bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinct purinergic signaling pathways in prepubescent mouse spermatogonia
Authors: Fleck David , Mundt Nadine , Bruentgens Felicitas , Geilenkirchen Petra , Machado Patricia A. , Veitinger Thomas , Veitinger Sophie , Lipartowski Susanne M. , Engelhardt Corinna H. , Oldiges Marco , Spehr Jennifer , Spehr Marc
Published: August 2016

Spermatogenesis ranks among the most complex, yet least understood, developmental processes. The physiological principles that control male germ cell development in mammals are notoriously difficult to unravel, given the intricate anatomy and complex endo- and paracrinology of the testis. Accordingly, we lack a conceptual understanding of the basic signaling mechanisms within the testis, which control the seminiferous epithelial cycle and thus govern spermatogenesis. Here, we address paracrine signal transduction in undifferentiated male germ cells from an electrophysiological perspective. We identify distinct purinergic signaling pathways in prepubescent mouse spermatogonia, both in vitro and in situ. ATP—a dynamic, widespread, and evolutionary conserved mediator of cell to cell communication in various developmental contexts—activates at least two different spermatogonial purinoceptor isoforms. Both receptors operate within nonoverlapping stimulus concentration ranges, display distinct response kinetics and, in the juvenile seminiferous cord, are uniquely expressed in spermatogonia. We further find that spermatogonia express Ca2+-activated large-conductance K+ channels that appear to function as a safeguard against prolonged ATP-dependent depolarization. Quantitative purine measurements additionally suggest testicular ATP-induced ATP release, a mechanism that could increase the paracrine radius of initially localized signaling events. Moreover, we establish a novel seminiferous tubule slice preparation that allows targeted electrophysiological recordings from identified testicular cell types in an intact epithelial environment. This unique approach not only confirms our in vitro findings, but also supports the notion of purinergic signaling during the early stages of spermatogenesis.
A nonlinear history-dependent boundary value problem
Authors: Sofonea Mircea , Benseghir Aissa
Published: August 2016

We consider a nonlinear boundary value problem with unilateral constraints in a two-dimensional rectangle. We derive a variational formulation of the problem which is in the form of a history-dependent variational inequality. Then, we establish the existence of a unique weak solution to the problem. We also prove two convergence results. The first one provides the continuous dependence of the solution with respect to the unilateral constraint. The second one shows the convergence of the solution of the penalized problem to the solution of the original problem, as the penalization parameter converges to zero.
Impacts of the Transatlantic Trade and Investment Partnership on Processed Food Trade under Monopolistic Competition and Firm Heterogeneity
Authors: Luckstead Jeff , Devadoss Stephen
Published: August 2016

Food processing firms vary in size, exhibit productivity differences, produce highly differentiated products, and engage in monopolistic competition. As the Transatlantic Trade and Investment Partnership negotiation is gaining momentum and trade in processed food is becoming more important, it is worth analyzing the impact of this potential trade liberalization on the U.S. and E.U. processed food markets. This study develops a three‐region (United States, European Union, and Rest of the World) monopolistic competition trade model with heterogeneous firms to analyze the effects of U.S.–E.U. bilateral tariff elimination and nontariff barrier harmonization on prices, domestic production, bilateral trade, productivity, measure of operating firms, and welfare in the processed food sector. The results show that this trade liberalization expands cross‐hauling, with U.S. exports to the European Union increasing by about 95% and E.U. exports to the United States rising by about 87%. This increase in cross‐hauling displaces exports from the Rest of the World to the United States and the European Union by approximately 3% and 8%, respectively. U.S. and E.U. total processed food production increases by about 4% and 0.4%, respectively. Because of lower prices and more consumption, net welfare expands in all three regions.
Identifying collaborative care teams through electronic medical record utilization patterns
Authors: Chen You , Lorenzi Nancy M , Sandberg Warren S , Wolgast Kelly , Malin Bradley A
Published: August 2016

Objective: The goal of this investigation was to determine whether automated approaches can learn patient-oriented care teams via utilization of an electronic medical record (EMR) system.

Materials and Methods: To perform this investigation, we designed a data-mining framework that relies on a combination of latent topic modeling and network analysis to infer patterns of collaborative teams. We applied the framework to the EMR utilization records of over 10 000 employees and 17 000 inpatients at a large academic medical center during a 4-month window in 2010. Next, we conducted an extrinsic evaluation of the patterns to determine the plausibility of the inferred care teams via surveys with knowledgeable experts. Finally, we conducted an intrinsic evaluation to contextualize each team in terms of collaboration strength (via a cluster coefficient) and clinical credibility (via associations between teams and patient comorbidities).

Results: The framework discovered 34 collaborative care teams, 27 (79.4%) of which were confirmed as administratively plausible. Of those, 26 teams depicted strong collaborations, with a cluster coefficient > 0.5. There were 119 diagnostic conditions associated with 34 care teams. Additionally, to provide clarity on how the survey respondents arrived at their determinations, we worked with several oncologists to develop an illustrative example of how a certain team functions in cancer care.

Discussion: Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices.

