bluuebunny/crossref_metadata_2025 huggingface dataset:
Developmental Differences Between Children and Adults in the Use of Visual Cues for Segmentation
Authors: Lavi‐Rotbain Ori , Arnon Inbal
Published: September 2017

Recent work asked if visual cues facilitate word segmentation in adults and infants (Thiessen, 2010). While adults showed better word segmentation when presented with a regular visual cue (consistent mapping between words and objects), infants did not. This difference was attributed to infants' lack of understanding that objects have labels. Alternatively, infants’ performance could reflect their difficulty with tracking and integrating multiple multimodal cues. We contrasted these two accounts by looking at the effect of visual cues on word segmentation in adults and across childhood (6–12 years). We found that older children (Mage 10;7) benefitted from the regular visual cues, but younger children (Mage 7;10), who already knew that objects have labels, did not. Knowing that objects have labels was not enough to use visual cues as an aid for segmentation. These findings show that the ability to integrate multimodal cues develops during childhood, and it is not yet adult‐like in children.
Both Earlier Times and the Future Are “Front”: The Distinction Between Time‐ and Ego‐Reference‐Points in Mandarin Speakers’ Temporal Representation
Authors: Xiao Chengli , Zhao Mengya , Chen Lei
Published: September 2017

Mandarin speakers, like most other language speakers around the world, use spatial terms to talk about time. However, the direction of their mental temporal representation along the front‐back axis remains controversial because they use the spatial term “front” to refer to both earlier times (e.g., front‐year means “the year before last”) and the future (e.g., front‐road means “prospect”). Although the linguistic distinction between time‐ and ego‐reference‐point spatiotemporal metaphors in Mandarin suggests a promising clarification of the above controversy, there is little empirical evidence verifying this distinction. In this study, Mandarin speakers’ time‐ and ego‐reference‐point temporal representations on three axes (i.e., sagittal, lateral, and vertical) were separately examined through two tasks. In a time‐reference‐point task, Mandarin speakers judged whether the time point of the second picture was earlier or later than the time point of the first picture, while in an ego‐reference‐point task, they judged whether an event or phase had happened in the past or would happen in the future. The results indicate that Mandarin speakers construe an earlier‐times‐in‐front‐of‐later‐times temporal sequence and adopt the front‐to‐the‐future orientation.
Nontraditional sites for vascular anastomoses to enable kidney transplantation in patients with major systemic venous thromboses
Authors: Lonze Bonnie E. , Dagher Nabil N. , Alachkar Nada , Jackson Annette M. , Montgomery Robert A.
Published: September 2017

Successful renal transplantation requires low‐pressure venous drainage to permit adequate outflow from the allograft. We report here a series of three patients in whom the inferior vena cava as well as bilateral iliac veins were thrombosed, making it necessary to explore less traditional vessels for venous drainage of the renal allograft. We utilized the splanchnic vasculature in two cases and the native left renal vein in another. The resulting atypical intra‐abdominal locations of these allografts also presented difficulties for arterial anastomoses and for urinary drainage. Arterial conduits were utilized in two cases to facilitate anastomosis to the common iliac artery or the aorta, and in the third case, the splenic artery was used for arterial inflow. A traditional ureterocystostomy was technically feasible for only one patient. In another, ureteroureterostomy to the native ureter was performed, and in the third case, the creation of an ileal conduit was necessary. All three patients had antibodies to human leukocyte antigens and two required desensitization. All three kidneys had immediate graft function and continued to function at 1 year post‐transplant. With a combination of planning, creativity, and persistence, patients with IVC thrombosis can enjoy the benefits of renal transplantation.
Primary large cell neuroendocrine carcinoma of the skin: An under‐recognized entity and a mimic of metastatic disease
Authors: Lano Ian Marie , Rayson Daniel , Arnason Thomas , Walsh Noreen M.G.
Published: September 2017

Primary large cell neuroendocrine carcinomas of the skin are exceptionally rare and can be diagnosed only when a metastasis from another organ has been excluded. We report the case of a 62‐year‐old woman with a cutaneous papule on the mid‐chest which generated a differential diagnosis of vascular lesion and basal cell carcinoma. Following excision, microscopic evaluation revealed a dermal large cell undifferentiated carcinoma, with a brisk mitotic rate and focal geographic necrosis. Mucin production was absent. On immunohistochemistry, the lesion expressed CK7, AE1AE3, CK8/18, chromogranin, synaptophysin, CD56, calcitonin (patchy) and TTF‐1 (minimal focal). Stains for neurofilament, CK20, CK5/6, p40, p63, SOX10, MART‐1, EMA, CEA, ER/PR, GATA3, GCDFP, mammoglobin, PAX‐8, CDX2, napsin, ERG and MCPyV proved negative. The histopathological diagnosis was of a large cell neuroendocrine carcinoma, probably metastatic. The patient underwent comprehensive clinical, laboratory and radiographic investigations and no underlying primary carcinoma was detected. During a 20‐month follow‐up period with an oncologist, the patient remains well and free of any apparent carcinoma. This suggests a primary large cell neuroendocrine carcinoma of skin. To date, 3 such cases have been reported in Japanese patients. This is the first in a Caucasian resident of North America.
NOS: a software suite to compute node overlap and segregation in ecological networks
Authors: Strona Giovanni , Matthews Thomas J. , Kortsch Susanne , Veech Joseph A.
Published: September 2017

