bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of Risk Prediction Model for Venous Thromboembolism in Postpartum Women: Multinational Cohort Study
Authors: Abdul Sultan Alyshah , West Joe , Grainge Matthw J. , Riley Richard D. , Tata Laila J. , Stephansson Olof , Fleming Kate M. , Nelson-Piercy Catherine , Ludvigsson Jonas F.
Published: November 2017

(BMJ. 2016;355:i6253)

Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in developed countries as the risk is increased significantly during pregnancy with its occurrence at its peak during the postpartum period. Targeted thromboprophylaxis has been used to prevent postpartum VTE with evidence suggesting minimum harm associated with this treatment. However, there is not consensus about which parturients should receive thromboprophylaxis. While its use in high risk patients is not questioned, most women experiencing VTE do not fit into this category, but rather are considered to be low to moderate risk due to factors such as obesity or cesarean delivery. Currently, recommendations for thromboprophylaxis in pregnant women are inconsistent across countries. The aim of this cohort study was to develop and validate a risk prediction model for VTE within the first 6 weeks postpartum on the basis of each woman’s individualized clinical risk profile, and to compare this with the existing guidelines on thromboprophylaxis from the Royal College of Obstetricians and Gynaecologists in the United Kingdom and the Swedish guidelines.
The Labor Analgesia Requirements in Nulliparous Women Randomized to Epidural Catheter Placement in a High or Low Intervertebral Space
Authors: Moore A. , Villeneuve V. , Bravim B. , El-Bahrawy A. , El-Mouallem E. , Kaufman I. , Hatzakorzian R. , Li Pi Shan W.
Published: November 2017

(Anesth Analg. 2017 May 11) [Epub ahead of print]

There is no current evidence to guide the choice of epidural catheter placement level during labor. In fact, placement either at the higher or lower intervertebral spaces is often based only on provider preference. Therefore, the authors of the present study devised a single-blind, randomized controlled trial to test the hypothesis that epidural catheters placed at a low level require less rescue analgesia than catheters placed at a high level when using patient-controlled epidural analgesia (PCEA).
Does Obesity Complicate Regional Anesthesia and Result in Longer Decision to Delivery Time for Emergency Cesarean Section?
Authors: Väänänen A.J. , Kainu J.P. , Eriksson H. , Lång M. , Tekay A. , Sarvela J.
Published: November 2017

(Acta Anaesthesiol Scand. 2017;61(6):609–618)

Maternal obesity is known to increase the risk of anesthesiology and obstetrical complications, for example failed epidural, as well as to prolong the decision-to-incision and/or decision-to-delivery interval (DDI) times. In the present study, the authors evaluated the association between maternal body mass index (BMI) and DDI, the effects of regional anesthesia on decision-to-incision times, and regional anesthesia failure rates during emergency cesarean section (CS).
Prediction of Hypotension During Spinal Anesthesia for Elective Cesarean Section by Altered Heart Rate Variability Induced by Postural Change
Authors: Sakata K. , Yoshimura N. , Tanabe K. , Kito K. , Nagase K. , Iida H.
Published: November 2017

(Int J Obstet Anesth. 2017;29:34–38)

Hypotension is a common problem during cesarean deliveries performed under spinal anesthesia. Identifying patients at risk for spinal-induced hypotension could be useful for the management of anesthesia as maternal hypotension can have deleterious effects on both the mother and child. Previous work has found maternal heart rate variability to be useful in predicting which parturients will develop hypotension during spinal anesthesia. It has also been suggested that changes in maternal heart rate with changes in maternal position could be predictive of patients at risk for developing hypotension. This study was devised to assess whether heart rate variability changes caused by maternal position changes could be a predictor of hypotension during spinal anesthesia.
Choice of Anaesthesia for Category-1 Caesarean Section in Women With Anticipated Difficult Tracheal Intubation: The Use of Decision Analysis
Authors: Krom A.J. , Cohen Y. , Miller J.P. , Ezri T. , Halpern S.H. , Ginosar Y.
Published: November 2017

(Anaesthesia. 2017;72:156–171)

In cases where a difficult airway is suspected in the setting of an emergency category-1 cesarean delivery, decisions regarding the choice of anesthesia must balance the need to quickly and safely deliver a fetus with concern for the mother’s health. Since such cases are relatively rare and urgent in nature, in this current study a literature review was undertaken to determine how long it took to establish anesthesia and the probability of failure with various anesthetic techniques. Decision analysis was used to assess risk among the different types of anesthesia with the investigators’ hypothesis being that rapid sequence induction of general anesthesia would provide the quickest delivery time for the fetus and acceptable risk for the mother.
The Cricoid Force Necessary to Occlude the Esophageal Entrance: Is There a Gender Difference?
Authors: Zeidan A.M. , Salem M.R. , Bamadhaj M. , Mazoit J.X. , Sadek H. , Houjairy H. , Abdulkhaleq K. , Bamadhaj N.
Published: November 2017

(Anesth Analg. 2017;124(4):1168–1173)

