bluuebunny/crossref_metadata_2025 huggingface dataset:
What systems participants know about access and service entry and why managers should listen
Authors: Duncombe Rohena
Published: August 2016

Objective
The present study looked at the views of people directly involved in the entry process for community health counselling using the frame of the health access literature. The concurrence of system participants’ views with the access literature highlights access issues, particularly for people who are vulnerable or disadvantaged. The paper privileges the voices of the system participants, inviting local health services to consider using participatory design to improve access at the entry point.

Methods
People involved in the entry process for community health counselling explored the question, ‘What, for you, are the features of a good intake system?’ They also commented on themes identified during pilot interviews. These were thematically analysed for each participant group by the researcher to develop a voice for each stakeholder group.

Results
People accessing the service could be vulnerable and the entry process failed to take that into account. People directly involved in the counselling service entry system, system participants, consisted of: professionals referring in, people seeking services and reception staff taking first enquiries. They shared substantially the same concerns as each other. The responses from these system participants are consistent with the international literature on access and entry into health services.

Conclusion
Participatory service design could improve primary healthcare service entry at the local level. Canvassing the experiences of system participants is important for delivering services to those who have the least access and, in that way, could contribute to health equity.

What is known about the topic?
People with the highest health needs receive the fewest services. Health inequality is increasing.

What does this paper add?
System participants can provide advice consistent with the academic research literature that is useful for improving service entry at the local level.

What are the implications for practitioners?
Participatory design can inform policy makers and service providers. Entry systems could acknowledge the potential vulnerability or disadvantage of people approaching the service.
Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour
Authors: Yelland Jane , Biro Mary Anne , Dawson Wendy , Riggs Elisha , Vanpraag Dannielle , Wigg Karen , Antonopoulos John , Morgans Jenny , Szwarc Jo , East Chris , Brown Stephanie
Published: August 2016

Objective The aim of the study was to improve the engagement of professional interpreters for women during labour. Methods The quality improvement initiative was co-designed by a multidisciplinary group at one Melbourne hospital and implemented in the birth suite using the plan-do-study-act framework. The initiative of offering women an interpreter early in labour was modified over cycles of implementation and scaled up based on feedback from midwives and language services data. Results The engagement of interpreters for women identified as requiring one increased from 28% (21/74) at baseline to 62% (45/72) at the 9th month of implementation. Conclusion Improving interpreter use in high-intensity hospital birth suites is possible with supportive leadership, multidisciplinary co-design and within a framework of quality improvement cycles of change. What is known about the topic? Despite Australian healthcare standards and policies stipulating the use of accredited interpreters where needed, studies indicate that services fall well short of meeting these during critical stages of childbirth. What does the paper add? Collaborative approaches to quality improvement in hospitals can significantly improve the engagement of interpreters to facilitate communication between health professionals and women with low English proficiency. What are the implications for practice? This language services initiative has potential for replication in services committed to improving effective communication between health professionals and patients.
An In Silico Approach of Coumarin-Derived Inhibitors for Human DNA Topoisomerase I
Authors: Guruge Amali G. , Udawatte Chandani , Weerasinghe Samantha
Published: August 2016

Human topoisomerase I (Htopo I) is a vital target for anti-cancer agents; however, available anti-cancer agents are linked with several limitations. Therefore, designing novel inhibitors for Htopo I is significant. The rationale behind the current study is to identify novel coumarin inhibitors for Htopo I using in silico approaches and predict drug leads for in vitro studies. Using molecular docking and molecular dynamics, the binding affinities of 75 coumarins were compared with a known Htopo I inhibitor, topotecan. Docking studies predict three coumarins T1L25, T2L25, and T3L25 as most potent inhibitors for Htopo I. T2L25 gives the best grid score (–295 kJ mol–1), which is very comparable with that of topotecan (–302 kJ mol–1). The binding of these coumarins occurs preferentially via a planar geometry, and ligands bind at the binding site parallel to the axis of base pairing. NHCOCH3-substituted ligands are more favourable for binding when compared with the other substitute groups considered. The binding free energies calculated from molecular mechanics Poisson–Boltzmann surface area (MM-PBSA) method imply that T3L25 possesses the highest binding affinity when compared with the other two ligands. However, T1L25 and T2L25 have comparable binding free energies according to MM-PBSA calculations. Additionally, other calculated properties also support the suitability of these three derivatives as inhibitors for Htopo I. Therefore, the current study theoretically predicts three coumarin derivatives T1L25, T2L25, and T3L25 as potent inhibitors for Htopo I. These findings could lead to exploring novel non-camptothecin inhibitors for Htopo I.
Integrative systematic studies on tardigrades from Antarctica identify new genera and new species within Macrobiotoidea and Echiniscoidea
Authors: Vecchi Matteo , Cesari Michele , Bertolani Roberto , Jönsson K. Ingemar , Rebecchi Lorena , Guidetti Roberto
Published: August 2016

