bluuebunny/crossref_metadata_2025 huggingface dataset:
Dissecting the proton transport pathway in electrogenic Na
+
/H
+
antiporters
Authors: Uzdavinys Povilas , Coinçon Mathieu , Nji Emmanuel , Ndi Mama , Winkelmann Iven , von Ballmoos Christoph , Drew David
Published: February 2017

Significance

Cells express transporters that strictly exchange protons for sodium ions to regulate many fundamental processes, such as intracellular pH and cell volume. The bacterial Na
+
/H
+
exchangers typically use the energy stored in membrane potentials, whereas the mammalian transporters do not. The energetic difference stems from the ability of the bacterial proteins to transport multiple protons in exchange for one sodium ion. The mechanism for how this is achieved, however, has remained elusive. Here, using purified components in synthetic membranes, we have compared the energetics and kinetics of the bacterial exchanger NapA to the human exchanger NHA2, which has been linked to insulin secretion. Remarkably, the judicial placement of a transmembrane embedded lysine is the key for harnessing a membrane potential.
On the dynamical structure of calcium oscillations
Authors: Sneyd James , Han Jung Min , Wang Liwei , Chen Jun , Yang Xueshan , Tanimura Akihiko , Sanderson Michael J. , Kirk Vivien , Yule David I.
Published: February 2017

Significance

Oscillations in the concentration of free cytosolic calcium are an important control mechanism in many cell types. However, we still have little understanding of how some cells can exhibit calcium oscillations with a period of less than a second, whereas other cells have oscillations with a period of hundreds of seconds. Here, we show that one common type of calcium oscillation has a dynamic structure that is independent of the period. We thus hypothesize that cells control their oscillation period by varying the rate at which their critical internal variables move around this common dynamic structure and that this rate can be controlled by the rate at which calcium activates calcium release from the endoplasmic/sarcoplasmic reticulum.
Tubby family proteins are adapters for ciliary trafficking of integral membrane proteins
Authors: Badgandi Hemant B. , Hwang Sun-hee , Shimada Issei S. , Loriot Evan , Mukhopadhyay Saikat
Published: February 2017

The primary cilium is a paradigmatic organelle for studying compartmentalized signaling; however, unlike soluble protein trafficking, processes targeting integral membrane proteins to cilia are poorly understood. In this study, we determine that the tubby family protein TULP3 functions as a general adapter for ciliary trafficking of structurally diverse integral membrane cargo, including multiple reported and novel rhodopsin family G protein–coupled receptors (GPCRs) and the polycystic kidney disease–causing polycystin 1/2 complex. The founding tubby family member TUB also localizes to cilia similar to TULP3 and determines trafficking of a subset of these GPCRs to neuronal cilia. Using minimal ciliary localization sequences from GPCRs and fibrocystin (also implicated in polycystic kidney disease), we demonstrate these motifs to be sufficient and TULP3 dependent for ciliary trafficking. We propose a three-step model for TULP3/TUB-mediated ciliary trafficking, including the capture of diverse membrane cargo by the tubby domain in a phosphoinositide 4,5-bisphosphate (PI(4,5)P2)-dependent manner, ciliary delivery by intraflagellar transport complex A binding to the TULP3/TUB N terminus, and subsequent release into PI(4,5)P2-deficient ciliary membrane.
Green’s function and pointwise convergence for compressible Navier-Stokes equations
Authors: Deng Shijin , Yu Shih-Hsien
Published: February 2017

In this paper we introduce a program to construct the Green’s function for the linearized compressible Navier-Stokes equations in several space dimensions. This program contains three components, a procedure to isolate global singularities in the Green’s function for a multi-spatial-dimensional problem, a long wave-short wave decomposition for the Green’s function and an energy method together with Sobolev inequalities. These three components together split the Green’s function into singular and regular parts with the singular part given explicitly and the regular part bounded by exponentially sharp pointwise estimates. The exponentially sharp singular-regular description of the Green’s function together with Duhamel’s principle and results of Matsumura-Nishida on

L
∞

L^\infty

decay yield through a bootstrap procedure an exponentially sharp space-time pointwise description of solutions of the full compressible Navier-Stokes equations in

R

n

(
n
=
2
,
3
)

{\mathbb R}^n(n=2,3)

.
Shelter Needs in Relation to Land Use
Authors: Nichols J. E.
Published: February 2017

The needs of stock and crops are not necessarily the same in time and space. The greatest single contribution to total shelter is the configuration of the land itself (geomorphic shelter) while the contribution of other topographic shelter such as heather, low bushes, even rushes, walls, hedges, and buildings is considerable.

Forest shelter should be thought of as added shelter and related to the distribution of exposure risks over the farm as a whole. Its value may be greatest, provided space can be allotted, where stock has to be concentrated at critical times and cannot therefore make use of geomorphic shelter.

