bluuebunny/crossref_metadata_2025 huggingface dataset:
Essential role of endogenous calcitonin gene‐related peptide in pain‐associated plasticity in the central amygdala
Authors: Shinohara Kei , Watabe Ayako M. , Nagase Masashi , Okutsu Yuya , Takahashi Yukari , Kurihara Hiroki , Kato Fusao
Published: August 2017

The role of the neuropeptide calcitonin gene‐related peptide (CGRP) is well established in nociceptive behaviors. CGRP is highly expressed in the projection pathway from the parabrachial nucleus to the laterocapsular region of the central amygdala (CeC), which plays a critical role in relaying nociceptive information. The CeC is a key structure in pain behavior because it integrates and modulates nociceptive information along with other sensory signals. Previous studies have demonstrated that blockade of the amygdalar CGRP‐signaling cascade attenuates nociceptive behaviors in pain models, while CGRP application facilitates amygdalar synaptic transmission and induces pain behaviors. Despite these lines of evidence, it remains unclear whether endogenous CGRP is involved in the development of nociceptive behaviors accompanied with amygdalar plasticity in a peripheral inflammation model in vivo. To directly address this, we utilized a previously generated CGRP knockout (KO) mouse to longitudinally study formalin‐induced plasticity and nociceptive behavior. We found that synaptic potentiation in the right PB‐CeC pathway that was observed in wild‐type mice was drastically attenuated in the CGRP KO mice 6 h post‐inflammation, when acute nociceptive behavior was no longer observed. Furthermore, the bilateral tactile allodynia 6 h post‐inflammation was significantly decreased in the CGRP KO mice. In contrast, the acute nociceptive behavior immediately after the formalin injection was reduced only at 20–25 min post‐injection in the CGRP KO mice. These results suggest that endogenous CGRP contributes to peripheral inflammation‐induced synaptic plasticity in the amygdala, and this plasticity may underlie the exaggerated nociception–emotion linkage in pain chronification.
Changes in structure and perfusion of grey matter tissues during recovery from Ischaemic subcortical stroke: a longitudinal MRI study
Authors: Yu Xinfeng , Yang Linglin , Song Ruirui , Jiaerken Yerfan , Yang Jun , Lou Min , Jiang Quan , Zhang Minming
Published: August 2017

Stroke recovery with changes in volume and perfusion of grey matter (GM) tissues remains largely unknown. We hypothesized that GM atrophy co‐existed with GM plasticity presenting with increased volume and perfusion in specific regions in the period of post‐stroke recovery. Twelve well‐recovered stroke patients with pure subcortical lesions in the middle cerebral artery‐perfused zone were included. All of them underwent structural and perfusion magnetic resonance imaging (MRI) examinations at admission and a mean of 6 months after stroke onset. Differences in GM volume (GMV) on structural images and cerebral blood flow (CBF) derived from perfusion images between two examinations were compared using voxel‐based morphometry. The associations between changes in GMV and CBF with clinical scores were analysed. Decreased GMV was found in post‐central gyrus, pre‐central gyrus, precuneus, angular gyrus, insula, thalamus and cerebellum, and increased GMV was found in hippocampus, orbital gyrus and lingual gyrus (all corrected P < 0.05) at the follow‐up examination. Increased CBF was found in subcallosal cingulate gyrus, hippocampus and lingual gyrus (all corrected P < 0.05) at the follow‐up examination. Only decreased GMV in the anterior lobe of cerebellum was negatively associated with improvement of Barthel index (β = −0.683, P = 0.014). Our study provides the imaging evidence of GM atrophy co‐existing with GM plasticity involving in increased volume and perfusion in specific regions (including cognition, vision and emotion) in well‐recovered stroke patients, which advances our understanding of neurobiology of stroke recovery.
Splenic abscessation in the horse: A retrospective study of 12 cases
Authors: Coleman M. C. , Schmitz D. G.
Published: August 2017

This paper summarises the clinical findings of 12 cases of splenic abscessation in horses presented to Texas A&M University Veterinary Medical Teaching Hospital from 1993 to 2015. The objective of this study was to describe the signalment, clinical and laboratory findings, diagnostics, treatment and outcome of horses affected with splenic abscessation. Only horses in which a splenic abscess was confirmed by microbiological or cytological confirmation from a percutaneous, surgical, or necropsy sample were included in this study. No apparent breed or sex predilection was identified. The mean age of presentation was 9 years, with a range of 1–21 years of age. The most common presenting clinical signs were nonspecific signs including fever, anorexia and lethargy. A variety of bacterial organisms were identified and treatment with antimicrobial agents or surgical exploration was attempted in several of the cases. None of the cases survived to discharge from the hospital.
Congenital occipitoatlantoaxial malformation in a Warmblood mare
Authors: Brünisholz H. P. , Wildhaber N. , Hoey S. , Ruetten M. , Boos A. , Kümmerle J. M.
Published: August 2017

