bluuebunny/crossref_metadata_2025 huggingface dataset:
Proposition and operational characteristics of a new dispatch scale to specifically identify acute strokes
Authors: Dami Fabrice , Emery Alexandre , Pasquier Mathieu , Carron Pierre-Nicolas , Fuchs Vincent , Yersin Bertrand , Hugli Olivier
Published: December 2015

Objective

Prehospital recognition of an acute stroke improves the time from onset to thrombolysis and rates of reperfusion therapy. Studies conducted to evaluate paramedic and dispatcher performance in suspecting stroke are disappointing. This study addresses the specific issue of stroke recognition by dispatchers, taking into account delay in reporting the onset of symptoms (<5 h).

Methods

This is an observational analysis conducted over a 12-month period. Dispatchers used a modified Cincinnati Stroke Scale to specifically identify acute strokes in a criteria-based dispatch. Data were extracted from the State’s dispatch and the State’s stroke centre. All calls to the dispatch were included. Dispatcher’s suspicion of acute stroke and the patient’s final destination and diagnosis were collected. Simple descriptive statistics were used. Sensitivity and positive predictive value were calculated.

Results

The dispatch received 27 719 calls resulting in ambulance dispatches; 427 calls [1.5%; 95% confidence interval (CI) 1.4–1.7] were classified as suspicion of acute stroke by dispatchers, and 40 of them (9.4%; 95% CI 6.6–12.1) fulfilled the criteria for thrombolysis (sensitivity 67.8%; 95% CI 54.3–79.4%). Dispatchers missed 19 of 59 strokes (32.2%; 95% CI 20.3–44.1) that received thrombolysis; 16 cases were missed because of unspecific acute symptoms (unconsciousness, dyspnoea), and three more because of unspecific nonacute symptoms (vertigo, dizziness).

Conclusion

The revised Cincinnati Stroke Scale for dispatch adds the notion of delay in the process of triage. It identifies 67.8% and misses 32.2% of the stroke patients treated by thrombolysis. Its performance is similar to previous results using the regular Cincinnati Stroke Scale, but allows for targeting acute strokes.
Comparison of Diagnostic Accuracy and Concordance of Video Capsule Endoscopy and Double Balloon Enteroscopy in Children
Authors: Danialifar Tanaz F. , Naon Hillel , Liu Quin Y.
Published: December 2015

Objectives:

To compare the diagnostic yield, sensitivity, and specificity of video capsule endoscopy (VCE) with double balloon enteroscopy (DBE), including comparison with histological findings as well as degree of concordance of the studies.

Methods:

Retrospective review of pediatric patients who had DBE following VCE at a single center from 2006 to 2013. VCEs were interpreted by 1 of 4 pediatric gastroenterologists and DBEs were performed by a single endoscopist.

Results:

Thirty‐six patients ranging from 5 to 20 years had DBE following VCE. There were positive findings in 32 (88.8%) of VCE and 21 (58.3%) of DBE. Significant histological findings were identified in 16 patients (44.4%). When comparing VCE with DBE findings, VCE had a sensitivity of 95% and specificity of 20%. Overall concordance between VCE and DBE findings was weak with calculated kappa index of 0.1702; however, this varied widely by indication. VCE had sensitivity 100% and specificity 20% for detecting histologically significant lesions. DBE had sensitivity of 87% and specificity of 65%.

Conclusions:

This is the first pediatric study to evaluate diagnostic accuracy and concordance of VCE and DBE and to compare both to histological findings. Our study supports the high diagnostic utility of both the studies. VCE is highly sensitive with an excellent negative predictive value both for DBE findings and for histological findings; however, the utility of VCE is limited by low specificity. Sensitivity and specificity of DBE for detecting histologically significant findings were good. Overall agreement between VCE and DBE is low but varies by indication for the study. These results support the use of VCE and DBE as complementary studies.
Neurodevelopmental and Cognitive Outcomes in Children With Intestinal Failure
Authors: Chesley Patrick M. , Sanchez Sabrina E. , Melzer Lilah , Oron Assaf P. , Horslen Simon P. , Bennett F. Curt , Javid Patrick J.
Published: December 2015

Objectives:

Recent advances in medical and surgical management have led to improved long‐term survival in children with intestinal failure. Yet, limited data exist on their neurodevelopmental and cognitive outcomes. The aim of the present study was to measure neurodevelopmental outcomes in children with intestinal failure.

Methods:

Children enrolled in a regional intestinal failure program underwent prospective neurodevelopmental and psychometric evaluation using a validated scoring tool. Cognitive impairment was defined as a mental developmental index <70. Neurodevelopmental impairment was defined as cerebral palsy, visual or hearing impairment, or cognitive impairment. Univariate analyses were performed using the Wilcoxon rank‐sum test. Data are presented as median (range).

Results:

Fifteen children with a remnant bowel length of 18 (5–85) cm were studied at age 17 (12–67) months. Thirteen patients remained dependent on parenteral nutrition. Twelve (80%) subjects scored within the normal range on cognitive testing. Each child with cognitive impairment was noted to have additional risk factors independent of intestinal failure including cardiac arrest and extreme prematurity. On univariate analysis, cognitive impairment was associated with longer inpatient hospital stays, increased number of surgical procedures, and prematurity (P < 0.02). In total, 4 (27%) children demonstrated findings consistent with neurodevelopmental impairment.

