bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-Time PCR Detection of the Basidiomycetous Fungus Bjerkandera adusta: A Tool to Identify Itraconazole Responder Patients with Unexplained Chronic Cough
Authors: Tone Kazuya , Ogawa Haruhiko , Alshahni Mohamed Mahdi , Kuwano Kazuyoshi , Makimura Koichi
Published: October 2018

Background: Filamentous basidiomycetes (f-BMs) are involved in some unexplained chronic cough (UCC) cases that can be improved by the administration of antifungal agents. The disease concept was termed fungus-associated chronic cough (FACC). The current diagnostic criteria warrant environmental fungi isolation from respiratory specimens, which is hardly conceivable for such fungi. Objectives: This study aimed to detect the f-BMs Bjerkandera adusta, the most common pathogen in FACC, from respiratory specimens of patients with UCC using real-time polymerase chain reaction (PCR). It also evaluated the applicability of the PCR system to detect antifungal agent responders among patients with unexplained cough. Methods: The PCR system specific to B. adusta was developed and its utility was evaluated using sputum samples from 23 patients with chronic cough. Results: B. adusta was detected in 10 out of 14 patients with UCC (71.4%), in contrast to only 2 out of 9 patients with non-UCC (22.2%; p < 0.05 with the Fisher’s exact test). The copy number of the samples correlated with the therapeutic impact score for cough symptoms following the oral administration of itraconazole. Conclusion: Development of the real-time PCR system enabled us to demonstrate that many patients with UCC might be influenced by B. adusta, a fact evidenced by the improvement of symptoms with itraconazole administration in most PCR-positive patients. This method would help in detecting itraconazole responders among patients with UCC when the isolation of f-BMs is not achievable.
A Bortezomib-Based Protocol Induces a High Rate of Complete Remission with Minor Toxicity in Adult Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia
Authors: Nachmias Boaz , Shaulov Adir , Gatt Moshe E. , Shapira Michael , Gural Alexander
Published: October 2018

The treatment of relapsed/refractory acute lymphoblastic leukemia (RR-ALL) presents a true clinical challenge. In 2012, a protocol combining bortezomib, dexamethasone, asparaginase, doxorubicin, and vincristine administered to children with RR-ALL was published with encouraging results. Over the past 5 years, we have implemented this protocol in the adult RR-ALL population (> 18 years) and addressed its feasibility in terms of remission rate and toxicity. Here, we present the results of our experience in 9 patients, all of whom received multiple previous chemotherapy protocols, two of them relapsing after an allogeneic bone marrow transplantation. All of the five B-ALL patients, and two of the four T-ALL achieved complete remission. Of the seven patients achieving complete remission, two patients were referred for allogeneic bone marrow transplantation, two patients were subsequently given blinatumomab, and one patient subsequently received donor lymphocyte infusion followed by blinatumomab. Thus, five out of nine patients treated (55%) were able to proceed to best available therapy in a complete remission. We observed minimal adverse effects, mainly hematological toxicity. We conclude that the bortezomib-based protocol should be evaluated as an effective and well-tolerated treatment option for adult patients either unfit for or failing standard salvage chemotherapy, as a bridge to immunotherapy or allogeneic bone marrow transplantation.
Dialysate Calcium Concentration below 3.0 mEq/L Is Not Associated with Improved Outcomes in the Japanese Dialysis Outcomes and Practice Patterns Study
Authors: Iseki Kunitoshi , Henn Lisa L. , Nomura Takanobu , Kanda Eiichiro , Tsuruya Kazuhiko , Hirakata Hideki , Port Friedrich K. , Pisoni Ronald L. , Tentori Francesca , Robinson Bruce M.
Published: October 2018

Background: Abnormal chronic kidney disease-mineral and bone disorder (CKD-MBD) markers have been associated with adverse outcomes in hemodialysis (HD) patients. Dialysate calcium concentration (D-Ca) likely influences serum calcium and phosphorus levels. Optimal D-Ca level remains unclear. We hypothesized that higher D-Ca is associated with cardiovascular events and mortality among Japanese HD patients. Methods: Enrollment data of chronic HD patients in the prospective observational study JDOPPS, phases 1–5 (1999–2015), provided exposures and covariates. All-cause mortality, non-arrhythmic cardiovascular events (NonAR-CVE), or their composites were analyzed by D-Ca, and divided into 2.5, 2.75, and 3.0 mEq/L. To minimize confounding by indication, analyses were restricted to facilities in which at least 90% of patients received the same D-Ca prescription. Association of D-Ca level with outcomes was evaluated in Cox models stratified by phase and accounting for facility clustering. Covariates describing patient demographics, comorbidities, laboratory values, CKD-MBD therapy, and facility attributes provided adjustment. Results: Of 9,201 patients included, 25.0% had D-Ca of 2.5 mEq/L; 6.8% D-Ca 2.75; and 68.2% D-Ca 3.0. Median follow-up time was 2.03 years. D-Ca was not associated with all-cause mortality, with hazards ratios for 2.5 vs. 3.0 mEq/L of 0.90 and 95% CI (0.73–1.11), nor with other outcomes. One effect modification occurred, protective for lower D-Ca on NonAR-CVE in the absence of cardiovascular comorbidities (p = 0.032), although corresponding D-Ca effects were not significant after multiple comparisons adjustment (p = 0.261 [D-Ca 2.5] and 0.125 [D-Ca 2.75]). Conclusion: Lowering D-Ca level below 3.0 mEq/L seems not to have a meaningful effect on patient outcomes.
Medical Cannabis Use by Hodgkin Lymphoma Patients: Experience of a Single Center
Authors: Sarid Nadav , Zada Mor , Lev-Ran Shaul , Yashphe Eva , Givon Ido , Barzilai Merav , Perry Chava , Avivi Irit , Wolf Ido
Published: October 2018