A 3‐year‐old Warmblood mare was presented with spinal ataxia of 3 months’ duration. Clinically, reduced mobility of the neck and a prominent atlas were identified. Neurological evaluation revealed hypermetria, circumduction and reduced proprioception, predominantly in the hindlimbs. Occipitoatlantoaxial malformation (OAAM) was diagnosed based on radiography and computed tomography, and confirmed on post‐mortem magnetic resonance imaging and pathological examination. Both the atlas and axis were hypoplastic and dysplastic, and a fusion of the atlanto‐occipital joint was found. A dynamic compression of the spinal cord was present at the first and second cervical vertebrae. Histologically, the spinal cord was degenerated due to compression. Furthermore, there were muscular malformations including a fibrotic obliquus capitis cranialis muscle, aplasia of parts of the rectus capitis muscles and presence of additional abnormal muscle. Such muscular abnormalities associated with OAAM have not been reported yet and this is the first report of a case of OAAM in a Warmblood horse.
Managing Internal Supply Chain Integration: Integration Mechanisms and Requirements
Authors: Turkulainen Virpi , Roh Joseph , Whipple Judith M. , Swink Morgan
Published: August 2017

In response to globalization, diversification, and other organizational drivers, managers continue to seek organizational designs that promote integration. We study this phenomenon by focusing on requirements and mechanisms for internal supply chain integration (SCI). Using qualitative interview data, we examine how managers in manufacturing firms integrate internal supply chain activities. We elaborate and extend the information processing view by studying why organizations integrate (integration requirements) and how integration mechanisms are associated with different integration requirements. Four patterns of integration requirement–mechanism linkages emerged from our study, depicting integration mechanisms that are associated with a particular integration requirement, and those that are not. We provide a detailed examination of the multidimensional nature of integration requirements, as well as an increased understanding of how integration mechanisms are used to manage different integration requirements. These findings offer deeper insights into organizational integration, enhancing the understanding of integration in the context of internal supply chains, while also contributing to the literature on organizational design. For supply chain managers, these findings describe ways in which organizational design decisions can support internal SCI efforts with varying aims.
A Primer on Moderated Mediation Analysis: Exploring Logistics Involvement in New Product Development
Authors: Calantone Roger , Whipple Judith M. , Wang Joyce (Feng) , Sardashti Hanieh , Miller Jason W.
Published: August 2017

Theorizing and empirically testing moderated mediation hypotheses allows logistics and supply chain management (L&SCM) scholars to extend the boundaries of our current understanding by examining how, when, and why relationships arise between constructs central to our theories. However, while moderated mediation analyses can enrich theory in L&SCM, they are few in number, likely due to the complexities associated with their execution. In this article, we provide a didactic treatment for executing moderated mediation analysis. We do so using primary data regarding logistics involvement in new product development. In the hopes of spurring greater application of moderated mediation in L&SCM, we devise a series of recommendations that guide scholars through the process of conducting such analyses. These recommendations extend prior treatments by explaining how to address challenges associated with devising theories to undergird moderated mediation hypotheses, measuring constructs using multiple indicators, providing guidance for detecting influential cases that can unduly affect results, and integrating what results should be reported.
Reply to Comment on: Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End‐Stage Renal Disease
Authors: Balogun Seki A. , Balogun Rasheed , Philbrick John , Rahman Emaad Abdel
Published: August 2017

This letter comments on the Letter by Nancy G. Kutner
Indoor and outdoor winter activity of Culicoides biting midges, vectors of bluetongue virus, in Italy
Authors: MAGLIANO A. , SCARAMOZZINO P. , RAVAGNAN S. , MONTARSI F. , DA ROLD G. , CINCINELLI G. , MONI A. , SILVESTRI P. , CARVELLI A. , DE LIBERATO C.
Published: August 2017

Indoor and outdoor winter activity of Culicoides spp. (Diptera: Ceratopogonidae) in central Italy was investigated in order to evaluate whether indoor activity might account for the overwintering of bluetongue virus, as has been hypothesized by some authors. Weekly Culicoides collections were performed at three farms over three consecutive winter seasons. At each farm, two black‐light traps were operated simultaneously, indoors and outdoors. Culicoides were identified using both morphological and molecular means. The Culicoides obsoletus group accounted for 98.2% of sampled specimens. Within this group, C. obsoletus s.s. accounted for 56.8% and Culicoides scoticus for 43.2% of samples. Nulliparous, parous and engorged females were caught throughout the entire winter, both indoors and outdoors. At times, indoor catch sizes outnumbered outdoor collections. A significant inverse correlation was found between minimum temperature and the proportion of indoor Culicoides of the total midge catch, thus indicating that lower outdoor temperatures drive Culicoides midges indoors. High rates of engorged females were recorded indoors, possibly as the result of the propensity of C. obsoletus females to feed indoors. Higher proportions of parous females were found in indoor than in outdoor catches, indicating higher survival rates indoors and, consequently, higher vectorial capacities of midges sheltering indoors compared with those remaining outdoors.
Reference conditions for restoration of heterogeneous Mediterranean wetland are best defined by multiple, hydrologically diverse sites
Authors: Vélez‐Martín Alberto , Davy Anthony J. , Luque Carlos J. , Castellanos Eloy M.
Published: August 2017