Investigating the structure of ecological networks can help unravel the mechanisms promoting and maintaining biodiversity. Recently, Strona and Veech 2015 (A new measure of ecological network structure based on node overlap and segregation. – Methods Ecol. Evol. 6: 907–915) introduced a new metric (Ɲ̅, pronounced ‘nos’), that allows assessment of structural patterns in networks ranging from complete node segregation to perfect nestedness, and that also provides a visual and quantitative assessment of the degree of network modularity. The Ɲ̅ metric permits testing of a wide range of hypotheses regarding the tendency for species to share interacting partners by taking into account ecologically plausible species interactions based on constraints such as trophic levels and habitat preference. Here we introduce NOS, a software suite (including a web interface freely accessible at  http://nos.alwaysdata.net , an executable program, and Python and R packages) that makes it possible to exploit the full potential of this method. Besides computing node overlap and segregation (Ɲ̅), the software provides different functions to automatically identify a set of possible resource–consumer interactions in food webs based on trophic levels. As an example of application, we analyzed two well‐resolved high‐latitude marine food webs, showing that an explicit a priori consideration of trophic levels is fundamental for a proper assessment of food web structure.
Artificial daily fluctuations of river discharge affect the larval drift and survival of a tropical amphidromous goby
Authors: Lagarde Raphaël , Teichert Nils , Faivre Laëtitia , Grondin Henri , Magalon Hélène , Pirog Agathe , Valade Pierre , Ponton Dominique
Published: September 2017

Amphidromous fish species reproduce in rivers, and their larvae immediately drift to the sea after hatching. Most of these larvae survive in freshwater for a few days only, rapidly reaching sea water is thus essential. Being of small size, especially among species of the Sicydiinae subfamily, the larvae possess poor swimming abilities; their drift dynamics is considered to be mainly passive and influenced by flow conditions. The influence of daily fluctuations in flow regime on Sicyopterus lagocephalus (Sicydiinae) larval drift patterns was studied using drift nets at three sites along the dammed Langevin River in Reunion Island. The river flow was stable at the upstream site when frequent anthropogenic river flow fluctuations were observed at the two sites downstream to the dam. Weak diel larval drift dynamics were detected at the upstream site and the first site under anthropogenic river flow conditions. In contrast, larval drift dynamics at the most downstream site was strongly influenced by anthropogenic daily fluctuations of discharge: the abundance of drifting larvae increased with peaks of discharge, regardless of the time. As higher mortality rates of drifting larvae were observed during discharge peaks, the benefit of a more rapid travel to the ocean associated with these peaks should be lower than expected. It is concluded that peaks of discharge increase the number of larvae drifting to the sea probably due to higher physical constraints on the egg clutches, but also decrease the chance of survival for larvae that may be nonfully developed.
A randomized, controlled study evaluating effects of amlodipine addition to chelators to reduce iron loading in patients with thalassemia major
Authors: Eghbali Aziz , Kazemi Hamideh , Taherahmadi Hassan , Ghandi Yazdan , Rafiei Mohammad , Bagheri Bahador
Published: September 2017

Aim

Cardiomyopathy due to iron overload can be fatal in patients with thalassemia major. Calcium channel blockers seem to be effective to reduce iron loading. Our goal was to study effects of amlodipine addition to chelators on iron loading in patients with thalassemia major.

Methods

This randomized, controlled, and single‐center trial was performed on 56 patients with thalassemia major. Patients were randomized 1:1 to combined group (iron chelator plus amlodipine) or control group (iron chelator) for 1 year. Iron content was measured by magnetic resonance imaging; heart T2*, and liver T2*. Serum ferritin was also measured.

Results

After 12 months of treatment, myocardial T2* values had significant improvement in combined group (21.9 ± 8.0 ms to 24.5 ± 7.6 ms; P < .05); Difference between two groups was significant (P = .02). Combined treatment had no effect on hepatic T2* value (9.6 ± 2.8 ms to 9.5 ± 3.6 ms); difference between two groups was not significant (P = .2). In addition, a significant reduction was seen in serum ferritin levels in two groups. Mild gastrointestinal upset was the most common untoward effect.

