bluuebunny/crossref_metadata_2025 huggingface dataset:
Geriatric Nutritional Risk Index for independent walking function in maintenance hemodialysis patients: A single‐facility retrospective cohort study
Authors: Tanaka Tokuharu , Nishiyama Kei , Yamamura Osamu , Watase Hiroko , Yokoyama Yoshinari , Horiguchi Takayasu , Konishi Takashi , Hayashi Hiroyuki
Published: October 2018

Aim

The target Geriatric Nutritional Risk Index (GNRI) for patients on chronic maintenance hemodialysis is unclear. We aimed to determine the relationship between the GNRI and independent walking ability in such patients.

Methods

In the present retrospective cohort study, 90 patients receiving chronic maintenance hemodialysis were included. Logistic regression analyses were carried out to evaluate the relationship between the GNRI and independent walking ability. Receiver operating characteristic curve analysis was carried out to determine the cut‐off GNRI for predicting independent walking ability.

Results

Multivariate logistic regression analysis showed significant differences in age (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6–0.9), creatinine generation rate percentage (OR 1.1, 95% CI 1.0–1.2), GNRI (OR 1.4, 95% CI 1.1–1.8; P < 0.01) and urea removal rate (OR 0.3, 95% CI 0.1–0.9; P < 0.05). The cut‐off GNRI for independent walking ability was 86.7 (area under the curve 0.80, sensitivity 92.1%, specificity 66.7%, positive hit ratio 86.6%, negative hit ratio 78.3%). The factors correlated with survival in the univariate analysis were the GNRI, equilibrated Kt/V, urea removal rate, clear space rate, salt intake amount (P < 0.01), number of days of hospitalization and %creatinine generation rate (P < 0.05). The Cox proportional hazard regression model showed an OR of 0.77 (95% CI 0.32–1.8) at a GNRI <86/GNRI ≥86. In the multivariate survival analysis, we observed no significant differences in any of the factors.

Conclusions

GNRI was correlated with walking ability, which indicated that GNRI might predict future walking ability; also, a GNRI of 87 might be the target for maintaining walking ability. Geriatr Gerontol Int 2018; 18: 1556–1561.
Determinants of clinical presentation on outcomes in older patients with myocardial infarction
Authors: Breining Alice , Negers Antonin , Mora Lucie , Moïsi Laura , Golmard Jean L , Cohen Ariel , Verny Marc , Collet Jean P , Boddaert Jacques
Published: October 2018

Aim

Myocardial infarction without chest pain misleads the clinician, resulting in a diagnosis delay and an increase of mortality. The main objective of the present study was to determine the risk factors of atypical presentation in older patients with myocardial infarction.

Methods

All consecutive patients aged ≥75 years presenting with myocardial infarction and hospitalized in the cardiology intensive care unit were included in the present prospective multicenter observational study. All patients benefited from both specialized cardiac management and geriatric assessment.

Results

A total of 215 consecutive patients were included. The mean age was 85 ± 6 years. A total of 142 patients (66%) had a typical presentation (i.e. chest pain) and 73 patients (34%) had an atypical clinical presentation (i.e. no chest pain). A total of 29 (13.5%) patients died within 30 days of the index hospitalization. Higher Cumulative Illness Rating Score‐Geriatric severity index score (P = 0.019) and initial atrial fibrillation (P = 0.022) were predictive of 30‐day all‐cause mortality. Typical presentation (P = 0.010) was a protective factor of 30‐day all‐cause mortality. A Cumulative Illness Rating Score for Geriatrics total score increase (P = 0.0003) and residing in a nursing home (P = 0.024) emerged as independent risk factors for atypical presentation.

Conclusions

In “real‐life” elderly patients, comorbidities influence the prognosis of myocardial infarction, but also clinical presentation. Identification of patients at risk of atypical presentation; that is, patients with multiple comorbid conditions, might help refine the prognostic value in older patients with myocardial infarction. Geriatr Gerontol Int 2018; 18: 1591–1596.
Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis
Authors: Kakio Yuki , Uchida Haruhito A , Takeuchi Hidemi , Okuyama Yuka , Okuyama Michihiro , Umebayashi Ryoko , Wada Kentaro , Sugiyama Hitoshi , Sugimoto Ken , Rakugi Hiromi , Kasahara Shingo , Wada Jun
Published: October 2018

Aim

Since 1998, the leading cause of chronic hemodialysis in Japan has been diabetic nephropathy. Diabetes mellitus is known to be a risk factor for frailty, but it still remains unknown whether diabetic nephropathy is associated with frailty in chronic dialysis patients. The authors carried out the present study to reveal the association between frailty and diabetic nephropathy in chronic hemodialysis patients.

Methods

A total of 355 patients who were on hemodialysis were recruited. Participants were divided into two groups of either patients who suffered diabetic nephropathy with end‐stage renal disease (DN group, n = 150) or not (Non‐DN group, n = 205). The authors investigated the difference of the prevalence of frailty between the two groups. Furthermore, the authors examined the risk factors for frailty.

Results

The prevalence of frailty in the DN group was significantly higher than that in the Non‐DN group (28.0% vs 16.5%, P = 0.0161). To evaluate the association between frailty and its risk factors, we compared frail patients (n = 71) and non‐frail patients (n = 262). After adjusting their interrelationships by using multivariate logistic regression analysis, diabetic nephropathy was determined as a significant risk factor for frailty.