Conclusions:

A majority of children with intestinal failure demonstrated normal neurodevelopmental and cognitive outcomes on psychometric testing. These data suggest that children with intestinal failure without significant comorbidity may be at low risk for long‐term neurodevelopmental impairment.
Prevalence and Outcomes of Liver Transplantation in Children With Intellectual Disability
Authors: Wightman Aaron , Hsu Evelyn , Zhao Qianqian , Smith Jodi
Published: December 2015

Objective:

We sought to describe the prevalence and outcomes of liver transplantation in children with intellectual disability (ID). We hypothesized that recipients with ID have comparable short‐term outcomes compared with those without ID.

Methods:

We performed a retrospective cohort analysis of children receiving a first liver‐alone transplant in the United Network for Organ Sharing dataset from 2008 to 2013. Recipients with definite or probable ID were compared to children without ID using χ2 tests. Kaplan‐Meier curves were constructed for patient and graft survival. Cox proportional hazard models were used to estimate the association between ID and graft failure and patient survival.

Results:

During the study period, 254 children with definite (115) or probable (139) ID underwent first liver transplant, accounting for 15% of all first pediatric liver transplants (1721). Recipients with definite ID tended to be male have a metabolic indication for transplant, a lower pediatric end‐stage liver disease score at listing than recipients with no ID, and were less likely to receive a living donor transplant. Recipients with ID were more likely to have public insurance and had more treatment‐related hospitalizations in the first year than those without ID. Functional status tended to improve in all recipients at follow‐up. ID was not significantly associated with patient or graft survival.

Conclusions:

Children with ID form a significant portion of total liver transplant recipients, and their short‐term graft and patient survival are comparable with children without ID. Further research is needed to examine long‐term outcomes of transplant in this population.
Soap Suds Enemas Are Efficacious and Safe for Treating Fecal Impaction in Children With Abdominal Pain
Authors: Chumpitazi Corrie E. , Henkel Erin B. , Valdez Karina L. , Chumpitazi Bruno P.
Published: December 2015

Objectives:

Constipation is a common cause of pediatric abdominal pain and emergency department (ED) presentation. Despite the high prevalence, there is a dearth of clinical information and wide practice variation in childhood constipation management in the ED. The objective of the study was to assess the efficacy and safety of soap suds enema (SSE) in the therapy for fecal impaction in children with abdominal pain within the pediatric ED setting. The primary outcome was stool output following SSE. Secondary outcomes were adverse events, admissions, and return visits within 72 hours.

Methods:

The present study is a retrospective cross‐sectional study performed in the ED at a quaternary care children's hospital of patients seen during a 12‐month period who received an SSE for fecal impaction.

Results:

Five hundred twelve patients (53% girls, median age 7.8 years, range: 8 months–23 years) received SSE therapy during a 1‐year period. Successful therapy (bowel movement) following SSE occurred in 419 (82%). Adverse events included abdominal pain in 24 (5%) and nausea/vomiting in 18 (4%). No SSE‐related serious adverse events were identified. Following SSE, 405 (79%) were subsequently discharged, of which 15 (3.7%) returned to the ED for re‐evaluation within 72 hours.

Conclusions:

SSE is an efficacious and safe therapeutic option for the acute treatment of childhood fecal impaction in the ED setting.
Vitamin D Levels in Infants With Biliary Atresia
Authors: Ng Jessica , Paul Anu , Wright Naomi , Hadzic Nedim , Davenport Mark
Published: December 2015

Objectives:

Infants with biliary atresia (BA) are at high risk of vitamin D deficiency. We aimed to determine the prevalence and factors influencing vitamin D levels at presentation and post‐Kasai portoenterostomy (KPE).

Methods:

Single‐centre retrospective review of infants with BA who underwent KPE. Pre‐ and postoperatively 25‐hydroxyvitamin D (25‐OHVD), liver and bone biochemistry data were collected. 25‐OHVD levels <10 and 10 to 20 ng/mL were defined as vitamin D “deficiency” and “insufficiency,” respectively.

Results:

One hundred twenty‐nine infants with BA (isolated n = 101, developmental n = 28, and white n = 79; non‐white n = 50) were included in this study. At presentation, 75 of 92 (81%) were vitamin D deficient and only 1 infant had a level >20 ng/mL. Median 25‐OHVD levels were 5(2–23), 17(2–72), 15(2–80), 17(2–69), and 23(2–98) ng/mL at pre‐KPE, 1, 4, 6, and 12 months postoperation. There was no difference in 25‐OHVD levels between the isolated and developmental groups with BA. Pre‐KPE, white infants had significantly higher levels than non‐white infants (6[2–23] vs 3[2–14] ng/mL, P = 0.01). Post‐KPE 25‐OHVD levels correlated well with liver and bone biochemical variables (eg, at 6 months: bilirubin rs = −0.34; P < 0.001, alkaline phosphatase rs = −0.46; P < 0.00001, and phosphate rs = 0.49; P < 0.00001).

