bluuebunny/crossref_metadata_2025 huggingface dataset:
Macroalgal assemblage changes on coral reefs along a natural gradient from fish farms in southern Hainan Island
Authors: Li Xiubao , Titlyanov Eduard A. , Zhang Jing , Titlyanova Tamara V. , Zhang Guosen , Huang Hui
Published: October 2017

Degradation processes on coral reefs are associated with changes in macroalgal assemblages. In this study, a floristic study of the macrophyte species on coral reefs along a pollution gradient at 3 transects in southern Hainan Island, China, was conducted in April 2014. A total of 73 benthic macroalgal taxa were collected, of which 58% were reds, 23% browns and 19% greens. Along with the distance away from the outlet of fish farms, macroalgal species richness increased significantly from 40 species to 71 species. However, macroalgal biomass decreased from 1.58 kg m−2 to 1.1 kg m−2. Brown blooms of Chnoospora implexa, Padina australis, Sargassum polycystum and S. sanyaense changed to green blooms of Ulva lactuca and Caulerpa racemosa from moderately polluted sites to severely polluted sites close to the outlet. This study supports the results that severe pollution can lead not only to a significant decline of macroalgal species richness and changes in macroalgal assemblages, but also to the occurrence of green blooms. This study will hopefully provide more accurate cases to link nutrient pollution to changes in benthic organisms on coral reefs.
Benthic macrofaunal communities along an estuarine gradient in the Jiaojiang River estuary, China
Authors: Liao Yibo , Shou Lu , Jiang Zhibing , Gao Aigen , Zeng Jiangning , Chen Quanzhen , Yan Xiaojun
Published: October 2017

Benthic macrofaunal communities along an estuarine gradient of a macrotidal estuary of the Jiaojiang River, China were analyzed to reveal spatial variations in those communities and their relationships with environmental variables. Benthic macrofauna were collected from 15 sampling stations in May and October 2010. Polychaetes and Mollusks are the dominant taxonomic groups. The species richness, density and Shannon diversity index generally tended to increase as one moved away from shore toward the outer stations of the estuary. Cluster analysis and multidimensional scaling ordinations indicated the presence of three distinct zones of macrofaunal communities in the estuary. Multivariate analyses showed a strong relationship exists between the macrofaunal communities and the environmental parameters in the Jiaojiang River estuary. Aside from salinity, dissolved inorganic nitrogen and soluble reactive phosphate contents were also the major factor affecting the structure of the macrofaunal communities. The results demonstrated the important effects of nutrient-load on the distributional patterns of benthic macrofaunal communities in nutrient-rich estuaries.
Long term urban impacts on the ecological status of a lowland river as determined by diatom indices
Authors: Szczepocka E. , Nowicka-Krawczyk P. , Knysak P. , Żelazna-Wieczorek J.
Published: October 2017

This study determined changes in the ecological status of a lowland river under the impact of an urban agglomeration after modernizing the wastewater management. For 174 years the Ner River was loaded with pollution from expanding industry. Construction of the Group Sewage Treatment Plant (GOŚ) in 1994 and its subsequent modernization should have improved the water quality. After 20 years of proper sewage treatment the ecological status of the river hasn't improved.

Study sites were established on the river above and below sewage disposal from GOŚ, and the ecological status was assessed on the basis of benthic diatoms. Diatom indices: IO, GDI, IPS were calculated in order to determine the ecological status and water quality. Hierarchical cluster analysis and multivariate analysis of diatom assemblages were used to reveal differences of the study sites. It was revealed that the river is divided into two sections: the first is above the sewage disposal and the second is below it. In the first section, domination of species sensitive to organic pollution Meridion circulare and Ulnaria ulna was noted, while in the second section species resistant and tolerant to organic pollution, Hippodonta capitata and Navicula gregaria, were noted. The ecological status at the first section was moderate to poor, while at the second it was poor to very poor.

The division of the urban river into two sections with different ecological status stems from the history of water management. The present location of the GOŚ outflow served in the past as a dump of untreated sewage from the industry of the Łódź Agglomeration. Development of the city led to the degradation of the ecosystem. Modernization of wastewater management did not reverse the degradation of the river. The persistence of accumulated industrial pollution in sediments caused by the long-term impact of urban agglomeration almost completely destroyed the ecosystem of the river.
Physical processes affecting water quality in Hamilton Harbour
Authors: Yerubandi Ram R. , Boegman Leon , Bolkhari Hadiseh , Hiriart-Baer Veronique
Published: October 2017

This article presents an overview of selected physical processes and their effects on water quality in Hamilton Harbour. An understanding of circulation and mixing processes are essential to assess the fate and transport of water quality constituents in Hamilton Harbour. Water level measurements showed that in addition to harbour and lake seiches, the Helholtz mode, due to pumping action from Lake Ontario, is important in generating harbour water movements while the circulation patterns in the open waters of the harbour are influenced by prevailing winds. In general, the mean summer circulation consists of two counter-rotating gyres occupying the harbour. Hamilton Harbour physical processes are further characterized by substantial water exchanges with Lake Ontario. These exchange flows play a major role in determining the retention time of the harbour, thereby exerting a large influence on water quality, including hypolimnetic dissolved oxygen concentrations.
Seasonal variation of dissolved oxygen in Sanya Bay
Authors: Xu Hongzhou , Liu Sumin , Xie Qiang , Hong Bo , Zhou Weihua , Zhang Yanying , Li Tao
Published: October 2017

