bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the potential impact of pharmacy technician performance of anticoagulation clinic tasks on operational efficiency
Authors: Ourth Heather L , Folstad Jon , Mambourg Scott E , Hopwood Geena , Marchiando Christy , Combs Carolyn , Gonzalez Carrie
Published: August 2019

Purpose

Results of a study to determine the proportion of anticoagulation clinic workload that could be performed by clinical pharmacy technicians (CPTs) and the potential impact on operational efficiency of pharmacist-managed anticoagulation clinics (ACCs) are reported.

Methods

In a quality improvement project involving 11 Veterans Affairs (VA) medical centers, investigators conducted a 3-day time study in pharmacist-managed ACCs followed by scoring of task appropriateness for CPTs via the RAND/UCLA appropriateness method by the VA Anticoagulation Subject Matter Expert (SME) Workgroup. The primary outcome was the percentage of tasks deemed appropriate for a CPT to perform.

Results

The Anticoagulation SME Workgroup determined that a wide variety of mainly administrative ACC tasks could be completed by a CPT. At the 11 VA ACCs, an average of 53.4% (range, 39.9–76.1%) of tasks being performed by pharmacists were deemed appropriate for CPTs. The average percentage of total clinic time associated with performing tasks appropriate for a CPT equated to an estimated 1,111 hours per year. Shifting that portion of the annual work hours to a CPT could potentially result in cost avoidance of $55,302.

Conclusion

At the ACCs evaluated, a significant proportion of tasks (53.4% on average) may be appropriate to assign to CPTs to improve the operational efficiency of these clinics. This finding supports development of business plans for the addition of CPTs in ACCs along with elements to inform crafting of an effective template for ACC structure, including clearly defined CPT roles.
Analysis to determine cost-effectiveness of procalcitonin-guided antibiotic use in adult patients with suspected bacterial infection and sepsis
Authors: Collins Curtis D , Brockhaus Kara , Sim Taeyong , Suneja Anupam , Malani Anurag N
Published: August 2019

Purpose

Results of a study incorporating real-world results into a predictive model to assess the cost-effectiveness of procalcitonin (PCT)-guided antibiotic use in intensive care unit patients with sepsis are reported.

Methods

A single-center, retrospective cross-sectional study was conducted to determine whether reductions in antibiotic therapy duration and other care improvements resulting from PCT testing and use of an associated treatment pathway offset the costs of PCT testing. Selected base-case cost outcomes in adults with sepsis admitted to a medical intensive care unit (MICU) were assessed in preintervention and postintervention cohorts using a decision analytic model. Cost-minimization and cost–utility analyses were performed from the hospital perspective with a 1-year time horizon. Secondary and univariate sensitivity analyses tested a variety of clinically relevant scenarios and the robustness of the model.

Results

Base-case modeling predicted that use of a PCT-guided treatment algorithm would results in hospital cost savings of $45 per patient and result in a gain of 0.0001 quality-adjusted life-year. After exclusion of patients in the postintervention cohort for PCT test ordering outside of institutional guidelines, the mean inpatient antibiotic therapy duration was significantly reduced in the postintervention group relative to the preintervention group (6.2 days versus 4.9 days, p = 0.04) after adjustment for patient sex and age, Charlson Comorbidity Index score, study period, vasopressor use, and ventilator use. Total annual hospital cost savings of $4,840 were predicted.

Conclusion

Real-world implementation of PCT-guided antibiotic use may have improved patients’ quality of life while decreasing hospital costs in MICU patients with undifferentiated sepsis.
Depression and the Diagnosis of MCI in a Culturally Diverse Sample in the United States
Authors: Lang Merike , Rosselli Mónica , Greig Maria T , Torres Valeria L , Vélez-Uribe Idaly , Arruda Fernanda , Barker Warren W , Garcia Patricia , Loewenstein David A , Curiel Rosie E , Duara Ranjan
Published: August 2019

Objective

To analyze (1) whether there are ethnic differences in the severity of depressive symptoms between groups of elders classified as cognitively normal (CN) or amnestic mild cognitive impairment (aMCI) and (2) the influence of depressive symptoms on specific cognitive performance by ethnicity across diagnoses, controlling for covariates.

Methods

164 Hispanics residing in the United States (HAs) and European Americans (EAs) (100 women; Mage = 72.1, SD = 8.0) were diagnosed as either CN or aMCI. Depressive symptoms were measured with the Geriatric Depression Scale (GDS-15). Cognition was assessed using the Loewenstein-Acevedo Scales for Semantic Interference and Learning (semantic memory), Multilingual Naming Test (confrontation naming), and the Stroop Test (Color–Word condition; executive function). A 2 × 2 univariate ANCOVA as well as linear and logistic regressions explored differences in depressive symptoms among diagnostic and ethnic groups.

Results

Higher depression was seen in aMCI compared to the CN group for both ethnicities, after controlling for age, education, gender, and Mini-Mental State Examination score. Greater levels of depression also predicted lower scores in confrontation naming and semantic memory for only the EA group and marginally in scores of executive function for HA participants. GDS-15 scores of ≤ 4 also predicted less likelihood of aMCI diagnosis.

