bluuebunny/crossref_metadata_2025 huggingface dataset:
The Decline of the Scottish Conservatives in North‐East Scotland, 1965–79: A Regional Perspective
Authors: Saleh Taym
Published: June 2017

This article takes a fresh look at the decline of the Conservative Party in post‐war Scotland, a phenomenon that has provoked much debate. The analysis presented here is innovative in that it takes a regional approach, whereas other contributions to this field have tended to ignore the considerable regional diversity of Scottish political behaviour. By examining one particular region of Scotland – the rural north‐east – this article demonstrates that the Conservatives’ decline occurred at the hands of parties – the Liberals and the Scottish Nationalists – that did not brand themselves as left wing or right wing; the latter in particular eschewed conventional political labels. This marks another departure from the established literature, which has tended to discuss the decline in terms of the Conservative Party or the Scottish electorate moving ‘left’ or ‘right’. Furthermore, the article makes it clear that a serious decline befell the party between 1965 and 1979: before the advent of Thatcherism that has widely been held responsible for the Scottish Conservatives’ electoral woes. This analysis is conducted by examining the local press coverage of the region, as well as the national and regional records of the parties concerned. It therefore seeks to make a contribution to the wider study of post‐war British politics, by demonstrating the benefits of local and regional approaches in this period where they have been largely overlooked. This article demonstrates that even in the 1960s and 1970s, when politics seemed so nationally uniform, there is considerable diversity to be appreciated in different parts of the country.
Comparing polyarteritis nodosa in children and adults: a single center study
Authors: Erden Abdulsamet , Batu Ezgi D. , Sönmez Hafize E. , Sarı Alper , Armagan Berkan , Arıcı Zehra S. , Bilgin Emre , Kalyoncu Umut , Karadağ Ömer , Bilginer Yelda , Ertenli Ali Ihsan , Özen Seza
Published: June 2017

Objective

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium/small arteries. We aimed to examine the characteristics of adult‐ and childhood‐onset PAN.

Methods

Fifteen pediatric (˂ 18 years) and 22 adult PAN patients who fulfilled the Ankara 2008 and American College of Rheumatology 1990 criteria, respectively, were included in the study.

Results

Five children had cutaneous and all the rest of the patients had systemic PAN. Weight loss was more common (59.1% vs. 20%, P = 0.041) and presence of an angiography at diagnosis was more frequent (81.8% vs. 33.3%, P = 0.003) in adults than children. Arthralgia/arthritis and skin involvement were more common in children (86.7% vs. 59.1%; 93.3% vs. 72.7%, respectively) while renal and neurologic involvement were more frequently observed in adult patients (50% vs. 20%; 59.1% vs. 40%, respectively) (P > 0.05 for all). Cutaneous PAN patients were treated with corticosteroids only. All but one adult patient received cyclophosphamide while mycophenolate mofetil was used in five and cyclophosphamide was used in four children as induction treatment. The median duration of induction treatment was longer in adults than children (12 vs. 3 months, respectively; P = 0.004). The most common maintenance drug was mycophenolate mofetil in children and azathioprine in adults. The mortality rate was 13.6% (n = 3) and 0% in adults and children, respectively.

Conclusion

To our knowledge, this is the first study comparing characteristics of adult and childhood onset PAN. Our results have suggested that juvenile PAN had a more benign course (with less renal and neurologic involvement, shorter duration of induction treatment) than adult onset PAN.
Serum Interleukin‐37: a new player in Lupus Nephritis?
Authors: Tawfik Marwa G. , Nasef Samah I. , Omar Hanan H. , Ghaly Mona S.
Published: June 2017

Introduction

Interleukin‐37 (IL‐37) has been proved to be a fundamental natural suppressor of innate immunity and inflammatory responses in autoimmune diseases such as systemic lupus erythematous (SLE). The purpose of this study was to assess serum IL‐37 level in SLE patients and its correlation with disease activity and clinical and laboratory manifestations of SLE patients.

Patients/methods

The serum level of IL‐37 was assessed and analyzed in 100 SLE patients and 50 healthy controls by using enzyme‐linked immunosorbent assay (ELISA). Clinical and laboratory manifestations and disease activity using SLE Disease Activity Index (SLEDAI) were also assessed.

Results

IL‐37 serum level was significantly higher among SLE patients than controls. It has statistically significant correlation with disease activity, renal and mucocutaneous involvement in SLE patients.

Conclusion

IL‐37 level is elevated in SLE patients in comparison to healthy controls and is correlated to high disease activity, mucocutaneous and renal involvement.
Post‐discharge nausea and vomiting after total intravenous anaesthesia and standardised PONV prophylaxis for ambulatory surgery
Authors: Bruderer U. , Fisler A. , Steurer M. P. , Steurer M. , Dullenkopf A.
Published: June 2017

Background

The incidence of post‐discharge nausea and vomiting (PDNV) after ambulatory anaesthesia using total intravenous anaesthesia with a risk‐stratified anti‐emetic approach is not well documented in the literature. In this study, we outline such an approach. The goal was to achieve an acceptably low rate of PDNV both immediately and the day after surgery.

Methods

With ethics committee approval, adult patients undergoing outpatient surgery received a Propofol‐based general anaesthetic plus standardised PONV‐prophylaxis corresponding to their Apfel risk‐score (0–4); ondansetron (risk‐score 2), additional dexamethasone (risk‐score 3), and additional droperidol (risk‐score 4).

On post‐operative days one and two, patients scored PDNV and pain (numeric rating scale (NRS); 0 = none at all; 10 = worst imaginable). On post‐operative day two, patients indicated the level of interference of PDNV and/or pain with their quality of life. Data are descriptive (%) or mean.

