bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary Complications of Rheumatoid Arthritis
Authors: Farquhar Hamish , Vassallo Robert , Edwards Adrienne L. , Matteson Eric L.
Published: May 2019

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that characteristically causes joint inflammation and damage. In addition, many patients develop extraarticular manifestations which may cause significant comorbidity and premature mortality.

Some respiratory tract involvement of the upper and lower airways and parenchymal disease features are unique to RA, including cricoarytenoid arthritis and RA pulmonary nodulosis, and others, especially the interstitial parenchymal involvement, occur in many other idiopathic and autoimmune diseases. The pathophysiology of lung disease is not well understood. Rheumatoid lung disease may even predate the onset of joint disease, and could be triggered by chronic airway and alveolar epithelial injury. Chronic systemic inflammation and risk factors such as cigarette smoking, infection, host genetics, and immune dysregulation are contributors. Treatment of the respiratory disease is directed at reducing the systemic inflammation of RA. Less well understood is the management of the interstitial lung disease of RA, for which antifibrotic and immune suppressive agents may be helpful. The management of RA-related lung disease is perhaps the major remaining hurdle in reduction of the disease burden related to extraarticular manifestations of this disease.
Multidisciplinary Evaluation in Patients with Lung Disease Associated with Connective Tissue Disease
Authors: Wells Athol , Devaraj Anand , Renzoni Elizabetta A. , Denton Christopher P.
Published: May 2019

Multidisciplinary diagnosis is now viewed as the diagnostic reference standard in interstitial lung disease (ILD). This process consists of the integration of the evidence base with clinical reasoning in the formulation of a diagnosis and requires input from clinicians, radiologists, and, in selected cases, histopathologists. In ILD associated with connective tissue disease (CTD-ILD), multidisciplinary evaluation is especially helpful when CTD is suspected but cannot be diagnosed using strict criteria. In this context, the integration of systemic clinical data, serologic information, and computed tomography and biopsy findings may allow CTD-ILD to be diagnosed. However, the value of multidisciplinary evaluation in CTD-ILD is not confined to diagnosis. The frequent coexistence of pulmonary processes other than ILD, including pulmonary vascular disease, extrapulmonic restriction, and airways disease, often has a major impact on symptoms and pulmonary function tests (PFTs). In this review, we highlight the value of multidisciplinary discussion (MDD) in reconciling clinical data, PFT, and imaging data in the accurate staging of disease severity, baseline prognostic evaluation, and the identification of progression of ILD. MDD also provides a means to combine the views of respiratory physicians and rheumatologists in formulating a treatment strategy. It is often possible to reach a robust view as to whether management should be driven by systemic disease, pulmonary disease, or both. When treatment needs to be introduced or modified for both systemic and pulmonary reasons, face-to-face discussion facilities the selection of therapeutic agents that are likely to be efficacious for both systemic and pulmonary diseases.
Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience
Authors: Ramos Innocentini Lara Maria Alencar , Teixeira Alisson Henrique , Casemiro Luciana Assirati , Andrade Matheus Carrijo , Ferrari Tatiane Cristina , Ricz Hilton Marcos Alves , Macedo Leandro Dorigan de
Published: May 2019

Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature.

Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx.

Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression.

Results A total of 107 patients with a mean age of 59.8 years (range 19–81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04).

Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.
Face Validity and Content Validity of a Game for Distal Radius Fracture Rehabilitation
Authors: Meijer Henriëtte A.W. , Graafland Maurits , Obdeijn Miryam C. , Goslings J. Carel , Schijven Marlies P.
Published: May 2019

Background Patients recovering from a variety of wrist injuries are frequently advised to exercise to regain lost wrist and hand function. Treatment regimens to regain motion in the wrist are highly variable, and adherence to exercise protocols is known to be low. A serious game ReValidate! incorporating standardized exercise regimens was developed to motivate patients. In this study, the game is evaluated regarding its face validity and content validity.

Methods In this cross-sectional study, a mixed group of “users” (n = 53) including patients currently recovering from wrist injury, and a mixed group of “experts” (n = 46) including professionals advising patients on therapy regimen after wrist injury played at least one complete level of the serious game. Players evaluated the game by means of a structured questionnaire regarding its content, clinical applicability, and user experience. Questions were answered on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Results All groups valued the game as being able to support wrist rehabilitation and being of use to patients recovering from a distal radius fracture (users: median 4, P25–P75 3–4 vs. experts: median 4, P25–P75 3.50–5; p = not significant). The types of exercises performed during the game were considered to be both realistic and complete compared with regular physiotherapy exercises (users: median 4, P25–P75 3–4 vs. experts: median 4, P25–P75 3–5, p = not significant).

Conclusions The ReValidate! serious game can be regarded as a valid tool for patients to regain their wrist function after injury.