In a Mediterranean climate, the vegetation of embanked salt marshes can vary considerably in time and space to obscure the definition of reference condition for restoration purposes. The aim of our study was to find a basis for defining reference vegetation for the reinstatement of a wetland hydrological regime on abandoned agricultural land. We investigated five reference sites surrounding a 2,668 ha restoration site in the Doñana National Park (southwest Spain). Environmental conditions were monitored on a sampling grid for 7 years: surface elevation and hydroperiod were mapped (using Light Detection and Ranging [LIDAR] and satellite imagery, respectively) and rainfall, soil salinity, and soil pH were recorded. The reference sites collectively encompassed the range of elevation and environmental conditions at the restoration site, although none individually was representative. The vegetation at the reference sites was sampled annually at fixed grid points. Hierarchical cluster analyses identified assemblages of perennial and annual species that were differently distributed among the reference sites. BIO‐ENV analysis showed that the distribution of perennial assemblages was determined by elevation, annual hydroperiod, and salinity. More labile annual assemblages were loosely associated with particular perennial ones. Species composition fluctuated over 7 years, in concert with rainfall and hydroperiod, but showed no directional change. Understanding the hydrochemical drivers of spatiotemporal variation in vegetation across multiple sites has established a rationale for defining reference conditions for large, heterogeneous wetland restoration sites.
Intranational Price Convergence and Price Stickiness: Evidence from Denmark
Authors: Michael Bergman U. , Hansen Niels Lynggård , Heeb⊘ll Christian
Published: August 2017

We show that estimates of the half‐life of deviations from the law of one price are biased when their precision is not taken into account when aggregating data for different types of goods. Using a comprehensive dataset with monthly price data for 124 homogeneous products across regions in Denmark over the period 1997–2010, we find a large positive aggregation bias. On average, we find that the half‐life is 8.4 months when taking the bias into account, compared with 28.7 months when applying the standard method. The heterogeneity in the estimated half‐life can be explained by price stickiness, distance between regions, and whether the good is traded or non‐traded.
Aggressive Behaviors and Suicide Ideation in Inpatient Adolescents: The Moderating Roles of Internalizing Symptoms and Stress
Authors: Buitron Victor , Hartley Chelsey M. , Pettit Jeremy W. , Hatkevich Claire , Sharp Carla
Published: August 2017

The present study examined a conceptual model in which the association between aggressive behaviors and suicide ideation is moderated by internalizing symptoms and ongoing stress. Participants were 304 psychiatric inpatient adolescents (65.8% girls) ranging in age from 12 to 17 years (Mean age = 14.69). The association between aggressive behaviors and suicide ideation was significantly moderated by internalizing symptoms and ongoing stress; the association was positive in adolescents low in internalizing symptoms or high in ongoing stress, but negative in adolescents high in internalizing symptoms or low in ongoing stress. The three‐way interaction between aggressive behaviors, internalizing symptoms, and ongoing stress was not statistically significant. The current findings indicate that in adolescents who display high levels of aggressive behaviors, the presence of high ongoing stress provides a more useful indicator of levels of suicide ideation than the presence of high internalizing symptoms. Implications for case identification and prevention are discussed.
Race, Offense Type, and Suicide Ideation: Tests of the Interpersonal‐Psychological Theory in Juvenile Offenders
Authors: Cero Ian , Zuromski Kelly L. , Witte Tracy K. , Fix Rebecca L. , Burkhart Barry
Published: August 2017

This study evaluated the synergy hypothesis of the Interpersonal‐Psychological Theory of Suicide (IPTS), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despite adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at‐risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absence of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes.
Preoperative management of colorectal cancer–induced iron deficiency anemia in clinical practice: data from a large observational cohort
Authors: Laso‐Morales MaríaJesús , Jericó Carlos , Gómez‐Ramírez Susana , Castellví Jordi , Viso Lorenzo , Roig‐Martínez Inmaculada , Pontes Caridad , Muñoz Manuel
Published: August 2017

BACKGROUND

Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC.

STUDY DESIGN AND METHODS

This was a retrospective analysis of consecutive CRC resections at two Spanish centers (January 2012 to December 2013). Preoperative anemia was defined as a hemoglobin (Hb) level of less than 13 g/dL and treated with intravenous iron (IVI) or standard care (oral iron or no iron). Red blood cell transfusion (RBCT) requirements was the primary outcome variable. Postoperative infection rate and length of hospital stay (LOS) were secondary outcome variables. Patients were managed with a restrictive transfusion trigger (Hb < 8 g/dL). Infection was diagnosed clinically and confirmed by laboratory, microbiologic, and/or radiologic evidence.

