bluuebunny/crossref_metadata_2025 huggingface dataset:
Apixaban for the Secondary Prevention of Thrombosis Among Patients With Antiphospholipid Syndrome
Authors: Woller Scott C. , Stevens Scott M. , Kaplan David A. , Branch D. Ware , Aston Valerie T. , Wilson Emily L. , Gallo Heather M. , Johnson Eric G. , Rondina Matthew T. , Lloyd James F. , Evans R. Scott , Elliott C. Gregory
Published: November 2015

Background:

Antiphospholipid syndrome (APS) is an acquired thrombophilia characterized by thrombosis, pregnancy morbidity, and the presence of characteristic antibodies. Current therapy for patients having APS with a history of thrombosis necessitates anticoagulation with the vitamin K antagonist warfarin, a challenging drug to manage. Apixaban, approved for the treatment and prevention of venous thrombosis with a low rate of bleeding observed, has never been studied among patients with APS.

Aims and Methods:

We report study rationale and design of Apixaban for the Secondary Prevention of Thrombosis Among Patients With Antiphospholipid Syndrome (ASTRO-APS), a prospective randomized open-label blinded event pilot study that will randomize patients with a clinical diagnosis of APS receiving therapeutic anticoagulation to either adjusted-dose warfarin or apixaban 2.5 mg twice a day. We aim to report our ability to identify, recruit, randomize, and retain patients with APS randomized to apixaban compared with warfarin. We will report clinically important outcomes of thrombosis and bleeding. All clinical outcomes will be adjudicated by a panel blinded to the treatment arm. A unique aspect of this study is the enrollment of patients with an established clinical diagnosis of APS. Also unique is our use of electronic medical record interrogation techniques to identify patients who would likely meet our inclusion criteria and use of an electronic portal for follow-up visit data capture.

Conclusion:

ASTRO-APS will be the largest prospective study to date comparing a direct oral anticoagulant with warfarin among patients with APS for the secondary prevention of thrombosis. Our inclusion criteria assure that outcomes obtained will be clinically applicable to the routine management of patients with APS receiving indefinite anticoagulation.
The Role of Anticoagulants in the Prevention of Pregnancy Complications
Authors: Leaf Rebecca Karp , Connors Jean M.
Published: November 2015

The role of anticoagulants in the prevention of pregnancy complications, including recurrent miscarriage, late fetal loss, and preeclampsia, continues to be an area of active research and debate. Although prophylactic anticoagulation with heparin and aspirin is considered the standard of care in some conditions, such as obstetric antiphospholipid antibody syndrome, the optimal management of pregnant women with factor V Leiden mutation, prothrombin G20210A mutation, and other inherited thrombophilias without a history of thrombosis remains unknown. Some studies suggest a benefit of heparins in preventing late-term losses but not earlier miscarriages in the inherited thrombophilias. In the following review, we will discuss the recent literature regarding anticoagulation and pregnancy complications and conclude with our suggested approach to the management of these challenging patients.
The Experience of Resilience for Adult Female Survivors of Intimate Partner Violence
Authors: Crann Sara E. , Barata Paula C.
Published: November 2015

While resilience research in the context of intimate partner violence (IPV) is increasing, there remains little known about women’s lived experience of resilience. Using a phenomenological approach, this study examined the experience of resilience for adult female survivors of IPV. Sixteen women who were currently experiencing or had previously experienced abuse by an intimate partner participated in semi-structured interviews. Resilience was experienced as multiple cognitive, emotional, and behavioral shifts across three theme areas: toward resistance, in the experience of control, and toward positivity. The results of this study suggest a number of applications for clinical practice and intervention.
Enhancing Police Responses to Domestic Violence Incidents
Authors: Goodman-Delahunty Jane , Crehan Anna Corbo
Published: November 2015

In an online survey about experiences with the police complaint system, 239 client advocates described a recent incident in which a client with grounds to lodge a complaint declined to do so. Almost one third of those incidents involved domestic violence. Thematic analysis of case descriptions revealed that many police did not take domestic violence reports seriously. A typology of problematic police conduct was developed. Many officers failed to observe current procedures and appeared to lack knowledge of relevant laws. Citizens feared retaliatory victimization by police and/or perceived that complaining was futile. Implications of these findings are reviewed in light of procedural justice theory.
Family history of atherosclerotic vascular disease is associated with the presence of abdominal aortic aneurysm
Authors: Ye Zi , Bailey Kent R , Austin Erin , Kullo Iftikhar J
Published: November 2015

We investigated whether family history (FHx) of atherosclerotic cardiovascular disease (ASCVD) was associated with presence of abdominal aortic aneurysm (AAA). The study cohort comprised of 696 patients with AAA (70±8 years, 84% men) and 2686 controls (68±10 years, 61% men) recruited from noninvasive vascular and stress electrocardiogram (ECG) laboratories at Mayo Clinic. AAA was defined as a transverse diameter of abdominal aorta ⩾ 3 cm or history of AAA repair. Controls were not known to have AAA. FHx was defined as having at least one first-degree relative with aortic aneurysm or with onset of ASCVD (coronary, cerebral or peripheral artery disease) before age 65 years. FHx of aortic aneurysm or ASCVD were each associated with presence of AAA after adjustment for age, sex, conventional risk factors and ASCVD: adjusted odds ratios (OR; 95% confidence interval): 2.17 (1.66–2.83, p < 0.01) and 1.31 (1.08–1.59, p < 0.01), respectively. FHx of ASCVD remained associated with AAA after additional adjustment for FHx of aortic aneurysm: adjusted OR: 1.27 (1.05–1.55, p = 0.01). FHx of ASCVD in multiple arterial locations was associated with higher odds of having AAA: the adjusted odds were 1.23 times higher for each additionally affected arterial location reported in the FHx (1.08–1.40, p = 0.01). Our results suggest both unique and shared environmental and genetic factors mediating susceptibility to AAA and ASCVD.
Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism
Authors: Sista Akhilesh K , Horowitz James M , Goldhaber Samuel Z
Published: November 2015