Conclusions:

25‐OHVD deficiency is invariable at presentation in infants with BA, irrespective of its likely aetiology, and is more severe in non‐white infants. Despite routine parenteral and enteral supplementation, low 25‐OHVD levels persist post KPE especially in icteric infants. More aggressive vitamin D supplementation and monitoring in this population is paramount.
Infant Colic—What works
Authors: Harb Tracy , Matsuyama Misa , David Michael , Hill Rebecca J.
Published: December 2015

Objectives:

To determine the strength of evidence for commonly used interventions for colic in breast‐fed and mixed‐fed infants younger than 6 months.

Methods:

Searches of PubMed, CINAHL, Embase, AMED, and Web of Science databases were conducted from July 2014 to July 2015. Included studies were randomised controlled trials involving mothers and their colicky infants younger than 6 months; assessed colic against the Wessel or modified Wessel criteria; and included phytotherapies, prescription medicines, and maternal dietary interventions. Studies with <16 participants were excluded. Meta‐analyses were conducted where data were sufficient to enable pooling. Quality was assessed against the Cochrane Risk Bias Assessment Tool.

Results:

A total of 17 articles met the inclusion criteria for this review. The 6 studies included for subgroup meta‐analysis on probiotic treatment, notably Lactobacillus reuteri, demonstrated that probiotics appear an effective treatment, with an overall mean difference in crying time at day 21 of −55.8 min/day (95% CI −64.4 to −47.3, P = 0.001). The 3 studies included for subgroup meta‐analysis on preparations containing fennel suggest it to be effective, with an overall mean difference of −72.1 min/day (95% CI −126.4 to −17.7, P < 0.001).

Conclusions:

Probiotics, in particular L reuteri, and preparations containing fennel oil appear effective for reducing colic, although there are limitations to these findings. The evidence for maternal dietary manipulation, lactase, sucrose, glucose, and simethicone is weak. Further well‐designed clinical trials are required to strengthen the evidence for all of these interventions.
EBV Status and Thiopurine Use in Pediatric IBD
Authors: Gordon Julia , Ramaswami Archana , Beuttler Marc , Jossen Jacqueline , Pittman Nanci , Lai Joanne , Dunkin David , Benkov Keith , Dubinsky Marla
Published: December 2015

Objectives:

Epstein Barr virus (EBV) is a human herpes virus that infects 90% of the world's population and has been linked to the development of lymphoproliferative disorders (LPDs) and immunosuppression. Primary EBV infection in patients with IBD on thiopurines is a risk factor for LPD, including lymphoma. We aimed to describe EBV status in a pediatric population with IBD with an emphasis on those initiating thiopurines.

Methods:

Electronic medical records and EBV serologies were reviewed and categorized into asymptomatic screening versus suspicion for acute infection. EBV status before therapy was described by sex, age, and therapeutic regimen. Descriptive statistics and univariate analysis were employed.

Results:

Only 150 (22%) of our 688 pediatric patients with IBD had documented EBV status regardless of age or treatment regimen. Only 17% were assessed for suspicion of acute infection and 83% for screening. Sixty‐four (52%) screened patients were checked before starting any treatment and only 40% were immunoglobulin (Ig)G positive. There was no difference in mean age between the seronegative and seropositive group. The majority (63%) of thiopurine‐treated patients were IgG negative before starting therapy. Eighty percent of primary EBV infections occurred on thiopurines at a mean (SD) of 2 ± 1.5 years after initiating therapy.

Conclusions:

The majority of our pediatric patients with IBD with documented EBV status were IgG negative at thiopurine initiation. Thiopurines were also associated with primary EBV infection. EBV status may be an important determinate of whether physicians prescribe thiopurines given the risk of primary EBV infections and lymphoproliferative diseases.
Human copy number variants are enriched in regions of low mappability
Authors: Monlong Jean , Cossette Patrick , Meloche Caroline , Rouleau Guy , Girard Simon L. , Bourque Guillaume
Published: December 2015

Copy number variants (CNVs) are known to affect a large portion of the human genome and have been implicated in many diseases. Although whole-genome sequencing (WGS) can help identify CNVs, most analytical methods suffer from limited sensitivity and specificity, especially in regions of low mappability. To address this, we usePopSV, a CNV caller that relies on multiple samples to control for technical variation. We demonstrate that our calls are stable across different types of repeat-rich regions and validate the accuracy of our predictions using orthogonal approaches. ApplyingPopSVto 640 human genomes, we find that low-mappability regions are approximately 5 times more likely to harbor germline CNVs, in stark contrast to the nearly uniform distribution observed for somatic CNVs in 95 cancer genomes. In addition to known enrichments in segmental duplication and near centromeres and telomeres, we also report that CNVs are enriched in specific types of satellite and in some of the most recent families of transposable elements. Finally, using this comprehensive approach, we identify 3,455 regions with recurrent CNVs that were missing from existing catalogs. In particular, we identify 347 genes with a novel exonic CNV in low-mappability regions, including 29 genes previously associated with disease.
Protective coding variants inCFHandPELI3and a variant nearCTRB1are associated with age-related macular degeneration
Authors: Wagner Erin K. , Yu Yi , Souied Eric H. , Seitsonen Sanna , Immonen Ilkka J. , Häppölä Paavo , Raychaudhuri Soumya , Daly Mark J. , Seddon Johanna M.
Published: December 2015