RESULTS

Overall, 322 of 571 patients (56%) presented with anemia: 232 received IVI and 90 standard care. There were differences in RBCT rate between no anemia and anemia (2% vs. 16%; p < 0.01), but not in postoperative infections (19% vs. 22%; p = NS) or LOS. Compared to those on standard care, anemic patients on IVI presented with lower Hb (10.8 g/dL vs. 12.0 g/dL; p < 0.001) at baseline, but similar Hb on day of surgery and Postoperative Day 30. There were no between‐group differences in RBCT rates (16% vs. 17%; p = NS), but infection rates were lower among IVI‐treated patients (18% vs. 29%; p < 0.05). No relevant IVI‐related side effects were recorded.

CONCLUSION

Compared to standard care, IVI was more effective in treating preoperative anemia in CRC patients and appeared to reduce infection rate, although it did not reduce postoperative RBCT.
Low hepatitis E virus RNA prevalence in a large‐scale survey of United States source plasma donors
Authors: Roth Nathan J. , Schäfer Wolfram , Alexander Rick , Elliott Kevin , Elliott‐Browne Wlenyeno , Knowles Jonathan , Wenzel Jürgen J. , Simon Toby L.
Published: August 2017

BACKGROUND

Hepatitis E virus (HEV) is a small, nonenveloped, single‐stranded, RNA virus of emerging concern in industrialized countries. HEV transmission through transfusion of blood components has been reported, but not via plasma‐derived medicinal products (PDMPs) manufactured with virus inactivation and/or removal steps. This study aimed to determine the prevalence of HEV among US source plasma donors.

STUDY DESIGN AND METHODS

Samples were collected from US source plasma donors at centers across the United States and were initially screened for HEV RNA in 96‐sample minipools using the Roche cobas HEV test on the cobas 8800 system. Assuming a sensitivity of 18.6 IU/mL, the minipool screening strategy allowed for reliable detection of individual donations with HEV RNA titers of more than 2 × 103 IU/mL. Reactive minipools were resolved to individual donations, which were further analyzed to quantify viral RNA concentration, determine HEV genotype, and immunoglobulin (Ig)G and IgM HEV antibody status.

RESULTS

A total of 128,020 samples were collected from 96 CSL Plasma centers in the United States, representing 27 states. The prevalence of HEV RNA–positive samples was 0.002% with three unique HEV‐positive donors identified, all HEV Subgenotype 3a. Virus titers of HEV‐positive samples were relatively low (103‐104 IU HEV RNA/mL). One positive donation was HEV IgG seropositive.

CONCLUSION

Routine screening of US source plasma donations for HEV would not substantially improve the safety of most PDMPs. The low prevalence and potential viral load of HEV, together with effective virus reduction steps in manufacturing processes, results in a low residual risk and acceptable safety margins for PDMPs derived from US plasma donors.
Abrasive Wear of Polymer Fibers Investigated by Reciprocal Scratching in an Atomic Force Microscope
Authors: Giordano Michael , Schmid Steven , Arjmandi Mohammadreza , Ramezani Maziar
Published: August 2017

Three-dimensional (3D) woven fabrics have been considered by biomedical researchers to be used as load-bearing surfaces in joint and ligament replacements. In this regard, wear is a crucial phenomenon that determines material failure as well as biological response of body to wear debris. The current study evaluates various microscale screening methods with the aid of atomic force microscopy (AFM) for biocompatible polymer fibers that are used in 3D woven fabrics. Fibers in mono- and multi-filament forms were subjected to indentation, scratching, and line wear testing in dry and soaked conditions, and the effect of key parameters such as applied normal load, sliding velocity, and number of wear cycles was investigated. The area of worn material was determined by geometric approximation superimposed on the measured residual scratch of line wear. Moisture was found to lower the indentation hardness of some fibers while increasing the hardness of others. Line wear results clearly suggest ultrahigh molecular weight polyethylene (UHMWPE) to be the primary material for further investigation and that monofilament fibers should be avoided.
Indentation of a Transversely Isotropic Thermoporoelastic Half-Space by a Rigid Circular Cylindrical Punch
Authors: Huang Yilan , Xia Guozhan , Chen Weiqiu , Li Xiangyu
Published: August 2017

Exact solutions to the three-dimensional (3D) contact problem of a rigid flat-ended circular cylindrical indenter punching onto a transversely isotropic thermoporoelastic half-space are presented. The couplings among the elastic, hydrostatic, and thermal fields are considered, and two different sets of boundary conditions are formulated for two different cases. We use a concise general solution to represent all the field variables in terms of potential functions and transform the original problem to the one that is mathematically expressed by integral (or integro-differential) equations. The potential theory method is extended and applied to exactly solve these integral equations. As a consequence, all the physical quantities of the coupling fields are derived analytically. To validate the analytical solutions, we also simulate the contact behavior by using the finite element method (FEM). An excellent agreement between the analytical predictions and the numerical simulations is obtained. Further attention is also paid to the discussion on the obtained results. The present solutions can be used as a theoretical reference when practically applying microscale image formation techniques such as thermal scanning probe microscopy (SPM) and electrochemical strain microscopy (ESM).
Ducted Wind Turbine Optimization
Authors: Venters Ravon , Helenbrook Brian T. , Visser Kenneth D.
Published: August 2017