We have still much to learn about the nature of plant and animal responses to exposure risks and the shelter needs of a particular area or farm must be assessed from a case study involving exposure risks, existing shelter, and husbandry methods obtaining or proposed, before any scheme is undertaken to provide added forest shelter.
Autolysis and extension of isolated walls from growing cucumber hypocotyls
Authors: Cosgrove Daniel J. , Durachko Daniel M.
Published: February 2017

Walls isolated from cucumber hypocotyls retain autolytic activities and the ability to extend when placed under the appropriate conditions. To test whether autolysis and extension are related, we treated the walls in various ways to enhance or inhibit long-term wall extension (‘creep’) and measured autolysis as release of various saccharides from the wall. Except for some non-specific inhibitors of enzymatic activity, we found no correlation between wall extension and wall autolysis. Most notably, autolysis and extension differed strongly in their pH dependence.

We also found that exogenous cellulases and pectinases enhanced extension in native walls, but when applied to walls previously inactivated with heat or protease these enzymes caused breakage without sustained extension. In contrast, pretreatment of walls with pectinase or cellulase, followed by boiling in methanol to inactivate the enzymes, resulted in walls with much stronger expansin-mediated extension responses. Crude protein preparations from the digestive tracts of snails enhanced extension of both native and inactivated walls, and these preparations contained expansin-like proteins (assessed by Western blotting).

Our results indicate that the extension of isolated cucumber walls does not depend directly on the activity of endogenous wall-bound autolytic enzymes. The results with exogenous enzymes suggest that the hydrolysis of matrix polysaccharides may not induce wall creep by itself, but may act synergistically with expansins to enhance wall extension.
A toy model for the X-ray spectral variability of active galactic nuclei
Authors: Cao Xinwu , Wang Jun-Xian
Published: February 2017

Investigations into the long-term X-ray spectral variability of 10 active galactic nuclei (AGNs) revealed a positive spectral index–flux correlation for each object. An inner advection-dominated accretion flow (ADAF) may connect to a thin disc/corona at a certain transition radius. Both these structures are responsible for the hard X-ray emission in AGNs. The ADAF is hot and its X-ray spectrum is hard, while the corona above the disc is relatively cold and its X-ray spectrum is therefore soft. The radiation efficiency of the ADAF is usually much lower than that of the thin disc. An increase in the transition radius may lead to a decrease in the spectral index (i.e. a hard spectrum) and the X-ray luminosity even if the accretion rate is fixed, and a decrease of transition radius leads to an increase in spectral index. We propose that such X-ray variability is caused by a change in the transition radius. Our model calculations can reproduce the observed index–flux correlations, if the transition radius fluctuates around an equilibrium position and the radiation efficiency of ADAFs is ∼5 per cent of that for a thin disc. The average spectral index–Eddington ratio correlation for these ten AGNs sample can also be reproduced by our model calculations, if the equilibrium transition radius increases with decreasing mass accretion rate.
The SLUGGS survey: globular clusters and the dark matter content of early-type galaxies
Authors: Forbes Duncan A. , Alabi Adebusola , Romanowsky Aaron J. , Brodie Jean P. , Strader Jay , Usher Christopher , Pota Vincenzo
Published: February 2017

A strong correlation exists between the total mass of a globular cluster (GC) system and the virial halo mass of the host galaxy. However, the total halo mass in this correlation is a statistical measure conducted on spatial scales that are some 10 times that of a typical GC system. Here we investigate the connection between GC systems and galaxy's dark matter on comparable spatial scales, using dynamical masses measured on a galaxy-by-galaxy basis. Our sample consists of 17 well-studied massive (∼1011 M⊙) early-type galaxies from the SLUGGS survey. We find the strongest correlation to be that of the blue (metal-poor) GC subpopulation and the dark matter content. This correlation implies that the dark matter mass of a galaxy can be estimated to within a factor of 2 from careful imaging of its GC system. The ratio of the GC system mass to that of the enclosed dark matter is nearly constant. We also find a strong correlation between the fraction of blue GCs and the fraction of enclosed dark matter, so that a typical galaxy with a blue GC fraction of 60 per cent has a dark matter fraction of 86 per cent over similar spatial scales. Both halo growth and removal (via tidal stripping) may play some role in shaping this trend. In the context of the two-phase model for galaxy formation, we find galaxies with the highest fractions of accreted stars to have higher dark matter fractions for a given fraction of blue GCs.
Risk Factors for Sexual Transmission of Hepatitis C Virus Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men: A Case-Control Study
Authors: Vanhommerig Joost W. , Lambers Femke A. E. , Schinkel Janke , Geskus Ronald B. , Arends Joop E. , van de Laar Thijs J. W. , Lauw Fanny N. , Brinkman Kees , Gras Luuk , Rijnders Bart J. A. , van der Meer Jan T. M. , Prins Maria ,   on behalf of the MOSAIC (MSM Observational Study of Acute Infection With Hepatitis C) Study Group, van der Meer J.T.M. , Molenkamp R. , Mutschelknauss M. , Nobel H.E. , Reesink H.W. , Schinkel J. , van der Valk M. , van den Berk G.E.L. , Brinkman K. , Kwa D. , van der Meche N. , Toonen A. , Vos D. , van Broekhuizen M. , Lauw F.N. , Mulder J.W. , Arends J.E. , van Kessel A. , de Kroon I. , Boonstra A. , van der Ende M.E. , Hullegie S. , Rijnders B.J.A. , van de Laar T.J.W. , Gras L. , Smit C. , Lambers F.A.E. , Prins M. , Vanhommerig J.W. , van der Veldt W.
Published: February 2017

Background.  Since 2000, incidence of sexually acquired hepatitis C virus (HCV)-infection has increased among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). To date, few case-control and cohort studies evaluating HCV transmission risk factors were conducted in this population, and most of these studies were initially designed to study HIV-related risk behavior and characteristics.

