bluuebunny/crossref_metadata_2025 huggingface dataset:
The major threats to Atlantic salmon in Norway
Authors: Forseth Torbjørn , Barlaup Bjørn T. , Finstad Bengt , Fiske Peder , Gjøsæter Harald , Falkegård Morten , Hindar Atle , Mo Tor Atle , Rikardsen Audun H. , Thorstad Eva B. , Vøllestad Leif Asbjørn , Wennevik Vidar
Published: February 2017

Atlantic salmon (Salmo salar) is an economically and culturally important species. Norway has more than 400 watercourses with Atlantic salmon and supports a large proportion of the world’s wild Atlantic salmon. Atlantic salmon are structured into numerous genetically differentiated populations, and are therefore managed at the population level. Long-distance migrations between freshwater and ocean habitats expose Atlantic salmon to multiple threats, and a number of anthropogenic factors have contributed to the decline of Atlantic salmon during the last decades. Knowledge on the relative importance of the different anthropogenic factors is vital for prioritizing management measures. We developed a semi-quantitative 2D classification system to rank the different anthropogenic factors and used this to assess the major threats to Norwegian Atlantic salmon. Escaped farmed salmon and salmon lice from fish farms were identified as expanding population threats, with escaped farmed salmon being the largest current threat. These two factors affect populations to the extent that they may be critically endangered or lost, with a large likelihood of causing further reductions and losses in the future. The introduced parasite Gyrodactylus salaris, freshwater acidification, hydropower regulation and other habitat alterations were identified as stabilized population threats, which have contributed to populations becoming critically endangered or lost, but with a low likelihood of causing further loss. Other impacts were identified as less influential, either as stabilized or expanding factors that cause loss in terms of number of returning adults, but not to the extent that populations become threatened. Management based on population specific reference points (conservation limits) has reduced exploitation in Norway, and overexploitation was therefore no longer regarded an important impact factor. The classification system may be used as a template for ranking of anthropogenic impact factors in other countries and as a support for national and international conservation efforts.
Allelic inflation in depleted fish populations with low recruitment
Authors: Niwa Hiro-Sato , Nashida Kazuya , Yanagimoto Takashi
Published: February 2017

When the recruitment process in highly fecund species involves within-litter correlations in survival probability, the offspring-number distribution can exhibit a power law. Such reproductive skew appears to be prevalent in abundant marine species. We show that an apparent paradox arises in the reproductive skew model. In years of occasionally large recruitment, we expect to observe elevated levels of relatedness among recruits. Conversely, the effective number of alleles within the population is inflated during periods of low-recruitment. Thus, depressed fish populations have excesses of singleton offspring and thus, overexploitation may cause stock depletion but with increasing genetic diversity. Some studies have documented such a diversity paradox. It does not seem possible to explain large effective population sizes of collapsed species on the basis of normal reproduction models in the domain of attraction of the Kingman coalescent. The approach outlined here provides a novel method to examine the resilience and potential for recovery in depleted populations using short-length time-series data on recruitment.
Drivers of fuel use in rock lobster fisheries
Authors: Parker Robert W. R. , Gardner Caleb , Green Bridget S. , Hartmann Klaas , Watson Reg A.
Published: February 2017

Fuel consumption is a leading cost to fishers and the primary source of greenhouse gas emissions from the global fishing industry. Fuel performance varies substantially between and within fisheries, but the drivers behind this variation are unclear and inconsistent across studies. We surveyed rock lobster fishers in Australia and New Zealand to measure rates of fuel use and assess the influence of technological (e.g. vessel size, engine power), behavioural (e.g. distance travelled, speed), and managerial (e.g. catch per unit effort, fishery capacity) factors. Weighted fuel use intensity across the region was 1,890 l/t. Managerial factors were the most influential drivers of fuel use in single day trips while technological factors heavily influenced multi-day trips. Catch per unit effort was the only significant driver present across both types of fishing trips. The vast majority of surveyed fishers identified fuel use as an important aspect of fishing operations, and nearly half had already implemented changes to try to reduce consumption. Our results suggest that efforts to reduce fuel consumption, costs, and emissions in fisheries need to be tailored to the nature of individual fisheries, as the relative roles of technology, behaviour, and management vary.
Representation and coding of signal geometry
Authors: Boufounos Petros T , Rane Shantanu , Mansour Hassan
Published: February 2017

Approaches to signal representation and coding theory have traditionally focused on how to best represent signals using parsimonious representations that incur the lowest possible distortion. Classical examples include linear and nonlinear approximations, sparse representations and rate-distortion theory. Very often, however, the goal of processing is to extract specific information from the signal, and the distortion should be measured on the extracted information. The corresponding representation should, therefore, represent that information as parsimoniously as possible, without necessarily accurately representing the signal itself.

