bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise and Parkinson Disease: Comparing Tango, Treadmill, and Stretching
Authors: Rawson Kerri S. , McNeely Marie E. , Duncan Ryan P. , Pickett Kristen A. , Perlmutter Joel S. , Earhart Gammon M.
Published: December 2018

Background and Purpose:

Impaired gait, balance, and motor function are common in Parkinson disease (PD) and may lead to falls and injuries. Different forms of exercise improve motor function in persons with PD, but determining which form of exercise is most effective requires a direct comparison of various approaches. In this prospective, controlled trial, we evaluated the impact of tango, treadmill walking, and stretching on gait, balance, motor function, and quality of life. We hypothesized tango and treadmill would improve forward walking and motor symptom severity, and tango would also improve backward walking, balance, and quality of life.

Methods:

Ninety-six participants (age: 67.2 ± 8.9 years, 42% female) with mild to moderate idiopathic PD were serially assigned to tango, treadmill walking, or stretching (active control group) and attended 1-hour classes twice weekly for 12 weeks. Assessments occurred OFF anti-PD medication before and after the intervention and at follow-up 12 weeks after the intervention.

Results:

Forward velocity and backward velocity improved for the treadmill group from baseline to posttest and improvements persisted at follow-up. Backward velocity and motor functioning improved for the stretching group from baseline to posttest, but results did not persist at follow-up. There were no significant changes in the tango group across time points.

Discussion and Conclusions:

Contrary to our hypotheses, only treadmill improved forward walking, while backward walking improved with treadmill and stretching. Future research should examine combinations of exercises with a focus on optimizing dosing and examining whether specific characteristics of people with PD correlate with different types of exercise.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A237).
Effectiveness of Two Targeted Temperature Management Methods After Pediatric Postcardiac Arrest: A Multicenter International Study*
Authors: Yunge Mauricio , Cordero Jaime , Martinez Daniela , Bustos Raul , Wegner Adriana , Castro Magdalena , Arrau Lorena , Diaz Betsy , Dalmazzo Roberto , Hickmann Lilian , Lapadula Michelangelo , Yañez Leticia , Roque Jorge , Cecchetti Corrado , Bravo Pablo , Cruces Pablo , Acuña Carlos , Oyaguez Pablo , Miras Alicia , Morales Antonio , Nieto Manuel , Lopez Yolanda , Morales Gonzalo , Drago Michele , Nalegach Maria Elisa , Sepulveda German , Menchaca Amanda , Jerez Florencia , Glasinovic Maritza , Mallea Fernando , Lopez-Herce Jesus
Published: December 2018

Objectives:

It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children.

Design:

Prospective, multicenter, nonrandomized, study.

Setting:

PICUs of 20 hospitals in South America, Spain, and Italy, 2012–2014.

Patients:

Under 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included.

Methods:

TTM to 32–34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months. Primary outcome: feasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months.

Measurements and Main Results:

Seventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups.

Conclusions:

TTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques.
Impact of Economic Downturn on the Surgical Volumes of Common Hand Procedures
Authors: Fujihara Nasa , Fujihara Yuki , Sterbenz Jennifer M. , Shauver Melissa J. , Chung Ting-Ting , Chung Kevin C.
Published: December 2018

Background:

Economic conditions affect surgical volumes, particularly for elective procedures. In this study, the authors aimed to identify the effects of the 2008 U.S. economic downturn on hand surgery volumes to guide surgeons and managers when facing future economic crises.

Methods:

The authors used the California State Ambulatory Surgery and Services Database from January of 2005 to December of 2011, which includes the entire period of the Great Recession (December of 2007 to June of 2009). The authors abstracted the monthly volume of five common hand procedures using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes. Pearson statistics were used to identify the correlation between unemployment rate and surgical volume for each procedure.

Results:

The total number of operative cases was 345,583 during the 7-year study period. Most common elective hand procedures, such as carpal tunnel release and trigger finger release, had a negative correlation with unemployment rate, but the volume of distal radius fracture surgery did not show any correlation. Compared with carpal tunnel release (r = −0.88) or trigger finger release volumes (r = −0.85), thumb arthroplasty/arthrodesis volumes (r = −0.45) showed only a moderate correlation.

Conclusions:

The economic downturn decreased elective hand procedure surgical volumes. This may be detrimental to small surgical practices that rely on revenue from elective procedures. Taking advantage of the principle that increased volume reduces unit cost may mitigate the lost revenue from these elective procedures. In addition, consolidating hand surgery services at larger, regional centers may reduce the effect of the economic environment on individual hand surgeons.
A Novel Model for Cutaneous Wound Healing and Scarring in the Rat
Authors: Zhou Sizheng , Wang Wenjin , Zhou Shuangbai , Zhang Guoyou , He Jizhou , Li Qingfeng
Published: December 2018

Background:

Current rodent models of wound healing and scarring are flawed because of rapid wound contraction and inconspicuous scarring after healing, which is not closely parallel to the physiologic process in humans. This study aimed to establish a novel model of wound healing and scarring in rats.

