bluuebunny/crossref_metadata_2025 huggingface dataset:
Composition and inclusion of probiotics in broiler diets alter intestinal permeability and spleen immune cell profiles without negatively affecting performance1
Authors: Meyer Meaghan M , Fries-Craft Krysten A , Bobeck Elizabeth A
Published: December 2019

Probiotic feed additives with potential to enhance performance, health, and immunity have gained considerable popularity in commercial broiler production. The study objectives were to measure broiler performance, gut integrity, and splenic immune cell profiles in birds fed one of two probiotics at two inclusion levels. Nine hundred sixty Ross 708 broilers (12 per pen) were randomly assigned to no additive control, 0.05% or 0.10% LactoCare (Lactobacillus reuteri), or 0.05% or 0.10% LactoPlan (Lactobacillus plantarum) dietary treatments for 6 wk. On day 27, a 20-pen subset was utilized for a fluorescein isothiocyanate dextran (FITC-d) assay, where half of the pens were subject to a 12-h feed restriction (FR) pregavage. Serum collected from blood drawn 1-h postgavage was analyzed for relative fluorescence of FITC-d absorbed across the intestinal barrier as a gut leakiness indicator. On day 42, spleens from eight birds per treatment were collected for immune cell profile analysis by multicolor flow cytometry. Although performance outcomes were not affected by dietary treatment, FITC-d absorption post-FR was increased 57% in the 0.05% LactoPlan treatment, and was decreased by 12.6% in the 0.05% LactoCare diet, 12% in the 0.10% LactoCare diet, and 22% in the 0.10% LactoPlan diet compared with the control. This indicates a positive impact in barrier integrity maintenance due to 0.05% and 0.10% LactoCare and 0.10% LactoPlan diet following a challenge. Immune cell profiles varied between the two probiotic compositions, with an approximately 50% reduction in splenic innate immune cells (monocyte/macrophage+) in birds fed LactoPlan (P < 0.0001) and greater overall percentages of CD45+ leukocytes and CD3+ T cells in birds fed 0.10% LactoCare (P < 0.0001). LactoPlan diets shifted splenic T-cell populations in favor of CD8α + cytotoxic T cells (TC; P = 0.007), while higher inclusions (0.10%) of either probiotic increased the percentage of activated CD4+ helper T cells (TH; P < 0.0001). These results indicate that compositionally different probiotics had varying effects on the gut permeability and splenic immune cell profiles in broiler chickens, particularly at higher inclusion rates, but observed changes to underlying physiology did not negatively impact performance outcomes. The ability of a probiotic to alter gut permeability and immune cell profile, therefore, may depend on the compositional complexity of the product as well as inclusion rate.
Impact of Colorized Display of Mammograms on Lesion Detection
Authors: Knippa Emily E , Berg Erica , Richard Samuel , Lin Yuan , Roy Choudhury Kingshuk , Samei Ehsan , Baker Jay A
Published: December 2019

Objective

To assess the effect of the colorized display of digital mammograms on observer detection of subtle breast lesions.

Methods

Three separate observer studies compared detection performance using grayscale versus color display of 1) low-contrast mass-like objects in a standardized mammography phantom; 2) simulated microcalcifications in a background of normal breast parenchyma; and 3) standard-of-care clinical digital mammograms with subtle calcifications and masses. Colorization of the images was done by displaying each image pixel in blue, green, and red hues, or gray, maintaining DICOM–calibrated luminance scale and consistent luminance range. For the simulated calcifications and clinical mammogram studies, comparison of detection rates was computed using McNemar’s test for paired differences.

Results

For the phantom study, mass-like object detection was significantly better using a green colormap than grayscale (73.3% vs 70.8%, P = .009), with no significant improvement using blue or red colormaps (72.6% and 72.5%, respectively). For simulated microcalcifications, no significant difference was noted in detection using the green colormap, as compared with grayscale. For clinical digital screening mammograms, no significant difference was noted between gray and green colormaps for detection of microcalcifications. Green color display, however, resulted in decreased sensitivity for detection of subtle masses (63% vs 69%, P = .03).

Conclusion

Although modest improvement was demonstrated for a detection task using colorized display of a standard mammography phantom, no significant improvement was demonstrated using a color display for a simulated clinical detection task, and actual clinical performance was worse for colorized display of mammograms in comparison to standard grayscale display.
Evaluation of Insecticide Thresholds in Late-Planted Bt and Non-Bt Corn for Management of Fall Armyworm (Lepidoptera: Noctuidae)
Authors: Bilbo Tom R , Reay-Jones Francis P F , Greene Jeremy K
Published: December 2019