Level of evidence This is a Level II study.
Mismatch Negativity in Children with Cochlear Implant
Authors: Fernandes Natalia Martinez , Gil Daniela , Azevedo Marisa Frasson de
Published: May 2019

Introduction The mismatch negativity (MMN) is a negative long-latency auditory potential elicited by any discriminable change in a repetitive aspect of auditory stimulation. This evoked potential can provide cortical information about the sound processing, including in children who use cochlear implants.

Objective To identify MMN characteristics regarding latency, amplitude, and wave area in cochlear implanted children and to identify associations among language development, speech perception and family involvement.

Methods This is a descriptive, observational, cross-sectional study, which compared two groups: study group—children with cochlear implant, and control group—hearing children. The children were submitted to MMN evaluation with non-verbal tone burst stimulus, differing in frequency in sound field at 70 dBHL, with SmartEP equipment (Intelligent Hearing Systems, Miami, FL, USA). Speech perception and language development questionnaires were also applied, and the family participation in the rehabilitation process was classified.

Results The occurrence of MMN was 73.3% for the control group and 53.3% for the study group. Values of latency, amplitude and area of MMN of children using cochlear implants were similar to those of hearing children, and did not differ between groups. The occurrence of MMN was not correlated to the variables of hearing, language and family categories.

Conclusion Children with cochlear implants showed similar MMN responses to those of the children in the control group, with mean latency, amplitude and area of 208.9 ms (±12.8), -2.37 μV (±0.38) and 86.5 μVms (±23.4), respectively. There was no correlation between the presence of MMN and children's performance in the auditory and language development tests or family involvement during rehabilitation.
The behavioral model and game theory
Authors: Askari Gholamreza , Gordji Madjid Eshaghi , Park Choonkil
Published: May 2019

The rational choice theory is based on this idea that people rationally pursue goals for increasing their personal interests. Here, we present a new concept of rational choice as ahyper-rational choicein which the actor thinks about profit or loss of other actors in addition to his personal profit or loss and then will choose an action that is desirable to him. We implement the hyper-rational choice to generalize and expand the game theory. Results of this study will help to model the behavior of people considering environmental conditions, the type of behavioral interaction, valuation system of itself and others, and system of beliefs and internal values of societies. Hyper-rationality helps us understand how human decision-makers behave in interactive decisions.
Driving forces and charge-carrier separation in p-n junction solar cells
Authors: Lipovšek Benjamin , Smole Franc , Topič Marko , Humar Iztok , Sinigoj Anton Rafael
Published: May 2019

While p-n junction solar cells have long been established as the dominant solar-cell technology in the market, the origin of the charge-carrier separation in these devices remains open to debate. It is often attributed to the built-in electric field that exists across the junction in thermodynamic equilibrium, although this interpretation can lead to physical inconsistencies. In this work we present an interpretation approach based on the analogy between a solar cell and a generalized electric source model. Our interpretation is given through a detailed analysis of the electric potential and the non-electric chemical potential across each device, which are plotted together in complete potential diagrams introduced for this purpose. We demonstrate that the driving force separating the free charge carriers in both devices originates from the change of the non-electric chemical voltage that happens once the device is brought out of thermodynamic equilibrium. This change, therefore, can be interpreted as the driving force that triggers the selective motion of charge carriers and, thus, induces the electric voltage at the terminals of the device.
On the prospect of CZTSSe-based thin film solar cells for indoor photovoltaic applications: A simulation study
Authors: Haque K. A. , Baten Md Zunaid
Published: May 2019

In this work we present the first systematic study on the prospect of Cu2ZnSn(S,Se)4 or CZTSSe-based thin film photovoltaic devices for indoor energy harvesting applications. Based on numerical analysis, we estimate the performance characteristics of the experimentally reported highest-efficiency CZTSSe device when it is operated under a commercially available white light emitting diode (LED). The obtained efficiency of 13.77% and fill factor of 71.05% are both higher than the values reported under AM1.5 solar radiation. The results of our analysis indicate that performance enhancement under indoor condition arises from the enhanced short-circuit current at high intensity and open-circuit voltage at low intensity, which are both related to the high photon yield of the indoor spectrum corresponding to the bandgap of CZTSSe. Further performance enhancement under indoor condition can be achieved using a type-II band alignment, which we have designed and analyzed employing an intrinsic ZnO layer. The enhanced charge separation resulting from built-in-field of the ZnO layer increases the open circuit voltage by as much as 0.17 V, which in effect leads to an overall efficiency of 15.85% when operated under the considered white LED spectrum.
Music in premature infants enhances high-level cognitive brain networks
Authors: Lordier Lara , Meskaldji Djalel-Eddine , Grouiller Frédéric , Pittet Marie P. , Vollenweider Andreas , Vasung Lana , Borradori-Tolsa Cristina , Lazeyras François , Grandjean Didier , Van De Ville Dimitri , Hüppi Petra S.
Published: May 2019