Methods:

Excisional wounds were generated in rat tail or dorsal skin and histologic changes and wound contraction were assessed 2, 10, and 16 days after injury. After healing, rat tail scar was investigated for 24 consecutive weeks by histologic and immunohistochemical staining. Finally, a stretched scar model was generated in rat tail with high or low strain after reepithelialization to mimic human hypertrophic scars. The tail hypertrophic scars were analyzed by histology, immunohistochemical staining, and mRNA quantification 0, 2, 6, 12, and 24 weeks after stretching.

Results:

Compared with the dorsal wounds, a larger dermal gap percentage (p < 0.05) and more pronounced granulation were found in rat tail wounds. Tail scars remained conspicuous and underwent maturation over 24 weeks after wound healing. In addition, high mechanical strain induced significantly increased scar area (p < 0.01), scar height (p < 0.05), vessel density (p < 0.01) and hypertrophic scar–related molecule expression, and distorted collagen arrangement in rat tail scars.

Conclusions:

The rat tail model exhibits minor wound contraction and biological features analogous to both normotrophic and hypertrophic scar in humans when generated with or without stretching, respectively. It is a promising new model for studies of both cutaneous wound healing and scarring.
Retrospective Review of the Complication Profile Associated with 71 Subcranial and Transcranial Midface Distraction Procedures at a Single Institution
Authors: Zhang Rosaline S. , Lin Lawrence O. , Hoppe Ian C. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: December 2018

Background:

This study characterizes the perioperative morbidity of a large cohort of subjects with syndromic craniosynostosis who underwent transcranial or subcranial midface distraction.

Methods:

Demographic and perioperative data were compared between those who underwent transcranial or subcranial midface distraction osteogenesis between July of 1999 and December of 2017. Univariate analysis was conducted using chi-square and Fisher’s exact tests for categorical variables and the Mann-Whitney U test for continuous variables. Multivariate analysis was conducted using logistic regression modeling. Complications were graded using the Clavien-Dindo classification.

Results:

Sixty-four subjects underwent a total of 71 midface distraction procedures. There was a total of 28 complications (39 percent). The trans cranial cohort had a significantly higher frequency of complications (58 percent) compared with the subcranial cohort (29 percent; p = 0.017), with a significantly greater proportion of infection-related complications in the transcranial cohort (80 percent versus 54 percent; p = 0.028). Transcranial complications included cranial contamination, whereas most subcranial cohort infections were superficial or limited facial abscesses. The only significant predictor variable for complications in a multivariate analysis was whether the osteotomy approach was transcranial as opposed to subcranial, with an odds ratio of 5.80 (p = 0.013).

Conclusions:

Complication rates in midface distraction remain high, with transcranial procedures having significantly higher complication rates, infection-related complications, and notably greater severity of complications. Although the goals of surgery often dictate choice of osteotomy, the risks associated with transcranial procedures must be thoroughly understood by surgeon and patient alike.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression
Authors: Turan Bulent , Crockett Kaylee B. , Buyukcan-Tetik Asuman , Kempf Mirjam-Colette , Konkle-Parker Deborah , Wilson Tracey E. , Tien Phyllis C. , Wingood Gina , Neilands Torsten B. , Johnson Mallory O. , Weiser Sheri D. , Turan Janet M.
Published: December 2018

Background:

One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits—fear of negative social evaluation, attachment-related anxiety, and dispositional resilience—in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.

Setting/Methods:

In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.

Results:

In both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.

Conclusions:

Interventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.
The Evolving Role of Shear Wave Elastography in the Diagnosis and Treatment of Prostate Cancer
Authors: Gandhi Jason , Zaidi Saher , Shah Janki , Joshi Gunjan , Khan Sardar Ali
Published: December 2018

To forego misdiagnosis and biopsy-related complications, we explore a novel technique that embraces tissue elasticity to circumvent the current limitations in the accurate, non-invasive detection of prostate cancer. A MEDLINE® database search of literature pertinent to prostate elastography published in the last five years was guided using the following terms: tissue elasticity, ultrasound elastography, strain elastography, magnetic resonance elastography, and shear wave elastography. Ultrasound shear wave elastography (SWE) utilizes the propagation of induced shear waves to provide a quantitative measurement of elasticity of soft tissue. Studies attempting to prove SWE as a strong predictor of malignant prostatic tissue have validated its high specificity and sensitivity compared to the sub-50% range observed with magnetic resonance imaging or transrectal ultrasound. Because its median positive predictive value is also much higher than the sub-40% range attributed to more conventional techniques, SWE yields reduced false-negative biopsy rates. It furthermore exhibits higher intraobserver reproducibility compared to conventional ultrasound. Recent treatments have also utilized SWE for noninvasive prostate cancer tissue ablation. Future improvements include standardized cutoff ranges for quantifying elasticity of malignant tissue. The implementation of a scoring system to predict cancer aggressiveness and prognosis may eliminate the need for unwarranted repeat biopsies postdiagnosis.
Impact of a simplified management algorithm on outcome following exsanguinating pelvic fractures: A 10-year experience
Authors: Lewis Richard H. , Sharpe John P. , Berning Bennett , Fabian Timothy C. , Croce Martin A. , Magnotti Louis J.
Published: December 2018