Conclusions

The authors found the close association between frailty and diabetic nephropathy in chronic hemodialysis patients. Geriatr Gerontol Int 2018; 18: 1597–1602.
Gut microbiome can be restored without adverse events after Helicobacter pylori eradication therapy in teenagers
Authors: Gotoda Takuji , Takano Chika , Kusano Chika , Suzuki Sho , Ikehara Hisatomo , Hayakawa Satoshi , Andoh Akira
Published: October 2018

Objectives

The effect of Helicobacter pylori eradication on the gut microbiota of teenagers is unknown; hence, this study aimed to assess changes in the gut microbiome after H. pylori eradication therapy in teenagers.

Materials and Methods

Changes in gut microbiota before and after H. pylori eradication were prospectively investigated in eight students without any underlying diseases, via next‐generation sequencing of 16S rDNA. Twenty‐four stool samples were collected, and operational taxonomic unit analysis was performed. As secondary analyses, alpha and beta diversity were evaluated. Furthermore, pre‐treatment microbiome compositions were compared with those 1 week and 2 months after treatment.

Results

Alpha diversity analysis revealed that both species richness and evenness were recovered to pre‐treatment levels at 2 months after eradication therapy. Slight but non‐significant differences were observed in bacterial species abundance between pre‐ and post‐treatment samples, upon beta diversity analysis. Although the relative abundance of Bacteroidetes tended to increase and that of Actinobacteria significantly decreased immediately after eradication therapy, the taxonomic composition was similar to that before treatment and at 2 months post‐eradication. However, two students showed significant changes in the gut microbiota in relative abundances at the level of the phylum, class, and order.

Conclusions

Although H. pylori eradication therapy caused short‐term dysbiosis, microbial diversity was restored in healthy teenagers. However, as the relative abundance of gut microbiota in some cases remained altered, the effect of H. pylori eradication therapy on the gut microbiome should be continuously monitored.
Serum cryptococcal antigen titre as a diagnostic tool and a predictor of mortality in HIV‐infected patients with cryptococcal meningitis
Authors: Chen J , Zhang R , Shen Y , Liu L , Qi T , Wang Z , Mehraj V , Routy JP , Lu H
Published: October 2018

Objectives

The aim was to determine the effectiveness of the serum cryptococcal antigen (CrAg) test in the diagnosis of concurrent cryptococcal meningitis (CM) and as a predictor of mortality in HIV‐infected patients.

Methods

In this retrospective study, all HIV‐infected patients admitted to Shanghai Public Health Clinical Center from 1 January 2014 to 31 August 2016 were screened for serum CrAg using the latex agglutination test. Serum CrAg‐positive patients underwent lumbar puncture to confirm CM prior to the initiation of appropriate antifungal therapy and were followed up for at least 6 months.

Results

One hundred and four (7.1%) of the total of 1474 HIV‐infected patients screened were serum CrAg‐positive. CM was diagnosed in the majority of serum CrAg‐positive patients (71.3%; 67 of 94) and was confirmed in all (46 of 46) of the patients with headache or coma and in 43.8% (21 of 48) of patients without neurological symptoms. CrAg titres ≥ 1:1024 showed a sensitivity of 82.5% and a specificity of 86.7% for the diagnosis of concurrent CM (P < 0.001). The positive predictive value for CM in this population was 94.3%. A total of 13 serum CrAg‐positive patients [13.8%; 95% confidence interval (CI) 7.5–22.4%] died (11 as a result of CM and two others as a result of bacterial pneumonia) despite early antifungal treatment initiation. Serum CrAg titres ≥ 1:1024 predicted all‐cause mortality (hazard ratio 3.69; P = 0.03).

Conclusions

Serum CrAg titres ≥ 1:1024 not only were associated with concurrent CM but also predicted mortality. HIV‐infected patients with a positive serum CrAg test during screening should receive lumbar punctures regardless of symptoms to rule out CM and patients with serum CrAg titres ≥ 1:1024 should be offered immediate care.
Integration and Retention of Refugees in Smaller Communities
Authors: Fang Tony , Sapeha Halina , Neil Kerri
Published: October 2018

While advanced economies attempt to pursue a regionalized immigration policy, which aims at shifting migration flows away from the most popular urban centre destinations to smaller communities, the experiences of immigrants settling in such locations remains underexplored. This research provides timely knowledge of refugee labour market integration in smaller communities, using Newfoundland and Labrador's provincial capital, St. John's, as an example of such communities. The article examines the resettlement and labour market integration of refugees in a medium‐sized city with particular attention to factors that enhance refugee labour market integration and factors that negatively impact refugee integration and their retention in the receiving community. The study finds that the negative perception of employment opportunities is a significant factor in refugee's decision to move. Securing employment of refugees is facilitated by strong English language skills, social connections and is hampered by discrimination in the labour market.
Family presence during resuscitation in emergency departments: professionals’ attitudes in Brazil
Authors: Barreto M.S. , Garcia‐Vivar C. , Mitchell M. , Marcon S.S.
Published: October 2018

Aim

The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil.

Background

International emergency associations endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside.

Methods

A qualitative research was conducted. Thirty‐two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In‐depth interviews were conducted, and data were analysed using content analysis.

Findings

Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that ‘changes are needed’ to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families.

Discussion

Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts.

Conclusion

This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments.

