

Methods

The study was carried out in a tertiary armed forces hospital, where mothers did not have support from other female relatives and other postpartum mothers agreed to act as alternative female KC providers. We exposed 51 stable preterm neonates, with a gestational age of 30–36 weeks, to KMC, alternative female KC and swaddling for 30 minutes before heel lancing. The outcome measures included the Preterm Infant Pain Profile (PIPP) scores at 30 seconds and the time taken for the heart rate to return to baseline.

Results

The mean PIPP scores were lower with KMC (10.59) and alternative female KC (11.24) than swaddling (12.96) and heart rate normalisation took 111, 117 and 149 seconds respectively. The p values were <0.001 for individual groups and outcomes. KMC fared better than alternative female KC for both pain (p = 0.045) and heart rate (p = 0.013).

Conclusion

Providing KMC and alternative female KC before heel lancing resulted in better pain relief than swaddling.
Cigarette and Alcohol Expenditures in Malaysia: Implications for Anti‐Smoking and Drinking Policies*
Authors: Tan Andrew K.G. , Yen Steven T. , Hasan Abdul Rahman
Published: December 2016

A number of studies have examined alcohol and cigarette consumption, but none have explored demand for both products simultaneously even though consumption decisions are likely often related. The present study uses microdata from the 2009/2010 Malaysian Household Expenditure Survey. A novel bivariate Tobit model that accounts for error heteroscedasticity is used to estimate Malaysian consumers' decisions to purchase cigarettes and alcohol and amount spent for each. The results indicate that household income and regional location, and the age, gender, education level and occupation type of the household head are associated with consumption decisions and expenditure levels, with some variation by ethnic group, suggesting the importance of these characteristics in policy deliberations to reduce consumption.
Idarucizumab for Reversal of Dabigatran Prior to Acute Surgery: A Schematic Approach Based on a Case Report
Authors: Rosenberg Lene , Gerstrøm Gustav , Nybo Mads
Published: December 2016

Dabigatran, an oral direct thrombin inhibitor, is frequently used in treatment of venous thromboembolism and prevention of stroke in non‐valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment that reverses the dabigatran effect, was introduced to the market to be used in case of life‐threatening bleeding or acute surgery/invasive procedures. Whether usage should be guided by measurement of plasma dabigatran and/or other coagulation parameters is, however, still uncertain. We here describe the use of idarucizumab prior to acute surgery in a patient on dabigatran and acetylsalicylic acid. In this case, the decision to use idarucizumab was based on the clinical manifestations and other routine coagulation parameters, as the plasma dabigatran concentration was not available prior to administration. Due to challenges with the plasma dabigatran analysis and taking the safety of idarucizumab into consideration, it could be questioned whether a dabigatran measurement in general is necessary in this setting. Based on this case, we suggest a scheduled approach when considering requesting a plasma dabigatran measurement prior to administration of idarucizumab.
Update review of the acute porphyrias
Authors: Stein Penelope E. , Badminton Michael N. , Rees David C.
Published: December 2016

Acute porphyrias are rare inherited disorders due to deficiencies of haem synthesis enzymes. To date, all UK cases have been one of the three autosomal dominant forms, although penetrance is low and most gene carriers remain asymptomatic. Clinical presentation is typically with acute neurovisceral attacks characterised by severe abdominal pain, vomiting, tachycardia and hypertension. Severe attacks may be complicated by hyponatraemia, peripheral neuropathy sometimes causing paralysis, seizures and psychiatric features. Attacks are triggered by prescribed drugs, alcohol, hormonal changes, fasting or stress. The diagnosis is made by finding increased porphobilinogen excretion in a light‐protected random urine sample. Management includes administration of intravenous human haemin and supportive treatment with non‐porphyrinogenic drugs. A few patients develop recurrent attacks, a chronic illness requiring specialist management. Late complications include chronic pain, hepatocellular carcinoma, chronic renal failure and hypertension. In the UK, the National Acute Porphyria Service provides clinical advice and supplies haemin when indicated.
Randomized phase 2 study of otlertuzumab and bendamustine versus bendamustine in patients with relapsed chronic lymphocytic leukaemia
Authors: Robak Tadeusz , Hellmann Andrzej , Kloczko Janusz , Loscertales Javier , Lech‐Maranda Ewa , Pagel John M. , Mato Anthony , Byrd John C. , Awan Farrukh T. , Hebart Holger , Garcia‐Marco Jose A. , Hill Brian T. , Hallek Michael , Eisenfeld Amy J. , Stromatt Scott C. , Jaeger Ulrich
Published: December 2016