BACKGROUND

Optimal management of exsanguinating pelvic fractures remains controversial. Our previous experience suggested that management decisions based on a defined algorithm were associated with a significant reduction in transfusion requirements and mortality. Based on these outcomes, a clinical pathway (PW) for the management of exsanguinating pelvic fractures was developed. The purpose of this study was to evaluate the impact of this PW on outcomes.

METHODS

Consecutive patients over 10 years with blunt pelvic fractures subsequent to the implementation of the clinical PW were identified. Patients with hemodynamically unstable pelvic fractures are managed initially with a pelvic orthotic device. For those with continued hemodynamic instability and no extrapelvic source of hemorrhage, pelvic angiography was performed followed by elective pelvic fixation. Patients managed according to the PW were compared with those patients whose management deviated (DEV) from the PW.

RESULTS

There were 3,467 patients identified. Three hundred twelve (9%) met entry criteria: 246 (79%) comprised the PW group and 66 (21%) the DEV group. Injury severity, as measured by Injury Severity Score (35 vs. 36; p = 0.55), admission Glasgow Coma Scale (10 vs. 10; p = 0.58), admission BE (−7.4 vs. −6.4, p = 0.38), admission SBP (107 vs. 104, p = 0.53), and PRBC requirements during initial resuscitation (6.1 units vs. 6.6 units, p = 0.22) were similar between the groups. Pelvic orthotic device use was 48% in the DEV group (p < 0.001). Twenty-four percent of the PW group required angiography compared with 74% of the DEV group (p < 0.001). Forty-eight-hour transfusions (11 vs. 16, p = 0.01) and mortality (35% vs. 48%, p = 0.04) were reduced in the PW group compared with the DEV group. Pathway adherence was identified as an independent predictor of both decreased transfusions (β = −5.8, p = 0.002) via multiple linear regression and decreased mortality (hazard ratio, 0.74; 95% confidence interval, 0.42–0.98) via multivariable cox proportional hazards analysis.

CONCLUSION

Adherence to a defined clinical PW simplified the management of exsanguinating pelvic fractures and contributed to a reduction in both transfusion requirements and mortality.

LEVEL OF EVIDENCE

Prognostic, level III.
Interhospital variability in time to discharge to rehabilitation among insured trauma patients
Authors: Knowlton Lisa M. , Harris Alex H.S. , Tennakoon Lakshika , Hawn Mary T. , Spain David A. , Staudenmayer Kristan L.
Published: December 2018

BACKGROUND

Hospital costs are partly a function of length of stay (LOS), which can be impacted by the local availability of postacute care (PAC) resources (inpatient rehabilitation and skilled nursing facilities), particularly for injured patients. We hypothesized that LOS for trauma patients destined for PAC would be variable based on insurance type and hospitals from which they are discharged.

METHODS

We used the 2014 to 2015 National Inpatient Sample from the Healthcare Cost and Utilization Project. We included all adult admissions with a primary diagnosis of trauma (International Classification of Diseases, 9th Revision, Clinical Modification codes), who were insured and discharged to PAC. We then ranked hospitals based upon mean LOS and divided them into quartiles to determine differences. The primary outcome was inpatient LOS; secondary outcome was cost.

RESULTS

There are 958,005 trauma patients that met the inclusion criteria. Mean LOS varied based upon insurance type (Medicaid vs. Private vs. Medicare: 12.7 days vs. 8.8 days and 5.7 days; p < 0.001). Shortest LOS hospitals had a marginal variation in LOS (Medicaid vs. Private vs. Medicare: 5.5 days vs. 4.8 days vs. 4.2 days; p < 0.001). Longest LOS hospitals had mean LOS that varied substantially (16.4 days vs. 11.0 days vs. 6.7 days; p < 0.001). Multivariate regression controlling for patient and hospital characteristics revealed that Medicaid patients spent Medicaid patients spent an additional 0.4 days in shortest LOS hospitals and an additional 2.6 days in longest LOS hospitals (p < 0.001). The average daily cost of inpatient care was US $3,500 (SD, US $132). Even with conservative estimates, Medicaid patients at hospitals without easy access to rehabilitation incur significant additional inpatient costs over $10,000 in some hospitals.