Results

There were 222 patients included (age 43 years, 44% female, anaesthesia time 95 min). On the day of surgery, 69.4% of patients did not experience any nausea, 10.4% complained about severe (NRS > 6) nausea, 6.3% experienced vomiting or retching. On the first and second postoperative day, nausea was absent in 88.7% of patients and 97.3%, respectively. Quality of life was impacted (NRS ≥ 4) more by pain (32.8% of cases), than by PDNV (13.6%).

Conclusion

Acceptably low rates of PDNV were achieved with the proposed standardised approach to PDNV prophylaxis. For almost 90% of patients, PDNV was not an issue the first day after surgery. Pain after discharge was a more common problem.
Hysterectomy trends in Australia, 2000–2001 to 2013–2014: joinpoint regression analysis
Authors: Wilson Louise F. , Pandeya Nirmala , Mishra Gita D.
Published: June 2017

Introduction

Hysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000–2001 to 2013–2014.

Material and methods

For women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Age‐specific and age‐standardized hysterectomy rates per 10 000 women were estimated with adjustment for hysterectomy prevalence in the population. Using joinpoint regression analysis, we estimated the average annual percentage change over the whole study period (2000–2014) and the annual percentage change for each identified trend line segment.

Results

A total of 431 162 hysterectomy procedures were performed between 2000–2001 and 2013–2014; an annual average of 30 797 procedures (for women aged 25+ years). The age‐standardized hysterectomy rate, adjusted for underlying hysterectomy prevalence, decreased significantly over the whole study period [average annual percentage change −2.8%; 95% confidence interval (CI) −3.5%, −2.2%]. The trend was not linear with one joinpoint detected in 2008–2009. Between 2000–2001 and 2008–2009 there was a significant decrease in incidence (annual percentage change −4.4%; 95% CI −5.2%, −3.7%); from 2008–2009 to 2013–2014 the decrease was minimal and not significantly different from zero (annual percentage change −0.1%; 95% CI −1.7%, 1.5%). A similar change in trend was seen in all age groups.

Conclusions

Hysterectomy rates in Australian women aged 25 years and over have declined in the first decade of the 21st century. However, in the last 5 years, rates appear to have stabilized.
Lack of immunogenicity of hydrolysed wheat flour in patients with coeliac disease after a short‐term oral challenge
Authors: Mandile R. , Picascia S. , Parrella C. , Camarca A. , Gobbetti M. , Greco L. , Troncone R. , Gianfrani C. , Auricchio R.
Published: June 2017

Background

A gluten‐free diet is currently the only reliable therapeutic strategy that is approved for coeliac disease (CD). For many patients, however, compliance remains inadequate.

Aim

To investigate the immunogenicity of wheat flour that was pre‐treated with selected lactobacilli and fungal proteases (hydrolysed wheat gluten) in coeliac patients.

Methods

The immunogenicity of hydrolysed wheat gluten was evaluated both in vitro in intestinal T cell lines (TCLs) and in vivo in treated CD patients after a short‐term gluten challenge. Twenty treated CD patients were enrolled and equally randomised into two groups. The patients ate bread that was prepared with hydrolysed wheat flour or natural wheat flour (10 g of gluten/d for 3 days). The interferon (INF)‐γ responses to natural gliadin and a 33‐mer peptide were assessed by the enzyme‐linked immunospot (ELISPOT) assay on peripheral blood mononuclear cells (PBMCs) both before and 6 days after the start of the challenge.

Results

Hydrolysed wheat was not able to activate the TCLs from the coeliac intestinal mucosa. Consistent with the in vitro results, no significant increase in INF‐γ secretion was observed in patients who consumed hydrolysed wheat flour. Conversely, the consumption of natural wheat gluten mobilised INF‐γ secreting cells in the blood (P<.05).

Conclusions

We confirm that fermentation of wheat flour with sourdough lactobacilli and fungal proteases is capable of abolishing the T cell immunogenicity of gluten in coeliac patients. Our data also validate the short‐term oral challenge as a useful tool for testing the efficacy of novel therapeutic approaches.
Clinical Experience with the Integrase Inhibitors Dolutegravir and Elvitegravir in HIV‐infected Patients: Efficacy, Safety and Tolerance
Authors: Cid‐Silva Purificación , Llibre Josep M. , Fernández‐Bargiela Noelia , Margusino‐Framiñán Luis , Balboa‐Barreiro Vanesa , Pernas‐Souto Berta , Martín‐Herranz Isabel , Castro‐Iglesias Ángeles , Poveda Eva
Published: June 2017