Tardigrades represent one of the most abundant groups of Antarctic metazoans in terms of abundance and diversity, thanks to their ability to withstand desiccation and freezing; however, their biodiversity is underestimated. Antarctic tardigrades from Dronning Maud Land and Victoria Land were analysed from a morphological point of view with light microscopy and scanning electron microscopy, and from a molecular point of view using two genes (18S, 28S) analysed in Bayesian inference and maximum-likelihood frameworks. In addition, indel-coding datasets were used for the first time to infer tardigrade phylogenies. We also compared Antarctic specimens with those from Italy and Greenland. A combined morphological and molecular analysis led to the identification of two new evolutionary lineages, for which we here erect the new genera Acanthechiniscus, gen. nov. (Echiniscidae, Echiniscoidea) and Mesobiotus, gen. nov. (Macrobiotidae, Macrobiotoidea). Moreover, two species new to science were discovered: Pseudechiniscus titianae, sp. nov. (Echiniscidae : Echiniscoidea) and Mesobiotus hilariae, sp. nov. (Macrobiotidae : Macrobiotoidea). This study highlights the high tardigrade diversity in Antarctica and the importance of an integrated approach in faunal and taxonomic studies. http://zoobank.org/urn:lsid:zoobank.org:pub:8AAB42BF-B781-4418-A385-DC80C18EC31D
Consumption of a high-fat diet alters the seminal fluid and gut microbiomes in male mice
Authors: Javurek Angela B. , Spollen William G. , Johnson Sarah A. , Bivens Nathan J. , Bromert Karen H. , Givan Scott A. , Rosenfeld Cheryl S.
Published: August 2016

Our prior work showed that a novel microbiome resides in the seminal vesicles of wild-type and oestrogen receptor α (Esr1) knock-out mice and is impacted by the presence of functional Esr1 genes. The seminal fluid microbiome (SFM) may influence the health and reproductive status of the male, along with that of his partner and offspring. A high-fat diet (HFD) alters metabolites and other factors within seminal fluid and might affect the SFM. Adult (~15 weeks old) male mice were placed for 4 weeks on a control or high-fat diet and seminal fluid and fecal samples were collected, bacterial DNA isolated and subjected to 16s rRNA sequencing. Corynebacterium spp. were elevated in the seminal fluid of HFD males; however, Acinetobacter johnsonii, Streptophyta, Ammoniphilus spp., Bacillus spp. and Propionibacterium acnes were increased in control males. Rikenellaceae was more abundant in the fecal samples from HFD males. However, Bacteroides ovatus and another Bacteroides species, Bilophila, Sutterella spp., Parabacteroides, Bifidobacterium longum, Akkermansia muciniphila and Desulfovibrio spp. were greater in control males. Thus, short-term consumption of a HFD influences the seminal fluid and fecal microbiomes, which may have important health consequence for males and developmental origins of health and disease effects in resulting offspring.
Opportunities to increase rates of human papillomavirus vaccination in the New South Wales school program through enhanced catch-up
Authors: Staples Christine , Butler Michelle , Nguyen Jennifer , Durrheim David N. , Cashman Patrick , Brotherton Julia M. L.
Published: August 2016

Background
The National Human Papillomavirus (HPV) Vaccination Program provides HPV vaccine to high school students through school-based vaccination. We aimed to: 1) assess the vaccine completion rates achieved when general practice is used for completing doses missed at school; 2) estimate the extent of under-notification by general practices of vaccine doses administered; and 3) assess the reasons reported by parents of students for non-completion of HPV vaccination. Methods: A postal survey was conducted of parents and carers of students and identified, using school-program records, as incompletely vaccinated in a large regional area of northern NSW vaccinated during 2010. Information about additional HPV vaccine doses received or reasons for non-completion were sought. Responses were analysed and records cross-checked against the National HPV Vaccination Program Register. Results: Of 660 parents or carers contacted, 207 (31.4%) responded. We found: 1) completion rates increased, an additional 122/207 (45.2%) students had completed all three doses of HPV through their general practitioner (GP); 2) under-notification of GP doses to the National HPV Vaccination Program Register was an issue with only 5/165 (3.0%) reported; 3) the main reason for non-completion was being unaware of the opportunity to catch-up at a GP. Conclusions: Underreporting by GPs of HPV vaccine doses administered and failure to complete courses identifies two opportunities to increase HPV vaccine coverage. These could be addressed by extending provision of catch-up HPV doses in school and by developing practice software solutions for automatic notification of doses from GPs. Reasons given by parents for non-completion, mostly logistical barriers, indicate a high degree of acceptance of HPV vaccination.
Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys
Authors: Holt Martin , Lea Toby , Mao Limin , Zablotska Iryna , Lee Evelyn , de Wit John B. F. , Prestage Garrett
Published: August 2016

Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia’s primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000–15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. Results: Between 2000 and 2015, there were significant increases (P < 0.001) in annual HIV testing (56.1–64.8%), condomless sex with casual partners (26.8—38.8%) and the proportion of HIV-positive men on HIV treatment (72.5–88.4%) and with an undetectable viral load (73.7–94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
Emerging models of clinical services for men who have sex with men: focused versus comprehensive approaches
Authors: Mayer Kenneth H. , Vanderwarker Rodney , Grasso Chris , Boswell Stephen L.
Published: August 2016

