bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression and Pain in Heart Transplant Recipients
Authors: Conway Aaron , Sheridan Judith , Maddicks-Law Joanne , Fulbrook Paul , Ski Chantal F. , Thompson David R. , Clark Robyn A. , Doering Lynn V.
Published: September 2016

Characterizing how physical and psychological symptoms interact in heart transplant recipients may lead to advances in therapeutic options. This study examined associations between pain and major depression.

Method:

A cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants meeting the criteria for major depression. Hierarchical linear regression was used to determine if there was an association between pain and major depression, controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics including immunosuppression medication which may induce pain as a side effect.

Results:

Average pain score of the 48 heart transplant recipients was 43 ( SD ± 10, range 0–100, lower scores indicate worse pain), with moderate pain reported by 39% ( n = 19). Major depression was associated with worse pain ( R2 change = 36%, β = −16, 95% confidence interval [CI] = [−30, −4], p = .012). Pharmacological treatment for depression was associated with better pain scores ( R2 change = 1.5%, β = 13, 95% CI [4, 23], p = .006).

Conclusions:

Heart transplant recipients with major depression had worse pain after controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics. Thus, it is imperative that clinicians devising a treatment regimen for pain in heart transplant recipients take into account co-occurring depression and vice versa.
‘Almost the same, but not quite’: Ontological politics of recognition in modern science fiction
Authors: Hellstrand Ingvil
Published: August 2016

This article explores how issues of ‘not quite human-ness’ expose the conditions of possibility of being considered human; of human ontology. I refer to these dynamics for identifying sameness and difference as ontological politics of recognition. Tracing the genealogies of passing, I situate passing and Othering socio-political regulation and ideological frameworks for conceptualising ontology. I am particularly concerned with how the notion of ontology is bound up in questions of race and gender, and with the entanglements of technology and biology that can destabilise apparently fixed boundaries between the (natural/normative) human and its (constructed/abnormal) Others. I identify three trajectories of passing as human in the histories of science fiction. The first trajectory discusses ontological mimicry: the ways in which the non-human attempts to be like the human. The second trajectory addresses how passing as human relies on a Butlerian performativity: doing human-ness by complying with the regulatory frames for appearances and practices. The final trajectory discusses what is at stake in contemporary ontological politics of recognition: a renegotiation of human supremacy through an emphasis on collectivity and collaboration rather that singularity and boundedness.
Clarity and confusion: Epistemological struggles with Islamic identity and secular education
Authors: Baksh Bibi S
Published: September 2016

As a first-year doctoral student, I experience challenges of confronting conflicts between my secular education, my Islamic beliefs, my past in Guyana, and my present and presence in Canada, while simultaneously contemplating my future. In this paper, I share my struggles with identity and epistemology through the contours of clarity, confusion, and twilight as I think about my doctoral research. I will present a brief synopsis of my professional and educational background, as well as my identity as a Muslim immigrant, and examine what emerged from this as a personal epistemology that will guide my qualitative research.
Sellout, Blackout, or Get Out
Authors: Gropper Catherine C. , Anderson Benjamin C.
Published: September 2016

Prior to the 2012-2013 season, National Football League franchises had the option to significantly adjust their TV blackout policies for the first time since 1973. Using data from team policy choices and local TV blackouts during the 2007-2008 to 2014-2015 seasons, we examine whether the policy change was effective in reducing the probability of blackouts or affected attendance. Controlling for team fixed effects, we find no evidence that policy-adopting teams experienced significantly fewer blackouts or a change in attendance following the policy implementation. Our analysis sheds light on the economic factors that are correlated with local TV blackouts and game attendance.
Optimization of mechanical properties of silk fiber-reinforced polypropylene composite using Box–Behnken experimental design
Authors: Govindaraju Rajkumar , Jagannathan Srinivasan
Published: September 2016

In this study, the compression molding process parameters for the development of silk fiber-reinforced polypropylene composites was optimized using Box–Behnken experimental Design with response surface methodology. The trimmed silk fibers from shuttleless loom silk selvedge waste were used as reinforcement in polypropylene fiber matrix. The process parameters of compression molding such as temperature (165–185℃), time (7–15 min) and pressure (35–45 bar) were optimized with respect to the mechanical properties of the silk fiber-reinforced polypropylene composite. The optimum parameters for better mechanical properties were found to be temperature, 180℃; time, 7 min, and pressure, 35 bar in compression molding. The optimised level of parameters has shown good response to the predicted model.
Characterizing thermal protective fabrics of firefighters’ clothing in hot surface contact
Authors: Mandal Sumit , Song Guowen
Published: September 2016