Although >20 common frequency age-related macular degeneration (AMD) alleles have been discovered with genome-wide association studies, substantial disease heritability remains unexplained. In this study we sought to identify additional variants, both common and rare, that have an association with advanced AMD. We genotyped 4,332 cases and 25,268 controls of European ancestry from three different populations using the Illumina Infinium HumanExome BeadChip. We performed meta-analyses to identify associations with common variants and performed single variant and gene-based burden tests to identify associations with rare variants. Two protective, low frequency, non-synonymous variants A307V inPELI3(odds ratio [OR]=0.14,P=4.3×10−10) and N1050Y inCFH(OR=0.76,Pconditional=1.6×10−11) were significantly associated with a decrease in risk of AMD. Additionally, we identified an enrichment of protective alleles inPELI3using a burden test (OR=0.14). The new variants have a large effect size, similar to rare mutations we reported previously in a targeted sequencing study, which remain significant in this analysis:CFHR1210C (OR=18.82,P=3.5×10−07),C3K155Q (OR=3.27,P=1.5×10−10), andC9P167S (OR=2.04,P=2.8×10−07). We also identified a strong protective signal for a common variant (rs8056814) nearCTRB1associated with a decrease in AMD risk (logistic regression: OR = 0.71, P = 1.8x10−07; Firth corrected OR = 0.64, P = 9.6x10−11). This study supports the involvement of both common and low frequency protective variants in AMD. It also may expand the role of the high-density lipoprotein pathway and branches of the innate immune pathway, outside that of the complement system, in the etiology of AMD.
Inferences from a network to a subnetwork and vice versa under an assumption of symmetry
Authors: Porta Mana P.G.L. , Torre E. , Rostami V.
Published: December 2015

This note summarizes some mathematical relations between the probability distributions for the states of a network of binary units and a subnetwork thereof, under an assumption of symmetry. These relations are standard results of probability theory, but seem to be rarely used in neuroscience. Some of their consequences for inferences between network and subnetwork, especially in connection with the maximum-entropy principle, are briefly discussed. The meanings and applicability of the assumption of symmetry are also discussed.

PACS: 87.19.L-,87.19.lo,05.90.+m

MSC: 03B48,97K50
Peroxisomes move by hitchhiking on early endosomes using the novel linker protein PxdA
Authors: Salogiannis John , Egan Martin J. , Reck-Peterson Samara L.
Published: December 2015

Eukaryotic cells use microtubule-based intracellular transport for the delivery of many subcellular cargos, including organelles. The canonical view of organelle transport is that organelles directly recruit molecular motors via cargo-specific adaptors. In contrast to this view, we show here that peroxisomes move by hitchhiking on early endosomes, an organelle that directly recruits the transport machinery. Using the filamentous fungusAspergillus nidulanswe find that hitchhiking is mediated by a novel endosome-associated linker protein, PxdA. PxdA is required for normal distribution and long-range movement of peroxisomes, but not early endosomes or nuclei. Using simultaneous time-lapse imaging we find that early endosome-associated PxdA localizes to the leading edge of moving peroxisomes. We identify a coiled-coil region within PxdA that is necessary and sufficient for early endosome localization and peroxisome distribution and motility. These results present a new mechanism of microtubule-based organelle transport where peroxisomes hitchhike on early endosomes and identify PxdA as the novel linker protein required for this coupling.
Daylight photodynamic therapy with 1.5% 3‐butenyl 5‐aminolevulinate gel as a convenient, effective and safe therapy in acne treatment: A double‐blind randomized controlled trial
Authors: Kwon Hyuck Hoon , Moon Ki Rang , Park Seon Yong , Yoon Ji Young , Suh Dae Hun , Lee Jee Bum
Published: December 2015

While daylight photodynamic therapy (PDT) is a simpler and more tolerable treatment procedure for both clinicians and patients, it has never been applied for acne treatment. In this study, we evaluated efficacy, safety and histological changes of facial acne after application of the novel variant of 5‐aminolevulinate (ALA)‐ester, 1.5% 3‐butenyl ALA‐bu gel, using daylight only as the potential visible light source. Forty‐six acne patients were randomly assigned to either ALA‐bu or vehicle application group in a double‐blind fashion. Both groups applied the allocated gel to facial acne lesions every other day for 12 weeks. At the final 12 week, both inflammatory and non‐inflammatory acne lesions had decreased significantly by 58.0% and 34.1% in the ALA‐bu group, respectively. Only a few patients expressed mild adverse effects. In the histopathological analysis, attenuated inflammatory cell infiltrations were observed and immunostaining intensities for interleukin‐8, interleukin‐1β, matrix metalloproteinase‐9 and phosphorylated nuclear factor‐κB were reduced concomitantly. Changes of their mRNA expression demonstrated comparable patterns. In conclusion, this ambulatory PDT was effective, very well tolerated and convenient for treating inflammatory acne lesions. Experimental results correlated well with clinical results. This novel regimen would provide a viable option for acne therapy.
Skin testing of gallic acid‐based hair dye in paraphenylenediamine/paratoluenediamine‐reactive patients
Authors: Choi Yunseok , Lee Joon Ho , Kwon Hyok Bu , An Susun , Lee Ai‐Young
Published: December 2015