Significance

Preterm babies are cared for in neonatal intensive care units (NICU), which are busy places with a lot of mechanical noise increasingly recognized to disrupt normal brain development. NICUs therefore invest in developmental care procedures, with music for example, but neurobiological evidence for these interventions is missing. We present results from a clinical trial to study the effects of a music intervention on preterm infants’ brain development. Based on resting-state fMRI, we provide evidence that music enhanced connectivity in a brain circuitry involving the salience network with regions implicated in sensory and higher-order cognitive functions, previously found to be altered in preterm infants. To our knowledge, this study is unique in observing an impact of music on brain development in preterm newborns.
Evolution of global marine fishing fleets and the response of fished resources
Authors: Rousseau Yannick , Watson Reg A. , Blanchard Julia L. , Fulton Elizabeth A.
Published: May 2019

Significance

We independently reconstructed vessels number, engine power, and effort of the global marine fishing fleet, in both the artisanal and industrial sectors. Although global fishing capacity and effort have more than doubled since 1950 in all but the most industrialized regions, the nominal catch per unit of effort (CPUE) has comparatively decreased. Between 1950 and 2015 the effective CPUE, among the most widely used indicator to assess fisheries management and stocks well being, has decreased by over 80% for most countries. This paper highlights the large differences in the development of sectorial fishing fleets regionally. This detailed paper empowers future exploration of the drivers of these changes, critical to develop sector and regionally specific management models targeting global fisheries sustainability.
Applying IPCC 2014 framework for hazard-specific vulnerability assessment under climate change
Authors: Sharma Jagmohan , Ravindranath Nijavalli H
Published: May 2019

The Intergovernmental Panel on Climate Change (IPCC), Working Group II Report (2014) presents vulnerability as a pre-existing characteristic property of a system. Accordingly, indicators for ‘sensitivity’ and ‘adaptive capacity’, which are internal properties of a system, are employed to assess it. Comparatively, the IPCC 2007 report includes ‘exposure’, an external factor, as the third component of vulnerability. We have compared the construct of vulnerability presented in IPCC 2007 and 2014 reports. It is argued that the results of vulnerability assessment obtained by adopting IPCC 2014 framework are practically more useful for reducing current vulnerability in preparedness to deal with an uncertain future. In the process, we have articulated the novel concepts of ‘selecting hazard-relevant vulnerability indicators’ and ‘assessing hazard-specific vulnerability’. Use of these concepts improves the contextualization of an assessment and thereby the acceptability of assessment results by the stakeholders.
Laboratory Evaluation of Antiphospholipid Syndrome
Authors: Heikal Nahla , Martins Thomas B , White Sandra K , Willis Rohan , Ware Branch D , Schmidt Robert L , Tebo Anne E
Published: May 2019

Objectives

Anti-β2 glycoprotein I domain I (anti-domain I) and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies are present in patients with antiphospholipid syndrome (APS); however, their use in evaluation remains unclear.

Methods

Diagnostic attributes of lupus anticoagulant (LAC), anti-domain I IgG, anti-cardiolipin, anti-β2 glycoprotein I (anti-β2GPI), and aPS/PT IgG and IgM antibodies were assessed in 216 patients evaluated for APS.

Results

LAC had the best odds ratio (OR, 14.2) while that for anti-domain 1 IgG was comparable to anti-β2GPI IgG (OR, 8.3 vs 9.4) but higher than all others. Significant correlations were observed for thrombosis (P = .03) and pregnancy-related morbidity (P = .001) with anti-domain IgG and for any thrombosis with aPS/PT IgG (P = .006). Use of noncriteria antiphospholipid with or without criteria markers did not significantly increase the probability to diagnose APS.

Conclusions

Noncriteria tests can contribute to diagnosis and stratification of APS but do not improve diagnostic yield. Optimal strategies for implementation require prospective investigation.
Mental Health and Affect Regulation Impairment in Fetal Alcohol Spectrum Disorder (FASD): Results from the Canadian National FASD Database
Authors: Temple Valerie K , Cook Jocelynn L , Unsworth Kathy , Rajani Hasu , Mela Mansfield
Published: May 2019

Aims

Individuals with fetal alcohol spectrum disorder (FASD) frequently have challenges with regulating emotional arousal, or affect regulation (AR), and experience high rates of mental health disorders. This study examined children and adults with FASD to investigate the relationship between AR impairment and several mental health problems and diagnoses.

Methods

Data from the Canadian national FASD database was used for analysis. Seven mental health diagnoses, including attention-deficit/hyperactivity disorder, post-traumatic stress disorder, conduct disorder, attachment disorder, intellectual disability, and language disorder were examined. A history of suicidality was also examined. The prevalence of these mental health problems in individuals with and without AR impairment was compared.

Results

Individuals with FASD and AR impairment were significantly more likely to be diagnosed with conduct disorder (OR 4.8), attachment disorder (OR 6.1), or post-traumatic stress disorder (OR 8.1) when compared to those without AR impairment. They were also more likely to have a history of suicidality (OR 8.6). AR impairment was most commonly found in those with greater overall neurodevelopmental impairment. Having AR impairment was associated with receiving a diagnosis of FASD at a later age, but was not related to gender, intellectual disability, or language disorder.