Submassive pulmonary embolism (PE) remains a vexing entity, and the appropriate use of thrombolytic therapy for this subgroup continues to be actively debated. Catheter-directed thrombolysis has shown efficacy for submassive PE and is gaining momentum because of theoretically improved safety. This review poses and responds to four questions that explore the complex issues surrounding optimal therapy of submassive PE.
From spectator to composer: The roses and rocks in the life of a language teacher
Authors: Parsaiyan Seyyedeh Fahimeh , Ghahremani Ghajar Sue-San , Salahimoghaddam Soheila , Janahmadi Fatemeh
Published: November 2015

The growing need for professional development requires the language teachers not to be mere consumers of commercial instructional materials or implementers of sets of mandated or recommended techniques, but to attempt to generate their own classroom materials, seek innovative pedagogical approaches, explore the contexts in which their designed practice is embedded, and become self-critics of their own personal and professional lives. The present article is a self-narrative of moments of epiphanies that an Iranian English teacher and materials developer began to experience over a period of 18 months during which she could see herself moving from a spectatorship position to that of a composership. Benefiting from the guidance and consultations of English Language Teaching (ELT), Persian Literature, and Islamic History advisors, the teacher commenced a journey towards abandoning text-book defined routine practices and attempted for adapting literary works of art (mainly the ones deriving their roots in Persian classic mystic and epic literature) and designing reflective classroom activities instead. Reflecting on self and documenting the events narratively made the teacher come face to face with a number of long-held teaching assumptions and practices (or even nostrums) that she had overlooked or avoided in the past. In light of interplay of internal driving forces and external forces she began to see herself transforming from being an orchestrator in classroom conduct to a self-vocalist. This was accompanied by moving from the domain of words to the realm of non-words and worlds, and from fragmented practices to more interconnected ones. It is hoped that the narrated experiences and overt or covert challenges embedded within them would be instrumental to those other teachers interested in similar expeditions of self-inquiry.
Social network analysis of children with autism spectrum disorder: Predictors of fragmentation and connectivity in elementary school classrooms
Authors: Anderson Ariana , Locke Jill , Kretzmann Mark , Kasari Connie ,   AIR-B Network
Published: November 2015

Although children with autism spectrum disorder are frequently included in mainstream classrooms, it is not known how their social networks change compared to typically developing children and whether the factors predictive of this change may be unique. This study identified and compared predictors of social connectivity of children with and without autism spectrum disorder using a social network analysis. Participants included 182 children with autism spectrum disorder and 152 children without autism spectrum disorder, aged 5–12 years in 152 general education K-5 classrooms. General linear models were used to compare how age, classroom size, gender, baseline connectivity, diagnosis, and intelligence quotient predicted changes in social connectivity (closeness). Gender and classroom size had a unique interaction in predicting final social connectivity and the change in connectivity for children with autism spectrum disorder; boys who were placed in larger classrooms showed increased social network fragmentation. This increased fragmentation for boys when placed in larger classrooms was not seen in typically developing boys. These results have implications regarding placement, intervention objectives, and ongoing school support that aimed to increase the social success of children with autism spectrum disorder in public schools.
Australian prosecutors’ perceptions of the utility of child investigative interview protocols
Authors: Benson Mairi S , Powell Martine B
Published: November 2015

Investigative interviews with alleged victims form the central plank of evidence in the prosecution of child sexual abuse. Despite interviewers being provided with a guiding framework, child sexual abuse cases are often not prosecuted because of poor-quality evidence. The purpose of this study was to elicit feedback from prosecutors about the structure and format of current interview protocols and the ways in which these could potentially be improved from an evidential perspective. Focus group discussions (ranging in length from 180 to 190 minutes) were conducted with 13 Crown prosecutors representing every jurisdiction of Australia. Thematic analysis of the focus group discussions revealed that prosecutors were supportive of the structure of interview protocols, however, concerns were raised about four of the interview elements. These elements were the oath and truth–lie competency test, the ground rules, the practice narrative and eliciting a disclosure. The prosecutors’ concerns and their implications for protocol developers and trainers are discussed.
Incidence, characteristics and impact of hypoglycaemia in patients receiving intensified treatment for inadequately controlled type 2 diabetes mellitus
Authors: Tschöpe Diethelm , Bramlage Peter , Schneider Steffen , Gitt Anselm K
Published: November 2015

Aims:

With the intensification of antidiabetic treatment, there is an increasing risk of hypoglycaemia. We aimed to determine incidence, characteristics and outcomes.

Methods:

Prospective, observational, multicenter cohort study. The included 3810 patients with type 2 diabetes had their treatment intensified at baseline.