Methods.  From 2009 onwards, HIV-infected MSM with acute HCV infection and controls (HIV-monoinfected MSM) were prospectively included in the MOSAIC (MSM Observational Study of Acute Infection with hepatitis C) study at 5 large HIV outpatient clinics in the Netherlands. Written questionnaires were administered, covering sociodemographics, bloodborne risk factors for HCV infection, sexual behavior, and drug use. Clinical data were acquired through linkage with databases from the Dutch HIV Monitoring Foundation. For this study, determinants of HCV acquisition collected at the inclusion visit were analyzed using logistic regression.

Results.  Two hundred thirteen HIV-infected MSM (82 MSM with acute HCV infection and 131 MSM without) were included with a median age of 45.7 years (interquartile range [IQR], 41.0–52.2). Receptive unprotected anal intercourse (adjusted odds ratio [aOR], 5.01; 95% confidence interval [CI], 1.63–15.4), sharing sex toys (aOR, 3.62; 95% CI, 1.04–12.5), unprotected fisting (aOR, 2.57; 95% CI, 1.02–6.44), injecting drugs (aOR, 15.62; 95% CI, 1.27–192.6), sharing straws when snorting drugs (aOR, 3.40; 95% CI, 1.39–8.32), lower CD4 cell count (aOR, 1.75 per cubic root; 95% CI, 1.19–2.58), and recent diagnosis of ulcerative sexually transmitted infection (aOR, 4.82; 95% CI, 1.60–14.53) had significant effects on HCV acquisition.

Conclusions.  In this study, both sexual behavior and biological factors appear to independently increase the risk of HCV acquisition among HIV-infected MSM.
BMP signaling orchestrates a transcriptional network to control the fate of mesenchymal stem cells (MSCs)
Authors: Feng Jifan , Jing Junjun , Li Jingyuan , Zhao Hu , Punj Vasu , Zhang Tingwei , Xu Jian , Chai Yang
Published: February 2017

Signaling pathways are used reiteratively in different developmental processes yet produce distinct cell fates through activating specific downstream transcription factors. In this study, we used tooth root development as a model to investigate how the BMP signaling pathway regulates specific downstream transcriptional complexes to direct the fate determination of multipotent mesenchymal stem cells (MSCs). We first identified the MSC population supporting mouse molar root growth as Gli1+ cells. Using a Gli1-mediated transgenic animal model, our results provide the firstin vivoevidence that BMP signaling activity is required for the odontogenic differentiation of MSCs. Specifically, we identified transcription factors that are downstream of BMP signaling and are expressed in a spatially restricted pattern consistent with their potential involvement in determining distinct cellular identities within the dental mesenchyme. Finally, we found that overactivation of one key transcription factor, Klf4, associated with the odontogenic region, promotes odontogenic differentiation of MSCs. Collectively, our results demonstrate the functional significance of BMP signaling in regulating the fate of MSCs during root development and shed light on how BMP signaling can achieve functional specificity in regulating diverse organ development.

Summary Statement

BMP signaling activity is required for the lineage commitment of MSCs and transcription factors downstream of BMP signaling may determine distinct cellular identities within the dental mesenchyme.
CRISPR-Cas9 targeted disruption of theyellowortholog in the housefly identifies thebrown bodylocus
Authors: Heinze Svenia D. , Kohlbrenner Tea , Ippolito Domenica , Meccariello Angela , Burger Alexa , Mosimann Christian , Saccone Giuseppe , Bopp Daniel
Published: February 2017

The classicbrown body(bwb) mutation in the houseflyMusca domesticaimpairs normal melanization of the adult cuticle. InDrosophila melanogaster, a reminiscent pigmentation defect results from mutations in theyellowgene encoding dopachrome conversion enzyme (DCE). Here, we demonstrate that thebwblocus structurally and functionally represents theyellowortholog ofMusca domestica,MdY. InbwbMusca strains, we identified two mutantMdYalleles that contain lesions predicted to result in premature truncation of the MdY open reading frame. We targeted wildtypeMdYby CRISPR-Cas9 RNPs and generated new mutant alleles that fail to complement existingMdYalleles, genetically confirming thatMdYis thebwblocus. We further found evidence for Cas9-mediated interchromosomal recombination between wildtype and mutantbwballeles. Our work resolves the molecular identity of the classicbwbmutation inMusca domesticaand establishes the feasibility of Cas9-mediated genome editing in the Musca model.
A compact permanent-magnet system for measuring magnetic circular dichroism in resonant inelastic soft X-ray scattering
Authors: Miyawaki Jun , Suga Shigemasa , Fujiwara Hidenori , Niwa Hideharu , Kiuchi Hisao , Harada Yoshihisa
Published: February 2017