This study characterizes the thermal protective fabrics of firefighters’ clothing under the exposure of hot surface contact. For this, thermal protective performance of different fabrics was evaluated using a laboratory-simulated hot surface contact test, and various factors affecting the performance were statistically identified. Additionally, heat transfer mechanisms during testing were analytically and mathematically modeled. It has been found that fabric’s constructional features and properties are the key factors to affect its thermal protective performance. In this study, the presence of a thicker thermal liner in a layered fabric system resulted in higher performance; in contrast, a multi-layered fabric system incorporating a moisture barrier in its outer layer displayed the lowest performance. Furthermore, it was demonstrated that a fabric’s air permeability has a minimal impact on performance, whereas weight, thickness, and thermal resistance have a significant positive impact on performance. Based on the analytical and mathematical models developed, it was apparent that conductive heat transfer mainly occurs through fabric during testing, and this conductive heat transfer depends upon the surface roughness and thermal properties (thermal conductivity, density, and specific heat) of the tested fabric. Here, thermal contact resistance between the hot surface and fabric also plays a crucial role in the heat transfer or thermal protective performance of fabric. Moreover, the heat transfer gradually decreases across fabric thickness, which can substantially affect thermal protective performance. This study can advance the theory of textile/materials science through better understanding of heat transfer in fabrics. This understanding can help in developing an integrated knowledge of fabric properties, heat transfer through fabrics, and thermal protective performance of fabrics. The findings from this study can also assist textile/material engineers with the development of a high performance thermal protective fabric for clothing to provide better occupational safety and health for firefighters.
Selective Spleen Embolization of Splenomegaly to Improve Thrombocytopenia Facilitating Open Aortic Aneurysm Repair
Authors: Maras Dimitrios , Kontopodis Nikolaos , Dedes Athansios , Tsanis Antonios , Mazarakis Ioannis , Gekas Christos , Ioannou Christos V.
Published: September 2016

We present an 82-year-old man with a history of hairy cell leukemia, having an 11-cm abdominal aortic aneurysm, who also had severe thrombocytopenia (about 20 000 platelets/μL) and splenomegaly at presentation. The patient had unfavorable anatomy for endovascular aneurysm repair, and therefore, an open procedure was planned. To reduce risk for perioperative bleeding and optimize patient preoperative status, a staged approach was employed. Initially, several sessions of embolization of 2 splenic artery branches were performed with the intent to decrease spleen size and to increase platelet count thus decreasing the perioperative bleeding risk. Then, after successfully increasing platelet count (280 000 PLT/μL), open repair of the aneurysm was conducted. This case demonstrates that selective splenic embolization in patients with hypersplenism and subsequent thrombocytopenia who are in need for major surgery may achieve a significant rise in platelet count and optimize patient’s preoperative status in order to avoid bleeding complications.
Safety and Effectiveness of the Denali Inferior Vena Cava Filter
Authors: Reis Stephen P. , Kovoor Jerry , Sutphin Patrick D. , Toomay Seth , Trimmer Clayton , Pillai Anil , Reddick Mark , Kalva Sanjeeva P.
Published: September 2016

Purpose:

The purpose of the study is to evaluate the clinical safety and effectiveness of the Denali (Bard, Tempe, Arizona) retrievable inferior vena cava (IVC) filter.

Materials and Methods:

In this retrospective study, authors reviewed the data of Denali IVC filters placed at their institution between 2013 and 2015. The clinical presentation, indications, and procedure-related complications during placement and retrieval were evaluated. The frequency of post filter pulmonary embolism (PE) and filter-related complications was assessed.

Results:

Denali filters were placed in 87 patients (47 males; mean age: 56 years). Twenty patients presented with PE, 45 with deep vein thrombosis (DVT), and 21 with both PE and DVT, 1 filter was placed prophylactically before surgery. Indications for filter placement included contraindications to anticoagulation (AC; n = 80), failure of AC (n = 4), and complications of AC (n = 3). No patients had PE on follow-up imaging after filter placement. Retrieval was attempted in 31 patients after a mean period of 125 days (range: 34-324 days). The filter was successfully removed in 31 (100%) patients. Follow-up imaging, available in 71 (82%) patients (range: 2-538 days), demonstrated penetration of 15 legs in 5 patients, caval thrombus in 3, 1 resulting in caval occlusion, <15° filter tilt in 5, and no leg fractures or crossed legs.

Conclusion:

The Denali filter is safe during deployment and readily retrievable. The overall safety following deployment is similar to those reported in the literature, and the incidence of filter fractures and migration appears to be less than the previous generation of Bard devices.
Retrospective Preevaluation-Postevaluation in Health Design
Authors: Malagon-Maldonado Gabriella
Published: September 2016

Background:

Retrospective preevaluation-postevaluation (RPPEs) in health design is a methodology allowing designers and healthcare providers to evaluate the effectiveness of the enhancements to the care environment.