Hodgkin lymphoma (HL) is one of the most curable malignancies. Despite its effectiveness, chemotherapy is often associated with adverse events (AEs) such as nausea, anorexia, and impairment of general well-being. Our objective was to assess the extent of medical cannabis use among HL patients and evaluate its efficacy in controlling chemotherapy-related AEs. Patterns of medical cannabis use and efficacy were evaluated using physician-completed application forms, medical files, and patient-completed questionnaires, for all consecutive adult HL patients treated at the Tel-Aviv Medical Center between June 2010 and November 2016. One-hundred and thirty-three patients met the inclusion criteria. The median age of the cohort was 37 years, 53% were male, 46% were diagnosed at an early stage, and 88% achieved a complete response to treatment. Fifty-one patients (38%) used medical cannabis. There were no significant differences in baseline characteristics between cannabis users and nonusers. Cannabis users reported improvement in pain, general well-being, appetite, and nausea in 94, 87, 82, and 79% of cases, respectively. Importantly, 81.5% reported a high overall efficacy of cannabis in relieving symptoms. AEs related to cannabis use itself were mild. Thus, medical cannabis use is prevalent in this HL cohort, and appears to be effective in ameliorating chemotherapy-related AEs.
Comparison of Clinical and Laboratory Characteristics of General Paresis and Non-Neurosyphilis Dementia
Authors: Tong Man-Li , Chen Yu-Yan , Zhu Xiao-Zhen , Gao Kun , Zhang Hui-Lin , Zheng Wei-Hong , Wang Hui-Rong , Liu Li-Li , Lin Yong , Lin Li-Rong , Yang Tian-Ci
Published: October 2018

Background: The differential diagnosis of general paresis (GP) and non-neurosyphilis (NS) dementia is not clearly defined. The present study examined the differences in clinical and laboratory features of GP and non-NS dementia. Materials and Methods: We retrospectively examined clinical and laboratory features of 85 GP patients and 196 non-NS dementia patients. Data were collected from Zhongshan Hospital between June 2005 and June 2014. Results: The GP group had a higher percentage of males (83.53%, 71/85) and younger median age ([52 [interquartile range 47.0–61.0] vs. 76 [68.3–82.0] years) than the non-NS dementia group. GP have higher Mini-Mental State Examination (MMSE; Z = –5.809; p = 0.000) than non-NS dementia. Distribution of CDR scores were significantly higher in the non-NS group than GP group (χ2 = 29.153; p = 0.000). The laboratory findings showed signiﬁcantly different total cholesterol (CH), low-density lipoprotein CH and homocysteine levels between the 2 groups. Serologic testing for syphilis revealed that the GP group had higher seropositive rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) rates than the non-NS dementia group (96.47% [82/85] vs. 0.51% [1/196], Z = –2.663, p = 0.008; 100% [85/85] vs. 1.02% [2/196], Z = –2.663, p = 0.008). Interestingly, cerebrospinal fluid (CSF) biochemical indices, including pleocytosis rates, increased protein levels, and positive RPR and TPPA rates in the GP group were higher than that in the non-NS dementia group. Conclusions: Based on these preliminary data, patients with clinically evident symptoms of dementia, especially middle-aged males, should undergo blood tests for syphilis. All patients with positive serology results should undergo CSF examinations to diagnose GP dementia before further pharmaceutical and behavioral interventions.
Using Motor Imagery Training to Increase Quadriceps Strength: A Pilot Study
Authors: Saumur Tyler M. , Perry Stephen D.
Published: October 2018

Background: Motor imagery training implements neural adaptation theory to improve muscle strength without physically performing muscle contractions. To date, motor imagery training research regarding the efficacy of improving torque of the quadriceps over a brief training period is limited. Objective: To determine the impact of a 3-week motor imagery training on peak torque during knee extension. Method: Ten young, healthy volunteers were randomly assigned to 1 of 3 groups over a 3-week period: strength training, motor imagery training and control. Results: Following training, an increase in peak torque was observed in all strength training participants (mean change of 38 ± 15%) and in 2 members of the motor imagery training group (45 ± 10%). Conclusion: Brief periods of motor imagery training may have the potential to improve quadriceps strength; however, more research is needed with larger populations to test this hypothesis.
Comment on the Report of the Siddiqui Review Panel, 2018
Authors: Grillo Ralph
Published: October 2018

Controversies over the possible application of Islamic law and practice (Shari’a) in the UK have been gathering pace since the mid-2000s. In 2016 two official inquiries were set in train, one of which, chaired by Mona Siddiqui, Professor of Islamic and Interreligious Studies, Edinburgh University, reported in February 2018. The Siddiqui Panel focused on two principal issues: the civil registration of Islamic marriages (nikah), and the role of Shari’a councils in the issuing of a religious (not civil) divorce. The paper sets out the background to the Shari’a debate in the UK, reviews the Panel’s recommendations on the two issues, and assesses their implications.
Establishing Islam in Britain
Authors: McNamara Brendan
Published: October 2018