In this article, we examine the problem of encoding signals such that sufficient information is preserved about their pairwise distances and their inner products. For that goal, we consider randomized embeddings as an encoding mechanism and provide a framework to analyze their performance. We also demonstrate that it is possible to design the embedding such that it represents different ranges of distances with different precision. These embeddings also allow the computation of kernel inner products with control on their inner product-preserving properties. Our results provide a broad framework to design and analyze embeddings and generalize existing results in this area, such as random Fourier kernels and universal embeddings.
Effects of consumer-oriented health information technologies in diabetes management over time: a systematic review and meta-analysis of randomized controlled trials
Authors: Tao Da , Wang Tieyan , Wang Tieshan , Liu Shuang , Qu Xingda
Published: February 2017

Objective: To reveal the effects of consumer-oriented health information technologies (CHITs) on patient outcomes in diabetes management over time through systematic review and meta-analysis.

Methods: We searched 5 electronic databases (from database inception to July 2016) for studies that reported on randomized controlled trials examining the effects of CHITs on glycemic control and other patient outcomes in diabetes management. Data were analyzed using either meta-analysis or a narrative synthesis approach.

Results: Eighty randomized controlled trial studies, representing 87 individual trials, were identified and included for analysis. Overall, the meta-analysis showed that the use of CHITs resulted in significant improvement in glycemic control compared to usual care (standardized mean difference = −0.31%, 95% confidence interval −0.38 to −0.23, P < .001) in patients with diabetes. Specifically, improvement in glycemic control was significant at intervention durations of 3, 6, 8, 9, 12, 15, 30, and 60 months, while no significant differences were found at other time points reported. The narrative synthesis provided mixed effects of CHITs on other clinical, psychosocial, behavioral, and knowledge outcomes.

Conclusions: The use of CHITs appears to be more effective than usual care in improving glycemic control for patients with diabetes. However, their effectiveness did not remain consistent over time and in other patient outcomes. Further efforts are required to examine long-term effects of CHITs and to explore factors that can moderate the effects over time.
Pragmatic (trial) informatics: a perspective from the NIH Health Care Systems Research Collaboratory
Authors: Richesson Rachel L , Green Beverly B , Laws Reesa , Puro Jon , Kahn Michael G , Bauck Alan , Smerek Michelle , Van Eaton Erik G , Zozus Meredith , Ed Hammond W , Stephens Kari A , Simon Greg E
Published: February 2017

Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes. These challenges impact the validity, reliability, and integrity of PCTs. Achieving the full potential of PCTs and a learning health system will require meaningful partnerships between health system leadership and operations, and federally driven standards and policies to ensure that future electronic health record systems have the flexibility to support research.
Comparison of multileaf collimator and conventional circular collimator systems in Cyberknife stereotactic radiotherapy
Authors: Murai Taro , Hattori Yukiko , Sugie Chikao , Iwata Hiromitsu , Iwabuchi Michio , Shibamoto Yuta
Published: February 2017

Multileaf collimator (MLC) technology has been newly introduced with the Cyberknife system. This study investigated the advantages of this system compared with the conventional circular collimator (CC) system. Dosimetric comparisons of MLC and CC plans were carried out. First, to investigate suitable target sizes for the MLC mode, MLC and CC plans were generated using computed tomography (CT) images from 5 patients for 1, 3, 5 and 7 cm diameter targets. Second, MLC and CC plans were compared in 10 patients, each with liver and prostate targets. For brain targets, doses to the brain could be spared in MLC plans better than in CC plans (P ≤ 0.02). The MLC mode also achieved more uniform dose delivery to the targets. The conformity index in MLC plans was stable, irrespective of the target size (P = 0.5). For patients with liver tumors, the MLC mode achieved higher target coverage than the CC mode (P = 0.04). For prostate tumors, doses to the rectum and the conformity index were lowered in MLC plans compared with in CC plans (P ≤ 0.04). In all target plans, treatment times in MLC plans were shorter than those in CC plans (P < 0.001). The newly introduced MLC technology can reduce treatment time and provide favorable or comparable dose distribution for 1–7 cm targets. In particular, the MLC mode has dosimetric advantage for targets near organs at risk. Therefore, the MLC mode is recommended as the first option in stereotactic body radiotherapy.
Long-term Outcomes With Planned Multistage Reduced Dose Repeat Stereotactic Radiosurgery for Treatment of Inoperable High-Grade Arteriovenous Malformations: An Observational Retrospective Cohort Study
Authors: Marciscano Ariel E. , Huang Judy , Tamargo Rafael J. , Hu Chen , Khattab Mohamed H. , Aggarwal Sameer , Lim Michael , Redmond Kristin J. , Rigamonti Daniele , Kleinberg Lawrence R.
Published: February 2017

BACKGROUND: There is no consensus regarding the optimal management of inoperable high-grade arteriovenous malformations (AVMs). This long-term study of 42 patients with high-grade AVMs reports obliteration and adverse event (AE) rates using planned multistage repeat stereotactic radiosurgery (SRS).

OBJECTIVE: To evaluate the efficacy and safety of multistage SRS with treatment of the entire AVM nidus at each treatment session to achieve complete obliteration of high-grade AVMs.

METHODS: Patients with high-grade Spetzler-Martin (S-M) III-V AVMs treated with at least 2 multistage SRS treatments from 1989 to 2013. Clinical outcomes of obliteration rate, minor/major AEs, and treatment characteristics were collected.