Purpose:

This article presents an overview of the nature of RPPE and addresses its usefulness in health design.

Methods:

A description of the RPPE method with examples are provided to illustrate how these methods can be used to evaluate healthcare projects during and after the design and the implications to consider on patient, provider, and organizational outcomes.

Outcomes:

The RPPE process can be very useful when evaluating health design. It is imperative for design and healthcare professionals to use the RPPE methods to gain factual knowledge, skills, and/or attitudes of how the built environment influences a respondent’s life, health, and illness and be able to translate these findings into effective healthcare designs.
School Nurses on the Front Lines of Medicine
Authors: Olympia Robert P.
Published: August 2016

Head trauma is a common chief complaint encountered by school nurses. This article describes the initial assessment and management of head trauma in children and adolescents, delineates reasons that may prompt the school nurse to transfer a student to a local emergency department, and discusses the role of the school nurse when a student is diagnosed with a concussion.
Conotruncal Heart Defect Repair in Sub-Saharan Africa
Authors: Edwin Frank , Entsua-Mensah Kow , Sereboe Lawrence A. , Tettey Mark M. , Aniteye Ernest A. , Tamatey Martin M. , Adzamli Innocent , Akyaa-Yao Nana , Gyan Kofi B. , Ofosu-Appiah Ernest , Kotei David
Published: September 2016

Background:

The outcome of children born with conotruncal heart defects may serve as an indication of the status of pediatric cardiac care in sub-Saharan Africa (SSA). This study was undertaken to determine the outcome of children born with conotruncal anomalies in SSA, regarding access to treatment and outcomes of surgical intervention.

Methods:

From our institution in Ghana, we retrospectively analyzed the outcomes of surgery, in the two-year period from June 2013 to May 2015. The birth prevalence of congenital heart defects (CHDs) in SSA countries was derived by extrapolation using an incidence of 8 per 1,000 live births for CHDs.

Results:

The birth prevalence of CHDs for the 48 countries in SSA using 2013 country data was 258,875; 10% of these are presumed to be conotruncal anomalies. Six countries (Nigeria, Democratic Republic of the Congo, Ethiopia, Tanzania, Uganda, and Kenya) accounted for 53.5% of the birth prevalence. In Ghana, 20 patients (tetralogy of Fallot [TOF], 17; pulmonary atresia, 3) underwent palliation and 50 (TOF, 36; double-outlet right ventricle, 14) underwent repair. Hospital mortality was 0% for palliation and 4% for repair. Only 6 (0.5%) of the expected 1,234 cases of conotruncal defects underwent palliation or repair within two years of birth.

Conclusion:

Six countries in SSA account for more than 50% of the CHD burden. Access to treatment within two years of birth is probably <1%. The experience from Ghana demonstrates that remarkable surgical outcomes are achievable in low- to middle-income countries of SSA.
Surgical Aortic Valvuloplasty Versus Balloon Aortic Valve Dilatation in Children
Authors: Donald Julia S. , Konstantinov Igor E.
Published: September 2016

Balloon aortic valve dilatation (BAD) is assumed to provide the same outcomes as surgical aortic valvuloplasty (SAV). However, the development of precise modern surgical valvuloplasty techniques may result in better long-term durability of the aortic valve repair. This review of the recent literature suggests that current SAV provides a safe and durable repair. Furthermore, primary SAV appears to have greater freedom from reintervention and aortic valve replacement when compared to BAD.
Development and Morphology of the Ventricular Outflow Tracts
Authors: Anderson Robert H. , Mori Shumpei , Spicer Diane E. , Brown Nigel A. , Mohun Timothy J.
Published: September 2016

It is customary, at the current time, to consider many, if not most, of the lesions involving the ventricular outflow tract in terms of conotruncal malformations. This reflects the introduction, in the early 1940s, of the terms conus and truncus to describe the components of the developing outflow tract. The definitive outflow tracts in the postnatal heart, however, possess three, rather than two, components. These are the intrapericardial arterial trunks, the arterial roots, and the subvalvar ventricular outflow tracts. Congenital lesions afflicting the arterial roots, however, are not currently considered to be conotruncal malformations. This suggests a lack of logic in the description of cardiac development and its use as a means of categorizing congenital malformations. It is our belief that the developing outflow tract, like the postnatal outflow tracts, can readily be described in tripartite fashion, with its distal, intermediate, and proximal components forming the primordiums of the postnatal parts. In this review, we present evidence obtained from developing mice and human hearts to substantiate this notion. We show that the outflow tract, initially with a common lumen, is divided into its aortic and pulmonary components by a combination of an aortopulmonary septum derived from the dorsal wall of the aortic sac and outflow tract cushions that spiral through its intermediate and proximal components. These embryonic septal structures, however, subsequently lose their septal functions as the outflow tracts develop their own discrete walls. We then compare the developmental findings with the anatomic arrangements seen postnatally in the normal human heart. We show how correlations with the embryologic findings permit logical analysis of the congenital lesions involving the outflow tracts.
Ascending Aortic Slide for Interrupted Aortic Arch Repair
Authors: Urencio Miguel , Dodge-Khatami Ali , Greenleaf Chris E. , Aru Giorgio , Salazar Jorge D.
Published: September 2016