Results:

The incidence of hypoglycaemia was 11.4% per year with 4.2 ± 4.4 episodes per patient. Hypoglycaemia was more frequent in patients with high blood glucose variability. Predictors were heart failure (odds ratio: 1.66; 95% confidence interval: 1.20–2.29) and insulin use (odds ratio: 4.03; 95% confidence interval: 3.05–5.33), with dipeptidyl peptidase–4 inhibitors being associated with reduced risk (odds ratio: 0.69; 95% confidence interval: 0.53–0.89). Macrovascular events were more frequent among patients reporting severe episodes of hypoglycaemia (odds ratio: 3.39; 95% confidence interval: 1.32–8.73). Microvascular events were more frequent in patients with non-severe episodes (odds ratio: 1.92; 95% confidence interval: 1.49–2.49).

Conclusion:

Case-by-case evaluation of patients as well as appropriate selection of antidiabetic pharmacotherapy and blood glucose treatment goals could maximize the benefits while reducing the risks of antidiabetic treatment.
Evaluation of the Effectiveness of Fluorescent Visualization of Bile Ducts Using Fluorescein and Ultraviolet A at Laparoscopic Cholecystectomy
Authors: Mohsen Amr , Elbasiouny Mahmoud S. , El-Shazli Mostafa , Azmy Osama , Amr Ahmed
Published: November 2015

Background. This work studied the diagnostic effectiveness of a new technology and device to augment visualization of bile ducts at laparoscopic cholecystectomy. It depends on excitation of fluorescein in bile by ultraviolet light to get green fluorescent light emanating from these ducts. Methods. Forty laparoscopic cholecystectomy patients received fluorescein sodium injections either in the gallbladder or intravenously, followed by exposure of the expected bile ducts area to ultraviolet light that was delivered by a specially designed device. Neutral observing surgeons were asked to judge whether or not they could see fluorescent bile ducts early in the operation before they were displayed by dissection. Accordingly, specificity, sensitivity, likelihood ratios, and predictive values of the technique were calculated. Results. Fluorescent bile ducts were seen at an earlier stage than their detection by dissection in 33 out of 40 operations. The technique had 100% specificity, 82.5% sensitivity, 0.18 negative likelihood ratio, 100% positive predictive value, and 85.11% negative predictive value. There were no complications related to the technique. Conclusions. The developing ultraviolet/fluorescein technique is helpful in early localization of bile ducts at laparoscopic cholecystectomy. When fluorescence is detected in the field, the technique can be completely relied on to denote the position of bile ducts. In a few cases fluorescence is not detected. Here further development of the device is the need to improve its sensitivity. Otherwise, the technique is quite simple and safe.
Dealing with difficult consultations
Authors: Pidduck Helen Rebecca
Published: November 2015

With over half of GPs recently reporting their morale levels as either ‘low’ or ‘very low’ in a recent British Medical Association survey, it is essential to consider how we can build and maintain resilience. The GP workforce crisis is clearly a multifaceted problem; however, reflecting upon what might affect job satisfaction is an important part of its solution. When Tom O’ Dowd coined the term ‘heartsink’ in 1988, it was to describe consultations that evoked unpleasant feelings in doctors. It was not to label particular patients. This article aims to examine what GPs commonly find difficult and provide a framework for managing such cases.
Evidence for Another Response to Ostracism
Authors: Ren Dongning , Wesselmann Eric , Williams Kipling D.
Published: November 2015

People may choose to move toward, move against, or move away in reaction to threatening social situations. Ostracism induces both prosocial behaviors (moving toward) and antisocial behaviors (moving against). One reason that moving away may be missing from these observed responses is the absence of including such a response in experiments. In four studies, we examined whether ostracized individuals would avail themselves of a moving away response (i.e., seeking solitude), if offered, and also whether one individual difference—introversion—predicted higher desires to move away. Correlational data (Study 1) showed that participants who reported more ostracism experiences indicated stronger desires to be alone; three experiments (Studies 2–4) demonstrated that manipulated ostracism experience increases the desire to be alone in a subsequent activity, especially among introverts. These findings suggest that ostracized individuals may desire a phase of solitude to cope with the social pain.
Does Self-Love or Self-Hate Predict Conspiracy Beliefs? Narcissism, Self-Esteem, and the Endorsement of Conspiracy Theories
Authors: Cichocka Aleksandra , Marchlewska Marta , de Zavala Agnieszka Golec
Published: November 2015

Across three studies, we examined the role of self-evaluation in predicting conspiracy beliefs. Previous research linked the endorsement of conspiracy theories to low self-esteem. We propose that conspiracy theories should rather be appealing to individuals with exaggerated feelings of self-love, such as narcissists, due to their paranoid tendencies. In Study 1, general conspiracist beliefs were predicted by high individual narcissism but low self-esteem. Study 2 demonstrated that these effects were differentially mediated by paranoid thoughts, and independent of the effects of collective narcissism. Individual narcissism predicted generalized conspiracist beliefs, regardless of the conspiracy theories implicating in-group or out-group members, while collective narcissism predicted belief in out-group but not in-group conspiracies. Study 3 replicated the effects of individual narcissism and self-esteem on the endorsement of various specific conspiracy theories and demonstrated that the negative effect of self-esteem was largely accounted for by the general negativity toward humans associated with low self-esteem.
Compensatory Relationship Enhancement
Authors: Auger Emilie , Hurley Stefani , Lydon John E.
Published: November 2015