Conclusion

AR impairment is strongly related to several mental health diagnoses in those with FASD and presents some promising possibilities for targeted early intervention.
Chronic stress and body condition of wolf-killed prey in Prince Albert National Park, Saskatchewan
Authors: Shave Justin R , Derocher Andrew E , Cherry Seth G , Thiemann Gregory W
Published: May 2019

Chronic stress and poor body condition can cause adverse physiological and behavioural responses and may make animals more vulnerable to predation. We examined hair cortisol concentration (HCC) and marrow lipid content, as bioindicators of chronic stress and body condition, respectively, of bison (Bison bison bison), moose (Alces alces) and white-tailed deer (Odocoileus virginianus) killed by wolves (Canis lupus) in Prince Albert National Park (PANP), Saskatchewan, Canada. The Sturgeon River plains bison population in PANP is one of only a few wild populations of plains bison in their historical range in Canada and has experienced a decline of around 50% since 2005. We expected wolf-killed bison to have elevated HCC compared to human-harvested bison and that there would be a negative relationship between HCC and marrow lipids among wolf-killed animals. We compared HCC between different mortality sources for bison (wolf-killed n = 20 or human-harvested n = 23) and found that HCC was significantly elevated in wolf-killed bison (̄ = 7.56 ± 1.35 pg/mg). We found that HCC, species, sex and snow depth were all significant predictor variables of marrow lipid content of bison (n = 14), moose (n = 11) and deer (n = 27). Bison displayed the strongest negative correlation between HCC and marrow lipid content (r2 = 0.31). Our results suggest that chronic stress and poor body condition make prey more vulnerable to predation by wolves. HCC and marrow lipid content can provide reliable indicators of the physiological response of animals to stressors and may provide information on expected predator success that can be used to predict predator population dynamics.
Relationships with Grandparents and Grandchildren’s Well-being after Parental Divorce
Authors: Jappens Maaike , Van Bavel Jan
Published: May 2019

Grandparents are often considered as providing important resources in times of family crisis. Little is known, however, about the influence of grandparents on the well-being of grandchildren after parental divorce. This article investigates the association between the quality of relationships with grandparents and grandchildren’s subjective well-being. Using data from the study ‘Divorce in Flanders’, the authors compare 567 grandchildren with divorced and 238 with married parents regarding four indicators of subjective well-being (life satisfaction, self-esteem, mastery, and depressive feelings) and also examine variation within the group with divorced parents. Results show that the strength of grandchild–grandparent relationships is positively associated with grandchildren’s subjective well-being and that having a very good relationship with a grandparent matters even more for grandchildren whose parents have divorced. Moreover, grandchildren who experience frequent conflicts between divorced parents seem to benefit most from close grandparent relationships.
Towards a more pragmatic and wiser approach to infertility care
Authors:   The Annual Capri Workshop Group, Bhattacharya Siladitya , Evers J L Hans , Gameiro Sofia , Negri Eva , Somigliana Edgardo , Vercellini Paolo , Wellings Kaye , Baird David T , Crosignani PierGiorgio , Glasier Anna , La Vecchia Carlo
Published: May 2019

Infertility represents a very peculiar area of medicine. Contrary to other areas, where signs and symptoms lead to a diagnosis, which in turn leads to a specific treatment, in reproduction the lack of signs and symptoms for more than 12 months suggests the diagnosis of ‘unexplained subfertility’, and if this condition has lasted for some years, couples qualify for IVF. Diagnosis and treatments can extend over long periods of time (even years) and the accuracy of the diagnostic armamentarium is not optimal. Uncertainty about diagnosis and the need for significant perseverance is demanding on both couples and physicians, and actually constitute a very favourable situation for overdiagnosis (‘unexplained subfertility’) and overtreatment (IVF) on one hand, and, on the other, it may also affect compliance with treatments. To improve our capacity to properly handle this challenging situation, increased attention should be given to the duration of pregnancy seeking. Initiating treatments earlier in older women is unwise because this population has a lower fecundity and, therefore, duration of pregnancy seeking is even more important to achieve a reliable diagnosis of infertility. Moreover, if the infertility work-up is unremarkable, duration of pregnancy seeking should be extended up to more than 2 years prior to making a diagnosis of unexplained infertility regardless of age. An adequate period of pregnancy seeking is also required for couples who are diagnosed with conditions that can interfere with fertility to avoid overdiagnosis and overtreatment. Indeed, most causes of infertility will reduce but not impair natural conception. Within this sometimes long-term management, physicians should also pay attention to detrimental life habits in order to optimize the chances of both natural and assisted reproduction technology -mediated pregnancy. Even if interventional studies are not conclusive, it is advisable to address the problems of obesity and smoking. Focussing on frequency of sexual intercourse may be also beneficial for natural conception. Finally, there is the need for improving our capacity to handle compliance. Providing information on the importance of persevering at the start of treatment, promoting shared decision-making and tackling patient, clinic and treatment causes of drop-out can all improve the overall chances of parenthood. Thus, we plead for a wiser and more pragmatic approach to infertility, paying more attention to these neglected, but in our opinion essential, aspects of infertility care.
Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients
Authors: Jensen Siri Beier , Vissink Arjan , Limesand Kirsten H , Reyland Mary E
Published: May 2019