Cricoid force (CF) is used to occlude the esophageal lumen and prevent regurgitation during surgery. However, excessive CF can deform the cricoid cartilage, oppose the vocal cords, interfere with tracheal tube passage, and result in ineffective gas exchange. Due to differences in cricoid plate size, women may require less CF than is recommended in the literature (at least 44 N). The authors of the present study hypothesized that gender differences exist in the necessary CF application to prevent regurgitation. Using a Glidescope video laryngoscope in anesthetized and paralyzed patients, they assessed the effectiveness of different CFs in occluding the esophageal entrance in men and women.
Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single Blinded, Randomized Controlled Trial
Authors: Munday J. , Osborne S. , Yates P. , Sturgess D. , Jones L. , Gosden E.
Published: November 2017

(Anesth Analg. 2017 May 12)[Epub ahead of print]

Rates of perioperative hypothermia, which has been associated with detrimental physiological effects in nonpregnant women, can be as high as 80%. Therefore, in the present study, the authors evaluated the effectiveness of a 20-min period of perioperative forced air warming on maternal temperature compared to no warming in women receiving intrathecal morphine during elective cesarean delivery.
Randomized Controlled Trial of Intravenous Acetaminophen for Postcesarean Delivery Pain Control
Authors: Altenau B. , Crisp C.C. , Devaiah C.G. , Lambers D.S.
Published: November 2017

(Am J Obstet Gynecol. 2017;217(3):362.e1–362.e6)

Postcesarean delivery pain management regimens are usually multimodal and include the use of regional anesthesia, nonsteroidal anti-inflammatory drugs, acetaminophen, and/or narcotic medications. Although intravenous (IV) acetaminophen has been shown to decrease narcotic consumption in the management of acute pain, there are limited studies on its use in the field of obstetrics for postcesarean delivery pain management. In the present study, the authors hypothesized that IV acetaminophen administration postcesarean delivery would reduce narcotic consumption 48 hours postoperatively.
Use of Hyperbaric Oxygen Therapy and PEGylated Carboxyhemoglobin Bovine in a Jehovah’s Witness With Life-Threatening Anemia Following Postpartum Hemorrhage
Authors: Thenuwara K. , Thomas J. , Ibsen M. , Ituka U. , Choib K. , Nickel E. , Goodheart M.J.
Published: November 2017

(Int J Obstet Anesth. 2017;29:73–80)

This report involved the case of a Jehovah’s Witness patient who would not allow the use of blood products based on religious beliefs and was undergoing a cesarean section which was complicated by the development of postpartum hemorrhage.
Experimental Induction of Physeal Injuries by Fracture, Drill, and Ablation Techniques: Analyses of Immunohistochemical Findings
Authors: Gruber Helen E. , Ashraf Nomaan , Cox Michael D. , Ingram Jane A. , Templin Megan , Wattenbarger John Michael
Published: November 2017

Background:

Although physeal fractures and physeal bars can result in significant clinical consequences to growth and development of the injured physis, little orthopaedic research has focused upon this topic. Our objective was to extend a previously developed rat model to examine the immunohistochemical features following surgical application of techniques disrupting the physis.

Methods:

Physes were surgically disrupted using fracture (control), epiphyseal scrape (ES), or epiphyseal drill (ED). After 1, 3, 6, 10, or 21 days, animals were euthanized, sites processed for histology and immunohistochemical localization of vascular endothelial growth factor (VEGF), Factor VIII, Sox-9, PTHrP (parathyroid hormone-related protein) and PTHrP-R (parathyroid hormone-related protein receptor) in resting, proliferative, and hypertrophic physeal zones. Incidence of physeal bars, vertical septa and islands within the metaphysis was quantified. Semiquantitative analysis of immunohistochemistry was performed.

Results:

Physeal bars, vertical septa, and displaced cartilage islands were present each of the surgical treatments. Fisher’s exact test showed a statistically significant increase in the presence of physeal bars (P=0.002) and vertical septa (P=0.012) in the ED group at 10 and 21 days. Analysis of VEGF showed significant differences among the surgical treatments involving the resting zone, and the proliferative zone for days 1, 6, and 21 (P≤0.02) with greater mean scores present in the fracture (control) group, followed by the ED group; the lowest scores were present in the ES group. PTHrP-R immunolocalization showed significant differences among treatments in the hypertrophic zone at days 6 and 21 (P=0.022 and 0.044, respectively).

Conclusions:

On the basis of the type of surgical treatment, results show significant differences in the presence of VEGF (reflecting the vascular bed) in the resting and proliferating zones at days 1, 6, and 21. VEGF localization was less abundant in the ED group (which had more physeal bars), suggesting that lack of vascular ingrowth plays a role in physeal bar formation.

Clinical Relevance:

Basic science data presented here provide insight into the importance of the various regions of the physis and its repair and continued growth after physeal fracture. We suggest that a better understanding of the cellular basis of physeal arrest following physeal fracture may have future relevance for the development of treatments to prevent or correct arrest.
Distinguishing Features of the Repetitive Nerve Stimulation Test Between Lambert–Eaton Myasthenic Syndrome and Myasthenia Gravis, 50-Year Reappraisal
Authors: Oh Shin J.
Published: November 2017

Objective:

To reappraise the distinguishing features of the repetitive nerve stimulation (RNS) tests in the abductor digiti quinti muscle between myasthenia gravis (MG) and Lambert–Eaton myasthenic syndrome (LEMS) 50 years after the 1965's Lambert seminal paper.