Dissolved oxygen concentration is central in determining the water quality level for an aquatic ecosystem. In this article, we analyzed in situ dissolved oxygen and other related parameters from a dataset observed during 2004–2010 in Sanya Bay to find out its status in recent years and what controlled its seasonal variation. Different to worldwide coastal and estuarine ecosystems, dissolved oxygen concentrations in the Bay reached minimum values in autumn rather than summer during most of the seven years, while maximum values were seen in winter. Results showed that the seasonal trend of dissolved oxygen was mainly controlled by physical instead of biochemical processes. While many harmful factors normally act to lower dissolved oxygen concentration during summer, such as high surface water temperature, strong stratification, and large loads of nutrients from the river basin, upwelling driven by summer monsoons cooled down the bottom water. This increased dissolved oxygen saturation and hindered biochemical oxygen demand. On the contrary, the bottom water was warmed up abruptly during autumn, when upwelling was reduced due to the cessation of summer monsoon. This decreased bottom water dissolved oxygen saturation and enhanced some biochemical processes. Overall, dissolved oxygen values were greater than 6.0 mg l−1 during most years, indicating a healthy water quality environment in the Bay. Nevertheless, low dissolved oxygen bottom water conditions (<6.0 mg l−1) still existed in the whole Bay during some seasons—like the summer of 2009—which indicates there is some concern for the current stage of water quality in the Bay.
Diet and foraging of Round Goby (Neogobius melanostomus) in a contaminated harbour
Authors: McCallum Erin S. , Marentette Julie R. , Schiller Claire , Jindal Shagun , Empringham Kyle , Marsh-Rollo Susan , Pettitt-Wade Harri , Koops Marten A. , Fisk Aaron T. , Balshine Sigal
Published: October 2017

Anthropogenic pollution and the introduction of invasive species are two contributing factors to ecosystem degradation. Although Hamilton Harbour (Ontario, Canada), a highly impacted ecosystem, is well-studied, the diet, trophic position, and foraging behaviour of the invasive Round Goby (Neogobius melanostomus) in this area is not well understood. In this study, we compared digestive tract contents, foraging behaviour, and stable isotope values of Round Goby from sites of low and high sediment contamination in Hamilton Harbour. We also assessed prey availability by conducting sediment invertebrate abundance analyses at these sites. Regardless of site, Chironomids, Cladocerans, Copepods and Dreissenids were the most common food items found in Round Goby digestive tracts, and females always had heavier gut contents compared to males. Fish from the high contamination site consumed fewer prey items, had lower gut fullness scores, and fed at a lower trophic level based on lower δ13C and δ15N values. Our results suggest that Round Goby living in highly contaminated areas are feeding less than Round Goby from areas of lower contamination, but that these diet differences do not reflect differences in prey availability. Fish from the high contamination site also typically moved more slowly while foraging. Taken together, these results provide an analysis of the main prey items of Round Goby in Hamilton Harbour, and demonstrate how polluted environments can impact diet, trophic position, and foraging of an introduced fish species.
River ecosystems of the Central Highland ecoregion: Spatial distribution of benthic flora and fauna in the Plateau rivers (tributaries of the Yamuna and Ganga) in Central India
Authors: Nautiyal Prakash , Mishra Asheesh Shivam , Verma Jyoti , Agrawal Asha
Published: October 2017

This study reveals the relationship of biotic assemblages to their environments in the Central Highland Ecoregion rivers (Ken, Paisuni and Tons). Such knowledge will enhance our predictive abilities in the ecological studies and resource management in the concerned region. Rivers of an ecoregion are expected to harbour similar flora, fauna, and communities. This hypothesis was examined by tracking the spatial variation in richness, density, and taxonomic composition of benthic diatom and macroinvertebrate assemblages in three Plateau rivers whose course lay within 3°N latitude. Taxonomic richness and density decreased with the reduction of substrate size from the headwaters to the lowlands. Cluster and ordination analyses indicate prevalence of intrabasin rather than interbasin gradients of abundance. In both assemblages, the most abundant taxon is rarely similar longitudinally or across the river sections in the ecoregion. Hence, proximate factors govern the assemblages rather than ecoregional properties (latitude, altitude). This, and the high richness of diatom flora, points to diverse assemblages from the headwater to the lowland section in each river and among the rivers of the ecoregion.
Socioeconomic status of riverine fisher communities in India
Authors: Katiha Pradeep K. , Pandit Arun , Ekka Anjana , Sharma A. P.
Published: October 2017