A compact and portable magnet system for measuring magnetic dichroism in resonant inelastic soft X-ray scattering (SX-RIXS) has been developed at the beamline BL07LSU in SPring-8. A magnetic circuit composed of Nd–Fe–B permanent magnets, which realised ∼0.25 T at the center of an 11 mm gap, was rotatable around the axis perpendicular to the X-ray scattering plane. Using the system, a SX-RIXS spectrum was obtained under the application of the magnetic field at an angle parallel, nearly 45° or perpendicular to the incident X-rays. A dedicated sample stage was also designed to be as compact as possible, making it possible to perform SX-RIXS measurements at arbitrary incident angles by rotating the sample stage in the gap between the magnetic poles. This system enables facile studies of magnetic dichroism in SX-RIXS for various experimental geometries of the sample and the magnetic field. A brief demonstration of the application is presented.
Self-regulation and compliance enforcement practices by the Investment Dealers Association in Canada
Authors: Lokanan Mark
Published: February 2017

Purpose

This paper aims to examine the enforcement practices of the Investment Dealers Association of Canada (IDA) and argue that self-regulation simply does not work in the financial sector, as the sanctions available are neither applied with sufficient severity nor are the responsibilities for enforcement adequately divided between self-regulation, provincial securities commissions and the police.

Design/methodology/approach

The core compliance data for the study came from the IDA’s tribunal cases that were heard between 1984 and June 2008. The theoretical approach involves the invocation of classic articles by the likes of Stigler, Posner and Becker, the essence of whose conclusions is that institutions will act in their own best interests and cannot be expected to act in the public interest.

Findings

The findings show that over the period from 1984 to 2008, the severity of the sanctions increased consistently over the period. When penalty ceilings were increased, penalties increased. When in the latter phase of the period, public members (i.e. non-members of the industry) chaired the tribunals, penalties also increased.

Research limitations/implications

Researchers can use the data to write a paper which asks “Why did the IDA tribunal penalties increase so consistently with time?” Future research could canvass various possible explanations, including the one presented in this paper, to focus sustained attention on the issue of self-regulation.

Originality/value

This study is the first to systematically examine the enforcement performance of the IDA.
Integrated care in practice – the South Eastern Sydney experience
Authors: Stewart Gregory , Bradd Patricia , Bruce Tish , Chapman Thomas , McDougall Brendon , Shaw Daniel , Soars Linda
Published: February 2017

Purpose

The purpose of this paper is to describe the recent efforts of a large publicly funded healthcare organisation in Sydney, Australia to implement integrated care (IC) “at scale and pace” in the messy, real-world context of a District Health Service.

Design/methodology/approach

The paper outlines the theoretical and practical considerations used to design and develop a localised IC Strategy informed by the “House of Care” model (NHS England, 2016).

Findings

The need for cross-agency partnership, a shared narrative, joint leadership and an IC Strategy underpinned by proven theoretical models model is described.

Originality/value

This paper highlights key factors relating to implementation and evaluation of a local IC Strategy in the real world.
Production of SrAl2O4:Eu2+, Dy3+ green-emitting phosphor nano-pigment powders via microwave processing route
Authors: Johari Mohammadreza , Rajabi Masoud , Mohammadi Vahid
Published: February 2017

Purpose

The present paper aims to synthesize SrAl2O4:Eu2+, Dy3+ green-emitting phosphor nano-pigment powder using a combination of citrate – gel processing and microwave-assisted heating route.

Design/methodology/approach

Microwave-assisted citrate – gel processing of SrAl2O4:Eu2+, Dy3+ green-emitting phosphor nano-pigment powder has been carried out by varying the pH and the molar ratio of H3Cit/Al3+ + Sr2+ +Eu2++Dy3+ (f/o). X-ray diffraction analysis showed that the produced powders were nearly pure SrAl2O4 phase, in which the SrAl2O4 host phase has the maximum fraction of green-emitting monoclinic SrAl2O4 phase.

Findings

Spectrophotometer results revealed that two excitation peaks appeared at 238 and 339 nm and an emission peak at 515 nm. The crystallite size of the green-emitting phosphor nano-pigment powder was about 37 nm as determined by Scherrer’s formula. The best conditions for formation of monoclinic SrAl2O4 phase with high purity were achieved at pH of precursor solution equal to 7 and the molar ratio of f/o equal to 3.