RESULTS: Forty-two patients met inclusion criteria (n = 26, S-M III; n = 13, S-M IV; n = 3, S-M V) with a median follow-up was 9.5 yr after first SRS. Median number of SRS treatment stages was 2, and median interval between stages was 3.5 yr. Twenty-two patients underwent pre-SRS embolization. Complete AVM obliteration rate was 38%, and the median time to obliteration was 9.7 yr. On multivariate analysis, higher S-M grade was significantly associated (P = .04) failure to achieve obliteration. Twenty-seven post-SRS AEs were observed, and the post-SRS intracranial hemorrhage rate was 0.027 events per patient year.

CONCLUSION: Treatment of high-grade AVMs with multistage SRS achieves AVM obliteration in a meaningful proportion of patients with acceptable AE rates. Lower obliteration rates were associated with higher S-M grade and pre-SRS embolization. This approach should be considered with caution, as partial obliteration does not protect from hemorrhage.
Management of Penetrating Cerebrovascular Injuries in Pediatric Trauma: A Retrospective Multicenter Study
Authors: Ravindra Vijay M. , Dewan Michael C. , Akbari Hassan , Bollo Robert J. , Limbrick David , Jea Andrew , Naftel Robert P. , Riva-Cambrin Jay K.
Published: February 2017

BACKGROUND: Blunt cerebrovascular injury is uncommon in the pediatric population; penetrating cerebrovascular injuries are even rarer and are thus poorly understood.

OBJECTIVE: To describe the diagnosis and management of penetrating cerebrovascular injuries and describe outcomes of available treatment modalities.

METHODS: Clinical and radiographic data were collected retrospectively from a multicenter trauma registry for children screened for cerebrovascular injury during 2003 to 2013 at 4 academic pediatric trauma centers.

RESULTS: Among 645 pediatric patients evaluated with computed tomography angiography with blunt cerebrovascular injury, 130 also had a penetrating trauma indication. Seven penetrating cerebrovascular injuries were diagnosed in 7 male patients (mean age 12.4 years, range 12-18 years). Focal neurological deficit and concomitant intracranial injury were each seen in 2 patients. There were 2 intracranial carotid artery injuries, 4 extracranial carotid artery injuries, and 1 vertebral artery injury. The majority of injuries were higher than grade I (5/7; 71%): 2 were grade I, 1 grade II, 2 grade III, and 2 grade IV. The 2 patients with grade III injuries required open surgery, and 1 patient with a grade IV injury underwent endovascular treatment. Two patients suffered immediate stroke secondary to the penetrating cerebrovascular injury. There were no delayed neurological deficits from the penetrating injuries, and no patients died as a result of the injuries.

CONCLUSION: This is the largest series of penetrating cerebrovascular trauma in the pediatric literature. Although rare, penetrating cerebrovascular injuries can be high-grade injuries that require urgent recognition and may require aggressive endovascular and/or open surgery for treatment.
Forty years of research on solid metallic lithium batteries: an interview with Liquan Chen
Authors: Li Hong
Published: February 2017

Li-ion batteries were first commercialized by Sony in 1991 and have been used widely in portable electronic devices, electric vehicles and grid applications. Although Li-ion batteries have achieved a phenomenon commercial success and become so pervasive and indispensable in our modern life, their development has been sluggish and fallen way behind the rapid advancement of electronic technologies. Batteries with a higher energy density than Li-ion batteries are highly desired for many emerging applications. It is widely recognized that solid metallic lithium batteries (SMLBs) are one of the most promising candidate technologies. The first research on SMLBs was reported by Michel Armand in 1978. At almost the same time, Liquan Chen studied lithium-ion conductors in Germany with Werner Weppner in 1977. When he came back to China in 1978, he initiated and pioneered the research on SMLBs and related fundamental studies of solid-state ionics in China for the first time. In this interview, Prof. Chen reviews his work of the past 40 years in solid lithium batteries and lithium-ion batteries, and the renaissance and future prospects of SMLBs.
Primary Outcomes From a Phase 3, Randomized, Double-Blind, Active-Controlled Trial of Surotomycin in Subjects With Clostridium difficile Infection
Authors: Boix Vicente , Fedorak Richard N. , Mullane Kathleen M. , Pesant Yves , Stoutenburgh Uschi , Jin Mandy , Adedoyin Adedayo , Chesnel Laurent , Guris Dalya , Larson Kajal B. , Murata Yoshihiko
Published: February 2017

Background

Although the incidence of Clostridium difficile infection (CDI) is increasing, available CDI treatment options are limited in terms of sustained response after treatment. This phase 3 trial assessed the efficacy and safety of surotomycin, a novel bactericidal cyclic lipopeptide, versus oral vancomycin in subjects with CDI.

Methods

In this randomized, double-blind, active-controlled, multicenter, international trial, subjects with CDI confirmed by a positive toxin result were randomized to receive surotomycin (250 mg twice daily) or vancomycin (125 mg 4 times daily) orally for 10 days. The primary endpoints were clinical response at end of treatment and evaluation of surotomycin safety. The key secondary endpoints were clinical response over time and sustained clinical response through a 30- to 40-day follow-up period. Clostridium difficile infection recurrence during follow-up and time to diarrhea resolution were also analyzed.