This study presents a numerical optimization of a ducted wind turbine (DWT) to maximize power output. The cross section of the duct was an Eppler 423 airfoil, which is a cambered airfoil with a high lift coefficient (CL). The rotor was modeled as an actuator disk, and the Reynolds-averaged Navier–Stokes (RANS) k–ε model was used to simulate the flow. The optimization determined the optimal placement and angle for the duct relative to the rotor disk, as well as the optimal coefficient of thrust for the rotor. It was determined that the optimal coefficient of thrust is similar to an open rotor in spite of the fact that the local flow velocity is modified by the duct. The optimal angle of attack of the duct was much larger than the separation angle of attack of the airfoil in a freestream. Large angles of attack did not induce separation on the duct because the expansion caused by the rotor disk helped keep the flow attached. For the same rotor area, the power output of the largest DWT was 66% greater than an open rotor. For the same total cross-sectional area of the entire device, the DWT also outperformed an open rotor, exceeding Betz's limit by a small margin.
A one-school year longitudinal study of secondary school teachers' voice parameters and the influence of classroom acoustics
Authors: Calosso Giulia , Puglisi Giuseppina Emma , Astolfi Arianna , Castellana Antonella , Carullo Alessio , Pellerey Franco
Published: August 2017

Recent literature reports that a large percentage of teachers complain that teaching has an adverse effect on their voice status. Thus, more needs to be done to study their vocal behavior. The objective of this longitudinal study was twofold: to determine changes in the voice use of teachers over a school year, and to study the relationships between voice use and classroom acoustic parameters. Thirty-one teachers from two secondary schools in Turin (Italy) were involved at the beginning of the 2014–2015 school year, and 22 of them also participated at the end of the same school year. The results show that teachers adjust their voices with noise and reverberation. A minimum value of the sound pressure level of voice (SPL) was found at a mid-frequency reverberation time of 0.8 s in both periods. Moreover, the teachers who worked in the worst classroom acoustic conditions showed an increase of 2.3 dB in the mean SPL and a decrease of 10% in the voicing time percentage at the end of the school year. A predictive model that can be used to estimate the mean SPL from the background noise level and the reverberation time, based on collected data, is here proposed.
Effects of Echinocandins in Combination with Nikkomycin Z against Invasive Candida albicans Bloodstream Isolates and the
fks
Mutants
Authors: Cheung Yuk-Yam , Hui Mamie
Published: August 2017

We evaluated the
in vitro
and
in vivo
effects of nikkomycin Z combined with an echinocandin (anidulafungin or micafungin) against two
Candida albicans
isolates and their lab-derived echinocandin-resistant
fks
mutants with FKS1 S645Y and FKS1 S645P. Synergistic effects were observed in all tested strains (fractional inhibitory concentration index, <0.5). Enhanced survival was observed in an immunocompromised murine model (log-rank test,
P
< 0.02). Our study demonstrated the therapeutic potential of nikkomycin Z-echinocandin combinations in managing echinocandin resistance.
Activation of Bvg-Repressed Genes in Bordetella pertussis by RisA Requires Cross Talk from Noncooperonic Histidine Kinase RisK
Authors: Chen Qing , Ng Victoria , Warfel Jason M. , Merkel Tod J. , Stibitz Scott
Published: August 2017

The two-component response regulator RisA, encoded by open reading frame BP3554 in the
Bordetella pertussis
Tohama I genomic sequence, is a known activator of
vrg
genes, a set of genes whose expression is increased under the same environmental conditions (known as modulation) that result in repression of the
bvgAS
virulence regulon. Here we demonstrate that RisA is phosphorylated
in vivo
and that RisA phosphorylation is required for activation of
vrg
genes. An adjacent histidine kinase gene,
risS
, is truncated by frameshift mutation in
B. pertussis
but not in
Bordetella bronchiseptica
or
Bordetella parapertussis
. Neither deletion of
risS
′ or
bvgAS
nor phenotypic modulation with MgSO
4
affected levels of phosphorylated RisA (RisA∼P) in
B. pertussis
. However, RisA phosphorylation did require the histidine kinase encoded by BP3223, here named RisK (cognate histidine kinase of RisA). RisK was also required for expression of the
vrg
genes. This requirement could be obviated by the introduction of the phosphorylation-mimicking RisA
D60E
mutant, indicating that an active conformation of RisA, but not phosphorylation
per se
, is crucial for
vrg
activation. Interestingly, expression of
vrg
genes is still modulated by MgSO
4
in cells harboring the RisA
D60E
mutation, suggesting that the activated RisA senses additional signals to control
vrg
expression in response to environmental stimuli.