Conclusion

Addition of amlodipine to iron chelators has beneficial effects for reduction of iron loading in patients with thalassemia major. This combination therapy seems safe.
High‐dose transdermal nicotine in Parkinson's disease patients: a randomized, open‐label, blinded‐endpoint evaluation phase 2 study
Authors: Villafane G. , Thiriez C. , Audureau E. , Straczek C. , Kerschen P. , Cormier‐Dequaire F. , Van Der Gucht A. , Gurruchaga J.‐M. , Quéré‐Carne M. , Evangelista E. , Paul M. , Defer G. , Damier P. , Remy P. , Itti E. , Fénelon G.
Published: September 2017

Background and purpose

Studies of the effects of nicotine on motor symptoms in Parkinson's disease (PD) brought out discordant results. The aim of the present study was to evaluate the efficacy and safety of high doses of transdermal nicotine on motor symptoms in PD.

Methods

Forty PD patients were randomly assigned to a treated and untreated arm in an open‐label study. Treated patients received increasing doses of nicotine to reach 90 mg/day by 11 weeks. This dosage was maintained for 28 weeks (W39) and then reduced over 6 weeks. Final evaluation was performed 6 weeks after washout. The main outcome measure was the OFF‐DOPA Unified Parkinson's Disease Rating Scale (UPDRS) motor score measured on video recordings by raters blinded to the medication status of the patients.

Results

There was no significant difference in OFF‐DOPA UPDRS motor scores between the nicotine‐treated and non‐treated groups, neither at W39 (19.4 ± 9.3 vs. 21.5 ± 14.2) nor considering W39 differences from baseline (−1.5 ± 12.1 vs. +0.9 ± 12.1). The 39‐item Parkinson's disease questionnaire scores decreased in nicotine‐treated patients and increased in non‐treated patients, but the difference was not significant. Overall tolerability was acceptable, and 12/20 treated patients reached the maximal dosage.

Conclusions

High doses of transdermal nicotine were tolerated, but our study failed to demonstrate significant improvement in UPDRS motor scores. Improvement in unblinded secondary outcomes (UPDRS‐II, UPDRS‐IV, doses of l‐DOPA equivalents) suggest a possible benefit for patients treated with nicotine, which should be confirmed in larger double blind, placebo‐controlled studies.
Does the intestinal microenvironment have an impact on the choleretic effect of inchinkoto, a hepatoprotective herbal medicine?
Authors: Uji Masahito , Yokoyama Yukihiro , Asahara Takashi , Ebata Tomoki , Igami Tsuyoshi , Mizuno Takashi , Yamaguchi Junpei , Nagino Masato
Published: September 2017

Aim

The choleretic effects of inchinkoto (ICKT), a hepatoprotective herbal medicine, are variable among patients. This study sought to investigate the correlation between the choleretic effects of ICKT and the intestinal microenvironment in patients with biliary obstruction.

Methods

Patients with biliary obstruction who underwent external biliary drainage were enrolled. The concentrations of total bilirubin and bile acid in the bile, and genipin, a major active ingredient of ICKT, in the bloodstream before and after ICKT treatment were measured. Feces were collected from the patients to determine bacterial count and organic acid concentrations.

Results

Samples from 37 patients were collected and analyzed. The serum concentration of genipin increased 3 h after ICKT treatment and showed a positive correlation with the percent changes of biliary concentrations of bile acid, total bilirubin, and direct bilirubin. Serum genipin concentration also showed a positive correlation with the fecal concentrations of representative obligate anaerobes such as the Clostridium leptum subgroup, Bacteroides fragilis group, Bifidobacterium, and the Atopobium cluster. In sharp contrast, so‐called harmful bacteria such as Clostridium difficile, Enterobacteriaceae, and Enterococcus showed a negative correlation with the concentration of genipin. Genipin concentration after ICKT administration showed a positive correlation with the fecal concentration of short chain fatty acids such as propionic acid and butyric acid, and a negative correlation with the fecal concentration of lactic acid.

Conclusions

The absorption of genipin was variable among patients. This variability may be associated with the fecal microenvironment profile and partly explain the variable choleretic effects of ICKT among patients.
Did boninite originate from the heterogeneous mantle with recycled ancient slab?
Authors: Umino Susumu , Kanayama Kyoko , Kitamura Keitaro , Tamura Akihiro , Ishizuka Osamu , Senda Ryoko , Arai Shoji
Published: September 2017