Results

In total, 570 subjects were randomized and had confirmed CDI; 290 subjects received surotomycin and 280 subjects received vancomycin. Surotomycin clinical cure rates at end of treatment (surotomycin/vancomycin: 79.0%/83.6%; difference of −4.6%; 95% confidence interval, −11.0 to 1.9]), clinical response over time (stratified log-rank test, P = .832), and sustained clinical response at end of trial (Day 40–50) (60.6%/61.4%; difference of −0.8%; 95% CI, −8.8 to 7.1) in the microbiological modified intent to treat population did not meet noninferiority or superiority criteria versus vancomycin. Both treatments were generally well tolerated.

Conclusions

Surotomycin failed to meet the criteria for noninferiority versus vancomycin for the primary and key secondary endpoints in this trial.
How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections?
Authors: Young Heather , Miller Whitney , Burnham Randy , Heard Susan , Berg Chrystal , Jenkins Timothy C.
Published: February 2017

abstract

The impact of preoperative antibiotics on culture of diabetic foot infection samples has not been studied. We found that increasing exposure to preoperative antibiotics was associated with less frequent growth of streptococci and anaerobes and more culture-negative results. In contrast, the yield of Staphylococcus aureus and Gram-negative bacilli was unaffected.
Barriers to Hepatitis C Virus (HCV) Treatment Initiation in Patients With Human Immunodeficiency Virus/HCV Coinfection: Lessons From the Interferon Era
Authors: Wansom Tanyaporn , Falade-Nwulia Oluwaseun , Sutcliffe Catherine G. , Mehta Shruti H. , Moore Richard D. , Thomas David L. , Sulkowski Mark S.
Published: February 2017

Background

Hepatitis C is a major cause of mortality among human immunodeficiency virus (HIV)-infected patients, yet hepatitis C virus (HCV) treatment uptake has historically been low. Although the removal of interferon removes a major barrier to HCV treatment uptake, oral therapies alone may not fully eliminate barriers in this population.

Methods

Within the Johns Hopkins Hospital HIV cohort, a nested case-control study was conducted to identify cases, defined as patients initiating HCV treatment between January 1996 and 2013, and controls, which were selected using incidence density sampling (3:1 ratio). Controls were matched to cases on date of enrollment. Conditional logistic regression was used to evaluate factors associated with HCV treatment initiation.

Results

Among 208 treated cases and 624 untreated controls, the presence of advanced fibrosis (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.26–3.95), recent active drug use (OR, 0.36; 95% CI, 0.19–0.69), and non-black race (OR, 2.01; 95% CI, 1.26–3.20) were independently associated with initiation of HCV therapy. An increasing proportion of missed visits was also independently associated with lower odds of HCV treatment (25%–49% missed visits [OR, 0.49; 95% CI, 0.27–0.91] and ≥50% missed visits [OR, 0.24; 95% CI, 0.12–0.48]).

Conclusions

Interferon-free treatments may not be sufficient to fully overcome barriers to HCV care in HIV-infected patients. Interventions to increase engagement in care for HIV and substance use are needed to expand HCV treatment uptake.
Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis
Authors: Lachance Philippe , Chen Justin , Featherstone Robin , Sligl Wendy I
Published: February 2017

Background

The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods

We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results

Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.

Conclusions

In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.
Quasi-probabilities in conditioned quantum measurement and a geometric/statistical interpretation of Aharonov’s weak value
Authors: Lee Jaeha , Tsutsui Izumi
Published: February 2017

We show that the joint behavior of an arbitrary pair of (generally noncommuting) quantum observables can be described by quasi-probabilities, which are an extended version of the standard probabilities used for describing the outcome of measurement for a single observable. The physical situations that require these quasi-probabilities arise when one considers quantum measurement of an observable conditioned by some other variable, with the notable example being the weak measurement employed to obtain Aharonov’s weak value. Specifically, we present a general prescription for the construction of quasi-joint probability (QJP) distributions associated with a given combination of observables. These QJP distributions are introduced in two complementary approaches: one from a bottom-up, strictly operational construction realized by examining the mathematical framework of the conditioned measurement scheme, and the other from a top-down viewpoint realized by applying the results of the spectral theorem for normal operators and their Fourier transforms. It is then revealed that, for a pair of simultaneously measurable observables, the QJP distribution reduces to the unique standard joint probability distribution of the pair, whereas for a noncommuting pair there exists an inherent indefiniteness in the choice of such QJP distributions, admitting a multitude of candidates that may equally be used for describing the joint behavior of the pair. In the course of our argument, we find that the QJP distributions furnish the space of operators in the underlying Hilbert space with their characteristic geometric structures such that the orthogonal projections and inner products of observables can be given statistical interpretations as, respectively, “conditionings” and “correlations”. The weak value $A_{w}$ for an observable $A$ is then given a geometric/statistical interpretation as either the orthogonal projection of $A$ onto the subspace generated by another observable $B$, or equivalently, as the conditioning of $A$ given $B$ with respect to the QJP distribution under consideration.
Single Session of Functional Electrical Stimulation-Assisted Walking Produces Corticomotor Symmetry Changes Related to Changes in Poststroke Walking Mechanics
Authors: Palmer Jacqueline A. , Hsiao HaoYuan , Wright Tamara , Binder-Macleod Stuart A.
Published: February 2017

Background. Recent research demonstrated that the symmetry of corticomotor drive with the paretic and nonparetic plantarflexor muscles was related to the biomechanical ankle moment strategy that people with chronic stroke used to achieve their greatest walking speeds. Rehabilitation strategies that promote corticomotor balance might improve poststroke walking mechanics and enhance functional ambulation.