The inland traditional fishers, such as those from riverine, estuarine, reservoirs, and wetlands of India, are primarily dependent on natural waters for their livelihoods. Governments at various levels have made several efforts, including decentralization of management rights, promotion of cooperatives and formation of self-help groups, to develop the fisheries. Despite these efforts, production from most of the culture-based inland fishery waters (particularly adopting fish stock enhancements) is below potential, as a vast gap is observed between the potential and existing fish production. There is immense potential for increasing the fishing effort, production and income. Capture fishery resources, particularly in the riverine fisheries, are declining due to resource degradation and excessive exploitation. The impact of fisheries developmental programmes instituted by government agencies like the National Fisheries Development Board are hardly recognised on fisheries communities due to the multiple-use common pool resource nature of the fishing resource. Comprehensive investigations on the socioeconomic status of riverine fisher communities are rare. The present investigation studies the socioeconomic conditions of riverine fisher communities in different regions of India. The study covered six states of five regions in India: Uttar Pradesh in the North; Tamil Nadu and Kerala in the South; Orissa and West Bengal in the East; Gujarat in the West; Assam in the northeastern region. The overall socioeconomic index results concluded that almost all the regions have achieved only 46% to 52% of the socioeconomic criteria studied. Institutional financial support for alternate income generation activities; organisation under self-help groups, and vocational training for fisherwomen to undertake alternate income-generating activities during the closed/off season are some of the suggestions resulting from the investigation.
𝑉𝐶_{ℓ}-dimension and the jump to the fastest speed of a hereditary ℒ-property
Authors: Terry C.
Published: October 2017

In this paper we investigate a connection between the growth rates of certain classes of finite structures and a generalization of

V
C

\mathrm {VC}

-dimension called

V
C

ℓ

\mathrm {VC}_{\ell }

-dimension. Let

L

\mathcal {L}

be a finite relational language with maximum arity

r
r

. A hereditary

L

\mathcal {L}

-property is a class of finite

L

\mathcal {L}

-structures closed under isomorphism and substructures. The speed of a hereditary

L

\mathcal {L}

-property

H

\mathcal {H}

is the function which sends

n
n

to

|

H

n

|

|\mathcal {H}_n|

, where

H

n

\mathcal {H}_n

is the set of elements of

H

\mathcal {H}

with universe

{
1
,
…
,
n
}

\{1,\ldots , n\}

. It was previously known that there exists a gap between the fastest possible speed of a hereditary

L

\mathcal {L}

-property and all lower speeds, namely between the speeds

2

Θ
(

n
r

)

2^{\Theta (n^r)}

and

2

o
(

n
r

)

2^{o(n^r)}

. We strengthen this gap by showing that for any hereditary

L

\mathcal {L}

-property

H

\mathcal {H}

, either

|

H

n

|

=

2

Θ
(

n
r

)

|\mathcal {H}_n|=2^{\Theta (n^r)}

or there is

ϵ
>
0

\epsilon >0

such that for all large enough

n
n

,

|

H

n

|

≤

2

n

r
−
ϵ

|\mathcal {H}_n|\leq 2^{n^{r-\epsilon }}

. This improves what was previously known about this gap when

r
≥
3

r\geq 3

. Further, we show this gap can be characterized in terms of

V
C

ℓ

\mathrm {VC}_{\ell }

-dimension, therefore drawing a connection between this finite counting problem and the model theoretic dividing line known as

ℓ
\ell

-dependence.
Agricultural Cooperatives and Investment in Organic Soil Amendments and Chemical Fertilizer in China
Authors: Ma Wanglin , Abdulai Awudu , Goetz Renan
Published: October 2017

In this article, we develop a dynamic model to show how membership in agricultural cooperatives influences smallholder farmers' decisions to invest in organic soil amendments and chemical fertilizer. The model considers management decisions of heterogonous producers within an intertemporal framework, with the decision to join the cooperative assumed to be endogenous. Farm‐level data of apple farmers from three provinces in China are used to estimate the impact of cooperative membership on investment in organic soil amendments and chemical fertilizer. A recursive bivariate probit model that accounts for potential endogeneity of cooperative membership and selection bias is employed in the empirical analysis. The empirical results show that cooperative membership exerts a positive and statistically significant impact on the likelihood of investing in organic soil amendments. The findings also reveal that tenure security, human capital, farm size, and access to credit positively and significantly influence the probability of a farmer joining a cooperative and the likelihood of investing in soil quality measures.
Microvascular Adaptations to Exercise: Protective Effect of PGC-1 Alpha
Authors: Kadlec Andrew O , Barnes Chad , Durand Matthew J , Gutterman David D
Published: October 2017

BACKGROUND

Sedentary behavior and obesity are major risk factors for cardiovascular disease. Regular physical activity has independent protective effects on the cardiovascular system, but the mechanisms responsible remain elusive. Recent studies suggest that the protein peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) participates in the response to exercise training. We hypothesized that the arterioles of athletes maintain dilation to flow despite combined inhibition of multiple vasodilators, but loss of PGC-1α renders these vessels susceptible to inhibition of a single vasodilator pathway. In addition, arterioles from overweight and obese individuals will display an an exercise-like phenotype when PGC-1α is activated.

METHODS

Isolated arterioles from exercise-trained (ET) and from mildly overweight or obese subjects (body mass index >25) were cannulated, and changes in lumen diameter in response to graded increases in flow were recorded in the absence and presence of compounds that inhibit various endothelium-dependent vasodilators.