CONCLUSION

Prolonged LOS is likely a function of access to postacute facilities, which is largely out of the hands of trauma centers. Efficiencies in care are magnified by access to postacute beds, suggesting that increased availability of rehabilitation facilities, particularly for Medicaid patients, might help to reduce LOS.

LEVEL OF EVIDENCE

Epidemiologic, level III; care management, level IV.
Accelerating structure-function mapping using the ViVa webtool to mine natural variation
Authors: Hamm Morgan O , Moss Britney L , Leydon Alexander R , Gala Hardik P , Lanctot Amy , Ramos Román , Klaeser Hannah , Lemmex Andrew C , Zahler Mollye L , Nemhauser Jennifer L , Wright R Clay
Published: December 2018

Thousands of sequenced genomes are now publicly available capturing a significant amount of natural variation within plant species; yet, much of this data remains inaccessible to researchers without significant bioinformatics experience. Here, we present a webtool called ViVa (Visualizing Variation) which aims to empower any researcher to take advantage of the amazing genetic resource collected in the Arabidopsis thaliana 1001 Genomes Project (http://1001genomes.org). ViVa facilitates data mining on the gene, gene family or gene network level. To test the utility and accessibility of ViVa, we assembled a team with a range of expertise within biology and bioinformatics to analyze the natural variation within the well-studied nuclear auxin signaling pathway. Our analysis has provided further confirmation of existing knowledge and has also helped generate new hypotheses regarding this well studied pathway. These results highlight how natural variation could be used to generate and test hypotheses about less studied gene families and networks, especially when paired with biochemical and genetic characterization. ViVa is also readily extensible to databases of interspecific genetic variation in plants as well as other organisms, such as the 3,000 Rice Genomes Project (http://snp-seek.irri.org/) and human genetic variation (https://www.ncbi.nlm.nih.gov/clinvar/).
Estimation of swine movement network at farm level in the US from the Census of Agriculture data
Authors: Moon Sifat A. , Ferdousi Tanvir , Self Adrian , Scoglio Caterina M.
Published: December 2018

Swine movement networks among farms/operations are an important source of information to understand and prevent the spread of diseases, nearly nonexistent in the United States. An understanding of the movement networks can help the policymakers in planning effective disease control measures. The objectives of this work are: 1) estimate swine movement probabilities at the county level from comprehensive anonymous inventory and sales data published by the United States Department of Agriculture - National Agriculture Statistics Service database, 2) develop a network based on those estimated probabilities, and 3) analyze that network using network science metrics. First, we use a probabilistic approach based on the maximum entropy method to estimate the movement probabilities among different swine populations. Then, we create a swine movement network using the estimated probabilities for the counties of the central agricultural district of Iowa. The analysis of this network has found evidence of small-world phenomenon. Our study suggests that the US swine industry may be vulnerable to infectious disease outbreaks because of the small-world structure of its movement network. Our system is easily adaptable to estimate movement networks for other sets of data, farm animal production systems, and geographic regions.
PhyloSuite: an integrated and scalable desktop platform for streamlined molecular sequence data management and evolutionary phylogenetics studies
Authors: Zhang Dong , Gao Fangluan , Li Wen X , Jakovlić Ivan , Zou Hong , Zhang Jin , Wang Gui T
Published: December 2018

Multi-gene and genomic datasets have become commonplace in the field of phylogenetics, but many of the existing tools are not designed for such datasets, which makes the analysis time-consuming and tedious. We therefore present PhyloSuite, a user-friendly workflow desktop platform dedicated to streamlining molecular sequence data management and evolutionary phylogenetics studies. It employs a plugin-based system that integrates a number of useful phylogenetic and bioinformatic tools, thereby streamlining the entire procedure, from data acquisition to phylogenetic tree annotation, with the following features: (i) point-and-click and drag-and-drop graphical user interface, (ii) a workspace to manage and organize molecular sequence data and results of analyses, (iii) GenBank entries extraction and comparative statistics, (iv) a phylogenetic workflow with batch processing capability, (v) elaborate bioinformatic analysis for mitochondrial genomes. The aim of PhyloSuite is to enable researchers to spend more time playing with scientific questions, instead of wasting it on conducting standard analyses. The compiled binary of PhyloSuite is available under the GPL license at https://github.com/dongzhang0725/PhyloSuite/releases, implemented in Python and runs on Windows, Mac OSX and Linux.
A reevaluation of the electrophysiological correlates of absolute pitch and relative pitch: No evidence for an absolute pitch-specific negativity.
Authors: Leipold Simon , Oderbolz Chantal , Greber Marielle , Jaencke Lutz
Published: December 2018

