bluuebunny/crossref_metadata_2025 huggingface dataset:
Woodland birds persisting in least disturbed environment: Birds of Dryandra Woodland 1953–2008.
Authors: Fulton Graham R
Published: May 2016

Woodland birds have seriously declined across southern Australian with local extinctions reported in many areas.
Dryandra Woodland presents a contrasting picture to this decline with declining species persisting there. It retains an
almost full community of birds, many of which have declined or disappeared from the surrounding wheatbelt. It is 27
000 ha of remnant woodland, situated ~160 km south-east of Perth, in south-western Australia. Birds were surveyed
predominately by professional biologists and/or taken from their archives, publications and institutional databases for
a 55 year period (173 observation years) from 1953 to 2008; 141 species were detected. Persistence rather than
extinction and increase rather than decline were the dominant paradigms for the birds of Dryandra. This is the inverse
of what has happened in the greater wheatbelt, in which Dryandra is located. It is postulated that Dryandra’s birds
persist because their habitat is relatively unchanged compared to that of the surrounding wheatbelt. Despite the many
‘success stories’ some birds had declined, for example, Malleefowl Leipoa ocellata and Hooded Robin Melanodryas
cucullata. Three species were judged to be locally extinct at Dryandra Spotted Nightjar Eurostopodus argus, Chestnut
Quail-thrush Cinclosoma castanotum and Crested Bellbird Oreoica gutturalis.
Biodiversity - political responsibilities and agendas for research and conservation
Authors: L. Kitching R.
Published: May 2016

Global and national authorities have devised international conventions and national strategies for biodiversity management which commit them to a variety of courses of action in diversity inventory and management. In many instances these refer to "species", displaying a naivety about the nature of "species" and our knowledge of species' taxonomy and diversity. Questions arise about the relative importance of species and this has led to an unfortunate concatenation between the research and management agendas relating to endangered species and those concerning multi-species assemblages. There are compelling reasons for preserving functional ecosystems and the biodiversity they contain: for the maintenance of ecological services, as repositories of biological information, and as a reflection of human conscience and responsibility. Although useful concepts have been defined for evaluating species within such species sets ("keystone species", "guilds", "indicator species", etc.) we lack basic information on the numbers of species within assemblages, which of these species play "keystone" roles, what proportion of any particular ecological guild is vital, and what biological species or sets of species are proper surrogates for measures of overall diversity. A national research agenda must be set which matches national and international commitments with respect to biodiversity and the crucial lack of knowledge in these areas. We need a national strategy for the design and funding of such research activities. Biodiversity management demands a landscape approach, already well developed in Australia, and an on-going involvement of government in overseeing and directing activities.
Toward an ecological framework for sustainability: considerations for ecosystem management
Authors: R. Dovers Stephen , W. Norton Tony
Published: May 2016

Increasingly, resource and environmental management issues are considered within the emerging framework of sustainability (sustainable development, ecologically sustainable development, sustainable environmental management). While this notion has great potential as an integrative framework, current mainstream approaches and definitions tend to be vague, inoperative and do not translate well to the level of management in specific ecosystems. The current debate about "sustainable development" lacks structure, clarity, and an operational direction. In particular, it is difficult to translate the general concerns of sustainability in a manner useful to a task such as ecosystem management. This paper takes a long-term, systems view to construct an integrative approach to sustainability. This approach is more cognisant of ecological realities than the notion of sustainable development as presently construed. Extending the principles thus identified; a checklist of questions to guide considerations in ecosystem management at a more practical level is then constructed. Two examples from resource and environmental management in Australia ? fisheries and the conservation of terrestrial species (particularly the Koala . Phascolarctos cinereus) ? are analysed to support the discussion.
Coral reef gastropods - a sustainable resource?
Authors: L. Poulsen Ann
Published: May 2016

Large, colourful coral reef gastropods including the Giant Triton Charonia tritonis,helmet shells (Cassidae), cowries (Cypraeidae) and volutes (Volutidae) are exploited in an unregulated and unsustainable way throughout much of the Indo-Pacific region. The consequences for their populations, for the populations of their prey or for the ecology of their habitats are rarely considered. Serious decline in stocks of edible coral reef molluscs through unregulated harvesting demonstrates the need for controls on the collection and trade of commercially important species. Continued, unrestricted collecting will eventually lead to the local extinction of vulnerable species on substantial numbers of reefs. Research on the biology and ecology of ornamental species is urgently needed to facilitate the implementation of appropriate management strategies for long-term utilization. A co-operative effort to monitor and regulate trade will also contribute toward the maintenance of sustainable gastropod populations on coral reefs.
Changes in the status and distribution of four species of parrot in the south of Western Australia during 1970-90
Authors: R. Mawson Peter , L. Long John
Published: May 2016