RESULTS

Microvessels of ET subjects displayed robust dilation that could not be inhibited through targeting the combination of nitric oxide, prostaglandins, and hydrogen peroxide, but were inhibited via interference with membrane hyperpolarization. Loss of PGC-1α (siRNA) in the microcirculation of ET subjects eliminates this vasodilatory robustness rendering vessels susceptible to blockade of H2O2 alone. Pharmacological activation of PGC-1α with alpha-lipoic acid in isolated microvessels from sedentary, overweight, and obese subjects increases arteriolar resistance to vasodilator blockade and protects against acute increases in intraluminal pressure.

CONCLUSIONS

These findings suggest that the microvascular adaptations to exercise training, and the exercise-induced protection against acute vascular stress in overweight/obese subjects, are mediated by PGC-1α.
Joan of Arc as prisonnière de guerre
Authors: Ambühl Rémy
Published: October 2017

Contrary to long-standing claims, the French term prisonnier de guerre dates back to long before the early seventeenth century. The corpus of documents at the centre of this article includes some sixty occurrences of the term (in French or Latin) over a period of more than a century, the earliest dating to 1357. In contrast with previous studies on the status of prisoners of war which have tended to rely on a modern conception of the term, this investigation focuses on contemporary perceptions of those who were designated prisonniers de guerre in the later Middle Ages. The significance of this discussion is demonstrated through a detailed examination of the example of Joan of Arc, who, perhaps surprisingly, was considered a prisonnière de guerre by the English. In her case—which was by no means an exception to the general rule—the status of prisonnier de guerre derived from the property rights which her ‘master’ (or captor) enjoyed over her. It did not involve any protection of the prisoner her- (or him-) self. Contemporary debates about the status of prisonniers de guerre, when such questions were raised, were focused on the rights of the master. It may, therefore, be more appropriate to speak not of the status of prisoner of war but rather of the status of the master of the prisoner of war.
Anaerobic Soil Disinfestation Reduces Germination and Affects Colonization of Sclerotium rolfsii Sclerotia
Authors: Shrestha Utsala , Dee Mary E. , Ownley Bonnie H. , Butler David M.
Published: October 2017

Growth chamber and field studies were conducted with organic amendment mixtures of carbon (C) and nitrogen (N) at C:N ratios 10:1, 20:1, 30:1, and 40:1 and amendment rates of C at 2, 4, 6, and 8 mg/g of soil (C:N ratio 30:1) to evaluate anaerobic soil disinfestation (ASD) effects on germination and colonization of Sclerotium rolfsii. In the growth chamber, sclerotial germination was reduced in all ASD treatments regardless of C:N ratio (0.6 to 8.5% germination) or amendment rate (7.5 to 46%) as compared with nonamended controls (21 to 36% and 61 to 96%, respectively). ASD treatment increased Trichoderma spp. colonization of sclerotia, with consistently higher colonization in ASD treatments with amendment rates of C at 2 or 4 mg/g of soil (>87% colonization) compared with nonamended controls (<50% colonization). In the 2014 field study, sclerotial germination was reduced by 24 to 30% in ASD treatments when compared with the nonamended control. Sclerotial colonization by Trichoderma spp. was predominant; however, other potential mycoparasites (i.e., Aspergillus spp., Fusarium spp., zygomycetes, and other fungi) were present in the field study. Amendment C:N ratios in the range of 10:1 to 40:1 were equally effective in reducing sclerotial germination and enhancing colonization by potentially beneficial mycoparasites of sclerotia.
Impact of Required Versus Self-Directed Use of Virtual Patient Cases on Clerkship Performance: A Mixed-Methods Study
Authors: Kim Sarang , Willett Laura R. , Pan Wilbur J. , Afran Joyce , Walker John A. , Shea Judy A.
Published: October 2017

Purpose

To explore how students use and benefit from virtual patient cases (VPCs).

Method

In academic years 2013–2014 and 2014–2015, cohorts of students in pediatrics (Peds), family medicine (FM), and internal medicine (IM) clerkships were allocated to either core required use (CRU) or self-directed use (SU) of MedU VPCs. Outcomes included number and time of case review, student perception of learning from VPCs, National Board of Medical Examiners (NBME) subject examination scores, and summative clinical ratings for medical knowledge and differential diagnoses/problem solving. Focus groups were conducted each year. Mean differences were compared by t test.

Results

A total of 255 students participated in the study. Mean number of cases completed by the CRU group was significantly higher than that by the SU group (13.9 vs. 3.1 for FM, 16.1 vs. 3.9 for Peds, and 10.4 vs. 1.2 for IM) (P < .001). Student-perceived value ratings of VPCs were similar between groups. Students described VPCs as time consuming but useful for supplementing clinical conditions not seen in person. Mean scores on NBME subject examinations for CRU versus SU groups were not different between groups in any clerkship, nor were there significant differences in the summative clinical ratings for medical knowledge or differential diagnosis/clinical reasoning.