By the early 1970s, it was increasingly recognised that men who have sex with men (MSM) were at risk for specific sexually transmissible infections (STI), and clinician awareness regarding MSM STI grew significantly after the AIDS epidemic was first recognised in 1981. In many urban centres in the USA and other resource-rich countries, the development of clinical infrastructure to address the AIDS epidemic led to the creation of clinics that provided services for large numbers of MSM. During the same time period, other health centres were created that were community-focused, providing comprehensive behavioural health and medical services for all sexual and gender minority patients. Over the next few years, multiple models for MSM sexual health will evolve, ranging from centres that embed STI care in primary care, to more focused centres that can use new technology to provide an efficient assessment for at-risk MSM desiring quick screening services.
Effects of permanent grass versus tillage on aggregation and organic matter dynamics in a poorly developed vineyard soil
Authors: Belmonte Sergio A. , Celi Luisella , Stanchi Silvia , Said-Pullicino Daniel , Zanini Ermanno , Bonifacio Eleonora
Published: August 2016

Vineyard soils are typically characterised by poor development, low organic matter content and steep slopes. Consequently, they have a limited capacity for conservation of organic matter that is weakly bound to the mineral soil phase. Under such conditions, establishment of permanent grass may improve soil quality conservation. The aim of this study was to evaluate the effects of permanent grass v. single autumn tillage on soil structure and organic matter dynamics in a hilly vineyard. During the periods 1994–1996 and 2010–2012, soil samples were collected three times per year, in different seasons. Aggregate stability analyses and organic matter fractionation were performed. The effects of grass cover on soil recovery capacity after tillage disturbance were slow to become apparent. Slight increases in aggregate resistance and organic matter contents were visible after 3 years, and the two plots (permanent grass/previously tilled) showed a large decrease of aggregate losses and increase of organic matter only after long-lasting permanent grass. However, even a single tillage produced an immediate decrease in aggregate resistance, while the organic matter content remained unaffected. Organic matter, however, showed marked seasonal dynamics, which involved not only recently added organic matter fractions but also the mineral-associated pool. Tillage altered organic matter dynamics by preventing the addition of new material into the mineral-associated organic fractions and limiting the stabilisation of aggregates.
Soil carbon and inferred net primary production in high- and low-intensity grazing systems on the New England Tableland, eastern Australia
Authors: Young Rick , Cowie Annette , Harden Steven , McLeod Ross
Published: August 2016

Management of grazing lands for the accumulation of soil carbon stocks (CS) has been proposed as an effective way to reduce net greenhouse gas emissions from agriculture. However, there are conflicting reports on the effects of grazing management on soil carbon. Most comparisons have involved some combination of no grazing, rotational grazing and set stocking. In the present study we compared two adjacent commercial grazing systems, distinguished on the basis of inputs and livestock productivity, located on New England basaltic landscapes experiencing a cool temperate climate. The high-intensity (H) system sustains an average stocking rate of 18 dry sheep equivalents (dse) ha–1, with a turnoff rate of 9dseha–1year–1, with high levels of investment in assets, management and fertiliser. The low-intensity (L) system, with less intensive management and half the fertiliser of the H system, sustains a stocking rate of 9dseha–1, with a turnoff rate of 3dseha–1year–1, which is slightly higher than the regional average. Pasture biomass production was inferred (back-calculated) from stocking rates and animal feed requirements using published data. From the H and L systems, seven paired landscapes from valley floor to upper hillslopes and plateaux were selected. The seventh included a forest reserve. One hundred and eighty-six undisturbed soil cores (0–0.5m depth) were assessed for bulk density, total C and N, particulate C and a range of plant nutrients. There were few differences in CS, soil pH and nutrient levels between H and L grazing systems. Average CS (0–0.3m) in pasture soils was 103Mgha–1, but was higher in the forest soil at 190Mgha–1. Regression of CS versus soil mass was a satisfactory method of dealing with the bias introduced by the higher soil bulk density in perennial pasture systems compared with the forest. The similarity of CS in H and L pasture soils was despite inferred net primary production being 1.9–3.6MgCha–1year–1 greater in H than L systems, implying higher rates of C turnover in the former. The global warming potential of the inferred annual emissions of CH4 and N2O in the H and L systems was equivalent to approximately 19% and 13% of the cycling atmospheric–plant CO2 carbon respectively.
Effects of municipal solid waste compost, rice-straw compost and mineral fertilisers on biological and chemical properties of a saline soil and yields in a mustard–pearl millet cropping system
Authors: Meena M. D. , Joshi P. K. , Narjary B. , Sheoran P. , Jat H. S. , Chinchmalatpure A. R. , Yadav R. K. , Sharma D. K.
Published: August 2016