For repair of interrupted aortic arch, unfavorable anatomy challenges a tension-free anastomosis. We describe a useful alternative surgical technique used in five neonates/infants, involving splitting the ascending aorta from the sinotubular junction to the arch origin, leftward and posterior “sliding” of the flap with anastomosis to the distal arch creating a native tissue bridge, and reconstruction with a patch. With wide interruption gaps between proximal and distal aortic portions, the ascending aortic slide is a safe and reproducible technique, providing a tension-free native tissue bridge with potential for growth, and a scaffold for patch augmentation in biventricular hearts, or for Norwood stage I in univentricular palliation.
Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria
Authors: Ugo Okoli , Ezinne Eze-Ajoku , Modupe Oludipe , Nicole Spieker , Winifred Ekezie , Kelechi Ohiri
Published: September 2016

Background:

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas.

Objective:

To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered.

Method:

A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared.

Result:

Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group.

Conclusion:

The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.
Prenatal Diagnosis of Subependymal Hemorrhage
Authors: Auckland Amanda
Published: September 2016

Fetal intracranial hemorrhage is a rare sonographic finding. Due to the subtle and variable nature of hemorrhage on sonography, prenatal diagnosis of intracranial hemorrhage is difficult. Subependymal hemorrhage of the germinal matrix is the least severe form of intracranial hemorrhage. Knowledge of the sonographic appearances of intracranial hemorrhage can make prenatal diagnosis possible and is essential to protecting the neurodevelopmental outcome of the fetus.
Cell-derived microparticles and the lung
Authors: Nieri Dario , Neri Tommaso , Petrini Silvia , Vagaggini Barbara , Paggiaro Pierluigi , Celi Alessandro
Published: September 2016

Cell-derived microparticles are small (0.1–1 μm) vesicles shed by most eukaryotic cells upon activation or during apoptosis. Microparticles carry on their surface, and enclose within their cytoplasm, molecules derived from the parental cell, including proteins, DNA, RNA, microRNA and phospholipids. Microparticles are now considered functional units that represent a disseminated storage pool of bioactive effectors and participate both in the maintenance of homeostasis and in the pathogenesis of diseases. The mechanisms involved in microparticle generation include intracellular calcium mobilisation, cytoskeleton rearrangement, kinase phosphorylation and activation of the nuclear factor-κB. The role of microparticles in blood coagulation and inflammation, including airway inflammation, is well established inin vitroand animal models. The role of microparticles in human pulmonary diseases, both as pathogenic determinants and biomarkers, is being actively investigated. Microparticles of endothelial origin, suggestive of apoptosis, have been demonstrated in the peripheral blood of patients with emphysema, lending support to the hypothesis that endothelial dysfunction and apoptosis are involved in the pathogenesis of the disease and represent a link with cardiovascular comorbidities. Microparticles also have potential roles in patients with asthma, diffuse parenchymal lung disease, thromboembolism, lung cancer and pulmonary arterial hypertension.
Direct oral anticoagulants and venous thromboembolism
Authors: Franchini Massimo , Mannucci Pier Mannuccio
Published: September 2016

Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g.rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g.dabigatran etexilate). This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.
The management of benign non-infective pleural effusions
Authors: Bintcliffe Oliver J. , Lee Gary Y.C. , Rahman Najib M. , Maskell Nick A.
Published: September 2016

The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.

The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations.

Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting.
Sports related to drowning
Authors: Szpilman David , Orlowski James P.
Published: September 2016

Aquatic sports are included in the top list of risky practices as the environmentper secarries a possibility of death by drowning if not rescued in time. Not only are aquatic sports related to a high risk of death, but also all sports practiced on the water, over the water and on ice. Whatever the reason a person is in the water, drowning carries a higher possibility of death if the individual is unable to cope with the water situation, which may simply be caused by an inability to stay afloat and get out of the water or by an injury or disease that may lead to physical inability or unconsciousness. The competitive nature of sports is a common pathway that leads the sports person to exceed their ability to cope with the environment or simply misjudge their physical capability. Drowning involves some principles and medical interventions that are rarely found in other medical situations as it occurs in a deceptively hostile environment that may not seem dangerous. Therefore, it is essential that health professionals are aware of the complete sequence of action in drowning. This article focuses on the pulmonary injury in sports and recreational activities where drowning plays the major role.
Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing
Authors: O'Donnell Denis E. , Elbehairy Amany F. , Faisal Azmy , Webb Katherine A. , Neder J. Alberto , Mahler Donald A.
Published: September 2016

Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET.
Dysfunctional breathing: a review of the literature and proposal for classification
Authors: Boulding Richard , Stacey Rebecca , Niven Rob , Fowler Stephen J.
Published: September 2016

Dysfunctional breathing is a term describing breathing disorders where chronic changes in breathing pattern result in dyspnoea and other symptoms in the absence or in excess of the magnitude of physiological respiratory or cardiac disease. We reviewed the literature and propose a classification system for the common dysfunctional breathing patterns described. The literature was searched using the terms: dysfunctional breathing, hyperventilation, Nijmegen questionnaire and thoraco-abdominal asynchrony. We have summarised the presentation, assessment and treatment of dysfunctional breathing, and propose that the following system be used for classification. 1) Hyperventilation syndrome: associated with symptoms both related to respiratory alkalosis and independent of hypocapnia. 2) Periodic deep sighing: frequent sighing with an irregular breathing pattern. 3) Thoracic dominant breathing: can often manifest in somatic disease, if occurring without disease it may be considered dysfunctional and results in dyspnoea. 4) Forced abdominal expiration: these patients utilise inappropriate and excessive abdominal muscle contraction to aid expiration. 5) Thoraco-abdominal asynchrony: where there is delay between rib cage and abdominal contraction resulting in ineffective breathing mechanics.

This review highlights the common abnormalities, current diagnostic methods and therapeutic implications in dysfunctional breathing. Future work should aim to further investigate the prevalence, clinical associations and treatment of these presentations.
Cough in idiopathic pulmonary fibrosis
Authors: van Manen Mirjam J.G. , Birring Surinder S. , Vancheri Carlo , Cottin Vincent , Renzoni Elisabetta A. , Russell Anne-Marie , Wijsenbeek Marlies S.
Published: September 2016

Many patients with idiopathic pulmonary fibrosis (IPF) complain of chronic refractory cough. Chronic cough is a distressing and disabling symptom with a major impact on quality of life. During recent years, progress has been made in gaining insight into the pathogenesis of cough in IPF, which is most probably “multifactorial” and influenced by mechanical, biochemical and neurosensory changes, with an important role for comorbidities as well. Clinical trials of cough treatment in IPF are emerging, and cough is increasingly included as a secondary end-point in trials assessing new compounds for IPF. It is important that such studies include adequate end-points to assess cough both objectively and subjectively. This article summarises the latest insights into chronic cough in IPF. It describes the different theories regarding the pathophysiology of cough, reviews the different methods to assess cough and deals with recent and future developments in the treatment of cough in IPF.
Global impact of bronchiectasis and cystic fibrosis
Authors: Redondo Margarida , Keyt Holly , Dhar Raja , Chalmers James D.
Published: September 2016

Educational aims

To recognise the clinical and radiological presentation of the spectrum of diseases associated with bronchiectasis.

To understand variation in the aetiology, microbiology and burden of bronchiectasis and cystic fibrosis across different global healthcare systems.

Bronchiectasis is the term used to refer to dilatation of the bronchi that is usually permanent and is associated with a clinical syndrome of cough, sputum production and recurrent respiratory infections. It can be caused by a range of inherited and acquired disorders, or may be idiopathic in nature. The most well recognised inherited disorder in Western countries is cystic fibrosis (CF), an autosomal recessive condition that leads to progressive bronchiectasis, bacterial infection and premature mortality.

Both bronchiectasis due to CF and bronchiectasis due to other conditions are placing an increasing burden on healthcare systems internationally. Treatments for CF are becoming more effective leading to more adult patients with complex healthcare needs. Bronchiectasis not due to CF is becoming increasingly recognised, particularly in the elderly population. Recognition is important and can lead to identification of the underlying cause, appropriate treatment and improved quality of life. The disease is highly diverse in its presentation, requiring all respiratory physicians to have knowledge of the different “bronchiectasis syndromes”. The most common aetiologies and presenting syndromes vary depending on geography, with nontuberculous mycobacterial disease predominating in some parts of North America, post-infectious and idiopathic disease predominating in Western Europe, and post-tuberculosis bronchiectasis dominating in South Asia and Eastern Europe.

Ongoing global collaborative studies will greatly advance our understanding of the international impact of bronchiectasis and CF.
European Lung Foundation: from local to global
Authors: Powell Pippa , Williams Sîan , Smyth Dan
Published: September 2016

Key points

Although there are many patient organisations in Europe, this is not the case in all countries across the globe.