IMPORTANCE
In
B. pertussis
, the BvgAS two-component system activates the expression of virulence genes by binding of BvgA∼P to their promoters. Expression of the reciprocally regulated
vrg
genes requires RisA and is also repressed by the Bvg-activated BvgR. RisA is an OmpR-like response regulator, but RisA phosphorylation was not expected because the gene for its presumed, cooperonic, histidine kinase is inactivated by mutation. In this study, we demonstrate phosphorylation of RisA
in vivo
by a noncooperonic histidine kinase. We also show that RisA phosphorylation is necessary but not sufficient for
vrg
activation but, importantly, is not affected by BvgAS status. Instead, we propose that
vrg
expression is controlled by BvgAS through its regulation of BvgR, a cyclic di-GMP (c-di-GMP) phosphodiesterase.
Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals
Authors: Germack Hayley D , Griffiths Peter , Sloane Douglas M , Rafferty Anne Marie , Ball Jane E , Aiken Linda H
Published: August 2017

Objectives

To examine whether patient satisfaction with nursing care in National Health Service (NHS) hospitals in England is associated with the proportion of non-UK educated nurses providing care.

Design

Cross-sectional analysis using data from the 2010 NHS Adult Inpatient Survey merged with data from nurse and hospital administrator surveys. Logistic regression models with corrections for clustering were used to determine whether the proportions of non-UK educated nurses were significantly related to patient satisfaction before and after taking account of other hospital, nursing and patient characteristics.

Setting

31 English NHS trusts.

Participants

12 506 patients 16 years of age and older with at least one overnight stay that completed a satisfaction survey; 2962 bedside care nurses who completed a nurse survey; and 31 NHS trusts.

Main outcome measure

Patient satisfaction.

Results

The percentage of non-UK educated nurses providing bedside hospital care, which ranged from 1% to 52% of nurses, was significantly associated with patient satisfaction. After controlling for potential confounding factors, each 10-point increase in the percentage of non-UK educated nurses diminished the odds of patients reporting good or excellent care by 12% (OR=0.88), and decreased the odds of patients agreeing that they always had confidence and trust in nurses by 13% (OR=0.87). Other indicators of patient satisfaction also revealed lower satisfaction in hospitals with higher percentages of non-UK educated nurses.

Conclusions

Use of non-UK educated nurses in English NHS hospitals is associated with lower patient satisfaction. Importing nurses from abroad to substitute for domestically educated nurses may negatively impact quality of care.
Supporting the use of theory in cross-country health services research: a participatory qualitative approach using Normalisation Process Theory as an example
Authors: O'Donnell Catherine A , Mair Frances S , Dowrick Christopher , Brún Mary O’Reilly-de , Brún Tomas de , Burns Nicola , Lionis Christos , Saridaki Aristoula , Papadakaki Maria , Muijsenbergh Maria van den , Weel-Baumgarten Evelyn van , Gravenhorst Katja , Cooper Lucy , Princz Christine , Teunissen Erik , Mareeuw Francine van den Driessen , Vlahadi Maria , Spiegel Wolfgang , MacFarlane Anne
Published: August 2017

Objectives

To describe and reflect on the process of designing and delivering a training programme supporting the use of theory, in this case Normalisation Process Theory (NPT), in a multisite cross-country health services research study.

Design

Participatory research approach using qualitative methods.

Setting

Six European primary care settings involving research teams from Austria, England, Greece, Ireland, The Netherlands and Scotland.

Participants

RESTORE research team consisting of 8 project applicants, all senior primary care academics, and 10 researchers. Professional backgrounds included general practitioners/family doctors, social/cultural anthropologists, sociologists and health services/primary care researchers.

Primary outcome measures

Views of all research team members (n=18) were assessed using qualitative evaluation methods, analysed qualitatively by the trainers after each session.

Results

Most of the team had no experience of using NPT and many had not applied theory to prospective, qualitative research projects. Early training proved didactic and overloaded participants with information. Drawing on RESTORE’s methodological approach of Participatory Learning and Action, workshops using role play, experiential interactive exercises and light-hearted examples not directly related to the study subject matter were developed. Evaluation showed the study team quickly grew in knowledge and confidence in applying theory to fieldwork.

Recommendations applicable to other studies include: accepting that theory application is not a linear process, that time is needed to address researcher concerns with the process, and that experiential, interactive learning is a key device in building conceptual and practical knowledge. An unanticipated benefit was the smooth transition to cross-country qualitative coding of study data.

Conclusion

A structured programme of training enhanced and supported the prospective application of a theory, NPT, to our work but raised challenges. These were not unique to NPT but could arise with the application of any theory, especially in large multisite, international projects. The lessons learnt are applicable to other theoretically informed studies.
Assessing the potential return on investment of the proposed UK NHS diabetes prevention programme in different population subgroups: an economic evaluation
Authors: Thomas Chloe , Sadler Susi , Breeze Penny , Squires Hazel , Gillett Michael , Brennan Alan
Published: August 2017

Objectives

To evaluate potential return on investment of the National Health Service Diabetes Prevention Programme (NHS DPP) in England and estimate which population subgroups are likely to benefit most in terms of cost-effectiveness, cost-savings and health benefits.

Design

Economic analysis using the School for Public Health Research Diabetes Prevention Model.

Setting

England 2015–2016.