Conclusions

Severity of depressive symptoms was associated with greater cognitive impairment, independent of ethnicity. Significant results suggest detrimental effects of depression on clinical diagnoses most evidently for subjects from the EA group.
PIRD: Pan Immune Repertoire Database
Authors: Zhang Wei , Wang Longlong , Liu Ke , Wei Xiaofeng , Yang Kai , Du Wensi , Wang Shiyu , Guo Nannan , Ma Chuanchuan , Luo Lihua , Wu Jinghua , Lin Liya , Yang Fan , Gao Fei , Wang Xie , Li Tao , Zhang Ruifang , Saksena Nitin K , Yang Huanming , Wang Jian , Fang Lin , Hou Yong , Xu Xun , Liu Xiao
Published: August 2019

Motivation

T and B cell receptors (TCRs and BCRs) play a pivotal role in the adaptive immune system by recognizing an enormous variety of external and internal antigens. Understanding these receptors is critical for exploring the process of immunoreaction and exploiting potential applications in immunotherapy and antibody drug design. Although a large number of samples have had their TCR and BCR repertoires sequenced using high-throughput sequencing in recent years, very few databases have been constructed to store these kinds of data. To resolve this issue, we developed a database.

Results

We developed a database, the Pan Immune Repertoire Database (PIRD), located in China National GeneBank (CNGBdb), to collect and store annotated TCR and BCR sequencing data, including from Homo sapiens and other species. In addition to data storage, PIRD also provides functions of data visualization and interactive online analysis. Additionally, a manually curated database of TCRs and BCRs targeting known antigens (TBAdb) was also deposited in PIRD.

Availability and implementation

PIRD can be freely accessed at https://db.cngb.org/pird.
Recursive hierarchical embedding in vision is impaired by posterior middle temporal gyrus lesions
Authors: Martins Mauricio J D , Krause Carina , Neville David A , Pino Daniele , Villringer Arno , Obrig Hellmuth
Published: August 2019

Hierarchical structures are central to language, music and complex actions. Martins et al. demonstrate that the ability to represent visuospatial hierarchies shares cognitive and neural resources with the processing of linguistic syntax. Left posterior middle temporal gyrus lesions impair the integration of information during the generation of new hierarchical levels.
The quagga mussel genome and the evolution of freshwater tolerance
Authors: Calcino Andrew D , de Oliveira André Luiz , Simakov Oleg , Schwaha Thomas , Zieger Elisabeth , Wollesen Tim , Wanninger Andreas
Published: August 2019

Freshwater dreissenid mussels evolved from marine ancestors during the Miocene ∼30 million years ago and today include some of the most successful and destructive invasive species of freshwater environments. Here, we sequenced the genome of the quagga mussel Dreissena rostriformis to identify adaptations involved in embryonic osmoregulation. We provide evidence that a lophotrochozoan-specific aquaporin water channel, a vacuolar ATPase subunit and a sodium/hydrogen exchanger are involved in osmoregulation throughout early cleavage, during which time large intercellular fluid-filled ‘cleavage cavities’ repeatedly form, coalesce and collapse, expelling excess water to the exterior. Independent expansions of aquaporins coinciding with at least five freshwater colonization events confirm their role in freshwater adaptation. Repeated aquaporin expansions and the evolution of membrane-bound fluid-filled osmoregulatory structures in diverse freshwater taxa point to a fundamental principle guiding the evolution of freshwater tolerance and provide a framework for future species control efforts.
Infective endocarditis after transcatheter aortic valve implantation: a nationwide study
Authors: Bjursten Henrik , Rasmussen Magnus , Nozohoor Shahab , Götberg Mattias , Olaison Lars , Rück Andreas , Ragnarsson Sigurdur
Published: August 2019

Aims 

Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study.

Methods and results 

Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0–1.8%) the first year and 0.8% (0.6–1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49–68%), and 5-year survival was 29% (17–41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality.

Conclusion 

The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients.

Clinical Trial Registration

NCT03768180 (http://clinicaltrials.gov/).
IBD-Associated Dysplastic Lesions Show More Chromosomal Instability Than Sporadic Adenomas
Authors: Wanders Linda K , Cordes Martijn , Voorham Quirinus , Sie Daoud , de Vries Sara D , d’Haens Geert R A M , de Boer Nanne K H , Ylstra Bauke , van Grieken Nicole C T , Meijer Gerrit A , Dekker Evelien , Carvalho Beatriz
Published: August 2019

Inflammatory bowel disease (IBD) patients are at increased risk of developing colorectal cancer. However, histologically, it is challenging to distinguish between IBD-associated dysplasia from sporadic adenomas. We have molecularly characterized these precursor lesions and show that IBD-associated dysplasia lesions are genomically much more unstable.
Isolating red flags to enhance diagnosis (I-RED): An experimental vignette study
Authors: Chartan Corey , Singh Hardeep , Krishnamurthy Parthasarathy , Sur Moushumi , Meyer Ashley , Lutfi Riad , Stark Julie , Thammasitboon Satid
Published: August 2019

Objective

To investigate effects of a cognitive intervention based on isolation of red flags (I-RED) on diagnostic accuracy of ‘do-not-miss diagnoses.’

Design

A 2 × 2 randomized case vignette-based experiment with manipulation of I-RED strategy between subjects and case complexity within subjects.

Setting

Two university-based residency programs.

Participants

One-hundred and nine pediatric residents from all levels of training.