Methods:

The various parameters of the RNS test were compared between 34 patients with LEMS and 140 patients with MG to assess their diagnostic sensitivity.

Results:

RNS test was abnormal in all (100%) patients with LEMS and 76 (54%) patients with MG. The diagnostic hallmark of LEMS, ≥60% increment at high-rate stimulation or postexercise facilitation, was present in 33 (97%) of patients. The diagnostic hallmark of MG, decrement at low-rate stimulation (LRS), was present in 65 (46%) of patients with MG. The most prominent difference in the various parameters of RNS tests was noted between LEMS versus MG and normal controls.

Conclusions:

Distinguishing features of the RNS test in LEMS and MG are confirmed in this direct comparison study: the low compound muscle action potential amplitude, decrement at LRS, and increment at high-rate stimulation or postexercise facilitation for LEMS and normal compound muscle action potential amplitude and decrement at LRS for MG.
Self-efficacy Mediates the Relationship Between Motivation and Physical Activity in Patients With Heart Failure
Authors: Klompstra Leonie , Jaarsma Tiny , Strömberg Anna
Published: November 2017

Background:

Motivation is necessary in patients with heart failure (HF) who are attempting to become more physically active but may not be sufficient to initiate physical activity. Self-efficacy might explain the relationship between motivation and physical activity.

Objective:

The aim of this study was to examine the role of exercise self-efficacy in the relationship between exercise motivation and physical activity in patients with HF.

Methods:

A total of 100 stable patients with HF (88% in New York Heart Association class II/III; mean age, 67 ± 13 years; 62% men) were studied. Self-efficacy was measured with the Exercise Self-Efficacy Scale; motivation, with the Exercise Motivation Index; and physical activity, with a self-report questionnaire. Logistic regression analyses were made to examine the mediation effect of exercise self-efficacy on the relationship between exercise motivation and physical activity.

Results:

Forty-two percent of the 100 patients reported engaging in less than 60 minutes per week of physical activity. Motivation predicted physical activity (b = 0.58, P < .05), but after controlling for self-efficacy, the relationship between motivation and physical activity was no longer significant (b = 0.76, P = .06), indicating full mediation.

Conclusion:

Motivation to be physically active is important but not sufficient. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of self-efficacy.
A cognitive map of sustainable decision-making in entrepreneurship
Authors: Muñoz Pablo
Published: November 2017

Purpose

Under what conditions do entrepreneurs make the sustainable decisions they need to develop socially and environmentally responsible new businesses? Explanations of sustainable decision-making have involved various cognitive features; however, it is not yet clear how they play a role in empirical terms and, moreover, how they combine to induce business decisions based on social, environmental and economic considerations. The purpose of this paper is to explore how five cognitive factors combine and causally connect to produce sustainable decision-making in entrepreneurship.

Design/methodology/approach

This study uses fuzzy-set qualitative comparative analysis to examine the decision-making of 37 sustainable entrepreneurs. It focuses on a substantive conception of entrepreneurial behaviour to uncover the cognitive antecedents underlying entrepreneurial decisions that involve the explicit development and implementation of measures, targets and strategies aimed at improving its impact on people and the environment.

Findings

The configurational analysis reveals a typology comprising five combinations of cognitive factors constituting a comprehensive cognitive map of sustainable decision-making in entrepreneurship, namely: purpose-driven, determined; value-based, vacillating; value-based, unintended; single motive, single solution; and purpose-driven, hesitant.

Research limitations/implications

This study demonstrates that no single condition is necessary nor sufficient for triggering decision-making involving social and environmental concerns, revealing five mental models leading to sustainable decision-making. In doing so, this paper responds to recent calls that stress the need for studies capable of uncovering the complex constellation of cognitive factors underlying entrepreneurial sustainable behaviour. Theoretical and practical implications are discussed.

Originality/value

This paper provides a systematic characterization of the cognitive underpinnings of sustainable decision-making and offers a basis for organizing the study of sustainable outcomes and configurations of cognitive antecedents. It reconciles prior efforts aimed at characterizing sustainability decisions in the context of SMEs and new enterprises, challenging current models based on awareness, experience and ethical normative frameworks.
Interface defects detection and quantification on a Si/SiO2 structure
Authors: Elias Rawad , Ziade Pierre , Habchi Roland
Published: November 2017

Purpose

The purpose of this paper is to investigate and classify the defects on silicon-based power devices under extreme conditions.

Design/methodology/approach

Electrical characterization was performed on MOS devices to study their interface defects. The devices were subjected to a voltage or a current constraint to induce defects, and then measurements were done to detect the effects of those defects. Measurements include current voltage, capacitance and conductance characterization. The Hill–Coleman method was used to calculate the interface states density in each case.

Findings

It was found that most of the defects have energies within the upper band gap of the semiconductor.

Originality value

The method used in this paper allows the determination of any interface defects on a Si/SiO2 structure.
Variation of thermal resistance with input current and ambient temperature in low-power SMD LED
Authors: Raypah Muna E. , M.K. Dheepan , Devarajan Mutharasu , Subramani Shanmugan , Sulaiman Fauziah
Published: November 2017

Purpose

Thermal behavior of light-emitting diode (LED) device under different operating conditions must be known to enhance its reliability and efficiency in various applications. The purpose of this study is to report the influence of input current and ambient temperature on thermal resistance of InGaAlP low-power surface-mount device (SMD) LED.