Background

The most manifest long-term consequences of radiation therapy in the head and neck cancer patient are salivary gland hypofunction and a sensation of oral dryness (xerostomia).

Methods

This critical review addresses the consequences of radiation injury to salivary gland tissue, the clinical management of salivary gland hypofunction and xerostomia, and current and potential strategies to prevent or reduce radiation injury to salivary gland tissue or restore the function of radiation-injured salivary gland tissue.

Results

Salivary gland hypofunction and xerostomia have severe implications for oral functioning, maintenance of oral and general health, and quality of life. Significant progress has been made to spare salivary gland function chiefly due to advances in radiation techniques. Other strategies have also been developed, e.g., radioprotectors, identification and preservation/expansion of salivary stem cells by stimulation with cholinergic muscarinic agonists, and application of new lubricating or stimulatory agents, surgical transfer of submandibular glands, and acupuncture.

Conclusion

Many advances to manage salivary gland hypofunction and xerostomia induced by radiation therapy still only offer partial protection since they are often of short duration, lack the protective effects of saliva, or potentially have significant adverse effects. Intensity-modulated radiation therapy (IMRT), and its next step, proton therapy, have the greatest potential as a management strategy for permanently preserving salivary gland function in head and neck cancer patients.

Presently, gene transfer to supplement fluid formation and stem cell transfer to increase the regenerative potential in radiation-damaged salivary glands are promising approaches for regaining function and/or regeneration of radiation-damaged salivary gland tissue.
DOES MERGER POLICY CONVERGE AFTER THE 2004 EUROPEAN UNION REFORM?
Authors: Bergman Mats A , Coate Malcolm B , Mai Anh T V , Ulrick Shawn W
Published: May 2019

The European Union (EU) formally changed its merger policy in 2004, moving from a dominance standard to one based on a significant impediment of effective competition, which appears more closely aligned with the U.S. substantial lessening of competition standard. We use data from both before and after this reform to explore whether EU policy has converged toward the U.S. standard. We start by identifying changes in the EU regime and detect a softer EU policy for unilateral effects. We model the outcomes of EU and U.S. investigations with logit models and use their predictions in decompositions and other exercises to show policy convergence for unilateral effects cases.
Transience as method: A conceptual lens to understanding evolving trends in migration, mobility, and diversity in the transnational space
Authors: Gomes Catherine
Published: May 2019

Migration as an act and as a concept is becoming more complex and nuanced not only because of increasing numbers of people and groups criss-crossing and circulating international borders but also because of push–pull factors that determine agendas and aspirations affecting transnational mobile actors. Static and binary understandings of migration as either settled or temporary are thus disrupted with new and impactful rising trends in the migration-mobility nexus identified. Based on observations of global political and community responses to transnational migration, and various research projects I have been involved with on temporary migration (international students, working holiday makers, and university-educated professional workers) in the Asia-Pacific, this article puts forward the idea that transience—a phenomenon where migrants regardless of visa and residency status are, for different reasons, spatially unsettled and transnationally mobile—be used as a conceptual lens in order to see emerging dynamics within the migration-mobility experience. Transience as a conceptual lens provides a disjuncture in our understanding of the migration-mobility nexus beyond the categories of temporary and permanent, and is a useful method in helping us understand the complexities, nuances, and ecologies which emerge from the migration experience, and making us aware of evolving patterns of diversity. Transience, in other words, becomes a new method in understanding evolving and emerging migration patterns by investigating the unevenness of the migrant(ion) journey.
Were You a Part of Your Mother?
Authors: Kingma Elselijn
Published: May 2019

Is the mammalian embryo/fetus a part of the organism that gestates it? According to the containment view, the fetus is not a part of, but merely contained within or surrounded by, the gestating organism. According to the parthood view, the fetus is a part of the gestating organism. This paper proceeds in two stages. First, I argue that the containment view is the received view; that it is generally assumed without good reason; and that it needs substantial support if it is to be taken seriously. Second, I argue that the parthood view derives considerable support from a range of biological and physiological considerations. I tentatively conclude in favour of the parthood view, and end by identifying some of the interesting questions it raises.
The Epigenetic Signature of Colonizing New Environments in Anolis Lizards
Authors: Hu Juntao , Askary Arash M , Thurman Timothy J , Spiller Dave A , Palmer Todd M , Pringle Robert M , Barrett Rowan D H
Published: May 2019