Implications for nursing and health policy

Hospital‐based policies are required to improve family‐centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family‐focused education in health science degrees, continuing education and in the community is required.
Novel cupric acetate self‐induced, stabilized cupric oxide mesoporous nanosheets via a reflux‐hydrothermal method
Authors: Liu Chong , Liu Chao , Ji Xiujie , Zhao Yangyang , Chen Qiling , Fang Ziyan
Published: October 2018

Cupric oxide mesoporous nanosheets (CuO‐MNS) were successfully synthesized via a novel cupric acetate self‐induced, stabilized route. X‐ray diffraction analysis showed that CuO‐MNS are well crystallized and present a pure monoclinic phase. Transmission electron microscopy (TEM) exhibited that CuO‐MNS are of 8‐24 nm in thickness. Mesopores of 2‐5 nm in diameter were also confirmed and calculated by nitrogen adsorption/desorption isotherms, which is well consistent with TEM observation. CuO‐MNS have Brunauer‐Emmett‐Teller surface area of 34.7 m2/g and pore volume of 0.26 cm3/g. Acetate ion plays the roles of inducing nucleation and growth of CuO nanosheets, as well as inducing and stabilizing mesopores in the nanosheets. Combining with the calculation and Gibbs theory, the synthetic mechanism was proposed in thermodynamics. This novel cupric acetate self‐induced, stabilized route is green, low‐cost, efficient, facile, and surfactant‐free and may be useful for the synthesis of other mesoporous materials.
Stress‐induced anisotropy during sintering of hierarchical porosity ceramics
Authors: Shang Haixia , Olevsky Eugene A. , Bordia Rajendra K.
Published: October 2018

There is significant interest in the design and processing of porous ceramics due to their use in a variety of applications including energy storage, catalysis, adsorption, separation, and life science applications. For many of these applications, it is desirable to have a hierarchical porous structure in which there is a distinct difference between sizes of pores. Our previous study has shown that microstructure and properties of porous materials become anisotropic after sinter‐forging. In particular, the small interparticle pores (intrinsic pores) orient parallel to the applied compressive stress, in contrast to large pores from pore formers (extrinsic), which orient perpendicular to the applied stress. However, the pore size, for transition from extrinsic to intrinsic behavior, (transient pore size) has not been quantified. In this study, we report on the effect of applied stresses during sinter‐forging on the morphology (shape and size) of pores of different size. Based on these results, we propose a two‐step approach to predict transient pore size for hierarchically porous ceramics. We use this approach to quantify the effect of applied stresses on the transient pore size. Finally, we postulate that the stress dependence of the transient pore size may be related to sintering stress—a fundamental quantity in continuum models of sintering. In addition, it can be used to calculate the effective surface energy of complex sintering systems.
The influence of the Gondwanan breakup on the biogeographic history of the ziziphoids (Rhamnaceae)
Authors: Hauenschild Frank , Favre Adrien , Michalak Ingo , Muellner‐Riehl Alexandra N.
Published: October 2018

Aim

We investigated whether the fossil‐rich and cosmopolitan buckthorn family (Rhamnaceae, dating back to the Cretaceous) was influenced by vicariance events following the Gondwanan breakup. To answer this question, we focused on the ziziphoid lineage of the buckthorn family, because extant ziziphoid taxa comprise tribes and genera exclusively or at least predominantly distributed in the Southern Hemisphere (Australia, Africa, and South America).

Location

World‐wide.

Methods

We generated a DNA alignment of 26,989 bp (from plastid, mitochondrial, and nuclear genomes), comprising 575 taxa of Rhamnaceae and related families, including all major lineages within Rhamnaceae and closely related families. We used nine internal fossils to set constraints in our molecular dating analyses. We used ‘BioGeoBEARS’ in R to reconstruct ancestral areas in order to infer the impact of vicariance events on the ziziphoids caused by Gondwanan fragmentation.

Results

Our biogeographic analyses illustrate that the ziziphoid lineage was influenced by both long‐distance dispersal and Gondwanan breakup vicariance events. Yet, these vicariance events cannot explain all divergence events at the backbone of this lineage.

Main conclusions

Our study highlights that a taxon's distribution throughout the Northern Hemisphere can be the result of vicariance, but this process may be obliterated by more recent long‐distance dispersal (LDD). Our study also highlights that sufficiently old taxa may sometimes constitute better models to investigate the impact of Gondwanan‐driven vicariance than taxa with a current disjunct distribution in the Southern Hemisphere.
Ancient DNA reveals the origins, colonization histories, and evolutionary pathways of two recently extinct species of giant scops owl from Mauritius and Rodrigues Islands (Mascarene Islands, south‐western Indian Ocean)
Authors: Louchart Antoine , Bastian Fabiola , Baptista Marilia , Guarino‐Vignon Perle , Hume Julian P. , Jacot‐des‐Combes Cécile , Mourer‐Chauviré Cécile , Hänni Catherine , Ollivier Morgane
Published: October 2018

Aim

The islands of the south‐western Indian Ocean region are home to many endemic bird species, with their closest relatives occurring in Africa and Madagascar, Eurasia, the Sunda Islands, and the Australasian region. Among owls, the extant endemic scops owls (genus Otus) from Madagascar, Comoros, Seychelles, and Socotra are related to the Southeast Asian species, O. sunia, the Oriental scops owl. Three owl species, presumably Otus derivatives, twice the size of standard scops owls and now extinct, once inhabited the Mascarene Islands, and have been placed in a separate genus, Mascarenotus. Insular apomorphies have made their precise relationships difficult to determine. Here we investigate the phylogenetic position of these enigmatic owls.