The commissioning of a mosque in Woking in early 1913 marks a seminal moment in the establishment of Islam in Britain. It was the first purpose-built Muslim place of worship to be raised at the heart of Empire, though it did not come fully into use until some years after it was built in 1889. This article problematises the accepted narrative of how the mosque became operational and highlights factors bearing on the establishment of the Woking Islamic mission that are now obscure or have not previously been analysed. Addressing the ‘afterlife’ of the events and figures at the heart of this narrative, the mnemohistorical dimension will be juxtaposed with the historiographical towards recovering recondite aspects central to the first Islamic institutional stirrings in Britain. The article complexifies what may in contemporary terms be categorised as ‘difficult history’.
A Late Antique Vegetation History of the Western Mediterranean in Context
Authors: López-Sáez José Antonio , Pérez-Díaz Sebastián , Galop Didier , Alba-Sánchez Francisca , Abel-Schaad Daniel
Published: October 2018

Fossil pollen records from 70 sites with reliable chronologies and high-resolution data in the western Mediterranean, were synthesised to document Late Holocene vegetation and climate change. The key elements of vegetation dynamics and landscape construction during Late Antiquity are clear in the light of the fossil pollen records. These are: fire events (natural or anthropogenically induced); grazing activities in high-mountain areas; agriculture; arboriculture; and human settlement in the lowlands. In terms of anthropogenic pressure, the differences recorded between highlands and lowlands suggest an imbalance in land use. Such practices were related to three main types of activities: wood exploitation and management, cultivation, and pastoralism. In lowland areas there seems to be some synchronism in vegetation dynamics during the late antique period, since most of the territories of the western Mediterranean had been deforested by the Early Roman period. However, in mountainous regions, pollen records document a clear asynchrony.
Olive Cultivation and Olive Products in Southern Apulia (6th–11th c.)
Authors: Stranieri Giovanni
Published: October 2018

This paper focuses on the interactions between the environment and human society from Late Antiquity to the Early Middle Ages in southern Apulia, at the heel of Italy, at the lower part of the Adriatic region. The results of recent archaeological investigations and palaeoenvironmental studies, has led us to establish a correlation between the indicators of extensive olive cultivation, the archaeological markers indicating the movement of goods either side of the Adriatic Sea, and Byzantine economic and political dominance over all or part of the region, as well as the lower Adriatic.
Raoiella of the world (Trombidiformes: Tetranychoidea: Tenuipalpidae)
Authors: BEARD JENNIFER J. , OCHOA RONALD , BAUCHAN GARY R. , POOLEY CHRISTOPHER , DOWLING ASHLEY P.G.
Published: October 2018

We describe 16 new species and redescribe six established species in the genus Raoiella—R. argenta sp. nov. Beard, R. australica Womersley, R. bauchani sp. nov. Beard & Ochoa, R. calgoa sp. nov. Beard & Ochoa, R. crebra sp. nov. Beard & Ochoa, R. davisi sp. nov. Beard, R. didcota sp. nov. Beard, R. eugeniae (Mohanasundaram), R. goyderi sp. nov. Ochoa & Beard, R. hallingi sp. nov. Beard, R. illyarrie sp. nov. Beard & Ochoa, R. indica Hirst, R. karri sp. nov. Ochoa & Beard, R. macfarlanei Pritchard & Baker, R. marri sp. nov. Beard & Ochoa, R. pandanae Mohanasundaram, R. pooleyi sp. nov. Beard & Ochoa, R. shimpana Meyer, R. tallerack sp. nov. Beard & Ochoa, R. taronga sp. nov. Beard & Ochoa, R. todtiana sp. nov. Beard & Ochoa, R. wandoo sp. nov. Beard & Ochoa. We discuss molecular evidence of species separation, shared character states among groups of species, and patterns in the additions of leg setae throughout ontogeny that occur in the genus. We provide a key to the known species of Raoiella.
North American Supercell Environments in Atmospheric Reanalyses and RUC-2
Authors: King Austin T. , Kennedy Aaron D.
Published: October 2018

A suite of modern atmospheric reanalyses is analyzed to determine how they represent North American supercell environments. This analysis is performed by comparing a database of Rapid Update Cycle (RUC-2) proximity soundings with profiles derived from the nearest grid point in each reanalysis. Parameters are calculated using the Sounding and Hodograph Analysis and Research Program in Python (SHARPpy), an open-source Python sounding-analysis package. Representation of supercell environments varies across the reanalyses, and the results have ramifications for climatological studies that use these datasets. In particular, thermodynamic parameters such as the convective available potential energy (CAPE) show the widest range in biases, with reanalyses falling into two camps. The North American Regional Reanalysis (NARR) and the Japanese 55-year Reanalysis (JRA-55) are similar to RUC-2, but other reanalyses have a substantial negative bias. The reasons for these biases vary and range from thermodynamic biases at the surface to evidence of convective contamination. Overall, it is found that thermodynamic biases feed back to other convective parameters that incorporate CAPE directly or indirectly via the effective layer. As a result, significant negative biases are found for indices such as the supercell composite parameter. These biases are smallest for NARR and JRA-55. Kinematic parameters are more consistent across the reanalyses. Given the issues with thermodynamic properties, better segregation of soundings by storm type is found for fixed-layer parameters than for effective-layer shear parameters. Although no reanalysis can exactly reproduce the results of earlier RUC-2 studies, many of the reanalyses can broadly distinguish between environments that are significantly tornadic versus nontornadic.
The Balance of Salinity Variance in a Partially Stratified Estuary: Implications for Exchange Flow, Mixing, and Stratification
Authors: Wang Tao , Geyer W. Rockwell
Published: October 2018