Objective. The study objectives were to test the effectiveness of a single session of gait training using functional electrical stimulation (FES) to improve plantarflexor corticomotor symmetry and plantarflexion ankle moment symmetry and to determine whether changes in corticomotor symmetry were related to changes in ankle moment symmetry within the session.

Design. This was a repeated-measures crossover study.

Methods. On separate days, 20 people with chronic stroke completed a session of treadmill walking either with or without the use of FES of their ankle dorsi- and plantarflexor muscles. We calculated plantarflexor corticomotor symmetry using transcranial magnetic stimulation and plantarflexion ankle moment symmetry during walking between the paretic and the nonparetic limbs before and after each session. We compared changes and tested relationships between corticomotor symmetry and ankle moment symmetry following each session.

Results. Following the session with FES, there was an increase in plantarflexor corticomotor symmetry that was related to the observed increase in ankle moment symmetry. In contrast, following the session without FES, there were no changes in corticomotor symmetry or ankle moment symmetry.

Limitations. No stratification was made on the basis of lesion size, location, or clinical severity.

Conclusions. These findings demonstrate, for the first time (to our knowledge), the ability of a single session of gait training with FES to induce positive corticomotor plasticity in people in the chronic stage of stroke recovery. They also provide insight into the neurophysiologic mechanisms underlying improvements in biomechanical walking function.
Impact of Cane Use on Bone Marrow Lesion Volume in People With Medial Knee Osteoarthritis (CUBA Trial)
Authors: Van Ginckel Ans , Hinman Rana S. , Wrigley Tim V. , Hunter David J. , Marshall Charlotte J. , Melo Luciano , Meneses Sarah R.F. , Simic Milena , Kasza Jessica , Duryea Jeff , Wallis Jason A. , Bennell Kim L.
Published: February 2017

Background. No effective cure exists for knee osteoarthritis (OA). Low-burden self-management strategies that can slow disease progression are needed. Bone marrow lesions (BMLs) are a source of knee pain and accelerate cartilage loss. Importantly, they may be responsive to biomechanical off-loading treatments.

Objective. The study objective is to investigate whether, in people with medial tibiofemoral OA, daily cane use for 12 weeks reduces the volume of medial tibiofemoral BMLs and improves pain, physical function, and health-related quality of life.

Design. This study will be an assessor-masked, 2-arm, parallel-group, multisite randomized controlled trial.

Setting. The community will serve as the setting for this study.

Participants. The study participants will be people who are 50 years old or older and have medial tibiofemoral OA and at least 1 medial tibiofemoral BML.

Intervention. The participants will be allocated to either the cane group (using a cane daily whenever walking for 12 weeks) or the control group (not using any gait aid for 12 weeks).

Measurements. Outcomes will be measured at baseline and 13 weeks. The primary outcome will be total medial tibiofemoral BML volume measured from magnetic resonance imaging. Secondary outcomes will include BML volume of the medial tibia and/or femur, knee pain overall and on walking, physical function, participant-perceived global change, and health-related quality of life. Additional measures will include physical activity, cointerventions, adverse events, participation, participant demographics, cane training process measures and feasibility, barriers to and facilitators of cane use, and loss to follow-up.

Limitations. People who are morbidly obese will not be included because of difficulties with magnetic resonance imaging.

Conclusions. The findings of this study will help to determine whether cane use can alter disease progression in people with medial tibiofemoral OA and/or influence clinical symptoms. This study may directly influence clinical guidelines for the management of knee OA.
Epalrestat Stimulated Oxidative Stress, Inflammation, and Fibrogenesis in Mouse Liver
Authors: Le Yuan , Chen Liming , Zhang Yue , Bu Pengli , Dai Guoli , Cheng Xingguo
Published: February 2017