Mail surveys were sent to field staff of the Agriculture Protection Board of Western Australia to assess the distribution and status of four species of parrot in the agricultural region of south-west Western Australia in 1970, 1980 and 1990. The surveys indicated that the populations of the Regent Parrot (Polytelis anthopeplus) and the Western Rosella (Platycercus icterotis) have declined in range considerably since 1970. The populations of the Red-capped Parrot (Purpureicephalus spurius) and the Port Lincoln Ringneck (Barnardius zonarius) have suffered little or not at all during the same period. Factors which appear to have contributed to the observed changes in distribution and status include clearing for agriculture, dietary preferences, physiology, habitat requirements, altered fire regimes, grazing by exotic herbivores and reduced winter rainfall. These surveys have shown that species which were formerly considered common and widespread have declined with little comment having been made of these changes. The implications of this are serious, both for these formerly common species and for rarer bird species which have similar ecological requirements. The technique of mail surveys has considerable merit for quickly assessing the status of some species of birds, but will be limited by the expertise of the respondents and the degree to which the species in question can be observed.
Integrating management of Pittosporum undulatum with other environmental weeds in Sydney's urban bushland
Authors: Rose Stefan
Published: May 2016

Natural bushland is a dwindling resource in the Sydney Metropolitan Area, not only because of direct clearing, but also because uncontrolled impacts from surrounding development have caused increasing degradation over time. Community change has been characterized by invasions of environmental weeds, and consequent displacement of many indigenous species. A few locally native species, Pittosporum undulatum in particular, have emerged as environmental weeds. Invasion of new habitats within a species' natural geographic range must be recognized, since their impact on natural communities can be as serious as that of the worst exotic invaders. Factors implicated as the immediate cause of environmental weed invasions include increased human-induced dispersal by birds, anthropogenic disturbance, suppression of fire and increased moisture and nutrients. Management of plant invasions often includes mitigation to reduce impacts of the immediate causes. Strategies to maximize the success of mitigation by identifying and ameliorating the factors which impact bushland from remote sources are discussed. Practical recommendations for restoration of degraded sites are given. Native weeds such as P. undulatum require specialized treatment within an integrated environmental weed management strategy. It is stressed that application of the best management strategies available will be wasted if more fundamental issues related to current planning practices are ignored. Uncoordinated and ad hoc decisions are continuing to reduce urban bushland to mere remnants with high edge-to-interior ratios. Only when these practices are recognized and addressed can long-term success in the treatment of environmental weed invasions be achieved by the many excellent restoration techniques being developed.
Aquaglyceroporins 3 and 7 in bull spermatozoa: identification, localisation and their relationship with sperm cryotolerance
Authors: Prieto-Martínez Noelia , Morató Roser , Muiño Rodrigo , Hidalgo Carlos O. , Rodríguez-Gil Joan E. , Bonet Sergi , Yeste Marc
Published: May 2016

The present study aimed to determine the localisation of aquaglyceroporins 3 (AQP3) and 7 (AQP7) in bull spermatozoa and their relationship with the sperm cell’s resilience to withstand cryopreservation (i.e. cryotolerance). A total of 18 bull ejaculates were cryopreserved and their sperm quality analysed before and after freeze–thawing. The presence and localisation of AQP3 and AQP7 was determined through immunoblotting and immunocytochemistry. AQP3 was found in the mid-piece and AQP7 in the mid-piece and post-acrosomal region of bull spermatozoa. Immunoblotting showed specific signal bands at 30 and 60 kDa for AQP3 and at 25 kDa for AQP7. Neither the relative abundance of AQP3 and AQP7 nor their localisation patterns was altered by cryopreservation but individual differences between bull ejaculates were found in immunoblots. In order to determine whether these individual differences were related to sperm cryotolerance, bull ejaculates were classified as having good (GFE) or poor freezability (PFE) on the basis of their sperm quality after thawing. While the relative abundance of AQP3 before cryopreservation did not differ between ejaculates with GFE and PFE, the abundance of AQP7 was higher in GFE than in PFE ejaculates. This finding was further confirmed through principal component and linear regression analyses. In conclusion, the relative abundance of AQP7 in fresh semen may be used as a marker to predict bull sperm cryotolerance.
Transcendence tests for Mahler functions
Authors: Bell Jason , Coons Michael
Published: May 2016

We give two tests for transcendence of Mahler functions. For our first, we introduce the notion of the eigenvalue

λ
F

\lambda _F

of a Mahler function

F
(
z
)

F(z)

and develop a quick test for the transcendence of

F
(
z
)

F(z)

over

C

(
z
)

\mathbb {C}(z)

, which is determined by the value of the eigenvalue

λ
F

\lambda _F

. While our first test is quick and applicable for a large class of functions, our second test, while a bit slower than our first, is universal; it depends on the rank of a certain Hankel matrix determined by the initial coefficients of

F
(
z
)

F(z)

. We note that these are the first transcendence tests for Mahler functions of arbitrary degree. Several examples and applications are given.
The Psychosis Continuum: Testing a Bifactor Model of Psychosis in a General Population Sample
Authors: Shevlin Mark , McElroy Eoin , Bentall Richard P. , Reininghaus Ulrich , Murphy Jamie
Published: May 2016