Interventions

Participants were randomly assigned to the I-RED vs. control group, and within each group, they were further randomized to the order in which they saw simple and complex cases. The I-RED strategy involved an instruction to look for a constellation of symptoms, signs, clinical data or circumstances that should heighten suspicion for a serious condition.

Main Outcome Measures

Primary outcome was diagnostic accuracy, scored as 1 if any of the three differentials given by participants included the correct diagnosis, and 0 if not. We analyzed effects of I-RED strategy on diagnostic accuracy using logistic regression.

Results

I-RED strategy did not yield statistically higher diagnostic accuracy compared to controls (62 vs. 48%, respectively; odd ratio = 2.07 [95% confidence interval, 0.78–5.5], P = 0.14) although participants reported higher decision confidence compared to controls (7.00 vs. 5.77 on a scale of 1 to 10, P < 0.02) in simple but not complex cases. I-RED strategy significantly shortened time to decision (460 vs. 657 s, P < 0.001) and increased the number of red flags generated (3.04 vs. 2.09, P < 0.001).

Conclusions

A cognitive strategy of prompting red flag isolation prior to differential diagnosis did not improve diagnostic accuracy of ‘do-not-miss diagnoses.’ Given the paucity of evidence-based solutions to reduce diagnostic error and the intervention’s potential effect on confidence, findings warrant additional exploration.
Pediatric Burns Among Refugee Communities in Lebanon: Evidence to Inform Policies and Programs
Authors: Al-Hajj Samar , Pike Ian , Oneissi Ahmad , Zheng Alex , Abu-Sittah Ghassan
Published: August 2019

Burn-related injury is a global public health problem with significant rates of morbidity and mortality. The adverse effect of burn leads to substantial functional, psychological, and economic repercussions. Low- and middle-income countries, including Lebanon, carry a disproportionately greater burden of burn injuries. This study adopted a mixed method approach to explore burn-related injuries in a sample (n = 347) of refugee children settling in Lebanon. We reviewed 179 cases of patients records that met the criteria of a child aged 0 to 19 years and has sustained a burn due to living conditions. War-related burn injuries were excluded. The findings demonstrate that there is a significantly higher proportion of 0- to 4-year-olds with burn injuries (53.6%) compared with the older age groups. Scald burns, caused by boiling liquid, were the most common cause of burns (58.6%), followed by fire/open flame (12.8%) and heat contact (6.7%). Upper trunk and arm burns were significantly higher than other body parts (35.2%), females were among the potential at-risk group with due to boiling liquids caused by food preparation and serving. Fifteen to nineteen years showed a high proportion of fire/flame burn caused by labor accident. Qualitative analysis of case reports further confirmed our findings and emphasized the impact of low socioeconomic status, overcrowded living conditions and open floor cooking and heating on increasing risk of pediatric burns. Additional research is needed to increase understanding on risk factors pertaining to pediatric burns in the refugee community with a view to integrating appropriate preventive measures and informing evidence-based policies and programs.
Changes in activity rates in the cherry shrimp Neocaridina davidi Bouvier, 1904 (Decapoda: Caridea: Atyidae) in response to concentrations of neuropeptides and glucose
Authors: Stout Joseph S , Granda Carla L , Mancuso Molly L
Published: August 2019

Although behavioral studies of whole animals are usually undertaken on rats and mice, studies in crustaceans offer an alternative group that provides new evolutionary insights into the relationship between physiology and behavior. In the cherry shrimp Neocaridina davidi (Bouvier, 1904), food-seeking movement increases in response to glutamate (MSG), decreases when exposed to dopamine, and increases when exposed to glucose. Activity of shrimp individuals was observed in 4l tanks over twenty minutes after individuals were exposed to treatments applied directly into the water. Glutamate-stimulated seeking behavior was statistically similar to seeking behavior after exposure to food pellet filtrate. Glucose also stimulated seeking behavior, but with a reduction over time, whereas MSG-stimulated seeking behavior increased over time. Insulin reduced activity but showed no effect when paired with glucose, whereas dopamine increased activity when paired with glucose. This was contrary to the reduced activity observed when dopamine was paired with MSG. The decrease in activity after exposure to dopamine also contrasts with vertebrate (rat) models where dopaminergic drugs such as caffeine and cocaine are stimulants. The stimulatory effect of dopamine paired with glucose was unexpected given its inhibitory effect on its own or when paired with MSG. This crustacean-based model aims to give new insights regarding the role of inhibitory and stimulatory neurotransmitters on the behavior of whole crustacean individuals. These mechanisms show different results than predicted by vertebrate models, implying either differences in underlying physiology, problems with the vertebrate models, or both.
Refinement of Global Domestic Horse Biogeography Using Historic Landrace Chinese Mongolian Populations
Authors: Han Haige , Bryan Kenneth , Shiraigol Wunierfu , Bai Dongyi , Zhao Yiping , Bao Wuyingga , Yang Siqin , Zhang Wengang , MacHugh David E , Dugarjaviin Manglai , Hill Emmeline W
Published: August 2019