Two integrase inhibitors (INSTIs), dolutegravir (DTG) and elvitegravir/cobicistat (EVG/COBI), have joined recently the pharmacotherapy arsenal against HIV. This study evaluated the efficacy and tolerability of these INSTIs in the last two years. A retrospective observational study in patients who started DTG or EVG/COBI from January 2015 to January 2017 at a reference hospital in north‐western Spain was done. Epidemiological, clinical and immunovirological data were recorded. A statistical analysis was performed with SPSS software. A total of 542 DTG (n = 275)‐ or EVG/COBI (n = 267)‐based therapies were initiated during the study period. Overall, more than 90% of naïve and pre‐treated patients had virological suppression in both groups after 48 weeks of initiation of treatment per‐protocol snapshot analysis. During follow‐up, 10.2% of patients were treated with DTG and 4.5% of those treated with EVG discontinued due to adverse events (AE). In the case of DTG mainly related to neuropsychiatric disturbances (70.4%) and for EVG/COBI with gastrointestinal discomfort (50%). Female sex [HR 2.255 (95%CI 1.121–4.535), p = 0.023] and DTG treatment [HR 2.453 (95%CI 1.221–4.931), p = 0.012] were associated with AE discontinuations. Specifically for neuropsychiatric events, DTG treatment [HR 5.906 (95%CI 1.954–17.846), p = 0.002] and receiving abacavir/lamivudine/DTG [HR 4.380 (95%CI 1.348–14.233), p = 0.014] were identified as predictive risk factors for treatment discontinuations in two different multivariate analyses. A high percentage of AE discontinuations not previously described in clinical trials has been observed, especially with DTG. Female gender and DTG treatment were identified as risk factors for AE discontinuation. DTG‐based therapies, especially in combination with abacavir/lamivudine, were associated with an increased risk of treatment discontinuation due to neuropsychiatric AE.
The Acute Effect of Loperamide on Ileostomy Output: A Randomized, Double‐Blinded, Placebo‐Controlled, Crossover Study
Authors: Kristensen Katrine , Qvist Niels
Published: June 2017

High stoma output is a common problem in patients with ileostomy and can lead to dehydration and electrolyte disturbances. The first drug of choice to reduce stoma output is often loperamide. The aim was to assess the acute effect of loperamide on (a) ileostomy output in g/day, (b) gastrointestinal transit time and (c) patient‐reported effects. A total of 12 patients completed this double‐blinded, randomized, placebo‐controlled, crossover study, consisting of a 3‐day treatment period with loperamide 12 mg/day or placebo followed by the reverse after a washout period of 5–7 days. Patients collected stoma output and noted food and fluid intake over 48 hr and swallowed a capsule with radiopaque markers for the determination of gastrointestinal transit time over 24 hr. At the end of the study, patients were asked to report their treatment sequence. Ileostomy output was significantly reduced during loperamide treatment (p < 0.02) with a median of 16.5% (range −5% to 46%). Transit time was reduced significantly for the passage of 10% of the markers (p = 0.02), but not for 50% and 100% of the markers. Fifty‐eight per cent (N = 7) of the patients reported the correct treatment sequence (p = 0.41). Loperamide 12 mg/day reduced ileostomy output statistically significantly, but with varying effects among patients and without reaching the clinical significance of 20% set‐up by this study. Dose–response studies should be performed, and standard treatment doses of loperamide should be reassessed. The study was registered at ClinicalTrials.gov – NCT02266849.
“…their opinions mean something”: Care staff's attitudes to health research involving people with intellectual disabilities
Authors: Hall Natalie , Durand Marie‐Anne , Mengoni Silvana E.
Published: June 2017

Accessible summary

It is important for people with intellectual disabilities to be involved in research about their health care.

Eight people working in the care sector were interviewed about their views about supporting people with intellectual disabilities to take part in research.

Care staff were positive about research but talked about things that may make it difficult for people with intellectual disabilities to take part in research.

We suggest some ideas that could help care staff and researchers to support people with intellectual disabilities to take part in research.

Background

Despite experiencing health inequalities, people with intellectual disabilities are under‐represented in health research. Previous research has identified barriers but has typically focused on under‐recruitment to specific studies. This study aimed to explore care staff's attitudes to health research involving people with intellectual disabilities, identify barriers to conducting such research and consider solutions to those barriers.

Materials and Methods

Eight members of care sector staff took part in a focus group or telephone interview, to explore their views on health research involving people with intellectual disabilities. The transcriptions were analysed using thematic analysis; 50% were double‐coded, and the emerging themes were agreed by three researchers.

Results

Three themes were identified: perceptions of research; barriers to conducting research; solutions to maximise recruitment and project success. Benefits to research were identified, but there were concerns that the time and effort required may outweigh these benefits. Barriers were identified including organisational policy and following the Mental Capacity Act 2005. There was some indication that such barriers may differ according to the severity of intellectual disabilities and the type of care setting. Solutions were proposed that involved greater collaboration between researchers and the care sector, and a more flexible approach to research.

Conclusions

Care staff are largely supportive of research that is appropriate and relevant to their service users. However, there is a need for clear communication from researchers and flexible recruitment and data collection strategies. This is likely to be facilitated by closer collaboration between researchers and the social care sector.
Genetic alterations in adult T‐cell leukemia/lymphoma
Authors: Kogure Yasunori , Kataoka Keisuke
Published: June 2017

Adult T‐cell leukemia/lymphoma (ATL) is a peripheral T‐cell neoplasm with a dismal prognosis. It is caused by human T‐cell leukemia virus type‐1 (HTLV‐1) retrovirus. A long latency period from HTLV‐1 infection to ATL onset suggests that not only HTLV‐1 proteins, such as Tax and HBZ, but also additional genetic and/or epigenetic events are required for ATL development. Although many studies have demonstrated the biological functions of viral genes, alterations of cellular genes associated with ATL have not been fully investigated. Recently, a large‐scale integrated genetic analysis revealed the entire landscape of somatic aberrations in ATL. This neoplasm is characterized by frequent gain‐of‐function alterations in components of the T‐cell receptor/NF‐κB signaling pathway, including activating mutations in the PLCG1, PRKCB, CARD11 and VAV1 genes, and CTLA4‐CD28 and ICOS‐CD28 fusions. Importantly, molecules associated with immune surveillance, such as HLA‐A/B, CD58 and FAS, are affected recurrently. Among them, one notable lesion occurs as frequent structural variations that truncate the PD‐L1 3′‐untranslated region, leading to its overexpression. Other genetic targets include transcription factors (IRF4, IKZF2, and GATA3) and chemokine receptors (CCR4, CCR7 and GPR183), which are functionally relevant in normal T cells. A substantial proportion of ATL cases show widespread accumulation of repressive epigenetic changes, such as trimethylation of histone H3 lysine 27 and DNA hypermethylation of CpG islands, which coordinately modulate multiple pathways, including Cys2‐His2 zinc finger genes involved in silencing retroelements. Here we review the current understanding of the genetic/epigenetic aberrations in ATL, focusing on their relevance in its molecular pathogenesis.
Exhaled breath profiles in the monitoring of loss of control and clinical recovery in asthma
Authors: Brinkman P. , van de Pol M. A. , Gerritsen M. G. , Bos L. D. , Dekker T. , Smids B. S. , Sinha A. , Majoor C. J. , Sneeboer M. M. , Knobel H. H. , Vink T. J. , de Jongh F. H. , Lutter R. , Sterk P. J. , Fens N.
Published: June 2017