Although the factor structure of psychosis continues to be debated by taxonomists, recent studies have supported a bifactor model consisting of a general psychosis factor and 5 uncorrelated symptom-specific factors. While this model has received support in clinical samples, it has not been tested at the general population level. Analysis was conducted on Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34 653). Twenty-two psychotic symptoms were used as observed indicators of psychosis. These items were chosen based on their conceptual similarity to the items used in a similar study based on clinical samples. Confirmatory factor analysis and confirmatory bifactor modeling were used to test a variety of competing models. The best fitting model consisted of a general psychosis factor that was uncorrelated with 5 specific factors: positive, negative, disorganization, mania, and depression. These findings suggest that the bifactor model can be extended to general population samples, supporting the continuity between clinical and subclinical psychotic experiences. Theoretical and practical implications are discussed.
Digital Imaging in Secondary Rhinoplasty
Authors: Lehrman Craig R. , Lee Michael R. , Ramanadham Smita , Rohrich Rod J.
Published: May 2016

Background:

Rhinoplasty remains one of the most commonly performed operations in plastic surgery. Little is known regarding the use of imaging in secondary rhinoplasty. Secondary rhinoplasty is a far more complex operation than primary rhinoplasty. The objective of this study was to assess the role of software imaging in patients undergoing secondary rhinoplasty.

Methods:

A retrospective review was performed to identify patients undergoing secondary rhinoplasty performed by the senior author (R.J.R.) from January of 2000 to August of 2013. Forty consecutive patients met inclusion criteria. The degree of improvement was graded in comparison with both the preoperative photographs and software imaging using a graded scale.

Results:

A total of 40 patients met inclusion criteria. There were 35 women (87.5 percent) and five men (12.5 percent). The nasal dorsum was found to have an average rating of 2.36 between the two observers, the midvault had an average rating of 2.65, the nasal tip had an average rating of 2.27, the nasal alae had an average rating of 2.63, and the nasal base had an average score of 2.99

Conclusions:

Based on the results of this study, the authors have determined that preoperative digital imaging can provide a reasonable expectation for patients undergoing secondary rhinoplasty. However, digital imaging must be used with caution, as secondary rhinoplasty patients have heightened expectations and unknown anatomy from their previous operation. The nasal tip and dorsum are especially difficult to adequately predict, and this should be discussed with the patient before surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Town and Gown Differences Among the 100 Largest Medical Groups in the United States
Authors: Welch W. Pete , Bindman Andrew B.
Published: May 2016

Purpose

The authors undertook a study to determine whether large academic and community-based medical groups differ in terms of their financial stake in Medicare Advantage or Medicare Accountable Care Organizations (ACOs) and whether their participation in these alternative payment models is related to their size, specialty mix, and Medicare physician market share in their local area.

Method

The authors used the 2013 Medicare Data on Provider Practice and Specialty database and a national database of ACOs to conduct a cross-sectional descriptive study of the 100 largest medical groups in the United States. Medical groups were categorized as academic or community based on matches of their name with a list of U.S. medical schools or the results of a series of Internet search procedures.

Results

Sixty-eight of the 100 largest groups were academic, and 32 were community based. On average, community-based groups had more than twice the percentage of primary care physicians as academic groups (mean, 38.4%; 95% CI, 34.7%–42.0%; vs. 18.3%; 95% CI, 17.0%–19.6%). Community groups were significantly (P < .001) more likely than academic groups to have a financial stake in a Medicare ACO or Medicare Advantage plan, but this difference was no longer significant when the percentage of primary care physicians in the group was added to the model.

Conclusions

The specialty mix within academic medical groups may hinder their ability to transform themselves into organizations that can manage the financial responsibilities of caring for a patient population through a Medicare ACO or Medicare Advantage.
Variation in Treatment of Displaced Geriatric Acetabular Fractures Among 15 Level-I Trauma Centers
Authors: Manson Theodore T. , Reider Lisa , O'Toole Robert V. , Scharfstein Daniel O. , Tornetta Paul , Gary Joshua L. ,   the Major Extremity Trauma Research Consortium (METRC)*
Published: May 2016

Objectives:

To document the initial treatment of displaced acetabular fractures among older adults across multiple trauma centers and to investigate the factors that influence the decision to operate and the choice of operative procedure [open reduction internal fixation (ORIF) vs. total hip arthroplasty (THA)].

Design:

Retrospective observational study.

Setting:

Fifteen US level-I trauma centers participating in the Major Extremity Trauma Research Consortium.

Patients/Participants:

Overall, 269 patients aged 60 years or older admitted for the treatment of a displaced acetabular fracture.

Intervention:

None.

Main Outcome Measurements:

Treatment.

Results:

Sixty percent of fractures (n = 162) were treated operatively. Younger age (<80 years), injury from high-energy mechanism, fractures with femoral head impaction, and fractures without hip congruency were significantly associated with receiving operative treatment (P < 0.05). Significant site variation in operative versus nonoperative treatment occurred even after accounting for these factors (P = 0.0044). Among operatively treated patients, 88% (n = 142) received ORIF and 12% (n = 20) received THA as the initial treatment. Women were more likely to be treated with initial THA compared with men; of the known risk factors for poor outcomes with ORIF (ie, dome or roof impaction, femoral head impaction, or posterior wall involvement), only dome impaction was significantly associated with receiving initial THA (P < 0.05).