The fall armyworm, Spodoptera frugiperda (J. E. Smith), is a major pest of corn in North and South America. It is managed primarily with transgenic corn-producing insecticidal proteins of Bacillus thuringiensis (Bt), but the development of resistance threatens their durability and necessitates the use of alternative management strategies. We conducted late-planted field trials during 2016 and 2017 in South Carolina using natural infestations. We evaluated the use of Bt and non-Bt corn hybrids in combination with foliar applications of chlorantraniliprole at varying infestation thresholds to protect field corn from infestation and damage and determine effects on grain yield. All Bt hybrids were more effective at reducing fall armyworm infestation rates and leaf injury than multiple insecticide sprays, and no Bt hybrid reached the lowest infestation threshold (20%) to require supplemental insecticide treatments, despite infestations in non-Bt corn reaching >68% in each year. The only Bt and/or insecticide treatment to significantly reduce ear feeding or the proportion of ears injured (mainly by Helicoverpa zea [Boddie]) was the Bt hybrid pyramid producing Vip3A. However, significant protection of yield was detected only in the Bt hybrids producing Cry1A.105 + Cry2Ab2. All Bt traits tested in this study were effective in reducing infestation and feeding damage from fall armyworm, although this did not always result in significant protection of yield. Our results demonstrate the potential and limitations of using chlorantraniliprole with Bt (when resistance is present) and non-Bt corn to manage this pest.
From Conventions to Protocols: Conceptualizing Changes to the International Dispute Resolution Landscape
Authors: Guo Yvonne
Published: December 2019

The recently-concluded Singapore Mediation Convention and Hague Judgements Convention have aimed to facilitate the cross-border enforcement of mediated settlement agreements and court judgements in the same way that the New York Convention has facilitated the cross-border enforcement of arbitral awards. This shift in the international dispute resolution landscape is analysed on three levels: normative, strategic and operational. Drawing from theories of private international law, international political economy and comparative public policy, this article asserts that convergent public and private interests likely championed the elaboration of international conventions as a means of promoting harmonization in international dispute settlement. It demonstrates that while the conversion of court judgements and mediated settlement agreements into arbitral awards could also have facilitated their cross-border enforcement, the further development of new mechanisms that respond directly to commercial parties’ needs remains necessary to complement the evolving treaty framework.
Barriers and Facilitators to Involvement in Children’s Diabetes Management Among Minority Parents
Authors: Butler Ashley M , Hilliard Marisa E , Titus Courtney , Rodriguez Evadne , Al-Gadi Iman , Cole-Lewis Yasmin , Thompson Deborah
Published: December 2019

Objective

This study aimed to describe parents’ perceptions of the factors that facilitate or are barriers to their involvement in children’s type 1 diabetes (T1D) management among African American and Latino parents.

Methods

African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability–Opportunity–Motivation–Behavior (COM-B) framework.

Results

Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents’ desire for their child to have a “normal” life was described as both a Motivation-based facilitator and barrier.

Conclusions

African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families’ unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children’s diabetes management.
Incidence and Clinical Outcomes of Streptococcus anginosus in Acute Complicated Sinusitis: A Pediatric Cohort
Authors: Troy Elizabeth , Sillau Stefan , Bernard Timothy J , Rao Suchitra
Published: December 2019

We conducted a retrospective cohort study of 160 hospitalized children admitted for acute complicated sinusitis and compared children with S anginosus–associated infection to children with other or no pathogens identified. The incidence of S anginosus–associated infections increased 12% per year, and infections with S anginosus are associated with increased morbidity.
The GATA transcription factor GNC plays an important role in photosynthesis and growth in poplar
Authors: An Yi , Zhou Yangyan , Han Xiao , Shen Chao , Wang Shu , Liu Chao , Yin Weilun , Xia Xinli
Published: December 2019

GATA transcription factors are involved in the regulation of diverse growth processes and environmental responses in Arabidopsis and rice. In this study, we conducted a comprehensive bioinformatic survey of the GATA family in the woody perennial Populus trichocarpa. Thirty-nine Populus GATA genes were classified into four subfamilies based on gene structure and phylogenetic relationships. Predicted cis-elements suggested potential roles of poplar GATA genes in light, phytohormone, development, and stress responses. A poplar GATA gene, PdGATA19/PdGNC (GATA nitrate-inducible carbon-metabolism-involved), was identified from a fast growing poplar clone. PdGNC expression was significantly up-regulated in leaves under both high (50 mM) and low (0.2 mM) nitrate concentrations. The CRISPR/Cas9-mediated mutant crispr-GNC showed severely retarded growth and enhanced secondary xylem differentiation. PdGNC-overexpressing transformants exhibited 25–30% faster growth, 20–28% higher biomass accumulation, and ~25% increase in chlorophyll content, photosynthetic rate, and plant height, compared with the wild type. Transcriptomic analysis showed that PdGNC was involved in photosynthetic electron transfer and carbon assimilation in the leaf, cell division and carbohydrate utilization in the stem, and nitrogen uptake in the root. These data indicated that PdGNC plays a crucial role in plant growth and is potentially useful in tree molecular breeding.
Joint Space Injection for Osteitis Pubis in an Airborne Jump Injury: A Case Report
Authors: Beall Jackson P , Oliver Joshua J , Bridwell Rachel E , Young Scott E
Published: December 2019