Founder populations often show rapid divergence from source populations after colonizing new environments. Epigenetic modifications can mediate phenotypic responses to environmental change and may be an important mechanism promoting rapid differentiation in founder populations. Whereas many long-term studies have explored the extent to which divergence between source and founder populations is genetically heritable versus plastic, the role of epigenetic processes during colonization remains unclear. To investigate epigenetic modifications in founding populations, we experimentally colonized eight small Caribbean islands with brown anole lizards (Anolis sagrei) from a common source population. We then quantitatively measured genome-wide DNA methylation in liver tissue using reduced representation bisulfite sequencing of individuals transplanted onto islands with high- versus low-habitat quality. We found that lizard sex and habitat quality explained a significant proportion of epigenetic variation. Differentially methylated cytosines mapped to genes that encode proteins with functions likely to be relevant to habitat change (e.g., signal transduction, immune response, circadian rhythm). This study provides experimental evidence of a relationship between epigenetic responses and the earliest stages of colonization of novel environments in nature and suggests that habitat quality influences the nature of these epigenetic modifications.
How do office workers respond to media coverage of sitting?
Authors: Yusuf M , Jagatia A , Mahmood Z , McCabe E , de Bruijn G-J , Smith L , Gardner B
Published: May 2019

Background

Sitting time is associated with adverse physical and mental health outcomes, and premature mortality. Office workers sit for prolonged periods, so are at particular risk. Scientific advances in public health threats are predominantly communicated to the public through media reports.

Aims

This study aimed to examine office workers’ impromptu responses to media coverage of scientific evidence related to the health risks of sedentary behaviour.

Methods

Semi-structured interviews were run with 26 office workers (mean age 35 years), recruited from four organizations in southern England. Within the interview, each participant provided a ‘think-aloud’ narrative as they read three real-world news reports relating to sedentary behaviour. Thematic analysis was conducted on verbatim transcripts.

Results

Three themes were extracted from the data: gauging the personal relevance of the news reports; questioning their trustworthiness and challenging the feasibility of proposed sitting-reduction strategies. Participants voiced scepticism about the applicability of the reports to their personal circumstances, and the validity of the reports and the scientific evidence underpinning them.

Conclusions

Researchers, press officers and journalists should emphasise the ways in which participants in research studies represent the broader population of office workers, and offer greater transparency in reporting study methods, when reporting scientific advances in sedentary behaviour.
Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series
Authors: Wang Timothy Y , Karikari Isaac O , Amrhein Timothy J , Gray Linda , Kranz Peter G
Published: May 2019

BACKGROUND

Cerebrospinal fluid-venous fistula (CVF) is a recently described cause of spontaneous intracranial hypotension (SIH). Surgical ligation of CVF has been reported, but clinical outcomes are not well described.

OBJECTIVE

To determine the clinical efficacy of surgical ligation for treatment of CVF.

METHODS

Outcomes metrics were collected in this prospective, single-arm, cross-sectional investigation. Inclusion criteria were as follows: diagnosis of SIH, demonstration of CVF on myelography, and surgical treatment of CVF. Pre- and postoperative headache severity was assessed with the Headache Impact Test (HIT-6), a validated headache scale ranging from 36 (asymptomatic) to 78 (most severe). Patient satisfaction with treatment was measured with Patient Global Impression of Change (PGIC).

RESULTS

Twenty subjects were enrolled, with mean postoperative follow-up at 16.0 ± 9.7 mo. All CVFs were located in the thoracic region (between T4 and T12). Pretreatment headache severity was high (mean HIT-6 scores 65 ± 6). Surgical treatment resulted in marked improvement in headache severity (mean HIT-6 change of –21 ± –9, mean postoperative HIT-6 of 44 ± 8). Of subjects with baseline headache scores in the most severe category, 83% showed a major improvement in severity (transition to the lowest 2 severity categories) after surgery. All subjects (100%) reported clinically significant levels of satisfaction with treatment (PGIC score 6 or 7); 90% reported the highest level of satisfaction. There were no short- or long-term complications or 30-d readmissions.

CONCLUSION

Surgical ligation is highly effective for the treatment of SIH due to CVF. Larger controlled trials with longer follow-up period are indicated to better assess its long-term efficacy and safety profile.
Tumour necrosis factor inhibitor exposure and radiographic outcomes in Veterans with rheumatoid arthritis: a longitudinal cohort study
Authors: Cannon Grant W , Erickson Alan R , Teng Chia-Chen , Huynh Tina , Austin Sharon , Wade Sally W , Stolshek Bradley S , Collier David H , Mutebi Alex , Sauer Brian C
Published: May 2019

Objectives

The aim was to estimate the impact of TNF inhibitor (TNFi) exposure on radiographic disease progression in US Veterans with RA during the first year after initiating therapy.