Conclusions:

Currently, no treatment guidelines exist for acetabular fractures in older adults, which likely explains the significant site variation in operative versus nonoperative treatment. This study identifies patient and injury factors that drive treatment decisions, which will be important in planning and designing future trials needed to determine the best treatment for these fractures.
Extraperiosteal Dual Plate Fixation of Acute Mid-Shaft Clavicle Fractures: A Technical Trick
Authors: Shannon Steven F. , Chen Xiaobin , Torchia Michael , Schoch Bradley
Published: May 2016

Historically, surgical treatment of acute mid-shaft clavicle fractures has excellent outcomes with low rates of nonunion. More complex fracture patterns with significant comminution may limit the fixation that can be obtained with a single plate. The authors describe the surgical technique and case series of patients treated with extraperiosteal dual plating for acute mid-shaft clavicle fractures.
Metformin, other antidiabetic drugs, and endometrial cancer risk: a nested case–control study within Italian healthcare utilization databases
Authors: Franchi Matteo , Asciutto Rosario , Nicotra Federica , Merlino Luca , La Vecchia Carlo , Corrao Giovanni , Bosetti Cristina
Published: May 2016

Metformin may reduce the risk of endometrial cancer whereas other drugs for the treatment of type 2 diabetes mellitus appear to increase it, although the evidence is still limited. We investigated this issue using data from a nested case–control study within the healthcare utilization databases of the Lombardy Region, Italy. This study included 376 diabetic women with endometrial cancer and 7485 diabetic controls matched for cases on age, date at cohort entry, and duration of follow-up. We used conditional logistic regression models to estimate the odds ratio (OR) of endometrial cancer in relation to use of antidiabetic drugs, adjusted for the Charlson’s comorbidity index, selected medical conditions, prescription of selected drugs, and concomitant use of other antidiabetic drugs. At cohort entry, no significant associations were observed for metformin [OR=0.99, 95% confidence interval (CI) 0.80–1.23], sulfonylureas (OR=1.14, 95% CI 0.91–1.42), insulin (OR=0.72, 95% CI 0.34–1.56), and other antidiabetic drugs (OR=1.21, 95% CI 0.75–1.95). When we considered use during follow-up, a borderline significant excess risk was found for metformin (OR=1.30, 95% CI 1.00–1.70). However, this estimate decreased to 1.07 (95% CI 0.82–1.41) when taking into account BMI using a Monte Carlo sensitivity analysis. No significant associations were found for sulfonylureas (OR=1.16, 95% CI 0.91–1.47), thiazolidinediones (OR=0.77, 95% CI 0.48–1.24), repaglinide (OR=1.32, 95% CI 0.94–1.87), incretins (OR=1.21, 95% CI 0.63–2.32), and insulin (OR=1.19, 95% CI 0.82–1.71). Our data indicate that metformin, insulin, and other antidiabetic drugs did not meaningfully affect the risk of endometrial cancer.
Lung cancer screening with low-dose spiral computed tomography: evidence from a pooled analysis of two Italian randomized trials
Authors: Infante Maurizio , Sestini Stefano , Galeone Carlotta , Marchianò Alfonso , Lutman Fabio R. , Angeli Enzo , Calareso Giuseppina , Pelosi Giuseppe , Sozzi Gabriella , Silva Mario , Sverzellati Nicola , Cavuto Silvio , La Vecchia Carlo , Santoro Armando , Alloisio Marco , Pastorino Ugo
Published: May 2016

The benefits and harms of lung cancer (LC) screening with low-dose computed tomography (LDCT) are debatable. Positive results from the US National Lung Screening Trial were not evident in the European trials, possibly due to their smaller sample sizes. To address this issue, we conducted a patient-level pooled analysis of two Italian randomized controlled trials. Data from DANTE and MILD trials were combined for a total of 3640 individuals in the LDCT arm and 2909 in the control arm. LC and overall mortality were analyzed using multivariate hazard ratios (HRs) and log-rank tests stratified by study. The median follow-up was 8.2 years, with a total of 30 480 person-years in the LDCT arm and 22 157 in the control arm. A total of 192 patients developed LC in the LDCT arm and 105 in the control arm. Half of the LC cases in the LDCT arm had stage IA or IB cancer, as compared with 21% in the control arm. Overall mortality rates/100 000 person-years were 925 in the LDCT arm and 1074 in the control arm, and LC mortality rates were 299 and 357, respectively. The multivariate pooled overall mortality HR was 0.89 (95% confidence interval: 0.74–1.06) and the LC mortality HR was 0.83 (95% confidence interval: 0.61–1.12) for the LDCT arm as compared with the control arm. The present pooled analysis shows a nonsignificant 11% reduction in overall mortality in individuals undergoing LDCT screening as compared with the control arm. A pooled analysis of all European trials would be a useful contribution to assess the real benefit of LDCT screening.
Cutaneous Extranodal Natural Killer/T-Cell Lymphomas Histopathologically Mimicking Benign Inflammatory Disease
Authors: Lee Woo Jin , Kang Hyun Ji , Won Chong Hyun , Chang Sung Eun , Choi Jee Ho , Lee Mi Woo
Published: May 2016