Osteitis Pubis (OP) is groin pain caused by overloading stresses on the pubic symphysis. This is often caused by the repetitive stress seen in competitive sports, but can also be caused by rapid acceleration or deceleration. It is a diagnosis of exclusion made after other entities such as fracture or infection are ruled out. It is often treated conservatively with rest, Non-Steroidal Anti-inflammatories (NSAIDS), and Physical Therapy (PT). After these treatment modalities have failed, intra-articular injection with local anesthetics and steroids can be considered. We report a case of a 22-year-old Male Active Duty Army Soldier who presented with OP immediately after landing during a routine Airborne Jump exercise. The Soldier reported landing in such a way that his feet did not impact the ground at the same time, creating a sheering force on his pelvis. Following two months of failed treatment involving NSAIDS and PT, the patient was referred to Sports Medicine where he received an injection of 1 mL of 1% lidocaine and 40 mg of triamcinolone into the pubic symphysis joint space. Shortly afterward the patient endorses complete resolution of his symptoms without return of symptoms at 1-month follow-up. Although injection of the pubic symphysis with local anesthetic and steroids has been previously described, this is the first time it has been described in a jump injury.
Analysis of Factors and Conditions Influencing Military Neurosurgery Recruitment and Retention
Authors: Menger Richard , LeFever Devon C , Zuckerman Scott L , Robbins J Will , Bell Randy
Published: December 2019

Introduction: The Defense Health Agency has shifted focus of military medicine to operational readiness. As such, neurosurgery remains a critical wartime specialty. We investigate the factors impacting recruitment and retention of military neurosurgeons. Methods: Survey of military neurosurgeons was performed via the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Committee of Military Neurosurgeons and the Council of State Neurosurgical Societies. Retention and recruitment were queried. Results: 93/119 (78.2%) current or previously affiliated military neurosurgeons would recommend service as a military neurosurgeon to a colleague. Those who felt a sense of patriotism were 4.3 times more likely to recommend military service (P = 0.027, CI 1.19–16.82). Those who developed a sense of camaraderie showed a trend to recommending military neurosurgery (P = 0.058, CI 0.95–9.78). Those with a current military obligation were.28 times (P = 0.02, CI 0.09–0.85) as likely to recommend service. Military physicians who felt a need for reform to increase salary were 2.5 times less likely to be retained. Discussion: Service in the US military is a positive experience with camaraderie, patriotism, and unique military experiences predictive of recruitment. Meanwhile, focus on pay discrepancy can result in lost retention. These factors should be explored regarding recruitment and retention of military neurosurgeons.
The Association Between History of an Ankle Sprain and Traumatic Meniscal Injury Among Infantry Combat Soldiers in the Israeli Defense Forces: A Historical Cohort Study
Authors: Schwartz Oren , Bulis Shir , Olsen Cara H , Glasberg Elon , Dudkiewicz Israel
Published: December 2019

Introduction

The high frequency and number of ankle inversion injuries and meniscal injuries in military populations is an area of concern due to the debilitating effects and cumulative consequences of these particular injuries on the soldiers sustaining injury and the consequences on the operational effectiveness of the Israeli Defense Force (IDF). This study examines the possible relationship between ankle inversion injury and potential for subsequent meniscal injury in infantry soldiers in the IDF.

Material and Methods

All 89,069 infantry combat soldiers (including special units), recruited to the IDF between 2007 and 2017 were included in this study. A historical cohort study was conducted. The cohort was divided into two groups: The exposure group included all participants that had suffered at least one ankle sprain in the past and the unexposed group that included all participants who did not suffer an ankle sprain in the past. A Cox proportional-hazards model (COX) model was used in order to obtain the adjusted to confounders association between exposure and outcome expressed in hazard ratio (HR).

Results

The crude association between ankle sprain in the past and the development of meniscal injury in this study was 0.87 (Relative risk = 0.87, P = 0.007). After adjusting for unit type, Body Mass Index (BMI), previous fracture of the lower limb, and the use of eyeglasses, using a COX model, the adjusted association between ankle sprain in the past and the development of meniscal injury was 0.8 (HR = 0.8, P = 0.001, confidence interval (95%) 0.74, 0.88).

Conclusion

The results of this study indicate ankle sprains to be a protective factor for meniscal injury. Our main conclusion from the results of this study is that the assumption that those with previous leg injuries are at a greater risk for further leg injuries is questionable and cannot be generalized. Hence, the association between different types of injuries should be investigated separately.
Dasypus septemcinctus (Cingulata: Dasypodidae)
Authors: Feijó Anderson
Published: December 2019

Dasypus septemcinctus Linnaeus, 1758, commonly called the seven-banded armadillo, is the smallest species of the genus Dasypus, with 6–7 movable bands and a flattened dorsal profile of the skull. It has the most southern distribution of the genus, with a latitudinal range from 0º to 39ºS, including Brazil, eastern Paraguay, Bolivia, Uruguay, and eastern, central, and northern Argentina. D. septemcinctus is diurnal, feeds mainly on insects, and has been recorded in savannas, grasslands, forests, and disturbed habitats. It is classified as “Least Concern” by the International Union for Conservation of Nature and Natural Resources and the major threats are hunting and habitat loss.
A key interaction with RPA orients XPA in NER complexes
Authors: Topolska-Woś Agnieszka M , Sugitani Norie , Cordoba John J , Le Meur Kateryna V , Le Meur Rémy A , Kim Hyun Suk , Yeo Jung-Eun , Rosenberg Daniel , Hammel Michal , Schärer Orlando D , Chazin Walter J
Published: December 2019