Design/methodology/approach

Thermal parameters of the LED were measured using thermal transient measurement via Thermal Transient Tester (T3Ster). The experimental results were validated using computational fluid dynamics (CFD) software.

Findings

As input current increases from 50 to 90 mA at 25°C, the relative increase in LED package (ΔRthJS) and total thermal resistance (ΔRthJA) is about 10 and 4 per cent, respectively. In addition, at 50 mA and ambient temperature from 25 to 65°C, the ΔRthJSand ΔRthJAare roughly 28 and 22 per cent, respectively. A good agreement between simulation and experiment results of junction temperature.

Originality/value

Most of previous studies have focused on thermal management of high-power LEDs. There were no studies on thermal analysis of low-power SMD LED so far. This work will help in predicting the thermal performance of low-power LEDs in solid-state lighting applications.
The use of anti-psychotic and other psychotropic medication in a specialist community service for adults with learning disabilities
Authors: Clare Isabel C.H. , Wade Kelly A. , Bolton Sorcha , Wagner Adam P. , Steven Tatsiana , Holland Anthony J.
Published: November 2017

Purpose

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Design/methodology/approach

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

Findings

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

Research limitations/implications

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

Practical implications

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Originality/value

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.
Optimising psychotropic medication use
Authors: Sheehan Rory
Published: November 2017

Purpose

This commentary accompanies Clare et al.’s study investigating psychotropic drug prescribing for adults with intellectual disability who were referred to specialist community learning disability teams in the east of England. The purpose of this paper is to explore some of the background to psychotropic drug prescribing for people with intellectual disability, review important contextual factors that influence prescribing decisions, and consider how we might make the best use of psychotropic drugs in this group.

Design/methodology/approach

Narrative summary and opinion, supported by reference to recent research literature.

Findings

Psychotropic drug use for people with intellectual disability raises complex issues, not least because of the lack of research evidence that exists on the topic. Psychotropic drugs can be an important part of treatment for people with mental illness but further research is needed to support prescribing for challenging behaviour. Medication optimisation is a framework within which individual preferences and values are considered alongside the evidence base and clinical judgement in order to inform safe, effective, and collaborative management decisions.

Practical implications

Prescribing decisions should be individualised and reviewed regularly, incorporating evidence from patients and carers. Improving the use of psychotropic medication requires concerted action, adequate social support, and the provision of alternative, non-pharmacological interventions that are acceptable and effective.

Originality/value

This paper reviews some of the current concerns about the use of psychotropic drugs and opens up new avenues of discussion.
Bioelectrical Impedance as a Technique for Estimating Postmortem Interval,,
Authors: Hansen Eriek S. , Baigent Christiane , Reck Sophia I. , Connor Melissa
Published: November 2017

Estimation of postmortem interval (PMI) is a critical component of death investigation. A cadaver can be hypothesized to be a resistor–capacitor (RC) circuit the impedance (Z) of which changes in a quantifiable manner as the cadaver decomposes. This hypothesis was tested using bioelectrical impedance analysis (BIA) equipment to apply a current with a fixed amplitude at a single frequency to four cadavers over time and measuring two components of Z, resistance (R) and reactance (Xc). Quadratic regression analysis between Z and accumulated degree days (ADD) showed a statistically significant parabolic relationship. The parabolic relationship poses an initial challenge to the use of the method, and additional research is needed to address this issue. However, the results of the reported research support the hypothesis that Z measured using BIA has a relationship to PMI.
Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase I healthy volunteer study
Authors: McDonald Rebecca , Lorch Ulrike , Woodward Jo , Bosse Björn , Dooner Helen , Mundin Gill , Smith Kevin , Strang John
Published: November 2017

Background and Aims

Take‐home naloxone can prevent death from heroin/opioid overdose, but pre‐provision is difficult because naloxone is usually given by injection. Non‐injectable alternatives, including naloxone nasal sprays, are currently being developed. To be effective, the intranasal (i.n.) spray dose must be adequate but not excessive, and early absorption must be comparable to intramuscular (i.m.) injection. We report on the pharmacokinetics (PK) of a specially produced concentrated novel nasal spray. The specific aims were to: (1) estimate PK profiles of i.n. naloxone, (2) compare early systemic exposure with i.n. versus i.m. naloxone and (3) estimate i.n. bioavailability.

Design

Open‐label, randomized, five‐way cross‐over PK study.

Setting

Clinical trials facility (Croydon, UK).

Participants

Thirty‐eight healthy volunteers (age 20–54 years; 11 female).

Intervention and comparator

Three doses of i.n. (1 mg/0.1 ml, 2 mg/0.1 ml, 4 mg/0.2 ml) versus 0.4 mg i.m. (reference) and 0.4 mg intravenous (i.v.) naloxone.

Measurements

Regular blood samples were taken, with high‐frequency sampling during the first 15 minutes to capture early systemic exposure. PK parameters were determined from plasma naloxone concentrations. Exploratory analyses involved simulation of repeat administration.