Location

The Mascarene Islands (Réunion, Mauritius, Rodrigues) in the south‐western Indian Ocean.

Methods

Phylogenetic relationships were reconstructed using ancient DNA extracted from subfossil remains. Fragments of cytochrome b gene were amplified and sequenced. The ancient sequences were analysed with modern sequences of 19 ingroup Otus taxa using Bayesian and Maximum Likelihood methods.

Results

The Mauritian extinct species M. sauzieri was reconstructed as the sister to both O. pauliani (Grand Comoro) and O. rutilus (Madagascar). The Rodrigues extinct species M. murivorus was the sister, in a star‐like differentiation, to the preceding clade as well as the remaining Comorian species and a clade formed by O. insularis (Seychelles) and O. sunia.

Main conclusions

The ancestor of O. sunia simultaneously colonized Rodrigues Island (evolving into Otus murivorus), Madagascar, and part of the Comoros Islands around 3 million years ago. Later, presumably from Madagascar, new lineages colonized Grand Comoro and Mauritius (O. sauzieri). Independently, a more recent O. sunia ancestor colonized the Seychelles Islands and Socotra. These colonizations were probably favoured by Pliocene cyclonic events, stronger and more frequent than today. Several features, including giantism, wing reduction, and a relative decrease in skull and orbit size evolved convergently in the polyphyletic species O. sauzieri and O. murivorus.
Assessment of spatial patterns in benthic macrofauna of the U.S. west coast continental shelf
Authors: Henkel Sarah K. , Nelson Walter G.
Published: October 2018

Aim

We assessed whether currently described marine biogeographic boundaries apply to shelf macrofauna and which environmental drivers were most associated with species differences among regions.

Location

Pacific coast of North America from the Strait of Juan de Fuca in Washington to the California–Mexico border.

Methods

Van Veen grab samples were collected from soft sediment 28–138 m deep and sieved using 1 mm mesh. Spatial patterns of species richness, diversity, and abundance were examined in relation to latitude and environmental parameters (temperature, salinity, dissolved oxygen, sediment % fines, and total organic carbon). Analyses of latitudinal distribution patterns of individual species were combined with multivariate analyses of community composition to determine biogeographic and habitat boundaries for mid‐depth continental shelf macrofauna.

Results

Species richness, diversity, and abundance significantly decreased with increasing latitude, primarily between 32 and 40°N. There were positive associations of richness, diversity (H’), and abundance with upwelling index, sediment % fines, and TOC (<2%). Temperature and DO also were significant for richness and H’ but not abundance. Assessment of individual species ranges found major faunal transitions at latitudes 33–34°, 37°, 44°, and 46–47°. Major assemblage differences were found at 34.5° and 42°. Within each latitudinal region, significantly different macrofauna communities were found in sediment with <5% fines.

Main conclusions

The biogeographic boundaries proposed under the Marine Ecoregions of the World schema are more closely aligned with shelf fauna distributions than those developed using west coast rocky intertidal communities. However, the proposed province boundary at Cape Mendocino is not apparent in the shelf macrofauna, and a transition appears to occur closer to the Oregon–California border. Further, the shelf macrofauna indicate the Channel Islands should be a separate subregion from mainland southern California Bight. Multivariate community analyses minimizing the impact of rare species appeared more useful in determining macrofaunal community biogeographic boundaries than analysis of individual species range endpoints, which are strongly influenced by uncommon species.
Post‐glacial range revolutions in South European hares (Lepus spp.): Insights from ancient DNA and ecological niche modelling
Authors: Lado Sara , Farelo Liliana , Forest Vianney , Acevedo Pelayo , Dalén Love , Melo‐Ferreira José
Published: October 2018

Aim

The distribution of hares (Lepus spp.) in southern Europe was markedly different at the Last Glacial Maximum. Historical hybridization during range replacements led to high frequencies of mtDNA introgression from Lepus timidus into populations of three other species in northern Iberian Peninsula, even though L. timidus subsequently disappeared from the region. We use palaeontological records to provide new insights on the biogeographic history of these range replacements, combining ancient DNA and ecological niche modelling.

Location

Southern France.

Taxon

Hares (genus Lepus).

Methods

DNA was extracted from hare bones collected at Neolithic sites in southern France (5.5–7.5 thousand years before present; kyr bp) with uncertain species assignment. One mtDNA fragment was sequenced and 27 SNPs from 11 nuclear genes with species‐diagnostic information were genotyped. Distributions of L. granatensis, L. europaeus, and L. timidus were modelled using spatial and bioclimatic predictors, and the favourability function. Each model was transferred to 6 kyr bp and favourabilities were combined to determine the species with the highest environmental favourability in each sampled locality.

Results

Ancient DNA analysis showed that the screened specimens belong to L. granatensis, a species presently confined to the Iberian Peninsula, but carried mtDNA haplotypes from L. timidus. Niche models show that L. granatensis achieved highest favourability in southern France 6 kyr bp reinforcing the molecular evidences.