The XPA protein functions together with the single-stranded DNA (ssDNA) binding protein RPA as the central scaffold to ensure proper positioning of repair factors in multi-protein nucleotide excision repair (NER) machinery. We previously determined the structure of a short motif in the disordered XPA N-terminus bound to the RPA32C domain. However, a second contact between the XPA DNA-binding domain (XPA DBD) and the RPA70AB tandem ssDNA-binding domains, which is likely to influence the orientation of XPA and RPA on the damaged DNA substrate, remains poorly characterized. NMR was used to map the binding interfaces of XPA DBD and RPA70AB. Combining NMR and X-ray scattering data with comprehensive docking and refinement revealed how XPA DBD and RPA70AB orient on model NER DNA substrates. The structural model enabled design of XPA mutations that inhibit the interaction with RPA70AB. These mutations decreased activity in cell-based NER assays, demonstrating the functional importance of XPA DBD–RPA70AB interaction. Our results inform ongoing controversy about where XPA is bound within the NER bubble, provide structural insights into the molecular basis for malfunction of disease-associated XPA missense mutations, and contribute to understanding of the structure and mechanical action of the NER machinery.
Species-specific recruitment of transcription factors dictates toxin expression
Authors: Trouillon Julian , Sentausa Erwin , Ragno Michel , Robert-Genthon Mylène , Lory Stephen , Attrée Ina , Elsen Sylvie
Published: December 2019

Tight and coordinate regulation of virulence determinants is essential for bacterial biology and involves dynamic shaping of transcriptional regulatory networks during evolution. The horizontally transferred two-partner secretion system ExlB–ExlA is instrumental in the virulence of different Pseudomonas species, ranging from soil- and plant-dwelling biocontrol agents to the major human pathogen Pseudomonas aeruginosa. Here, we identify a Cro/CI-like repressor, named ErfA, which together with Vfr, a CRP-like activator, controls exlBA expression in P. aeruginosa. The characterization of ErfA regulon across P. aeruginosa subfamilies revealed a second conserved target, the ergAB operon, with functions unrelated to virulence. To gain insights into this functional dichotomy, we defined the pan-regulon of ErfA in several Pseudomonas species and found ergAB as the sole conserved target of ErfA. The analysis of 446 exlBA promoter sequences from all exlBA+ genomes revealed a wide variety of regulatory sequences, as ErfA- and Vfr-binding sites were found to have evolved specifically in P. aeruginosa and nearly each species carries different regulatory sequences for this operon. We propose that the emergence of different regulatory cis-elements in the promoters of horizontally transferred genes is an example of plasticity of regulatory networks evolving to provide an adapted response in each individual niche.
Pilot Randomized Controlled Trial of Web-Delivered Acceptance and Commitment Therapy Versus Smokefree.gov for Smokers With Bipolar Disorder
Authors: Heffner Jaimee L , Kelly Megan M , Waxmonsky Jeanette , Mattocks Kristin , Serfozo Edit , Bricker Jonathan B , Mull Kristin E , Watson Noreen L , Ostacher Michael
Published: December 2019

Introduction

Smokers with bipolar disorder (BD) are less successful at quitting than the general population. In this study, we evaluated in a pilot randomized controlled trial a novel, targeted, web-based intervention for smokers with BD based on acceptance and commitment therapy (ACT) and designed for reach and disseminability.

Aims and Methods

Daily smokers (n = 51) with bipolar I or II disorder were recruited from four US sites and randomly assigned to one of two web-based smoking cessation interventions—ACT-based WebQuit Plus (n = 25) or Smokefree.gov (n = 26) over a 10-week treatment period. All participants received nicotine patch for 8 weeks. Key outcomes were trial design feasibility, intervention acceptability, and cessation at end of treatment and 1-month follow-up.

Results

We screened 119 to enroll 51 participants (target sample size = 60) over 24 months. The most common reason for ineligibility was the inability to attend study appointments. Retention was 73% at end of treatment and 80% at follow-up, with no differences by arm. The mean number of logins was twice as high for WebQuit Plus (10.3 vs. 5.3). The usefulness of program skills was rated higher for WebQuit Plus (75% vs. 29%). Biochemically confirmed, 7-day abstinence at end of treatment was 12% in WebQuit Plus versus 8% in Smokefree.gov (odds ratio = 1.46, 95% confidence interval = 0.21 to 9.97). At follow-up, abstinence rates were 8% in both arms.

Conclusions

Trial design produced favorable retention rates, although alternative recruitment methods will be needed for a larger trial. At end of treatment, acceptability and estimated effect size of WebQuit Plus relative to Smokefree.gov were promising and support continued program refinement and evaluation.

Implications

In this first randomized controlled trial of a targeted intervention for smokers with BD, we found that the ACT-based WebQuit Plus intervention, delivered in combination with the nicotine patch, had promising acceptability and cessation outcomes relative to Smokefree.gov. The observed signals for acceptability and cessation suggest that the WebQuit Plus program should be refined based on participant feedback and evaluated in a larger trial. Feasibility findings from this study also provide direction for refining trial procedures to enhance the recruitment of smokers with BD.
Diagnostic Accuracy of a Novel and Rapid Lipoarabinomannan Test for Diagnosing Tuberculosis Among People With Human Immunodeficiency Virus
Authors: Bjerrum Stephanie , Broger Tobias , Székely Rita , Mitarai Satoshi , Opintan Japheth A , Kenu Ernest , Lartey Margaret , Addo Kennedy K , Chikamatsu Kinuyo , Macé Aurélien , Schumacher Samuel G , Moreau Emmanuel , Shah Maunank , Johansen Isik Somuncu , Denkinger Claudia M
Published: December 2019

Background

The novel Fujifilm SILVAMP TB-LAM (FujiLAM) assay detects mycobacterial lipoarabinomannan in urine and has demonstrated superior sensitivity to the Alere Determine TB-LAM Ag (AlereLAM) assay for detection of tuberculosis among hospitalized people with human immunodeficiency virus (PWH). This is the first study to evaluate the assay among a broad population referred for antiretroviral therapy including both outpatients (mainly) and inpatients.