Originality/value

The present research work for the first time (to the best of the authors’ knowledge) has used microwave and sol–gel combination techniques to produce green-emitting phosphor nano-pigment powder (without using any other heating system).
Detection of individual ploidy levels with genotyping‐by‐sequencing (GBS) analysis
Authors: Gompert Zachariah , Mock Karen E.
Published: February 2017

Ploidy levels sometimes vary among individuals or populations, particularly in plants. When such variation exists, accurate determination of cytotype can inform studies of ecology or trait variation and is required for population genetic analyses. Here, we propose and evaluate a statistical approach for distinguishing low‐level ploidy variants (e.g. diploids, triploids and tetraploids) based on genotyping‐by‐sequencing (GBS) data. The method infers cytotypes based on observed heterozygosity and the ratio of DNA sequences containing different alleles at thousands of heterozygous SNPs (i.e. allelic ratios). Whereas the method does not require prior information on ploidy, a reference set of samples with known ploidy can be included in the analysis if it is available. We explore the power and limitations of this method using simulated data sets and GBS data from natural populations of aspen (Populus tremuloides) known to include both diploid and triploid individuals. The proposed method was able to reliably discriminate among diploids, triploids and tetraploids in simulated data sets, and this was true for different levels of genetic diversity, inbreeding and population structure. Power and accuracy were minimally affected by low coverage (i.e. 2×), but did sometimes suffer when simulated mixtures of diploids, autotetraploids and allotetraploids were analysed. Cytotype assignments based on the proposed method closely matched those from previous microsatellite and flow cytometry data when applied to GBS data from aspen. An R package (gbs2ploidy) implementing the proposed method is available from CRAN.
Editorial: improving in‐hospital management of decompensated cirrhosis by a ‘care bundle’ – hope, frustration and lessons to learn. Authors’ reply
Authors: McPherson S. , Dyson J. K. , Hudson M.
Published: February 2017

Linked Content

This article is linked to McPherson et al and Bosch papers. To view these articles visit https://doi.org/10.1111/apt.13806 and https://doi.org/10.1111/apt.13924.
Pulmonary thromboembolism as a complication of lung transplantation
Authors: Kristensen Anna Warncke , Mortensen Jann , Berg Ronan M. G.
Published: February 2017

Post‐transplantation mortality after lung transplantation (LTX) is higher than for other solid organ transplantations. Thoracic surgery is associated with increased risk of thromboembolic complications, and as LTX recipients lack the collateral bronchial circulation, pulmonary thromboembolism (PTE) may represent a pertinent yet largely underdiagnosed cause of post‐transplantation respiratory failure. In this systematic review, we sought to elucidate the occurrence and predilection site of PTE after LTX, and its potential impact on LTX‐associated mortality. Based on twelve original articles identified by a systematic search strategy in PubMed, we found that PTE was reported in 4% of LTX recipients, and 38% of these events occurred within the first 30 days after the LTX procedure. In single‐lung transplantation (SLTX) recipients, 12% were diagnosed with PTE, with 92% of these affecting the allograft. Of LTX patients diagnosed with PTE, 11% died within 1 year after LTX and 75% of these deaths occurred within the first 30 days. Our findings suggest that PTE is a potentially underdiagnosed cause of early post‐LTX respiratory failure. This should be confirmed in larger studies with systematic follow‐up diagnostic imaging.
Effects of mogamulizumab in adult T‐cell leukemia/lymphoma in clinical practice
Authors: Sekine Masaaki , Kubuki Yoko , Kameda Takuro , Takeuchi Masanori , Toyama Takanori , Kawano Noriaki , Maeda Kouichi , Sato Seiichi , Ishizaki Junzo , Kawano Hiroshi , Kamiunten Ayako , Akizuki Keiichi , Tahira Yuki , Shimoda Haruko , Shide Kotaro , Hidaka Tomonori , Kitanaka Akira , Yamashita Kiyoshi , Matsuoka Hitoshi , Shimoda Kazuya
Published: February 2017

Objective

The efficacy of mogamulizumab in adult T‐cell leukemia/lymphoma (ATLL) was reported in a previous phase 2 study. Compared with patients in clinical trials, however, most patients in real‐life settings have demonstrated worse outcomes.

Method

We retrospectively analyzed 96 patients with relapsed/refractory ATLL who received mogamulizumab treatment.

Results

Relapsed/refractory ATLL patients with a median age of 70 years received a median of five courses of mogamulizumab. Hematologic toxicity and skin rash were the most common adverse events, and both were manageable. Of 96 patients, 87 were evaluable for efficacy. The overall response rate was 36%, and the median progression‐free survival (PFS) and overall survival (OS) from the start of mogamulizumab therapy were 1.8 and 4.0 months, respectively. Of the original 96 patients, only 25 fulfilled the inclusion criteria of the phase 2 study. Those who met the criteria demonstrated longer median PFS and OS durations of 2.7 and 8.5 months, respectively. The median OS from diagnosis in relapsed/refractory ATLL patients receiving mogamulizumab was 12 months, longer than the 5.8 months in a historical cohort without mogamulizumab.

Conclusion

In clinical practice, mogamulizumab exhibited antitumor activity in patients with relapsed/refractory ATLL, with an acceptable toxicity profile. Mogamulizumab therapy improved the OS of ATLL patients.
Venous thromboembolism management practices and knowledge of guidelines: a survey of Australian haematologists and respiratory physicians
Authors: Wallace Rory , Anderson Mary‐Ann , See Katharine , Gorelik Alexandra , Irving Louis , Manser Renee
Published: February 2017

Background

Current international clinical practice guidelines do not adequately address all clinical scenarios in the management of venous thromboembolism (VTE), and no comprehensive Australian guidelines exist.