Background

Asthma is a chronic inflammatory airway disease, associated with episodes of exacerbations. Therapy with inhaled corticosteroids (ICS) targets airway inflammation, which aims to maintain and restore asthma control. Clinical features are only modestly associated with airways inflammation. Therefore, we hypothesized that exhaled volatile metabolites identify longitudinal changes between clinically stable episodes and loss of asthma control.

Objectives

To determine whether exhaled volatile organic compounds (VOCs) as measured by gas‐chromatography/mass‐spectrometry (GC/MS) and electronic nose (eNose) technology discriminate between clinically stable and unstable episodes of asthma.

Methods

Twenty‐three patients with (partly) controlled mild to moderate persistent asthma usingICSwere included in this prospective steroid withdrawal study. Exhaled metabolites were measured at baseline, during loss of control and after recovery. Standardized sampling of exhaled air was performed, after which samples were analysed byGC/MSandeNose. Univariate analysis of covariance (ANCOVA), followed by multivariate principal component analysis (PCA) was used to reduce data dimensionality. Next pairedttests were utilized to analyse within‐subject breath profile differences at the different time‐points. Finally, associations between exhaled metabolites and sputum inflammation markers were examined.

Results

Breath profiles byeNose showed 95% (21/22) correct classification for baseline vs loss of control and 86% (19/22) for loss of control vs recovery. Breath profiles usingGC/MSshowed accuracies of 68% (14/22) and 77% (17/22) for baseline vs loss of control and loss of control vs recovery, respectively. Significant associations between exhaled metabolites captured byGC/MSand sputum eosinophils were found (Pearsonr≥.46,P<.01).

Conclusions & Clinical Relevance

Loss of asthma control can be discriminated from clinically stable episodes by longitudinal monitoring of exhaled metabolites measured byGC/MSand particularlyeNose. Part of the uncovered biomarkers was associated with sputum eosinophils. These findings provide proof of principle for monitoring and identification of loss of asthma control by breathomics.
Surgical treatment of peri‐implantitis intrabony lesions by means of deproteinized bovine bone mineral with 10% collagen: 7‐year‐results
Authors: Roccuzzo Mario , Pittoni Dario , Roccuzzo Andrea , Charrier Lorena , Dalmasso Paola
Published: June 2017

Objectives

The aim of this study was to evaluate the long‐term results of the surgical treatment of single peri‐implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC).

Material and Methods

The original population consisted of 26 patients with one crater‐like defect, around either sandblasted and acid‐etched (SLA) or titanium plasma‐sprayed (TPS) dental implants, with a probing depth (PD) ≥6 mm and no implant mobility (Roccuzzo et al. J Clin Periodontol. 2011; 38: 738). Implants were mechanically debrided and treated using EDTA gel and chlorhexidine gel. The bone defects were filled with DBBMC, and the flap was sutured around the non‐submerged implant. Patients were placed on an individually tailored supportive periodontal therapy (SPT).

Results

Two patients were lost to follow‐up. During SPT, additional antibiotic and/or surgical therapy was necessary in eight implants, and four of these were removed for biologic complications. At 7‐year, the survival rate was 83.3% for SLA implants and 71.4% for TPS. PD was significantly reduced from 6.6 ± 1.3 to 3.2 ± 0.7 mm in SLA and 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. Bleeding on probing decreased from 75.0 ± 31.2% to 7.5 ± 12.1% (SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% (TPS). When successful therapy was defined as PD ≤5 mm, absence of bleeding/suppuration on probing, and no further bone loss, treatment success was obtained in 2 of 14 (14.3%) of the TPS and in 7 of 12 (58.3%) of the SLA implants.

Conclusions

Seven years after surgical treatment with DBBMC, patients, in an adequate SPT, maintained sufficient peri‐implant conditions in many cases, particularly around SLA implants. Nevertheless, some patients required further treatment and some lost implants. The clinical decision on whether implants should be treated or removed should be based on several factors, including implant surface characteristics.
Donor‐specific antibodies are associated with micro‐ and macrovascular coronary disease, restrictive myocardial damage, and poor outcome in heart‐transplanted patients
Authors: Clemmensen Tor Skibsted , Koefoed‐Nielsen Pernille , Jensen Lis‐Ann , Poulsen Steen Hvitfeldt , Holm Niels Ramsing , Løgstrup Brian Bridal , Christiansen Evald Høj , Dijkstra Jouke , Valen Kamilla Pernille Bjerre , Eiskjær Hans
Published: June 2017

Aims

We examined the relationship between donor‐specific HLA antibody (DSA) presence and graft function, hemodynamics, cardiac allograft vasculopathy (CAV), and major adverse cardiac events (MACE) in stable long‐term heart‐transplanted (HTx) patients.