The motivation-management model suggests that people are equipped with a variety of motivated strategies to mitigate against relationship threats such as conflicts of interests and partner transgressions. We propose that such strategies are more likely to be enacted when the nature of the threat is calibrated with the motivational basis for relationship maintenance. We examine how value dissimilarity may pose an identity threat that triggers reaffirming and bolstering one’s positive views of the partner and the relationship, namely, compensatory relationship enhancement. We experimentally manipulated feedback to dating couples about value similarity regarding a possible pregnancy decision (similar vs. control vs. dissimilar) and assessed relationship evaluations pre- and postmanipulation. Using multilevel modeling, we found that individuals highly identified with their relationship increased their baseline positive relationship evaluations in response to the threat of value dissimilarity.
Multiple, zonal and multi‐zone adenoma detection rates according to quality of cleansing during colonoscopy
Authors: Pontone Stefano , Hassan Cesare , Maselli Roberta , Pontone Paolo , Angelini Rita , Brighi Manuela , Patrizi Gregorio , Pironi Daniele , Magliocca Fabio Massimo , Filippini Angelo
Published: November 2015

Background

The safety and diagnostic accuracy of colonoscopy depend on the quality of colon cleansing. The adenoma detection rate is usually used as a quality measurement score.

Objective

We aimed to introduce and evaluate three new parameters to determine polyps and adenomas segmental localization and their distribution in association with different bowel preparation levels during colonoscopy. We introduce the multiple adenoma detection rate (the percentage of patients with >2 adenomas diagnosed during colonoscopy), the zonal adenoma detection rate (the percentage of patients with >2 adenomas diagnosed during colonoscopy in different colon areas (rectum, sigmoid, descending, transverse, ascending and cecum colon)), and multi‐zone adenoma detection rate (the percentage of patients with >2 adenomas diagnosed during colonoscopy in different colon areas with at least a segment between them with or without lesions (i.e. rectum and descending colon with or without lesions in the sigmoid)).

Methods

We prospectively enrolled outpatients who underwent colonoscopy from January 2013 to October 2014. The bowel preparation quality, according to the Aronchick modified scale, number and location of lesions, Paris classification and histology, were recorded. The multiple adenoma/polyp detection rate, zonal adenoma/polyp detection rate, and multi‐zone adenoma/polyp detection rate were determined.

Results

In total, 519 consecutive patients (266/253 M/F; mean age 55.3 ± 12.8 years) were enrolled. The adenoma and polyp detection rates were 21% and 35%, respectively. Multiple adenomas were detected in 28 patients. Adenoma and polyp detection rate and new parameters were statistically significantly higher in the optimal as compared with the adequate bowel preparation.

Conclusions

An optimal level of bowel preparation was strongly associated not only with a higher adenoma detection rate, but also with a higher chance of detecting multiple clinically relevant lesions in adjacent or discrete segments of the colon.
Post-operative use of Low Molecular Weight Heparin: Are patients doing their bit?
Authors: Hardy TJ , Upchurch E , Duff H , Davenport K
Published: November 2015

Introduction:

Current National Institute for Health and Care Excellence (NICE) guidelines recommend the use of Low Molecular Weight Heparin (LMWH) for one month post-operatively in abdominal and pelvic cancer surgery to reduce risk of venous thromboembolism. We audited the prescription of LMWH at discharge and the compliance of patients with LMWH post-operatively and instigated measures to improve compliance.

Materials and Methods:

All patients undergoing major urological surgery from November 2011 to April 2012 were audited, with data collected on evidence of post-operative prescription (from discharge summaries). Patients within this 3-month period were questioned regarding compliance following discharge. Following this, changes were instigated to improve compliance (earlier discussion of post-operative LMWH administration in clinic, improved patient and junior doctor education). All patients undergoing surgery from November 2012 to June 2013 were identified and a re-audit completed.

Results:

Post-operative prescription of LMWH improved overall from 73% to 88%. Patient compliance to complete LMWH course improved from 23% to 88%. At re-audit, 97% of patients felt that training was adequate, and 94% of patients understood the rationale for taking LMWH at re-audit.

Conclusion:

Education of junior doctors improved prescription of LMWH at discharge. Improved patient education improves community LMWH use compliance post-discharge.
Assessment of Quality of Life in Patients With Skin Disorders Undergoing Ayurvedic Panchakarma (Biopurification) as Management
Authors: Deshpande Harish , Shivakumar  , Kavita M. B. , Tripathy T. B. , Chaturvedi Ashutosh
Published: November 2015

Background.

Chronic skin conditions can have a negative impact on one’s quality of life, affecting their physical, functional, and emotional well-being. Whereas biopurifactory measures ( panchakarma) of Ayurveda claims to provide better quality of life after treatment. Hence current study is planned to provide evidence in patients with skin disorders, undergoing Ayurvedic treatment.

Methodology.

Sixty patients with skin disorder, who underwent purification therapies like therapeutic emesis and therapeutic purgation, were randomly placed in 2 groups to assess quality of life. Quality of life assessment was done with the help of Skindex-29 among the patients before and after Ayurvedic purification therapy. Thereafter, the quality of life assessment was done on the first follow-up.