Incidence of allergic contact dermatitis (ACD) to para‐phenylenediamine (PPD)/paratoluenediamine (PTD) hair dyes is increasing. Hair dyes utilizing gallic acid (GA) may be a safe alternative. However, pretesting is recommended. We investigated the contact sensitivity to ingredients of a dye product; GA, monoethanolamine thioglycolate (MT), l‐cystein and ferrous sulfate, and an appropriate pretest method in 31 patients reactive to PPD and/or PTD. An open test was performed with the test dye following the patch test. Subsequently, a use test was performed twice, with a 4‐week interval. One subject showed a positive reaction to ferrous sulfate in the patch test. Another subject reacted to the first compound alone in the open test. Thirteen subjects manifesting cutaneous lesions from previous regular hair dyeing, showed reactions at the first use of the test dye; and six had reactions with reduced severity at the second test. GA and MT are safe for use in ACD patients reactive to PPD and/or PTD. For predicting contact allergy to hair dyes, the open test appeared to be a better pretest method than the patch test.
Contact immunotherapy enhances the therapeutic effects of nivolumab in treating in‐transit melanoma: Two cases reports
Authors: Fujimura Taku , Furudate Sadanori , Kakizaki Aya , Kambayashi Yumi , Haga Takahiro , Hashimoto Akira , Aiba Setsuya
Published: December 2015

Because nivolumab significantly prolongs survival in patients with metastatic melanoma, enhancing its antitumor immune response is of great interest to dermato‐oncologists. In this report, we describe two cases of metastatic melanoma successfully treated with nivolumab in combination with contact immunotherapy, using contact sensitizing agents, such as squaric acid dibutylester and diphencyprone. In addition, immunohistochemical staining supported one of the possible mechanisms of this combination therapy. Our present cases suggested a possible therapy for metastatic melanoma using nivolumab in combination with contact immunotherapy.
Thermal climate‐linked variation in annual survival rate of hibernating rodents: shorter winter dormancy and lower survival in warmer climates
Authors: Turbill Christopher , Prior Samantha
Published: December 2015

In seasonal climates, many animals, including a wide range of small mammals, are physiologically capable of prolonged dormancy (˜hibernation), when foraging‐related activity ceases entirely for part the year. Low metabolic rates while dormant minimise energy and water requirements, but the behavioural state of inactivity also reduces exposure to mortality risks, especially predation.

Thermal effects on activity underlie spatial patterns in annual survival rate of ectothermic animals. We hypothesised that, because local thermal conditions affect the duration of mammalian hibernation, positive effects of dormancy on survival could also underlie a negative relationship between spatial variation in thermal climate and annual survival rate among populations of hibernating rodents.

We applied mixed models to test for effects of local thermal climate on collated data of hibernation duration and annual survival rate among populations of hibernating and a representative sample of non‐hibernating rodent species.

Our analyses revealed strong negative effects of mean annual temperature on hibernation duration and adult annual survival rate within hibernating species (β: −8·6 day and −5·1% per 1 °C) but no effect in non‐hibernating rodent species. This thermal climate‐linked pattern in annual survival rate seems to be unique among mammals. A parsimonious explanation lies in the large increase in monthly survival rates during hibernation compared to activity.

The current spatial pattern suggests ongoing climate warming might reduce annual survival rates of hibernating rodents by shortening their hibernation season. Decreased annual survival because of increased activity in warmer climates with shorter winter seasons is an unappreciated mechanism leading to impacts of global warming on animal populations in temperate climates.
One lump or two? Explaining a major latitudinal transition in reproductive allocation in a viviparous lizard
Authors: Schwarzkopf Lin , Caley Michael Julian , Kearney Michael R.
Published: December 2015

In viviparous ectotherms, the interval between reproductive bouts is often extended by long gestation times, preventing multiple reproductive events per annum.

We assessed the potential roles of physiological adaptation and environmental constraints in driving an unusual case of geographic variation in life history, in the viviparous lizard (Eulamprus quoyii), which has either one or two reproductive bouts per annum, depending on the geographic location of the population.

Using dynamic energy budget theory, we developed an integrated model of the energetics of growth and reproduction in this lizard, and applied it in conjunction with biophysical calculations of body temperature and activity time across its geographic range to predict reproductive frequency.

Our model indicated that geographic variation in body temperature alone (i.e. environmental constraints) explained the observed pattern of litter frequency, suggesting that differences in energy allocation among populations were unlikely to be a major cause of differences in litter frequency in E. quoyii. It also suggested that natural selection should favour fixation of litter size in the transition zone.
Convergence of leaf‐out towards minimum risk of freezing damage in temperate trees
Authors: Lenz Armando , Hoch Günter , Körner Christian , Vitasse Yann
Published: December 2015

Within the same forest stand, temperate deciduous trees generally exhibit a distinct pattern in leaf‐out timing, with some species flushing earlier than other species. This study aimed to explain the timing of leaf‐out of various temperate tree species in relation to the risk of freezing damage to leaves.

We combined long‐term series of leaf‐out date (14–32 years) of five temperate tree species located in both low and high elevations in Switzerland, daily minimum temperatures recorded at the same sites and species‐specific freezing resistance (LT50) of emerging leaves. We calculated temperature safety margins (the temperature difference between absolute minimum temperature during leaf‐out and species‐specific LT50 values), and date safety margins (time lag between the last day when temperature falls below species‐specific LT50 values and the date of leaf‐out).