Few studies have evaluated the histopathological features of cutaneous extranodal NK/T-cell lymphoma (ENKTL). The authors' study aims to describe cases of cutaneous ENKTL that histopathologically mimic benign inflammatory dermatosis. The authors searched the database of Asan Medical Center to identify cases of cutaneous ENKTL that were confirmed by skin biopsy between January 1998 and December 2014. The authors included cases that were initially diagnosed as benign inflammatory disorders on the histopathological examination, but finally diagnosed as cutaneous ENKTL on further evaluation. This study included 10 cases of cutaneous ENKTL. Six cases demonstrated nonspecific perivascular cellular infiltration, 2 cases demonstrated lupus erythematosus-like histological features, 1 case demonstrated psoriasiform lichenoid reaction, and 1 case demonstrated vasculitis-like features on histopathological examination. All cases were positive for CD56 and Epstein–Barr virus in situ hybridization. Perivascular infiltrations throughout the superficial and deep dermis with vasculopathy and panniculitic infiltration were common histopathological findings. The clinical features included 7 cases of erythematous to purpuric patches, 2 cases of facial swelling, and 1 case of cellulitis-like swelling. In conclusion, cutaneous ENKTL can histopathologically mimic benign inflammatory dermatosis. Cutaneous ENKTL should be suspected when histopathology shows perivascular dermal infiltration with vasculopathy and panniculitic cellular infiltration.
Insular balance of glutamatergic and GABAergic signaling modulates pain processing
Authors: Watson Christopher J.
Published: May 2016

Neuroimaging studies of patients with chronic pain have shown that neurotransmitter abnormalities, including increases in glutamate and decreases in GABA, could be responsible for the cortical hyperactivity and hyperalgesia/allodynia observed in some pain conditions. These finding are particularly evident in the insula, a brain region known to play a role in both the sensory–discriminative and the affective–motivational aspects of pain processing. However, clinical studies are not entirely able to determine the directionality of these findings, nor whether they are causal or epiphenomenon. Thus, a set of animal studies was performed to determine whether alterations in glutamate and GABA are the result of injury, the cause of augmented pain processing, or both. Compared with controls, the excitatory neurotransmitters glutamate and aspartate are significantly higher in the rat insula after chronic constriction injury of the sciatic nerve (CCI). The CCI also produced significant increases in allodynia (mechanical and cold), thermal hyperalgesia, and nociceptive aversiveness. Unilateral microinjection of ionotropic glutamate receptor antagonists restored these nociceptive behaviors to preinjury values. Increasing endogenous levels of GABA or enhancing signaling at inhibitory glycinergic receptors had similar effects as the glutamate receptor antagonists. In naive rats, increasing endogenous levels of glutamate, decreasing endogenous levels of GABA, or blocking strychnine-sensitive glycine receptors in the insula significantly increased thermal hyperalgesia and mechanical allodynia. These data support the hypothesis that an altered balance of excitatory and inhibitory neurotransmitters in brain regions such as the insula occurs in chronic pain states and leads to augmented central pain processing and increased pain sensitivity.
Swedish Translation and Reliability of the Full Outline of Unresponsiveness Score
Authors: Hickisch Annika , Holmefur Marie
Published: May 2016

Background: It is important for patient safety that the patient’s level of consciousness is assessed and documented in a structured and reliable manner. The Full Outline of Unresponsiveness (FOUR) score measures the level of consciousness more comprehensively than the coma scales that are commonly used in Sweden. Therefore, there was a need to translate the FOUR score into Swedish and to evaluate its use in a Swedish healthcare context. Objectives: The aim of this study was to translate the FOUR score into Swedish and to evaluate the reliability of the Swedish version compared with the reliability of the Glasgow Coma Scale (GCS). Methods: The English version of the FOUR score was translated into Swedish and evaluated in terms of interrater reliability and internal consistency on fictitious patient cases with an advanced high-fidelity patient simulator. Two nurses rated 30 patient cases with the FOUR score and the GCS. Interrater reliability for items was determined by quadratic-weighted kappa and for the total score by intraclass correlation coefficient. Internal consistency was calculated with Cronbach’s alpha. Results: The fourth version of the Swedish translation reached consensus in the expert panel. The back-translation was approved by the author of the original FOUR score. Interrater reliability of the Swedish version of the FOUR score was excellent; the weighted kappa was 0.94–1, and intraclass correlation coefficient = .99 (95% CI [0.97, 0.99]), and these were equal to the reliability of the GCS. Cronbach’s alpha showed a high degree of internal consistency for the FOUR score (α = .92 for rater A and .91 for rater B), which was slightly higher than that for the GCS. Conclusions: The Swedish version of the FOUR score is equivalent to the original English version and has shown excellent reliability using fictitious patient cases with an advanced patient simulator.
A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury
Authors: McNett Molly M. , Amato Shelly , Philippbar Sue Ann
Published: May 2016

