bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-Term Isoflavone Intervention in the Treatment of Severe Vasomotor Symptoms after Surgical Menopause: A Case Report and Literature Review
Authors: Teekachunhatean Supanimit , Mattawanon Natnita , Khunamornpong Surapan
Published: October 2015

Isoflavones are soy phytoestrogens that potentially exert various favorable effects in postmenopausal women, for example, alleviating vasomotor episodes, attenuating bone loss, and stimulating vaginal epithelial maturation. There has, however, been lack of consensus regarding those therapeutic effects. Most clinical studies of isoflavones have been conducted with women who had undergone natural menopause, but not those who had undergone surgical menopause. This study reports on a 51-year-old woman who presented with severe vasomotor episodes after undergoing a hysterectomy and a bilateral oophorectomy due to hypermenorrhea secondary to myoma uteri. She refused hormone therapy due to fear of adverse drug reactions so was treated with oral soy isoflavones (two capsules twice daily, equivalent to at least 100 mg daily dose) for 8 weeks. The number and severity of hot flushes and her menopause-specific quality of life dramatically improved from baseline values. The serum bone resorption marker (beta C-telopeptide) decreased markedly, while vaginal epithelial maturation improved slightly, suggesting the potential of isoflavones in attenuating bone loss and stimulating vaginal maturation. The intervention did not adversely affect the hormonal profile (FSH, LH, and estradiol) and liver or renal functions. Thus, isoflavones could be an option for women experiencing severe vasomotor episodes after surgical menopause.
Fast Antinoise RFID-Aided Medical Care System
Authors: Yang Ming-Hour , Luo Jia-Ning
Published: October 2015

We propose a grouping proof scheme to help the nursing staff on their final check automatically before a medicine round. During the medicine round, even though their RFID reader is offline, our method can generate multiple proofs for each patient and help the medical caretakers follow the five-right policy to correctly administer the drugs to their patients. Besides, because our scheme enables a nurse to target specific group tags during a medicine round, it is able to generate proofs even when the illegitimate tags are on site. We prove that our generated proof is reliable because it can resist most security threats and guarantee the integrity of the proof. Besides, our proposed scheme guarantees anonymity on the RFID tags, so the patients’ sensitive information and location privacy can be protected. Last, we run a simulation to show that compared with the related methods our proposed scheme requires the least transmission time and the lowest computation loads to generate a proof.
Fc Gamma Receptor 3A and 2A Polymorphisms Do Not Predict Response to Rituximab in Follicular Lymphoma
Authors: Kenkre Vaishalee P. , Hong Fangxin , Cerhan James R. , Lewis Marcia , Sullivan Leslie , Williams Michael E. , Gascoyne Randy D. , Horning Sandra J. , Kahl Brad S.
Published: October 2015

Purpose: Preclinical studies suggest that SNPs in the Fc gamma receptor (FCGR) genes influence response to rituximab, but the clinical relevance of this is uncertain.

Experimental Design: We prospectively obtained specimens for genotyping in the rituximab extended schedule or re-treatment trial (RESORT) study, in which 408 previously untreated, low tumor burden follicular lymphoma (FL) patients were treated with single agent rituximab. Patients received rituximab in 4 weekly doses and responders were randomized to rituximab re-treatment (RR) upon progression versus maintenance rituximab (MR). SNP genotyping was performed in 321 consenting patients.

Results: Response rates to initial therapy and response duration were correlated with the FCGR3A SNP at position 158 (rs396991) and the FCGR2A SNP at position 131 (rs1801274). The response rate to initial rituximab was 71%. No FCGR genotypes or grouping of genotypes were predictive of initial response. A total of 289 patients were randomized to RR (n = 143) or to MR (n = 146). With a median follow-up of 5.5 years, the 3-year response duration in the RR arm and the MR arm was 50% and 78%, respectively. Genotyping was available in 235 of 289 randomized patients. In patients receiving RR (n = 115) or MR (n = 120), response duration was not associated with any FCGR genotypes or genotype combinations.

Conclusions: Based on this analysis of treatment-naïve, low tumor burden FL, we conclude that the FCGR3A and FCGR2A SNPs do not confer differential responsiveness to rituximab. Clin Cancer Res; 22(4); 821–6. ©2015 AACR.

See related commentary by Cartron et al., p. 787
Right-Sizing Adjuvant and Neoadjuvant Clinical Trials in Breast Cancer
Authors: Berry Donald A.
Published: October 2015

I describe a simple and intuitive method for finding sample size for clinical trials in primary breast cancer based on neoadjuvant trial results and using the FDA's patient-level meta-analysis. Then I explain a problem with this method and how the problem can be remedied. Clin Cancer Res; 22(1); 3–5. ©2015 AACR.