Methods

This historical longitudinal cohort design used clinical and claims data to evaluate radiographic progression after initiation of TNFi. US Veterans with RA initiating TNFi treatment (index date), ≥ 6 months pre-index and ≥ 12 months post-index VA enrolment/activity, and initial (6 months pre-index to 30 days post-index) and follow-up (10–18 months post-index) bilateral hand radiographs were eligible. The cumulative TNFi exposure and change in modified Sharp score (MSS) between initial and follow-up radiographs were calculated. The percentage of patients with clinically meaningful change in MSS (≥ 5) for each month of exposure was assessed using a longitudinal marginal structural model with inverse probability of treatment weights. Mean values and CIs were generated using 1000 bootstrapped samples.

Results

For 246 eligible patients, the mean (s.d.) age was 58 (11) years; 81% were male. The mean (s.d.) initial MSS was 19.6 (33.4) (range 0–214). The mean change (s.d.) in MSS was 0.3 (3.6) (median 0, range −19 to 22). Patients with the greatest exposure had the least radiographic progression for both crude and adjusted model analyses. Adjusted rates of MSS change ≥ 5 points (95% CI) were 10.6% (9.8%, 11.4%) for patients with 3 months of exposure compared with 5.4% (5.1%, 5.7%) for patients with 12 months of exposure.

Conclusion

One-year changes in radiographic progression were small. Patients with the greatest cumulative TNFi exposure experienced the least progression.
Helping Troubled Children and Cultivating the Race: The Mental Hygienic Guidance Centres of the Public Health Association of Swedish Finland, 1930s–1950s
Authors: Bergenheim Sophy
Published: May 2019

This article looks at the mental hygienic guidance centres of the Public Health Association of Swedish Finland (Samfundet Folkhälsan, or Folkhälsan for short). For Folkhälsan, mental hygiene was a part of a broader context, in which public health and racial hygiene were fundamentally motivated by Finland-Swedish minority nationalism. Folkhälsan’s mental hygienic ideas are illuminated through the interrelated frames of degeneration and social engineering. The former portrayed mental and social deviance as a social, biological and moral threat to the collective, whereas the latter saw social behaviour, including maladjustment, as a phenomenon that could be influenced. For Folkhälsan’s mental hygienists, it was central to determine type and degree of abnormality; whether the clients were socially maladjusted ‘problem children’ or ‘feeble-minded children’. In both cases, the problem was seen to be caused by (lower-class) parents: through incompetent parenting and/or by passing on poor mental qualities to their offspring.
Patient-controlled Analgesia For Vaso-Occlusive Crisis
Authors: Averbukh Yelena , Porrovecchio Andrea , Southern William N.
Published: May 2019

Background:

Sickle cell disease (SCD) accounts for over 68,000 hospital admissions each year in the United States, with long inpatient length of stays (LOS) and frequent readmission common. Patient-controlled analgesia (PCA) has been used to treat patients admitted with vaso-occlusive crisis (VOC), but it is unknown if PCA is associated with shorter LOS and reduced risk of readmission.

Methods:

We examined all admissions for acute VOC treated with parenteral opioids to an urban, academic health system over 3 years. We compared LOS, 30-day readmission, and discharges against medical advice between admissions treated with PCA versus standard therapy in unadjusted and adjusted analyses using generalized estimating equations to adjust for demographic and clinical characteristics.

Results:

Of 823 admissions included, 536 (65.1%) were treated with PCA and 287 (34.9%) were treated with standard nurse-administered opioid therapy. Treatment with PCA was associated with significantly shorter LOS in the unadjusted analyses (7.46 vs. 9.42 d, P=0.001), but the difference was not significant after adjustment (adjusted difference: 1.47 d, P=0.06). Treatment with PCA was also associated with significantly decreased risk of 30-day readmission in unadjusted analysis (odds ratio [OR]unadj: 0.69; 95% confidence interval [CI]: 0.54-0.89, P=0.004), but after adjustment the association was no longer significant (ORadj: 0.76; 95% CI: 0.54-1.06, P=0.11). Finally, treatment with PCA was not associated with increased risk of discharge against medical advice in Generalized Estimating Equation modeled unadjusted (ORunadj: 1.10; 95% CI: 0.69-1.76, P=0.68), or adjusted analysis (ORadj: 1.19; 95% CI: 0.73-1.94, P=0.49).

Conclusions:

Treatment with PCA may be associated with shorter LOS and may be considered as the primary modality for opioid-based pain control for patients with SCD who are admitted with painful VOC.
Pharmacokinetic/Pharmacodynamic Analysis of Voriconazole Against Candida spp. and Aspergillus spp. in Allogeneic Stem Cell Transplant Recipients
Authors: Perez-Pitarch Alejandro , Guglieri-Lopez Beatriz , Ferriols-Lisart Rafael , Pérez Ariadna , Ezquer-Garín Carlos , Hernández-Boluda Juan C. , Piñana Jose L. , Navarro David , Solano Carlos , Alós-Almiñana Manuel
Published: May 2019

Background:

To evaluate the adequacy of different dosing regimens of voriconazole for the prophylaxis of invasive candidiasis and aspergillosis in adult allogeneic stem cell transplant recipients by means of population pharmacokinetic (PK) modelling and simulation.