Conclusions: EMR utilization records can be mined for collaborative care patterns in large complex medical centers.
Reevaluation of Two Quantitative Trait Loci for Type II Resistance to Fusarium Head Blight in Wheat Germplasm PI 672538
Authors: Li X. , Xiang Z. P. , Chen W. Q. , Huang Q. L. , Liu T. G. , Li Q. , Zhong S. F. , Zhang M. , Guo J. W. , Lei L. , Luo P. G.
Published: August 2016

Fusarium head blight (FHB), mainly caused by Fusarium graminearum, is a destructive disease in wheat. A population consisting of 229 F2 and F2:3 plants derived from the cross PI 672538 × L661 was used to evaluate the reactions to FHB. The FHB resistance data distribution in the F2 population indicates that some quantitative trait loci (QTLs) were controlling the FHB resistance in PI 672538. We further detected two major QTLs (Qfhs-2B, Qfhs-3B) from analysis of the resistance data and the PCR-amplified results using WinQTLCart 2.5 software. Qfhs-2B, flanked by Xbarc55-2B and Xbarc1155-2B, explained more than 11.6% of the phenotypic variation of the percentage of diseased spikelets (PDS), and Qfhs-3B, flanked by Xwmc54-3B and Xgwm566-3B, explained more than 10% of the PDS phenotypic variation in the F2:3 population. In addition, Qfhs-3B was different from Fhb1 in terms of the pedigree, inheritance, resistance response, chromosomal location, and marker diagnosis. We also detected QTLs for other disease resistance indices, including the percentage of damaged kernels and 1,000-grain weight, in similar chromosomal regions. Therefore, the FHB resistance of PI 672538 was mainly controlled by two major QTLs, mapped on 2B (FhbL693a) and 3B (FhbL693b). PI 672538 could be a useful germplasm for improving wheat FHB resistance.
Distal Radius Bone Graft From the Second Extensor Compartment: A Safe and Effective Technique
Authors: Vyrva Oleksandra , Thirkannad Sunil M.
Published: August 2016

We describe a technique for harvesting cancellous bone graft from the floor of the second extensor compartment that is both easy and effective. It confines surgery to a single operative field under the same regional anesthesia and tourniquet as the primary hand surgical procedure while at the same time allowing wide visualization for harvesting bone graft. It provides cancellous bone of sufficient quality and quantity for use in most hand surgical cases. The technique has so far been used in 80 patients and has proven to be very safe.
The influence of postoperative lymph node radiation therapy on overall survival of patients with stage III melanoma, a National Cancer Database analysis
Authors: Danish Hasan H. , Patel Kirtesh R. , Switchenko Jeffrey M. , Gillespie Theresa W. , Jhaveri Jaymin , Chowdhary Mudit , Abugideiri Mustafa , Delman Keith A. , Lawson David H. , Khan Mohammad K.
Published: August 2016

Recently, TROG 02.01 results showed that in stage III melanoma patients with nodal metastasis, adjuvant radiation to lymph node basin after nodal dissection improves lymph node field relapse without an overall survival (OS) benefit. However, this trial was neither designed nor powered to detect an OS difference. In the present study, we analyzed patients in the National Cancer Database (NCDB) with stage III melanoma with pathologically involved nodes and compared survival outcomes of adjuvant radiation and no-radiation cohorts. Inclusion criteria were as follows: age at least 18 years; diagnosed 2003–2011; surgery to regional lymph nodes; pathologically involved lymph nodes; and American Joint Committee on Cancer stage (IIIA–C). We used propensity score matching analysis to compare the OS of patients with similar baseline demographic, clinical, and pathologic characteristics who received adjuvant radiation and no adjuvant radiation. Overall, 912 patients were analyzed with an average age at diagnosis of 54.4 years and a median follow-up time of 5.5 years. In this cohort, the 5-year OS was 69.0, 51.1, and 30.6% for stage IIIA, IIIB, and IIIC, respectively. On propensity score-adjusted multivariate analysis, we found that adjuvant radiation had no statistically significant impact on OS (hazard ratio: 1.09, 95% confidence interval: 0.75–1.58, P=0.640). Furthermore, age older than 60 years, number of nodes, increasing pathologic stage, and absence of immunotherapy correlated with worse OS. In this NCDB analysis, we found that the adjuvant radiotherapy for node-positive, stage III melanoma patients did not improve OS. This is consistent with TROG 02.01; however, there may be patient selection bias not accounted for by the NCDB.
Metaphyseal dysplasia, Spahr type; missense MMP13 mutations in two Iraqi siblings
Authors: Tadros Shereen , Scott Richard H. , Calder Alistair D. , Hurst Jane A.
Published: August 2016

We report on two siblings of Iraqi descent with clinical and radiographic features of metaphyseal dysplasia, Spahr type (MDST), born to consanguineous unaffected parents. Molecular testing confirmed pathogenic mutations in MMP13. We review the considerable overlap between MDST and other related disorders. These cases confirm the phenotypic variability and regressive nature of MDST in addition to suggesting bone fragility as a feature.
Combined Multichannel Intraluminal Impedance and pH Measurement in Detecting Gastroesophageal Reflux Disease in Children
Authors: Safe Mark , Cho Jemma , Krishnan Usha
Published: August 2016

Objective:

The aim of the study was to evaluate and compare multichannel intraluminal impedance‐pH (MII‐pH) monitoring with standard investigations including pH testing for detecting gastroesophageal reflux disease (GERD) in children.