See related article by Hatzis et al., p. 26
Sulforaphane Bioavailability and Chemopreventive Activity in Women Scheduled for Breast Biopsy
Authors: Atwell Lauren L. , Zhang Zhenzhen , Mori Motomi , Farris Paige E. , Vetto John T. , Naik Arpana M. , Oh Karen Y. , Thuillier Philippe , Ho Emily , Shannon Jackilen
Published: October 2015

Epidemiologic studies suggest a protective effect of cruciferous vegetables on breast cancer. Sulforaphane (SFN), an active food component derived from crucifers, has been shown to be effective in breast cancer chemoprevention. This study evaluated the chemopreventive effect of SFN on selective biomarkers from blood and breast tissues. In a 2- to 8-week double-blinded, randomized controlled trial, 54 women with abnormal mammograms and scheduled for breast biopsy were randomized to consume a placebo or a glucoraphanin (GFN) supplement providing SFN (n = 27). Plasma and urinary SFN metabolites, peripheral blood mononuclear cell (PBMC) histone deacetylase (HDAC) activity, and tissue biomarkers (H3K18ac, H3K9ac, HDAC3, HDAC6, Ki-67, p21) were measured before and after the intervention in benign, ductal carcinoma in situ, or invasive ductal carcinoma breast tissues. Within the supplement group, Ki-67 (P = 0.003) and HDAC3 (P = 0.044) levels significantly decreased in benign tissue. Pre-to-postintervention changes in these biomarkers were not significantly different between treatment groups after multiple comparison adjustment. GFN supplementation was associated with a significant decrease in PBMC HDAC activity (P = 0.04). No significant associations were observed between SFN and examined tissue biomarkers when comparing treatment groups. This study provides evidence that GFN supplementation for a few weeks is safe but may not be sufficient for producing changes in breast tissue tumor biomarkers. Future studies employing larger sample sizes should evaluate alternative dosing and duration regimens to inform dietary SFN strategies in breast cancer chemoprevention. Cancer Prev Res; 8(12); 1184–91. ©2015 AACR.
Comparison of the Superagonist Complex, ALT-803, to IL15 as Cancer Immunotherapeutics in Animal Models
Authors: Rhode Peter R. , Egan Jack O. , Xu Wenxin , Hong Hao , Webb Gabriela M. , Chen Xiaoyue , Liu Bai , Zhu Xiaoyun , Wen Jinghai , You Lijing , Kong Lin , Edwards Ana C. , Han Kaiping , Shi Sixiang , Alter Sarah , Sacha Jonah B. , Jeng Emily K. , Cai Weibo , Wong Hing C.
Published: October 2015

IL15, a potent stimulant of CD8+ T cells and natural killer (NK) cells, is a promising cancer immunotherapeutic. ALT-803 is a complex of an IL15 superagonist mutant and a dimeric IL15 receptor αSu/Fc fusion protein that was found to exhibit enhanced biologic activity in vivo, with a substantially longer serum half-life than recombinant IL15. A single intravenous dose of ALT-803, but not IL15, eliminated well-established tumors and prolonged survival of mice bearing multiple myeloma. In this study, we extended these findings to demonstrate the superior antitumor activity of ALT-803 over IL15 in mice bearing subcutaneous B16F10 melanoma tumors and CT26 colon carcinoma metastases. Tissue biodistribution studies in mice also showed much greater retention of ALT-803 in the lymphoid organs compared with IL15, consistent with its highly potent immunostimulatory and antitumor activities in vivo. Weekly dosing with 1 mg/kg ALT-803 in C57BL/6 mice was well tolerated, yet capable of increasing peripheral blood lymphocyte, neutrophil, and monocyte counts by >8-fold. ALT-803 dose-dependent stimulation of immune cell infiltration into the lymphoid organs was also observed. Similarly, cynomolgus monkeys treated weekly with ALT-803 showed dose-dependent increases of peripheral blood lymphocyte counts, including NK, CD4+, and CD8+ memory T-cell subsets. In vitro studies demonstrated ALT-803–mediated stimulation of mouse and human immune cell proliferation and IFNγ production without inducing a broad-based release of other proinflammatory cytokines (i.e., cytokine storm). Based on these results, a weekly dosing regimen of ALT-803 has been implemented in multiple clinical studies to evaluate the dose required for effective immune cell stimulation in humans. Cancer Immunol Res; 4(1); 49–60. ©2015 AACR.
Tissue-Specific Regulation of Drosophila NF-κB Pathway Activation by Peptidoglycan Recognition Protein SC
Authors: Costechareyre Denis , Capo Florence , Fabre Alexandre , Chaduli Delphine , Kellenberger Christine , Roussel Alain , Charroux Bernard , Royet Julien
Published: October 2015

In Drosophila, peptidoglycan (PGN) is detected by PGN recognition proteins (PGRPs) that act as pattern recognition receptors. Some PGRPs such as PGRP-LB or PGRP-SCs are able to cleave PGN, therefore reducing the amount of immune elicitors and dampening immune deficiency (IMD) pathway activation. The precise role of PGRP-SC is less well defined because the PGRP-SC genes (PGRP-SC1a, PGRP-SC1b and PGRP-SC2) lie very close on the chromosome and have been studied using a deletion encompassing the three genes. By generating PGRP-SC-specific mutants, we reevaluated the roles of PGRP-LB, PGRP-SC1 and PGRP-SC2, respectively, during immune responses. We showed that these genes are expressed in different gut domains and that they follow distinct transcriptional regulation. Loss-of-function mutant analysis indicates that PGRP-LB is playing a major role in IMD pathway activation and bacterial load regulation in the gut, although PGRP-SCs are expressed at high levels in this organ. We also demonstrated that PGRP-SC2 is the main negative regulator of IMD pathway activation in the fat body. Accordingly, we showed that mutants for either PGRP-LB or PGRP-SC2 displayed a distinct susceptibility to bacteria depending on the infection route. Lastly, we demonstrated that PGRP-SC1 and PGRP-SC2 are required in vivo for full Toll pathway activation by Gram-positive bacteria.
Role of MiR-3619-5p in β-Catenin-Mediated Non-Small Cell Lung Cancer Growth and Invasion
Authors: Niu Xuecai , Liu Sen , Jia Li , Chen Jing
Published: October 2015