Epalrestat (EPS), an aldose reductase inhibitor, is widely prescribed to manage diabetic neuropathy. It is generally believed that EPS is beneficial to diabetic patients because it can protect endothelial cells, Schwann cells, or other neural cells from oxidative stress. However, several clinical studies revealed that EPS therapy led to liver dysfunction, which limited its clinical applications. Currently, the underlying mechanism by which EPS causes liver dysfunction is unknown. This study aimed to investigate the mechanism responsible for EPS-induced liver injury. In mouse liver, EPS 1) increased oxidative stress, indicated by increased expression of manganese superoxide dismutase, Ho-1, and Nqo1, 2) induced inflammation, indicated by infiltration of inflammatory cells, and induced expression of tumor necrosis factor-alpha, CD11b, and CD11c, as well as 3) predisposed to induce fibrosis, evidenced by increased mRNA and protein expression of early profibrotic biomarker genes procollagen I and alpha-smooth muscle actin, and by increased collagen deposition. In cultured mouse and human hepatoma cells, EPS treatment induced oxidative stress, decreased cell viability, and triggered apoptosis evidenced by increased Caspase-3 cleavage/activation. In addition, EPS increased mRNA and protein expression of cytoglobin in mouse liver, indicating that EPS activated hepatic stellate cells (HSCs). Furthermore, EPS treatment in cultured human HSCs increased cell viability. In summary, EPS administration induced oxidative stress and inflammation in mouse liver, and stimulated liver fibrogenesis. Therefore, cautions should be exercised during EPS therapy.
Caring for Pregnant Women for Whom Transfusion is Not an Option. A National Review to Assist in Patient Care
Authors: Kidson-Gerber Giselle , Kerridge Ian , Farmer Shannon , Stewart Cameron L. , Savoia Helen , Challis Daniel
Published: February 2017

(Aust N Z J Obstet Gynaecol. 2016;56(2):127–136)

In situations where the administration of blood or blood products is not a therapeutic option, management of obstetric hemorrhage can be extremely difficult and require additional multidisciplinary communication as well as unique approaches. Transfusion may not be an option when a woman has complex red cell antibodies or a rare blood group, because blood products are unavailable, or because the patient refuses transfusion for religious (as in the case of Jehovah’s Witnesses) or other reasons. In these circumstances, it is critically important that these women receive optimal management despite the inability to transfuse blood products. Research has shown that postpartum hemorrhage is the leading cause of maternal mortality and morbidity globally. A coordinated multidisciplinary approach, which may include blood products, is required in management of these situations.
Evaluation of High-risk Obstetric Patients: A Survey of US Academic Centers
Authors: Butwick A.J. , Tiouririne M.
Published: February 2017

(J Clin Anesth. 2016;33:460–468)

Patients at high risk for medical, obstetric, neuraxial, and/or general anesthetic-related morbidity may benefit from antenatal anesthetic evaluation. Although this service is provided at obstetric anesthesia clinics (OACs), few studies have examined the availability or characteristics of OACs. Consequently, the authors of the present study evaluated use, operational characteristics, and referral patterns (high-risk patients to anesthesiologists) of OACs at various academic centers.
The Role of Aspirin Dose on the Prevention of Preeclampsia and Fetal Growth Restriction: Systematic Review and Meta-Analysis
Authors: Roberge S. , Nicolaides K. , Demers S. , Hyett J. , Chaillet N. , Bujold E.
Published: February 2017

(Am J Obstet Gynecol. 2016 pii: S0002-9378(16)30783–30789)

Preeclampsia (PE) and fetal growth restriction (FGR) are important causes of perinatal morbidity and mortality. Several studies have suggested that the prophylactic use of low-dose aspirin may help to reduce risk in pregnant women. However, the optimal dosage remains unclear. Therefore, these authors performed a systematic review and meta-analyses of randomized controlled trials and evaluated the dose-response effect of aspirin on the prevention of PE and FGR.
Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated With Neuraxialn Opioid Administration: An Updated Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine
Authors: Apfelbaum Jeffrey L. , Horlocker Terese T. , Agarkar Madhulika , Connis Richard T. , Hebl James R. , Nickinovich David G. , Palmer Craig M. , Rathmell James P. , Rosenquist Richard W. , Wu Christopher L.
Published: February 2017

(Anesthesiology. 2016;124:535–552)

Practice guidelines are systematically developed recommendations that enable the practitioner and the patient to make informed health care decisions. They may be adopted, modified, or rejected based on clinical needs and constraints, and are subject to revision as necessitated by the advancement of medical knowledge, technology, and practice. This review is an update of the American Society of Anesthesiologists guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. The purpose of these updated guidelines was to improve patient safety and anesthetic care quality by decreasing the incidence and severity of neuraxial opioid-related respiratory depression. These updated guidelines focused on managing patients receiving epidural or spinal opioids in inpatient or ambulatory settings. A thorough methodology was used in the preparation of these guidelines by obtaining scientific evidence and opinion-based evidence.
Malpractice and Obstetric Practice: The Correlation of Malpractice Premiums to Rates of Vaginal and Cesarean Delivery
Authors: Johnson C.T. , Choubey V. , Satin A.J. , Werner E.F.
Published: February 2017

(Am J Obstet Gynecol. 2016;545–546)

Malpractice lawsuits can influence patient care, since the burden of professional liability could change the way physicians decide to manage care. Already, liability suits have caused 22% of providers to reduce their patient volume when it comes to high-risk obstetric cases, 14% to discontinue their obstetric practice altogether, and 9% to reduce all obstetric patient volume. Considering this correlation, the authors of this paper attempted to determine how the phenomenon of professional liability might impact the rate of cesarean delivery.
Second-stage Labor: How Long is Too Long?
Authors: Leveno Kenneth J. , Nelson David B. , McIntire Donald D.
Published: February 2017

(Am J Obstet Gynecol. 2016;214(4):484–489)