Conclusions

Although VPCs continue to serve an important role in exposing students to clinical conditions not seen in person, the optimal employment of this technology in clerkship pedagogy requires further exploration.
Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries
Authors: Talib Zohray , van Schalkwyk Susan , Couper Ian , Pattanaik Swaha , Turay Khadija , Sagay Atiene S. , Baingana Rhona , Baird Sarah , Gaede Bernhard , Iputo Jehu , Kibore Minnie , Manongi Rachel , Matsika Antony , Mogodi Mpho , Ramucesse Jeremais , Ross Heather , Simuyeba Moses , Haile-Mariam Damen
Published: October 2017

Purpose

African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities.

Method

Participants were from 11 Medical Education Partnership Initiative–funded medical schools in 10 African countries. Each school identified two clinical training sites—one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences.

Results

The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students.

Conclusions

Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.
Fathers: The Lost Ring in the Chain of Family-Centered Care
Authors: Valizadeh Sousan , Mirlashari Jila , Navab Elham , Higman Wendy , Ghorbani Fatemeh
Published: October 2017

Background:

The basic principles of family-centered care in neonatal intensive care unit (NICU) include the unlimited presence of parents and their participation in infant's care. Nurses play a central role in encouraging parental attachment with their infant.

Purpose:

This study was carried out with the aim of understanding NICU nurses' lived experiences of family participation in family-centered care.

Methods:

This interpretative phenomenological study was conducted on the basis of Heideggerian philosophy. The data were collected using semistructured interviews and field notes and analyzed through the 7-stage Diekelmann, Allen, and Tanner approach.

Findings:

Two overarching themes emerged including “mother's centrality in the care chain” and “fathers; the lost ring in the care chain” each of which consisted of 3 and 4 subthemes, respectively. Interviews indicated that in Iran's NICUs, conditions for the presence of parents were appropriate for the mothers and they were encouraged to engage in family-centered care but the fathers' participation was limited due to traditional attitudes, cultural-religious background, and difficulties relating to the hospitals' organizational rules.

Implications for Practice:

Fathers' participation in family-centered care seems to be enhanced through providing facilities, altering the organizational rules, attempting to modify traditional social attitudes, and educating parents and nurses.

Implications for Research:

Future research should explore the experience of mothers and fathers of infants in NICU in Iran to achieve a comprehensive understanding of their role in family-centered care.
Ability of Nonstrain Diastolic Parameters to Predict Doxorubicin-Induced Cardiomyopathy
Authors: Nagiub Mohamed , Nixon John V. , Kontos Michael C.
Published: October 2017

Doxorubicin is an important cause of chemotherapy-induced cardiomyopathy. Prior studies have found conflicting results of whether nonstrain diastolic parameters can predict doxorubicin-induced cardiotoxicity. We performed a systematic review of English written publications using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following inclusion criteria were applied: cancer subjects, echo-derived nonstrain diastolic profile, and patients compared before and after treatment to predict systolic dysfunction. The following exclusion criteria were applied: other cardiotoxic agents, non-echo studies, or used protective medications. Meta-analysis was performed using comprehensive meta-analysis software V3 to calculate cumulative means, SD, and odds ratios (ORs). Only 4 studies were designed to predict doxorubicin-induced cardiotoxicity. Of the 7 common parameters identified among studies, only 4 were significant: mitral E [OR: 3.4; 95% confidence interval (CI): 1.5–7.8;P= 0.003]; lateral E′ (OR: 3.7; 95% CI: 1.5–9.4;P< 0.005); mitral E/A (OR: 4.3; 95% CI: 2.1–8.9;P< 0.0001); and lateral S′ (OR: 2.7; 95% CI: 1.2–5.8;P= 0.01). We found that conventional nonstrain diastolic parameters predicted doxorubicin-induced systolic dysfunction. Whether nonstrain diastolic parameters can be used to supplement strain imaging for predicting doxorubicin-induced systolic function warrants further investigation in larger studies.
Yosprala
Authors: Veltri Keith T.
Published: October 2017

Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Patients who survive a primary cerebrovascular or cardiovascular event are at increased risk of a subsequent occurrence. Antiplatelet therapy plays an essential role for secondary prevention in individuals with stroke, transient ischemic attack, acute or chronic artery disease, or peripheral arterial disease. Maintaining high-risk patients on low-dose aspirin therapy is a fundamental component of management. However, poor adherence, secondary to the drug’s gastrointestinal side effects, has been associated with negative cardiovascular outcomes. Numerous studies have indicated that proton-pump inhibitors significantly reduce the risk of upper gastrointestinal adverse events in aspirin-treated patients. The US Food and Drug Administration approved Yosprala (Aralez Pharmaceuticals), a fixed-dose combination of delayed-release aspirin and immediate-release omeprazole, on September 15, 2016. It is the first product to become available in the United States that combines these 2 pharmacologic drug classes, and represents a new therapeutic option for patients and healthcare providers who strive to improve adherence to daily aspirin therapy.
Effects of Anti-Inflammatory Medications in Patients With Coronary Artery Disease: A Focus on Losmapimod
Authors: Tun Bradley , Frishman William H.
Published: October 2017