The Mongolian horse is one of the oldest extant horse populations and although domesticated, most animals are free-ranging and experience minimal human intervention. As an ancient population originating in one of the key domestication centers, the Mongolian horse may play a key role in understanding the origins and recent evolutionary history of horses. Here we describe an analysis of high-density genome-wide single-nucleotide polymorphism (SNP) data in 40 globally dispersed horse populations (n = 895). In particular, we have focused on new results from Chinese Mongolian horses (n = 100) that represent 5 distinct populations. These animals were genotyped for 670K SNPs and the data were analyzed in conjunction with 35K SNP data for 35 distinct breeds. Analyses of these integrated SNP data sets demonstrated that the Chinese Mongolian populations were genetically distinct from other modern horse populations. In addition, compared to other domestic horse breeds, the Chinese Mongolian horse populations exhibited relatively high genomic diversity. These results suggest that, in genetic terms, extant Chinese Mongolian horses may be the most similar modern populations to the animals originally domesticated in this region of Asia. Chinese Mongolian horse populations may therefore retain ancestral genetic variants from the earliest domesticates. Further genomic characterization of these populations in conjunction with archaeogenetic sequence data should be prioritized for understanding recent horse evolution and the domestication process that has led to the wealth of diversity observed in modern global horse breeds.
Prognostic Value of PFKFB3 to PFKFB4 mRNA Ratio in Patients With Primary Glioblastoma (IDH-Wildtype)
Authors: Kessler Renate , Fleischer Michael , Springsguth Christopher , Bigl Marina , Warnke Jan-Peter , Eschrich Klaus
Published: August 2019

A hallmark of glioblastoma is the high level of aerobic glycolysis. PFKFB3 and PFKFB4 are regulatory glycolytic enzymes, which are overexpressed in glioblastomas. Selective inhibition of these enzymes has emerged as a new approach in tumor therapy. We investigated the ratios of PFKFB3 to PFKFB4 mRNA expression in 66 astrocytic tumors of different malignancy grades. PFKFB3 mRNA levels were considerably higher than those of PFKFB4 in all analyzed tumors. IDH-wildtype glioblastomas showed lower PFKFB3 to PFKFB4 mRNA ratios (7.7:1) than IDH-mutant low-grade astrocytomas (36.5:1), indicating a dependency of the ratio on malignancy grade. In IDH-wildtype glioblastomas exhibiting loss of heterozygosity (LOH) of the PFKFB3 gene locus, the decrease of PFKFB3 mRNA levels was accompanied by lower PFKFB4 mRNA levels, but the PFKFB3 to PFKFB4 mRNA ratio did not differ between tumors with or without PFKFB3 LOH. IDH-wildtype primary glioblastoma patients with high PFKFB3 to PFKFB4 mRNA ratios above the average of 7.7:1 had a significantly longer overall survival time (14 months) than patients with lower ratios (9 months). Our results indicate that low PFKFB3 to PFKFB4 expression ratio is a poor prognostic factor in patients with IDH-wildtype primary glioblastoma and that PFKFB3 and PFKFB4 might represent promising targets for astrocytoma and glioblastoma treatment.
The SAMI galaxy survey: stellar population radial gradients in early-type galaxies
Authors: Ferreras Ignacio , Scott Nicholas , La Barbera Francesco , Croom Scott , van de Sande Jesse , Hopkins Andrew , Colless Matthew , Barone Tania M , d’Eugenio Francesco , Bland-Hawthorn Joss , Brough Sarah , Bryant Julia J , Konstantopoulos Iraklis S , Lagos Claudia , Lawrence Jon S , López-Sánchez Angel , Medling Anne M , Owers Matt S , Richards Samuel N
Published: August 2019

We study the internal radial gradients of the stellar populations in a sample comprising 522 early-type galaxies (ETGs) from the SAMI (Sydney-AAO Multi-object Integral field spectrograph) Galaxy Survey. We stack the spectra of individual spaxels in radial bins, and derive basic stellar population properties: total metallicity ([Z/H]), [Mg/Fe], [C/Fe] and age. The radial gradient (∇) and central value of the fits (evaluated at Re/4) are compared against a set of six observables that may act as drivers of the trends. We find that velocity dispersion (σ) – or, equivalently gravitational potential – is the dominant driver of the chemical composition gradients. Surface mass density is also correlated with the trends, especially with stellar age. The decrease of ∇[Mg/Fe] with increasing σ is contrasted by a rather shallow dependence of ∇[Z/H] with σ (although this radial gradient is overall rather steep). This result, along with a shallow age slope at the massive end, imposes a substantial constraint on the progenitors of the populations that contribute to the formation of the outer envelopes of ETGs. The SAMI sample is split, by design, between ‘field’ and cluster galaxies. Only weak environment-related differences are found, most notably a stronger dependence of central total metallicity ([Z/H]e4) with σ, along with a marginal trend of ∇[Z/H] to steepen in cluster galaxies, a result that is not followed by [Mg/Fe]. The results presented here serve as stringent constraints on numerical models of the formation and evolution of ETGs.
Modelling the spectral energy distribution of super-Eddington quasars
Authors: Kubota Aya , Done Chris
Published: August 2019