Purpose:The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury.Methods:This is a prospective cohort study. Data were gathered on adult patients with traumatic brain injury admitted to urban level I trauma center. GCS and FOUR scores were assigned at 24 and 72 hours and at hospital discharge. Glasgow Outcome Scale scores were assigned at 6 and 12 months.Results:The sample size wasn= 107. Mean age was 53.5 (SD= ±21, range = 18–91) years. Spearman correlations were comparable and strongest among discharge GCS and FOUR scores and 12-month outcome (r= .73,p< .000;r= .72,p< .000). Multivariate regression models indicate that age and discharge GCS were the strongest predictors of outcome. Areas under the curve were similar for GCS and FOUR scores, with discharge scores occupying the largest areas.Conclusion:GCS and FOUR scores were comparable in bivariate associations with long-term outcome. Discharge coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.
Natural Antibodies to Human Papillomavirus 16 and Recurrence of Vulvar High-Grade Intraepithelial Neoplasia (VIN3)
Authors: Madeleine Margaret M. , Johnson Lisa G. , Doody David R. , Tipton Elaine R. , Carter Joseph J. , Galloway Denise A.
Published: May 2016

Objectives

Approximately 30% of women treated for squamous high-grade intraepithelial neoplasia (VIN3), often associated with human papillomavirus (HPV), have recurrent disease. In this study, we assess predictors of recurrence that may provide targets for early prevention or treatment.

Materials and Methods

Women with VIN3 who participated in a previous population-based case-control study with blood and tumor samples completed a follow-up telephone interview an average of 5 years after initial diagnosis. The risk of recurrence was determined by proportional hazards modeling.

Results

Women with VIN3 in the follow-up study (n = 65) were similar to women with VIN3 in the parent study (n = 215) with regard to age at primary diagnosis, level of current cigarette smoking (>60%), and lifetime number of partners. We found that 22 (33.8%) of 65 participants had a vulvar recurrence and that 73.4% recurred within 3 years of treatment. Recurrences occurred more often among women with common warts in the decade before diagnosis (hazard ratio [HR] = 2.5, 95% CI = 1.1–5.8) and among those with a previous anogenital cancer (HR = 2.7, 95% CI = 1.2–6.3). Interestingly, recurrence was less frequent among women who mounted a natural antibody response to HPV16 (HR = 0.4, 95% CI = 0.2–0.9).

Conclusions

These data provide strong preliminary evidence that VIN3 recurrence was less frequent among those with HPV16 antibodies. Vaccination with the currently licensed HPV vaccine as part of adjunctive therapy for VIN3 would increase antibody response and may decrease risk of recurrence. Randomized controlled trials are needed to determine whether HPV vaccination is effective against VIN3 recurrence.
Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers
Authors: Chang Chiang-Hua , Lewis Valerie A. , Meara Ellen , Lurie Jon D. , Bynum Julie P.W.
Published: May 2016

Background:

Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs.

Objective:

To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use.

Research Design:

Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries aged 65 years and older.

Subjects:

Subjects included beneficiaries with at least 1 evaluation and management (E&M) visit in 2011, categorized as FQHC users (≥1 E&M visit to FQHCs) or nonusers living in the same primary care service areas as FQHC users. Users were subclassified as predominant if the majority of their E&M visits were to FQHCs.

Measures:

Demographic characteristics, physician visits, and inpatient care use.

Results:

Most FQHC users (56.6%) were predominant users. Predominant and nonpredominant users, compared with nonusers, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all P<0.05). In adjusted analyses (reference: nonusers), predominant users had fewer physician visits (RR=0.81; 95% CI, 0.81–0.81) and fewer hospitalizations (RR=0.84; 95% CI, 0.84–0.85), whereas nonpredominant users had higher use of both types of service (RR=1.18, 95% CI, 1.18–1.18; RR=1.09, 95% CI, 1.08–1.10, respectively).

Conclusions:

Even controlling for primary care delivery markets, nonpredominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary care only payment incentives for FQHCs could induce fragmented care.
The Face Transplantation Update: 2016
Authors: Sosin Michael , Rodriguez Eduardo D.
Published: May 2016

Background:

Ten years after the first face transplantation, the available data in peer-reviewed literature, various media outlets, and recent specialty meetings and courses are conflicting and inconsistently reported. The purpose of this study was to consolidate the available data by means of multiple sources to reflect an accurate and current state of facial vascularized composite allotransplantation as of December of 2015.

Methods:

Using applied search terms pertaining to face transplantation, a systematic PubMed search, Google search, and review of Plastic Surgery Education Network News Connection e-mailed newsletters were performed, and data presented at three meetings (i.e., the most recent American Society of Reconstructive Transplantation biennial meeting, the American Society of Reconstructive Microsurgery annual meeting, and the biennial AO North America State of the Art: Face Reconstruction and Transplantation course) were consolidated to capture the most contemporary and accurate data in face transplantation.