Methods

Sera from 79 patients (median 7.5 years after HTx) were analyzed for DSA presence. Graft function was evaluated by echocardiography and right heart catheterization. CAV burden was determined by coronary angiography, optical coherence tomography (OCT), and coronary flow velocity reserve (CFVR). Patients were prospectively followed after DSA assessment. MACE included significant CAV progression, heart failure, treated rejection, and cardiovascular death.

Results

Sixty patients had no DSA, and 19 patients were sensitized. The vasculopathy burden by angiography, OCT, and CFVR was more pronounced in DSA‐positive patients than in DSA‐negative patients. DSA‐positive patients had higher pulmonary capillary wedge pressure (16 [8; 21] vs 9 mm Hg [7; 11], P<.05) and right atrial pressure (8 [6; 9] vs 4 mm Hg [2; 6], P<.01) and lower global longitudinal strain (−13% [−10; −15] vs −16% [−14; −17], P<.01) than DSA‐negative patients.

DSA presence was a strong MACE predictor (HR 4.7 (95% CI 2.0‐11.4), P<.001).

Conclusions

DSA‐positive patients had higher vasculopathy burden, higher filling pressures, and lower longitudinal myocardial deformation than DSA‐negative patients. The DSA presence was a strong MACE predictor.
Acral dermatofibrosarcoma protuberans with myoid differentiation: A report of 2 cases
Authors: Al‐Zaid Tariq , Khoja Hatim
Published: June 2017

Dermatofibrosarcoma protuberans (DFSP) is a low‐grade mesenchymal neoplasm with a tendency for local recurrence; it is rarely metastatic. Dermatofibrosarcoma protuberans typically arises in the trunk and proximal extremities. However, it can arise in unusual sites such as the hands and feet. Several variants have been described, including DFSP with myoid differentiation, which is very uncommon. This variant tends to be observed more with the fibrosarcomatous variant, and it can be either in the form of myoid bundles and nodules with no vascular relationship or represent hyperplastic blood vessels within the tumor. Here, we report 2 cases of DFSP with myoid differentiation (ordinary and fibrosarcomatous) on the foot. To the best of our knowledge, these cases represent the first 2 cases of acral DFSP with myoid differentiation.
Myxoid variant of primary cutaneous anaplastic large cell lymphoma: First 2 cases
Authors: Fernandez‐Flores Angel , Eginli Ariana , Cassarino David S.
Published: June 2017

Anaplastic large cell lymphoma (ALCL) is a CD30+ T‐cell non‐Hodgkin lymphoma with 2 main clinical presentations: primary cutaneous ALCL (pcALCL) and systemic ALCL (sALCL). While rare cases of myxoid sALCL have been reported, there are no previous cases of myxoid pcALCL reported. We present 2 unusual cases of pcALCL showing prominent collections of dermal mucin closely intermingling with the anaplastic lymphocytes. Patient 1 was a 30‐year‐old woman who presented with ulcerated nodules on her neck, abdomen, chest and shoulders. A systemic lymphoma was excluded by physical examination, positron emission tomography and computed tomography (PET‐CT) scan, as well as by bone marrow biopsy and flow cytometry studies. The patient was closely followed‐up for 10 months without evidence of systemic involvement. The biopsy showed diffuse infiltration of the dermis by a CD2+, CD30+, anaplastic lymphoma kinase (ALK)‐negative ALCL. Patient 2 was a 55‐year‐old woman who presented with a single nodule on her right arm. A systemic lymphoma was excluded by physical examination as well as by a PET‐CT scan. The biopsy showed diffuse and dense lymphoid infiltration of the whole biopsy by a CD3+, CD4+, CD30+, ALK‐negative ALCL. The atypical lymphocytes were intermingled with large amounts of dermal stromal mucin.
A pilot study comparing histological and immunophenotypic patterns in stage 4 skin graft vs host disease from toxic epidermal necrolysis
Authors: Naik Haley , Lockwood Stephen , Saavedra Arturo
Published: June 2017

Background

Stage 4 skin graft‐versus‐host disease (GVHD) is associated with poor prognosis and high mortality rates. Clinical and histologic similarities with toxic epidermal necrolysis (TEN) make it difficult to distinguish between these 2 life‐threatening conditions.

Methods

A retrospective cohort study was conducted from a tertiary referral center. Skin biopsies were obtained from 11 patients who developed stage 4 skin GVHD and 11 patients who developed TEN between 2005 and 2012. The CD8+/CD4+ T lymphocyte ratios were assessed in lesional skin specimens.

Results

Average CD8+and CD4+ cell counts co‐expressing CD3 were 126.29 (range 86.42‐173.06) and 84.60 (29.87‐197.20) for stage 4 skin GVHD patients, and 61.97 (45.79‐146.67) and 7.65 (0.00‐39.50) for TEN patients, respectively. Immunohistochemical studies of stage 4 skin GVHD and TEN skin demonstrated average CD8+/CD4+ ratios of 1.78 (range 0.69‐3.09) and 7.33 (1.16‐12.3), respectively (P = .013).

Conclusions

Stage 4 skin GVHD and TEN are processes with cytotoxic profiles. TEN is notable for a greater relative depletion of CD4+ T lymphocytes compared with stage 4 skin GVHD, while stage 4 skin GVHD tends to be more inflammatory than TEN. These data suggest an immunohistologic method by which these 2 entities may be distinguished.
Markedly increased incidence of critical illness in adults with Type 1 diabetes
Authors: Marrie R. A. , Sellers E. A. C. , Chen H. , Fransoo R. , Bernstein C. N. , Hitchon C. A. , Peschken C. A. , Garland A.
Published: June 2017

Aims

To compare the incidence of and mortality after intensive care unit admission in adults with paediatric‐onset Type 1 diabetes vs the general population.