We investigated the effects of organic amendments, municipal solid waste compost (MSWC) and rice-straw compost (RSC) with and without mineral fertilisers on biological and chemical properties of a saline soil. Field experiments were conducted for two consecutive years during 2012–14. In the first year, application of 8tha–1 of MSWC+50% of the recommended dose of fertilisers (RDF) resulted in higher microbial biomass carbon (MBC), enzyme activities, soil organic carbon (SOC), available nitrogen (N), phosphorus (P) and potassium (K) than 7tha–1 of RSC+50% RDF, after mustard (Brassica juncea) and pearl millet (Pennisetum glaucum) harvests. Combined use of 8tha–1 of MSWC+50% RDF resulted in 47% and 54% more MBC than the unfertilised control after mustard and pearl millet harvests, respectively. Dehydrogenase activity was significantly higher with 100% RDF than the control after 2 years of the cropping cycle. Among organic amendments, MSWC was superior to RSC in terms of MBC, and activities of dehydrogenase, alkaline phosphatase and urease. SOC was significantly increased under MSWC+50% RDF compared with 100% RDF alone. Significant build-up of soil fertility in terms of available N, P and K was observed with RSC+50% RDF compared with the control. During the second year of the cropping system, soil treated with RSC+50% RDF had 14%, 17% and 9% higher N, P and K than soil treated with 100% RDF, after pearl millet harvest. The magnitude of change in soil electrical conductivity and pH was low during 2012–13; however, soil salinity decreased by 55% and 48% with MSWC+50% RDF and RSC+50% RDF, respectively, relative to the control at 120 days of pearl millet growth in 2013–14. Application of MSWC +50% RDF produced 2.5 and 2.70tha–1 of mustard and pearl millet, and increased grain yield by 19% and 15%, respectively, compared with 100% RDF. Integrated use organic amendments and mineral fertiliser is recommended for promoting biological and chemical properties of saline soil in a mustard–pearl millet cropping system.
Genetic Analysis Shows that Morphology Alone Cannot Distinguish Asian Carp Eggs from Those of Other Cyprinid Species
Authors: Larson James H. , Grace McCalla S. , Chapman Duane C. , Rees Christopher , Knights Brent C. , Vallazza Jon M. , George Amy E. , Richardson William B. , Amberg Jon
Published: August 2016

Fish eggs and embryos (hereafter collectively referred to as “eggs”) were collected in the upper Mississippi River main stem (~300 km upstream of previously reported spawning by invasive Asian carp) during summer 2013. Based on previously published morphological characteristics, the eggs were identified as belonging to Asian carp. A subsample of the eggs was subsequently analyzed by using molecular methods to determine species identity. Genetic identification using the cytochrome-c oxidase 1 gene was attempted for a total of 41 eggs. Due to the preservation technique used (formalin) and the resulting DNA degradation, sequences were recovered from only 17 individual eggs. In all 17 cases, cyprinids other than Asian carp (usually Notropis sp.) were identified as the most likely species. In previously published reports, a key characteristic that distinguished Asian carp eggs from those of other cyprinids was size: Asian carp eggs exhibited diameters ranging from 4.0 to 6.0 mm and were thought to be much larger than the otherwise similar eggs of native species. Eggs from endemic cyprinids were believed to rarely reach 3.0 mm and had not been observed to exceed 3.3 mm. However, many of the eggs that were genetically identified as originating from native cyprinids were as large as 4.0 mm in diameter (at early developmental stages) and were therefore large enough to overlap with the lower end of the size range observed for Asian carp eggs. Researchers studying the egg stages of Asian carp and other cyprinids should plan on preserving subsets of eggs for genetic analysis to confirm morphological identifications.

Received July 30, 2015; accepted April 22, 2016 Published online August 31, 2016
Mapping Lake Sturgeon Spawning Habitat in the Upper Tennessee River using Side-Scan Sonar
Authors: Walker Daniel J. , Alford J. Brian
Published: August 2016

The Lake Sturgeon Acipenser fulvescens is a fish species that was once dispersed widely throughout the Mississippi River drainage but was largely extirpated from the southern portions of its range by overfishing and habitat degradation. There is an ongoing restoration effort to reestablish the Lake Sturgeon to rivers of the southeastern United States. Reintroduced juvenile Lake Sturgeon now occupy several reservoirs separated from each other by hydroelectric dams along the upper Tennessee River. To complete their life history, Lake Sturgeon will migrate upriver from reservoir habitats to more lotic habitats and spawn over coarse rocky substrate, even in the tailwaters of impassable dams. Using low-cost, consumer-grade, side-scan sonar and a GIS, we mapped the substrate of four tailwaters that may be future spawning locations for Lake Sturgeon. We used video imagery collected from random locations within the mapped areas to validate our digitization of sonar imagery. We calculated the area of four substrate classes displayed in the maps to evaluate that aspect of the suitability of each of the tailwaters for Lake Sturgeon spawning. The revised maps showed that the best spawning substrate (unembedded, coarse, rocky substrate, 6–25 cm in diameter) comprised 17.0–30.5% of the total area mapped at each tailwater, while the least suitable substrate class (fine sediment, <0.2 cm in diameter) comprised 6.2–30.7% of the mapped areas. Our results suggest that any future spawning events by Lake Sturgeon below each of these dams are likely to encounter some suitable spawning substrate patches, while management opportunities exist to supplement tailwater areas with suitable spawning substrate.