Aims

To identify areas of uncertainty in VTE management and whether self‐reported practice is consistent with guidelines.

Methods

We conducted an Australian cross‐sectional online survey consisting of 53 questions to investigate doctors’ VTE management practices. The survey was distributed to consultant and trainee/registrar haematologists and respiratory physicians with the aid of participating medical societies.

Results

A total of 71 haematologists and 110 respiratory physicians responded to the survey. The majority of survey respondents were 31–50‐years old and worked in teaching hospitals and in the acute care setting. Under‐treatment was reported for high‐risk pulmonary embolism (PE) and duration of anticoagulation for first‐episode unprovoked PE (32 and 83% respectively). Over‐treatment was reported in areas of thrombolysis for intermediate‐risk PE (16%) and duration of anticoagulation for first‐episode provoked PE (41%). Uncertainty and variations in doctors’ management approaches were also found.

Conclusion

This survey demonstrated significant over‐treatment, under‐treatment and variability in the practice of VTE management. The findings highlight the need for the development and implementation of national guidelines for the management of VTE in Australia.
Using a worst pain intensity measure in children and adolescents
Authors: Avian Alexander , Messerer Brigitte , Meissner Winfried , Sandner‐Kiesling Andreas , Kammel Julian , Labugger Marlies , Weinberg Annelie , Berghold Andrea
Published: February 2017

Aims

To explore inconsistencies and the reliability in worst pain intensity ratings in children.

Background

Asking for worst pain always requires a retrospective evaluation which is controversially discussed.

Design

Retrospective analysis of registry data and a prospective study.

Methods

Retrospective study: 5970 patients [age: 10·2(4·0) years, female: 41% data collection: 2008–2015]; Prospective study: 240 patients [age: 14·7(1·9) years, female: 43%, data collection 2013–2014] were included. In both studies, the number of implausible pain intensity ratings was calculated (both studies: worst pain lower than movement pain or pain at rest, prospective study: number of patients reporting lower pain intensity ratings in worst pain items for the same time period in a second assessment). Test–retest reliability was calculated for the prospective study. Changes in worst pain ratings were analyzed using Wilcoxon signed ranks test.

Results

Test–retest reliability ranged from ρ = 0·77–0·90. In the retrospective study, 8·9% (95%CI: 8·2–9·6%) of our patients reported higher movement and/or pain at rest compared with worst pain. In the prospective study, 35·8% (95%CI: 30·0–42·1%) reported higher activity pain ratings compared with worst pain ratings in at least one pain assessment; 13·8% of the pediatric patients reported lower pain intensity ratings in worst pain items in a second assessment compared with the first assessment.

Conclusion

Nine to 36% of our patients showed inconsistent worst pain ratings. To overcome this problem, more specific pain intensity items, more than one item or a better instruction for pediatric patients could be used.
Identification of genomic islands in Chilean Piscirickettsia salmonis strains and analysis of gene expression involved in virulence
Authors: Lagos F , Cartes C , Vera T , Haussmann D , Figueroa J
Published: February 2017

Piscirickettsia salmonis, an agent of Piscirickettsiosis, is the cause of major losses in the Chilean salmon industry. We identified, characterized and bioinformatically analysed genomic islands in field strains of P. Salmonis, using the bioinformatic software PIPS, that uses the characteristics of the islands of pathogenicity to identify them. We analysed nine partially sequenced genomes in different new field strains, and compared them with the LF‐89 (Type strain) genome, selecting a genomic island present in all of them. We then evaluated the relative expression of three genes present in that island. From the obtained results, we conclude that the expression of the tcf gene is directly proportional to the cytopathogenicity in vitro of the bacteria; the product of the dnsa gene could contribute to its pathogenicity, but would be potentiated by one or more factors. The product of the gene liso is necessary for the virulence process and could have functions in early stages of infection. Regarding the strains, the IBM‐040 strain showed a significant increase in the expression of all the genes in the study. Contrarily, LF‐89 only presented a significant increase in expression of the gene liso, which correlates with the cytopathogenicity in vitro observed in the SHK‐1 cells.
Economic Analysis of Primary Care‐Based Physical Activity Counseling in Older Men: The VA‐LIFE Trial
Authors: Cowper Patricia A. , Peterson Matthew J. , Pieper Carl F. , Sloane Richard J. , Hall Katherine S. , McConnell Eleanor S. , Bosworth Hayden B. , Ekelund Carola C. , Pearson Megan P. , Morey Miriam C.
Published: February 2017

Objectives

To perform an economic evaluation of a primary care‐based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans.

Design

Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost.

Setting

Veterans Affairs Medical Center, Durham, North Carolina.

Participants

Male veterans aged ≥70 years (n = 398).

Intervention

An experienced health counselor provided baseline in‐person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly.

Measurements

Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow‐up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated.

Results

The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow‐up reached $10,418 with the intervention, versus $12,052 with usual care (difference = −$1,634 (95% confidence interval = −$4,683 to $1,416; P = .29)). Expressed in terms of short‐term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed.