Salinity variance dissipation is related to exchange flow through the salinity variance balance equation, and meanwhile its magnitude is also proportional to the turbulence production and stratification inside the estuary. As river flow increases, estuarine volume-integrated salinity variance dissipation increases owing to more variance input from the open boundaries driven by exchange flow and river flow. This corresponds to the increased efficient conversion of turbulence production to salinity variance dissipation due to the intensified stratification with higher river flow. Through the spring–neap cycle, the temporal variation of salinity variance dissipation is more dependent on stratification than turbulence production, so it reaches its maximum during the transition from neap to spring tides. During most of the transition time from spring to neap tides, the advective input of salinity variance from the open boundaries is larger than dissipation, resulting in the net increase of variance, which is mainly expressed as vertical variance, that is, stratification. The intensified stratification in turn increases salinity variance dissipation. During neap tides, a large amount of enhanced salinity variance dissipation is induced by the internal shear stress near the halocline. During most of the transition time from neap to spring tides, dissipation becomes larger than the advective input, so salinity variance decreases and the stratification is destroyed.
A Background Investigation of Tornado Activity across the Southern Cumberland Plateau Terrain System of Northeastern Alabama
Authors: Lyza Anthony W. , Knupp Kevin R.
Published: October 2018

The effects of terrain on tornadoes are poorly understood. Efforts to understand terrain effects on tornadoes have been limited in scope, typically examining a small number of cases with limited observations or idealized numerical simulations. This study evaluates an apparent tornado activity maximum across the Sand Mountain and Lookout Mountain plateaus of northeastern Alabama. These plateaus, separated by the narrow Wills Valley, span ~5000 km2 and were impacted by 79 tornadoes from 1992 to 2016. This area represents a relative regional statistical maximum in tornadogenesis, with a particular tendency for tornadogenesis on the northwestern side of Sand Mountain. This exploratory paper investigates storm behavior and possible physical explanations for this density of tornadogenesis events and tornadoes. Long-term surface observation datasets indicate that surface winds tend to be stronger and more backed atop Sand Mountain than over the adjacent Tennessee Valley, potentially indicative of changes in the low-level wind profile supportive to storm rotation. The surface data additionally indicate potentially lower lifting condensation levels over the plateaus versus the adjacent valleys, an attribute previously shown to be favorable for tornadogenesis. Rapid Update Cycle and Rapid Refresh model output indicate that Froude numbers for the plateaus in tornadic environments are likely supportive of enhanced low-level flow over the plateaus, which further indicates the potential for favorable wind profile changes for tornado production. Examples of tornadic storms rapidly acquiring increased low-level rotation while reaching the plateaus of northeast Alabama are presented. The use of this background to inform the VORTEX-SE 2017 field campaign is discussed.
Reschedule Your Travel Plans: Human Health and Air Pollution
Authors: Sun Jing , Mei Jinping , Li Hu , Shi Jinlian
Published: October 2018

Air pollution is one of the biggest challenges for human health, and this is especially true for PM2.5 pollution in developing countries like China. Much of the PM2.5 research has been conducted in urban areas, but most tourist attractions are outdoors and outside cities and have been left out of related studies, leaving tourists unaware of the deadly air. To fill this gap, we investigated monthly PM2.5 concentrations in all of China’s outdoor tourist attractions. Our results indicated that summer is the healthiest time to travel in the Northeast, South, Southwest, and Northwest of China. Without air pollution management, our results also indicated that more than one third of the outdoor attractions would become unhealthy throughout the year. Thus, our work provides medical information to suggest that all tourists schedule China travel during periods of healthy air quality and also calls for instant air pollution management in China and beyond.
Concepts of Originality in the Natural Science, Medical, and Engineering Disciplines: An Analysis of Research Proposals
Authors: Barlösius Eva
Published: October 2018

Science is fundamentally devoted to generating original knowledge, and therefore concepts of scientific originality are keys to understanding its very essence. Scientific originality has long been thought of as discovery, but new studies of the humanities and social sciences have shown that other, discipline-specific concepts of originality are used in these fields of study. Does this finding also hold for disciplines in the natural science, medicine, and engineering? Are concepts of originality scientifically grounded or do they instead reflect extrascientific modes of originality? These questions lie at the heart of research proposals responding to an initiative explicitly calling for original scientific projects. The proposals undergo a two-step analysis based on grounded theory[Per style, reference citation is not allowed in abstract section. Hence, we have deleted Charmaz, 2006. Please approve.]. First, three empirically identified modes of scientific originality are described: temporal, partially different, and revolutionary. The three modes of originality are consistent with extrascientific ones such as those in art and fashion. Second, six disciplines—two each in the natural science, medical, and engineering—are analyzed for ways the three modes of originality are used and for their associated disciplinary characteristics in order to identify discipline-specific concepts of originality.
A history of injection treatments – I the syringe
Authors: Myers Kenneth
Published: October 2018

Introduction

The syringe has become an indispensable instrument for many aspects of interventional medicine and everyday practice.