Received March 11, 2016; accepted May 30, 2016 Published online August 31, 2016
Duras et la littérature de quatre sous: un malentendu?
Authors: Killeen Marie-Chantal
Published: August 2016

Qu’en est-il donc de Marguerite Duras et du romanesque? On sait que l’écrivaine n’a jamais rougi d’exploiter les poncifs les plus rebattus de la littérature de quatre sous: les triangles amoureux, les femmes fatales et les coups de foudre sont autant de motifs qu’elle ressasse inlassablement dans ses œuvres. Afin de chasser ce spectre gênant du roman populaire, plusieurs critiques se sont appliqués à montrer les entorses que l’auteure lui fait subir. Selon ces lecteurs, Duras ne mobiliserait les tropes du roman de gare que pour mieux démonter les mythes qu’il véhicule. Mais suffit-il de dépister ce leurre pour que se dissipe le ‘malentendu’ qui pèse sur l’œuvre? Ce n’est pas sûr. Car si l’écrivaine s’ingénie à éviter l’écueil du kitsch en rusant avec les codes qu’elle reproduit, elle ne les tourne pas pour autant en dérision. C’est justement ce refus de l’ironie qui constitue une part indéniable de son génie et du plaisir qu’on prend à la lire. En nous concentrant ici sur deux clichés du roman rose que Duras revivifie à sa manière singulière — le coup de foudre et le désir de mourir d’amour —, nous examinons le rapport décidément ambivalent que son œuvre noue à la littérature de grande consommation.
Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use
Authors: Levine David M , Healey Michael J , Wright Adam , Bates David W , Linder Jeffrey A , Samal Lipika
Published: August 2016

Background: The Centers for Medicare and Medicaid Services (CMS) canceled Meaningful Use (MU), replacing it with Advancing Care Information, which preserves many MU elements. Therefore, transitioning from MU stage 1 to MU stage 2 has important implications for the new policy, yet the quality of care provided by physicians transitioning from MU1 to MU2 is unknown.

Methods: Retrospective longitudinal evaluation of the quality of care delivered by outpatient physicians at an academic medical center in the transition between MU1 and MU2.

Results: Between MU1 and MU2, 4 measures improved: hypertension control (35% vs 40%), influenza immunization (63% vs 68%), tobacco use assessment/counseling (86% vs 96%), and diabetes control (93% vs 96%; P all <.01). One worsened: senior weight screening/follow-up (54% vs 49%; P < .01). Two were unchanged: chlamydia screening and adult weight screening/follow-up.

Conclusion: In this single-site study, when clinicians progressed from MU1 to MU2, 4 quality measures improved, 2 were unchanged, and 1 worsened. Analysis of national data should guide policy decisions about the content of MU’s successor.
The GhTT2_A07 gene is linked to the brown colour and natural flame retardancy phenotypes of Lc1 cotton ( Gossypium hirsutum L.) fibres
Authors: Hinchliffe Doug J. , Condon Brian D. , Thyssen Gregory , Naoumkina Marina , Madison Crista A. , Reynolds Michael , Delhom Christopher D. , Fang David D. , Li Ping , McCarty Jack
Published: August 2016

Some naturally coloured brown cotton fibres from accessions of Gossypium hirsutum L. can be used to make textiles with enhanced flame retardancy (FR). Several independent brown fibre loci have been identified and mapped to chromosomes, but the underlying genes have not yet been identified, and the mechanism of lint fibre FR is not yet fully understood. In this study, we show that both the brown colour and enhanced FR of the Lc1 lint colour locus are linked to a 1.4Mb inversion on chromosome A07 that is immediately upstream of a gene with similarity to Arabidopsis TRANSPARENT TESTA 2 (TT2). As a result of the alternative upstream sequence, the transcription factor GhTT2_A07 is highly up-regulated in developing fibres. In turn, genes in the phenylpropanoid metabolic pathway are activated, leading to biosynthesis of proanthocyanidins and accumulation of inorganic elements. We show that enhanced FR and anthocyanin precursors appear in developing brown fibres well before the brown colour is detectible, demonstrating for the first time that the polymerized proanthocyanidins that constitute the brown colour are not the source of enhanced FR. Identifying the particular colourless metabolite that provides Lc1 cotton with enhanced FR could help minimize the use of synthetic chemical flame retardant additives in textiles.
Hyperspectral phenotyping of the reaction of grapevine genotypes to Plasmopara viticola
Authors: Oerke Erich-Christian , Herzog Katja , Toepfer Reinhard
Published: August 2016