Inflammation plays an integral role in atherogenesis and the pathogenesis of coronary artery disease (CAD). The question remains as to whether targeted inhibition of specific pathways of inflammation will have any clinical benefits in CAD. In this article, we will review p38 mitogen-activated protein kinase, one of the key sensors of cellular stress that plays an important role in the inflammatory cascade. In addition, we will review losmapimod, a reversible competitive inhibitor of the α and β isoforms of p38 mitogen-activated protein kinase, and its efficacy when added to standard of care in patients hospitalized with myocardial infarction. In the phase III trial, LATITUDE-TIMI 60, the investigators found that treating patients hospitalized with acute myocardial infarction with losmapimod did not reduce the risk of major adverse cardiovascular events. Lastly, we will briefly review trials recently completed and currently underway, investigating other anti-inflammatory medications such as canakinumab, methotrexate, varespladib, darapladib, and colchicine, and their role in CAD.
Spontaneous Rupture of Lacrimal Gland Pleomorphic Adenoma: Pivotal Role in Masquerading Orbital Cellulitis
Authors: Pakdel Farzad , Pirmarzdashti Niloofar , Soltani Sasan , Nozarian Zohreh , Asadi Amoli Fahimeh , Kassaee Abolfazl
Published: October 2017

The authors aim to report a 68-year-old patient presenting with acute swelling and redness of orbital area diagnosed initially as orbital cellulitis. Surgical excision was decided based on clinical and imaging findings with the diagnosis of pleomorphic adenoma of the lacrimal gland. Lacrimal gland pleomorphic adenoma usually presents with painless gradual swelling of upper eyelid. In an exceptionally rare circumstance, this case showed acute orbital inflammation, and imaging findings of orbital inflammation mostly focused around the cystic space of the lacrimal gland tumor. Histologic evaluation confirmed a ruptured cystic space of pleomorphic adenoma with foreign body–type inflammatory reaction. The authors propose spontaneous rupture of cystic space in the lacrimal gland pleomorphic adenoma as underlying mechanism for acute presentation of this tumor. Imaging and clinical characteristics and also prognostic implication of this phenomenon are discussed.
Effect of Clozapine vs Other Second-Generation Antipsychotics on Hospitalization and Seclusion
Authors: Misawa Fuminari , Suzuki Takefumi , Fujii Yasuo
Published: October 2017

Background

Clozapine has been regarded as the gold standard for patients with treatment-resistant schizophrenia, but a recent network meta-analysis has questioned its relative superiority over other second-generation antipsychotics (SGAs) such as olanzapine and risperidone.

Purpose

We conducted a retrospective mirror-image study of clozapine vs other SGAs to evaluate real-world effectiveness of clozapine in terms of the duration of hospitalization and seclusion, both of which represent a critical outcome.

Methods

We included all patients who initiated clozapine at the Yamanashi Prefectural KITA Hospital and had continued to take any SGA(s) other than clozapine for at least 1 year before the initiation of clozapine. We obtained data on hospitalization and seclusion during 1 year of SGA treatment (SGA phase) and 1 year after the treatment was switched to clozapine (clozapine phase).

Results

The study included 35 patients (21 men, 31 with schizophrenia, 4 with schizoaffective disorder) with the average ± SD age of 37.3 ± 11.1 years. The results indicated that total hospitalization days did not differ significantly between SGA and clozapine treatment. However, total duration of seclusion was significantly shorter in the clozapine phase than in the SGA phase. Furthermore, the number of patients who were secluded at least once was significantly smaller in the clozapine phase than in the SGA phase. The results were essentially unchanged when outlier patients were excluded and only when patients taking olanzapine and/or risperidone during the SGA phase were considered.

Conclusions

Although the findings from this retrospective analysis need to be further tested in prospective trials, they endorse the relative effectiveness of clozapine over other SGAs in the real world.
Pharmacokinetics of Amikacin in Critical Care Patients on Extracorporeal Device
Authors: Ruiz-Ramos Jesus , Gimeno Ricardo , Pérez Francisca , Ramirez Paula , Villarreal Esther , Gordon Monica , Vicent Carlos , Remedios Marqués María , Castellanos-Ortega Álvaro
Published: October 2017

In this study, we evaluate the effect of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (Levitronix) on the pharmacokinetic of amikacin in critically ill patients. Twelve patients with ECMO and three with Levitronix devices who started treatment with amikacin were included. Amikacin pre (Cmax) and post (Cmin) dose serum concentrations were measured during the first 72–96 hours of treatment initiation. Pharmacokinetic parameters were performed by Bayesian adjustment. The median initial dose was 1,000 mg (range: 600–1,400 mg). Mean plasma concentrations were Cmax 58.6 mg/L (17.0 mg/L); Cmin 9.58 mg/L (7.8 mg/L). Patients with an ECMO device had a higher volume of distribution (0.346 [0.033] vs. 0.288 [0.110] L/kg) and a lower plasma clearance (1.58 [0.21] vs. 3.73 [1.03] L/h) than the control group. This phenomenon was also observed in those patients with simultaneous use of ECMO and hemodilafiltration. For patients with Levitronix system, no significant alterations in the volume of distribution were observed, although a lower plasma clearance was noticed. Placement of ECMO devices alters the pharmacokinetic parameters of amikacin in the critically ill patients and should be considered when selecting the initial dose.
Transjugular intrahepatic portosystemic shunt placement before abdominal intervention in cirrhotic patients with portal hypertension: lessons from a pilot study
Authors: Fares Nadim , Robic Marie-Angèle , Péron Jean-Marie , Muscari Fabrice , Otal Philippe , Suc Bertrand , Vinel Jean-Pierre , Bureau Christophe
Published: October 2017