Results.

A statistically significant improvement in the quality of life domains—emotions, functioning, and symptoms—after the Ayurvedic management was observed with P value <.001.

Conclusion.

Study concludes that there is improvement in quality of life among patients with skin disease after undergoing Ayurveda purification therapies.
Barriers and Facilitators to Retaining and Reengaging HIV Clients in Care
Authors: Berger Miriam B. , Sullivan Kristen A. , Parnell Heather E. , Keller Jennifer , Pollard Alice , Cox Mary E. , Clymore Jacquelyn M. , Quinlivan Evelyn Byrd
Published: November 2015

Retention in HIV care is critical to decrease disease-related mortality and morbidity and achieve national benchmarks. However, a myriad of barriers and facilitators impact retention in care; these can be understood within the social–ecological model. To elucidate the unique factors that impact consistent HIV care engagement, a qualitative case study was conducted in North Carolina to examine the barriers and facilitators to retain and reengage HIV clients in care. HIV professionals (n = 21) from a variety of health care settings across the state participated in interviews that were transcribed and analyzed for emergent themes. Respondents described barriers to care at all levels within the HIV prevention and care system including intrapersonal, interpersonal, institutional, community, and public policy. Participants also described recent statewide initiatives with the potential to improve care engagement. Results from this study may assist other states with similar challenges to identify needed programs and priorities to optimize client retention in HIV care.
Rate of CD4 Decline and Factors Associated with Rapid CD4 Decline in Asymptomatic HIV-Infected Patients
Authors: Chaiyasin Natdanai , Sungkanuparph Somnuek
Published: November 2015

The accurate marker to assess the risk of disease progression in HIV disease is CD4 count. CD4 decline to <200 cells/mm3 prompts the patients to have risk of opportunistic infections. A retrospective cohort study was conducted in asymptomatic HIV-infected patients who had CD4 count >200 cell/mm3, were antiretroviral naive, and had ≥1-year follow-up. Eighty patients, with mean age of 36.4 (standard deviation [SD] = 9.1) years and 58.8% females, were analyzed. The mean (SD) baseline CD4 count was 423 (119) cells/mm3. During the median (IQR) time of 29.0 (14.1-49.6) months, 26.3% had CD4 declined to <200 cells/mm3. From Cox proportional hazard model, only baseline CD4 count <350 cells/mm3 was significantly associated with rapid decline in CD4 count (HR 4.208; 95%CI, 1.428-12.397; P = .009). Age, gender, comorbid disease, risk of HIV infection, duration of HIV diagnosis, and body weight were not associated with rapid CD4 decline. This indicates that asymptomatic patients with CD4 count <350 cells/mm3 are at priority for antiretroviral therapy in resource-limited settings.
Residual Impact of Previous Injury on Musculoskeletal Characteristics in Special Forces Operators
Authors: Parr Jeffrey J. , Clark Nicholas C. , Abt John P. , Kresta Julie Y. , Keenan Karen A. , Kane Shawn F. , Lephart Scott M.
Published: November 2015

Background

Musculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury.

Purpose

To identify the residual impact of previous injury on musculoskeletal characteristics.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Isokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based on previous history of low back, knee, or shoulder injury, and within-group and between-group comparisons were made for musculoskeletal variables.

Results

Knee injury analysis showed no significant strength or flexibility differences. Shoulder injury analysis found internal rotation strength of the healthy subjects (H) was significantly higher compared with injured (I) and uninjured (U) limbs of the injured group (H, 60.8 ± 11.5 percent body weight [%BW]; I, 54.5 ± 10.5 %BW; U, 55.5 ± 11.3 %BW) ( P = .014 [H vs I] and P = .05 [H vs U]). The external rotation/internal rotation strength ratio was significantly lower in the healthy subjects compared with injured and uninjured limbs of the injured group (H, 0.653 ± 0.122; I, 0.724 ± 0.121; U, 0.724 ± 0.124) ( P = .026 [H vs I] and P = .018 [H vs U]). Posterior shoulder tightness was significantly different between the injured and uninjured limb of the injured group (I, 111.6° ± 9.4°; U, 114.4° ± 9.3°; P = .008). The back injury analysis found no significant strength differences between the healthy and injured groups.

Conclusion

Few physical differences existed between operators with prior knee or back injury. However, operators with a previous history of shoulder injury demonstrated significantly less shoulder strength than uninjured operators as well as decreased shoulder flexibility on the injured side. All operators, regardless of prior injury, must perform the same tasks; therefore, a targeted injury rehabilitation/human performance training specifically focused on internal rotation strength and tightness of the posterior capsule may help reduce the risk for recurrence of injury. Operators presenting with musculoskeletal asymmetries and/or insufficient strength ratios may be predisposed to musculoskeletal injury.