A major aim in grapevine breeding is the provision of cultivars resistant to downy mildew. As Plasmopara viticola produces sporangia on the abaxial surface of susceptible cultivars, disease symptoms on both leaf sides may be detected and quantified by technical sensors. The response of cultivars ‘Mueller-Thurgau’, ‘Regent’, and ‘Solaris’, which differ in resistance to P. viticola , was characterized under controlled conditions by using hyperspectral sensors. Spectral reflectance was suitable to differentiate between non-infected cultivars and leaf sides of the bicolored grapevine. Brown discoloration of tissue became visible on both leaf sides of resistant cultivars 2 days before downy mildew symptoms appeared on the susceptible ‘Mueller-Thurgau’ cultivar. Infection of this cultivar resulted in significant ( P <0.05) reflectance changes 1–2 days prior to abaxial sporulation induced by high relative humidity, or the formation of adaxial oil spots. Hyperspectral imaging was more sensitive in disease detection than non-imaging and provided spatial information on the leaf level. Spectral indices provided information on the variability of chlorophyll content, photosynthetic activity, and relative water content of leaf tissue in time and space. On ‘Mueller-Thurgau’ downy mildew translated reflectance to higher values as detectable by the index DMI_3=(R 470 +R 682 +R 800 )/(R 800 /R 682 ) and affected reflectance at 1450nm. Tissue discoloration on ‘Regent’ and ‘Solaris’ cultivars was associated with lower reflectance between 750 and 900nm; blue and red reflectance demonstrated differences from leaf necroses. With high inoculum densities, P. viticola sporulated on even resistant cultivars. Hyperspectral characterization at the tissue level proved suitable for phenotyping plant resistance to pathogens and provided information on resistance mechanisms.
A diagnostic for localizing red giant differential rotation
Authors: Klion Hannah , Quataert Eliot
Published: August 2016

We present a simple diagnostic that can be used to constrain the location of the differential rotation in red giants with measured mixed mode rotational splittings. Specifically, in red giants with radii ∼4 Rȯ, the splittings of p-dominated modes (sound wave-dominated) relative to those of g-dominated modes (internal gravity wave-dominated) are sensitive to how much of the differential rotation resides in the outer convection zone versus the radiative interior of the red giant. An independently measured surface rotation rate significantly aids breaking degeneracies in interpreting the measured splittings. We apply our results to existing observations of red giants, particularly those of Kepler-56, and find that most of the differential rotation resides in the radiative region rather than in the convection zone. This conclusion is consistent with results in the literature from rotational inversions, but our results are insensitive to some of the uncertainties in the inversion process and can be readily applied to large samples of red giants with even a modest number of measured rotational splittings. We argue that differential rotation in the radiative interior strongly suggests that angular momentum transport in red giants is dominated by local fluid instabilities rather than large-scale magnetic stresses.
Long-term survival in AIDS-related primary central nervous system lymphoma
Authors: Gupta Neel K. , Nolan Amber , Omuro Antonio , Reid Erin G. , Wang Chia-Ching , Mannis Gabriel , Jaglal Michael , Chavez Julio C. , Rubinstein Paul G. , Griffin Ann , Abrams Donald I. , Hwang Jimmy , Kaplan Lawrence D. , Luce Judith A. , Volberding Paul , Treseler Patrick A. , Rubenstein James L.
Published: August 2016

Background.

The optimal therapeutic approach for patients with AIDS-related primary central nervous system lymphoma (AR-PCNSL) remains undefined. While its incidence declined substantially with combination antiretroviral therapy (cART), AR-PCNSL remains a highly aggressive neoplasm for which whole brain radiotherapy (WBRT) is considered a standard first-line intervention.

Methods.

To identify therapy-related factors associated with favorable survival, we first retrospectively analyzed outcomes of AR-PCNSL patients treated at San Francisco General Hospital, a public hospital with a long history of dedicated care for patients with HIV and AIDS-related malignancies. Results were validated in a retrospective, multicenter analysis that evaluated all newly diagnosed patients with AR-PCNSL treated with cART plus high-dose methotrexate (HD-MTX).

Results.

We provide evidence that CD4+ reconstitution with cART administered during HD-MTX correlates with long-term survival among patients with CD4 <100. This was confirmed in a multicenter analysis which demonstrated that integration of cART regimens with HD-MTX was generally well tolerated and resulted in longer progression-free survival than other treatments. No profound differences in immunophenotype were identified in an analysis of AR-PCNSL tumors that arose in the pre- versus post-cART eras. However, we detected evidence for a demographic shift, as the proportion of minority patients with AR-PCNSL increased since advent of cART.

Conclusion.

Long-term disease-free survival can be achieved in AR-PCNSL, even among those with histories of opportunistic infections, limited access to health care, and medical non-adherence. Given this, as well as the long-term toxicities of WBRT, we recommend that integration of cART plus first-line HD-MTX be considered for all patients with AR-PCNSL.
Novel Metrics in the Longitudinal Evaluation of Pain Data in Sickle Cell Disease
Authors: Bakshi Nitya , Smith Meagan E. , Ross Diana , Krishnamurti Lakshmanan
Published: August 2016

Background:

Available modalities for the longitudinal capture and analysis of pain intensity in patients with sickle cell disease (SCD) limit our ability to study intraindividual and interindividual variation in pain and the factors influencing the transition from acute to chronic pain in patients with SCD.