Main conclusions

L. granatensis replaced L. timidus populations from Iberia to southern France, being present in this region 5.5 kyr bp. Subsequent westwards invasion of L. europaeus likely replaced these L. granatensis populations towards northern Iberia, establishing current ranges. Despite successive species replacements, introgressed mtDNA haplotypes from L. timidus mark the distribution of the species in northern Iberian Peninsula before it disappeared in the region. Characterizing complex biogeographic histories of interacting species is a key to understand processes that led to current distributions of genetic diversity.
Reported obstructive sleep apnea does not diminish the cardiometabolic health benefits from a comprehensive lifestyle intervention program
Authors: Farrehi Peter M. , Brook Robert D. , Godley Robert , Walden Patrick , Jiang Qingmei , Rubenfire Melvyn
Published: October 2018

Obstructive sleep apnea (OSA) commonly coexists with the metabolic syndrome, a condition for which behavioral changes are often prescribed. Whether OSA diminishes the cardiometabolic health benefits from lifestyle interventions remains unclear. We evaluated 278 consecutive metabolic syndrome participants enrolled in a 12‐week comprehensive lifestyle intervention program. The changes in blood pressure (BP), along with other metabolic health parameters, from baseline to follow‐up were compared between those with and without OSA. Mean age was 52.4 ± 10.9 years and 37% were male. At enrollment, mean body mass index (BMI) was 38.2 ± 7.7 kg/m2. OSA was reported in 126 of 269 final participants (47%). At baseline, participants with reported OSA were more likely to be male, older, have a higher BMI, waist and neck size (all P < 0.05). At program completion, participants with (−5.8 ± 16.1/−3.0 ± 10.0 mm Hg) and without OSA (−4.7 ± 13.1/−3.3 ± 8.2 mm Hg) had significant reductions in systolic and diastolic BP as well as BMI, fasting glucose, and triglyceride levels. There were no significant differences in the absolute or percentage changes in BP or other metabolic parameters between groups. Our findings support that patients with the metabolic syndrome can derive substantial health benefits, including reductions in BP, by a lifestyle intervention program regardless of the presence of OSA.
The impact of access to consumer data on the competitive effects of horizontal mergers and exclusive dealing
Authors: Kim Jin‐Hyuk , Wagman Liad , Wickelgren Abraham L.
Published: October 2018

We examine the influence of firms’ ability to employ individualized pricing on the welfare consequences of horizontal mergers. In a two‐to‐one merger, the merger reduces consumer surplus more when firms can price discriminate based on individual preferences compared to when they cannot. However, the opposite holds true in a three‐to‐two merger, in which the reduction in consumer surplus is substantially lower with individualized pricing than with uniform pricing. Further, the merger requires an even smaller marginal cost reduction to justify when an upstream data provider can make exclusive offers for its data to downstream firms. We also show that exclusive contracts for consumer data pose significant antitrust concerns independent of merger considerations. Implications for vertical integration and data mergers are drawn.
Should emergentologists follow up on patients diagnosed with UTI having negative urine cultures? Implications for processing post‐discharge laboratory results
Authors: Woodfine Jason D. , van Walraven Carl
Published: October 2018

Objectives

After patients are discharged from the emergency department (ED), follow‐up of test results focuses on abnormal values. In the elderly, non‐specific symptoms can result in an incorrect diagnosis of urinary tract infection (UTI). This study compared the outcomes of patients discharged from the ED with a diagnosis of UTI based on urine culture results.

Methods

We conducted a retrospective cohort study using linked health databases and chart review of a random sample of elderly patients (age > 65 years) discharged from the Ottawa Hospital ED between 2006 and 2014 with a diagnosis of UTI. Patients were categorized based on whether urine cultures were positive and bacterial sensitivity to prescribed antibiotics. Primary outcome was return to ED, admission to hospital, or death within 30 days.

Results

A total of 1001 patients were included in the study (401 culture‐negative; 474 culture‐positive antibiotic‐sensitive; 126 culture positive antibiotic‐insensitive). Patients were elderly (mean age 80 years, SD 7.6) with a high prevalence of dementia (18.0%). Almost a third of patients (n = 313, 31.3%) experienced an outcome. Compared to culture‐positive antibiotic‐sensitive patients, culture negative patients (adjOR 1.45, 95% CI 1.07‐1.97) and culture‐positive antibiotic‐insensitive patients (adjOR 1.49, 95% CI 0.90‐2.14) were significantly more likely to experience an outcome (P = 0.04).

Conclusions

Patients discharged from the ED with a diagnosis of UTI have an increased risk of return to ED, urgent readmission or death if the uropathogen is insensitive to the prescribed antibiotic or if the culture is negative. Patients diagnosed with UTI with a negative culture may need further assessment.
Recommendations for identifying pathogenic Vibrio spp. as part of disease surveillance programmes in recirculating aquaculture systems for Pacific white shrimps (Litopenaeus vannamei)
Authors: Bauer Julia , Teitge Felix , Neffe Lisa , Adamek Mikolaj , Jung Arne , Peppler Christina , Steinhagen Dieter , Jung‐Schroers Verena
Published: October 2018