Results:

A total of 37 face transplants have been performed (20 partial and 17 full face) from 2005 to December of 2015. A discrepancy between actual transplantations performed and peer-reviewed reports exists at multiple time points, with a propensity for underreporting. Ten cases were described through media outlets but were not reported by the surgical teams in peer-reviewed literature. Two clinical cases were not described in peer-reviewed literature or media. There have been a total of five deaths, and posttransplant malignancy and revision surgery have been underreported.

Conclusions:

This serves as the most contemporary and all-inclusive face transplantation review. There is a critical need for timely reporting and outcome transparency in the reconstructive transplant community.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Principles and Planning in Nasal and Facial Reconstruction: Making a Normal Face
Authors: Menick Frederick J.
Published: May 2016

Learning Objectives:

After reading this article, the participant should be able to: 1. Understand the rationale and value of principles of facial reconstruction in the complex patient. 2. Understand the importance of diagnosis and planning. 3. Appreciate the value of surgical staging. 4. Modify tissues to the requirements of the defect. 5. Know how to treat ischemic cover and lining complications. 6. Learn methods of late revision.

It is easy to be overwhelmed by a complex defect. What to do? How? When? In what order? Success is determined by careful planning, guided by principles. The aesthetic and anatomical deficiencies must be identified. Then, what is absent, both visually and anatomically, and what is missing must be determined. What are the priorities? What is the best timing for each stage? What are the available options and what will be the likely result? Should I choose another option? How can the surgeon maintain vascularity, transfer tissue, and improve tissue quality and contour? What are potential backup salvage maneuvers? Sound surgical principles based on the contributions of Gillies and Millard provide strategic instructions that help the surgeon “make sense” of a complex problem. They provide coordinated rules that clarify the diagnosis, planning, timing, and stages of repair. These should be combined with a regional unit approach to facial repair that provides tactical rules to establish the skin quality, border outline, and three-dimensional shape of the normal face.
Rheumatic Diseases in Chihuahua, México
Authors: Del Río Nájera Danyella , González-Chávez Susana Aideé , Quiñonez-Flores Celia María , Peláez-Ballestas Ingris , Hernández-Nájera Norma , Pacheco-Tena César F.
Published: May 2016

Background

Rheumatic diseases (RDs) represent a global problem for health care systems and patients. Community Oriented Program for Control of Rheumatic Diseases (COPCORD) is a low-cost screening tool for detecting musculoskeletal (MSK) pain and RDs.

Objective

The aim of this study was to examine the pattern of MSK pain and RDs in clinic population in Chihuahua City, Mexico.

Methods

A cross-sectional study was conducted in 7 primary health clinics using the COPCORD methodology in subjects older than 18 years. People with MSK pain not induced by trauma (positive cases) were evaluated by primary care physicians and rheumatologists.

Results

The study included 1006 individuals with a mean age of 46.0 (SD, 15.8) years; 751 (74.7%) were women. Musculoskeletal pain in the previous 7 days was reported by 571 individuals (56.75%; 95% confidence interval [CI], 53.8%–60.1%), and 356 cases (35.4%; 95% CI, 32.5%–38.4%) were COPCORD positive. The mean pain intensity in visual analog scale was 6.62 (SD, 2.4). The most common painful joint was the knee (54.7%; 95% CI, 51.1%–59.0%). Two hundred eighty subjects with MSK pain (49.0%) previously sought medical attention, and 375 (65.7%) were under treatment. Functional impairment was reported by 69.8% of the COPCORD-positive subjects. The prevalence of RDs was 21.4% (95% CI, 18.9%–23.8%). The most prevalent disease was osteoarthritis (10.3%; 95% CI, 8.6%–12.4%), followed by regional pain syndromes (5.5%; 95% CI, 4.1%–7.0%), rheumatoid arthritis (1.4%; 95% CI, 0.8%–2.2%), and mechanical low-back pain (1.4%; 95% CI, 0.7%–2.2%).

Conclusions

Musculoskeletal pain is an important problem that affects our community. The data provided in this study will be presented to the local authorities to help in the development of prevention strategies.
Predictors of Dissection in Aortic Aneurysms From Giant Cell Arteritis
Authors: Kermani Tanaz A. , Warrington Kenneth J. , Crowson Cynthia S. , Hunder Gene G. , Ytterberg Steven R. , Gabriel Sherine E. , Matteson Eric L.
Published: May 2016

Background

Factors associated with dissection from inflammatory aortic aneurysms may be different from those in the general population.

Objective

The aim of this study was to evaluate the risk factors for aortic dissection/rupture in patients with giant cell arteritis (GCA) and aortic aneurysms.

Methods

A population-based incident cohort of patients with a diagnosis of GCA from 1950 to 2004 was used. All patients with aortic aneurysms diagnosed 1 year prior to GCA diagnosis or any time thereafter were included. Cox proportional hazard models were used to evaluate risk factors for aortic dissection/rupture.

Results

The study included 33 patients (91% women) with GCA and aortic aneurysms. Mean age at diagnosis of aortic aneurysm was 83.6 years. There were 27 thoracic aneurysms and 19 abdominal aneurysms. Eight patients developed aortic dissection/rupture (both thoracic and abdominal aorta in 5 cases, thoracic aorta only in 2 cases, and isolated abdominal aorta in 1 case).