Background/Aims: The malignancy of non-small cell lung cancer (NSCLC) is largely due to its fast growth and invasion. WNT/β-catenin signaling plays a critical role in regulating NSCLC carcinogenesis. Hence, suppression of β-catenin signal transduction in NSCLC cells may improve the therapeutic outcome. Methods: We analyzed the levels of β-catenin and miR-3619-5p in NSCLC specimens, compared to paired non-tumor normal lung tissue (NT). We did Bioinformatics analyses on the binding sites of 3'-UTR of β-catenin mRNA by miR-3619-5p. We modified the levels of miR-3619-5p in NSCLC cells and examined their effects on β-catenin levels, and on the growth and invasion of NSCLC cells in an MTT assay and a transwell cell migration assay, respectively. Results: NSCLC specimens had significant higher levels of β-catenin, and significantly lower levels of miR-3619-5p, compared to NT. The levels of β-catenin and miR-3619-5p were inversely correlated in NSCLC specimens. Bioinformatics analyses showed that miR-3619-5p bound to 3'-UTR of β-catenin mRNA in NSCLC cells to inhibit its translation. Overexpression of miR-3619-5p decreased β-catenin protein, while depletion of miR-3619-5p increased β-catenin protein in NSCLC cells, without altering β-catenin mRNA levels. Overexpression of miR-3619-5p in NSCLC cells inhibited cell growth and invasion, while depletion of miR-3619-5p in NSCLC lines increased cell growth and invasion. Conclusion: Our data demonstrate a previously unappreciated role for miR-3619-5p in suppression of β-catenin-mediated cancer growth and invasion in NSCLC cells, and highlight miR-3619-5p as a novel cancer suppressor in NSCLC.
DWI Lesion Patterns in Cancer-Related Stroke - Specifying the Phenotype
Authors: Schwarzbach Christopher Jan , Fatar Marc , Eisele Philipp , Ebert Anne D. , Hennerici Michael G. , Szabo Kristina
Published: October 2015

Background: Due to the lack of specific diagnostic markers, the diagnosis of cancer-related stroke strongly depends on its phenotype. Distinct DWI lesion patterns with involvement of multiple vascular territories have been reported repeatedly in cancer-related stroke but have not been addressed in detail in a selected cohort of prospectively recruited cancer patients with emphasis on hypercoagulable conditions. Patients and Methods: Ischemic stroke patients with known malignant cancer activity, laboratory evidence of strong plasmatic hypercoagulation (D-dimer levels >3 µg/ml) and without competing stroke etiologies according to the recently introduced ASCOD (A - atherosclerosis, S - small vessel disease, C - cardiac pathology, O - other cause, and D - dissection) classification of evidence-rated etiology of stroke subtypes were included in the analysis. Cerebral MRI on admission was reviewed with respect to ischemic lesion patterns. Results: Thirty-two patients met the inclusion criteria. The mean D-dimer levels were 15.39 µg/ml (±10.84). Acute infarction in ≥2 vascular territories was present in 27/32 (84%) patients. (Micro-) embolic scattering of infarction was present in 25/32 (78%) patients. Evidence for previous, potentially oligosymptomatic infarction was found in 16 (50%) patients, demonstrated by the additional presence of subacute or chronic ischemic lesions. Conclusion: When excluding competing embolic and nonembolic stroke etiologies, the pattern of scattered DWI lesions in multiple vascular supply territories strongly dominates the phenotype of cancer-related stroke. Additionally, evidence of recurrent infarction is frequent in this cohort of patients. This is not only important for the diagnosis of cancer-related stroke itself but may prove helpful for the identification of cancer-related stroke patients with unknown malignancy at the time of stroke manifestation and evaluation of strategies for secondary prevention.
Patient-Reported Outcome Measurement in Clinical Dermatological Practice: Relevance and Feasibility of a Web-Based Portal
Authors: van Cranenburgh Oda D. , ter Stege Jacqueline A. , de Korte John , de Rie Menno A. , Sprangers Mirjam A.G. , Smets Ellen M.A.
Published: October 2015

Background/Aims: Patient-reported outcomes (PROs) are increasingly considered important. We developed a web-based application to electronically assess PROs in routine dermatological practice. We assessed (1) the relevance of PRO measurement according to health care providers and patients, (2) the feasibility of our application in routine practice according to health care providers, supporting staff and patients, and (3) barriers/facilitators for implementation according to health care providers and supporting staff. Methods: Health care providers, supporting staff and patients completed study-specific questionnaires. Also, website statistics were analysed. Results: 3/6 clinics participated, including 9 professionals and 80 patients. Both health care providers and patients rated PRO measurement as relevant. However, implementation was only moderately feasible. Time constraints and logistical problems were mentioned as barriers, and motivated patients and supportive staff as facilitators. Conclusion: Electronic PRO assessment in routine practice is not self-evident. Adjustments in logistics are recommended to optimize implementation, using a plan-do-study-act approach.
Evaluation of Computed Tomography for Lymph Node Staging in Bladder Cancer Prior to Radical Cystectomy
Authors: Horn Thomas , Zahel Tina , Adt Nathanja , Schmid Sebastian C. , Heck Matthias M. , Thalgott Mark K. , Hatzichristodoulou Georgios , Haller Bernhard , Autenrieth Michael , Kübler Hubert R. , Gschwend Jürgen E. , Holzapfel Konstantin , Maurer Tobias
Published: October 2015