We develop a broad-band spectral model, agnslim, to describe super-Eddington black hole accretion disc spectra. This is based on the slim disc emissivity, where radial advection keeps the surface luminosity at the local Eddington limit, resulting in L(r) ∝ r−2 rather than the r−3 expected from the Novikov-Thorne (standard, sub-Eddington) disc emissivity. Wind losses should also be important but these are expected to produce a similar radiative emissivity. We assume that the flow is radially stratified, with an outer standard disc, an inner hot Comptonizing region and an intermediate warm Comptonizing region to produce the soft X-ray excess. This gives the model enough flexibility to fit the observed data, but with the additional requirement of energy conservation to give physical constraints. We use this to fit the broad-band spectrum of one of the most extreme Active Galactic Nuclei, the Narrow Line Seyfert 1 RX J0439.6−5311, which has a black hole mass of $(6\sim 9)\times 10^6\, \mathrm{M}_\odot$ as derived from the H β line width. This cannot be fit with the standard disc emissivity at this mass, as even zero spin models overproduce the observed luminosity. Instead, we show that the spectrum is well reproduced by the slim disc model, giving mass accretion rates around (5 ∼ 10) × Eddington limit. There is no constraint on black hole spin as the efficiency is reduced by advection. Such extreme accretion rates should be characteristic of the first Quasars, and we demonstrate this by fitting to the spectrum of a recently discovered super-Eddington Quasar, PSO J006 + 39, at z = 6.6.
Evolution of relativistic thin discs with a finite ISCO stress – I. Stalled accretion
Authors: Mummery Andrew , Balbus Steven A
Published: August 2019

We present solutions to the relativistic thin disc evolutionary equation using an α-model for the turbulent stress tensor. Solutions with a finite stress at the innermost stable circular orbit (ISCO) give rise to bolometric light curves with a shallow power-law time dependence, in good agreement with those observed in tidal disruption events. A self-similar model based on electron scattering opacity, for example, yields a power-law index of −11/14, as opposed to −19/16 for the case of zero ISCO stress. These solutions correspond to an extended period of relaxation of the evolving disc which, like the light curves they produce, is not sustainable indefinitely. Cumulative departures from the approximation of exact circular orbits cause the power-law index to evolve slowly with time, leading eventually to the steeper fall-off associated with traditional zero ISCO stress models. These modified solutions are discussed in detail in a companion paper.
Trajectory of Improvement in Myelopathic Symptoms From 3 to 12 Months Following Surgery for Degenerative Cervical Myelopathy
Authors: Khan Inamullah , Archer Kristin R , Wanner John Paul , Bydon Mohamad , Pennings Jacquelyn S , Sivaganesan Ahilan , Knightly John J , Foley Kevin T , Bisson Erica F , Shaffrey Christopher , McGirt Matthew J , Asher Anthony L , Devin Clinton J ,   QOD Vanguard Sites Asher Anthony L MD McGirt Matthew J MD Devin Clinton J MD Foley Kevin T MD Sorenson Jeffrey M MD Briggs Thomas B MD Kremer Adam MD Griffitt Wesley E MD Bisson Erica F MD Shaffrey Mark E Shaffrey Christopher MD Fassett Daniel MD Oetting Gregory MD Elowitz Eric H MD Rumana Christopher MD, Asher Anthony L , McGirt Matthew J , Devin Clinton J , Foley Kevin T , Sorenson Jeffrey M , Briggs Thomas B , Kremer Adam , Griffitt Wesley E , Bisson Erica F , Shaffrey Mark E , Shaffrey Christopher , Fassett Daniel , Oetting Gregory , Elowitz Eric H , Rumana Christopher
Published: August 2019

BACKGROUND

Degenerative cervical myelopathy (DCM) is a progressive disease resulting from cervical cord compression. The modified Japanese Orthopaedic Association (mJOA) is commonly used to grade myelopathic symptoms, but its persistent postoperative improvement has not been previously explored.

OBJECTIVE

To utilize the Quality Outcomes Database (QOD) to evaluate the trajectory of outcomes in those operatively treated for DCM.

METHODS

This study is a retrospective analysis of prospectively collected data. The QOD was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9-13), or severe (<9) categories for their baseline severity of myelopathic symptoms (mJOA scores). A parsimonious multivariable logistic regression model was fitted with 2 points improvement on mJOA from 3- to 12-mo follow-up as the outcome of interest.

RESULTS

A total of 2156 patients who underwent elective surgery for DCM and had complete 3- and 12-mo follow-up were included in our analysis. Patients improved significantly from baseline to 3-mo on their mJOA scores, regardless of their baseline mJOA severity. After adjusting for the relevant preoperative characteristics, the baseline mJOA categories had significant impact on outcome of whether a patient keeps improving in mJOA score from 3 to 12 mo postsurgery. Patient with severe mJOA score at baseline had a higher likelihood of improvement in their myelopathic symptoms, compared to patients with mild mJOA score in.

CONCLUSION

Most patients achieve improvement on a shorter follow-up; however, patients with severe symptoms keep on improving until after a longer follow-up. Preoperative identification of such patients helps the clinician settling realistic expectations for each follow-up timepoint.
Pediatric trauma mortality: an ecological analysis evaluating correlation between injury-related mortality and geographic access to trauma care in the United States in 2010
Authors: Pender T M , David A P , Dodson B K , Calland J Forrest
Published: August 2019

Background

Trauma is the leading cause of mortality in the pediatric population >1 year. Analyzing relationships between pediatric trauma-related mortality and geographic access to trauma centers (among other social covariates) elucidates the importance of cost and care effective regionalization of designated trauma facilities.