Methods:

A retrospective review of all MII‐pH studies performed between July 2007 and March 2013 at Sydney Children's Hospital. Results from MII‐pH testing, esophagogastroduodenoscopy (EGD), barium meal and pepsin assay, symptoms, underlying comorbidities, age, and medication usage were evaluated.

Results:

An additional 47.18% of children had GERD detected by MII‐pH testing, which would have been missed by pH testing alone. Based on symptomatology, 50.49% of children with respiratory symptoms as a result of GERD and 47.54% of those with gastrointestinal symptoms would have been missed by pH testing alone. GERD was detected in an additional 39.47% of children with neurological impairment, 44.44% for those with cystic fibrosis, and 52.17% for those with esophageal atresia‐tracheoesophageal fistula by MII‐pH. In patients with persistent symptoms on anti‐reflux medication, GERD would have been missed by pH testing alone in 50.40%. GERD was detected in an additional 62.79% of infants and 42.76% of older children by MII‐pH compared with pH testing alone. With reference to MII‐pH, the sensitivity of other standard investigations, pH testing (32.35%), barium meal (25.00%), EGD (45.26%), and pepsin assay (48.89%) was significantly lower in the detection of GERD in children. Of all abnormal MII‐pH results, 51.1% were abnormal because of symptom association alone.

Conclusions:

Combined MII‐pH testing is superior to standard investigations such as 24‐hour pH testing, barium meal, EGD, and pepsin assay in detecting GERD in children, particular because of its ability to associate symptoms with acid and non‐acid reflux events.
Mobile Apps for Educational Purposes
Authors: Pilcher Jobeth
Published: August 2016

With the growing number of mobile resources, nurse educators and professional development practitioners have the opportunity to harness mobile applications as a tool for their education toolbox. Yet, the overwhelming availability of choices can lead to questions, such as the following: How do we locate apps without spending huge amounts of our valuable time? How do we know which apps to choose? How can we evaluate apps? This article is aimed at addressing these questions.
Higher Prostate Cancer Grade Groups Are Detected in Patients Undergoing Multiparametric MRI-targeted Biopsy Compared With Standard Biopsy
Authors: Gordetsky Jennifer B. , Thomas John V. , Nix Jeffrey W. , Rais-Bahrami Soroush
Published: August 2016

Recent studies have suggested that multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion–guided prostate biopsy can detect more clinically significant prostate cancers, which could impact patient management. As many of the studies evaluating MRI/US fusion–guided prostate biopsy were conducted in specialized quaternary care centers, the question remains whether this technology is transferable to general practice. Our study assesses the diagnostic ability of MRI/US fusion–guided prostate biopsy compared with standard biopsy in the new era of prostate cancer Grade Grouping. We reviewed our prostate biopsy database evaluating men who underwent MRI/US fusion–guided prostate biopsy with concurrent standard 12-core extended-sextant biopsy. Patient demographics and pathologic findings were reviewed. All patient biopsies were performed by 1 of 2 urologic oncologists. Tumors were given a Grade Group for each biopsy based on the core with the highest grade in each case. A total of 191 patients underwent MRI/US fusion–guided biopsy with concurrent 12-core extended sextant biopsy, with a cancer detection rate of 56%. The average number of biopsy cores obtained via the targeted approach was significantly less than those obtained by standard biopsy, 4.8 cores versus 12 cores, respectively, P<0.001. There was no difference in cancer detection between targeted and standard biopsy, 41.4% and 49.2%, respectively, P=0.15. However, when comparing the 2 techniques, the degree of detection of ≥Grade Group 3 tumors significantly favored targeted biopsy over standard biopsy (P=0.009). MRI/US fusion–guided prostate biopsy is equivalent to the standard-of-care 12-core biopsy in terms of cancer detection and superior in detecting higher grade disease.
Integration of genomics and histology revises diagnosis and enables effective therapy of refractory cancer of unknown primary with PDL1 amplification
Authors: Gröschel Stefan , Bommer Martin , Hutter Barbara , Budczies Jan , Bonekamp David , Heining Christoph , Horak Peter , Fröhlich Martina , Uhrig Sebastian , Hübschmann Daniel , Geörg Christina , Richter Daniela , Pfarr Nicole , Pfütze Katrin , Wolf Stephan , Schirmacher Peter , Jäger Dirk , von Kalle Christof , Brors Benedikt , Glimm Hanno , Weichert Wilko , Stenzinger Albrecht , Fröhling Stefan
Published: August 2016