Objectives: To retrospectively evaluate the value of CT for lymph node (LN) staging in bladder cancer. Methods: Two uroradiologists reviewed CT scans of 231 patients who underwent radical cystectomy and pelvic lymphadenectomy according to a predefined 12-field template. A 5-step model was used to grade the radiological likelihood of a LN to represent malignant spread based on size, configuration and structure as well as regional clustering. Statistical analyses were performed both on patient- and field-based levels. Results: LN metastases were found in 59 of 231 patients (25.5%). On a patient-based level, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 52.6, 93.6, 73.2, 85.6 and 83.4%, respectively. Using the field-based approach, a total of 1,649 anatomical fields were evaluable, of which 114 fields showed malignancy (6.9%). On a field basis, sensitivity, specificity, PPV, NPV and accuracy were 30.2, 98, 51.5, 94.5 and 93.3%, respectively. Concerning local staging (pT category), the overall accuracy was 78%; overstaging occurred in 6% and understaging in 16%. Conclusions: In line with prior studies, the sensitivity of CT imaging for the detection of LN metastases was low, while high values for specificity were achieved. This was further underlined by analyzing standardized anatomical fields. Concerning local staging, postoperative changes after TURB-T rarely led to overstaging.
Angiogenic Gene Expression in Down Syndrome Fetal Hearts
Authors: Sánchez Olga , Domínguez Carmen , Ruiz Aina , Ribera Irene , Alijotas Jaume , Cabero Lluís , Carreras Elena , Llurba Elisa
Published: October 2015

Introduction: Forty percent of Down syndrome (DS) fetuses have congenital heart defects (CHD). An abnormal angiogenic environment has been described in euploid fetuses with CHD. However, the underlying pathophysiologic pathway that contributes to CHD in DS remains unknown. The objective was to compare the expression of angiogenic factors and chronic hypoxia genes in heart tissue from DS and euploid fetuses with and without CHD. Methods: The gene expression profile was determined by real-time PCR quantification in heart tissue from 33 fetuses with DS, 23 euploid fetuses with CHD and 23 control fetuses. Results: Angiogenic factors mRNA expression was significantly increased in the DS group compared to the controls (soluble fms-like tyrosine kinase-1, 81%, p = 0.007; vascular endothelial growth factor A, 57%, p = 0.006, and placental growth factor, 32%, p = 0.0227). Significant increases in the transcript level of hypoxia-inducible factor-2α and heme oxygenase 1 were also observed in the DS group compared to the controls. The expression of angiogenic factors was similar in DS fetuses and CHD euploid fetuses with CHD. Conclusion: Abnormal angiogenesis was detected in the hearts of DS fetuses with and without CHD. Our results suggest that DS determines an intrinsically angiogenic impairment that may be present in the fetal heart.
The Relationship of Metabolic Syndrome and Body Composition in Children with Premature Adrenarche: Is It Age Related?
Authors: Williams Kristen M. , Oberfield Sharon E. , Zhang Chengchen , McMahon Donald J. , Sopher Aviva B.
Published: October 2015

Background: Studies that evaluate both body composition and metabolic syndrome (MeS) risk in prepubertal children with premature adrenarche (PA) are limited. Methods: Fifty-eight prepubertal children (aged 5-9 years, 33 female and 25 male), 30 with PA and 28 controls, were evaluated for the presence of MeS as defined by age-modified National Cholesterol Education Program Adult Treatment Panel III criteria. A subset had dual-energy X-ray absorptiometry and bone markers (n = 23/58) to evaluate the effect of hyperandrogenism on metabolic abnormalities and body composition. Results: There was no difference in the prevalence of MeS between PA and controls (p = 0.138). Children with MeS were obese with an increased waist circumference (WC) and decreased high-density lipoprotein levels. Androgens were not associated with having more than one criterion for MeS (p = 0.08) but were associated with triglycerides and WC (p = 0.029 and p = 0.041, respectively). Lean mass was greater in PA subjects (p = 0.039), and androgens correlated with bone mineral density (p = 0.029) and total body fat (p = 0.008). Subjects with a higher percent of body fat were more likely to have more than one MeS risk factor (p = 0.005). Conclusions: MeS was seen only in obese subjects whether or not they had PA. Thus, it appears that obesity drives metabolic risk in the prepubertal population rather than PA. Our findings are important in determining how the prepubertal patient with PA should be evaluated for metabolic risk.
Unilateral Vogt-Koyanagi-Harada Disease: A Clinical Case Report
Authors: Neves Arminda , Cardoso Ana , Almeida Mariana , Campos Joana , Campos António , Castro Sousa João Paulo
Published: October 2015

Purpose: To report a case of a 20-year-old female with decreased visual acuity (VA) in the left eye (LE). Methods: This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. Results: A 20-year-old female presented with decreased VA in the LE for 3 days. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (RE) and 20/40 in the LE. Pupillary function, intraocular pressure, results of external segment examinations and slit-lamp biomicroscopy were normal, bilaterally. RE fundoscopy was normal, and in the LE it revealed papillitis and posterior pole exudative retinal detachment. Optical coherence tomography (OCT) confirmed the macular serous retinal detachment and showed thickening of the posterior choroid also revealed by orbital ultrasound and magnetic resonance imaging (MRI). Fluorescein angiography showed angiographic features typical of Vogt-Koyanagi-Harada (VKH) disease: disseminated spotted choroidal hyperfluorescence and choroidal multifocal hypofluorescence, multifocal profuse leakage in the retina with pooling, serous retinal detachment and optic disc hyperfluorescence. Serological testing for the diagnosis of infectious pathologies was negative, and the review of systems was normal. The patient received systemic steroids and cyclosporine. LE BCVA improved up to 20/20 at 18 months after the diagnosis, with complete reabsorption of subretinal fluid and normal retinal and choroidal thickness by OCT. Conclusion: Despite the unilateral involvement, the clinical and angiographic features were typical of VKH disease, and ophthalmologists should be aware to recognize this rare clinical variant of the disease.
Edoxaban: Impact on routine and specific coagulation assays
Authors: Chatelain Bernard , Chatelain Christian , Douxfils Jonathan , Dogné Jean-Michel , Mullier François
Published: October 2015