Musicians with absolute pitch effortlessly identify the pitch of a sound without an external reference. Previous neuroscientific studies on absolute pitch have typically had small samples sizes and low statistical power, making them susceptible for false positive findings. In a seminal study, Itoh et al. (2005) reported the elicitation of an absolute pitch-specific event-related potential component during tone listening - the AP negativity. Additionally, they identified several components as correlates of relative pitch, the ability to identify relations between pitches. Here, we attempted to replicate the main findings of Itoh et al.'s study in a large sample of musicians (n = 104) using both frequentist and Bayesian inference. We were not able to replicate the presence of an AP negativity during tone listening in individuals with high levels of absolute pitch, but we partially replicated the findings concerning the correlates of relative pitch. Our results are consistent with several previous studies reporting an absence of differences between musicians with and without absolute pitch in early auditory evoked potential components. We conclude that replication studies form a crucial part in assessing extraordinary findings, even more so in small fields where a single finding can have a large impact on further research.
Resequencing and association mapping of the generalist pathogenBotrytis cinerea
Authors: Atwell Susanna , Corwin Jason A. , Soltis Nicole , Zhang Wei , Copeland Daniel , Feusier Julie , Eshbaugh Robert , Kliebenstein Daniel J.
Published: December 2018

We performed whole genome resequencing of 84 field isolates ofBotrytis cinerea, largely collected from a local set of plant species. Combined with 13 previously resequenced isolates sampled from diverse locations, this gave a collection of 97 isolates for studies of natural variation. Alignment to the reference sequence T4 and SNP detection provided further data for population genetics analysis including a mapping population for association studies. Although much of the genomic diversity was captured in the original 13 isolates, the additional genomes increased total diversity in the population by a third. Surprisingly, the same additional genomes increase mitochondrial diversity 2-fold. Across the population, LD was limited and decayed rapidly, reflecting frequent outcrossings. Effectively, this sampling strategy increased the level of genetic diversity available, whilst limiting the problem of population stratification and enabling GWAS of several phenotypes on commonArabidopsisplants affected in disease pathways. Overlap of results using all GWAS methods revealed numerous candidate genes / pathways that potentially contribute to its broad host range and offer conceivable pathogen decrease targets.
Cerebrospinal fluid transcriptional analyses reveals upregulation of IL-17, Type 1 interferon transcriptional pathways and neutrophil persistence genes associated with increased mortality from pneumococcal meningitis in adults
Authors: Wall Emma C , Guerra-Assunção José Afonso , Pollara Gabriele , Venturini Cristina , Mlozowa Veronica S , Allain Theresa J , Lalloo David G , Noursadeghi Mahdad , Brown Jeremy S , Heyderman Robert S
Published: December 2018

Background

Improving outcomes from pneumococcal meningitis (PM), particularly in populations with high HIV prevalence, requires better understanding of host inflammatory responses to infection.

Methods

We compared the transcriptome in pre-antibiotic cerebrospinal fluid (CSF) and blood from Malawian adults with PM using RNA sequencing. We used network analyses and cellular/process deconvolution of the transcriptome to identify important patho-physiological associations with outcome.

Findings

Blood transcriptional profiles were obtained in 28 patients (21 HIV co-infected; median age 33 years [26-66]; median CSF WCC 28 cells/mm3 [0-3660]; median bacterial load 4.7×106 copies/ml CSF [671-2×109]; in-hospital mortality 64%), paired CSF profiles were obtained in 13. Marked differences in gene expression by outcome were confined to the CSF. In non-survivors, differentially expressed genes in the CSF were co-correlated in a network of pro-inflammatory gene-clusters enriched for collagen degradation and platelet degranulation. In contrast, CSF gene expression networks from surviving patients were dominated by DNA repair, transcriptional regulation and immunological signalling. CSF expression of gene response-modules for IL-17, Type 1 interferons and IL-10 were enriched in non-survivors, expression of cell-specific response-modules did not differ by outcome. However, genes for neutrophil chemotaxis and persistence were highly over-expressed in non-survivors.

Interpretation

These data suggest poor outcome in PM is associated with over-expression of IL-17 and T1-IFN associated pro-inflammatory responses in the CSF and suggest a role for neutrophil-mediated inflammation. These responses are unlikely to be effected by current adjunctive treatments. Improving poor outcomes from PM will require better-targeted interventions.