Due to their pathogenic potential, identifying Vibrio species from recirculating aquaculture systems (RAS) for Pacific white shrimp (Litopenaeus vannamei) is of great importance to determine the risk for animal's as well as for the consumer's health. The present study compared identification results for a total of 93 Vibrio isolates, including type strains and isolates from shrimp aquaculture. Results from biochemical identifications, 16S rRNA sequencing, sequencing of the uridylate kinase encoding gene pyrH and analysis of the protein spectra assessed by MALDI‐TOF MS were compared. The results achieved by these different methods were highly divergent for many of the analysed isolates and for several Vibrio spp difficulties in reliably identifying occurred. These difficulties mainly resulted from missing entries in digital databases, a low number of comparable isolates analysed so far, and high interspecific similarities of biochemical traits and nucleotide sequences between the closely related Vibrio species. Due to the presented data, it can be concluded that for identifying Vibrio spp. from samples in routine diagnostics, it is recommended to use MALDI‐TOF MS analysis for a quick and reliable identification of pathogenic Vibrio sp. Nevertheless, editing the database, containing the main spectra of Vibrio is recommended to achieve reliable identification results.
Increased dietary protein‐to‐lipid ratio improves survival during naturally occurring pancreas disease in Atlantic salmon, Salmo salar L.
Authors: Dessen Jens‐Erik , Mørkøre Turid , Bildøy Jan Ivar , Johnsen Stig N. , Poppe Lars Thomas , Hatlen Bjarne , Thomassen Magny S. , Rørvik Kjell‐Arne
Published: October 2018

This study demonstrated that increased dietary protein‐to‐lipid ratio (P/L‐ratio) improved survival of farmed Atlantic salmon naturally affected by pancreas disease (PD). In addition to diet, body weight (BW) and delousing mortality prior to the PD outbreak also contributed significantly (p < 0.05) to explain the observed variation in PD‐associated mortality. Subsequent to the PD outbreak, large amount of fish failed to grow and caused thin fish with poor condition (runts). At the end of the trial, significantly (p < 0.05) lower amounts of runt fish and increased amount of superior graded fish where detected among fish fed increased P/L‐ratio and within the fish with the largest BWs prior to PD. Diet, BW and delousing mortality contributed significantly (p < 0.05) to explain the variation in the amount of superior graded fish, whereas BW and diet explained the variation in the amount of runt fish. A significant (p < 0.01) negative linear relationship was observed between the amount of superior graded fish and the total mortality, whereas a positive linear relationship was detected between percentage of fillets with melanin and the total mortality. Thus, increased dietary P/L‐ratio seem to reduce the mortality and impaired slaughter quality associated with PD.
The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta‐analysis
Authors: Yeh Jen‐Hao , Hsu Ming‐Hung , Tseng Chao‐Ming , Chen Tzu‐Haw , Huang Ru‐Yi , Lee Ching‐Tai , Lin Chi‐Wei , Wang Wen‐Lun
Published: October 2018

Background and Aim

Simethicone is an anti‐foaming agent commonly used during colonoscopy. Although several randomized trials have shown that oral simethicone in the bowel preparation regimen may improve bowel cleanness, whether it improves adenoma detection rate (ADR) or polyp detection rate remains undetermined. The aim of this study was to determine if oral simethicone in bowel preparation regimen before colonoscopy improves the ADR.

Methods

A comprehensive literature review was conducted using PubMed, SDOL, Cochrane Library, and ProQuest databases through December 2017. Randomized controlled trials that compared bowel preparation regimens with simethicone versus those without it were included. Effect estimates from each study were extracted and underwent meta‐analysis using appropriate models. The primary outcomes were ADR and polyp detection rate, and secondary outcomes included bowel preparation, bubble score, and withdrawal time.

Results

Twelve published randomized controlled studies with 6003 participants were included for meta‐analysis. There was no difference in the overall ADR (pooled risk ratio = 1.06, 95% confidence interval = 0.91–1.24) and right‐side ADR (risk ratio = 1.50, 95% confidence interval = 0.82–2.75) between the groups with or without simethicone. However, the addition of simethicone improved adenoma detected per patient (2.20 ± 1.36 vs 1.63 ± 0.89) according to one of the included studies. Meta‐regression revealed that the baseline ADR < 25% of the included studies was associated with significant benefit of oral simethicone; the number needed to treat was 15.

Conclusions

The adjunction of oral simethicone significantly improved bowel preparation quality and might benefit adenoma detection in specific settings with low baseline ADR.
Cardiovascular Disease Profile of the Oldest Adults in Rural South Africa: Data from the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities)
Authors: Jardim Thiago Veiga , Witham Miles D. , Abrahams‐Gessel Shafika , Gómez‐Olivé F. Xavier , Tollman Stephen , Berkman Lisa , Gaziano Thomas A.
Published: October 2018

Objectives

To characterize the cardiovascular disease (CVD) profile of individuals aged 80 and older in rural South Africa.

Design

First wave of population‐based longitudinal cohort.

Setting

Agincourt subdistrict (Mpumalanga Province) in rural South Africa.

Participants

Adults residents (N = 5,059).

Measurements

In‐person interviews were conducted to obtain social, behavioral, economic, and clinical data. Prevalence of hypertension, diabetes, dyslipidemia, high waist‐to‐hip ratio, overweight and obesity, high‐risk high‐sensitivity C‐reactive protein, smoking, stroke, myocardial infarction, angina pectoris, and heart failure in individuals younger than 65, aged 65 to 79, and aged 80 and older were compared. Associations between self‐reported treatments and determinants of hypertension treatment in those aged 80 and older were assessed using multivariable regression.