Data available show that the rates of cesarean delivery are increasing continually (reaching a record high of 32.9% in the United States in 2009), especially in the management of first and second stages of labor. Hence there is an increased scrutiny of the management of labor. The Society for Maternal-Fetal Medicine, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the American Congress of Obstetricians and Gynecologists convened a workshop to address this issue of rising cesarean delivery rates. One of their recommendations was that the accepted upper limit of the second stage of labor should be increased to ≥4 hours in nulliparous women with epidural analgesia and to >3 hours in parous women with epidural analgesia. These recommendations were presented in a document entitled “Safe Prevention of the Primary Cesarean Delivery,” which was the inaugural publication in the Obstetric Care Consensus series.
When Getting There is Not Enough: A Nationwide Cross-Sectional Study of 998 Maternal Deaths and 1451 Near-misses in Public Tertiary Hospitals in a Low-income Country
Authors: Oladapo O.T. , Adetoro O.O. , Ekele B.A. , Chama C. , Etuk S.J. , Aboyeji A.P. , Onah H.E. , Abasiattai A.M. , Adamu A.N. , Adegbola O. , Adeniran A.S. , Aimakhu C.O. , Akinsanya O. , Aliyu L.D. , Ande A.B. , Ashimi A. , Bwala M. , Fabamwo A. , Geidam A.D. , Ikechebelu J.I. , Imaralu J.O. , Kuti O. , Nwachukwu D. , Omo-Aghoja L. , Tunau K. , Tukur J. , Umeora O. , Umezulike A.C. , Dada O.A. , Tunçalp Ö. , Vogel J.P. , Gülmezoglu A.M.
Published: February 2017

(BJOG. 2016;123:928–938)

Achieving the fifth Millennium Development Goal (MDG-5) to reduce maternal mortality rates is a challenge in some low-income countries due to the lack of reliable data to evaluate progress and guide the appropriate actions. The aim of this study, the Nigeria Near-miss and Maternal Death Survey, was to determine the burden of maternal death and maternal near-miss occurrences through surveillance and data collection of life-threatening maternal complications or severe maternal outcomes (SMO) from Nigerian public tertiary hospitals.
Repeated Isoflurane Exposure and Neuroapoptosis in the Midgestation Fetal Sheep Brain
Authors: Olutoye Olutoyin A. , Sheikh Fariha , Zamora Irving J. , Yu Ling , Akinkuotu Adesola C. , Adesina Adekunle M. , Olutoye Oluyinka O.
Published: February 2017

(Am J Obstet Gynecol. 2016;214:542.e1–542.e8)

Despite current concerns about the detrimental effects of anesthesia on the developing brain, advances in surgery and technology allow for a variety of fetal interventions. Evidence has shown that the inhalational anesthetic agent, isoflurane, other gamma amino butyric acid agonists and N-methyl D aspartate antagonists induce neuroapoptosis. To study maternal-fetal physiological interactions and to investigate different surgical interventions on the fetus, the ovine model has been used extensively. The objective of this study was to determine the effects of different doses and duration of isoflurane on neuroapoptosis in midgestation fetal sheep.
The Effects of Vasopressin and Oxytocin on the Fetoplacental Distal Stem Arteriolar Vascular Resistance of the Dual-Perfused, Single, Isolated, Human Placental Cotyledon
Authors: Downing John W. , Baysinger Curtis L. , Johnson Raymond F. , Paschall Ray L. , Shotwell Matthew S.
Published: February 2017

(Anesth Analg. 2016;123:698–702)

Maternal hypotension during cesarean delivery can be treated with vasoactive agents like ephedrine, phenylephrine, or vasopressin. However, these agents may intensify hypoxemic fetoplacental vasoconstrictor responses and inhibit placental oxygen flow. In the present study, the authors hypothesized that vasopressin, a systemic vasoconstrictor, and oxytocin, an uterotonic agent with systemic vasodilator properties, would not influence distal stem villous arteriolar resistance.
The Impact of Ambient Operating Room Temperature on Neonatal and Maternal Hypothermia and Associated Morbidities: A Randomized Controlled Trial
Authors: Duryea Elaine L. , Nelson David B. , Wyckoff Myra H. , Grant Erica N. , Tao Weike , Sadana Neeti , Chalak Lina F. , McIntire Donald D. , Leveno Kenneth J.
Published: February 2017

(Am J Obstet Gynecol. 2016;214:505.e1–505.7)

The World Health Organization defines mild hypothermia as a temperature of 36.0°C to 36.4°C (96.8°F to 97.5°F) and moderate to severe hypothermia as a temperature below <36.0°C (96.8°F). At the time of delivery, neonatal hypothermia can be caused by various factors, including the infant’s poor ability to regulate temperature owing to evaporative heat loss within a relatively cool delivery room. A condition common during cesarean delivery and in preterm infants, neonatal hypothermia has been associated with a range of morbidities in addition to increased neonatal mortality. Maternal hypothermia is also often uncomfortable for the surgical patient and has been associated with intraoperative and postoperative complications. There are various methods used to decrease the rates of neonatal and maternal hypothermia with varying levels of success. The objective of this study was to investigate whether an increase in operating room temperature at cesarean delivery resulted in a decrease in the rate of neonatal hypothermia and associated morbidities.
Accidental Dural Puncture Management: 10-Year Experience at an Academic Tertiary Care Center
Authors: Bolden Norman , Gebre Ermias
Published: February 2017