Clinical Relevance

Specific fitness programs to compensate for deficiencies in strength and flexibility need to be designed that may reduce the risk of injuries in Special Forces Operators.
“We Have in This City Many Good Mexican Citizens”
Authors: Jewell Joseph O.
Published: November 2015

Access to public spaces played an important role in constructing and defining racial boundaries in the late nineteenth century. In 1883, San Antonio’s Mexican American elites protested an order permanently barring them from using the dance pavilion in San Pedro Springs Park, resulting in the public censure of the park manager who gave the order and affirmations of Tejano elites’ right to equal access to public spaces. The author analyzes this historical case to show the importance of the race-class intersection, specifically racialized class identities, as a resource in racial boundary shifting: the movement of racial boundaries across people. Public exchanges in the “San Pedro Park incident” either challenged or defended Mexican Americans’ equal access to a white public space by drawing on competing racial narratives about their fitness for middle-class identity. The author argues that analyses of racial boundary shifting must give careful consideration to how social actors use understandings of class to expand or contract racial boundaries. Reproducing class identities that ensure continued economic domination over racial minorities is a central part of maintaining the racial order.
Measuring School Contexts
Authors: Muller Chandra L.
Published: November 2015

This article describes issues in measuring school contexts with an eye toward understanding students’ experiences and outcomes. I begin with an overview of the conceptual underpinnings related to measuring contexts, briefly describe the initiatives at the National Center for Education Statistics to measure school contexts, and identify possible gaps in those initiatives that if filled could provide valuable new data for researchers. Next, I discuss new approaches and opportunities for measurement, and special considerations related to diverse populations and youth development. I conclude with recommendations for future priorities.
Brain Natriuretic Peptide Constitutively Downregulates P2X3 Receptors by Controlling their Phosphorylation State and Membrane Localization
Authors: Marchenkova Anna , Vilotti Sandra , Fabbretti Elsa , Nistri Andrea
Published: November 2015

Background

ATP-gated P2X3 receptors are important transducers of nociceptive stimuli and are almost exclusively expressed by sensory ganglion neurons. In mouse trigeminal ganglion (TG), P2X3 receptor function is unexpectedly enhanced by pharmacological block of natriuretic peptide receptor-A (NPR-A), outlining a potential inhibitory role of endogenous natriuretic peptides in nociception mediated by P2X3 receptors. Lack of change in P2X3 protein expression indicates a complex modulation whose mechanisms for downregulating P2X3 receptor function remain unclear.

Results

To clarify this process in mouse TG cultures, we suppressed NPR-A signaling with either siRNA of the endogenous agonist BNP, or the NPR-A blocker anantin. Thus, we investigated changes in P2X3 receptor distribution in the lipid raft membrane compartment, their phosphorylation state, as well as their function with patch clamping. Delayed onset of P2X3 desensitization was one mechanism for the anantin-induced enhancement of P2X3 activity. Anantin application caused preferential P2X3 receptor redistribution to the lipid raft compartment and decreased P2X3 serine phosphorylation, two phenomena that were not interdependent. An inhibitor of cGMP-dependent protein kinase and siRNA-mediated knockdown of BNP mimicked the effect of anantin.

Conclusions

We demonstrated that in mouse trigeminal neurons endogenous BNP acts on NPR-A receptors to determine constitutive depression of P2X3 receptor function. Tonic inhibition of P2X3 receptor activity by BNP/NPR-A/PKG pathways occurs via two distinct mechanisms: P2X3 serine phosphorylation and receptor redistribution to nonraft membrane compartments. This novel mechanism of receptor control might be a target for future studies aiming at decreasing dysregulated P2X3 receptor activity in chronic pain.
RETRACTED ARTICLE: IL-6 signaling promotes DNA repair and prevents apoptosis in CD133+ stem-like cells of lung cancer after radiation
Authors: Chen Yuhchyau , Zhang Fuquan , Tsai Ying , Yang Xiadong , Yang Li , Duan Shanzhou , Wang Xin , Keng Peter , Lee Soo Ok
Published: November 2015

Background

Local tumor control by standard fractionated radiotherapy (RT) remains poor because of tumor resistance to radiation (radioresistance). It has been suggested that cancer stem cells (CSCs) are more radioresistant than non-CSCs. In previous studies, we have shown IL-6 promotes self-renewal of CD133+ CSC-like cells. In this study, we investigated whether IL-6 plays roles not only in promoting self-renewal of CD133+ cells after radiation, but also in conferring radioresistance of CD133+ cells in NSCLC.

Materials and methods

To compare radiation sensitivity of CSCs and non-CSCs, CD133+ CSC-like and CD133- cell populations were isolated from two NSCLC cell lines, A549 and H157, by immunomagnetic separation and their sensitivities to ionizing radiation were investigated using the clonogenic survival assay. To further study the IL-6 effect on the radiosensitivity of CD133+ CSC-like cells, CD133+ cells were isolated from A549IL-6si/sc and H157IL-6si/sc cells whose intracellular IL-6 levels were manipulated via the lentiviral transduction with IL-6siRNA. Post-irradiation DNA damage was analyzed by γ-H2AX staining and Comet assay. Molecular mechanisms by which IL-6 regulates the molecules associated with DNA repair and anti-apoptosis after radiation were analyzed by Western blot and immunofluoresecence (IF) staining analyses.

Results

NSCLC CD133+ CSC-like cells were enriched upon radiation. Survival of NSCLC CD133+ cells after radiation was higher than that of CD133- cells. Survival of IL-6 expressing NSC LC CD133+ cells (sc) was higher than that of IL-6 knocked-down cells (IL-6si) after radiation. IL-6 played a role in protecting NSCLC CD133+ cells from radiation-induced DNA damage and apoptosis.