Funding

Academy of Medical Sciences (UK), Wellcome Trust (UK) (089671/B/09/Z)
Arterial carboxyhaemoglobin levels in children admitted to PICU: a retrospective observational study
Authors: Chawla Ankur , Ray Samiran , Matettore Adela , Peters Mark
Published: December 2018

While carbon monoxide (CO) is considered toxic, low levels of endogenously produced CO are protective against cellular injury induced by oxidative stress. Carboxyhaemoglobin (COHb) levels have been associated with outcomes in critically ill adults. We aimed to describe the distribution of carboxyhaemoglobin in critically ill children and the relationship of these levels with clinical outcomes. This retrospective observational study was conducted at a large tertiary paediatric intensive care unit (PICU). We included all children admitted to the PICU over a two-year period who underwent arterial blood gas analysis. We measured the following: Population and age-related differences in COHb distribution; (ii) Change in COHb over the first week of admission using a multi-level linear regression analysis; (ii) Uni- and multivariable relationships between COHb and length of ventilation and PICU survival. Arterial COHb levels were available for 559/2029 admissions. The median COHb level was 1.20% (IQR 1.00-1.60%). Younger children had significantly higher COHb levels (p-value <2 x 10-16). Maximum Carboxyhaemoglobin was associated with survival 1.67 (95% CI 1.01-2.57, p-value=0.02) and length of ventilation (odds ratio 5.20, 95% CI 3.07-7.30, p-value 1.8 x 10-6) following multi-variable analysis. First measured and minimum COHb values were weakly associated with length of ventilation, but not survival. In conclusion, children have increased COHb levels in critical illness, which are greater in younger children. Higher COHb levels are associated with longer length of ventilation and death in PICU. This is likely to reflect increased oxidative stress.
To: Plos One Knowledge, experiences and perceptions of the Ghana National Health Insurance Scheme in three districts
Authors: Fuseini Sataru , Anthony Seddoh
Published: December 2018

Background
Ghana’s National Health Insurance Scheme is a demand side programme where the governing authority registers clients and purchases health care services for them from public and private providers. Access of services is high across a broad Benefits Package with no parallel enrolment necessary for any type of service at the point of access. Nonetheless, there is evidence of difficulty in acquiring and use of the NHIS card to access health care services.
Objective
While studies had been conducted into general awareness, there was no linkage between awareness, uptake and experiences with registration and use of the card. This study fills this gap.
Methods
This is a descriptive study. A mix of qualitative (39 Focus Group Discussions) and quantitative (625 household interviews) methods were used to collect the data. Qualitative data was analysed manually using a thematic approach while a frequency analysis was done for the quantitative data.
Results
Knowledge about the Scheme was near universal. Enrolment was lower among FGD discussants, 38.7% had valid cards, than for household respondents, 62.9% valid cards. While mixed experiences with the registration process was observed among FGD discussants, 74% of the households’ ranked attitudes of Scheme staff as positive. The study found the NHIS card facilitates access to facility based health care. Satisfaction levels with use of the card were mixed and contextual among discussants. However, 90% of households reported their cards were readily accepted at health facilities. Expired card (51.4%) and health facility had stopped accepting NHIS cards (14.3%) were mentioned as reasons for non-acceptance.
Conclusion
People’s experience during registration and use of the NHIS card to access health care has lasting effect on their perceptions of the Scheme. This can be harnessed to manage the high expectations, grow membership, discourage frivolous use and address artificial barriers of access.
Petrosal morphology and cochlear function in Mesozoic stem therians
Authors: Harper Tony , Rougier Guillermo
Published: December 2018

Here we describe the bony anatomy of the inner ear and surrounding structures seen in three of the most plesiomorphic crown mammalian petrosal specimens in the fossil record. Our study sample includes the stem therian taxa Priacodon fruitaensis from the Upper Jurassic of North America, and two isolated petrosal specimens colloquially known as the Höövör petrosals, recovered from Aptian-Albian sediments in Mongolia. The second Höövör petrosal is here described at length for the first time. All three of these stem therian petrosals and a comparative sample of extant mammalian taxa have been imaged using micro-CT, allowing for detailed anatomical descriptions of osteological correlates of functionally significant neurovascular features, especially along the abneural wall of the cochlear canal.
The high resolution imaging provided here clarifies several hypotheses regarding the mosaic evolution of features of the cochlear endocast in early mammals. In particular, these images demonstrate that the membranous cochlear duct adhered to the bony cochlear canal abneurally to a secondary bony lamina before the appearance of an opposing primary bony lamina or tractus foraminosus. Additionally, while corroborating the general trend of reduction of venous sinuses and plexuses within the pars cochlearis seen in crownward mammaliaformes generally, the Höövör petrosals show the localized enlargement of a portion of the intrapetrosal venous plexus. This new excavation is for the vein of cochlear aqueduct, a structure that is solely or predominantly responsible for the venous drainage of the cochlear apparatus in extant therians. However, given that these stem therian inner ears appear to have very limited high-frequency capabilities, the development of these modern vascular features the cochlear endocast suggest that neither the initiation or enlargement of the stria vascularis (a unique mammalian organ) is originally associated with the capacity for high-frequency hearing or precise sound-source localization.
A qualitative exploration of eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care
Authors: Jalbert Isabelle , Rahardjo Dian , Yashadhana Aryati , Liew Gerald , Gopinath Bamini
Published: December 2018