Population

Adults aged ≥16 with high risk of type 2 diabetes (HbA1c 6%–6.4%). Population subgroups defined by age, sex, ethnicity, socioeconomic deprivation, baseline body mass index, baseline HbA1c and working status.

Interventions

The proposed NHS DPP: an intensive lifestyle intervention focusing on dietary advice, physical activity and weight loss. Comparator: no diabetes prevention intervention.

Main outcome measures

Incremental costs, savings and return on investment, quality-adjusted life-years (QALYs), diabetes cases, cardiovascular cases and net monetary benefit from an NHS perspective.

Results

Intervention costs will be recouped through NHS savings within 12 years, with net NHS saving of £1.28 over 20 years for each £1 invested. Per 100 000 DPP interventions given, 3552 QALYs are gained. The DPP is most cost-effective and cost-saving in obese individuals, those with baseline HbA1c 6.2%–6.4% and those aged 40–74. QALY gains are lower in minority ethnic and low socioeconomic status subgroups. Probabilistic sensitivity analysis suggests that there is 97% probability that the DPP will be cost-effective within 20 years. NHS savings are highly sensitive to intervention cost, effectiveness and duration of effect.

Conclusions

The DPP is likely to be cost-effective and cost-saving under current assumptions. Prioritising obese individuals could create the most value for money and obtain the greatest health benefits per individual targeted. Low socioeconomic status or ethnic minority groups may gain fewer QALYs per intervention, so targeting strategies should ensure the DPP does not contribute to widening health inequalities. Further evidence is needed around the differential responsiveness of population subgroups to the DPP.
Association of workplace and population characteristics with prevalence of hypertension among Brazilian industry workers: a multilevel analysis
Authors: Vinholes Daniele B , Bassanesi Sérgio L , Chaves Junior Hilton de Castro , Machado Carlos Alberto , Melo Ione M F , Fuchs Flavio Danni , Fuchs Sandra Costa
Published: August 2017

Background

Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time.

Objectives

To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension.

Material and methods

This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI(Serviço Social da Indústria–Social Service of Industries)study and population-based data from the national census statistics. Workers aged ≥15 years were randomly selected from small (20–99), medium (100–499) and large (≥500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95% CI) adjusted for three-level variables.

Results

4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics—being male, ageing, low schooling, alcohol abuse and higher BMI—a workplace with no staff canteen (OR=1.28; 95% CI 1.08 to 1.52), small companies (OR=1.31; 95% CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95% CI 1.23 to 1.76) were associated with a higher risk for hypertension.

Conclusion

Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries.
Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study
Authors: Yagyuu Takahiro , Kawakami Mao , Ueyama Yoshihiro , Imada Mitsuhiko , Kurihara Miyako , Matsusue Yumiko , Imai Yuichiro , Yamamoto Kazuhiko , Kirita Tadaaki
Published: August 2017

Objective

The effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of postextraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin.

Design

This study was a retrospective cohort analysis. Incidence rates and propensity score-matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs.

Setting

The study took place in a single university hospital in Japan.

Participants

Between April 2013 and April 2015, 543 patients underwent a total of 1196 simple tooth extractions.

Primary outcome measure

The primary outcome measure was the occurrence of postextraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 min and 7 days after the extraction.

Results

A total of 1196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs and 1024 extractions (543 procedures) involving no anticoagulants. The incidences of postextraction bleeding per tooth for the DOAC, VKA and no anticoagulant extractions were 10.4%, 12.0% and 0.9%, respectively. The incidences of postextraction bleeding per procedure for DOACs, VKAs and no anticoagulants were 9.7%, 10.0% and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of postextraction bleeding (OR 0.69, 95% CIs 0.24 to 1.97; p=0.49).

Conclusions

The risk of postextraction bleeding was similar for DOAC and VKA extractions.
Comparison of health-related quality of life in patients with atrial fibrillation treated with catheter ablation or antiarrhythmic drug therapy: a systematic review and meta-analysis protocol
Authors: Allan Katherine S , Henry Shaunattonie , Aves Theresa , Banfield Laura , Victor J Charles , Dorian Paul , Healey Jeff S , Andrade Jason , Carroll Sandra , McGillion Michael
Published: August 2017

Introduction

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and causes patients considerable burden; symptoms such as palpitations and dyspnoea are common, leading to frequent emergency room visits. Patients with AF report reduced health-related quality of life (HQOL) compared with the general population; thus, treatments focus on the restoration of sinus rhythm to improve symptoms. Catheter ablation (CA) is a primary treatment strategy to treat AF-related burden in select patient populations; however, repeat procedures are often needed, there is a risk of major complications and the procedure is quite costly in comparison to medical therapy. As the outcomes after CA are mixed, an updated review that synthesises the available literature, on outcomes that matter to patients, is needed so that patients and their healthcare providers can make quality treatment decisions. The purpose of this review protocol is to extend previous findings by systematically analysing randomised controlled trials (RCTs) of CA in patients with AF and using meta-analytic techniques to identify the benefits and risks of CA with respect to HQOL and AF-related symptoms.