Boninites are widely distributed along the western margin of the Pacific Plate extruded during the incipient stage of the subduction zone development in the early Paleogene period. This paper discusses the genetic relationships of boninite and antecedent protoarc basalt magmas and demonstrates their recycled ancient slab origin based on the T–P conditions and Pb–Hf–Nd–Os isotopic modeling. Primitive melt inclusions in chrome spinel from Ogasawara and Guam islands show severely depleted high‐SiO2, MgO (high‐silica) and less depleted low‐SiO2, MgO (low‐silica and ultralow‐silica) boninitic compositions. The genetic conditions of 1 346 °C at 0.58 GPa and 1 292 °C at 0.69 GPa for the low‐ and ultralow‐silica boninite magmas lie on adiabatic melting paths of depleted mid‐ocean ridge basalt mantle with a potential temperature of 1 430 °C in Ogasawara and of 1 370 °C in Guam, respectively. This is consistent with the model that the low‐ and ultralow‐silica boninites were produced by remelting of the residue of the protoarc basalt during the forearc spreading immediately following the subduction initiation. In contrast, the genetic conditions of 1 428 °C and 0.96 GPa for the high‐silica boninite magma is reconciled with the ascent of more depleted harzburgitic source which pre‐existed below the Izu–Ogasawara–Mariana forearc region before the subduction started. Mixing calculations based on the Pb–Nd–Hf isotopic data for the Mariana protoarc basalt and boninites support the above remelting model for the (ultra)low‐silica boninite and the discrete harzburgite source for the high‐silica boninite. Yb–Os isotopic modeling of the high‐Si boninite source indicates 18–30 wt% melting of the primitive upper mantle at 1.5–1.7 Ga, whereas the source mantle of the protoarc basalt, the residue of which became the source of the (ultra)low‐Si boninite, experienced only 3.5–4.0 wt% melt depletion at 3.6–3.1 Ga, much earlier than the average depleted mid‐ocean ridge basalt mantle with similar degrees of melt depletion at 2.6–2.2 Ga.
Examination of intensive care unit patients' oral health
Authors: Celik Gul Gunes , Eser Ismet
Published: September 2017

Background

Oral health problems are common complications that most intensive care unit patients experience. There are many factors that affect oral health negatively and nurses have important responsibilities in this regard.

Aim

The aim of this study was assessment of the intensive care unit patients' oral health and risk factors.

Methods

This study was planned as a descriptive study and conducted between December 2015 and June 2016, with 202 patients in 20 intensive care units of 6 hospitals in Turkey. Data were collected via Data Collection Form and Bedside Oral Exam guide. Oral health assessment of patients was made using a source of light and a tongue depressor.

Results

We observed a significant difference in score of the Bedside Oral Exam guide by age, consciousness, type of respiration and feeding, the frequency of oral health, the total number of drugs, and technique of oral care (P < 0.05). None of the intensive care units were using the oral assessment guide.

Conclusion

The result of this study shows that there are various risk factors that adversely affect the oral health of intensive care unit patients. Nurses should undertake assessments on the basis of oral care protocols for patients at risk and carry out evidence‐based individualized oral care applications.
The contribution of a directional preference of stiffness to the efficacy of prophylactic sacral dressings in protecting healthy and diabetic tissues from pressure injury: computational modelling studies
Authors: Levy Ayelet , Schwartz Dafna , Gefen Amit
Published: September 2017

The sacral region is the most common site for pressure injuries (PIs) associated with lying in bed, and such sacral PIs often commence as deep tissue injuries (DTIs) that later present as open wounds. In complex patients, diabetes is common. Because, among other factors, diabetes affects connective tissue stiffness properties, making these tissues less able to dissipate mechanical loads through physiological deformations, diabetes is an additional biomechanical risk factor for PIs and DTIs. A preventive measure with established successful clinical outcomes is the use of sacral prophylactic dressings. The objective of this study has been to expand our previous work regarding the modes of action and biomechanical efficacy of prophylactic dressings in protecting the soft tissues adjacent to the sacrum by specifically examining the role of a directional stiffness preference (anisotropy) of the dressing while further accounting for diabetic tissue conditions. Multiple three‐dimensional anatomically detailed finite element (FE) model variants representing diabetic tissue conditions were used, and tissue loading state data were compared with healthy tissue simulations. We specifically compared soft tissue exposures to elevated internal shear stresses and strain energy densities (SED) near the sacrum during supine weight bearing on a standard (foam) hospital mattress without a dressing, with a prophylactic dressing lacking directional stiffness preferences and with an anisotropic dressing. Our results have clearly shown that an anisotropic dressing design reduces the peak tissue stresses and exposure to sustained tissue deformations in both healthy and diabetic cases. The present study provides additional important insights regarding the optimal structural and material design of prophylactic dressings, which in turn, informs clinicians and decision makers regarding beneficial features.
A systematic review of qualitative research into people's experiences of living with venous leg ulcers
Authors: Phillips Patrick , Lumley Elizabeth , Duncan Rosie , Aber Ahmed , Woods Helen Buckley , Jones Georgina L. , Michaels Jonathan
Published: September 2017

Aim

To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health‐related quality of life themes that are important from the perspective of patients with venous leg ulceration.

Background

Venous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health‐related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration.

Design

Qualitative evidence synthesis (using framework synthesis).

Data Sources

Multiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015.

Review Methods

Systematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations.

Results

Thirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment‐related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood.

Conclusion

The themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient‐reported outcome measures for use with this population.
Do adults with Down syndrome do the same amount of physical activity as adults without disability? A proof of principle study
Authors: Shields Nora , Plant Samantha , Warren Catherine , Wollersheim Dennis , Peiris Casey
Published: September 2017

Background

This study compared levels of physical activity completed by adults with and without Down syndrome.