Findings

Mean peak concentration (Cmax) values for 1 mg (1.51 ng/ml), 2 mg (2.87 ng/ml) and 4 mg (6.02 ng/ml) i.n. exceeded 0.4 mg i.m. (1.27 ng/ml) naloxone. All three i.n. doses rapidly achieved plasma levels > 50% of peak concentrations (T50%) by 10 minutes, peaking at 15–30 minutes (Tmax). For comparison, the i.m. reference reached Tmax at 10 minutes. Mean bioavailability was 47–51% for i.n. relative to i.m. naloxone. Simulation of repeat dosing (2 × 2 mg i.n. versus 5 × 0.4 mg i.m. doses) at 3‐minute intervals showed that comparable plasma naloxone concentrations would be anticipated.

Conclusions

Concentrated 2 mg intranasal naloxone is well‐absorbed and provides early exposure comparable to 0.4 mg intramuscular naloxone, following the 0.4 mg intramuscular curve closely in the first 10 minutes post‐dosing and maintaining blood levels above twice the intramuscular reference for the next 2 hours.
Invertebrate biodiversity in apple orchards: agrichemical sprays as explanatory variables for inter‐orchard community differences
Authors: Malone Louise A. , Burgess Elisabeth P. J. , Barraclough Emma I. , Poulton Joanne , Todd Jacqui H.
Published: November 2017

Invertebrates are important providers of ecosystem services to orchards and the orchards may benefit where there is greater biodiversity. Previous research has shown that apple orchards using organic or integrated pest management support different invertebrate communities, as can different orchards within the same management system.

In the present study, we examined the potential for agrichemical usage to explain inter‐orchard invertebrate community differences in 10 New Zealand apple orchards under integrated pest management.

Multiple regression models were used to examine relationships between spray diary data and invertebrates collected by branch tapping, pitfall and sticky traps in 2011/2012. Insecticides, fungicides, plant growth regulators and fertilizers were used as explanatory variables in these models and the most parsimonious models were identified.

Plant growth regulators were significant in most of the models for inter‐orchard variability in total invertebrate diversity. Insecticides featured strongly in models explaining pest assemblages, although not so strongly for models for their natural enemies. Fungicide and fertilizer use featured in models explaining communities of decomposers and fungivores.

The results generated several hypotheses about the impacts of specific agrichemicals on invertebrate biodiversity, which, if tested, could establish the feasibility of customizing spray schedules to meet both biodiversity and production goals.
The impact of mental health comorbidities on adherence to buprenorphine: A claims based analysis
Authors: Litz Megan , Leslie Douglas
Published: November 2017

Background and Objectives

Previous research has been inconclusive about whether opioid‐dependent patients with psychiatric comorbidities have shorter treatment retention and higher relapse rates. This study aims to evaluate the impact of mental health comorbidities on adherence to buprenorphine using a large, national health insurance claims data base.

Methods

We used MarketScan® data from 2012 to 2014 to perform this analysis. Inclusion criteria included all patients with an opioid use disorder‐related ICD‐9 code who had been prescribed buprenorphine (n = 2947). Medication adherence was defined using the Medication Possession Ratio ≥.8 (MPR) and logistic regression was used to examine the association between medication adherence and mental health diagnoses, which included Alzheimer's/dementia, schizophrenia, other psychosis, major depressive disorder/bipolar disorder (MDDBP), anxiety disorder, personality disorder, and mental health disorder not elsewhere specified (NOS).

Results

Of the 2947 patients included in our analysis, the most common diagnoses were anxiety disorder: n = 648 (22.0%), MDDBP: n = 467 (15.9%), and mental health disorder NOS: n = 959 (32.5%). Patients diagnosed with MDDBP were significantly less likely to adhere to opioid pharmacotherapy (OR = .805, 95%CI = .651, .994) than patients without MDDBP.

Conclusions and Scientific Significance

The presence of a psychiatric comorbidity can significantly affect adherence to buprenorphine. These trends illustrate the need for clinicians treating opioid use disorder with buprenorphine to screen for psychiatric disorders and monitor their medication adherence. There may also be opportunities to design interventions to help this vulnerable population adhere to buprenorphine and other forms of opioid pharmacotherapy. (Am J Addict 2017;26:859–863)
Testosterone replacement in transgenic sickle cell mice controls priapic activity and upregulates PDE5 expression and eNOS activity in the penis
Authors: Musicki B. , Karakus S. , Akakpo W. , Silva F. H. , Liu J. , Chen H. , Zirkin B. R. , Burnett A. L.
Published: November 2017