Access to care is one of the main global issues highlighted by the European Lung Foundation International Patient Advisory Committee.

The European Respiratory Society/European Lung Foundation Healthy Lungs for Life campaign can be used locally or globally to raise awareness of the risk factors for lung disease.

Implementation science is a method that can be used to assess the feasibility of using research findings in routine healthcare in clinical settings in different parts of the world.

Educational aims

To show how patient- and public-focussed initiatives and activities can be adapted and modified to be effective in local, national and international settings, and to provide specific examples of these from the European Lung Foundation.
Broadening Participation of Women and Underrepresented Minorities in STEM through a Hybrid Online Transfer Program
Authors: Drew Jennifer C. , Galindo-Gonzalez Sebastian , Ardissone Alexandria N. , Triplett Eric W.
Published: September 2016

The Microbiology and Cell Science (MCS) Department at the University of Florida (UF) developed a new model of a 2 + 2 program that uses a hybrid online approach to bring its science, technology, engineering, and mathematics (STEM) curriculum to students. In this paradigm, 2-year graduates transfer as online students into the Distance Education in MCS (DE MCS) bachelor of science program. The program has broadened access to STEM with a steadily increasing enrollment that does not draw students away from existing on-campus programs. Notably, half of the DE MCS students are from underrepresented minority (URM) backgrounds and two-thirds are women, which represents a greater level of diversity than the corresponding on-campus cohort and the entire university. Additionally, the DE MCS cohort has comparable retention and academic performance compared with the on-campus transfer cohort. Of those who have earned a BS through the DE MCS program, 71% are women and 61% are URM. Overall, these data demonstrate that the hybrid online approach is successful in increasing diversity and provides another viable route in the myriad of STEM pathways. As the first of its kind in a STEM field, the DE MCS program serves as a model for programs seeking to broaden their reach.
Hepatic stellate cells increase the immunosuppressive function of natural Foxp3+ regulatory T cells via IDO-induced AhR activation
Authors: Kumar Sudhir , Wang Jiang , Thomson Angus W , Gandhi Chandrashekhar R
Published: September 2016

Immunosuppressive, naturally occurring CD4+CD25+forkhead box p3+ (Foxp3+) regulatory T cells (nTregs) offer potential for the treatment of immune-mediated inflammatory disorders. However, potential instability of ex vivo-expanded nTregs following their adoptive transfer may be a significant limitation. LPS-stimulated hepatic stellate cells (HSCs) induce expansion and enhance the suppressive function and stability of allogeneic nTregs. We aimed to delineate mechanisms underlying HSC-induced expansion and increased potency of nTregs. HSCs and nTregs were isolated from mouse livers and spleens, respectively. Following coculture with LPS-pretreated allogeneic HSCs (LPS/HSCs), proliferation of nTregs was measured by CFSE dilution, and Foxp3 expression and acetylation were determined by immunoprecipitation (IP) and Western blotting analysis. Expression of various genes associated with immunologic tolerance was determined by quantitative RT-PCR (qRT-PCR). LPS stimulation increased the expression and activity of the immunoregulatory enzyme IDO1 in HSCs, and LPS/HSCs stimulated aryl hydrocarbon receptor (AhR) signaling in cocultured nTregs. Reciprocally, Tregs increased IDO1 expression in HSCs. IDO1−/− LPS/HSCs were inferior to WT LPS/HSCs in stimulating nTreg expansion. Pharmacologic inhibition of IDO1 in HSCs by 1-methyltryptophan (1MT) inhibited LPS/HSC-induced AhR signaling in nTregs, which was responsible for their expansion, Foxp3 expression, and stabilization of Foxp3 by increasing acetylation of lysine residues. Finally, HSCs cryopreserved, following 2–3 passages, were as potent as primary-cultured HSCs in expanding nTregs. In conclusion, LPS/HSCs expand allogeneic nTregs through an IDO-dependent, AhR-mediated mechanism and increase their stability through lysine-acetylation of Foxp3. nTregs expanded by cryopreserved HSCs may have potential for clinical use.
Dual inhibition of complement and Toll-like receptors as a novel approach to treat inflammatory diseases—C3 or C5 emerge together with CD14 as promising targets
Authors: Barratt-Due Andreas , Pischke Søren Erik , Nilsson Per H , Espevik Terje , Mollnes Tom Eirik
Published: September 2016