Methods

To trace the evolution of the syringe from ancient times to the present, using the internet for past documentation and the literature.

Conclusion

The syringe has long been used for aspiration, irrigation and infusion. This developed into injections for early transfusion, anaesthesia and surgical procedures including venous sclerotherapy. Syringes have been adapted for use to inject specific drugs.
A novel endovenous scaffold for the treatment of chronic venous obstruction in a porcine model: Histological and ultrastructural assessment
Authors: Zamboni Paolo , Giaquinta Alessia , Rimondi Erika , Pedriali Massimo , Scanziani Eugenio , Riccaboni Pietro , Veroux Massimiliano , Secchiero Paola , Veroux Pierfrancesco
Published: October 2018

Objective

To investigate the biological effects of a novel endovenous scaffold in a porcine model.

Methods

Petalo is a compliant venous scaffold implanted into the internal jugular veins of 12 healthy pigs. The pigs were sacrificed at one, two, three, and six months, respectively. Microscopic investigations were performed at two blinded laboratories.

Results

Neo-intima formation progressively covering up the stent metallic bars was observed. The inflammatory response of the venous wall showed a peak after three months by the implant, followed by marked reduction after six months. The device induced a significant ( p < 0.01) increase of the thickness respect to the control regions, but was comparable in sections obtained after three and six months.

Conclusions

The implant of Petalo compliant venous scaffold in the venous wall of this porcine model is characterized by neointima formation and by an inflammatory reaction which tends to decrease after six months. Our data point against the induction of smooth muscle cells proliferation and migration as confirmed by electronic transmission microscopy analyses.
Retrospective cohort study for evaluating the INR monitoring patterns in patients with deep vein thrombosis in daily practice: Analysis of 2010–2013 database of a tertiary care center
Authors: Sargin Murat , Tasdemir Muge Mete , Kuplay Huseyin , Erdogan Sevinc Bayer , Tandogar Nehir , Akansel Serdar , Kurc Erol , Orhan Gokcen , Aka Serap Aykut
Published: October 2018

Objective

To evaluate the international normalized ratio (INR) monitoring patterns in patients with deep vein thrombosis.

Methods

Of 32,012 patients with ≥1 outpatient INR measurement and 42,582 patients with confirmed deep vein thrombosis diagnosis registered to our hospital between 1 January 2010 and 31 December 2013, 6720 records were identified to have both deep vein thrombosis and international normalized ratio measurement, and 4.377 out of 6.720 single patient records were determined to be statistically analyzable.

Results

Median INR measurement frequency was 6.47 times/year and patients had INR levels of 2–3 in 34.3% of follow-up time. Having ≥70% vs. <70% of follow-up time within therapeutic range was associated with lower hospital admission frequency (9.7 vs. 10.3 times/year).

Conclusion

Our study revealed only one-third of the follow-up time to be spent within therapeutic INR, association of INR therapeutic range with lesser number of hospital admissions and INR monitoring frequency of 6.47 times/year despite lack of stable INR control in most of the deep vein thrombosis patients.
Henderson and beyond: Did the Northfield experiments influence Henderson Hospital and its Legacy?
Authors: Menzies Diana E
Published: October 2018

This article is the talk I gave at the GASI Winter Workshop 2018 and looks at whether the Northfield Experiments influenced the development of the Henderson Hospital and other democratic therapeutic communities that arose from it. It describes Maxwell Jones’ work with military personnel before and at the Henderson Hospital, his ‘marginal consciousness’ of, and the similarities with, the Northfield Experiments especially in the use of psychodrama. It describes the later indirect influence of Northfield on the Henderson Hospital, through Foulkes and group analysis. The article then looks at the legacy of the Henderson Hospital in terms of other therapeutic communities and how those in prisons in the UK seem to be surviving better than those in the mental health system as they have been ‘owned’ by the system and so not seen as counter-cultural. In having a place in our society’s wish to keep offenders behind bars they are more able to withstand the effect of the changes in society whereby everything is wanted or accessible instantly and where change is the only constant, drawing on Bauman’s concept of liquid modernity.
Implementing a Trauma-Informed Public Health System in San Francisco, California
Authors: Loomis Briana , Epstein Kenneth , Dauria Emily F. , Dolce Lynn
Published: October 2018

Background. Trauma is a ubiquitous and harmful public health concern. Much like individuals, organizations experience trauma and can embed it within their culture. Left unaddressed, trauma inhibits staff from confronting problems, communicating effectively, and generating solutions, factors that undermine organizational functioning. In response to trauma’s far-reaching impact, recent efforts have focused on creating “trauma-informed” systems that emphasize safety and avoid retraumatization. Trauma-informed systems are uniquely connected to relationships, as the impact of trauma both impairs relationships and is heightened in the absence of quality relationships. Developing trauma-informed relationships is therefore critical to creating a healing organizational culture. Aims. The objective of this article is to describe the process through which the San Francisco Department of Public Health (SFDPH) developed and implemented their Trauma-Informed Systems (TIS) Initiative, an organizational model to address trauma at the systems level. The article highlights the centrality of trauma-informed relationships to the initiative’s guiding principles, activities, and implementation process. Discussion. Six core principles underlie the work of the SFDPH’s TIS Initiative: (1) Understanding Trauma & Stress, (2) Compassion & Dependability, (3) Safety & Stability, (4) Collaboration & Empowerment, (5) Cultural Humility & Responsiveness, (6) Resilience & Recovery. Initiative components focus on creating and sustaining trauma-informed knowledge (i.e., foundational training, train-the-trainer program) and organizational practices (i.e., aligned efforts, leadership, and champion engagement). Conclusion. Trauma-informed systems represent an emergent organization-level intervention designed to address trauma and its sequelae. SFDPH’s TIS Initiative is creating a healing organization through its innovative response to the impact of trauma.
How to Reveal Magnitude of Gene Signals: Hierarchical Hypergeometric Complementary Cumulative Distribution Function
Authors: Kim Bongsong
Published: October 2018