Conclusions

IL-6 signaling promotes DNA repair while protecting CD133+ CSC-like cells from apoptotic death after radiation for lung cancer. A combined therapy of radiation and agents that inhibit IL-6 signaling (or its downstream signaling) is suggested to reduce CSC-mediated radioresistance in lung cancer.
Primary care referral to multidisciplinary high risk foot services – too few, too late
Authors: Plusch D , Penkala S , Dickson HG , Malone M
Published: November 2015

Background

To determine if patients with no contact with a multi‐disciplinary team High Risk Foot Service (MDT‐HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact. Secondary aims were to report on clinical outcomes.

Methods

A retrospective study was conducted at a major tertiary referral hospital in metropolitan Sydney over 12 months. An ICD‐10 search of the electronic medical record system and paper medical charts identified patients with diabetes mellitus (type 1 or type 2) and a primary admission for diabetes foot infection (DFI). Patients were categorised as having contact or no contact with an MDT‐HRFS.

Results

One hundred ninety‐six hospital admissions (156 patients) were identified with DFI over a 12‐month period. Patients with no contact with a MDT‐HRFS represented three quarters of admissions (no contact = 116, 74.7 % vs. contact = 40, 25.6 %, p = 0.0001) and presented with more severe infection (no contact = 39 vs. contact = 12). The odds of lower extremity amputation increased five‐fold when both no contact and severe infection occurred in combination (no contact with severe infection and amputation = 34, 82.9 % vs. contact with severe infection and amputation = 7, 17.1 %, OR 4.9, 95 % CI 1.1–21.4, p = 0.037). Using estimates of both the contact and no contact population of people with diabetes and high‐risk feet and assuming the risk of amputation was the same, than the number of expected amputations in the no contact group should have been 55, however the observed number was 77, 22 more than expected (p = 0.0001).

Conclusions

Patients with no contact with a MDT‐HRFS represented the majority of admissions for DFIs to a tertiary referral hospital. This group on population estimates appears to be at high risk of amputation of the lower extremity and therefore early referral of this high‐risk group might lower this risk.
Development of a therapy against metastatic bladder cancer using an interleukin-2 surface-modified MB49 bladder cancer stem cells vaccine
Authors: Zhu Yong-tong , Pang Shi-yu , Lei Cheng-yong , Luo Yang , Chu Qing-jun , Tan Wan-long
Published: November 2015

Introduction

In previous study the streptavidin interleukin-2 (SA-IL-2)-modified MB49 vaccine was effective against bladder cancer in a mouse model. However, a small portion of tumors regrew because the vaccine could not eliminate MB49 bladder cancer stem cells (MCSCs). Accordingly, we developed a SA-IL-2-modified MCSCs vaccine and evaluated its antitumor effects.

Methods

MCSCs were isolated and identified in cancer stem cells (CSCs) characters, with high expression of CSCs markers, higher resistance to chemotherapy, greater migration in vitro, and stronger tumorigenicity in vivo. The SA-IL-2 MCSCs vaccine was prepared and its bioactivity was evaluated. The protective, therapeutic, specific and memory immune response in animal experiments were designed to identify whether the vaccine elicited antitumor immunity and acted against metastatic bladder cancer.

Results

MCSCs had higher level of CD133 and CD44, less susceptibility to chemotherapy, more pronounced migration and greater tumorigenic ability. The successfully prepared SA-IL-2 MCSCs vaccine inhibited the tumor volume and prolonged mice survival in animal experiments. The expression of IgG, the population of dendritic cells, CD8+ and CD4+ T cells were highest in the experimental group than in the four control groups.

Conclusions

The SA-IL-2 MCSCs vaccine induced an antitumor immune response and was used to eliminate MCSCs to prevent tumor regrowth.
An intermixed algorithm for strict pseudo-contractions in Hilbert spaces
Authors: Yao Zhangsong , Kang Shin Min , Li Hong-Jun
Published: November 2015

An intermixed algorithm for two strict pseudo-contractions in Hilbert spaces have been presented. It is shown that the suggested algorithms converge strongly to the fixed points of two strict pseudo-contractions, independently. As a special case, we can find the common fixed points of two strict pseudo-contractions in Hilbert spaces.
Existence of best proximity points for controlled proximal contraction
Authors: Kiran Quanita , Ali Muhammad Usman , Kamran Tayyab , Karapınar Erdal
Published: November 2015

In this paper, we investigate the sufficient condition for the existence of best proximity points for non-self-multivalued mappings. Additionally, we discuss the stability theorem for such mappings. Our results improve and generalize some existing results on the topic in the literature, in particular, the results of Lim and of Abkar and Gabeleh.
Self-adaptive algorithms for proximal split feasibility problems and strong convergence analysis
Authors: Yao Yonghong , Yao Zhangsong , Abdou Afrah AN , Cho Yeol Je
Published: November 2015

The purpose of the paper is to study the proximal split feasibility problems. For solving the problems, we present new self-adaptive algorithms with the regularization technique. By using these algorithms, we give some strong convergence theorems for the proximal split feasibility problems.
A Gaussian function model for simulation of complex environmental sensing
Authors: Chaudhry Qasim Ali
Published: November 2015

Background

Sensors can be used to sense not only simple behavior but also complex ones. Previous work has demonstrated how agent-based modeling can be used to model sensing of complex behavior in Complex Environments.