Results

Of 5,059 individuals included, 549 (10.8%) were aged 80 and older, and their CVD prevalence was 17.9% (stroke 3.8%, myocardial infarction 0.5%, angina pectoris 13.5%, heart failure 0.7%). Hypertension prevalence in this group was 73.8%, and along with angina pectoris, it increased with age (p<.001), whereas overweight and obesity (46.4%), dyslipidemia (39.1%), and smoking prevalences (3.1%) decreased (p<.001). Hypertension treatment was significantly associated with being aged 80 and older (odds ratio (OR)=1.48; 95% confidence interval (CI)=1.14–1.92, p=.003). Male sex (OR=0.73, 95% CI=0.66–0.88, p=.001), being an immigrant (OR=0.80, 95% CI=0.65–0.98; p=.03), higher socioeconomic status (OR=1.28, 95% CI=1.06–1.53, p=.009), and higher depression score (OR=1.12, 95% CI=1.05–1.19, p<.001) were associated with hypertension treatment in those aged 80 and older.

Conclusion

This is the first study to characterize the CVD profile of individuals aged 80 and older in sub‐Saharan Africa and provides baseline data for comparison with future studies in this rapidly growing age group.J Am Geriatr Soc 66:2151–2157, 2018.
Rosiglitazone up‐regulates glial fibrillary acidic protein via HB‐EGF secreted from astrocytes and neurons through PPARγ pathway and reduces apoptosis in high‐fat diet‐fed mice
Authors: Kushwaha Rajesh , Mishra Juhi , Gupta Anand Prakash , Gupta Keerti , Vishwakarma Jitendra , Chattopadhyay Naibedya , Gayen Jiaur Rahaman , Kamthan Mohan , Bandyopadhyay Sanghamitra
Published: October 2018

The anti‐diabetic drug and peroxisome proliferator‐activated receptor‐gamma (PPARγ) agonist, rosiglitazone, alters astrocyte activation; however, its mechanism remains less‐known. We hypothesized participation of epidermal growth factor receptor (EGFR), known to control astrocyte reactivity. We first detected that rosiglitazone promoted glial fibrillary acidic protein (GFAP) expression in primary astrocytes as well as the mouse cerebral cortex, associated with increased EGFR activation. Screening for EGFR ligands revealed a rosiglitazone‐mediated increase of heparin‐binding epidermal growth factor (HB‐EGF) in astrocytes, resulting in HB‐EGF release into culture medium and mouse cerebrospinal fluid too. Treatment with HB‐EGF‐siRNA and EGFR inhibitors showed that the rosiglitazone‐induced HB‐EGF and p‐EFGR were interdependent, which participated in GFAP increase. Interestingly, we observed that rosiglitazone could induce cellular and secreted‐HB‐EGF in neurons also, contributing toward the activated EGFR‐induced GFAP in astrocytes. Probing whether these effects of rosiglitazone were PPARγ‐linked, revealed potential PPARγ‐responsive elements within HB‐EGF gene. Moreover, gel‐shift, site‐directed mutagenesis, chromatin‐immunoprecipitation and luciferase‐reporter assays demonstrated a PPARγ‐dependent HB‐EGF transactivation. Subsequently, we examined effects of rosiglitazone in a high‐fat diet‐fed diabetes mouse model, and supporting observations in the normal cortical cells, identified a rosiglitazone‐induced GFAP, astrocyte and neuronal HB‐EGF and secreted‐HB‐EGF in the cerebral cortex of diabetic mice. Moreover, assessing relevance of increased HB‐EGF and GFAP revealed an anti‐apoptotic role of rosiglitazone in the cerebral cortex, supported by a GFAP‐siRNA as well as HB‐EGF‐siRNA‐mediated increase in cleaved‐caspase 3 and 9 levels in the rosiglitazone‐treated astrocyte–neuron coculture. Overall, our study indicates that rosiglitazone may protect the brain, via a PPARγ‐dependent HB‐EGF/EGFR signaling and increased GFAP.

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Rheology of hyaluronic acid and dynamic facial rejuvenation: Topographical specificities
Authors: Michaud Thierry
Published: October 2018

Sound knowledge of the rheology of hyaluronic acids is fundamental for facial rejuvenation procedures. Hyaluronic acid implants are subjected to complex mechanical forces within the facial tissues that vary depending on the anatomical region. Analysis of these forces is important to establish the rheological specifications of hyaluronic acid implants in each specific zone. This approach will optimize the correction of age‐related loss of volume, since the filler will be chosen as a function of the mechanics of the anatomical zone, with the objective to respect facial dynamics.
Neuroimaging in Psychiatric Disorders: A Bibliometric Analysis of the 100 Most Highly Cited Articles
Authors: Gong Bo , Naveed Sadiq , Hafeez Dawood M. , Afzal Khalid I. , Majeed Salman , Abele Jonathan , Nicolaou Savvas , Khosa Faisal
Published: October 2018

BACKGROUND AND PURPOSE

Extensive research has been conducted to find neuroimaging biomarkers for psychiatric disorders. This study aimed at identifying trends of the 100 most highly cited articles on neuroimaging in primary psychiatric disorders.

METHODS

The most highly cited original research articles were identified and analyzed, following searches of MEDLINE and Web of Science All Databases.