Methods

We assessed diagnostic accuracy of FujiLAM and AlereLAM assays in biobanked urine samples from a cohort of adults referred for antiretroviral therapy in Ghana against a microbiological and a composite (including clinical judgement) reference standard, and we assessed the association of FujiLAM test positivity with mortality.

Results

We evaluated urine samples from 532 PWH (462 outpatients, 70 inpatients). Against a microbiological reference standard, the sensitivity of FujiLAM was 74.2% (95% confidence interval [CI], 62.0–84.2) compared to 53.0% (95% CI, 40.3–65.4) for AlereLAM, a difference of 21.2% (CI, 13.1–32.5). Specificity was 89.3% (95% CI, 85.8–92.2) versus 95.6% (95% CI, 93.0–97.4) for FujiLAM and AlereLAM, a difference of −6.3% (95% CI −9.6 to −3.3). Specificity estimates for FujiLAM increased markedly to 98.8% (95% CI, 96.6–99.8) in patients with CD4 >100 cells/µL and when using a composite reference standard. FujiLAM test positivity was associated with increased cumulative risk of mortality at 6 months (hazard ratio, 4.80; 95% CI, 3.01–7.64).

Conclusions

FujiLAM offers significantly increased diagnostic sensitivity in comparison to AlereLAM. Specificity estimates for FujiLAM were lower than for AlereLAM but were affected by the limited ability of the reference standard to correctly diagnose tuberculosis in individuals with low CD4 counts.
Polypharmacy, Drug–Drug Interactions, and Inappropriate Drugs: New Challenges in the Aging Population With HIV
Authors: Courlet Perrine , Livio Françoise , Guidi Monia , Cavassini Matthias , Battegay Manuel , Stoeckle Marcel , Buclin Thierry , Alves Saldanha Susana , Csajka Chantal , Marzolini Catia , Decosterd Laurent ,   Swiss HIV Cohort Study, Anagnostopoulos A , Battegay M , Bernasconi E , Böni J , Braun D L , Bucher H C , Calmy A , Cavassini M , Ciuffi A , Dollenmaier G , Egger M , Elzi L , Fehr J , Fellay J , Furrer H , Fux C A , Günthard H F , Haerry D , Hasse B , Hirsch H H , Hoffmann M , Hösli I , Huber M , Kahlert C R , Kaiser L , Keiser O , Klimkait T , Kouyos R D , Kovari H , Ledergerber B , Martinetti G , Martinez de Tejada B , Marzolini C , Metzner K J , Müller N , Nicca D , Paioni P , Pantaleo G , Perreau M , Rauch A , Rudin C , Scherrer A U , Schmid P , Speck R , Stöckle M , Tarr P , Trkola A , Vernazza P , Wandeler G , Weber R , Yerly S
Published: December 2019

Background

Antiretroviral therapy has transformed HIV infection from a deadly into a chronic condition. Aging people with HIV (PWH) are at higher risk of polypharmacy, potential drug–drug interactions (DDIs), and potentially inappropriate medications (PIMs). This study aims to compare prescribed drugs, polypharmacy, and potential DDIs between young (<65 years old) and elderly (≥65 years old) PWH. The prevalence of PIMs was assessed in elderly.

Methods

PWH from 2 centers within the Swiss HIV Cohort Study were asked to fill in a form with all their current medications. Polypharmacy was defined as being on ≥5 non-HIV drugs. PIMs were evaluated using Beers criteria. Potential DDIs for the most prescribed therapeutic classes were screened with the Liverpool interaction database.

Results

Among the 996 PWH included, 122 were ≥65 years old. Polypharmacy was more frequent in the elderly group (44% vs 12%). Medications and potential DDIs differed according to the age group: cardiovascular drugs and related potential DDIs were more common in the elderly group (73% of forms included ≥1 cardiovascular drug; 11% of cardiovascular drugs involved potential DDIs), whereas central nervous system drugs were more prescribed and involved in potential DDIs in younger PWH (26%, 11%). Potential DDIs were mostly managed through dosage adjustments. PIMs were found in 31% of the elderly group.