Identification of the tissue of origin in cancer of unknown primary (CUP) poses a diagnostic challenge and is critical for directing site-specific therapy. Currently, clinical decision-making in patients with CUP primarily relies on histopathology and clinical features. Comprehensive molecular profiling has the potential to contribute to diagnostic categorization and, most importantly, guide CUP therapy through identification of actionable lesions. We here report the case of an advanced-stage malignancy initially mimicking poorly differentiated soft-tissue sarcoma that did not respond to multiagent chemotherapy. Molecular profiling within a clinical whole-exome and transcriptome sequencing program revealed a heterozygous, highly amplified KRAS G12S mutation, compound-heterozygous TP53 mutation/deletion, high mutational load, and focal high-level amplification of Chromosomes 9p (including PDL1 [CD274] and JAK2) and 10p (including GATA3). Integrated analysis of molecular data and histopathology provided a rationale for immune checkpoint inhibitor (ICI) therapy with pembrolizumab, which resulted in rapid clinical improvement and a lasting partial remission. Histopathological analyses ruled out sarcoma and established the diagnosis of a poorly differentiated adenocarcinoma. Although neither histopathology nor molecular data were able to pinpoint the tissue of origin, our analyses established several differential diagnoses including triple-negative breast cancer (TNBC). We analyzed 157 TNBC samples from The Cancer Genome Atlas, revealing PDL1 copy number gains coinciding with excessive PDL1 mRNA expression in 24% of cases. Collectively, these results illustrate the impact of multidimensional tumor profiling in cases with nondescript histology and immunophenotype, show the predictive potential of PDL1 amplification for immune checkpoint inhibitors (ICIs), and suggest a targeted therapeutic strategy in Chromosome 9p24.1/PDL1-amplified cancers.
Case of pleomorphic rhabdomyosarcoma arising on subcutaneous tissue in an adult patient: Review of the published works of 13 cases arising on cutaneous or subcutaneous tissue
Authors: Watanabe Mai , Ansai Shin‐ichi , Iwakiri Itaru , Fukumoto Takaya , Murakami Masahiro
Published: August 2016

Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumor usually occurring in children, young adults, and predominantly arising in the head and neck or deep soft tissue of the extremities. Pleomorphic RMS (PRMS) arising on subcutaneous tissue in an adult patient's trunk is extremely rare. We present a case of primary PRMS occurring on the back of a 50‐year‐old man. The tumor was diagnosed by histological and immunohistochemical findings of the resected specimen. One month after the surgery, axillary lymph node metastases were found. Subsequently, the patient received three cycles of combined chemotherapy. The rest of those axillary lymph nodes were reduced in size and there was no local recurrence 6 months postoperatively. PRMS is a very rare but aggressive tumor. Thus, it is important to confirm the diagnosis and provide adequate treatments.
Pazopanib does not bring remarkable improvement in patients with angiosarcoma
Authors: Kitamura Shinya , Yanagi Teruki , Inamura Yuka , Hata Hiroo , Imafuku Keisuke , Yoshino Koji , Shimizu Hiroshi
Published: August 2016

Pazopanib is a potent and selective multi‐targeted tyrosine kinase inhibitor that has been reported to extend progression‐free survival in cases of metastatic soft‐tissue sarcoma. However, the efficacy of pazopanib for cutaneous angiosarcoma has not been confirmed. We report eight cases of angiosarcoma treated with pazopanib, and review the efficacy and safety of pazopanib therapy. We retrospectively investigated the clinical information, including age, sex, body surface area, location, performance status, lung or pleural metastasis, preceding treatment, oral dose of pazopanib, response rate, progression‐free survival and adverse effects. Five of the eight patients needed to stop the pazopanib treatment due to severe adverse effects, including thrombocytopenia, anemia, drug‐associated pancreatitis, acute fulminant hepatitis and general fatigue. Progression‐free survival ranged 0.5–3.5 months (mean ± standard deviation, 1.81 ± 1.03). Overall survival ranged 3–26 months (14.13 ± 9.47). Six of the eight cases showed progressive disease, and two of the eight cases showed stable disease. To assess overall survival in angiosarcoma treated with pazopanib, we compared the pazopanib‐treated group (n = 8) with the non‐pazopanib‐treated control group (n = 10). There was no significant difference between two groups (P = 0.19, log–rank test). In conclusion, our case series suggests that pazopanib does not bring remarkable improvement in patients with angiosarcoma.
Clinical and histological characteristics of livedo racemosa in essential thrombocythemia: A report of two cases and review of the published works
Authors: Inoue Sae , Okiyama Naoko , Okune Mari , Shiraki Nagisa , Kessoku Reiko , Fujimoto Manabu
Published: August 2016

Essential thrombocythemia (ET) is a rare clonal myeloproliferative disorder with a prevalence rate of approximately 1–3 cases per 100 000 individuals per year. ET is characterized by a persistent increase in the platelet count with hyperplasia of bone marrow megakaryocytes. It is difficult to make a diagnosis of ET, because most thrombocythemia are reactive to certain disease conditions including iron deficiency anemia, infection, collagen diseases and malignant tumors. Mutation in the Janus kinase (JAK)2 gene is present in approximately 50–70% of ET patients, and somatic mutations in the calreticulin (CALR) gene were recently discovered in approximately 20–25% of sporadic patients with ET or primary myelofibrosis. Various cutaneous manifestations of ET often occur by microvascular thrombosis and precede severe arterial and venous thromboembolic events in other organs. Therefore, in order to prevent such severe events, it is important to make an early diagnosis of ET based on a number of cutaneous manifestations. Here, we report two cases of ET diagnosed based on livedo racemosa on feet with gene mutations in JAK2 and CALR, respectively, and show the pathological and immunohistological findings of the livedo resulting from platelet thrombosis rather than vasculitis. We also review the cutaneous manifestations in current published reports of Japanese ET patients. Our patients were successfully treated with low‐dose aspirin, a vasodepressor and hydroxyurea, following regressed livedo and reduced platelet counts.
Herbivore‐specific induction of defence metabolites in a grass–endophyte association
Authors: Fuchs Benjamin , Krischke Markus , Mueller Martin J. , Krauss Jochen
Published: August 2016

Plants have developed a variety of defence strategies against herbivores. One possible strategy is the induced production of metabolites following herbivore attack. Plant‐associated micro‐organisms can be the source of such defensive compounds. For example, cool‐season grasses can be associated with systemic endophytic fungi of the genus Epichloё, which produce herbivore‐toxic alkaloids.