Methods

Using population‐based administrative data from Manitoba, Canada, we identified 814 cases of paediatric‐onset Type 1 diabetes, and 3579 general population controls matched on age, sex and region of residence. We estimated the incidence of intensive care unit admission in adulthood, and compared the findings between populations using incidence rate ratios and multivariable Cox proportional hazards regression, adjusting for age, sex, comorbidity and socio‐economic status. We estimated age‐ and sex‐standardized mortality rates after intensive care unit admission.

Results

Between January 2000 and October 2009, the average annual incidence of intensive care unit admission among prevalent cohorts was 910 per 100 000 in the Type 1 diabetes population, and 106 per 100 000 in matched controls, an eightfold increased risk (incidence rate ratio 8.6; 95% CI 5.5, 14.0). The adjusted risk of intensive care unit admission was elevated to a greater extent among women with Type 1 diabetes compared with matched women (hazard ratio 14.7; 95% CI 7.2, 29.4) than among men with Type 1 diabetes compared with matched men (hazard ratio 4.92; 95% CI 10.3, 2.36) The most common reasons for admission in the diabetes cohort were diabetic ketoacidosis, infection and ischaemic heart disease. At 30%, 5‐year mortality was higher in the diabetes cohort than in the matched cohort (relative risk 5.7; 95% CI 1.2, 8.9).

Conclusions

Compared with the general population, the risk of intensive care unit admission was higher in adults with paediatric‐onset Type 1 diabetes, and mortality after admission was also higher.
Racial and ethnic differences among children with new‐onset autoimmune Type 1 diabetes
Authors: Gandhi K. , Tosur M. , Schaub R. , Haymond M. W. , Redondo M. J.
Published: June 2017

Aim

To compare demographic and clinical characteristics among children from ethnic minorities and non‐Hispanic white children with new‐onset autoimmune Type 1 diabetes.

Methods

We analysed a single‐centre series of 712 children with new‐onset autoimmune Type 1 diabetes between January 2008 and March 2011. The median (range) age was 9.7 (0.3–18.1) years, the mean (sd) BMI percentile was 69.7 (25.4) and 48.3% of the cohort were girls. The cohort comprised 57.3% non‐Hispanic white, 20.5% Hispanic and 14.8% African‐American children, and 7.4% were of other, mixed or unknown race.

Results

The Hispanic subgroup, compared with non‐Hispanic white subgroup, had a higher mean (sd) C‐peptide level [0.82 (1.62) vs 0.55 (0.47) ng/ml; P=0.004), and a greater proportion of children with elevated BMI (overweight or obesity; 49.6% vs 32.5%; P<0.001) and diabetic ketoacidosis (51.8% vs 38.2%; P=0.006). The African‐American group had a higher mean (sd) glucose level [24.4 (12.8) vs 21.4 (10.7) mmol/l; P=0.017], a greater proportion of children with ketoacidosis (56.7% vs 38.2%; P=0.001), a greater proportion with elevated BMI (52.9% vs 32.5%; P<0.001), and a lower proportion of children at pre‐pubertal stage (49.0% vs 61.6%; P=0.01), and tended to have higher C‐peptide levels [0.65 (0.59) vs 0.55 [0.47] ng/ml; P=0.079) compared with the non‐Hispanic white children. The differences in C‐peptide levels compared with non‐Hispanic white children persisted for Hispanic (P=0.01) but not African‐American children (P=0.29) after adjustment for age, sex, BMI, ketoacidosis, glucose, Tanner stage and autoantibody number.

Conclusion

At the onset of paediatric autoimmune Type 1 diabetes, Hispanic, but not African‐American children had higher C‐peptide levels, after adjustment for potential confounders, compared with non‐Hispanic white children. These findings suggest that ethnicity may contribute to the heterogeneity of Type 1 diabetes pathogenesis, with possible implications for intervention.
Designing Competitive Industry Sectors
Authors: Peppou George , Thurgood Clementine , Bucolo Sam
Published: June 2017

Industry sectors are typified by their complex, networked, and open nature, characteristics making them well suited to innovation through the application of design. Despite this apparent suitability, there remains little research published specifically regarding the application of design to sector‐level strategy formation. This article describes the application of a design‐led innovation (DLI) approach to industry transformation strategy. DLI is a design thinking method that integrates deep customer insights into business models, informing organizational transformation and strategy. This article explores the adaptations and challenges that occur when scaling design to a sector in the form of a proposed framework: the Sector Grand Challenge Framework (SGC Framework). This is described through a case study applying the SGC Framework to the development of a food and agribusiness (agrifood) growth and competitiveness strategy in partnership with Food Innovation Australia Limited, an Australian Federal Government Industry Growth Centres initiative. The SGC Framework uses many of the same principles as DLI, scaling this approach to an entire industry sector. This scale exacerbates key challenges observed within a firm, including poor linkages between groups, large and complex stakeholder networks, and lack of unifying purpose or vision.
CAPitalising on conservation knowledge: Using Conservation Action Planning, Healthy Country Planning and the Open Standards in Australia
Authors: Carr Ben , Fitzsimons James , Holland Natalie , Berkinshaw Todd , Bradby Keith , Cowell Stuart , Deegan Paula , Koch Paul , Looker Michael , Varcoe Tony , Walsh Philippa , Weisenberger Frank
Published: June 2017