The host is protected by pattern recognition systems, including complement and TLRs, which are closely cross-talking. If improperly activated, these systems might induce tissue damage and disease. Inhibition of single downstream proinflammatory cytokines, such as TNF, IL-1β, and IL-6, have failed in clinical sepsis trials, which might not be unexpected, given the substantial amounts of mediators involved in the pathogenesis of this condition. Instead, we have put forward a hypothesis of inhibition at the recognition phase by “dual blockade” of bottleneck molecules of complement and TLRs. By acting upstream and broadly, the dual blockade could be beneficial in conditions with improper or uncontrolled innate immune activation threatening the host. Key bottleneck molecules in these systems that could be targets for inhibition are the central complement molecules C3 and C5 and the important CD14 molecule, which is a coreceptor for several TLRs, including TLR4 and TLR2. This review summarizes current knowledge of inhibition of complement and TLRs alone and in combination, in both sterile and nonsterile inflammatory processes, where activation of these systems is of crucial importance for tissue damage and disease. Thus, dual blockade might provide a general, broad-acting therapeutic regimen against a number of diseases where innate immunity is improperly activated.
Estimation of hydraulic conductivities using higher-order MRF-based stochastic joint inversion of hydrogeophysical measurements
Authors: Oware Erasmus Kofi
Published: September 2016

Stochastic imaging provides geologically realistic solutions to aquifer uncertainty quantification problems. Higher-order statistics for representing complex priors in stochastic-imaging problems are typically borrowed from training images, which may bias outcomes if the training images are unrepresentative of the desired structures. A Markov random field (MRF)-based stochastic-imaging algorithm, the spatial statistics of which are adaptively inferred directly from hydrogeophysical measurements without training images, is presented. For convenience of implementation, MRF models are commonly specified with pairwise interactions, limiting their ability to model complex architectures. MRF model specifications involving higher-order interactions are considered here. In the proposed algorithm, the lithologic structure of the aquifer and the hydraulic conductivities within the identified lithologies are simultaneously estimated in conformance to data-unconditioned and data-conditioned higher-order statistics while honoring the hydrogeophysical data sets. High reconstruction accuracy rates with nonsmooth, geologically realistic aquifer heterogeneities are reported in a hypothetical trinary hydrofacies aquifer characterization problem with various combinations of concentration and electrical-resistivity conditionings, illustrating the value of the different data types.
SEG Women's Network Committee announces Annual Meeting workshop on bullying, bias
Authors: Ali Hendratta , Sprunt Eve , Prasad Manika , Capello María Angela
Published: September 2016

To help SEG members identify and prevent bullying and bias at work, the SEG Women's Network Committee (WNC) has organized a postconvention workshop at the 2016 SEG Annual Meeting. The workshop, “W–7: Workplace navigating: How to recognize and avoid bias and bullying,” features Sheryl Skaggs, professor of sociology in the School of Economic, Political, and Policy Sciences (EPPS) at the University of Texas at Dallas, as the facilitator and guest speaker. The WNC encourages both men and women to attend the session from 1:30 to 5 p.m. Thursday, 20 October 2016, at the Kay Bailey Hutchison Convention Center in Dallas, Texas.
Aziz: Bringing the SEG Wiki into the classroom
Authors: Farley Isaac
Published: September 2016

This SEG Wiki interview, the fifth of the 2016 series, features Azie Sophia Aziz, Wiki Committee member and geophysicist at Lumina Technologies. Aziz joins Isaac Farley, SEG digital publications manager, to discuss how she would like to work to expand the reach of the SEG Wiki to universities and academics.

[Figure: see text]
The Great Weaver from Kashmir by Halldór Laxness: sleepless nights in the Valley of Roses
Authors: Baldwin David S.
Published: September 2016

The novels of the Icelandic Nobel laureate Halldór Laxness depict individuals who are confronted by personal, familial and societal challenges in an isolated, sparsely populated and unpredictable but sublime and almost magical land. Novels which are currently available in English translation carefully illustrate the potentially damaging consequences of parentlessness, childhood abuse, physical illness, unexpected bereavement and marital desertion; the often corrosive effects of social and economic inequality; and the undermining of the lives and aspirations of women by patriarchal institutions. The Great Weaver from Kashmir is probably his least well-known novel but addresses many of these themes: most of its characters fall by the wayside and only a few thrive on adversity.
Tomorrow's world: current developments in the therapeutic use of technology for psychosis
Authors: O'Hanlon Puffn , Aref-Adib Golnar , Fonseca Andres , Lloyd-Evans Brynmor , Osborn David , Johnson Sonia
Published: September 2016

There is now an established evidence base for the use of information and communication technology (ICT) to support mental healthcare (‘e-mental health’) for common mental health problems. Recently, there have been significant developments in the therapeutic use of computers, mobile phones, gaming and virtual reality technologies for the assessment and treatment of psychosis. We provide an overview of the therapeutic use of ICT for psychosis, drawing on searches of the scientific literature and the internet and using interviews with experts in the field. We outline interventions that are already relevant to clinical practice, some that may become available in the foreseeable future and emerging challenges for their implementation.
An introduction to peer-supported open dialogue in mental healthcare
Authors: Razzaque Russell , Stockmann Tom
Published: September 2016