Conclusion

Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.
Life‐Space Assessment Predicts Hospital Readmission in Home‐Limited Adults
Authors: Fathi Roya , Bacchetti Peter , Haan Mary N. , Houston Thomas K. , Patel Kanan , Ritchie Christine S.
Published: February 2017

Objectives

To describe the association between restricted life‐space and characteristics of community‐dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life‐space predicts hospital readmission.

Design

Observational.

Setting

Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama.

Participants

Individuals with CHF or COPD hospitalized from home (N = 478).

Measurements

The Life‐Space Assessment (LSA) measures mobility by asking about movement in situations ranging from within one's dwelling to beyond one's town. LSA scores below 60 correspond to “restricted life‐space.” Baseline LSA scores before admission were measured during an index hospitalization; follow‐up LSA scores were determined over the telephone at 90 days. Participant characteristics were examined according to baseline restricted life‐space using the chi‐square test and Student's t‐test. Each characteristic's association with restricted life‐space was estimated uisng logistic regression.

Results

Of the participants, 372 (77.8%) were classified as having baseline restricted life‐space. Baseline restricted life‐space was associated with older age (odds ratio (OR) = 1.29 per decade, 95% confidence interval (CI) = 1.17–1.42, P = .001), female sex (OR = 2.69, 95% CI = 1.69–4.29, P < .001), African‐American race (OR = 1.55, 95% CI = 1.00–2.41, P = .05), and having inadequate financial resources (OR = 2.03, 95% CI = 1.22–3.38, P = .006). In the baseline unrestricted life‐space group, 49.5% (n = 49) had restricted life‐space at 90‐day follow‐up. Baseline restricted life‐space was associated with greater odds of 90‐day hospital readmission (unadjusted OR = 1.64, 95% CI = 1.00–2.70, P = .05; adjusted OR = 1.72, 95% CI = 1.04–2.85, P = .03).

Conclusion

Baseline restricted life‐space was associated with greater risk of hospital readmission within 90 days after hospital discharge. These findings suggest a need to customize the management of individuals hospitalized with CHF or COPD based on baseline life‐space level.
Trajectories of Weight Change and Predictors Over 18‐Month Weight Loss Treatment
Authors: Zheng Yaguang , Sereika Susan M. , Danford Cynthia A. , Imes Christopher C. , Goode Rachel Woodson , Mancino Juliet , Burke Lora E.
Published: February 2017

Background

Obesity research has typically focused on weight change patterns using the whole sample in randomized clinical trials (RCTs), ignoring subsets of individuals with varying weight change trajectories (e.g., continuing to lose, or maintaining weight). The purpose was to explore possible trajectories of weight change and their associated predictors.

Methods

We conducted a secondary analysis of data from two RCTs using standard behavioral treatment for weight loss. Group‐based trajectory modeling was used to identify distinct classes of percent weight change trajectories over 18 months.

Results

The sample (N = 338) was primarily female (85.2%), White (73.7 %), 45.7 ± 9.0 years old, with 15.6 ± 2.8 years of education. Three trajectory groups were identified: good responders (>15% weight loss), fair responders (5%–10% weight loss), and poor responders (<5% weight loss). The good responders had a significantly larger decrease in perceived Barriers to Healthy Eating subscale scores than the fair and poor responders (p < .01). Compared to the poor responders, there was a significant decrease in fat gram intake in the good responders (p = .01).

Conclusions

Good responders differed from poor responders in decreasing their perceived barriers to healthy eating (e.g., managing emotions, social support, and daily mechanics of adopting a healthy diet) and reducing fat intake. Good responders differed from fair responders in perceived barriers to healthy eating.

Clinical Relevance

Clinicians need to focus on how we can assist those who are being unsuccessful in adopting some of the behaviors observed among those who have experienced successful weight loss and maintainers.
Chemotherapy‐induced alopecia management: Clinical experience and practical advice
Authors: Rossi Alfredo , Fortuna Maria Caterina , Caro Gemma , Pranteda Giulia , Garelli Valentina , Pompili Umberto , Carlesimo Marta
Published: February 2017

Background

Chemotherapy‐induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment‐related aspects such as drug dose, administration regimen, and exposure to X‐rays, but also patient‐related characteristics. To the best of our knowledge, no guidelines are available about CIA management.

Aims and methods

With this study, based on literature background and our clinical experience, we would like to propose a list of actions in order to estimate the risk of hair loss before starting chemotherapy and to manage this condition before, during, and after drug administration and to create a sort of practical guide for dermatologists and oncologists.

Results and conclusion

There is an urgent need for prospective studies to clarify the mechanistic basis of alopecia associated with these drugs and consequently to design evidence‐based management strategies.
Medication errors in home care: a qualitative focus group study
Authors: Berland Astrid , Bentsen Signe Berit
Published: February 2017

Aims and objectives

To explore registered nurses’ experiences of medication errors and patient safety in home care.

Background

The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality.

Design

An exploratory qualitative design with focus group interviews was used.

Methods

Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis.

Results

Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines.

Conclusion

Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home‐care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up‐to‐date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines.