In a controlled common garden approach, we tested the hypothesis that different types of herbivory induce endophyte growth and increase the endophyte‐mediated production of three bioactive alkaloids which can deter or toxify herbivores. During 18 weeks, we analysed biweekly endophyte and alkaloid concentrations in the grass Lolium perenne infected with the endophytic fungus Epichloё festucae var. lolii. The experiment was conducted throughout the field season and compared three different herbivore treatments to the control treatment (herbivory exclosure).

We showed that the concentration of the vertebrate toxic alkaloid lolitrem B increased following clipping (a simulation of grazing herbivores), while the insect deterring alkaloid peramine increased following locust herbivory (biting–chewing herbivores). The endophyte concentration increased slightly following clipping (P = 0·09). Sap sucking aphids altered neither endophyte nor alkaloid concentrations.

Our study provides evidence for an herbivore‐specific induction of endophyte‐mediated responses following herbivore attack on its host grass. Our results suggest that the grass–endophyte symbiosis involves a close chemical crosstalk between the interacting partners.
Resource‐ and pollinator‐mediated selection on floral traits
Authors: Sletvold Nina , Tye Matthew , Ågren Jon
Published: August 2016

Female reproductive success is predicted to be simultaneously limited by the availability of pollen and resources. Selection on floral traits results from both factors, but their relative importance and interaction is poorly understood.

We increased nutrient and pollen availability of the orchid Dactylorhiza lapponica in a factorial experiment to quantify resource‐ and pollinator‐mediated selection on floral traits. Hand‐pollination increased female fitness (number of fruits × mean fruit mass) by 74% in both nutrient treatments, whereas nutrient addition did not significantly affect female fitness.

There was selection for more flowers and longer spurs, and selection on spur length was significantly pollinator‐mediated and of similar strength across nutrient treatments (Δβpoll = 0·54 and Δβpoll_NPK = 0·59). There was no statistically significant resource‐mediated selection. Nutrient addition increased flower size the following year, but did not affect flower or fruit production, or selection on any trait.

The results demonstrate that D. lapponica does not increase flower production in response to nutrient addition, that the increase in female fitness in response to hand‐pollination is not resource limited, and suggest that natural resource variation does not influence selection on floral traits. The study illustrates that crossed manipulations of pollen and resources can clarify their relative importance for selection on floral traits.

A Lay Summary is available for this article.
Density function evaluation from borehole gravity meter data – regularized spectral domain deconvolution approach
Authors: Karcol Roland , Pašteka Roman
Published: August 2016

We present a new method of transforming borehole gravity meter data into vertical density logs. This new method is based on the regularized spectral domain deconvolution of density functions. It is a novel alternative to the “classical” approach, which is very sensitive to noise, especially for high‐definition surveys with relatively small sampling steps. The proposed approach responds well to vertical changes of density described by linear and polynomial functions. The model used is a vertical cylinder with large outer radius (flat circular plate) crossed by a synthetic vertical borehole profile. The task is formulated as a minimization problem, and the result is a low‐pass filter (controlled by a regularization parameter) in the spectral domain. This regularized approach is tested on synthetic datasets with noise and gives much more stable solutions than the classical approach based on the infinite Bouguer slab approximation. Next, the tests on real‐world datasets are presented. The properties and presented results make our proposed approach a viable alternative to the other processing methods of borehole gravity meter data based on horizontally layered formations.
‘Constrained collaboration’: Patient empowerment discourse as resource for countervailing power
Authors: Vinson Alexandra H.
Published: August 2016

Countervailing powers constrain the authority and autonomy of the medical profession. One countervailing power is patient consumerism, a movement with roots in health social movements. Patient empowerment discourses that emerge from health social movements suggest that active patienthood is a normative good, and that patients should inform themselves, claim their expertise, and participate in their care. Yet, little is known about how patient empowerment is understood by physicians. Drawing on ethnographic fieldwork in an American medical school, this article examines how physicians teach medical students to carry out patient encounters while adhering to American cultural expectations of a collaborative physician–patient relationship. Overt medical paternalism is characterised by professors as ‘here's the orders’ paternalism, and shown to be counterproductive to ‘closing the deal’ – achieving patient agreement to a course of treatment. To explain how physicians accomplish their therapeutic goals without violating cultural mandates of patient empowerment I develop the concept of ‘constrained collaboration’. This analysis of constrained collaboration contrasts with structural‐level narratives of diminishing professional authority and contributes to a theory of the micro‐level reproduction of medical authority as a set of interactional practices.
The Use and Intended Outcomes of Presence: A Focus Group Study
Authors: Stockmann Cherrill , Gabor Octavian , DiVito‐Thomas Pamela , Ehlers Caroline
Published: August 2016

PURPOSE

To explore and understand the use and intended outcomes of presence from the perspective of and as experienced by nurses.

METHODS

Twenty‐seven nurses participated in one of four focus groups. Data were analyzed using Giorgi's phenomenological method.

FINDINGS

Four themes emerged: (1) therapeutic communication; (2) nurse well‐being; (3) dimensions of presence; and (4) intention to improve client outcomes.