Assessment of plasma concentration/effect of edoxaban may be useful in some situations. Also, clinicians need to know how routine coagulation assays are influenced. It was our aim to determine coagulation tests useful for the assessment of edoxaban’s pharmacodynamics and provide recommendations for the interpretation of haemostasis diagnostic tests. Edoxaban was spiked at concentrations ranging from 0 to 1,000 ng/ml in platelet-poor plasma which covers the on-therapy range (from ± 25 ng/ml at Ctrough to ± 170 ng/ml at Cmax). aPTT, PT, dRVVT, chromogenic anti-Xa assays, TGA and a large panel of haemostasis diagnostic tests were performed using several reagents. A concentration-dependent prolongation of aPTT, PT and dRVVT was observed. The effect was dependent on the reagents. FXa chromogenic assays showed high sensitivity and a linear correlation depending on the methodology. TGA may be useful to assess the pharmacodynamics of edoxaban but its turnaround time and the lack of standardisation are limitations. Edoxaban impairs the assessment of lupus anticoagulant, protein S (clotting method), APC-R, antithrombin (FXa-based assay) and measurement of clotting factor activity. Immunological assays and assays acting below the FXa are not influenced by edoxaban. In conclusion, some PT reagents could be used to estimate edoxaban activity. Chromogenic anti-Xa assays are required to assess the plasma concentration. TGA may be useful but requires standardisation. In case of thrombophilia or in the exploration of a haemorrhagic event, immunological assays should be recommended, when applicable. Standardisation of the time between the last intake and the sampling is mandatory to provide a proper assessment of the result.

Supplementary Material to this article is available online at www.thrombosis-online.com.
Variation and Trends in the Documentation of National Institutes of Health Stroke Scale in GWTG-Stroke Hospitals
Authors: Reeves Mathew J. , Smith Eric E. , Fonarow Gregg C. , Zhao Xin , Thompson Michael , Peterson Eric D. , Schwamm Lee H. , Olson DaiWai
Published: October 2015

Background—

Although National Institutes of Health Stroke Scale (NIHSS) is an important prognostic variable, it is often incompletely documented in clinical registries, such as Get With The Guidelines (GWTG)–Stroke. We describe trends in NIHSS documentation by GWTG-Stroke hospitals, identify patient-level and hospital-level factors associated with documentation, and determine the degree to which the reporting of NIHSS is potentially biased.

Methods and Results—

We analyzed NIHSS documentation in 1 184 288 patients with acute ischemic stroke admitted to 1704 GWTG-Stroke hospitals between 2003 and 2012. We used multivariable logistic regression models to identify hospital-level and patient-level predictors of NIHSS documentation. We examined the relationship between hospital-level NIHSS documentation rates and observed NIHSS scores to determine whether the reporting of NIHSS data was subject to selection bias. The overall NIHSS documentation rate was 56.1%; the median NIHSS was 4 (interquartile range, 2–9). Between 2003 and 2012, mean hospital-level NIHSS documentation increased dramatically from 27% to 70% (
P
<0.0001). Documentation was higher in patients who arrived by ambulance, who arrived soon after onset, and were treated at larger, primary stroke centers. Hospital-level NIHSS documentation rates and NIHSS scores were modestly inversely correlated (
r
=−0.207;
P
<0.0001), suggesting that NIHSS data from hospitals with low documentation were shifted toward higher values. In sensitivity analysis, the degree of bias in NIHSS reporting was reduced in more recent years (2011–2012) when NIHSS documentation was noticeably better.

Conclusions—

Documentation of NIHSS is higher in patients who are thrombolysis candidates. Evidence of modest bias in NIHSS scores was observed but this has lessened as the documentation of NIHSS has improved in recent years.
Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy
Authors: Leffert Lisa R. , Clancy Caitlin R. , Bateman Brian T. , Cox Margueritte , Schulte Phillip J. , Smith Eric E. , Fonarow Gregg C. , Schwamm Lee H. , Kuklina Elena V. , George Mary G.
Published: October 2015

Background—

Hospitalizations for pregnancy-related stroke are rare but increasing. Hemorrhagic stroke (HS), ie, subarachnoid hemorrhage and intracerebral hemorrhage, is more common than ischemic stroke in pregnant versus nonpregnant women, reflecting different phenotypes or risk factors. We compared stroke risk factors and outcomes in pregnant versus nonpregnant HS in the Get With The Guidelines-Stroke Registry.