Older age (hazard ratio [HR], 0.27 per 10 years; 95% confidence interval [CI], 0.09–0.86) and later calendar year at diagnosis of aortic aneurysm (HR, 0.29 per 10 years; 95% CI, 0.13–0.69) were associated with decreased risk of dissection/rupture. Size of the thoracic aneurysm (HR, 1.17; 95% CI, 0.69–1.99) was not associated with dissection/rupture. Histopathology showed active aortitis in 4 of 7 patients with aortic dissection/rupture compared with 0 of 7 patients with aortic aneurysm without dissection/rupture.

Conclusions

Aneurysm size was not a predictor of aortic dissection/rupture in this cohort of patients with GCA. The higher frequency of active aortitis in patients with dissection suggests that active inflammation may play a role.
Neurological Complications Involving the Central Nervous System After Allogeneic Hematopoietic Stem Cell Transplantation During a Period of Evolution in Transplant Modalities: A Cohort Analysis
Authors: Colombo Anna Amelia , Marchioni Enrico , Diamanti Luca , Di Matteo Angela Maria , Baldanti Fausto , Furione Milena , Cazzola Mario , Ferretti Virginia Valeria , Pascutto Cristiana , Alessandrino Emilio Paolo
Published: May 2016

Background

Neurological complications (NC) after hematopoietic stem cell transplantation (HSCT) are rare events. The evolution of transplant procedures has resulted in improved survival and has allowed elderly patients or those with comorbidity to receive an HSCT. The risk of NC in these patients has still not been well defined. Therefore, we carried out an observational study to estimate the occurrence and identify the risks associated with NC.

Methods

The study cohort included 452 adult-allogeneic HSCT recipients, transplanted from 1997 to 2012. The median follow up was 1.3 year (0-15.7). A myeloablative regimen was used in 307 patients. Two hundred patients were grafted from matched unrelated donor (MUD), of these, 129 (64.5%) received an in vivo T-cell depletion.

Results

Out of 452 patients, 30 (6.6%) developed NC. Infections were the most frequent causes of NC (30%). Overall survival decreased in patients developing NC (P < 0.001). Univariate survival regression on the cumulative incidence of NC identified period of transplant, linear trend between 4-year periods (1997-2012) (P < 0.001), MUD (P < 0.001), and recipient's age (P = 0.034) as significant risk factors. In multivariate analysis, period of transplant (P < 0.001) and MUD (P = 0.004) remained significant independent risk factors. Matched unrelated donor recipients showed a 3.8-fold elevated risk of developing NC.

Conclusions

Analysis highlights a temporal trend of incidence of NC that progressively increased over time and confirms a strong association between donor type and risk of NC. Our observations suggest that, although relatively uncommon, NC after allo-HSCT, may become more frequent due to the improved overall survival in recent years.
Difluoromethanesulfonyl hypervalent iodonium ylides for electrophilic difluoromethylthiolation reactions under copper catalysis
Authors: Arimori Sadayuki , Matsubara Okiya , Takada Masahiro , Shiro Motoo , Shibata Norio
Published: May 2016

Difluoromethanesulfonyl hypervalent iodonium ylides 2 were developed as electrophilic difluoromethylthiolation reagents for a wide range of nucleophiles. Enamines, indoles, β-keto esters, silyl enol ethers and pyrroles were effectively reacted with 2 affording desired difluoromethylthio (SCF
2
H)-substituted compounds in good to high yields under copper catalysis. The reaction of allyl alcohols with 2 under the same conditions provided difluoromethylsulfinyl (S(O)CF
2
H) products in good yields. The difluoromethylthiolation of enamines is particularly effective with wide generality, thus the enamine method was nicely extended to the synthesis of a series of difluoromethythiolated cyclic and acyclic β-keto esters, 1,3-diketones, pyrazole and pyrimidine derivatives by a consecutive, two-step one-pot reaction using 2.
Rhythmic modulation of visual contrast discrimination triggered by action
Authors: Benedetto Alessandro , Spinelli Donatella , Morrone M. Concetta
Published: May 2016

Recent evidence suggests that ongoing brain oscillations may be instrumental in binding and integrating multisensory signals. In this experiment, we investigated the temporal dynamics of visual–motor integration processes. We show that action modulates sensitivity to visual contrast discrimination in a rhythmic fashion at frequencies of about 5 Hz (in the theta range), for up to 1 s after execution of action. To understand the origin of the oscillations, we measured oscillations in contrast sensitivity at different levels of luminance, which is known to affect the endogenous brain rhythms, boosting the power of alpha-frequencies. We found that the frequency of oscillation in sensitivity increased at low luminance, probably reflecting the shift in mean endogenous brain rhythm towards higher frequencies. Importantly, both at high and at low luminance, contrast discrimination showed a rhythmic motor-induced suppression effect, with the suppression occurring earlier at low luminance. We suggest that oscillations play a key role in sensory–motor integration, and that the motor-induced suppression may reflect the first manifestation of a rhythmic oscillation.