Despite the existence of evidence-based recommendations to decrease risk and progression of Age-Related Macular Degeneration (AMD) for some time, self-reported practices suggest that eyecare professionals’ advice and people with AMD’s adherence to these recommendations can be very poor. This study uses qualitative methods to explore Australian eyecare professionals’ perspective on barriers to effective AMD care. Seven focus groups involving 65 optometrists were conducted by an experienced facilitator. A nominal group technique was used to identify, prioritize and semi-quantify barriers and enablers to AMD care. Participants individually ranked their perceived top five barriers and enablers with the most important granted a score of 5 and the least important a score of 1. For each barrier or enabler, the number of votes it received and its total score were recorded. Barriers and enablers selected by at least one participant in their top 5 were then qualitatively analysed, grouped using thematic analysis and total score calculated for each consolidated barrier or enabler. In-depth individual interviews were conducted with 10 ophthalmologists and 2 optometrists. Contributions were audio-recorded, transcribed verbatim and analysed with NVivo software. One hundred and sixty-nine barriers and 51 enablers to AMD care were identified in the focus groups. Of these, 102 barriers and 42 enablers were selected as one of their top 5 by at least one participant and further consolidated into 16 barriers and 10 enablers after thematic analysis. Factors impacting AMD care identified through analysis of the transcripts were coded to three categories of influence: patient-centered, practitioner-centered, and structural factors. Eyecare professionals considered poor care pathways, people with AMD’s poor disease understanding / denial, and cost of care / lack of funding, as the most significant barriers to AMD care; they considered shared care model, access, and communication as the most significant enablers to good AMD care. These findings suggest that Australian eyecare professionals perceive that there is a need for improved patient support systems and appropriately funded, clearer care pathway to benefit people with AMD.
Replicative senescense as a consequence of stochastic processes
Authors: Fendrik Alejandro José , Romanelli Lilia , Rotondo Ernesto
Published: December 2018

The aging of multicellular organisms is a complex problem. It has been the subject of extensive research and have led to various theories. One of the remarkable features of aging is that is accompanied by the decrease in the rate of cell replication in tissue regeneration processes (replicative senescence). In the present work, we will show, if sporadic cell alterations occur in a homogenous set of stem cells, they lengthen the cell cycle and these are fixed with greater probability than non-altered stem cells.This effect is due to the inherent characteristics of the renewal dynamics and as time goes by it leads to a quiescence state for stem cells due to the recurrent fixation of such altered cell.
Molecular mechanism of the Orai channel activation
Authors: Liu Xiaofen , Wu Guangyan , Yu Yi , Chen Xiaozhe , Ji Renci , Lu Jing , Li Xin , Zhang Xing , Yang Xue , SHEN Yuequan
Published: December 2018

The Orai channel is characterized by voltage independence, low conductance and high Ca2+ selectivity and plays an important role in Ca2+ influx through the plasma membrane. How the channel is activated and promotes Ca2+ permeation are not well understood. Here, we report the crystal structure and cryo-electron microscopy reconstruction of a Drosophila melanogaster Orai mutant (P288L) channel that is constitutively active according to electrophysiology. The open state of the Orai channel showed a hexameric assembly in which six TM1 helices in the center form the ion-conducting pore, and six TM4 helices in the periphery form extended long helices. Orai channel activation requires conformational transduction from TM4 to TM1 and eventually causes the basic section of TM1 to twist outward. The wider pore on the cytosolic side aggregates anions to increase the potential gradient across the membrane and thus facilitate Ca2+ permeation. The open-state structure of the Orai channel offers insights into channel assembly, channel activation and Ca2+ permeation.
The impact of leadership styles on knowledge-sharing behavior: a review of literature
Authors: Mishra Madhurima , Pandey Agrata
Published: December 2018

Purpose

This study aims to summarize the extant literature investigating the impact of leadership styles on the knowledge-sharing behavior of followers in the organizational context.

Design/methodology/approach

A thorough review of the literature was conducted. Empirical, as well as conceptual, studies examining the relationship between leadership styles and follower knowledge-sharing behavior were reviewed.

Findings

Based on the findings of the studies reviewed, a theoretical framework is presented. The framework lists various leadership styles that have been found to significantly affect desirable individual- and team-level outcomes through a host of underlying mechanisms and subsequent knowledge sharing by the subordinates.

Practical implications

The theoretical framework proposed in this study holds direct relevance for practicing managers. It provides a range of leadership styles that managers may choose from and practice to successfully elicit knowledge sharing among their subordinates.

Originality/value

Considering the vast array of studies exploring the role of leadership in predicting followers’ knowledge-sharing behavior, the present study contributes by summarizing the scattered literature on the same. The framework is of immediate value to executives and saves hours of reading time by presenting the most relevant information in a condensed and easy-to-digest format.
Relationship between team culture and team performance through lens of knowledge sharing and team emotional intelligence
Authors: Jamshed Samia , Majeed Nauman
Published: December 2018

Purpose

The purpose of this study is to investigate the relationship between team culture and team performance through the mediating role of knowledge sharing and team emotional intelligence.