Methods and Results—

Using medical history or
International Classification of Diseases
-
Ninth Revision
codes, we identified 330 pregnant and 10 562 nonpregnant female patients aged 18 to 44 years with HS in Get With The Guidelines-Stroke (2008–2014). Differences in patient and care characteristics were compared by χ
2
or Fisher exact test (categorical variables) or Wilcoxon rank-sum (continuous variables) tests. Conditional logistic regression assessed the association of pregnancy with outcomes conditional on categorical age and further adjusted for patient and hospital characteristics. Pregnant versus nonpregnant HS patients were younger with fewer pre-existing stroke risk factors and medications. Pregnant versus nonpregnant subarachnoid hemorrhage patients were less impaired at arrival, and less than half met blood pressure criteria for severe preeclampsia. In-hospital mortality was lower in pregnant versus nonpregnant HS patients: adjusted odds ratios (95% CI) for subarachnoid hemorrhage 0.17 (0.06–0.45) and intracerebral hemorrhage 0.57 (0.34–0.94). Pregnant subarachnoid hemorrhage patients also had a higher likelihood of home discharge (2.60 [1.67–4.06]) and independent ambulation at discharge (2.40 [1.56–3.70]).

Conclusions—

Pregnant HS patients are younger and have fewer risk factors than their nonpregnant counterparts, and risk-adjusted in-hospital mortality is lower. Our findings suggest possible differences in underlying disease pathophysiology and challenges to identifying at-risk patients.
Effect of Warfarin Treatment on Survival of Patients With Pulmonary Arterial Hypertension (PAH) in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL)
Authors: Preston Ioana R. , Roberts Kari E. , Miller Dave P. , Sen Ginny P. , Selej Mona , Benton Wade W. , Hill Nicholas S. , Farber Harrison W.
Published: October 2015

Background—

Long-term anticoagulation is recommended in idiopathic pulmonary arterial hypertension (IPAH). In contrast, limited data support anticoagulation in pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). We assessed the effect of warfarin anticoagulation on survival in IPAH and SSc-PAH patients enrolled in Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a longitudinal registry of group I PAH.

Methods and Results—

Patients who initiated warfarin on study (n=187) were matched 1:1 with patients never on warfarin, by enrollment site, etiology, and diagnosis status. Descriptive analyses were conducted to compare warfarin users and nonusers by etiology. Survival analyses with and without risk adjustment were performed from the time of warfarin initiation or a corresponding quarterly update in matched pairs to avoid immortal time bias. Time-varying covariate models were used as sensitivity analyses. Mean warfarin treatment was 1 year; mean international normalized ratios were 1.9 (IPAH) and 2.0 (SSc-PAH). Two-thirds of patients initiating warfarin discontinued treatment before the last study assessment. There was no survival difference with warfarin in IPAH patients (adjusted hazard ratio, 1.37;
P
=0.21) or in SSc-PAH patients (adjusted hazard ratio, 1.60;
P
=0.15) in comparison with matched controls. However, SSc-PAH patients receiving warfarin within the previous year (hazard ratio, 1.57;
P
=0.031) or any time postbaseline (hazard ratio, 1.49;
P
=0.046) had increased mortality in comparison with warfarin-naïve patients.

Conclusions—

No significant survival advantage was observed in IPAH patients who started warfarin. In SSc-PAH patients, long-term warfarin was associated with poorer survival than in patients not receiving warfarin, even after adjusting for confounders.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00370214.
The Atlas Massif separates a northern and a southern mitochondrial haplotype group of North African water frogs Pelophylax saharicus (Anura: Ranidae) in Morocco
Authors: Lansari Aziza , Vences Miguel , Hauswaldt Susanne , Hendrix Ralf , Donaire David , Bouazza Abdellah , Joger Ulrich , El Mouden El Hassan , Slimani Tahar
Published: October 2015

We assessed the genetic variation of 47 Moroccan populations of the North African water frog (Pelophylax saharicus) using partial sequences of the mitochondrial cytochrome oxidase subunit I gene (COI). All 239 samples belonged to the main haplotype clade previously identified from Morocco, with no haplotypes of the Algerian/Tunisian clades among our samples. Altogether 40 haplotypes were found, with a maximum of 13 mutational steps between them. Two weakly divergent haplogroups separated by a minimum of six mutational steps were distributed (i) in the Anti-Atlas and the Sahara (south of the High Atlas Mountains) versus (ii) in the Middle Atlas, the High Atlas, and in the Rif area north of the Atlas Massif. Haplotypes of the northern haplogroup were found at the southernmost locality, which might be due to human translocation, and co-occurrence of the two haplogroups was recorded at three sites within the range of the northern haplogroup.
Soft Power, Bias and Manipulation of International Organizations in International Mediation
Authors: Vuković Siniša
Published: October 2015

The present study challenges three common assumptions of the international mediation literature. First, it challenges the perception that pure or weak mediators are unable to use manipulative and coercive strategies in the mediation process, but can only resort to facilitating the dialogue and at most formulating a proposal on behalf of the disputants. Secondly, it challenges the perception that only resource-based power can be used to manipulate the process and coerce (and direct) the parties toward mutually acceptable solutions. This misconception is based on the assumption that the expansion of the zone of possible agreement, which is mainly attributed to manipulative strategies, can be achieved only by the employment of carrots and sticks which are often inaccessible to pure or weak mediators. Lastly, it shows how this type of leverage can also indicate a particular bias that an apparent pure mediator might have: bias of outcome.
Peace Mediation and the Minefield of International Recognition Games
Authors: Aggestam Karin
Published: October 2015

This article analyzes the intricate dynamics between international mediation and the quest for recognition in protracted conflict. The overarching aim is two-fold: to analyze how the struggle for recognition relates to protracted conflict, and why, when and in what ways recognition poses a barrier to efficient peace diplomacy and mediation. The article explores how preferences and interests are infused with identity politics and claims for recognition. It advances three inter-related dimensions of recognition: ontological security, dignity and identity. The conceptual discussion utilizes empirical illustrations from the Israeli-Palestinian conflict. Three concluding remarks are made. First, international mediation may be accepted by negotiating parties to achieve international recognition rather than to reach an agreement. Second, due to the problem of recognition the notion of “ending conflict” can backfire in the mediation process. Third, mediators should focus on mutual, but thin recognition towards greater acknowledgement of the untenable and vulnerable positions the parties hold in conflict.
The Candle of Distinction: A Cultural Biography of the Havdalah Light
Authors: Klein Michele
Published: October 2015