More than 20 organisations use Conservation Action Planning (CAP), Healthy Country Planning and the Open Standards for the Practice of Conservation in over 140 projects, covering almost 160 million ha across Australia. This review documents the history, evolution and application ofCAPin Australia and discusses its strengths, limitations and lessons learnt by users, including conservation planners, practitioners and policymakers.
Observations of responses to re‐introducing fire in a Basalt Plains grassland after the removal of grazing: Implications for restoration
Authors: Bryant David , Bruce Matthew J. , Sinclair Steve J.
Published: June 2017

Natural grasslands in southern Australia commonly exist in altered states. One widespread altered state is grassland pasture dominated by cool‐season (C3) native grasses maintained by ongoing grazing. This study explores the consequences of removing grazing and introducing fire as a conservation management tool for such a site. We examined the abundance of two native and three exotic species, across a mosaic of fire regimes that occurred over a three‐year period: unburnt, summer wild‐fire (>2 years previous), autumn management fire (<1 year previously) and burnt in both fires. Given that one aim of conservation management is to increase native species at the expense of exotics, the impacts of the fires were largely positive. Native grasses were at higher cover levels in the fire‐managed vegetation than in the unburnt vegetation. Of the three exotic species, one was consistently at lower density in the burnt plots compared to the unburnt plots, while the others were lower only in those plots burnt in summer. The results show that the response of a species varies significantly between different fire events, and that the effects of one fire can persist through subsequent fires. Importantly, some of the effects were large, with changes in the density of plants of over 100‐fold. Fire is potentially a cost‐effective tool to assist the ecological restoration of retired grassland pastures at large scales.
An approximation in closed form for the integral of Oore–Burns for cracks similar to a star domain
Authors: Livieri P. , Segala F.
Published: June 2017

In this paper, we give an explicit new formulation for the three‐dimensional mode I weight function of Oore–Burns in the case where the crack border agrees with a star domain. Analysis in the complex field allows us to establish the asymptotic behaviour of the Riemann sums of the Oore–Burns integral in terms of the Fourier expansion of the crack border. The new approach gives remarkable accuracy in the computation of the Oore–Burns integral with the advantage of reducing the size of the mesh.

Furthermore, the asymptotic behaviour of the stress intensity factor at the tip of an elliptical crack subjected to uniform tensile stress is carefully evaluated. The obtained analytical equation shows that the error of the Oore–Burns integral tends to zero when the ratio between the ellipse axes tends to zero as further confirmation of its goodness of fit.
Probabilistic fatigue initiation assessment diagram pipe steel ×52: influence of hydrogen
Authors: Jallouf S. , Capelle J. , Pluvinage G.
Published: June 2017

A probabilistic fatigue assessment diagram is proposed as a tool to guarantee a prescribed number of applied fatigue cycles with a conventional low probability of failure. The fatigue failure assessment curve is given by a power law described by two parameters: the fatigue initiation resistance and the fatigue initiation exponent. From the targeted applied stress range, it is possible to find the probability of failure and its associated safety factor. An example of fatigue life duration of a pipe steel submitted to hydrogen embrittlement is given.
Interannual variability in the abundance and composition of spring larval fish assemblages in the Strait of Georgia (British Columbia, Canada) from 2007 to 2010
Authors: Guan Lu , Dower John F. , McKinnell Skip M. , Pepin Pierre , Pakhomov Evgeny A. , Hunt Brian P. V.
Published: June 2017

Spring larval fish assemblages in the Strait of Georgia (British Columbia, Canada) were characterized for the first time based on three spatially extensive field surveys in late‐April of 2007, 2009 and 2010, a period which spanned both warm and cold environmental conditions. The abundance, diversity and community structure of the assemblages were examined to investigate interannual variability, and responses to environmental fluctuations. A total of 49 taxa from 23 families were identified. The dominant taxa were Clupea pallasi, Gadus chalcogrammus, Merluccius productus, Leuroglossus schmidti, Lyopsetta exilis and Sebastes spp. Total larval abundance was much lower in 2009 (c. 32 per 1000 m3) than in 2007 and 2010 (c. 200 per 1000 m3). However, the mean size of individuals from several species was largest in 2009. Assemblage structure varied dramatically; from dominance by M. productus in 2007, to dominance by C. pallasi and G. chalcogrammus in 2009, followed by a shift to dominance by benthic species including Sebastes spp. and several flatfishes in 2010. Variability in assemblage structure among the three study years was primarily related to water temperature, whereas within‐year patterns were more closely associated with salinity and chlorophyll, both of which were affected by estuarine circulation. This study provides baseline information about the status of the larval fish community in the Strait of Georgia in recent years, and offers a better understanding of their short‐term dynamics and response to environmental fluctuations.
Does upwelling intensity determine larval fish habitats in upwelling ecosystems? The case of Senegal and Mauritania
Authors: Tiedemann Maik , Fock Heino O. , Brehmer Patrice , Döring Julian , Möllmann Christian
Published: June 2017