Sickle cell disease (SCD)‐associated priapism is characterized by decreased nitric oxide (NO) signaling and downregulated phosphodiesterase (PDE)5 protein expression and activity in the penis. Priapism is also associated with testosterone deficiency, but molecular mechanisms underlying testosterone effects in the penis in SCD are not known. Given the critical role of androgens in erection physiology and NO synthase (NOS)/PDE5 expression, we hypothesized that testosterone replacement to eugonadal testosterone levels reduces priapism by reversing impaired endothelial (e)NOS activity and molecular abnormalities involving PDE5. Adult male transgenic Berkeley sickle cell (Sickle) and wild‐type (WT) mice were implanted with testosterone pellets, which release 1.2 μg testosterone/day for 21 days, or vehicle. After 21 days, animals underwent erectile function assessment followed by collection of blood for serum testosterone measurements, penes for molecular analysis, and seminal vesicles as testosterone‐responsive tissue. Serum testosterone levels were measured by radioimmunoassay; protein expressions of PDE5, α‐smooth muscle actin, eNOS and nNOS, and phosphorylation of PDE5 at Ser‐92, eNOS at Ser‐1177, neuronal (n) NOS at Ser‐1412, and Akt at Ser‐473 were measured by Western blot in penile tissue. Testosterone treatment reversed downregulated serum testosterone levels and increased (p < 0.05) the weight of seminal vesicles in Sickle mice to levels comparable to that of WT mice, indicating restored testosterone levels in Sickle mice. Testosterone treatment reduced (p < 0.05) prolonged detumescence in Sickle mice and normalized downregulated P‐PDE5 (Ser‐92), PDE5, P‐eNOS (Ser‐1177), and P‐Akt (Ser‐473) protein expressions in the Sickle mouse penis. Testosterone treatment did not affect P‐nNOS (Ser‐1412), eNOS, nNOS, or α‐smooth muscle actin protein expressions in the Sickle mouse penis. In conclusion, in the mouse model of human SCD, increasing testosterone to eugonadal levels reduced priapic activity and reversed impaired Akt/eNOS activity and PDE5 protein expression in the penis.
Expression of oestrogen receptors (GPER, ESR1, ESR2) in human ductuli efferentes and proximal epididymis
Authors: Rago V. , Romeo F. , Giordano F. , Malivindi R. , Pezzi V. , Casaburi I. , Carpino A.
Published: November 2017

Oestrogen targeting in the human genital ducts is still not well‐known. In fact, to date, the localization of oestrogen receptors, ESR1 and ESR2, is controversial and the presence of the membrane oestrogen receptor GPER (G protein‐coupled oestrogen receptor) is unexplored. This study has investigated the expression of GPER, ESR1, ESR2 in human ductuli efferentes and proximal caput epididymis by immunohistochemistry and Western blot analysis. Furthermore, the presence of PELP1 (proline–glutamic acid–leucine‐rich protein 1), a co‐regulator of the oestrogen receptors, was also evaluated. In ductuli efferentes, GPER and ESR1 were clearly localized in all epithelial cells, while ESR2 was evidenced only in ciliated cells. Conversely, the epithelial cells of proximal caput epididymis revealed moderate GPER immunoreactivity, the absence of ERS1 and the occasional presence of ESR2. Furthermore, PELP1 was observed in ciliated cells of ductuli efferentes and in principal cells of proximal caput epididymis. Therefore, this study firstly demonstrated the expression of GPER in human male genital ducts, revealing a new mediator of oestrogen action in these anatomical sites. ESR1 and ESR2 were differentially localized in the two genital tracts together with PELP1, but cell sites of ERs and their co‐regulator were not homogeneous. So, a different regional/cellular association of GPER with the classical oestrogen receptors was highlighted, suggesting that oestrogen action could be mediated by GPER, ESR1, ESR2 in ductuli efferentes, while by GPER and, occasionally by ESR2, in proximal caput epididymis. This study suggests that the specific oestrogen‐mediated functions in human genital ducts might result from the different local interactions of oestrogens with oestrogen receptors and their co‐regulators.
Long‐term evaluation of painful symptoms and fertility after surgery for large rectovaginal endometriosis nodule: a retrospective study
Authors: Bourdel Nicolas , Comptour Aurélie , Bouchet Paméla , Gremeau Anne‐Sophie , Pouly Jean‐Luc , Slim Karem , Pereira Bruno , Canis Michel
Published: November 2017

Introduction

Optimal surgical treatment of rectovaginal endometriosis remains a controversial topic. The objective of this study was to evaluate long‐term postoperative outcomes after rectal shaving or colorectal resection for rectovaginal endometriosis.

Material and methods

195 patients underwent surgery (172 managed by shaving, 23 by colorectal resection) between January 2000 and June 2013 for rectovaginal endometriosis (>2 cm) involving at least the serosa of the rectum. Primary outcome measures were pain and fertility. Secondary outcome measures were complications, recurrence rates and quality of life.

Results

Mean follow‐up was 60 ± 42 months in the shaving group and 67 ± 47 months in the resection group. The mean VAS score for pelvic pain between the pre and postoperative period decreased from 5.5 ± 3.5 (shaving group) and 7.3 ± 2.9 (resection group) to 2.3 ± 2.4 (p < 0.001) and 2.0 ± 1.8 (p < 0.001), respectively. For dysmenorrhea, the mean baseline VAS score fell postoperatively from 7.7 ± 2.8 (shaving group) and 8.2 ± 2.6 (resection group) to 3.3 ± 2.9 (p < 0.001) and 2.7 ± 2.7 (p < 0.001), respectively. Pregnancy rates were 73% for shaving and 69% for resection. Major complications occurred in 4% of patients in the shaving group and in 26% in the resection group (p = 0.001). Thirteen patients (7.6%) from the shaving group and none from the resection group were reoperated for suspicion of endometriosis recurrence (p = 0.37). Postoperative quality of life scores revealed no differences between the two groups.