Objectives:

The objectives of this study were to determine the feasibility of electronic capture of longitudinal outpatient pain intensity data and to test the applicability of novel metrics in the study of intraindividual and interindividual variation in pain in patients with SCD.

Materials and Methods:

Twenty SCD patients aged 13 to 21 submitted 2045 diary days of pain intensity data over 229 days using a web-based electronic pain diary or through text message.

Results:

Participants reported pain (11-point Numerical Rating Score >0) on 1559 diary days (76.2%) suggesting a significant outpatient pain burden. In addition to mean maximum daily pain (MMDP), using maximum daily pain (MDP) scores, we calculated the ninetieth percentile (p90) of MDP, proportion of pain-free days (PPFD), Standard Deviation (SD) of MDP and coefficient of variation (CV) of MDP. Although p50 of MDP and p90 of MDP correlated positively with MMDP, PPFD correlated negatively with MMDP and both MMDP and PPFD correlated poorly with the SD of MDP. Examination of graphic representation of pain trends demonstrated how patients with similar MMDP had varying p90, PPFD, SD/coefficient of variation, and ultimately burden of pain over time. Missing data rates were lowest in the first 30 days of reporting and increased over time. Study participants reported a positive experience with momentary pain reporting and improved communication with health care providers regarding pain.

Conclusions:

The longitudinal collection of pain data with the inclusion of hospital data during periods of hospitalization is feasible and acceptable in patients with SCD over periods of 30 to 60 days. Long-term collection of pain diary data, while informative, is associated with higher rates of missing data. Novel metrics of pain have the potential to better describe intraindividual and interindividual variation in pain, inform studies of the transition from acute to chronic pain as well as contribute patient-reported end points of pain for interventional clinical trials of pain in SCD.
Conventional Supine MRI With a Lumbar Pillow—An Alternative to Weight-bearing MRI for Diagnosing Spinal Stenosis?
Authors: Hansen Bjarke Brandt , Hansen Philip , Grindsted Jacob , Rasti Zoreh , Bliddal Henning , Riis Robert G.C. , Boesen Mikael
Published: August 2016

Study Design.

Cross-sectional study.

Objective.

To investigate if adding a lumbar pillow in supine position during magnetic resonance imaging (MRI) is superior to standing positional MRI for diagnosing lumbar spinal stenosis (LSS).

Summary of Background Data.

The upright standing position and especially extension of the lumbar spine seem to worsening symptoms of LSS. However, it is unclear whether a forced lumbar extension by a pillow in the lower back during conventional supine MRI may improve the diagnostics of LSS compared with standing MRI.

Methods.

Patients suspected for LSS and referred to conventional MRI were included to an additional positional MRI scan (0.25T G-Scan) performed in: (1) conventional supine, (2) standing, (3) supine with a lumbar pillow in the lower back. LSS was evaluated for each position in consensus on a 0 to 3 semi-quantitative grading scale. Independently, L2-S1 lordosis angle, spinal cross-sectional diameter (SCSD), dural cross-sectional diameter (DCSD), and dural cross-sectional diameter (DCSA) were measured. The smallest dural diameter was defined as stenosis level and the largest control level for comparison.

Results.

Twenty-seven patients (60.6 years; ±9.4) were included. The lordosis angle increased significantly from supine to standing (3.2° CI: 1.2–5.2) and with the lumbar pillow (12.8° CI: 10.3–15.3). One-way analysis of variance (ANOVA) showed significant differences between positions (P < 0.001). When compared with the supine position, pairwise comparisons showed decreased SCSD, DCSD, DCSA, and increasing semi-quantitative grading, during both standing and supine with the lumbar pillow. A difference in the semi-quantitative grades was only found between standing and supine with a lumbar pillow, and the scan with a lumbar pillow was significantly more painful.

Conclusion.

Standing MRI and supine MRI with a lumbar pillow resulted in equal changes in the lumbar spine, although standing MRI may be more sensitive in the assessment of patients suspected for LSS.

Level of Evidence: 2
Refinement of the Interprofessional Socialization and Valuing Scale (ISVS-21) and Development of 9-Item Equivalent Versions
Authors: King Gillian , Orchard Carole , Khalili Hossein , Avery Lisa
Published: August 2016

Introduction:

Measures of interprofessional (IP) socialization are needed to capture the role of interprofessional education in preparing students and health practitioners to function as part of IP health care teams. The aims of this study were to refine a previously published version of the Interprofessional Socialization and Valuing Scale (the ISVS-24) and create two shorter equivalent forms to be used in pre–post studies.

Methods:

A graded response model was used to identify ISVS items in a practitioner data set (n = 345), with validation (measure invariance) conducted using a separate student sample (n = 341).