Conclusions

Potential DDIs remain common, and PIMs constitute an additional burden for the elderly. It is important that prescribers develop and maintain a proactive approach for the recognition and management of DDIs and other prescribing issues frequently encountered in geriatric medicine.
Conceptual Bases of Employee Accountability: A Psychological Approach
Authors: Han Yousueng , Perry James L
Published: December 2019

The external control of public organizations and their members, commonly referred to as accountability, is an enduring theme in public administration. This article shifts attention from a traditional focus on accountability as a macro-institutional matter to the psychology of accountability, that is, whether and how employees internalize accountability systems. The internalization of rules and expectations varies by individual, which, in turn, has significant consequences for accountability outcomes. We theorize that the micro-foundations of employee accountability are affected by five factors: attributability, observability, evaluability, answerability, and consequentiality. These five dimensions are conceptually distinct but interrelated, representing a deeper common psychological construct of employee accountability. Incorporating the psychological approach of accountability advances the potential of public accountability research. We conclude with a discussion of future research and practical implications.
Sleep characteristics and white matter hyperintensities among midlife women
Authors: Thurston Rebecca C , Wu Minjie , Aizenstein Howard J , Chang Yuefang , Barinas Mitchell Emma , Derby Carol A , Maki Pauline M
Published: December 2019

Study Objectives

Sleep disturbance is common among midlife women. Poor self-reported sleep characteristics have been linked to cerebrovascular disease and dementia risk. However, little work has considered the relation of objectively assessed sleep characteristics and white matter hyperintensities (WMHs), a marker of small vessel disease in the brain. Among 122 midlife women, we tested whether women with short or disrupted sleep would have greater WMH, adjusting for cardiovascular disease (CVD) risk factors, estradiol, and physiologically assessed sleep hot flashes.

Methods

We recruited 122 women (mean age = 58 years) without a history of stroke or dementia who underwent 72 h of actigraphy to quantify sleep, 24 h of physiologic monitoring to quantify hot flashes; magnetic resonance imaging to assess WMH; phlebotomy, questionnaires, and physical measures (blood pressure, height, and weight). Associations between actigraphy-assessed sleep (wake after sleep onset and total sleep time) and WMH were tested in linear regression models. Covariates included demographics, CVD risk factors (blood pressure, lipids, and diabetes), estradiol, mood, and sleep hot flashes.

Results

Greater actigraphy-assessed waking after sleep onset was associated with more WMH [B(SE) = .008 (.002), p = 0.002], adjusting for demographics, CVD risk factors, and sleep hot flashes. Findings persisted adjusting for estradiol and mood. Neither total sleep time nor subjective sleep quality was related to WMH.

Conclusions

Greater actigraphy-assessed waking after sleep onset but not subjective sleep was related to greater brain WMH among midlife women. Poor sleep may be associated with brain small vessel disease at midlife, which can increase the risk for brain disorders.
Sleep staging from electrocardiography and respiration with deep learning
Authors: Sun Haoqi , Ganglberger Wolfgang , Panneerselvam Ezhil , Leone Michael J , Quadri Syed A , Goparaju Balaji , Tesh Ryan A , Akeju Oluwaseun , Thomas Robert J , Westover M Brandon
Published: December 2019

Study Objectives

Sleep is reflected not only in the electroencephalogram but also in heart rhythms and breathing patterns. We hypothesized that it is possible to accurately stage sleep based on the electrocardiogram (ECG) and respiratory signals.

Methods

Using a dataset including 8682 polysomnograms, we develop deep neural networks to stage sleep from ECG and respiratory signals. Five deep neural networks consisting of convolutional networks and long- and short-term memory networks are trained to stage sleep using heart and breathing, including the timing of R peaks from ECG, abdominal and chest respiratory effort, and the combinations of these signals.

Results

ECG in combination with the abdominal respiratory effort achieved the best performance for staging all five sleep stages with a Cohen’s kappa of 0.585 (95% confidence interval ±0.017); and 0.760 (±0.019) for discriminating awake vs. rapid eye movement vs. nonrapid eye movement sleep. Performance is better for younger ages, whereas it is robust for body mass index, apnea severity, and commonly used outpatient medications.

Conclusions

Our results validate that ECG and respiratory effort provide substantial information about sleep stages in a large heterogeneous population. This opens new possibilities in sleep research and applications where electroencephalography is not readily available or may be infeasible.
How stress affects sleep and mental health: nocturnal heart rate increases during prolonged stress and interacts with childhood trauma exposure to predict anxiety
Authors: Azza Yasmine , Grueschow Marcus , Karlen Walter , Seifritz Erich , Kleim Birgit
Published: December 2019

Study Objectives

Stress can adversely impact sleep health by eliciting arousal increase and a cascade of endocrine reactions that may impair sleep. To date, little is known regarding continuous effects of real-world stress on physiological sleep characteristics and potential effects on stress-related psychopathology. We examined effects of stress on heart rate (HR) during sleep and total sleep time (TST) during prolonged real-world stress exposure in medical interns. Moreover, we investigated the influence of previous stress and childhood trauma exposure on HR during sleep, TST, and its interaction in predicting anxiety.

Methods

We examined a sample of 50 medical students prior to and during their first internship, a well described real-world stressor. HR and TST were continuously collected over 12 weeks non-invasively by a wrist-worn activity monitor. Prior to starting the internship, at baseline, participants reported on their sleep, anxiety, and childhood trauma exposure. They also tracked stress exposure during internship and reported on their anxiety symptoms 3 months after this professional stress.

Results

Mean HR during sleep increased over time, while TST remained unchanged. This effect was more pronounced in interns exposed to childhood trauma exposure. In multilevel models, childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety.