Leaf‐out occurred when the probability to encounter freezing damage approaches zero, irrespective of climatic conditions (low vs. high elevation) and species (early‐ and late‐flushing species). In other words, trees leaf out precisely at the beginning of the probabilistically safe period. Interestingly, the temperature safety margins did not differ significantly between low and high elevation. Yet, the date safety margin was smaller at high elevation, presumably due to a faster increase in temperature during the leaf‐out period at high elevation.

When species‐specific freezing resistance is taken into account, the time of leaf‐out converges among species towards a marginal risk of freezing damage. Thus, leaf‐out time has likely evolved in a way that the risk of freezing damage is minimized over a large spectrum of climatic conditions. Species with a small safety margin against freezing temperature, like Fagus sylvatica, appear to employ photoperiod co‐control of spring phenology, whereas species with a large safety margin depend largely on temperature for the right timing of leaf‐out.

Our results offer a new avenue to explain the differences in leaf‐out timing among co‐occurring tree species. They further suggest that in a warming climate, tree species can expand their distribution range to the extent their phenology matches the stochasticity of freezing temperatures in spring.
Fatigue and mental health in Australian rural and regional ambulance personnel
Authors: Pyper Zoe , Paterson Jessica L
Published: December 2015

Objective

Australian ambulance personnel experience stress, fatigue and exposure to traumatic events. These risks have been extensively researched in metropolitan paramedics. However, there has been limited research in rural and regional personnel. Rural and regional ambulance personnel make up a significant proportion of the Australian ambulance workforce and may be exposed to unique stressors. The aim of the current study was to investigate levels of fatigue, stress, and emotional trauma in rural and regional ambulance personnel.

Methods

A sample of 134 (103 male, 31 female) rural and regional ambulance personnel completed a mixed methods survey assessing fatigue, stress and emotional trauma. Data were analysed using a combination of descriptive analysis and qualitative, deductive analysis that involved data immersion, coding, and categorisation.

Results

Participants reported high levels of fatigue and emotional trauma. Qualitative data revealed stressors including community expectations and ‘office politics’. Participants also reported negative effects of fatigue including errors in drug administration and falling asleep while driving. The majority of participants reported normal levels of stress. It may be the case that working with known individuals in a community offers some degree of ‘protective’ impact for stress in rural and regional ambulance personnel.

Conclusions

This is one of the first studies to investigate fatigue, stress, and emotional trauma in a rural and regional ambulance population. Results indicate a complex and unique profile of risks and challenges for this critical and understudied community resource.
Kinetic Analysis of the Digestion of Bovine Type I Collagen Telopeptides with Porcine Pepsin
Authors: Qian Jun , Okada Yukari , Ogura Takayuki , Tanaka Keisuke , Hattori Shunji , Ito Shinji , Satoh Junko , Takita Teisuke , Yasukawa Kiyoshi
Published: December 2015

Collagen is frequently digested using pepsin in industries to produce a triple helical collagen without the N‐ and C‐terminal telopeptides. However, kinetic analysis of this reaction is difficult because several Lys residues in the N‐ and in the C‐terminal telopeptides form covalent bonds, leading to multiple substrates species, and pepsin cleaves collagen at various sites in the N‐terminal and in the C‐terminal telopeptides, yielding different products. Here we performed kinetic analysis of the digestion of bovine type I collagen with porcine pepsin. The reaction could be monitored by SDS‐PAGE by measuring the intensity of the protein bands corresponding to the variant β11 chain. We obtained kinetic parameters relative to the decrease in the variant β11 chain upon digestion. At pH 4.0, the Km and kcat values increased with increasing temperature (30 to 65 °C), although the kcat/Km values were stable. Additional cleavage at the helical region was detected at 45 to 65 °C. At 37 °C, the Km and kcat values increased with decreasing pH, and the kcat/Km values at pH 2.1 to 4.5 were stable and higher than those at pH 5.0 and 5.5. No additional cleavage was detected at the examined pH. Thus, the optimal pH and temperatures for selective digestion of collagen telopeptides with pepsin are 2.1 to 4.5 and 30 to 40 °C, respectively. These results suggest that the method might be useful for the kinetic analysis of the digestion of collagen telopeptides with pepsin.
Effect of Various Food Additives on the Levels of 4(5)‐Methylimidazole in a Soy Sauce Model System
Authors: Lee Sumin , Lee Jung‐Bin , Hwang Junho , Lee Kwang‐Geun
Published: December 2015

In this study, the effect of food additives such as iron sulfate, magnesium sulfate, zinc sulfate, citric acid, gallic acid, and ascorbic acid on the reduction of 4(5)‐methylimidazole (4(5)‐MI) was investigated using a soy sauce model system. The concentration of 4(5)‐MI in the soy sauce model system with 5% (v/v) caramel colorant III was 1404.13 μg/L. The reduction rate of 4(5)‐MI level with the addition of 0.1M additives followed in order: iron sulfate (81%) > zinc sulfate (61%) > citric acid (40%) > gallic acid (38%) > ascorbic acid (24%) > magnesium sulfate (13%). Correlations between 4(5)‐MI levels and the physicochemical properties of soy sauce, including the amount of caramel colorant, pH value, and color differences, were determined. The highest correlations were found between 4(5)‐MI levels and the amount of caramel colorant and pH values (r2 = 0.9712, r2 = 0.9378). The concentration of caramel colorants in 8 commercial soy sauces were estimated, and ranged from 0.01 to 1.34% (v/v).
Prevalence of dysglycaemia in rural Andhra Pradesh: 2005, 2010, and 2014
Authors: Affan Eshan T. , Praveen Devarsetty , Wu Jason H.Y. , Chow Clara K. , Peiris David , Patel Anushka , Neal Bruce C.
Published: December 2015

Background

Communities in rural Andhra Pradesh may be at increasing risk of diabetes. In the present study we analyzed three cross‐sectional studies over 9 years to estimate the changing prevalence of dysglycemia (diabetes and prediabetes).