(Reg Anesth Pain Med. 2016;41:169–174)

Epidural analgesia is the most effective form of analgesia for labor pain. However, the placement of an epidural catheter is associated with complications, such as accidental dural puncture (ADP) and postdural puncture headache (PDPH). The management of an ADP may be either resiting of the epidural catheter at another interspace or catheter insertion into the intrathecal space and use of the spinal catheter for labor analgesia. This study aimed to assess the impact of the use of spinal catheters and the administration of intrathecal saline on PDPH incidence and subsequent epidural blood patch (EBP) requirement at a tertiary care facility.
Effect of High-fidelity Shoulder Dystocia Simulation on Emergency Obstetric Skills and Crew Resource Management Skills Among Residents
Authors: Mannella P. , Palla G. , Cuttano A. , Boldrini A. , Simoncini T.
Published: February 2017

(Int J Gynaecol Obstet. 2016. pii: S0020-7292(16)30348–4)

Shoulder dystocia is associated with a high incidence of neonatal morbidity and mortality. Effective management of this obstetric complication requires swift collaboration between the lead physician and obstetrics team. In the present study, the authors determineed the impact of high-fidelity simulation training on the ability of obstetrics and gynecology residents to effectively manage shoulder dystocia emergencies.
Closed-Loop Insulin Delivery During Pregnancy in Women With Type 1 Diabetes
Authors: Stewart Z.A. , Wilinska M.E. , Hartnell S. , Temple R.C. , Rayman G. , Stanley K.P. , Simmons D. , Law G.R. , Scott E.M. , Hovorka R. , Murphy H.R.
Published: February 2017

(N Engl J Med. 2016;375:644–654)

Closed-loop systems use a computer algorithm to adjust insulin-pump delivery in response to real-time continuous glucose measurements. Such systems may improve glycemic control in pregnant women with type 1 diabetes, who are increased risk of having negative fetal outcomes (congenital anomalies, still-birth, neonatal death, preterm delivery, and macrosomia).
Strong Ion and Weak Acid Analysis in Severe Preeclampsia: Potential Clinical Significance
Authors: Ortner C.M. , Combrinck B. , Allie S. , Story D. , Landau R. , Cain K. , Dyer R.A.
Published: February 2017

(Br J Anaesth. 2015;115:275–284)

It has been suggested in preliminary work that abnormal acid-base status in pregnant women may be an indicator of preeclampsia disease severity. However, studies are scarce and there are no comprehensive analyses of independent or confounding factors. As acid/base measures using base excess (BE) have been used to predict outcomes in other clinical areas, the authors of the present study analyzed acid/base balance in women with severe preeclampsia and identified potential biological predictors of adverse outcomes.
Effects of Antenatal Exercise in Overweight and Obese Pregnant Women on Maternal and Perinatal Outcomes: A Randomized Controlled Trial
Authors: Seneviratne S.N. , Jiang Y. , Derraik J.G.B. , McCowan L.M.E. , Parry G.K. , Biggs J.B. , Craigie S. , Gusso S. , Peres G. , Rodrigues R.O. , Ekeroma A. , Cutfield W.S. , Hofmana P.L.
Published: February 2017

(BJOG. 2016;123:588–597)

Women who are overweight or obese during pregnancy have an increased risk of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, and cesarean section, and have a longer hospital stay.
Metabolic Acidemia in Live Births at 35 Weeks of Gestation or Greater
Authors: Morgan Jamie L. , Casey Brian M. , Bloom Steven L. , McIntire Donald D. , Leveno Kenneth J.
Published: February 2017

(Obstet Gynecol. 2015;126:279–283)

Metabolic acidemia, defined as umbilical artery pH<7.0 and base deficit ≥12 mmol/L, is one of the diagnostic tools indicative of intrapartum hypoxia, which at sufficient levels, can lead to neonatal encephalopathy, ischemia-induced neuroimaging patterns, and cerebral palsy. The authors of the present study examined the incidence of metabolic acidemia in singleton neonates born between 35 and 42 weeks gestation, in order to assess the link between metabolic acidemia and negative obstetric outcomes. The primary outcome was neonatal seizures (an index of neonatal encephalopathy) in the first 24 hours after birth.
Transfers to Hospital in Planned Home Birth in 4 Nordic Countries: A Prospective Cohort Study
Authors: Blix Ellen , Kumle Merethe H. , Ingversen Karen , Huitfeldt Anette S. , Hegaard Hanne K. , Ólafsdóttir Ólöf Á. , øian Pål , Lindgren Helena
Published: February 2017

(Acta Obstet Gynecol Scand. 2016;95:420–428)

Research has shown that of women planning to give birth at home in western countries up to one-third are transferred to a hospital during labor or after the birth. The objective of this study was to describe how often women and neonates were transferred from home to a hospital during labor or after birth; the indications for transfer; how long before or after birth the transfer occurred; the mode and duration of transfer; and the proportion of transfers classified as potentially urgent.