Otlertuzumab (TRU‐016) is a humanized anti‐CD37 protein therapeutic that triggers direct caspase‐independent apoptosis of malignant B cells and induces antibody‐dependent cell‐mediated cytotoxicity. Patients with relapsed chronic lymphocytic leukaemia (CLL) received either otlertuzumab (20 mg/kg) weekly by IV infusion for two 28‐day cycles then every 14 days for four 28‐day cycles and IV bendamustine (70 mg/m2) on Days 1 and 2 of each cycle for up to six 28‐day cycles or bendamustine alone. Thirty‐two patients were treated with otlertuzumab and bendamustine and 33 with bendamustine alone. Overall response rate according to the International Workshop on Chronic Lymphocytic Leukaemia criteria was 69% in the otlertuzumab and bendamustine arm and 39% in the bendamustine alone arm (P = 0·025). Median progression‐free survival (PFS) was 15·9 months in the otlertuzumab and bendamustine arm and 10·2 months in the bendamustine alone arm (P = 0·0192). There was a higher incidence of pyrexia (34% vs. 12%) and neutropenia (59% vs. 39%) with the combination but this did not result in a higher incidence of severe (grade 3/4) infections (13% vs. 27%). This combination significantly increased the response rate and prolonged the PFS over single agent bendamustine in patients with relapsed or refractory CLL.
Dawning of the age of genomics for platelet granule disorders: improving insight, diagnosis and management
Authors: Bariana Tadbir K. , Ouwehand Willem H. , Guerrero Jose A. , Gomez Keith ,   the BRIDGE Bleeding, Thrombotic and Platelet Disorders and ThromboGenomics Consortia
Published: December 2016

Inherited disorders of platelet granules are clinically heterogeneous and their prevalence is underestimated because most patients do not undergo a complete diagnostic work‐up. The lack of a genetic diagnosis limits the ability to tailor management, screen family members, aid with family planning, predict clinical progression and detect serious consequences, such as myelofibrosis, lung fibrosis and malignancy, in a timely manner. This is set to change with the introduction of high throughput sequencing (HTS) as a routine clinical diagnostic test. HTS diagnostic tests are now available, affordable and allow parallel screening of DNA samples for variants in all of the 80 known bleeding, thrombotic and platelet genes. Increased genetic diagnosis and curation of variants is, in turn, improving our understanding of the pathobiology and clinical course of inherited platelet disorders. Our understanding of the genetic causes of platelet granule disorders and the regulation of granule biogenesis is a work in progress and has been significantly enhanced by recent genomic discoveries from high‐powered genome‐wide association studies and genome sequencing projects. In the era of whole genome and epigenome sequencing, new strategies are required to integrate multiple sources of big data in the search for elusive, novel genes underlying granule disorders.
The future of academic haematology
Authors: Hay Deborah , Hatton Christian S.R. , Weatherall David J.
Published: December 2016

Recent advances in the basic medical sciences, particularly cell biology and genomics, have great promise for the future development of all aspects of haematological practice. They will also impinge on the hitherto neglected fields of haematology, including haematology involving the care of the rapidly increasing number of elderly patients and the complex problems of haematological practice in the developing countries. To obtain the maximum benefit from these new developments it will be necessary to review the patterns of training of haematologists of the future at every level. In short, it will be important to try to design and develop various career pathways for training haematologists including those who wish to work full time in basic research, combine research with clinical practice, or commit all their time to clinical work and teaching.
How I manage peripheral T‐cell lymphoma, not otherwise specified and angioimmunoblastic T‐cell lymphoma: current practice and a glimpse into the future
Authors: Schmitz Norbert , de Leval Laurence
Published: December 2016