Methods

The 2005 study sampled 4535 individuals from 20 villages, the 2010 study sampled 4024 individuals from 14 villages, and the 2014 project of 62 254 individuals sought to include all adults aged 40–85 years from 54 villages. Blood glucose levels were estimated using a hand‐held device in 2005 and 2014 and using HbA1c dried blood spots in 2010.

Results

In primary analyses restricted to assays based on fasting samples (2005, n = 3243; 2014, n = 749), the prevalence estimates for dysglycemia were 53.7% (95% confidence interval [CI] 51.8%–55.7%) in 2005 and 62.0% (95% CI 58.5%–65.4%) in 2014 (P < 0.001). Over the same period, mean body mass index (BMI) increased from 22.2 to 24.3 kg/m2 (mean difference 2.1 kg/m2; 95% CI 2.0–2.2 kg/m2; P < 0.001). In secondary analyses using data from all participants (2005, n = 4535; 2010, n = 4024; 2014, n = 62 254), regardless of measurement technique, the estimated prevalence of dysglycemia was 53.9% (95% CI 52.0%–55.9%) in 2005, 50.5% (95% CI 46.1%–54.9%) in 2010, and 41.3% (95% CI 40.9%–41.7%) in 2014 (P < 0.001).

Conclusions

The prevalence of dysglycemia was high at every assessment using every measurement method. Dysglycemia in this population is most likely to have risen with the rise in BMI. The decline in prevalence suggested by the secondary analyses was likely due to confounding from the different assessment methods.
Climate change, species range shifts and dispersal corridors: an evaluation of spatial conservation models
Authors: Alagador Diogo , Cerdeira Jorge Orestes , Araújo Miguel Bastos
Published: December 2015

The notion that conservation areas are static geographical units for biodiversity conservation should be revised when planning for climate‐change adaptation. Since species are expected to respond to climate change by shifting their distributions, conservation areas can lose the very same species that justified their designation. Methods exist to take into account the potential effects of climate on spatial priorities for conservation. One of such methods involves the identification of time‐ordered linkages between conservation areas (hereafter termed climate‐change corridors), thus enabling species tracking their suitable changing climates.

We critically review and synthesise existing quantitative approaches for spatial conservation planning under climate change. We extend these approaches focusing on the identification of climate‐change corridors, using three alternative models that vary on the objective function (minimum cost or maximum benefit sought) and on the nature of conservation targets (area‐based or persistence probabilities).

The three models for establishing climate‐change corridors are illustrated with a case study involving two species distributed across the Iberian Peninsula. The species were modelled in relation to climate‐change scenarios using ensembles of bioclimatic models and theoretical dispersal kernels. The corridors obtained are compared for their location, the temporal sequence of priorities, and the effectiveness with which solutions attain persistence and cost objectives.

By clearly framing the climate‐change corridors problem as three alternative models and providing the corresponding mathematical descriptions and solving tools, we offer planners a wide spectrum of models that can be easily adapted to a variety of conservation goals and constraints.
Understanding auditory verbal hallucinations: a systematic review of current evidence
Authors: Upthegrove R. , Broome M. R. , Caldwell K. , Ives J. , Oyebode F. , Wood S. J.
Published: December 2015

Objective

Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences.

Method

A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging.

Results

A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum ofAVHs from normal experience. Neuropsychological models includeAVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks.

Conclusion

There has been a large growth in research onAVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects andAVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.
Association between trajectories of buprenorphine treatment and emergency department and in‐patient utilization
Authors: Lo‐Ciganic Wei‐Hsuan , Gellad Walid F. , Gordon Adam J. , Cochran Gerald , Zemaitis Michael A. , Cathers Terri , Kelley David , Donohue Julie M.
Published: December 2015

Background and aims

Uncertainty about optimal treatment duration for buprenorphine opioid agonist therapy may lead to substantial variation in provider and payer decision‐making regarding treatment course. We aimed to identify distinct trajectories of buprenorphine use and examine outcomes associated with these trajectories to guide health system interventions regarding treatment length.

Design

Retrospective cohort study.

Setting

US Pennsylvania Medicaid.

Patients

A total of 10 945 enrollees aged 18–64 years initiating buprenorphine treatment between 2007 and 2012.

Measurements

Group‐based trajectory models were used to identify trajectories based on monthly proportion of days covered with buprenorphine in the 12 months post‐treatment initiation. We used separate multivariable Cox proportional hazard models to examine associations between trajectories and time to first all‐cause hospitalization and emergency department (ED) visit within 12 months after the first‐year treatment.