European sardine (Sardina pilchardus) and round sardinella (Sardinella aurita) comprise two‐thirds of total landings of small pelagic fishes in the Canary Current Eastern Boundary Ecosystem (CCEBE). Their spawning habitat is the continental shelf where upwelling is responsible for high productivity. While upwelling intensity is predicted to change through ocean warming, the effects of upwelling intensity on larval fish habitat expansion is not well understood. Larval habitat characteristics of both species were investigated during different upwelling intensity regimes. Three surveys were carried out to sample fish larvae during cold (permanent upwelling) and warm (low upwelling) seasons along the southern coastal upwelling area of the CCEBE (13°–22.5°N). Sardina pilchardus larvae were observed in areas of strong upwelling during both seasons. Larval habitat expansion was restricted from 22.5°N to 17.5°N during cold seasons and to 22.5°N during the warm season. Sardinella aurita larvae were observed from 13°N to 15°N during cold seasons and 16–21°N in the warm season under low upwelling conditions. Generalized additive models predicted upwelling intensity driven larval fish abundance patterns. Observations and modeling revealed species‐specific spawning times and locations, that resulted in a niche partitioning allowing species' co‐existence. Alterations in upwelling intensity may have drastic effects on the spawning behavior, larval survival, and probably recruitment success of a species. The results enable insights into the spawning behavior of major small pelagic fish species in the CCEBE. Understanding biological responses to physical variability are essential in managing marine resources under changing climate conditions.
Effects of Lactobacillus buchneri as a silage inoculant and as a probiotic on feed intake, apparent digestibility and ruminal fermentation and microbiology in wethers fed low‐dry‐matter whole‐crop maize silage
Authors: Rabelo C. H. S. , Basso F. C. , Lara E. C. , Jorge L. G. O. , Härter C. J. , Mesquita L. G. , Silva L. F. P. , Reis R. A.
Published: June 2017

Lactobacillus buchneri was investigated as a silage inoculant and as a probiotic on feed intake, apparent digestibility, and ruminal fermentation and microbiology in wethers fed low‐dry‐matter (DM) whole‐crop maize silage. Maize forage (279 g/kg DM) was ensiled without inoculant (untreated) and with L. buchneri CNCM I‐4323 at 1 × 105 cfu/g fresh forage (inoculated). Six cannulated wethers were arranged in a double 3 × 3 Latin square and assigned to one of three diets: (i) untreated maize silage (untreated), (ii) inoculated maize silage (inoculated), and (iii) untreated maize silage with a daily dose of L. buchneri (1 × 107 cfu/g supplied silage) injected directly into the rumen (LB‐probiotic). Wethers fed the inoculated diet had a higher (p = .050) DM intake (1.30% body weight [BW]) than wethers fed untreated and LB‐probiotic diets (1.17% and 1.18% BW respectively). The relative proportion of Ruminococcus flavefaciens (proportion of total estimated rumen bacterial 16S rDNA) in the rumen of wethers fed inoculated and LB‐probiotic diets (both 0.42%) tended (p = .098) to be lower than in the untreated diet (0.83%). Lactobacillus buchneri as a silage inoculant or as a probiotic had little effect on the variables measured in wethers.
Effects of a community disability prevention program for frail older adults at 48‐month follow up
Authors: Makizako Hyuma , Shimada Hiroyuki , Doi Takehiko , Tsutumimoto Kota , Yoshida Daisuke , Suzuki Takao
Published: June 2017

Aim

The present prospective study was carried out to determine whether participation in community‐based intervention studies exerted a positive impact on disability prevention in older adults with physical frailty.

Methods

A total of 514 community‐dwelling older adults (aged ≥65 years) with physical frailty who had undergone baseline assessment and participated in community‐based intervention studies (participants) or did not (non‐participants) were included in the present study. Non‐participants were selected through propensity score matching, to balance potential covariates at baseline. Disability incidence was followed up at 48 months as a main outcome. Demographic data (age, sex and medical history), global cognitive function, grip strength, walking speed, and blood test results including serum albumin and brain‐derived neurotrophic factor at baseline were included as covariates.

Results

Disability incidence rates differed significantly between participants (11.3%) and non‐participants (19.8%) of community‐based intervention studies during the 48‐month follow‐up period (P = 0.007). Participation in community‐based intervention studies (hazard ratio 0.55, 95% confidence interval 0.35–0.88) was significantly associated with the incidence of disability in older adults with physical frailty.

Conclusions

Participation in community‐based intervention studies could reduce the incidence of disability in older adults with physical frailty. Thus, strategies designed to increase the number of participants in community‐based intervention programs should be considered in community‐based approaches for the prevention of disability in older adults with physical frailty. Geriatr Gerontol Int 2017; 17: 2347–2353.
Deciding about nursing home care in dementia: A conjoint analysis of how older people balance competing goals
Authors: Fahey Alison , Ní Chaoimh Dearbhail , Mulkerrin Grainne R. , Mulkerrin Eamon C. , O'Keeffe Shaun T.
Published: June 2017

Aim

“Don't put me in a home” is a common preference of older people, but so too is “I don't want to be a burden on my family.” These and other goals often conflict with each other when people have worsening dementia and the issue of possible nursing home admission arises.

Methods

Community‐dwelling older hospital patients were asked to imagine that they lived alone, had dementia and were experiencing increasing practical difficulties, and were presented with 11 possible “outcome packages.” Conjoint analysis was used to investigate how participants ranked possible outcomes and traded‐off between these factors: place of residence (home or nursing home), burden on their family, risk of harm and duration of life.

Results

Of 122 potential participants, 102 inpatients aged 65–80 years completed the study. Of these participants, 46 (46%) patients give the greatest weight to reducing the burden on their family, 39 (39%) to remaining at home, 11 (11%) to minimizing the risk of harm and five (5%) to maximizing the length of life. There were no significant clinical or demographic differences between these groups. There was a strong negative correlation (Spearman's rho −0.59, P < 0.0001) between importance scores for place of residence and for burden on family.

Conclusions

There are important differences in how individual older people would balance the competing priorities of reducing the burden on their family and remaining at home in the event of developing dementia. Geriatr Gerontol Int 2017; 17: 2435–2440.