Conclusions

Prolonged stress may lead to increased HR during sleep, whereas individuals with childhood trauma exposure are more vulnerable. Childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. These findings may inform prevention and intervention measures.
The European starling (Sturnus vulgaris) shows signs of NREM sleep homeostasis but has very little REM sleep and no REM sleep homeostasis
Authors: van Hasselt Sjoerd J , Rusche Maria , Vyssotski Alexei L , Verhulst Simon , Rattenborg Niels C , Meerlo Peter
Published: December 2019

Most of our knowledge about the regulation and function of sleep is based on studies in a restricted number of mammalian species, particularly nocturnal rodents. Hence, there is still much to learn from comparative studies in other species. Birds are interesting because they appear to share key aspects of sleep with mammals, including the presence of two different forms of sleep, i.e. non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. We examined sleep architecture and sleep homeostasis in the European starling, using miniature dataloggers for electroencephalogram (EEG) recordings. Under controlled laboratory conditions with a 12:12 h light–dark cycle, the birds displayed a pronounced daily rhythm in sleep and wakefulness with most sleep occurring during the dark phase. Sleep mainly consisted of NREM sleep. In fact, the amount of REM sleep added up to only 1~2% of total sleep time. Animals were subjected to 4 or 8 h sleep deprivation to assess sleep homeostatic responses. Sleep deprivation induced changes in subsequent NREM sleep EEG spectral qualities for several hours, with increased spectral power from 1.17 Hz up to at least 25 Hz. In contrast, power below 1.17 Hz was decreased after sleep deprivation. Sleep deprivation also resulted in a small compensatory increase in NREM sleep time the next day. Changes in EEG spectral power and sleep time were largely similar after 4 and 8 h sleep deprivation. REM sleep was not noticeably compensated after sleep deprivation. In conclusion, starlings display signs of NREM sleep homeostasis but the results do not support the notion of important REM sleep functions.
In vitro evaluation of Lactobacillus plantarum as direct-fed microbials in high-producing dairy cows diets
Authors: Monteiro Hugo F , Lelis Ana Laura J , Brandao Virginia L N , Faccenda Andressa , Avila Andre S , Arce-Cordero Jose , Silva Lorrayny G , Dai Xiaoxia , Restelatto Rasiel , Carvalho Perivaldo , Lima Leni R , Faciola Antonio P
Published: December 2019

The objectives of this study were: 1) to compare the effects of live yeast (LY), yeast fermentation product (YFP), a mix of Lactobacillus acidophilus and Propionibacterium freudenreichii (MLP), and Lactobacillus plantarum included as additives in dairy cows’ diets on in vitro ruminal fermentation and gas production (GP); and 2) to evaluate the effects of L. plantarum as direct-fed microbials (DFM) in dairy cows’ diets on in vitro ruminal fermentation, GP, nutrient digestibility, and N metabolism. Three experiments were carried out: Exp. 1 had the objective to compare all additives regarding ruminal fermentation parameters: an Ankom GP system was used in a completely randomized design, consisting of four 48 h incubations, and eight replications per treatment. There were eight treatments: a basal diet without additive (CTRL) or with one of the following additives: LY, YFP, MLP, or L. plantarum at four levels (% of diet Dry Matter (DM)): 0.05% (L1), 0.10% (L2), 0.15% (L3), and 0.20% (L4). In Exp. 2, a batch culture was used to evaluate ruminal fermentation, and CO2 and CH4 production using the same treatments and a similar experimental design, except for having 16 replications per treatment. Based on Exp. 1 and 2 results, Exp. 3 aimed at evaluating the effects of the L. plantarum on ruminal true nutrient digestibility and N utilization in order to evaluate the use of L. plantarum as DFM. The treatments CTRL, MLP, L1, and L2 were used in a replicated 4 × 4 Latin square design using a dual-flow continuous culture system. Data were analyzed using linear and nonlinear regression; treatment means were compared through contrasts, and L treatments in Exp. 1 and 2 were tested for linear, quadratic, and cubic effects. In Exp. 1, all treatments containing additives tended to reduce OM digestibility as well as reduced total volatile fatty acids (VFA) concentration and total GP. The YFP had greater OM digestibility than LY, and MLP treatment had greater total VFA concentration compared to L. plantarum treatments. In Exp. 2, additives reduced CO2 production, and there were no major differences in CH4. In Exp. 3, all additives reduced NH3-N concentration. In conclusion, pH and lactate concentration were not affected in all three experiments regardless of additive tested, suggesting that these additives may not improve ruminal fermentation by pH modulation; and L. plantarum may improve ruminal N metabolism when used as DFM in high-producing dairy cows’ diets, mainly by reducing NH3-N concentration.
Changes in dental care behaviour between 2002 and 2012 and its association with complete dentition in men and women in Switzerland
Authors: Schneider Cornelia , Zitzmann Nicola U. , Zemp Elisabeth
Published: December 2019

Background

In industrialized countries, the awareness of oral hygiene measures has increased and the number of missing teeth has been decreasing. A higher number of missing teeth was reported by women despite their more intense oral hygiene. The aim of this study was to compare oral hygiene and its association to oral health with a complete dentition in women and men in Switzerland between 2002 and 2012.

Methods

Weighted data from the Swiss-Health-Surveys in 2002 and 2012 were used to quantify the number of missing teeth, the prevalence of prosthetic dental restorations, dental visits and tooth brushing. Sex-stratified logistic regression analysis was performed for subjects aged ≥65-yrs to assess associations between a complete or functional dentition and dental visits, frequency of tooth brushing and socio-demographic factors.