Peer-supported open dialogue is a variant of the ‘open dialogue’ approach that is currently practised in Finland and is being trialled in several countries around the world. The core principle of the approach is the provision of care at the social network level, by staff who have been trained in family, systems and related approaches. These staff include peer workers, who will help to enhance the democratic nature of the meetings around which care is centred, as well as enabling such meetings to occur where networks are fragmented or lacking. Certain organisational and practice features and underlying themes are key to the approach. Crucially, open dialogue is also a system of service provision. Staff trained in peer-supported open dialogue from six National Health Service (NHS) trusts will launch pilot teams in 2016, as part of an intended national multicentre randomised controlled trial.
Language in psychiatry: a bedevilling dictionary
Authors: Pierre Joseph M. , Frances Allan
Published: September 2016

The language of psychiatry can be ambiguous and idiosyncratic, reflecting the elastic borders of mental illness and psychiatric disorder. This problem is not unique to psychiatry, but as the medical specialty moves closer towards a 'spectrum view’ of mental illness, psychiatric terminology increasingly risks misappropriation and conflation with lay concepts of normal suffering. Deciding what words mean and how psychiatric disorders are defined requires ongoing consideration of the pragmatic consequences, both intended and unintended. Refining the lexicon of psychiatry with an eye towards precision and the minimisation of stigma requires that terms be revised and updated from time to time, but often suitable word replacements remain elusive.
Psychopathy in childhood: Why should we care about grandiose–manipulative and daring–impulsive traits?
Authors: Salekin Randall T.
Published: September 2016

Callous–unemotional traits have been incorporated into the DSM-5 and may be considered for the ICD-11. Despite the centrality of callous–unemotional traits, it is only one of three dimensions of child psychopathy. It is proposed that the grandiose–manipulative and daring–impulsive traits should be considered and potentially accepted as specifiers for conduct disorder in the DSM-5 and ICD-11.
Burkitt’s Lymphoma and B-Cell Lymphoma Unclassifiable With Features Intermediate Between Diffuse Large B-Cell Lymphoma and Burkitt’s Lymphoma in Patients With HIV: Outcomes in a South African Public Hospital
Authors: Sissolak Gerhard , Seftel Matthew , Uldrick Thomas S. , Esterhuizen Tonya M. , Mohamed Nooroudien , Kotze Danie
Published: September 2016

Purpose

Burkitt’s lymphoma (BL) is a common HIV-associated lymphoma in South Africa. B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma (BL/DLBCL) also occurs in HIV infection. Outcomes of HIV-infected patients with BL or BL/DLBCL in a resource-constrained setting are not defined.

Methods

We performed a retrospective study of HIV-positive patients with BL or BL/DLBCL treated from 2004 to 2012 with curative intent at a publically funded academic medical center in South Africa. Differences between BL and BL/DLBCL, survival outcomes, and factors associated with survival were analyzed.

Results

There were 35 patients with either HIV-associated BL (24) or BL/DLBCL (11) who met study criteria. Median CD4+ T-lymphocyte count at lymphoma diagnosis was 188 cells/μL (range, 10 to 535 cells/μL). Patients with BL/DLBCL were significantly older and had less bone marrow involvement and lower baseline serum lactase dehydrogenase than patients with BL. Eighty-nine percent of patients presented with advanced disease, and 25% had baseline CNS involvement. Chemotherapy regimens consisted of cytoreduction with low-dose cyclophosphamide, vincristine, and prednisone followed by induction with vincristine, methotrexate, cyclophosphamide, doxorubicin and prednisone (LMB 86; 57%); hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine (hyper-CVAD; 20%); cyclophosphamide, doxorubicin, vincristine, and prednisone and high-dose methotrexate with leucovorin rescue on day 10 with accompanying prophylactic IT chemotherapy (Stanford regimen; 14%); and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP-like; 9%) regimens. Twenty-three patients received CNS treatment or prophylaxis, and 31 received concurrent combination antiretroviral therapy. Two-year overall survival was 38% (95% CI, 22% to 54%) and 2-year event-free survival was 23% (95% CI, 11% to 38%), with no difference between histologic subtypes. Common causes of death were infection (41%) and CNS disease progression or systemic relapse (41%).

Conclusion

Cure of HIV-associated BL and BL/DLBCL with intensive regimens is possible in resource-limited settings, but lower toxicity regimens, improved CNS prophylaxis, and increased resources for supportive care are required.