Findings

Six trajectories [Bayesian information criterion (BIC) = −86 246.70] were identified: 24.9% discontinued buprenorphine < 3 months, 18.7% discontinued between 3 and 5 months, 12.4% discontinued between 5 and 8 months, 13.3% discontinued > 8 months, 9.5% refilled intermittently and 21.2% refilled persistently for 12 months. Persistent refill trajectories were associated with an 18% lower risk of all‐cause hospitalizations [hazard ratio (HR) = 0.82, 95% confidence interval (CI) = 0.70–0.95] and 14% lower risk of ED visits (HR = 0.86, 95% CI = 0.78–0.95) in the subsequent year, compared with those discontinuing between 3 and 5 months.

Conclusions

Six distinct buprenorphine treatment trajectories were identified in this population‐based low‐income Medicaid cohort in Pennsylvania, USA. There appears to be an association between persistent use of buprenorphine for 12 months and lower risk of all‐cause hospitalizations/emergency department visits.
Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight
Authors: Calderón Berniza , Gómez‐Martín Jesús M. , Vega‐Piñero Belén , Martín‐Hidalgo Antonia , Galindo Julio , Luque‐Ramírez Manuel , Escobar‐Morreale Héctor F. , Botella‐Carretero José I.
Published: December 2015

To study the prevalence of male obesity‐secondary hypogonadism (MOSH) in patients with moderate to severe obesity, we performed a prospective prevalence study including 100 male patients with moderate to severe obesity at a university tertiary hospital. Total testosterone (TT) and sex hormone‐binding globulin (SHBG) concentrations among others were assayed in all patients. Serum‐free testosterone (FT) concentration was calculated from TT and SHBG levels. Semen analysis was conducted in 31 patients. We found a prevalence of 45% (95% CI: 35–55%) when considering decreased TT and/or FT concentrations. Serum concentrations of TT were correlated negatively with glucose (r = −0.328, p < 0.001) and insulin resistance (r = −0.261, p = 0.011). The same occurred with FT and glucose (r = −0.340, p < 0.001) and insulin resistance (r = −0.246, p = 0.016). Sixty‐two percent (95% CI: 39–85%) of the patients with seminogram also presented abnormal results in semen analysis. The frequencies of low TT or low FT values were similar in patients with abnormal or normal semen analysis (p = 0.646 and p = 0.346, respectively). Ejaculate volume inversely correlated with BMI (ρ = −0.400, p = 0.029) and with excess body weight (ρ = −0.464, p = 0.010). Our data show the prevalence of MOSH in patients with moderate to severe obesity is high. Low circulating testosterone is associated with insulin resistance and low ejaculate volume with higher BMI and excess body weight. Semen analysis must be performed in these patients when considering fertility whether or not presenting low circulating testosterone.
Pre‐operative risk factors associated with need for vasoepididymostomy at the time of vasectomy reversal
Authors: Fuchs M. E. , Anderson R. E. , Ostrowski K. A. , Brant W. O. , Fuchs E. F.
Published: December 2015

The absence of sperm in the ejaculate after vasectomy reversal is commonly caused by failure to recognize and subsequently bypass epididymal or proximal vasal obstruction at the time of vasectomy reversal. If intra‐operative proximal obstruction is suspected, vasoepididymostomy (VE) is recommended rather than vasovasostomy (VV). We sought to calculate the associated risk of needing VE, rather than VV with time from original vasectomy (obstructive interval) using a large cohort of vasectomy reversal patients. We reviewed the electronic and paper vasectomy reversal database by a single surgeon from 1978 through 2012. We performed univariate analysis to identify variables that predicted the need for VE rather than VV, and then combined only significant univariates into our multi‐variable analysis. 2697 total men underwent vasectomy reversal, and 239 were repeat procedures. Of the 5296 individual testes operated on, 1029 were VE. Significant variables that predicted the need for VE on univariate analysis included: age, obstructive time interval, vasectomy reversal after previous VV (repeat vasectomy reversal), and year the procedure was performed. On multi‐variable analysis significant risk factors for VE were age above 50 (OR 1.36), repeat vasectomy reversal (OR 5.78), and greater obstructive time interval (OR 1.56). For every 3 years since original vasectomy, the risk of needing VE increases by 56%. There is a linear relationship between obstructive interval and need for VE. Men undergoing repeat vasectomy reversal have five times greater risk of requiring VE and men greater than 50 years of age are also at higher risk. Using these pre‐operative predictors is helpful in identifying patients who will benefit from referral to an experienced surgeon who can perform VE.
Milk kinship is not an obstacle to using donor human milk to feed preterm infants in Muslim countries
Authors: Khalil Aliaa , Buffin Rachel , Sanlaville Damien , Picaud Jean‐Charles
Published: December 2015

The development of human milk banks in Muslim countries is challenging because of the tradition of milk kinship. In other countries, this tradition imposes restrictions on Muslim mothers with regard to donating their milk or receiving donor milk for their preterm baby. However, Muslim law does allow the use of donated human milk under certain conditions, for example if it comes from a single known donor or is pooled from the milk of at least three donors.

Conclusion

Muslim parents need to be made aware that human milk banks can be used for preterm babies if strict conditions are met.