Methods

Pediatric crude injury mortality in 49 United States served as a dependent variable and state population within 45 minutes of trauma centers acted as the independent variable in four linear regression models. Multivariate analyses were performed using previously identified demographics as covariates.

Results

There is a favorable inverse relation between pediatric access to trauma centers and pediatric trauma-related mortality. Though research shows care is best at pediatric trauma centers, access to Adult Level 1 or 2 trauma centers held the most predictive power over mortality. A 4-year college degree attainment proved to be the most influential covariate, with predictive powers greater than the proximity variable.

Conclusions

Increased access to adult or pediatric trauma facilities yields improved outcomes in pediatric trauma mortality. Implementation of qualified, designated trauma centers, with respect to regionalization, has the potential to further lower pediatric mortality. Additionally, the percentage of state populations holding 4-year degrees is a stronger predictor of mortality than proximity and warrants further investigation.
Armed conflict and public health: into the 21st century
Authors: Garry S , Checchi F
Published: August 2019

Background

Many people worldwide are affected by conflict, and countries affected are less likely to meet the UN Sustainable Development Goals. This review outlines the effects of conflict on health and focuses on areas requiring more attention.

Methods

We completed a search of the literature using Medline, Embase and Global Health.

Results

Health effects of conflict include trauma; mental health; non-communicable diseases (NCDs); child health; sexual, reproductive and maternal health; and infectious diseases. Conflict damages health directly through fighting, and indirectly through wider socioeconomic effects. Health outcomes are influenced by pre-existing population health and demographics, and access to appropriate healthcare. Vulnerable populations (the elderly, children, neonates and women) are especially at risk.

Conclusion

Several areas pose key challenges including: tactics of war as a public health problem; a lack of focus on neonatal care and NCDs; the long-term consequences of conflict across a life-course and into future generations; and the need to focus on wellbeing beyond standard health parameters. Clear decisions about prioritisation need to be made. The effects on civilians must be documented and recorded. Further research is required to understand chronic health needs and effects on future generations, to support fair and equitable resource prioritisation to best meet the needs of conflict-affected populations.
Attention to Global Warming
Authors: Choi Darwin , Gao Zhenyu , Jiang Wenxi
Published: August 2019

We find that people revise their beliefs about climate change upward when experiencing warmer than usual temperatures in their area. Using international data, we show that attention to climate change, as proxied by Google search volume, increases when the local temperature is abnormally high. In financial markets, stocks of carbon-intensive firms underperform firms with low carbon emissions in abnormally warm weather. Retail investors (not institutional investors) sell carbon-intensive firms in such weather, and return patterns are unlikely to be driven by changes in fundamentals. Our study sheds light on peoples’ collective beliefs and actions about global warming.
Trends in all-cause and cardiovascular mortality in patients with incident rheumatoid arthritis: a 20-year follow-up matched case-cohort study
Authors: Provan Sella A , Lillegraven Siri , Sexton Joe , Angel Kristin , Austad Cathrine , Haavardsholm Espen A , Kvien Tore K , Uhlig Till
Published: August 2019

Objectives

To examine all-cause and cardiovascular disease (CVD) mortality in consecutive cohorts of patients with incident RA, compared with population comparators.

Methods

The Oslo RA register inclusion criteria were diagnosis of RA (1987 ACR criteria) and residency in Oslo. Patients with disease onset 1994–2008 and 10 matched comparators for each case were linked to the Norwegian Cause of Death Registry. Hazard ratios for all-cause and CVD mortality were calculated for 5, 10, 15 and 20 years of observation using stratified cox-regression models. Mortality trends were estimated by multivariate cox-regression.

Results

443, 479 and 469 cases with disease incidence in the periods 94–98, 99–03 and 04–08 were matched to 4430, 4790 and 4690 comparators, respectively. For cases diagnosed between 1994 and 2003, the all-cause mortality of cases diverged significantly from comparators after 10 years of disease duration [hazard ratio (95% CI) 94–98 cohort 1.42 (1.15–1.75): 99–03 cohort 1.37 (1.08–1.73)]. CVD related mortality was significantly increased after 5 years for the 94–98 cohort [hazard ratio (95% CI) 1.86 (1.16–2.98) and after 10 years for the 99–03 cohort 1.80 (1.20–2.70)]. Increased mortality was not observed in the 04–08 cohort where cases had significantly lower 10-year all-cause and CVD mortality compared with earlier cohorts.

Conclusion

All-cause and CVD mortality were significantly increased in RA patients diagnosed from 1994 to 2003, compared with matched comparators, but not in patients diagnosed after 2004. This may indicate that modern treatment strategies have a positive impact on mortality in patients with RA.
Faces and Phases of Women’s Empowerment: The Case of Women’s Cooperatives in Turkey
Authors: Cinar Kursat , Akyuz Selin , Ugur-Cinar Meral , Onculer-Yayalar Emine
Published: August 2019