This article introduces a new method for genome-wide association study (GWAS), hierarchical hypergeometric complementary cumulative distribution function (HH-CCDF). Existing GWAS methods, e.g. the linear model and hierarchical association coefficient algorithm, calculate the association between a marker variable and a phenotypic variable. The ideal GWAS practice is to calculate the association between a marker variable and a gene-signal variable. If the gene-signal variable and phenotypic variable are imperfectly proportional, the existing methods do not properly reveal the magnitude of the association between the gene-signal variable and marker variable. The HH-CCDF mitigates the impact of the imperfect proportionality between the phenotypic variable and gene-signal variable and thus better reveals the magnitude of gene signals. The HH-CCDF will provide new insights into GWAS approaches from the viewpoint of revealing the magnitude of gene signals.
SME development strategy and product/service innovation intention: A NCaRBS analysis of the role of uncertainty
Authors: Beynon Malcolm J , Jones Paul , Pickernell David
Published: October 2018

Small and medium-sized enterprises (SME) are tasked with driving economic recovery globally, in terms of contribution to economic growth. Understanding the determinants of SME innovation is essential in clarifying this phenomena. This study investigates the link between SME strategies and intention to undertake future innovation, using Federation of Small Businesses data. The analysis employs the novel N-State Classification and Ranking Belief Simplex (NCaRBS) technique, investigating relationships between changes in SME strategies, including staffing levels, importing/exporting and client base, and future (including uncertain) innovation intentions. NCaRBS can analyse an incomplete data set, with missing values in the considered characteristic variables, without the need to manage their presence. NCaRBS can also generate results providing insights into SME behaviour regarding strategy and innovation, while also increasing learning about potential reasons behind SMEs uncertainty regarding innovation intention. The study provides novel perspectives into how SMEs develop innovation intentions and the strategies required to support/exploit such intentions, of value to academia, enterprise support agencies and policymakers.
Acceptance and Commitment Therapy and Motivational Interviewing in the Treatment of Alcohol Use Disorder in a College Woman: A Case Study
Authors: Ehman Anandi C. , Gross Alan M.
Published: October 2018

Alcohol abuse is common among college students. Acceptance and commitment therapy (ACT) is widely supported as a treatment of alcohol abuse. However, little research has examined how ACT may be paired with other techniques traditionally applied to treat substance abuse, such as motivational interviewing (MI). This clinical case study describes the use of ACT and MI to facilitate treatment of a 20-year-old woman who was referred for treatment for alcohol abuse. The client remained in treatment in spite of her initial self-reported belief that treatment was unnecessary. At follow-up, the client reported increased present moment awareness, particularly of her drinking habits, and demonstrated the ability to behave in ways consistent with her values. At the completion of treatment, the client reported fewer episodes of alcohol consumption and less severe drinking. Implications of these findings are discussed, with an emphasis on the potential benefits of pairing MI techniques with ACT.
Health-Promoting Lifestyle: A Considerable Contributing Factor to Quality of Life in Patients With Hypertension
Authors: Samiei Siboni Fatemeh , Alimoradi Zainab , Atashi Vajihe
Published: October 2018

Aim: Investigating the relationship between health promoting behaviors and quality of life in patients with hypertension. Methods: In this cross-sectional study, health-promoting behaviors and quality of life in patients with hypertension were assessed in a cardiology clinic of a university hospital in an urban area of Iran. The sample consisted of 93 patients with hypertension who were recruited using a convenience sampling method. Demographic data, Health Promoting Lifestyle Behaviors Profile (HPLP II) and World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaires were used to gather data. Data were analyzed using SPSS software version 21. Results: The mean score of health promoting behaviors was moderate (2.51 ± 0.47) with highest and lowest scores in nutritional (2.80 ± 0.52) and physical activity (1.78 ± 0.62) dimension, respectively. There was a statistically significant relationship between health-promoting behaviors and quality of life. The relationship between health-promoting behaviors and quality of life had the highest power in psychological health dimension (β = 5.353, P < .001) and lowest power in the environmental dimension (β = 0.365, P < .001). Conclusion: Improving quality of life of patients requires paying attention to educational interventions for creating changes in the lifestyle to improve all aspects of quality of life.
Prognostic impact of low allelic ratio FLT3-ITD and NPM1 mutation in acute myeloid leukemia
Authors: Sakaguchi Masahiro , Yamaguchi Hiroki , Najima Yuho , Usuki Kensuke , Ueki Toshimitsu , Oh Iekuni , Mori Sinichiro , Kawata Eri , Uoshima Nobuhiko , Kobayashi Yutaka , Kako Shinichi , Tajika Kenji , Gomi Seiji , Shono Katsuhiro , Kayamori Kensuke , Hagihara Masao , Kanda Junya , Uchiyama Hitoji , Kuroda Junya , Uchida Naoyuki , Kubota Yasushi , Kimura Shinya , Kurosawa Saiko , Nakajima Nana , Marumo Atsushi , Omori Ikuko , Fujiwara Yusuke , Yui Shunsuke , Wakita Satoshi , Arai Kunihito , Kitano Tomoaki , Kakihana Kazuhiko , Kanda Yoshinobu , Ohashi Kazuteru , Fukuda Takahiro , Inokuchi Koiti
Published: October 2018