This case study explores how a general lighting device transformed into a distinctive Jewish ritual object, the Havdalah candle. In late antiquity, the ubiquitous oil lamp served for the fire-light blessing during the end-of-Sabbath Havdalah ritual but in the fourth century, a sage added a torch, avukah, aggrandizing the ceremonial light. Jews showed little concern for the lighting utensil until the late Middle Ages, when a variety of contemporary torch-candles employed in Church ritual and among Christian aristocracy inspired new rabbinic interpretations of the term avukah. Ashkenazi Jews favored a costly Gothic-style implement with intertwined tapers, which particularly suited the words of the ancient Havdalah blessing. This became a distinctively Ashkenazi Jewish ritual object in the sixteenth century, after Christians abandoned the old-fashioned style of torch-candle. Following the drop in cost of wax, and massive Jewish migrations in modern times, all observant Jews adopted the Ashkenazi intertwined candle.
‘To Kill’ and ‘To Die’ (and Other Suppletive Verbs) in Uto-Aztecan
Authors: Haugen Jason D. , Everdell Michael
Published: October 2015

Previous research has noted that verbal suppletion for ergative number agreement (i.e. agreement with the subjects of intransitives and the objects of transitives) is widespread throughout the Uto-Aztecan language family and is therefore reconstructable to Proto-Uto-Aztecan (PUA) (Langacker, 1977). However, no previous works have systematically surveyed the attested forms of suppletion in these languages nor posited specific proposals for reconstructions of particular suppletive morphs back to PUA. We redress this lacuna by surveying the suppletive verbs in the various subgroups of Uto-Aztecan and assessing which of those are sufficiently widespread to reconstruct to PUA. We argue for specific PUA reconstructions for two verbal domains: die and kill, arguing that there were three distinct suppletive verb stems for marking these functions: *muku die.sg, *ko(i) die.pl, and *mɨɁa kill.sg. The plural form of kill in PUA was derived by adding a causative suffix *-ya to the plural stem for die, yielding *ko-ya. Other suppletive verbs in the family are not as easily reconstructable to PUA due to variation in attested forms, although some semantic functions seem to be widespread enough to be reconstructable. The PUA forms serving those functions would have been altered in different ways at different times by a lexical replacement process endemic to cases of strong suppletion, i.e. incursion (Juge, 2000). We also consider the issue of potential areal contact involving suppletion patterns in the areas where Uto-Aztecan languages are spoken, finding limited but suggestive evidence for possible areal effects involving suppletion for verbal number agreement.
The Ecclesiological Self and the Other: Concepts of Social Identity and Their Implications for Free Churches in Secular Europe
Authors: Bartholomä Philipp F.
Published: October 2015

This article suggests that social identity research, especially the concept of self-other differentiation, may shed light on the observable ecclesiological and missional identity crisis of free churches in secular Europe. As free churches find positive value, meaning, and perspective in distinction to particular ‘collective others’, both their ecclesiological self as well as their philosophy of ministry are shaped by these kinds of social psychological procedures. It is thus proposed that the ecclesiological and missiological difficulties of free churches in Europe are at least partly due to the fact that what has historically been the most relevant ‘identity-forming other’ is fading away. While free churches originated within a Christendom context, they now face an increasingly secular environment. This seems to necessitate a mental rearrangement of sorts since it is no longer suitable to determine one’s identity in comparison and opposition to other Christian groups within the sphere of cultural Christianity.
A new species of Leposternon Wagler, 1824 (Squamata, Amphisbaenia) from northeastern Argentina
Authors: RIBEIRO SIRIA , SANTOS-JR ALFREDO P. , ZAHER HUSSAM
Published: October 2015

A new species of Leposternon is described from the Humid Chaco biome in Argentina. The species is known only from its type locality, at El Bagual Ecological Reserve, a conservation unit located in the province of Formosa. The new species can be distinguished from all its congeners by the presence of rostral processes in the maxillae and nasals that contact each other on the facial portion of the skull. Additionally, we present a key for the species of Leposternon.
Fungus-feeding Thysanoptera: Phlaeothripinae of the Idiothrips genus-group in Australia, with nine new species
Authors: MOUND LAURENCE A. , TREE DESLEY J.
Published: October 2015

In a group of fungus-feeding Phlaeothripinae characterized by complex body sculpture, identification keys are provided to three genera and 15 species from Australia, including nine new species. In the genus Azaleothrips one new species is described, and one Asian species is newly recorded from Australia. The genus Stictothrips is recorded from Australia for the first time, with two new species. Within the genus Strepterothrips considerable structural diversity is recorded including three new species in which antennal segment III is greatly reduced and bears no sense cones. Some species in this genus exhibit the unusual condition of having several setae on the pelta, the first abdominal tergite. Problems in the production of generic diagnoses within the Phlaeothripinae are discussed.
Two new species of Homidia (Collembola, Entomobryidae) and a key to species in the genus from Zhejiang Province, China
Authors: PAN ZHI-XIANG
Published: October 2015