This article provides an in-depth look at women’s empowerment through women’s cooperatives. Drawing on evidence from a diverse set of women’s cooperatives in Turkey, the article investigates the prospects and constraints of women’s empowerment in contexts lacking an enabling macro-institutional framework and societal structure. Listening to the real-life stories of women from different socioeconomic and political backgrounds, we explore how and to what extent members experience empowerment in their lives after joining the cooperatives. We find that, even under political and societal constraints, women experience economic, psychological, social, and organizational empowerment, though the extent of such empowerment varies across cases.
Comparing patterns and scales of plant virus phylogeography: Rice yellow mottle virus in Madagascar and in continental Africa
Authors: Rakotomalala Mbolarinosy , Vrancken Bram , Pinel-Galzi Agnès , Ramavovololona Perle , Hébrard Eugénie , Randrianangaly Jean Stéphan , Dellicour Simon , Lemey Philippe , Fargette Denis
Published: August 2019

Rice yellow mottle virus (RYMV) in Madagascar Island provides an opportunity to study the spread of a plant virus disease after a relatively recent introduction in a large and isolated country with a heterogeneous host landscape ecology. Here, we take advantage of field survey data on the occurrence of RYMV disease throughout Madagascar dating back to the 1970s, and of virus genetic data from ninety-four isolates collected since 1989 in most regions of the country to reconstruct the epidemic history. We find that the Malagasy isolates belong to a unique recombinant strain that most likely entered Madagascar through a long-distance introduction from the most eastern part of mainland Africa. We infer the spread of RYMV as a continuous process using a Bayesian statistical framework. In order to calibrate the time scale in calendar time units in this analysis, we pool the information about the RYMV evolutionary rate from several geographical partitions. Whereas the field surveys and the phylogeographic reconstructions both point to a rapid southward invasion across hundreds of kilometers throughout Madagascar within three to four decades, they differ on the inferred origin location and time of the epidemic. The phylogeographic reconstructions suggest a lineage displacement and unveil a re-invasion of the northern regions that may have remained unnoticed otherwise. Despite ecological differences that could affect the transmission potential of RYMV in Madagascar and in mainland Africa, we estimate similar invasion and dispersal rates. We could not identify environmental factors that have a relevant impact on the lineage dispersal velocity of RYMV in Madagascar. This study highlights the value and complementarity of (historical) nongenetic and (more contemporaneous) genetic surveillance data for reconstructing the history of spread of plant viruses.
Long‐term exercise prevents hepatic steatosis: a novel role of FABP1 in regulation of autophagy‐lysosomal machinery
Authors: Pi Huifeng , Liu Mengyu , Xi Yu , Chen Mengyan , Tian Li , Xie Jia , Chen Mingliang , Wang Zhen , Yang Min , Yu Zhengping , Zhou Zhou , Gao Feng
Published: August 2019

Nonalcoholic fatty liver disease (NAFLD) is one of the most prevalent diseases worldwide. Exercise is a first‐line therapy and an important preventive measure for patients with NAFLD, but the underlying mechanisms are not clear. C57BL/6 mice were fed a high‐fat diet (HFD) and subjected to 12 wk swimming exercise. Exercise protected against hepatic lipid accumulation and alleviated hepatocyte damage in HFD mice. Tandem mass tag—based quantitative proteomic analyses and ingenuity pathway analysis revealed that exercise down‐regulated fatty acid‐binding protein (FABP) 1 signaling pathway, which was most closely associated with lipid metabolism. Moreover, exercise significantly decreased FABP1 expression, and liver‐specific overexpression of FABP1 abolished the protective effect of exercise in NAFLD mice. Specifically, exercise significantly increased autophagic flux via restoring lysosomal function, including lysosomal proteolysis and lysosomal acidification maintenance, contributing to enhancement in autophagic clearance and subsequently alleviation of hepatic steatosis. Conversely, Fabp1 overexpression in the mouse liver blocked the protective effect of exercise via inhibiting autophagy flux. The present study identified FABP1 inhibition‐mediated replenishment of the autophagy‐lysosomal machinery as a novel endogenous mechanism whereby long‐term exercise improves lipid homeostasis and ameliorates hepatic steatosis in NAFLD.—Pi, H., Liu, M., Xi, Y., Chen, M., Tian, L., Xie, J., Chen, M., Wang, Z., Yang M., Yu, Z., Zhou, Z., Gao, F. Long‐term exercise prevents hepatic steatosis: a novel role of FABP1 in regulation of autophagy‐lysosomal machinery. FASEB J. 33, 11870‐11883 (2019). www.fasebj.org
Schema‐like learning and memory consolidation acting through myelination
Authors: Hasan Mahadi , Kanna Murugappan Suresh , Jun Wang , Ramkrishnan Aruna Surendran , Iqbal Zafar , Lee Youngjin , Li Ying
Published: August 2019

Memory is a dynamic brain function that is continually processed after encoding. Although psychologic concepts of mental schema are now well established, they have rarely been considered in animal studies. We used a behavior paradigm of multiple flavor‐place paired associates (PAs) and showed that memory schema facilitates fast acquisition of new PAs in a single trial. The hippocampus is necessary for the encoding of new PAs and for memory retrieval within a certain time window—24 h following new PA consolidation. Whereas the anterior cingulate cortex (ACC) plays a critical role for dynamic PA learning and consolidation during training sessions, ACC is essential in schema representation and activation. New myelin generation is essential for learning. Neural activity in the cortical regions impacts myelination by regulating oligodendrocyte (OL) proliferation, differentiation, and myelin formation. Here, we show that newly formed OL progenitor cells and mature OLs are increased following repeated PA learning and that establishment of the memory schema is associated with enhanced myelin strength in the ACC region. Furthermore, to ensure that myelination is necessary for the acquisition of paired‐associate learning, ACC lysolecithin‐induced demyelination revealed impaired PA learning associated with decrease in ACC θ band power and reduced spike‐field coherence and phase‐locking in ACC.—Hasan, M., Kanna, M. S., Jun, W., Ramkrishnan, A. S., Iqbal, Z., Lee, Y., Li, Y. Schema‐like learning and memory consolidation acting through myelination. FASEB J. 33, 11758–11775 (2019). www.fasebj.org
Health Literacy and Self-Reported Hearing Aid Use in the Health and Retirement Study
Authors: Munson Klyn Niall Andre , Mohammed Shaikh Zain , Dhar Sumitrajit
Published: August 2019