Background

Abdominal interventions are usually contraindicated in patients with cirrhosis and portal hypertension because of increased morbidity and mortality. Decreasing portal pressure with transjugular intrahepatic portosystemic shunt (TIPS) may improve patient outcomes. We report our experience with patients treated by neoadjuvant TIPS to identify those who would most benefit from this two-step procedure.

Patients and methods

All patients treated by dedicated neoadjuvant TIPS between 2005 and March 2013 in two tertiary referral hospitals were included. The primary endpoint was the rate of failure, defined by the inability to proceed to the planned intervention after TIPS placement or persistent liver decompensation 3 months after intervention. The secondary endpoints were the rate of complications, parameters associated with failure, and 1-year survival.

Results

Twenty-eight consecutive patients were included, with a mean age of 61.2±6.6 years, mean Child–Pugh score of 6.6±1.5, and mean model for end-stage liver disease score of 10.4±3.3. Procedures were digestive (43%) or liver (25%) resections, abdominal wall surgery (21%), or interventional gastrointestinal endoscopies (11%). The scheduled procedure was performed in 24 (86%) patients within a median of 25 days after TIPS. Procedure failures occurred in six (21%) patients: four did not undergo surgery and two experienced persistent liver decompensation. Seven (25%) patients had postoperative complications, mainly local. Viral origin of cirrhosis, history of encephalopathy, and hepatic surgery were found to be associated with failure. One-year survival in the whole cohort was 70%.

Conclusion

In selected patients, extrahepatic surgery or interventional endoscopies can be safely performed after portal hypertension has been controlled by TIPS.
Binaural integration: a challenge to overcome for children with hearing loss
Authors: Gordon Karen A. , Cushing Sharon L. , Easwar Vijayalakshmi , Polonenko Melissa J. , Papsin Blake C.
Published: October 2017

Purpose of review

Access to bilateral hearing can be provided to children with hearing loss by fitting appropriate hearing devices to each affected ear. It is not clear, however, that bilateral input is properly integrated through hearing devices to promote binaural hearing. In the present review, we examine evidence indicating that abnormal binaural hearing continues to be a challenge for children with hearing loss despite early access to bilateral input.

Recent findings

Behavioral responses and electrophysiological data in children, combined with data from developing animal models, reveal that deafness in early life disrupts binaural hearing and that present hearing devices are unable to reverse these changes and/or promote expected development. Possible limitations of hearing devices include mismatches in binaural place, level, and timing of stimulation. Such mismatches could be common in children with hearing loss. One potential solution is to modify present device fitting beyond providing audibility to each ear by implementing binaural fitting targets.

Efforts to better integrate bilateral input could improve spatial hearing in children with hearing loss.
Correlation between the pain numeric rating scale and the 12-item WHO Disability Assessment Schedule 2.0 in patients with musculoskeletal pain
Authors: Saltychev Mikhail , Bärlund Esa , Laimi Katri
Published: October 2017

Objective

The aim of this study was to assess the correlation between pain severity measured on a numeric rating scale and restrictions of functioning measured with the WHO Disability Assessment Schedule (WHODAS 2.0).

Patients and methods

This was a cross-sectional study of 1207 patients with musculoskeletal pain conditions. Correlation was assessed using Spearman’s and Pearson tests.

Results

Although all the Spearman’s rank correlations between WHODAS 2.0 items and pain severity were statistically significant, they were mostly weak, with only a few moderate associations for ‘S2 household responsibilities’, ‘S8 washing’, ‘S9 dressing’, and ‘S12 day-to-day work’. The correlation between the WHODAS 2.0 total score and pain severity was also moderate: 0.41 [95% confidence interval (CI): 0.36–0.45] for average pain and 0.42 (95% CI: 0.37–0.46) for worst pain. The correlation between the WHODAS 2.0 total score and pain level was also assessed using Pearson’s product–moment correlation, yielding figures that were similar to Spearman’s correlation: 0.42 (P<0.0001, 95% CI: 0.37–0.46) for average pain and 0.39 (P<0.0001, 95% CI: 0.34–0.44) for worst pain.

Conclusion

Among patients with chronic musculoskeletal pain, the correlation between pain severity measured by numeric rating scale and functioning level measured by WHODAS 2.0 was weak to moderate, with slightly stronger associations in physical domains of functioning.
Status of High Body Weight Among Nurse-Family Partnership Children
Authors: Thorland William , Currie Dustin , Colangelo Claire
Published: October 2017

Purpose:

Increased prevalence of high levels of body weight in early childhood has become a public health concern, given its potential association with adult obesity and related comorbidities. Both socioeconomic status and race-ethnicity are related to increased prevalence. The purpose of this study was to identify additional risk factors common to children of low-income families; and to guide quality improvement initiatives within home visiting programs, potentially fostering more desirable physical development outcomes.