Relevance to clinical practice

To prevent medication errors in home care, up‐to‐date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications.
Clinical classification and treatment of cesarean scar pregnancy
Authors: Zhang Hongwen , Huang Jingrui , Wu Xianqing , Fan Hong , Li Han , Gao Tian
Published: February 2017

Aim

Embryo implantation in a cesarean scar resulting in a cesarean scar pregnancy (CSP) is a special form of ectopic pregnancy. The aim of this article is to present our clinical classification and therapeutic strategy for CSP and to assess the efficacy, safety, and social benefits.

Methods

We categorized CSP as either risky or stable. Risky CSP have a high risk of severe hemorrhage and should be treated immediately, while stable CSP patients have neither obvious vaginal bleeding nor significantly elevated serum β‐human chorionic gonadotrophin (β‐hCG). According to the thickness of the myometrial wall between the sac and the bladder and the location of the gestational sac, risky CSP were classified into three types and the thinner myometrial wall type (type I) was divided into three subtypes. Four treatment categories were applied to the corresponding types and subtypes of CSP. A total of 331 patients with CSP in our hospital were studied. The study group (n = 81) was treated based on our classification and optimized treatment system, while the control group (n = 250) underwent the conventional methods. We assessed the efficacy, safety, and social benefits of our classification and optimized treatment system.

Results

The values of intraoperative blood loss, operative time, hospital stay, and hospital cost in the study group were significantly lower than those in the control group (P < 0.05). Suction curettage was more frequently used in the study group (P < 0.005).

Conclusion

Our clinical classification system and therapeutic strategy provide an effective and safe way to treat CSP patients resulting in reduced intraoperative bleeding, operative time, hospital days, and hospital cost.
Acquired hemophilia A manifesting as plasma transfusion‐uncontrolled severe bleeding 2 weeks after chorioamnionitis‐induced abortion
Authors: Matsuoka Ayumi , Sasaki Hiromasa , Sugimori Chiharu , Hirabuki Shinya , Hoshiba Tsutomu , Fujiwara Hiroshi
Published: February 2017

Acquired hemophilia A (AHA) is a serious and rare complication of pregnancy, caused by autoantibodies to coagulation factor VIII after delivery. We here report the case of a 36‐year‐old primigravida woman who developed AHA following chorioamnionitis‐caused miscarriage in the second trimester. Thirteen days after abortion, sudden, massive vaginal bleeding occurred with marked prolongation of activated partial thromboplastin time (APTT) in the absence of other abnormal coagulation data. Sequential transfusion of fresh frozen plasma did not achieve normalization of APTT. Further examination confirmed reduction of coagulation factor VIII and the presence of its inhibitor, leading to the final diagnosis of AHA. The patient was effectively treated with bypassing agents (activated prothrombin complex concentrate and recombinant activated factor VII) and immunosuppressive therapy. Fifteen months after remission, the patient became pregnant and successfully achieved term delivery with no signs of recurrence. This case illustrates that AHA should be considered in the occurrence of plasma transfusion‐uncontrolled severe bleeding after delivery.
The interactive effects of dual‐earner couples’ job insecurity: Linking conservation of resources theory with crossover research
Authors: Debus Maike E. , Unger Dana
Published: February 2017

The present study examines job insecurity in the context of dual‐earner couples. Linking conservation of resources theory (e.g., Hobfoll, , Am. Psychol., 44, 513) with crossover research (e.g., Westman, , Hum. Relat., 54, 717), we proposed that a partner's job insecurity constitutes an additional resource threat. Thus, the partner's job insecurity would exacerbate a person's negative reaction to his or her own job insecurity in terms of attitudinal (i.e., work engagement) and both health‐ and withdrawal‐related outcomes (i.e., psychological health and turnover intention). Using a time‐lagged design and multisource data from 171 mixed‐gender dual‐earner couples, multilevel path analysis applying the Actor‐Partner‐Interdependence Model revealed interesting gender differences. The negative relationship between the husband's job insecurity and his work engagement was stronger, the higher his wife's job insecurity was. The data further showed a moderated mediation, such that the husband's job insecurity was negatively and indirectly related to both psychological health and turnover intention (via reduced work engagement) if his wife experienced a medium or high level of job insecurity. Our study demonstrates the interactive effects of stressors in dual‐earner couples, and highlights the importance of overcoming an overly individualistic perspective when studying job insecurity in particular and stressors more generally.

Practitioner points

Job insecurity has become a highly potent stressor for a large number of employees nowadays. In the context of dual‐earner couples, we demonstrate that husbands react more negatively to job insecurity if their wives experience job insecurity too.

Dual‐earner couples are advised to diversify their occupational background, such that economic downturns in one industry sector are less likely to hit both partners.

Due to the fact that particularly husbands were affected by the job insecurity of their wives, it is important to tailor psychotherapeutic approaches to this group. Because men are usually more reluctant to approach psychotherapeutic counselling, the rise of job insecurity underscores the need to circumvent chronic mental health problems with adequate interventions.

Companies are advised to communicate with their employees in a transparent way, such that employees can better cope with organizational plans relating to mergers, acquisitions, and downsizing.