Methods and analysis

We will include all RCTs that compare CA with antiarrhythmic drugs, or radiofrequency CA with cryoballoon CA, in patients with paroxysmal or persistent AF. To locate studies we will perform comprehensive electronic database searches from database inception to 4 April 2017, with no language restrictions. We will conduct a quantitative synthesis of the effect of CA on HQOL as well as AF-related symptoms and the number of CA procedures needed for success, using meta-analytic techniques.

Ethics and dissemination

No ethical issues are foreseen and ethical approval is not required given that this is a protocol. The findings of the study will be reported at national and international conferences, and in a peer-reviewed journal using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Trial registration number

In accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 6 March 2017 and was last updated on 6 March 2017 (registration number CRD42017057427).

Protocol amendments

Any protocol amendments will be documented on the International Prospective Register of Systematic Reviews (PROSPERO) and in the final manuscript and indicated as such.
An investigation of the predictors of photoprotection and UVR dose to the face in patients with XP: a protocol using observational mixed methods
Authors: Walburn Jessica , Sarkany Robert , Norton Sam , Foster Lesley , Morgan Myfanwy , Sainsbury Kirby , Araújo-Soares Vera , Anderson Rebecca , Garrood Isabel , Heydenreich Jakob , Sniehotta Falko F , Vieira Rute , Wulf Hans Christian , Weinman John
Published: August 2017

Introduction

Xeroderma pigmentosum (XP) is a rare genetic condition caused by defective nucleotide excision repair and characterised by skin cancer, ocular and neurological involvement. Stringent ultraviolet protection is the only way to prevent skin cancer. Despite the risks, some patients’ photoprotection is poor, with a potentially devastating impact on their prognosis. The aim of this research is to identify disease-specific and psychosocial predictors of photoprotection behaviour and ultraviolet radiation (UVR) dose to the face.

Methods and analysis

Mixed methods research based on 45 UK patients will involve qualitative interviews to identify individuals’ experience of XP and the influences on their photoprotection behaviours and a cross-sectional quantitative survey to assess biopsychosocial correlates of these behaviours at baseline. This will be followed by objective measurement of UVR exposure for 21 days by wrist-worn dosimeter and daily recording of photoprotection behaviours and psychological variables for up to 50 days in the summer months. This novel methodology will enable UVR dose reaching the face to be calculated and analysed as a clinically relevant endpoint. A range of qualitative and quantitative analytical approaches will be used, reflecting the mixed methods (eg, cross-sectional qualitative interviews, n-of-1 studies). Framework analysis will be used to analyse the qualitative interviews; mixed-effects longitudinal models will be used to examine the association of clinical and psychosocial factors with the average daily UVR dose; dynamic logistic regression models will be used to investigate participant-specific psychosocial factors associated with photoprotection behaviours.

Ethics and dissemination

This research has been approved by Camden and King’s Cross Research Ethics Committee 15/LO/1395. The findings will be published in peer-reviewed journals and presented at national and international scientific conferences.
High intake of dairy during energy restriction does not affect energy balance or the intestinal microflora compared with low dairy intake in overweight individuals in a randomized controlled trial
Authors: Bendtsen Line Quist , Blædel Trine , Holm Jacob Bak , Lorenzen Janne Kunchel , Mark Alicja Budek , Kiilerich Pia , Kristiansen Karsten , Astrup Arne , Larsen Lesli Hingstrup
Published: August 2017

During weight loss, dairy calcium is proposed to accelerate weight and fat-mass loss through increased fecal fat excretion. The primary objective was to investigate if a high-dairy energy-restricted diet is superior to low dairy in terms of changes in body weight, body composition, and fecal fat excretion over 24 weeks. Secondary objectives included fecal energy and calcium excretion, resting energy expenditure, blood pressure, lipid metabolism, and gut microbiota. In a randomized, parallel-arm intervention study, 11 men and 69 women (body mass index, 30.6 ± 0.3 kg/m2; age, 44 ± 1 years) were allocated to a 500-kcal (2100 kJ) –deficit diet that was either high (HD: 1500 mg calcium/day) or low (LD: 600 mg calcium/day) in dairy products for 24 weeks. Habitual calcium intake was ∼1000 mg/day. Body weight loss (HD: –6.6 ± 1.3 kg, LD: –7.9 ± 1.5 kg, P = 0.73), fat-mass loss (HD: –7.8% ± 1.3%, LD: –8.5% ± 1.1%, P = 0.76), changes in fecal fat excretion (HD: –0.57 ± 0.76 g, LD: 0.46 ± 0.70 g, P = 0.12), and microbiota composition were similar for the groups over 24 weeks. However, total fat-mass loss was positively associated with relative abundance of Papillibacter (P = 0.017) independent of diet group. Consumption of a high-dairy diet did not increase fecal fat or accelerate weight and fat-mass loss beyond energy restriction over 24 weeks in overweight and obese adults with a habitual calcium intake of ∼1000 mg/day. However, this study indicates that Papillibacter is involved in body compositional changes.