Method

Fifteen adults with and 15 adults without Down syndrome matched for age and gender, took part. The intensity and duration of physical activity were measured using RT3 accelerometers worn for seven days.

Results

Only, 12 participants with Down syndrome had complete physical activity data, and these participants and their matched controls (total: six females, 18 males; aged 25.8 ± 9.7) were included in the analyses. There were significantly lower levels of moderate and vigorous physical activity per day for people with Down syndrome (median = 27 min) compared to those without (median = 101 min) (p < .001). Participants without disability were twice more likely to achieve recommended levels of physical activity than people with Down syndrome.

Conclusions

Adults with Down syndrome appear to participate in lower levels of physical activity than adults without Down syndrome. Further research should validate these estimates.
Use of reflectance confocal microscopy to evaluate 5‐fluorouracil 0.5%/salicylic acid 10% in the field‐directed treatment of subclinical lesions of actinic keratosis: subanalysis of a Phase III, randomized, double‐blind, vehicle‐controlled trial
Authors: Ulrich M. , Reinhold U. , Falqués M. , Rodriguez Azeredo R. , Stockfleth E.
Published: September 2017

Background

Actinic keratosis (AK) is a common skin disorder that can progress to invasive squamous‐cell carcinoma. AK can present as clinical (visible) or subclinical (invisible) lesions within areas of chronic sun damage. The importance of treating subclinical AK is gaining support. We present a subanalysis of a previously published Phase III, double‐blind, vehicle‐controlled study (NCT02289768), to assess 5‐fluorouracil (5‐FU) 0.5%/salicylic acid 10% treatment of subclinical AK lesions, based on reflectance confocal microscopy (RCM).

Objective

To determine the efficacy of 5‐FU 0.5%/salicylic acid 10% as field‐directed treatment for subclinical AK lesions using RCM.

Methods

For inclusion in this subanalysis, patients had to have at least three subclinical AK lesions within a 25 cm2 area of skin. Subclinical AK lesions were diagnosed according to the presence of three key RCM criteria: architectural disarray; keratinocyte atypia and pleomorphism at the basal, spinous and granular layer. Subclinical AK lesions were evaluated by RCM at baseline, after 4, 6 and 12 weeks of 5‐FU 0.5%/salicylic acid 10% treatment or vehicle, and 8 weeks following the end of treatment.

Results

Twenty‐seven patients were included: 17 [mean age = 72.2 years, standard deviation (SD) = 6.3] received 5‐FU 0.5%/salicylic acid 10% treatment and 10 (mean age = 76.4 years, SD = 3.9) received vehicle. Eight weeks following the end of treatment, the mean number of subclinical lesions declined (from 3.0 at baseline) to 0.3 (95% confidence interval [CI] 0.06–0.57) for the 5‐FU 0.5%/salicylic acid 10% group and 1.6 (95% CI 0.52–2.68) in the vehicle group (reductions of 90% [95% CI 72.1–107.1] vs. 47% [95% CI 24.8–69.5], respectively; P = 0.005). The proportion of patients receiving 5‐FU 0.5%/salicylic acid 10% showing complete clearance of three preselected subclinical AK lesions was numerically greater than in the vehicle group (69% vs. 40%, respectively; P = 0.183).

Conclusion

To the best of our knowledge, this is the first randomized, vehicle‐controlled study investigating 5‐FU 0.5%/salicylic acid 10% treatment for subclinical AK lesions. The present data suggest some treatment efficacy for subclinical AK lesions detected using RCM. However, this subanalysis was not sufficiently powered and should be reproduced in a larger, subsequent cohort.
Risk of Fracture in Women with Sarcopenia, Low Bone Mass, or Both
Authors: Harris Rebekah , Chang Yuefang , Beavers Kristen , Laddu‐Patel Deepika , Bea Jennifer , Johnson Karen , LeBoff Meryl , Womack Catherine , Wallace Robert , Li Wenjun , Crandall Carolyn , Cauley Jane
Published: September 2017

Objectives

To determine whether women with sarcopenia and low bone mineral density (BMD) are at greater risk of clinical fractures than those with sarcopenia or low BMD alone.

Design

Women's Health Initiative (WHI) Observational and Clinical trials.

Setting

Three U.S. clinical centers (Pittsburgh, PA; Birmingham, AL; Phoenix/Tucson, AZ).

Participants

Women (mean age 63.3 ± 0.07) with BMD measurements (N = 10,937).

Measurements

Sarcopenia was defined as appendicular lean mass values corrected for height and fat mass. Low BMD was defined as a femoral neck T‐score less than −1.0 based on the Third National Health and Nutrition Examination Survey reference database for white women. Cox proportional hazards analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). We followed women for incident fractures over a median of 15.9 years.