Peripheral T‐cell lymphoma (PTCL), not otherwise specified (NOS) and angioimmunoblastic T‐cell lymphoma (AITL) are the most frequent of more than 20 mature PTCL entities featuring a broad spectrum of morphological, immunophenotypic, molecular and clinical characteristics. Unfortunately, recent progress in understanding the (epi)genetic background of PTCL has not been met with similar advances in treatment. Thus, CHO(E)P [cyclophosphamide, doxorubicin, vincristine, and prednisone (plus etoposide)] remains standard first‐line therapy. Patients without comorbidities achieving complete or partial remission proceed to autologous stem cell transplantation. With this approach about 50% of patients survive long‐term. Patients relapsing after or progressing during first‐line therapy have a dismal prognosis. They receive salvage gemcitabine‐therapy followed by allogeneic transplantation whenever possible. After allografting, approximately half of the patients survive long‐term; any other treatment is palliative. New drugs investigated in phase II studies achieved response rates between 10% and 30%; long‐term remissions are the exception to the rule. While most new drugs are not licensed and not readily available, a plethora of other innovative drugs targeting (epi‐)genetic abnormalities are in early development. These, together with combinations of new and old drugs, will hopefully increase response to first‐line therapy, bridge more patients to transplantation, and finally improve prognosis for all patients with PTCL.
Clinical impact of 68Ga‐prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer with rising prostate‐specific antigen after treatment with curative intent: preliminary analysis of a multidisciplinary approach
Authors: Albisinni Simone , Artigas Carlos , Aoun Fouad , Biaou Ibrahim , Grosman Julien , Gil Thierry , Hawaux Eric , Limani Ksenija , Otte Francois‐Xavier , Peltier Alexandre , Sideris Spyridon , Sirtaine Nicolas , Flamen Patrick , van Velthoven Roland
Published: December 2016

Objective

To assess the impact of a novel molecular imaging technique, 68Ga‐(HBED‐CC)‐prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT), in the clinical management of patients with prostate cancer with rising prostate‐specific antigen (PSA) after treatment with curative intent.

Patients and Methods

In all, 131 consecutive patients were referred to our centre for a 68Ga‐PSMA PET/CT in the setting of recurring prostate cancer. Of these patients, 11/131(8%) presented with persistent PSA after radical prostatectomy, while 120/131 (92%) were referred for biochemical recurrence after surgery, radiotherapy or both. The images where taken 1 h after injection of 2 MBq/kg of the 68Ga‐(HBED‐CC)‐PSMA ligand. All examinations were interpreted by two experienced nuclear medicine specialists. Using the results of the examination, a multidisciplinary oncology committee (MOC) reported on the treatment strategy. A positive impact on clinical management was considered if the examination determined a modification in the treatment strategy compared to the MOC decision before PSMA imaging.

Results

All patients completed the examination with no adverse reactions. The median (interquartile range) PSA level at the time of the examination was 2.2 (0.72–6.7) ng/mL. Overall, 68Ga‐PSMA PET/CT detected at least one lesion suspicious for prostate cancer in 98/131 (75%) patients. There was an impact on subsequent management in 99/131 patients (76%). The main modifications included continuing surveillance (withholding hormonal therapy), hormonal manipulations, stereotaxic radiotherapy, salvage radiotherapy, salvage node dissection or salvage local treatment (prostatectomy, high‐intensity focussed ultrasound).

Conclusion

Our preliminary experience suggests that performing 68Ga‐PSMA PET/CT in patients with prostate cancer with rising PSA after treatment with curative intent can be clinically useful as it changes the treatment strategy in a significant proportion of patients. However, larger prospective trials are needed to validate our present findings.