Findings

Here, we propose a mathematical model using Gaussian function for the previously developed Agent Based Model (ABM) for Sensing of Emergent behavior in Complex Adaptive System (SECAS). The goodness of the fitted curve was observed by using standard tools, e.g. by determining SSE, SSM, ASSM and RMSE.

Conclusions

Our proposed model provides a good fit for data obtained from the earlier model. Also the developed model provides a bench mark against the data obtained from a former Agent Based Model.
Repeated Treatment with Bone Marrow Cell Secretory Products Maintains Long-Term Renoprotection in Experimental Chronic Kidney Disease: A Placebo-Controlled Trial
Authors: Yuen Darren A. , Kepecs David M. , Zhang Yanling , Advani Suzanne , Thai Kerri , Connelly Kim A. , Gilbert Richard E.
Published: November 2015

Background:

Bone marrow-derived early outgrowth cells (EOCs) secrete soluble factors that exert potent renoprotective effects, such that infusion of their conditioned medium recapitulates the affects of the cells themselves.

Objectives:

The objective of this study is to test whether the protective effect of conditioned medium infusion wanes with time and whether tachyphylaxis occurs with repeated administration.

Design:

This is a placebo-controlled animal study.

Setting:

The study was conducted at St. Michael's Hospital, Toronto, Ontario, Canada.

Subjects:

Fischer 344 (F344) rats were used in this study.

Measurements:

The following were measured: (1) urinary protein:creatinine ratio, (2) glomerular filtration rate, (3) systolic blood pressure, (4) body weight, (5) glomerular endothelial cell density, and (6) glomerular and tubulointerstitial type IV collagen deposition.

Methods:

Subtotally nephrectomized F344 rats, a model of progressive chronic kidney disease, were randomized 4 weeks post-surgery to receive thrice-weekly intravenous injections of concentrated EOC-conditioned medium (EOC CM) or unconditioned medium (UCM) over 2 weeks. Three animal groups were studied, according to whether they were administered conditioned medium: once (Initial Therapy Only group), twice (Repeat Therapy group), or not at all (No Therapy group).

Results:

Following initial therapy, EOC CM-treated animals excreted less urinary protein, a marker of renal injury, than their UCM-treated counterparts. At 10 weeks post-subtotal nephrectomy, however, mean urinary protein excretion in conditioned medium-treated animals was fourfold greater than at the completion of the initial treatment course. At this time point, conditioned medium-treated animals were randomized to receive a second course of either conditioned medium (Repeat Therapy group) or unconditioned medium (Initial Therapy Only group). At study end (14 weeks post-subtotal nephrectomy), Repeat Therapy animals demonstrated higher glomerular filtration rate, less proteinuria, preserved renal microvasculature, and diminished fibrosis when compared with the No Therapy group. Initial Therapy Only animals exhibited an intermediate effect.

Limitations:

Testing the effect of EOC-conditioned medium in a single model of chronic kidney disease (CKD) has limitations.

Conclusions:

These findings suggest that early outgrowth cell-derived factors, while renoprotective, have a limited duration of action. Repeated administration of these factors, however, is able to extend the duration of efficacy and attenuate the progression of experimental chronic kidney disease.
Genome sequence and description of Pantoea septica strain FF5
Authors: Lo Cheikh Ibrahima , Padhmanabhan Roshan , Mediannikov Oleg , Nguyen Thi Tien , Raoult Didier , Fournier Pierre-Edouard , Fenollar Florence
Published: November 2015

Strain FF5 was isolated from the skin flora of a healthy Senegalese 35-year-old woman. This strain was identified as belonging to the species Pantoea septica based on rpoB sequence identity of 99.7 % with Pantoea septica strain LMG 5345T and a highest MALDI-TOF-MS score of 2.3 with Pantoea septica. Like P. septica, this FF5 strain is a Gram-negative, aerobic, motile, and rod-shaped bacterium. Currently, 17 genomes have been sequenced within the genus Pantoea but none for Pantoea septica. Herein, we compared the genomic properties of strain FF5 to those of other species within the genus Pantoea. The genome of this strain is 4,548,444 bp in length (1 chromosome, no plasmid) with a G + C content of 59.1 % containing 4125 protein-coding and 68 RNA genes (including 2 rRNA operons). We also performed an extensive phenotypic analysis showing new phenotypic characteristics such as the production of alkaline phosphatase, acid phosphatase and naphthol-AS-BI-phosphohydrolase.
Institutional Knots: A Comparative Analysis of Cord Blood Policy in Canada and the United States
Authors: Denburg Avram
Published: November 2015

Umbilical cord blood is a rich source of blood stem cells, which are of critical clinical importance in the treatment of a variety of malignant and genetic conditions requiring stem cell transplantation. Many countries have established national public cord blood banks; such banks often coexist with a panoply of private options for cord blood banking. Until recently, Canada was the only G8 country without a national cord blood bank. This differs markedly from the United States, which years ago established a national cord blood bank policy and inventory. This article investigates potential reasons for this discrepancy through a comparative analysis of the evolution of programs and policies on national cord blood banking in Canada and the United States. My analysis suggests that cross-national discrepancies in policy on public cord blood banking were determined primarily by institutional factors, principal among them formal governmental structure and the legacy of past policies. Institutional entrepreneurialism in the health sector played a constitutive role in the earlier evolution of national cord blood policy in the United States as compared to Canada.