Results

Participants were classified into mutually exclusive groups based on BMD and sarcopenia status: normal BMD and no sarcopenia (n = 3,857, 35%), sarcopenia alone (n = 774, 7%), low BMD alone (n = 4,907, 45%), and low BMD and sarcopenia (n = 1,399, 13%). Women with low BMD, with (HR = 1.72, 95% CI = 1.44–2.06) or without sarcopenia (HR = 1.58, 95% CI = 1.37–1.83), had greater risk of fracture than women with normal BMD; the difference remained statistically significant after adjustment for important covariates. Women with low BMD, with (HR = 2.78, 95% CI = 1.78–4.30 and without (HR = 2.42, 95% CI = 1.63–3.59) sarcopenia had higher risk of hip fractures. Women with sarcopenia alone had similar HRs to women with normal BMD.

Conclusion

Compared to women with normal BMD.
Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants
Authors: Chalashika P. , Essex C. , Mellor D. , Swift J. A. , Langley‐Evans S.
Published: September 2017

Background

A better understanding of the nutritional status of infants who are HIV‐Exposed‐Uninfected (HEU) and HIV‐Unexposed‐Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub‐Saharan Africa.

Methods

A cross‐sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV‐exposed), aged 6–24 months, attending routine child health clinics, were recruited. Anthropometric, 24‐h dietary intake and socio‐demographic data was collected. Anthropometric Z‐scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression.

Results

Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio‐economic status.

Conclusions

HEU infants aged 6–24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.
Comparative morphology of snake (Squamata) endocasts: evidence of phylogenetic and ecological signals
Authors: Allemand Rémi , Boistel Renaud , Daghfous Gheylen , Blanchet Zoé , Cornette Raphaël , Bardet Nathalie , Vincent Peggy , Houssaye Alexandra
Published: September 2017

Brain endocasts obtained from computed tomography (CT) are now widely used in the field of comparative neuroanatomy. They provide an overview of the morphology of the brain and associated tissues located in the cranial cavity. Through anatomical comparisons between species, insights on the senses, the behavior, and the lifestyle can be gained. Although there are many studies dealing with mammal and bird endocasts, those performed on the brain endocasts of squamates are comparatively rare, thus limiting our understanding of their morphological variability and interpretations. Here, we provide the first comparative study of snake brain endocasts in order to bring new information about the morphology of these structures. Additionally, we test if the snake brain endocast encompasses a phylogenetic and/or an ecological signal. For this purpose, the digital endocasts of 45 snake specimens, including a wide diversity in terms of phylogeny and ecology, were digitized using CT, and compared both qualitatively and quantitatively. Snake endocasts exhibit a great variability. The different methods performed from descriptive characters, linear measurements and the outline curves provided complementary information. All these methods have shown that the shape of the snake brain endocast contains, as in mammals and birds, a phylogenetic signal but also an ecological one. Although phylogenetically related taxa share several similarities between each other, the brain endocast morphology reflects some notable ecological trends: e.g. (i) fossorial species possess both reduced optic tectum and pituitary gland; (ii) both fossorial and marine species have cerebral hemispheres poorly developed laterally; (iii) cerebral hemispheres and optic tectum are more developed in arboreal and terrestrial species.
Earliest depiction of vitiligo in “Venus at a Mirror” (1615) by Peter Paul Rubens (1577–1640)
Authors: Ashrafian Hutan
Published: September 2017

The 1615 painting of Venus at a Mirror by Peter Paul Rubens is considered a powerful example of the Flemish Baroque movement. Recently it has been identified that the Venus character in the image has a goitre, however on studying the image further, I note dermato‐pathology in another of the painting's main characters; the dark‐skinned female typically described as the Venus’ maidservant who clearly demonstrates patches of skin pigment loss on her face and neck with a concurrent streak of white hair. Together these suggest the underlying diagnosis of vitiligo. There is also a goitre in this individual suggesting thyroid disease. This new finding may offer additional insight into the historical epidemiology of disease in northern Europe but also offers further understanding of the method, origin, and pathological associations of this prominent painting from a genius artist.
The experiences of being a registered nurse prescriber within an acute service setting
Authors: Lennon Roisin , Fallon Anne
Published: September 2017

Aims and objectives

To explore the experiences of nurse prescribers in an acute service setting.

Design

A descriptive phenomenological design underpinned by Husserl's philosophy was used as the guiding framework.

Methods

Data were collected using semistructured interviews and purposive sampling of 11 current registered nurse prescribers from two acute hospitals. Colaizzi's seven steps were employed to analyse the data and develop themes which reflected the participants' experiences of prescribing.

Results

The study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing. The nurses interviewed were proud to be prescribers and perceived their prescribing practice as safe. This was a unique finding, not described by other research. Increased job satisfaction was also important to those interviewed as identified in previous studies pertaining to prescriptive authority. Ongoing challenges affecting prescribers included staff shortages, extra workload arising from prescribing and the need to educate colleagues about nurse prescribing. Those interviewed also suggested standardising both the prescribing course and local Drugs and Therapeutics Committees nationally, to overcome identified issues.

Conclusions

Further research into the safety of nurse prescribing is recommended to ascertain if what was described locally applies nationally. A larger study into the experiences of nurse and midwife prescribers is also required, to promote and maintain this practice and to ensure future prescribers embrace this extended scope of practice.