In the opinion of the European LeukemiaNet (ELN), nucleophosmin member 1 gene mutation (NPM1 mut)–positive acute myeloid leukemia (AML) with an fms-like kinase 3-internal tandem duplication (FLT3-ITD) allele ratio (AR) <0.5 (low AR) has a favorable prognosis, and allogeneic hematopoietic stem cell transplant (allo-HSCT) in the first complete remission (CR1) period is not actively recommended. We studied 147 patients with FLT3-ITD gene mutation–positive AML, dividing them into those with low AR and those with AR of ≥0.5 (high AR), and examined the prognostic impact according to allo-HSCT in CR1. Although FLT3-ITD AR and NPM1 mut are used in the prognostic stratification, we found that NPM1 mut–positive AML with FLT3-ITD low AR was not associated with favorable outcome (overall survival [OS], 41.3%). Moreover, patients in this group who underwent allo-HSCT in CR1 had a significantly more favorable outcome than those who did not (relapse-free survival [RFS] P = .013; OS P = .003). Multivariate analysis identified allo-HSCT in CR1 as the sole favorable prognostic factor (RFS P < .001; OS P < .001). The present study found that prognosis was unfavorable in NPM1 mut–positive AML with FLT3-ITD low AR when allo-HSCT was not carried out in CR1.
Treatment adherence and blood pressure outcome among hypertensive out-patients in two tertiary hospitals in Sokoto, Northwestern Nigeria
Authors: Adisa Rasaq , Ilesanmi Olumide Ayodeji , Fakeye Titilayo Oyelola
Published: October 2018

Background

Treatment adherence play important roles in blood pressure control leading to reduction in morbidity and mortality. This study therefore assessed adherence to pharmacological and non-pharmacological therapies among ambulatory hypertensive patients. Reasons for treatment non-adherence, and association between adherence and blood pressure were also investigated.

Methods

Cross-sectional questionnaire-guided interview and retrospective review of medical records of 605-patients from two-tertiary healthcare institutions in Sokoto, Northwestern Nigeria. Nine-item modified Morisky adherence scale was used to assess medication adherence. Overall adherence score to lifestyle modifications was obtained from the total scores from 4-domains of non-pharmacological measures including cigarette smoking and alcohol cessation, salt-restriction and exercise. Patient-specific adherence education was provided at contact to resolve the knowledge gap(s). Clinical-parameters were retrieved at contact and subsequent 2-months appointment. Descriptive statistics, Chi-square and Student’s t-test were used for analysis at p < 0.05.

Results

Fifty-four (8.9%) patients were adherent to medications. Forgetfulness (404; 35.2%) was the most common reason for medication non-adherence. Use of buddy/companion reminder (605, 30.2%) top the list of adherence education. Overall adherence to lifestyle modifications was 36(6.0%). Mean systolic blood pressure (SBP) at contact was 149.6 ± 22.5 versus 134.2 ± 15.8 mmHg at 2-months with a 10% reduction. There were significant associations in baseline SBP for patients with or without adherence to medication, cigarette smoking cessation, and exercise (p < 0.05).

Conclusions

Overall adherence to antihypertensive medications and lifestyle modifications is suboptimal, underscoring the need for continuous patient-specific adherence education to ensure better therapeutic outcomes.
Blood-brain barrier-associated pericytes internalize and clear aggregated amyloid-β42 by LRP1-dependent apolipoprotein E isoform-specific mechanism
Authors: Ma Qingyi , Zhao Zhen , Sagare Abhay P , Wu Yingxi , Wang Min , Owens Nelly Chuqui , Verghese Philip B , Herz Joachim , Holtzman David M , Zlokovic Berislav V
Published: October 2018

Background

Clearance at the blood-brain barrier (BBB) plays an important role in removal of Alzheimer’s amyloid-β (Aβ) toxin from brain both in humans and animal models. Apolipoprotein E (apoE), the major genetic risk factor for AD, disrupts Aβ clearance at the BBB. The cellular and molecular mechanisms, however, still remain unclear, particularly whether the BBB-associated brain capillary pericytes can contribute to removal of aggregated Aβ from brain capillaries, and whether removal of Aβ aggregates by pericytes requires apoE, and if so, is Aβ clearance on pericytes apoE isoform-specific.

Methods

We performed immunostaining for Aβ and pericyte biomarkers on brain capillaries (< 6 μm in diameter) on tissue sections derived from AD patients and age-matched controls, and APPSwe/0 mice and littermate controls. Human Cy3-Aβ42 uptake by pericytes was studied on freshly isolated brain slices from control mice, pericyte LRP1-deficient mice (Lrplox/lox;Cspg4-Cre) and littermate controls. Clearance of aggregated Aβ42 by mouse pericytes was studied on multi-spot glass slides under different experimental conditions including pharmacologic and/or genetic inhibition of the low density lipoprotein receptor related protein 1 (LRP1), an apoE receptor, and/or silencing mouse endogenous Apoe in the presence and absence of human astrocyte-derived lipidated apoE3 or apoE4. Student’s t-test and one-way ANOVA followed by Bonferroni's post-hoc test were used for statistical analysis.