Study Design and Methods:

A cohort of children (n = 14,318) of all mothers enrolled in Nurse–Family Partnership between 2007 and 2010 was evaluated. Measures consisted of demographics, health behaviors, and physical growth metrics collected by specially educated nurses during the course of home visits that also delivered the program model. Measures of weight (W) versus length (L) were converted to percentiles using the Centers for Disease Control and Prevention–World Health Organization norms with high W/L (≥97.7th percentile) defining a binary outcome. Multiple logistic regression modeling was then used to derive risk models for that outcome.

Results:

Across each of the four time points for body measures (child's age 6, 12, 18, and 24 months), race-ethnicity, prepregnancy body mass index (BMI), maternal weight gain, and breastfeeding duration emerged as common risk factors.

Clinical Implications:

Moderation of weight gain during pregnancy, extending breastfeeding duration, and normalization of BMI before subsequent pregnancies may potentially serve as means of lowering the prevalence of high body weight levels in young children of low-income families served by home visitors.
The Postpartum Maternal and Newborn Microbiomes
Authors: Mutic Abby D. , Jordan Sheila , Edwards Sara M. , Ferranti Erin P. , Thul Taylor A. , Yang Irene
Published: October 2017

Biological and environmental changes to maternal and newborn microbiomes in the postnatal period can affect health outcomes for the mother–baby dyad. Postpartum sleep deprivation and unmet dietary needs can alter commensal bacteria within the body and disrupt gut-brain communication. Perineal injury and breast infections also change microbial community composition, potentiating an environment favoring pathogen growth. The gut microbiome refers to the collection of microorganisms working in harmony. Disruptions within the gut microbiome and gut-brain communication may lead to postpartum depression, a potentially devastating sequela. Postnatal newborn changes to the gut and skin microbiome materialize quickly after birth and are profoundly influenced by mode of birth, feeding method, and bathing and skin care practices. During the newborn period, infant microbiomes are highly vulnerable and susceptible to multiple influences. Maternal–newborn nurses have a valuable role in helping mothers and newborns promote healthy microbiomes. Factors that influence the rapidly changing postnatal microbiome of the mother and her newborn, and the role nurses have to positively influence immediate and long-term health outcomes are presented.
The Neonatal Microbiome
Authors: Rodriguez Jeannie , Jordan Sheila , Mutic Abby , Thul Taylor
Published: October 2017

Nursing care of the neonate in the neonatal intensive care unit (NICU) is complex, due in large part to various physiological challenges. A newer and less well-known physiological consideration is the neonatal microbiome, the community of microorganisms, both helpful and harmful, that inhabit the human body. The neonatal microbiome is influenced by the maternal microbiome, mode of infant birth, and various aspects of NICU care such as feeding choice and use of antibiotics. The composition and diversity of the microbiome is thought to influence key health outcomes including development of necrotizing enterocolitis, late-onset sepsis, altered physical growth, and poor neurodevelopment. Nurses in the NICU play a key role in managing care that can positively influence the microbiome to promote more optimal health outcomes in this vulnerable population of newborns.
Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention
Authors: Nuckols Teryl K. , Needleman Jack , Grogan Tristan R. , Liang Li-Jung , Worobel-Luk Pamela , Anderson Laura , Czypinski Linda , Coles Courtney , Walsh Catherine M.
Published: October 2017

OBJECTIVE

The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals.

BACKGROUND

Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions.

METHODS

We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year.

RESULTS

Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities.

CONCLUSIONS

Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.
Metopism: a Study of the Persistent Metopic Suture
Authors: Zdilla Matthew J. , Russell Michelle L. , Koons Aaron W. , Bliss Kaitlyn N. , Mangus Kelsey R.
Published: October 2017

Metopism, the persistence of the metopic suture in adulthood, is a clinically significant radiographic finding. In addition to masquerading as a fracture of the frontal bone, a persistent metopic suture may be associated with other clinically significant anatomical variations including frontal sinus abnormalities. Several geographically and craniofacially distinct populations have yet to be assessed for the prevalence of metopism. This study aimed to determine the prevalence of metopic sutures in adult crania of diverse populations among which scant research exists. A total of 505 adult crania were examined for the presence of a metopic suture. A total of 13 (2.57%) demonstrated metopism. Among subpopulations, metopism was present in 8.06% (5:62) of European crania, 15.38% (2:13) of East Asian crania, 2.20% (2:91) of Egyptian crania, and 2.86% (1:35) of Bengali crania. Metopism was also found in 1 Chilean, Roman, and Tchuktchi cranium, respectively. Metopism was not seen in crania from individuals of African (non-Egyptian) descent (0:62), Peruvians (0:144), Malayans (0:23), or Mexicans (0:23). Among sexes, metopism was present in 3.77% (8:212) of females and 1.79% (5:279) of males. The prevalence of metopism differs between populations and sexes. The results of this study provide anthropological, developmental, and clinical insight with regard to metopism.