Methods:

Allogeneic stem cell transplant recipients receiving voriconazole were included in this observational study. A population PK model was developed. Three oral voriconazole-dosing regimens were simulated: 200, 300, and 400 mg twice daily. The pharmacodynamic target was defined as fAUC0–24/0.7. A probability of target attainment ≥90% was considered optimal. The cumulative fraction of response was defined as the fraction of patients achieving the pharmacodynamic target when a population of simulated patients is matched with a simulated population of different Candida spp. and Aspergillus spp. The percentage of patients with trough plasma concentrations at steady state (Ctrough) within the reference range (1–5.5 mg/L) was also calculated.

Results:

A 2-compartment PK model was developed using data from 40 patients, which contributed 237 voriconazole plasma samples, including trough and maximum concentrations. Voriconazole 200, 300, and 400 mg twice daily achieved probability of target attainment ≥90% for minimal inhibitory concentration values ≤0.25, ≤0.38, and ≤0.50 mg/L, respectively. The cumulative fraction of response for A. niger, A. versicolor, and A. flavus increased >10% when increasing voriconazole dose from 200 to 400 mg twice daily (from 72.5% to 89.5% for A. niger; from 77.7% to 88.7% for A. versicolor; and from 82.4% to 94.9% for A flavus). The percentage of patients with Ctrough within the reference range increased 15% when voriconazole dose was increased from 200 to 300 mg twice daily.

Conclusions:

The PK simulations in this study suggest that transplant recipients on voriconazole prophylaxis against invasive candidiasis or aspergillosis are likely to achieve the target concentrations associated with the desired treatment outcomes if the maintenance dose is 200 mg twice daily. However, Aspergillus spp. with high minimal inhibitory concentrations could require higher maintenance doses.
Improve Markets, Not Government Controls, for Real Health Reform
Authors: Antos Joseph
Published: May 2019

Proposals to replace the existing mix of public and private health financing with a fully nationalized government system (“Medicare for All”) fail to address fundamental problems of high cost, overutilization, and inefficiency. Those proposals are a reaction to the Affordable Care Act, which provided new insurance subsidies but did little to solve the cost problem. Stabilizing the individual insurance market is not the goal. Reform should focus on making the entire insurance market and the health delivery system more efficient and more equitable by promoting consumer choice, market competition, private initiative, and state experimentation.
Increased Sensorimotor Cortex Activation With Decreased Motor Performance During Functional Upper Extremity Tasks Poststroke
Authors: Lim Shannon B. , Eng Janice J.
Published: May 2019

Background and Purpose:

Current literature has focused on identifying neuroplastic changes associated with stroke through tasks and in positions that are not representative of functional rehabilitation. Emerging technologies such as functional near-infrared spectroscopy (fNIRS) provide new methods of expanding the area of neuroplasticity within rehabilitation. This study determined the differences in sensorimotor cortex activation during unrestrained reaching and gripping after stroke.

Methods:

Eleven individuals with chronic stroke and 11 neurologically healthy individuals completed reaching and gripping tasks under 3 conditions using their (1) stronger, (2) weaker, and (3) both arms together. Performance and sensorimotor cortex activation using fNIRS were collected. Group and arm differences were calculated using mixed analysis of covariance (covariate: age). Pairwise comparisons were used for post hoc analyses. Partial Pearson correlations between performance and activation were assessed for each task, group, and hemisphere.

Results:

Larger sensorimotor activations in the ipsilesional hemisphere were found for the stroke compared with healthy group for reaching and gripping conditions despite poorer performance. Significant correlations were observed between gripping performance (with the weaker arm and both arms simultaneously) and sensorimotor activation for the stroke group only.

Discussion and Conclusions:

Stroke leads to significantly larger sensorimotor activation during functional reaching and gripping despite poorer performance. This may indicate an increased sense of effort, decreased efficiency, or increased difficulty after stroke. fNIRS can be used for assessing differences in brain activation during movements in functional positions after stroke. This can be a promising tool for investigating possible neuroplastic changes associated with functional rehabilitation interventions in the stroke population.

Video Abstract available for more insights from the authors (see Video Abstract, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A269).
Chronic pain: breaking free from stickiness
Authors: Firouzian Shahrzad , Osborne Natalie R.
Published: May 2019

By introducing the concept of “pain stickiness” underlying treatment-resistant pain, Borsook et al. take a neurobiological perspective to capture the factors that may contribute to the transition of pain from acute to chronic form. However, there is more to consider, including the interconnected influences of resilience, brain gray matter and connectivity, sex differences, and the role of the environment. There still remains the question of how to eliminate this stickiness.