Two new species of Homidia are described from Yandang Mountain, China: H. yandangensis sp. nov. and H. quadrimaculata sp. nov. The new species are diagnosed by their unique colour patterns, the number of macrochaetae on areas A8–10 of abdominal segment IV, the relative position of specialised microchaetae/specialised ordinary chaetae on abdominal segment I and specialised ordinary chaetae/macrochaeta m3 on abdominal segment V. Specimens from two localities of H. yandangensis sp. nov. differ in the macrochaeta a5 on area A9 of abdominal segment IV. Descriptions of the subadult dorsal thoracic and abdominal chaetotaxy of H. yandangensis sp. nov. and a key to species of Homidia from Zhejiang Province are provided here.
A new species of bright-eyed treefrog (Mantellidae) from Madagascar, with comments on call evolution and patterns of syntopy in the Boophis ankaratra complex
Authors: HUTTER CARL R. , LAMBERT SHEA M. , COBB KERRY A. , ANDRIAMPENOMANANA ZO FANIRY , VENCES MIGUEL
Published: October 2015

We describe a new species of Boophis treefrog from Ranomafana National Park in the southern central east of Madagascar. This region has remarkably high anuran diversity, and along with neighbouring sites, hosts more than 35 Boophis species. Boophis boppa sp. nov. is part of the B. ankaratra sub-clade (herein named the B. ankaratra complex), previously identified within the monophyletic B. albipunctatus species group. It occurs sympatrically with two other species of the complex (B. ankaratra and B. schuboeae). Morphological differentiation of species within the B. ankaratra clade remains elusive, but species are well characterized by distinct advertisement calls, with B. boppa having the longest note duration and inter-note intervals when compared to closely related species. Furthermore, it has moderate differentiation in mitochondrial DNA, with pairwise distances of 1.9–3.7% to all other species in sequences of the mitochondrial 16S rRNA marker. Additional evidence is given by the lack of haplotype sharing with related species for the nuclear exon DNAH-3. All examples of syntopic occurrence in this complex involve species with strongly different advertisement calls, while allopatric species have more similar calls. Such a pattern might result from adaptive call co-evolution but could also be the result of non-adaptive processes. Thorough clarification of the systematics of the B. ankaratra sub-clade is required, and we outline future directions for both bioacoustic and genetic research.
An Assessment of Diurnal and Seasonal Cloud Cover Changes over the Hawaiian Islands Using Terra and Aqua MODIS*
Authors: Barnes Mallory L. , Miura Tomoaki , Giambelluca Thomas W.
Published: October 2015

A comprehensive understanding of the spatial, seasonal, and diurnal patterns in cloud cover frequency over the Hawaiian Islands was developed using high-resolution image data from the National Aeronautics and Space Administration’s Moderate Resolution Imaging Spectroradiometer (MODIS) sensors aboard the Terra and Aqua satellites. The Terra and Aqua MODIS cloud mask products, which provide the confidence that a given 1-km pixel is unobstructed by cloud, were obtained for the entire MODIS time series (10-plus years) over the main Hawaiian Islands. Monthly statistics were generated from the daily cloud mask data, including mean cloud cover frequency at the four daily overpass times. The derived mean cloud cover frequency showed patterns that were generally consistent with the known distribution of mean rainfall and with the results from previous studies. Cloud cover frequency was the highest over land areas with elevations between the lifting condensation level (~600 m) and the mean height of the trade wind inversion (TWI) base (~2200 m), especially for the windward (northeastern) mountain slopes. Above the TWI, cloud frequency decreased sharply with elevation. Irrespective of season, cloud cover frequency was generally higher in the afternoon than in the morning and higher in daytime than at nighttime although these trends varied spatially. The dry season months (May–October) were less cloudy than the wet season months (November–April) at nighttime. The analysis also revealed a local December–January minimum in the annual cycle of cloud cover frequency. The monthly time series produced in this study is the first high-spatial-resolution cloud cover dataset in Hawaii.
Radiative Impacts of the 2011 Abrupt Drops in Water Vapor and Ozone in the Tropical Tropopause Layer
Authors: Gilford Daniel M. , Solomon Susan , Portmann Robert W.
Published: October 2015

An abrupt drop in tropical tropopause layer (TTL) water vapor, similar to that observed in 2000, recently occurred in 2011, and was concurrent with reductions in TTL temperature and ozone. Previous studies have indicated that such large water vapor variability can have significant radiative impacts. This study uses Aura Microwave Limb Sounder observations, the Stratospheric Water Vapor and Ozone Satellite Homogenized dataset, and two radiative transfer models to examine the radiative effects of the observed changes in TTL water vapor and ozone on TTL temperatures and global radiative forcing (RF). The analyses herein suggest that quasi-isentropic poleward propagation of TTL water vapor reductions results in a zonal-mean structure with “wings” of extratropical water vapor reductions, which account for about half of the 2011 abrupt drop global radiative impact. RF values associated with the mean water vapor concentrations differences between 2012/13 and 2010/11 are between −0.01 and −0.09 W m−2, depending upon the altitude above which perturbations are considered. TTL water vapor and ozone variability during this period jointly lead to a transient radiative cooling of ~0.25–0.5 K in layers below the tropopause. The 2011 abrupt drop also prolonged the reduction in stratospheric water vapor that followed the 2000 abrupt drop, providing a longer-term radiative forcing of climate. Water vapor concentrations from 2005 to 2013 are lower than those from 1990 to 1999, resulting in a RF between these periods of about −0.045 W m−2, approximately 12% as large as, but of opposite sign to, the concurrent estimated CO2 forcing.