Conclusion

Our study demonstrates that rectal shaving, when feasible for rectovaginal nodule (>2 cm) infiltrating the digestive serosa, has equal impact on pain and pregnancy rates compared with colorectal resection at long‐term follow‐up, with low complication and favorable pregnancy rates.
A QUEST FOR UNFETTERED CREDIT: HOW MONETARY POLICY DRIVES CREDIT RISK TRANSFER OF STRUCTURED FINANCE PRODUCTS
Authors: Robertson Mari L.
Published: November 2017

This study examines the effects of monetary policy contractions on bank loans to households and firms and instruments in three different credit risk transfer (CRT) capital markets over two separate time periods (1995–2006 and 2007–2015). The findings show that in both periods, banks decrease business lending but increase lending to consumers through a combination of mortgage, auto, credit card, and student loans from more liquidity produced by consumer‐related CRT activity. Additional results reveal relative CRT movements toward securitized mortgages from bank mortgage debt over both periods and toward securitized and insured business loans from bank business debt in the latter period, which suggest vulnerabilities among interconnected credit markets. (JEL E44, E51, G21, G23)
Sustained release of stem cell factor in a double network hydrogel for ex vivo culture of cord blood‐derived CD34+ cells
Authors: Zhang Yuanhao , Pan Xiuwei , Shi Zhen , Cai Haibo , Gao Yun , Zhang Weian
Published: November 2017

Objectives

Stem cell factor (SCF) is considered as a commonly indispensable cytokine for proliferation of haematopoietic stem cells (HSCs), which is used in large dosages during ex vivo culture. The work presented here aimed to reduce the consumption of SCF by sustained release but still support cells proliferation and maintain the multipotency of HSCs.

Materials and methods

Stem cell factor was physically encapsulated within a hyaluronic acid/gelatin double network (HGDN) hydrogel to achieve a slow release rate. CD34+ cells were cultured within the SCF‐loaded HGDN hydrogel for 14 days. The cell number, phenotype and functional capacity were investigated after culture.

Results

The HGDN hydrogels had desirable properties and encapsulated SCF kept being released for more than 6 days. SCF remained the native bioactivity, and the proliferation of HSCs within the SCF‐loaded HGDN hydrogel was not affected, although the consumption of SCF was only a quarter in comparison with the conventional culture. Moreover, CD34+ cells harvested from the SCF‐loaded HGDN hydrogels generated more multipotent colony‐forming units (CFU‐GEMM).

Conclusion

The data suggested that the SCF‐loaded HGDN hydrogel could support ex vivo culture of HSCs, thus providing a cost‐effective culture protocol for HSCs.
Seventy years of stream‐fish collections reveal invasions and native range contractions in an Appalachian (USA) watershed
Authors: Buckwalter Joseph D. , Frimpong Emmanuel A. , Angermeier Paul L. , Barney Jacob N.
Published: November 2017

Aim

Knowledge of expanding and contracting ranges is critical for monitoring invasions and assessing conservation status, yet reliable data on distributional trends are lacking for most freshwater species. We developed a quantitative technique to detect the sign (expansion or contraction) and functional form of range‐size changes for freshwater species based on collections data, while accounting for possible biases due to variable collection effort. We applied this technique to quantify stream‐fish range expansions and contractions in a highly invaded river system.

Location

Upper and middle New River (UMNR) basin, Appalachian Mountains, USA.

Methods

We compiled a 77‐year stream‐fish collections dataset partitioned into ten time periods. To account for variable collection effort among time periods, we aggregated the collections into 100 watersheds and expressed a species’ range size as detections per watershed (HUC) sampled (DPHS). We regressed DPHS against time by species and used an information‐theoretic approach to compare linear and nonlinear functional forms fitted to the data points and to classify each species as spreader, stable or decliner.

Results

We analysed changes in range size for 74 UMNR fishes, including 35 native and 39 established introduced species. We classified the majority (51%) of introduced species as spreaders, compared to 31% of natives. An exponential functional form fits best for 84% of spreaders. Three natives were among the most rapid spreaders. All four decliners were New River natives.

Main conclusions

Our DPHS‐based approach facilitated quantitative analyses of distributional trends for stream fishes based on collections data. Partitioning the dataset into multiple time periods allowed us to distinguish long‐term trends from population fluctuations and to examine nonlinear forms of spread. Our framework sets the stage for further study of drivers of stream‐fish invasions and declines in the UMNR and is widely transferable to other freshwater taxa and geographic regions.
Saxagliptin add‐on therapy in Chinese patients with type 2 diabetes inadequately controlled by insulin with or without metformin: Results from the SUPER study, a randomized, double‐blind, placebo‐controlled trial
Authors: Chen Yingli , Liu Xiaomin , Li Quanmin , Ma Jianhua , Lv Xiaofeng , Guo Lixin , Wang Changjiang , Shi Yongquan , Li Yanbing , Johnsson Eva , Wang Mei , Zhao June , Ji Linong
Published: November 2017