CONCLUSIONS

Presence was described as a multidimensional intervention that required therapeutic communication and nurse well‐being with the intention of improving client outcomes. Study findings provide evidence of the significance of presence in the face of human interaction that is shifting to virtual, impersonal communication.
Environmental factors exert predominant effects on testate amoeba metacommunities during droughts in floodplains
Authors: Arrieira Rodrigo Leite , Schwind Leilane Talita Fatoreto , Bonecker Claudia Costa , Lansac‐Tôha Fábio Amodêo
Published: August 2016

Metacommunities have been evaluated as models for the relative importance of environmental and spatial processes in assembling ecological communities. Here, we tested the hypothesis that different hydrological periods (drought and flooding) influence the environmental associations of planktonic testate amoeba metacommunities. We predicted that environmental factors would exert the strongest effects on species dispersal under drought, but that they would be less significant during flooding. Testate amoebae were sampled during drought and flooding, from 72 lakes in four Brazilian floodplains (Amazonian, Araguaia, Pantanal and Paraná). Partial redundancy analysis indicated that only environmental factors were significant; they were significant in all floodplain lakes during the drought. Only the Paraná floodplain had significant results for environmental factors during both hydrological periods. Spatial factors did not contribute significantly to any of the metacommunities. The depth, pH and variables related to environmental productivity were identified as major predictors in the assembly of testate amoeba communities. Our results highlight that different hydrological periods vary in their relative importance in environmental and spatial processes. The species‐sorting model was predominant during drought, while stochastic processes prevailed during flooding in all but the Paraná floodplain. In the Paraná floodplain, the construction of dams could potentially alter the effects of environmental and spatial factors on the dispersal of planktonic testate amoebae. The pH and the environmental productivity factors were largely responsible for species selection and the structuring of the planktonic testate amoebae metacommunities in Brazilian floodplains.
Recovery from a fish kill in a semi‐arid Australian river: Can stocking augment natural recruitment processes?
Authors: Thiem Jason D. , Wooden Ian J. , Baumgartner Lee J. , Butler Gavin L. , Forbes Jamin P. , Conallin John
Published: August 2016

Localized catastrophic events can dramatically affect fish populations. Management interventions, such as stocking, are often undertaken to re‐establish populations that have experienced such events. Evaluations of the effectiveness of these interventions are required to inform future management actions. Multiple hypoxic blackwater events in 2010–2011 substantially reduced fish communities in the Edward‐Wakool river system in the southern Murray‐Darling Basin, New South Wales, Australia. These events led to extensive fish kills across large sections of the entire system following a period of prolonged drought. To expedite recovery efforts, 119 661 golden perch Macquaria ambigua and 59 088 Murray cod Maccullochella peelii fingerlings were stocked at five locations over 3 years. All fish stocked were chemically marked with calcein to enable retrospective evaluation of wild or hatchery origin. Targeted collections were undertaken 3 years post‐stocking to investigate the relative contribution of stocking efforts and recovery via natural recruitment in the system. Of the golden perch retained for annual ageing (n = 93) only nine were of an age that could have coincided with stocking activities. Of those, six were stocked. The dominant year‐class of golden perch were spawned in 2009; before the stocking programme began and prior to blackwater events. All Murray cod retained (n = 136) were of an age that coincided with stocking activities, although only eight were stocked. Among the Murray cod captured, the dominant year‐class was spawned in 2011, after the blackwater events occurred. The results from this study provide first evidence that natural spawning and recruitment, and possibly immigration, were the main drivers of golden perch and Murray cod recovery following catastrophic fish kills. Interpreted in the context of other recent examples, the collective results indicate limited benefit of stocking to existing connected populations already naturally recruiting in riverine systems.
Negative pressure wound therapy using a portable single‐use device for free skin grafts on the distal extremity in seven dogs
Authors: Miller AJ , Cashmore RG , Marchevsky AM , Havlicek M , Brown PM , Fearnside SM
Published: August 2016

Objective

Retrospective study to describe clinical experience with a portable single‐use negative pressure wound therapy device after application of full‐thickness meshed skin grafts to wounds on the distal extremities of seven dogs.

Methods

Seven dogs were treated with portable NPWT after receiving skin grafts; six as the result of tumour resection and one for traumatic injury. Medical records were reviewed and data recorded on patient signalment, cause and location of wound, surgical technique, application and maintenance of portable NPWT, graft survival and outcome, and complications encountered with the system.

Clinical outcomes

NPWT was provided for between 4 and 7 days. Five patients were discharged from hospital during the treatment period. Application and maintenance of the portable device was technically easy and no major complications were encountered. Minor complications consisted of fluid accumulation in the evacuation tubing. All dogs achieved 100% graft survival.

Conclusions

Application and maintenance of the portable device was technically straightforward. All dogs receiving portable NPWT after transfer of a free skin graft to the distal extremity had a successful outcome.
Prevalence of clinicopathological changes in healthy middle‐aged dogs and cats presenting to veterinary practices for routine procedures
Authors: Dell'Osa D , Jaensch S
Published: August 2016

Objective

The objective of the present study was to investigate the frequency of abnormal clinicopathological parameters in a population of client‐owned clinically healthy middle‐aged dogs and cats.

Materials and methods

Biochemical and haematological profiles, urinalysis and total T4 were measured in clinically healthy middle‐aged dogs (age, 5–8 years) and cats (age, 6–9 years) presenting to veterinary practices for routine procedures.