Design/methodology/approach

The study advocated that team culture influences the knowledge sharing behavior of team members and the development of emotional intelligence skill at the team level. Further, it is hypothesized that knowledge sharing and team emotional intelligence positively influence team performance. By adopting a quantitative research design, data were gathered by using a survey questionnaire from 535 respondents representing 95 teams working in private health-care institutions.

Findings

The findings significantly indicated that knowledge sharing and team emotional intelligence influence team working. Furthermore, this study confirms the strong association between team culture and team performance through the lens of knowledge sharing and team emotional intelligence.

Practical implications

This investigation offers observational proof to health-care services to familiarize workers with the ability of emotional intelligence and urge them to share knowledge for enhanced team performance. The study provides in-depth understanding to managers and leaders in health-care institutions to decentralize culture at the team level for endorsement of knowledge sharing behavior.

Originality/value

This is amongst one of the initial studies investigating team members making a pool of knowledge to realize potential gains enormously and influenced by the emotional intelligence. Team culture set a platform to share knowledge which is considered one of the principal execution conduct essential for accomplishing and managing team adequacy in a sensitive health-care environment.
A public goods model of outcomes from online knowledge sharing mediated by mental model processing
Authors: Rice Ronald E. , Heinz Marni , van Zoonen Ward
Published: December 2018

Purpose

This study aims to take a public goods approach to understand relationships between collecting and contributing knowledge to an online knowledge sharing portal (KSP), mental model processing and outcomes at the individual and collective levels.

Design/methodology/approach

This study reports on a survey (N = 602) among tax professionals, examining the perceived individual and collective benefits and costs associated with collecting and contributing knowledge. Hypotheses were tested using structural equation modeling.

Findings

Collecting and contributing knowledge led to considerable mental model processing of the knowledge. That in turn significantly influenced (primarily) individual and (some) collective costs and benefits. Results varied by the kinds of knowledge sharing. Whether directly from knowledge sharing, or mediated through mental modeling, the perceived costs and benefits may be internalized as an individual good rather than being interpreted at the collective level as a public good.

Research limitations/implications

The study is situated in the early stages of a wiki-type online KSP. A focus on the learning potential of the system could serve to draw in new users and contributors, heightening perceptions of the public goods dimension of a KSP.

Practical implications

A focus on the learning potential of the system could serve to draw in new users, and thus the number of subsequent contributors, heightening perceptions of the collective, public goods dimension of a KSP.

Originality/value

This study explores how knowledge sharing and mental model processing are directly and indirectly associated with individual and collective costs and benefits. As online knowledge sharing is both an individual and public good, costs and benefits must be considered from both perspectives.
The fall risk assessment and correlated factors among Iranians’ older adults
Authors: Salehi Leili , Akhondzadeh Elham , Esmaelzadeh Saeieh Sara , Yazd Khasti Mansoureh
Published: December 2018

Purpose

Falling was distinguished as leading cause of fatal and non-fatal injuries among elderly; there is a lack of information regarding the falling risk factors in developing countries. The purpose of this paper is to investigate the falling risk and correlated factors in community-dwelling elderly.

Design/methodology/approach

This cross-sectional study was performed on 280 elderly using a multi-sectional questionnaire in Karaj, Iran. The simple stratified random sampling was used. Adult who were over the age of 60, living independently, able to ambulate independently and safely, no cognition problem and speaking in Persian entered in the study. Exclusion criteria were residing in assisted living facility or unwilling to participate. Several statistical tests including logistic regression analysis were used to analyse the data.

Findings

The mean age of participants was 69.55±8.82 and 51 per cent of them were female. The results showed that there are significant differences between low-, medium- and high-risk groups regarding age, marital status, diabetes, blood pressure and osteoarthritis (p<0.05). Due to finding, the main predictors to higher chance of falling were age (OR=1.61; 95% CI 1.025–1.097), marital status (OR=1.485; 95% CI 1.170–1.279), vision acuity (OR=1.603; 95% CI 1.297–2.223), activities of daily living (OR=2.10; 95% CI 1.047–3.859), heart disease (OR=1.448; 95% CI 1.268–1.728), osteoarthritis (OR=1.238; 95% CI 1.711–2.127), falling history (OR=1.026; 95% CI 1.015–1.089) and medication (OR=5.975; 95% CI 1.525–23.412).

Practical implications

Better understanding of falling risk factors can lead to the implementation of effective preventive intervention, thus reducing public health expenditure, and improving the quality of life.

Originality/value

This study was conducted for the first time to assess the risk of falling in older people in Iran.