This prospective, multicentre, phase III study (NCT02104804) evaluated the efficacy and safety of saxagliptin add‐on therapy in Chinese patients with type 2 diabetes inadequately controlled by insulin ± metformin. Patients with glycated haemoglobin (HbA1c) 7.5% to 10.5% and fasting plasma glucose (FPG) <15 mmol/L (270 mg/dL) on stable insulin therapy (20‐150 U/d) were randomized (1:1) to saxagliptin 5 mg once daily (N = 232) or placebo (N = 230) for 24 weeks, stratified by metformin use. The primary efficacy measure was change in HbA1c. Saxagliptin treatment resulted in a greater adjusted mean change in HbA1c from baseline to week 24 than placebo (−0.58%; P < .001), irrespective of metformin use, and a greater mean change in FPG (0.9 mmol/L [−15.9 mg/dL]; P < .001). More patients achieved HbA1c <7% with saxagliptin (11.4%) than with placebo (3.5%, P = .002). Adverse events and incidence of hypoglycaemia were similar in both groups. Overall, add‐on saxagliptin 5 mg once daily significantly improved glycaemic control without increasing hypoglycaemia risk and was well tolerated in Chinese patients with type 2 diabetes inadequately controlled by insulin (± metformin).
Treatment of Helicobacter pylori infection: A clinical practice update
Authors: Zagari Rocco Maurizio , Rabitti Stefano , Eusebi Leonardo Henry , Bazzoli Franco
Published: November 2017

Background

Helicobacter pylori infection is still frequent in the community and all infected subjects should be offered an eradication therapy. Nowadays physicians have to face the challenge of antibiotic resistance in treating Helicobacter pylori‐infected individuals.

Aim

This review provides an overview of current international guidelines and reports recent evidence from systematic reviews and clinical trials on the treatment of Helicobacter pylori infection and should help physicians to better treat their patients.

Results

General rules to optimize the management of Helicobacter pylori infection include: (i) considering previous patient's exposure to antibiotics; (ii) using high dose of proton‐pump inhibitors; and (iii) avoiding repeating the same regimen, if it has already failure. Bismuth quadruple therapy and concomitant therapy are the best first‐line empirical treatments in areas with high clarithromycin resistance and in individuals with previous use of macrolides; otherwise, the 14‐day clarithromycin‐containing triple therapy is a valid regimen. The sequential therapy is no longer a suggested treatment by international guidelines.

Conclusions

Current international guidelines are consistent in defining treatment strategies for Helicobacter pylori infection. The use of national registries to monitor the efficacy and tolerability of different regimens in the real world of clinical practice is now needed.
Community structure of insect herbivores is driven by conservatism, escalation and divergence of defensive traits in Ficus
Authors: Volf Martin , Segar Simon T. , Miller Scott E. , Isua Brus , Sisol Mentap , Aubona Gibson , Šimek Petr , Moos Martin , Laitila Juuso , Kim Jorma , Zima Jan , Rota Jadranka , Weiblen George D. , Wossa Stewart , Salminen Juha‐Pekka , Basset Yves , Novotny Vojtech
Published: November 2017

Escalation (macroevolutionary increase) or divergence (disparity between relatives) in trait values are two frequent outcomes of the plant‐herbivore arms race. We studied the defences and caterpillars associated with 21 sympatric New Guinean figs. Herbivore generalists were concentrated on hosts with low protease and oxidative activity. The distribution of specialists correlated with phylogeny, protease and trichomes. Additionally, highly specialised Asota moths used alkaloid rich plants. The evolution of proteases was conserved, alkaloid diversity has escalated across the studied species, oxidative activity has escalated within one clade, and trichomes have diverged across the phylogeny. Herbivore specificity correlated with their response to host defences: escalating traits largely affected generalists and divergent traits specialists; but the effect of escalating traits on extreme specialists was positive. In turn, the evolution of defences in Ficus can be driven towards both escalation and divergence in individual traits, in combination providing protection against a broad spectrum of herbivores.
Considerations in performing and analyzing the responses of cortico‐cortical evoked potentials in stereo‐EEG
Authors: Prime David , Rowlands David , O'Keefe Steven , Dionisio Sasha
Published: November 2017

This review aims to highlight key considerations when performing cortico‐cortical evoked potentials (CCEPs) using stereo–electroencephalography (SEEG) for network mapping and show its clinical applicability to presurgical evaluations. The parameters for performing stimulation and safety aspects have been investigated in electrocorticography (ECoG) and deep brain stimulation (DBS), but not as extensively in SEEG. A review of current literature was performed, with an attempt made to emphasize practical insights from all modalities of intracranial stimulation. This paper reviews physical stimulation parameters, highlights safety limits, and considers the influence of changing common stimulation parameters. These factors are put into the context of CCEPs in SEEG. Given the paucity of direct research in this area, studies utilizing low frequency stimulation, DBS, and ECoG are incorporated along with the fundamental principles of electrical engineering. In addition, postprocessing considerations are reviewed, including electrode localization, application of digital filters, baseline selection, application of connectivity metrics, and higher order network analysis. The aim is to guide CCEP stimulation as well as to provide an understanding of the underlying principles of this technique. At present, there are few articles detailing the design of low‐frequency stimulation paradigms, especially in the setting of SEEG. Providing a review of the fundamentals and postprocessing considerations when performing CCEPs in SEEG will increase the accessibility of this technique.