Results

First, we found that 35% and 60% of brain capillary pericytes accumulate Aβ in AD patients and 8.5-month-old APPSw/0 mice, respectively, compared to negligible uptake in controls. Cy3-Aβ42 species were abundantly taken up by pericytes on cultured mouse brain slices via LRP1, as shown by both pharmacologic and genetic inhibition of LRP1 in pericytes. Mouse pericytes vigorously cleared aggregated Cy3-Aβ42 from multi-spot glass slides via LRP1, which was inhibited by pharmacologic and/or genetic knockdown of mouse endogenous apoE. Human astrocyte-derived lipidated apoE3, but not apoE4, normalized Aβ42 clearance by mouse pericytes with silenced mouse apoE.

Conclusions

Our data suggest that BBB-associated pericytes clear Aβ aggregates via an LRP1/apoE isoform-specific mechanism. These data support the role of LRP1/apoE interactions on pericytes as a potential therapeutic target for controlling Aβ clearance in AD.
Evaluation of PACE4 isoforms as biomarkers in thyroid cancer
Authors: Fradet Laurent , Temmar Rabia , Couture Frédéric , Belzile Mathieu , Fortier Pierre-Hugues , Day Robert
Published: October 2018

Background

To date, no single molecular marker has been demonstrated as clinically useful in differentiating malignant from benign thyroid nodules when a fine needle aspiration falls in the “unknown significance” categories of the Bethesda Classification. PACE4, a member of the proprotein convertase family of enzymes, has been shown to play a major role in the pathogenesis of prostate cancer, through the formation of an oncogenic isoform named PACE4-altCT. PACE4 isoforms have also been suggested to play a role in other cancers, including thyroid cancer, but have never been investigated in a detailed manner. Our objective is to compare the histochemical distribution of the two major PACE4 isoforms in benign and malignant thyroid nodules, in order to determine their potential usefulness as discriminatory biomarkers.

Methods

Thyroid tissues of patients who underwent thyroidectomy were classified according to final pathology. Corresponding tissue sections were immunostained, using two previously validated antibodies raised against the C-terminal end of the two PACE4 isoforms, namely the full-length PACE4 protein (PACE4-FL) and its alternative isoform (PACE4-altCT). Nodules were compared with adjacent normal parenchyma and immunostaining was rated as “low” or “high” by a head and neck pathologist.

Results

Non-lesional thyroid parenchyma did not express PACE4-FL ( p = 0.002). As a group, malignant ( n = 17) nodules expressed PACE4-FL significantly more than benign ( n = 24) nodules (percentage of high immunostaining: 52.9% vs 4.2%; p = 0.001). Reciprocally, there was a statistically lower expression of PACE4-altCT in malignant nodules than in adjacent non-lesional parenchyma ( p = 0.014). The specificity of a high PACE4-FL immunostaining in determining malignancy was 95.8% (95% CI, 78.9% to 99.9%).

Conclusion

This study supports the previously described relationship between PACE4-FL and PACE4-altCT through alternative splicing. It also suggests that PACE4-FL is a promising biomarker for thyroid malignancy. Its high specific expression for malignancy could make it an interesting “rule in” test for thyroid cancer. Further prospective, quantitative studies are currently being designed to address how measurements of PACE4 isoforms could be used in a clinical setting.

Trial registration

This study does not report the results of a health care intervention on human participants. It was nonetheless registered on ClinicalTrials.gov under reference number NCT03160482 .
Montgomery and shared decision-making: implications for good psychiatric practice
Authors: Adshead Gwen , Crepaz-Keay David , Deshpande Mayura , Fulford K.W.M (Bill) , Richards Veryan
Published: October 2018

The 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.

Declaration of interest

None.
Are rating scales for bipolar disorders fit for purpose?
Authors: Scott Jan , Murray Greg
Published: October 2018

The DSM-5 definition of bipolar disorder elevates increased activity or energy as a cardinal symptom (alongside mood changes) for mania and hypomania (‘hypo/mania’). The ICD-10 likewise requires increases in activity and energy (alongside mood) for hypo/mania, as well as decreases for bipolar depression. Using bipolar disorder as an example, we propose that, when diagnostic criteria are revised, instruments used to measure clinical course and treatment response may need revisiting. Here, we highlight that the ‘gold-standard’ symptom rating scales for hypo/mania and depression were developed in an era when abnormalities of mood were viewed as the cardinal symptom of bipolar disorder. We contend that archetypal measures fail to give proportionate weighting to activity or energy, undermining their utility in monitoring bipolar disorder and treatment response in clinical and research practice.

Declarations of interest

J.S. and G.M. are members of mMARCH, (Motor Activity Research Consortium for Health), which is led by Dr Kathleen Merikangas, National Institute for Mental Health. J.S. reports being a visiting professor at Diderot University, the Norwegian University of Science and Technology, Swinburne University of Technology and The University of Sydney; receiving grant funding from the UK Medical Research Council and from the UK Research for Patient Benefit programme; and receiving a personal fee from Janssen-Cilag for a non-promotional talk on sleep problems.