Results

Of the 406 dogs, only 55 had no abnormalities identified in the testing panel. Most changes were minor or considered artifactual; however, changes that were diagnostic of significant disease or warranting additional evaluation were identified in 25 dogs (6.2%). Of the 130 cats, only 26 had no abnormalities identified in the testing panel. Most changes were minor or considered artifactual; however, changes diagnostic of significant disease or warranting additional evaluation were identified in 25 cats (19.2%). Significant abnormalities included anaemia, inflammation and evidence of liver, kidney and pancreatic disease.

Conclusion

Biochemical and haematological testing as part of regular preventive health checks may facilitate early detection of diseases before they present clinically, allowing earlier intervention and better health outcomes.
Public Opinions About Infant Feeding in the United States
Authors: Nelson Jennifer M. , Li Ruowei , Perrine Cria G. , Scanlon Kelley S.
Published: August 2016

Background

Exclusive breastfeeding is recommended for the first 6 months of life. However, many barriers to breastfeeding exist. We examine public opinions about the benefits of breastfeeding and the infant health risks associated with formula feeding.

Methods

A national public opinion survey was conducted in 2013. Participants indicated their level of agreement with four breastfeeding‐related statements. Except for the last one, all statements were positively worded with agreement representing positive opinions toward breastfeeding. To focus on the prevalence of positive opinions, we estimated percentage agreement with the first three statements, but disagreement with the fourth. Multiple logistic regression was used to examine how odds of these positive opinions varied by socio‐demographic factors.

Results

Seventy‐eight percent of participants agreed that breastmilk is nutritionally designed for infants, but few believed breastfeeding protects against overweight (12%). Approximately one‐quarter agreed that formula feeding increases the chance of illness, whereas 45 percent disagreed that infant formula is equivalent to breastmilk. Older, less‐educated, unmarried, and non‐Hispanic black participants were less likely to agree that formula feeding increases the risk of infant illness. Races other than non‐Hispanic white, participants aged 30–44 years and 45–59 years, unmarried, and less‐educated participants were less likely to disagree with the equivalence of infant formula to breastmilk.

Discussion

The nutritional value of breastmilk is well known. Fewer adults believe that breastfeeding protects against childhood overweight or that formula feeding increases the chance of infant illness. Communication efforts may increase public awareness of the health benefits of breastfeeding.
Role of biobanking in urology: a review
Authors: Chalfin Heather J. , Fabian Elizabeth , Mangold Leslie , Yeater David B. , Pienta Kenneth J. , Partin Alan W.
Published: August 2016

In the current era of individualized medicine, a biorepository of human samples is essential to support clinical and translational research. There have been limited efforts in this arena within the field of urology, as cost, logistical and ethical issues represent significant deterrents to biobanking. The Johns Hopkins Brady Urological Institute Biorepository was founded in 1994 as a resource to facilitate discovery. Since its inception, the biorepository has enabled numerous research endeavours including pivotal trials leading to the regulatory approval of four diagnostic tests for prostate cancer. In the present review, we discuss the current state of biobanking within urology, outline the specific ethical and financial challenges to biobanking as well as solutions, and describe the operations of a successful urological biorepository.
In vitro study on potential pharmacological activity of curcumin analogues and their copper complexes
Authors: Ferrari Erika , Benassi Rois , Saladini Monica , Orteca Giulia , Gazova Zuzana , Siposova Katarina
Published: August 2016

Curcumin and its derivatives have attracted great interest in the prevention and treatment of Alzheimer's disease, thanks both to the ability to hinder the formation of amyloid‐beta (Aβ) aggregates and the ability to bind Cu (II) ion. In this article, we explore the ability of curcumin derivatives of K2T series to affect amyloid Aβ1–40 aggregation. These derivatives were obtained by introducing the t‐butyl ester group through a methylenic spacer on the central carbon atom of the β‐diketo moiety of curcumin frame. The studied curcuminoids were demonstrated to inhibit Aβ1–40 fibrillization at substoichiometric concentrations with IC50 value near that of curcumin. In addition, the antioxidant properties and DNA interaction of their Cu(II) complexes is evaluated. The structure of Cu(II)‐K2T31 complex is also proposed on the basis of DFT calculation.
Infant Attachment Moderates Paths From Early Negativity to Preadolescent Outcomes for Children and Parents
Authors: Boldt Lea J. , Kochanska Grazyna , Jonas Katherine
Published: August 2016

Although infant attachment has been long seen as key for development, its long‐term effects may be complex. Attachment may be a catalyst or moderator of future developmental sequelae rather than a source of main effects. In 102 mothers, fathers, and infants, attachment was assessed at 15 months; children's negativity (rejection of parental rules and modeling attempts) at 25, 38, 52, and 67 months; and developmental outcomes (the child's parent‐rated externalizing problems and the parent–child observed relationship quality) at ages 10 and 12. In both mother–child and father–child relationships, children's higher negativity was associated with more detrimental outcomes but only in dyads with formerly insecure infants. Infant insecurity appears to amplify detrimental cascades, whereas infant security appears to defuse such risks.
Circulating T cells to infliximab are detectable mainly in treated patients developing anti-drug antibodies and hypersensitivity reactions
Authors: Vultaggio A , Petroni G , Pratesi S , Nencini F , Cammelli D , Milla M , Prignano F , Annese V , Romagnani S , Maggi E , Matucci A ,   on behalf of the ABIRISK Consortium
Published: August 2016