Relevance to clinical practice

Insight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.
Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease
Authors: Hagström E. , Norlund F. , Stebbins A. , Armstrong P. W. , Chiswell K. , Granger C. B. , López‐Sendón J. , Pella D. , Soffer J. , Sy R. , Wallentin L. , White H. D. , Stewart R. A. H. , Held C.
Published: September 2017

Objectives

Assess the risk of ischaemic events associated with psychosocial stress in patients with stable coronary heart disease (CHD).

Methods

Psychosocial stress was assessed by a questionnaire in 14 577 patients (median age 65.0, IQR 59, 71; 81.6% males) with stable CHD on optimal secondary preventive therapy in the prospective randomized STABILITY clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors and outcomes.

Results

After 3.7 years of follow‐up, depressive symptoms, loss of interest and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of CV death (1.21, 1.09–1.34; 1.15, 1.05–1.27; and 1.19, 1.08–1.30, respectively) and the primary composite end‐point of CV death, nonfatal MI or nonfatal stroke (1.21, 1.13–1.30; 1.19, 1.11–1.27; and 1.17, 1.10–1.24, respectively). Living alone was related to higher risk of CV death (1.68, 1.38–2.05) and the primary composite end‐point (1.28, 1.11–1.48), whereas being married as compared with being widowed, was associated with lower risk of CV death (0.64, 0.49–0.82) and the primary composite end‐point (0.81, 0.67–0.97).

Conclusions

Psychosocial stress, such as depressive symptoms, loss of interest, living alone and financial stress, were associated with increased CV mortality in patients with stable CHD despite optimal medical secondary prevention treatment. Secondary prevention of CHD should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.
Three‐dimensional reconstruction with serial whole‐mount sections of oral tongue squamous cell carcinoma: A preliminary study
Authors: Wang Yujia , Chen Sheng , Ni Yanhong , Magee Derek , Pu Yumei , Zhou Qian , Wang Zhiyong , Zhang Lei , Huang Xiaofeng , Hu Qingang
Published: September 2017

Objectives

Margin status and invasion pattern are prognostic factors for oral tongue squamous cell carcinoma (OTSCC). Current methods to identify these factors are limited to 2D observation; it is necessary to explore 3D reconstruction with whole‐mount sample to improve the accuracy of analysis. This study aimed to study the tissue preparation, section generation, and 3D reconstruction with whole‐mount OTSCC specimen.

Study design

Two OTSCC samples were retrieved from Nanjing Stomatological Hospital, Medical School of Nanjing University. One sample was sliced into 3 equal‐sized pieces and subjected to different processing schedules to determine the best method. The second sample was processed accordingly. Serial whole‐mount sections of the second sample were generated, stained with HE/anticytokine antibody in intersection manner, and scanned into digital images. Digital images were aligned and reconstructed into 3D images with Hetero Genius Medical Image Manager 3D Pathology Add‐On [HGMIM3D].

Results

Successful serial whole‐mount sections of comparable quality to traditional sections were generated. Three‐dimensional images with serial whole‐mount sections were successfully generated.

Conclusions

Whole‐mount histopathological 3D reconstruction of OTSCC was successfully generated, providing a solid foundation for comprehensive margin and invasion analysis. Although future study and improvement were needed, whole‐mount histopathological 3D reconstruction proved to be a promising method in OTSCC study.
Influence of cluster analysis procedures on variation explained and consumer orientation in internal and external preference maps
Authors: Yenket Renoo , Chambers Edgar
Published: September 2017

Common statistical package clustering (SPC) methods may result in consumer segments that still are heterogeneous in product acceptance. Creating new products based on attributes selected from preference maps that use those clusters may result in product failure because the products are developed for consumers with some dissimilar preferences. Methods for clustering that produce more homogeneous clusters of consumers have been reported, that is, SPC with additional “manual” clustering used for gathering consumers with congruent liking of products. In this study, internal and external preference maps were created using two supplemental “manual” clustering approaches and are compared with maps from hierarchical and partitional clustering (i.e., k‐means) results. We observe how clusters with higher homogeneity in product liking patterns change spaces of consumers, descriptors, and product co‐ordinates in internal and external preference maps. Improvement in the preference mapping was exhibited, but the homogenous consumer clusters still miscommunicate some information, as the maps usually do. This was especially true for external preference maps with low percentage variance explained in the descriptors. Thus, it is essential to compare mapping results to the original data and to findings from the original descriptive study to gain the most appropriate information.