RESULTS

The top 100 articles ranked by yearly citation (from 137.5 to 31.1) were published between 1989 and 2017. Depressive disorders (30 articles), schizophrenia spectrum and other psychotic disorders (27), autism spectrum disorder (17), substance‐related and addictive disorders (7), and post‐traumatic stress disorder (7) were among the most studied conditions. Functional magnetic resonance imaging (42), structural magnetic resonance imaging (30), and positron emission tomography (22) were the most utilized neuroimaging modalities. While 85 articles investigated the pathophysiology of psychiatric disorders (including 7 focusing on developmental changes and 1 on genetic susceptibility), 15 articles studied the impact of treatment, including antidepressants (6), deep brain stimulation (4), antipsychotics (3), behavior therapy (3), and exercise (1). The analysis also identified the most contributing authors, countries (the United States: 71 articles, the United Kingdom: 8, Canada: 5, and China: 5), and journals (JAMA Psychiatry: 20 articles and Biological Psychiatry: 17). Ninety‐eight studies were prospective, and two were retrospective. The sample size ranged from 3 to 1,188 (median: 21).

CONCLUSIONS

Our study identified intellectual milestones in the utility of neuroimaging in investigating primary psychiatric disorders. The historic trends could help guide future research in this field.
Prevalence, comorbidity and factors associated with sleeping, crying and feeding problems at 1 month of age: A community‐based survey
Authors: Cook Fallon , Mensah Fiona , Bayer Jordana K , Hiscock Harriet
Published: October 2018

Aim

To examine, in a community cohort of healthy one‐month‐old infants, (i) the prevalence of early infant sleeping, crying and feeding problems; (ii) the extent to which they co‐exist; and (iii) infant and mother characteristics associated with each problem alone and with comorbid problems.

Methods

A survey at 4 weeks of infant age examined the presence of infant sleeping, crying and feeding problems (yes/no); parenting self‐efficacy; rating of self as a tense person; and doubts about parenting at bedtime.

Results

A total of 770 mothers (39% of those approached) with a total of 781 infants (11 twins) took part. Infant sleeping, crying and feeding problems were reported by 38.5, 27.4 and 25.2% of mothers, respectively. On comorbidity, 25.5% reported one problem, 20.5% reported two and 7.3% reported all three problems. Mothers of first‐born infants reported more crying problems and comorbid problems. Mothers who described themselves as a ‘tense person’ reported more infant feeding problems. Maternal doubt and low self‐efficacy were consistently associated with each type of infant problem and comorbid problems (adjusting for other factors).

Conclusion

Mothers expressing doubt and low parenting self‐efficacy may benefit from additional support and guidance on normal infant behaviour.
Post‐streptococcal glomerulonephritis: Some reduction in a disease of disparities
Authors: Vogel Alison M , Lennon Diana R , van der Werf Bert , Diack Max , Neutze Jocelyn M , Horsfall Maraekura , Emery Diane , Wong William
Published: October 2018

Aim

A retrospective Auckland‐wide (total population approximately 1.4 million) study of hospital admissions from 2007 to 2015 was conducted to assess trends in admissions for acute post‐streptococcal glomerulonephritis (APSGN) in children aged 0–14 years.

Methods

International Statistical Classification of Diseases (ICD10) discharge codes were used to identify potential cases of APSGN, and electronic clinical records and laboratory data were compared with established case definitions for definite or probable APSGN.

Results

A total of 430 cases of APSGN were identified (definite n = 337, probable n = 93), with a mean annual incidence of 15.2/100 000 (95% confidence interval (CI) 14.9–15.6). Incidence (0–14 years) was 17 times higher in Pacific peoples (50.2/100 000, 95% CI 48.6–51.8) and almost 7 times higher in Māori (19.6/100 000, 95% CI 18.6–20.7) than European/other populations (2.9/100 000, 95% CI 2.7–3.1). Multivariate analysis found ethnicity, deprivation, male gender, age (peak 3–8 years) and season (summer/autumn) to be associated with admission risk. Admission rates showed a significant change of −9.0% (95% CI −10.4, 7.4%) per year, with 2011 being an exception. Low C3 complement, hypertension, elevated streptococcal titres, oedema and heavy proteinuria were present in 94, 65, 67, 52 and 49% of cases, respectively. Relying on ICD10 codes without further review of clinical notes would result in an overcount of cases by 25%.

Conclusions

There is severe disparity in APSGN admission rates, with a disproportionate burden of disease for Pacific and Māori children and those living in deprived circumstances. Rates trended downward from 2007 to 2015.
Dynamic implications of tourism and environmental quality
Authors: Ouattara Bazoumana , Pérez‐Barahona Agustín , Strobl Eric
Published: October 2018

Many studies draw attention to the rising number of tourists seeking destinations in environmental hotspots. However, it is also recognized that tourism activities significantly deteriorate the environment. Our paper investigates the dynamic interaction between tourism and environmental quality, focusing on its effect on the development of tourism‐driven economies. We use a theoretical model to study the dynamic implications of this interaction. In this respect, we point out the role played by environmental maintenance activities and ecotourism. Ecotourism allows the economy to improve welfare in the long‐term, but we identify a social cost regarding current generations’ welfare. Finally, the existence of imbalance effects between tourism infrastructures and environmental quality provides new insights into the transitional dynamics of tourism destinations.
Price and quantity competition in an asymmetric duopoly with licensing
Authors: Niu Shuai
Published: October 2018

By introducing licensing, this study reconsiders the relative dominance of price‐ and quantity‐setting strategies in an asymmetric duopoly. It shows that if the initial cost difference is small or the goods are close substitutes, then both firms will prefer the quantity strategy. Conversely, for the other cases, heterogeneous‐strategy equilibrium will appear, under which the low‐cost firm will choose a price strategy and the high‐cost firm will choose a quantity strategy. With an endogenous mode of market competition, licensing has always proven to be welfare‐improving.