Results

In all age groups, the prevalence of dental visits and frequent tooth brushing increased and the prevalence of missing teeth decreased between 2002 and 2012. In 2012, the prevalence of a complete dentition was 87% in men and 85.3% women aged <25-yrs and 8.2% or 15.6% in the ≥85-yrs old. Prevalence of dental visits varied between 45.2% in the ≥85-yrs in 2002 and 73.1% in the 55-65-yrs old in 2012 in women and between 26.0% in the ≥85-yrs in 2002 and 68.1% in the 55-65-yrs old in 2012 in men. Frequent tooth brushing was more often reported by women (87.7%/81.4%) than men (73.5%/65.5%) in 2012 and 2002. Subjects aged ≥65-yrs, who visited their dentist within the last year, were twice as likely to have a functional dentition compared to subjects not having visited their dentist in the last year (men: 2.10, 1.68-2.63; women: 2.16, 1.73-2.70) in 2012, in 2002 this association was even stronger. A complete dentition was also associated with high income, higher education and non-smoking in 2012 in men and women.

Conclusion

In women and men, oral hygiene practices improved and the mean number of missing teeth substantially decreased between 2002 and 2012. Although women followed oral hygiene recommendations more closely than men, they still do not have a higher prevalence of a complete dentition, except in the oldest age groups.
Cost of hypertension illness and associated factors among patients attending hospitals in Southwest Shewa Zone, Oromia Regional State, Ethiopia
Authors: Bogale Addisu , Daba Teferi , Daka Dawit Wolde
Published: December 2019

Background

Hypertension is a common vascular disease and the main risk factor for cardiovascular diseases. The impact of hypertension is on the rise in Ethiopia, so that, it is predictable that the cost of healthcare services will further increase in the future. We aimed to estimate the total cost of hypertension illness among patients attending hospitals in Southwest Shewa zone, Oromia Regional State, Ethiopia.

Patients and methods

Institution based cross-sectional study was conducted from July 1-30, 2018. All hypertensive patients who were on treatment and whose age was greater than eighteen years old were eligible for this study. The total cost of hypertension illness was estimated by summing up the direct and indirect costs. Bivariate and multivariate linear regression analysis was conducted to identify factors associated with hypertension costs of illness.

Results

Overall, the mean monthly total cost of hypertension illness was US $ 22.3 (95% CI, 21.3-23.3). Direct and indirect costs share 51% and 49% of the total cost, respectively. The mean total direct cost of hypertension illness per patient per month was US $11.39(95% CI, 10.6-12.1). Out of these, drugs accounted of a higher cost (31%) followed by food (25%). The mean total indirect cost per patient per month was US $10.89(95% CI, 10.4-11.4). Educational status, distance from hospital, the presence of companion and the stage of hypertension were predictors of the cost of illness of hypertension.

Conclusion

The cost of hypertension illness was very high when compared with the mean monthly income of the patients letting patients to catastrophic costs. Therefore, due attention should be given by the government to protect patients from financial hardships.
The causes and consequences of Alzheimer’s disease: phenome-wide evidence from Mendelian randomization
Authors: Korologou-Linden Roxanna , Howe Laura D , Millard Louise A C , Ben-Shlomo Yoav , Williams Dylan M , Smith George Davey , Anderson Emma L , Stergiakouli Evie , Davies Neil M
Published: December 2019

Importance

Alzheimer’s disease is the leading cause of disability and healthy life years lost. However, to date, there are no proven causal and modifiable risk factors, or effective interventions.

Objective

We aimed to identify: a) factors modified by prodromal Alzheimer’s disease pathophysiology and b) causal risk factors for Alzheimer’s disease. We identified factors modified by Alzheimer’s disease using a phenome-wide association study (PheWAS) on the Alzheimer’s disease polygenic risk score (PRS) (p≤5×10-8), stratified by age tertiles. We used two-sample bidirectional Mendelian randomization (MR) to estimate the causal effects of identified risk factors and correlates on liability for Alzheimer’s disease.

Design, setting, and participants

334,968 participants of the UK Biobank aged 39 to 72 years old (111,656 in each tertile) met our eligibility criteria.

Exposures

Standardized weighted PRS for Alzheimer’s disease at p≤5×10-8.

Main outcomes and measures

All available phenotypes in UK Biobank, including data on health and lifestyle, as well as samples from urine, blood and saliva, at the time of analysis.

Results

Genetic liability for Alzheimer’s disease was associated with red blood cell indices and cognitive measures at all ages. In the middle and older age tertiles, ages 53 and above, higher genetic liability for Alzheimer’s disease was adversely associated with medical history (e.g. atherosclerosis, use of cholesterol-lowering medications), physical measures (e.g. body fat measures), blood cell indices (e.g. red blood cell distribution width), cognition (e.g. fluid intelligence score) and lifestyle (e.g. self-reported moderate activity). In follow-up analyses using MR, there was only evidence that education, fluid intelligence score, hip circumference, forced vital capacity, and self-reported moderate physical activity were likely to be causal risk factors for Alzheimer’s disease.

Conclusion and relevance

Genetic liability for Alzheimer’s disease is associated with over 160 phenotypes, some as early as age 39 years. However, findings from MR analyses imply that most of these associations are likely to be a consequence of prodromal disease or selection, rather than a cause of the disease.