Antibodies recognizing infliximab (IFX) may develop in a proportion of treated patients, leading to loss of response or hypersensitivity reactions (HRs). T cell response to IFX has been poorly investigated. This paper was addressed to detect IFX-specific T cells in treated patients with inflammatory diseases developing, or not, anti-drug antibodies (ADA) and to correlate the presence of specific T cells with the clinical outcomes of the treatment. A co-culture system of IFX-loaded dendritic cells and purified autologous CD4+ T cells was used to detect memory T cells in 32 ADA+ and 39 ADA– IFX-treated patients and control groups. The cytokine profile of IFX-specific T cells was also studied in culture supernatants. IFX-specific cell proliferation was detected mainly in cells from ADA+ patients, irrespective of their different diseases. HR patients displayed higher T cell proliferation than non-responder and tolerant patients. A mixed [interferon (IFN)-γ, interleukin (IL)-13, IL-10] cytokine profile was shown in cells from ADA+ patients, while IL-10 was the most frequently detected cytokine in the supernatants of cultures from ADA- patients. Immunoglobulin (Ig)E+ADA+ patients with previous HRs exhibited a more pronounced type 2 profile than IgE–ADA+ patients. This work provides evidence that IFX-specific circulating T cells are detectable mainly in ADA+ patients with HRs, regardless of their disease. The IFX-induced cytokine pattern partially correlates with the ADA isotype.
The pattern of GPI-80 expression is a useful marker for unusual myeloid maturation in peripheral blood
Authors: Takeda Y , Kato T , Ito H , Kurota Y , Yamagishi A , Sakurai T , Araki A , Nara H , Tsuchiya N , Asao H
Published: August 2016

Myeloid-derived suppressor cells (MDSCs) have a wide spectrum of immunosuppressive activity; control of these cells is a new target for improving clinical outcomes in cancer patients. MDSCs originate from unusual differentiation of neutrophils or monocytes induced by inflammatory cytokines, including granulocyte-colony stimulating factor (G-CSF) and granulocyte–macrophage (GM)-CSF. However, MDSCs are difficult to detect in neutrophil or monocyte populations because they are not uniform cells, resembling both neutrophils and monocytes; thus, they exist in a heterogeneous population. In this study, we investigated GPI-80, a known regulator of Mac-1 (CD11b/CD18) and associated closely with neutrophil maturation, to clarify this unusual differentiation. First, we demonstrated that the mean fluorescence intensity (MFI) of GPI-80 and coefficient of variation (CV) of GPI-80 were increased by treatment with G-CSF and GM-CSF, respectively, using a human promyelocytic leukaemia (HL60) cell differentiation model. To confirm the value of GPI-80 as a marker of unusual differentiation, we measured GPI-80 expression and MDSC functions using peripheral blood cells from metastatic renal cell carcinoma patients. The GPI-80 CV was augmented significantly in the CD16hi neutrophil cell population, and GPI-80 MFI was increased significantly in the CD33hi monocyte cell population. Furthermore, the GPI-80 CV in the CD16hi population was correlated inversely with the proliferative ability of T cells and the GPI-80 MFI of the CD33hi population was correlated with reactive oxygen species production. These results led us to propose that the pattern of GPI-80 expression in these populations is a simple and useful marker for unusual differentiation, which is related to MDSC functions.
Insulin storage in hot climates without refrigeration: temperature reduction efficacy of clay pots and other techniques
Authors: Ogle G. D. , Abdullah M. , Mason D. , Januszewski A. S. , Besançon S.
Published: August 2016

Aim

Insulin loses potency when stored at high temperatures. Various clay pots part‐filled with water, and other evaporative cooling devices, are used in less‐resourced countries when home refrigeration is unavailable. This study examined the cooling efficacy of such devices.

Methods

Thirteen devices used in Sudan, Ethiopia, Tanzania, Mali, India, Pakistan and Haiti (10 clay pots, a goat skin, a vegetable gourd and a bucket filled with wet sand), and two identical commercially manufactured cooling wallets were compared. Devices were maintained according to local instructions. Internal and ambient temperature and ambient humidity were measured by electronic loggers every 5 min in Khartoum (88 h), and, for the two Malian pots, in Bamako (84 h). Cooling efficacy was assessed by average absolute temperature difference (internal vs. ambient), and % maximal possible evaporative cooling (allowing for humidity).

Results

During the study period, mean ambient temperature and humidity were 31.0°C and 32.0% in Khartoum and 32.9°C and 39.8% in Bamako. All devices reduced the temperature (P < 0.001) with a mean (sd) reduction from 2.7 ± 0.5°C to 8.3 ± 1.0°C, depending on the device. When expressed as % maximal cooling, device efficacy ranged from 20.5% to 71.3%. On cluster analysis, the most efficacious devices were the goat skin, two clay pots (from Ethiopia and Sudan) and the suspended cooling wallet.

Conclusions

Low‐cost devices used in less‐resourced countries reduce storage temperatures. With more efficacious devices, average temperatures at or close to standard room temperature (20–25°C) can be achieved, even in hot climates. All devices are more efficacious at lower humidity. Further studies are needed on insulin stability to determine when these devices are necessary.