Results:

Analyses indicated a unidimensional 21-item version with excellent measurement properties, Cronbach alpha of 0.988, 95% confidence interval (CI) 0.985–0.991. There was evidence of measure invariance, as there was excellent agreement of the factor scores for the practitioner and student data, intraclass correlation coefficient = 0.993, 95% CI 0.991–0.994. This indicates that the ISVS-21 measures IP socialization consistently across groups. Two 9-item equivalent versions for pre–post use were developed, with excellent agreement between the two forms. The student score agreement for the two item sets was excellent: intraclass correlation coefficient = 0.970, 95% CI 0.963–0.976.

Discussion:

The ISVS-21 is a refined measure to assess existing levels of IP socialization in practitioners and students, and relate IP socialization to other important constructs such as IP collaboration and the development of an IP identity. The equivalent versions can be used to assess change in IP socialization as a result of interprofessional education.
Premonitory and nonheadache symptoms induced by CGRP and PACAP38 in patients with migraine
Authors: Guo Song , Vollesen Anne L.H. , Olesen Jes , Ashina Messoud
Published: August 2016

Migraine attacks are often preceded by premonitory symptoms (PS) that may be triggered pharmacologically. We investigated the incidence of PS after administration of calcitonin gene-related peptide (CGRP) or pituitary adenylate cyclase-activating peptide-38 (PACAP38) in patients with migraine without aura (MO) who reported and did not report migraine-like attacks induced by these pharmacological triggers. In addition, we investigated the association between PS and familial predisposition for migraine. In our study, MO patients received continuous intravenous infusion of α-CGRP (n = 40) and PACAP38 (n = 32) for 20 minutes. Premonitory and nonheadache symptoms were recorded by a self-administered questionnaire. Information on familial predisposition was obtained by telephone interview of first-degree relatives using a validated semistructured questionnaire. Twenty-five of 40 patients (63%) developed a migraine-like attack after CGRP infusion and 23 of 32 patients (72%) developed an attack after PACAP38 infusion. Only 2 patients (9%) with a CGRP-induced migraine-like attack reported PS, whereas 11 patients (48%) reported PS after PACAP38. Patients who developed a migraine-like attack did not report more PS than did patients with no attack after CGRP (P = 0.519) or PACAP38 (P = 0.103). Additionally, we found no difference in PS between patients with familial predisposition of migraine (75%) and patients with no family predisposition (56%) (P = 0.101). In conclusion, CGRP did not induce PS, whereas PACAP38 induced PS in 48% of patients. However, CGRP and PACAP38 did not induce more PS in patients who developed an attack compared with those who did not develop an attack.
Review of adult laryngotracheal stenosis: pathogenesis, management, and outcomes
Authors: Rosow David E. , Barbarite Eric
Published: August 2016

Purpose of review

Adult laryngotracheal stenosis (LTS) is a potentially life-threatening disorder that can be difficult to diagnose and treat. Much is unknown regarding the etiology of airway stenosis, and while many patients do well with standard surgical management, the recurrence rate is significant. Few medical therapies exist, but there is a growing need.

Recent findings

Several basic science studies have shown a role of inflammatory signaling pathways in the development of LTS. Infectious processes may also play a role in development of stenosis, while treatment with anti-inflammatory and immunosuppressive medications has shown some promise in preventing disease. Several risk factors, such as diabetes, BMI, length of stenosis, and need for T-tube, have been identified that portend worse surgical outcomes and may assist physicians in choosing appropriate treatment.

While adult LTS is a complex, challenging clinical entity, there is promising research into the inflammatory origins of the disorder, which may open up groundbreaking new avenues of medical treatment.
Evaluation of a Peer Nurse Coach Quality Improvement Project on New Nurse Hire Attitudes Toward Care for the Dying
Authors: Liang Zhan , DiNella Jeannine , Ren Dianxu , Tuite Patricia K. , Usher Barbara M.
Published: August 2016

Despite growth of hospices in the United States, there is increased use of intensive care and late referrals to hospice, and most patients die in hospitals. A national survey indicates that these patients can experience persistent pain, dyspnea, anxiety, and depression, and they and their families also have unmet needs for respectful treatment. Nursing leaders perceived that new nurse hires lacked end-of-life training and were uncomfortable caring for dying patients. Evidence from 2009 to 2011 using Frommelt Attitudes toward Care of the Dying (FATCOD) questionnaires collected during classroom exercises confirmed this and indicated areas for quality improvement. After further review, a peer nurse coach model was selected for the intervention. New nurse hire FATCOD data from 2009 to 2011 were used to design the intervention. This article examines FATCOD data collected immediately before the quality improvement project and data collected 5 months after to evaluate the impact of end-of-life peer nurse coaching on new nurse hire attitudes toward end-of-life care. The difference in total scores was not significant, although there were significant positive improvements in individual questionnaire items. Overall, the peer nurse coach model holds promise as a mechanism for engaging new nurse hires and for improving end-of-life care.