Objectives:

Understanding the determinants of hearing aid use is important to improve the provision of hearing healthcare. Prior research has indicated that materials in the clinic and online, as well as audiologists’ language during appointments, require a higher literacy level than most patients possess. We hypothesized that low health literacy is a barrier to entry in hearing healthcare, and therefore that health literacy would be positively correlated with the probability of hearing aid use.

Design:

We performed retrospective analyses of the Health and Retirement Study, a longitudinal survey of American adults of retirement age. Objective health literacy was measured in different but overlapping subsamples using subsets of the Test of Functional Health Literacy in Adults and the Rapid Estimate of Adult Literacy in Medicine (n = 1240, n = 1586, and n = 2412). Subjective health literacy was assessed using a single-question screener in a larger sample (n = 8362). Separate discrete time models including common covariates of hearing aid use were constructed for each subsample.

Results:

Objective health literacy measures did not correlate significantly with hearing aid use when age, gender, race/ethnicity, self-assessed hearing ability, and net income were included in the models. Subjective health literacy did correlate significantly with hearing aid use in the complete model, with lower subjective health literacy correlated with lower odds of reporting hearing aid use.

Conclusions:

Taken at face value, the results provide mixed evidence for a link between health literacy and hearing aid use. The results from the analysis of the largest sample, using the subjective health literacy measure, were consistent with the hypothesis that low health literacy is a barrier to hearing aid use. However, this was not supported by the analysis of the objective health literacy measures in these samples. Further research using full health literacy measurement tools and capturing other relevant variables would offer clarification on this conflict. The literacy level of clinical materials and conversation is a modifiable potential factor in hearing aid uptake, so further clinical and research consideration is warranted.
Age Effects on Cochlear Reflectance in Adults
Authors: Fultz Sara E. , Vaden Kenneth I. , Rasetshwane Daniel M. , Kopun Judy G. , Neely Stephen T. , Dubno Judy R.
Published: August 2019

Objectives:

Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is a type of otoacoustic emission that is calculated as a transfer function between forward pressure and reflected pressure. The purpose of this study was to assess effects of age on CR in adults and interactions among age, sex, and hearing loss.

Design:

Data were collected from 60 adults selected for their age (e.g., 20–29, 30–39, 40–49, 50–59, 60–69, 70–79 years) and normal middle ear status. A wideband noise stimulus presented at three stimulus levels (30, 40, 50 dB SPL) was used to elicit CR. Half-octave bands of CR signal magnitude (CRM), CR noise, and the CR signal-to-noise ratio (CR-SNR) were extracted from the wideband CR response. Regression analyses were conducted to assess interactions among CR, age, sex, and pure-tone thresholds at closely matched frequency bands across stimulus levels.

Results:

Although increased age was generally associated with lower CRM and CR-SNR at some band frequencies and stimulus levels, no significant effects of age remained after controlling for effects of pure-tone thresholds. Increases in pure-tone thresholds were associated with lower CRM and CR-SNR at most frequency bands and stimulus levels. Effects of hearing sensitivity were significant at some frequencies and levels after controlling for age and sex.

Conclusions:

When effects of age were controlled, adults with better hearing had significantly larger CRM and CR-SNR than those with poorer hearing. In contrast, when effects of hearing were controlled, no significant effects of age on CRM and CR-SNR remained.
T and B lymphocytes in fibrosis and systemic sclerosis
Authors: Pillai Shiv
Published: August 2019

Purpose of review

To summarize recent advances in the understanding of the pathogenesis of autoimmune fibrotic diseases. These diseases include IgG4-related disease, systemic sclerosis and lupus nephritis.

Recent findings

Recent studies indicate that a poorly studied subset of helper T cells, cytotoxic CD4+ T cells and sub-populations of disease-specific activated B cells infiltrate inflamed tissues and collaborate to induce tissue fibrosis in autoimmune fibrotic diseases. Cycles of apoptosis induced by antigen-specific cytotoxic CD4+ T cells followed by macrophage-mediated clearing of apoptotic cells and finally tissue remodeling driven by cytokines released by these auto-antigen-specific activated T and B cells may contribute to the activation of fibroblasts and myofibroblasts and the laying down of collagen. In scleroderma, this process likely involves the apoptosis of endothelial cells and other neighboring cells and the subsequent remodeling of the tissue.

Self-reactive cytotoxic CD4+ T cells infiltrate tissues where they may be nurtured by activated auto-reactive B cells, induce apoptosis, secrete cytokines and thus drive autoimmune fibrosis.