Practical applications

Correctness of sensory information is very important for further analysis. The methods using some additional clustering procedures yield more exactitude in consumer liking patterns than only statistical package clustering. Statistical package clustering with supplementary manual clustering ensures that consumers who share both the most liked product and the least liked products are placed in same in the cluster. However, that does not ensure that the “maps” generated allow for unqualified interpretation. It is essential that preference mapping procedure are joined with common sense reviewing of the original data, key descriptive findings, and key information on most and least liked products within various consumer groups.
Acute flaccid paralysis in South African children: Causes, respiratory complications and neurological outcome
Authors: van der Pijl Jolanda , Wilmshurst Jo M , van Dijk Monique , Argent Andrew , Booth Jane , Zampoli Marco
Published: September 2017

Aim

To describe the causes, clinical presentation and neurological outcome of acute flaccid paralysis in children.

Methods

A retrospective study in a tertiary paediatric hospital in South Africa. Data on clinical presentation, respiratory complications and long‐term neurological outcomes of children presenting with acute flaccid paralysis were collected. Logistic regression analysis was applied to determine predictors for the need of mechanical ventilation.

Results

The study included 119 patients, 99 of whom had Guillain‐Barré syndrome (GBS); 47 patients (39.5%) required mechanical ventilation. Backward logistic regression analysis revealed that bulbar dysfunction (P < 0.001), autonomic dysfunction (P = 0.003) and upper limb paralysis (P = 0.038) significantly predicted the need for mechanical ventilation. EuroQol‐5D scores of self‐care problems and usual activities after discharge significantly declined over time.

Conclusions

In this large series from Africa, GBS was the main cause of acute flaccid paralysis in children and was associated with significant morbidity. Other causes of acute flaccid paralysis mimicking GBS were not uncommon and should be excluded in this setting.
Evidence that glial cells attenuate G47R transthyretin accumulation in the central nervous system
Authors: Sumi‐Akamaru Hisae , Eto Masaki , Yamauchi Amane , Uehara Takuya , Kakuda Keita , Obayashi Konen , Kato Shinsuke , Naka Takashi , Mochizuki Hideki
Published: September 2017

Amyloidogenic protein forms amyloid aggregations at membranes leading to dysfunction of amyloid clearance and amyloidosis. Glial cells function in the clearance and degradation of amyloid β (Aβ) in the brain. This study aimed to clarify the reason why amyloid transthyretin (ATTR) rarely accumulates in the CNS. We pathologically analyzed the relationship between amyloid deposition with basement membranes or glial cells in a rare case of ATTR leptomeningeal amyloidosis. In addition, we compared the cytotoxicity of ATTR G47R, the amyloidosis‐causing mutation in the case studied (n = 1), and Aβ in brains from patients with cerebral amyloid angiopathy (n = 6). In the subarachnoid space of the ATTR G47R case, most amyloids accumulated at the components of basement membranes. On the CNS surface, ATTR accumulations were retained by astrocytic end feet. In areas where glial end feet enveloped ATTR, ubiquitination and micro‐vacuolation of ATTR was evident. The colocalization of GFAP and ubiquitin was also evident. The accumulation of ATTR G47R in the CNS was negatively correlated with the prevalence of astrocytes. Quantitatively, amyloid deposits along the vessels were mostly partial in cerebral Aβ angiopathy cases and nearly complete along the basement membrane in the ATTR G47R case. The vascular expressions of type IV collagen and smooth muscle actin were severely reduced in areas with ATTR G47R deposition, but not in areas with Aβ deposition. The vascular protein level recovered in the ATTR G47R case when vessels entered into areas of parenchyma that were rich in astrocytes. In addition, the strong interactions between the transthyretin variant and basement membranes may have led to dysfunction of transthyretin clearance and leptomeningeal amyloidosis. The present study was the first to show that glial cells may attenuate G47R transthyretin accumulation in the CNS.
Nectar‐inhabiting microorganisms influence nectar volatile composition and attractiveness to a generalist pollinator
Authors: Rering Caitlin C. , Beck John J. , Hall Griffin W. , McCartney Mitchell M. , Vannette Rachel L.
Published: September 2017

The plant microbiome can influence plant phenotype in diverse ways, yet microbial contribution to plant volatile phenotype remains poorly understood. We examine the presence of fungi and bacteria in the nectar of a coflowering plant community, characterize the volatiles produced by common nectar microbes and examine their influence on pollinator preference.

Nectar was sampled for the presence of nectar‐inhabiting microbes. We characterized the headspace of four common fungi and bacteria in a nectar analog. We examined electrophysiological and behavioral responses of honey bees to microbial volatiles. Floral headspace samples collected in the field were surveyed for the presence of microbial volatiles.

Microbes commonly inhabit floral nectar and the common species differ in volatile profiles. Honey bees detected most microbial volatiles tested and distinguished among solutions based on volatiles only. Floral headspace samples contained microbial‐associated volatiles, with 2‐ethyl‐1‐hexanol and 2‐nonanone – both detected by bees – more often detected when fungi were abundant.

Nectar‐inhabiting microorganisms produce volatile compounds, which can differentially affect honey bee preference. The yeast Metschnikowia reukaufii produced distinctive compounds and was the most attractive of all microbes compared. The variable presence of microbes may provide volatile cues that influence plant–pollinator interactions.