bluuebunny/crossref_metadata_2025 huggingface dataset:
Team‐based parent training by child specialists helps maltreated children
Authors: Yokoyama Hiroyuki , Tomizawa Yayoi , Sato Yoshinori , Kobayashi Atsuko , Katsushima Yuriko , Katsushima Fumio
Published: October 2018

Background

This study assessed the effects of the parent training (PT) technique, in which child specialists (CS) such as preschool and school teachers promote secure attachment in children with aberrant social behavior following maltreatment, using a team approach.

Methods

Child specialists confirmed the presence of child abuse, according to Japanese Ministry of Health, Labour and Welfare criteria. CS such as homeroom, special education‐related, student guidance‐related, nursing teachers and co‐workers received a PT course conducted by the authors. A homeroom teacher provided classroom management to model good examples of social life for the target child. A nursing teacher and assistant offered individualized instruction to foster the formation of secure attachments by the target child.

Result

Behavioral abnormalities in both school and home resolved in seven out of 12 cases. These subjects received the intervention for 2–4 years. In the other cases, behavioral abnormalities disappeared or decreased at school, but continued at home. Almost all children met the alternative criteria of attachment disorder proposed by Boris and Zeanah. One child met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM‐IV‐TR) criteria for reactive attachment disorder. This intervention is significantly more effective for children who have yet to begin elementary school than those in elementary school.

Conclusions

The PT technique as applied by CS using a team approach may be a useful intervention for fostering secure attachment in children with maltreatment who exhibit behavioral abnormalities. Early detection and intervention are necessary to successfully address the behavioral abnormalities of children with maltreatment.
Lymphadenitis by non‐tuberculous mycobacteria in children
Authors: Loizos Anastasios , Soteriades Elpidoforos S. , Pieridou Despo , Koliou Maria G.
Published: October 2018

Background

Non‐tuberculous mycobacteria (NTM) constitute an important cause of cervical lymphadenitis in immunocompetent children. The aims of this study were to estimate the incidence of lymphadenitis due to NTM in children in Cyprus and to describe the characteristics, diagnostic approach, management and outcome of such infections.

Methods

Children aged 1–5 years old, evaluated at Archbishop Makarios III Hospital, Nicosia, Cyprus, from 1 January 2007 to 31 December 2016 for lymphadenopathy, were included in the study. All children had positive lymph node culture for NTM.

Results

A total of 22 cases of culture‐positive lymphadenitis caused by NTM were reviewed. Patient age ranged from 16 to 55 months. Tuberculin skin test produced an induration in 81.0% of cases (diameter, 4–17 mm). Mycobacterium avium was isolated in 17 cases (77.3%), M. intracellulare in three (13.6%), M. paraffinicum in one (4.5%) and M. kansasii in one case (4.5%). All 22 patients underwent surgical excision of affected nodes. Additional anti‐mycobacterial treatment was given when complete excision was not achieved or for post‐surgical recurrence. Complications were few and included scar in three children and one case of transient facial nerve palsy.

Conclusion

Surgical excision of NTM‐infected lymph nodes is an effective diagnostic and therapeutic approach. When total surgical excision is not feasible, a combination of partial excision with a clarithromycin‐including drug regimen appears safe, effective and causes milder and fewer complications than surgery alone.
Risk factors and epidemiology of pediatric ventriculoperitoneal shunt infection
Authors: Erps Amir , Roth Jonathan , Constantini Shlomi , Lerner‐Geva Liat , Grisaru‐Soen Galia
Published: October 2018

Background

The aim of this study was to identify independent risk factors for cerebrospinal fluid shunt infection.

Methods

The medical records of all patients aged 0–18 years who underwent shunt‐related surgery for the treatment of hydrocephalus at the present institution between January 1996 and December 2015 were reviewed. For each case, two randomly selected controls with no shunt infection, matched for year of surgery, were chosen. Demographic clinical and microbiological data were abstracted.

Results

A total of 1,570 shunt‐related procedures met the inclusion criteria, yielding 68 infections (in 63 patients). The control group consisted of 132 infection‐free patients. The average annual infection rate was 4.2% cases per year. The median time between shunt procedures to infection was 19 days (range, 1–2,181). On multivariate analysis, risk factors associated with increased risk for developing an infection included a history of two or more previous revisions (OR, 4.8; 95%CI: 1.5–15.9); and age <5 years (OR, 4.5; 95%CI 1.5–13.4). A neoplastic etiology for hydrocephalus was found to be a protective factor for shunt infection (P = 0.001).

Conclusions

A history of shunt revision was the most significant risk factor in the development of subsequent shunt infection. Age >5 years was a protective factor. Future efforts should focus on modalities to optimize revision procedures and reduce the risk of subsequent infection.
LMX in team‐based contexts: TMX, authority differentiation, and skill differentiation as boundary conditions for leader reciprocation
Authors: Wang Linda C. , Hollenbeck John R.
Published: October 2018

The purpose of the current study is to develop an integrated theoretical model based upon social exchange theory focused on the simultaneous interplay of leader–member exchange (LMX) and team–member exchange (TMX) in team‐based contexts. We propose a model that extends current theories related to social exchange by integrating currently independent propositions in the literatures on LMX and TMX, showing how these propositions are contingent on the nature of the team in which leaders and followers are embedded. In a sample of 439 employees on 61 teams, the results show that when it comes to predicting individual performance (a) high TMX quality eliminates the otherwise negative effects of low LMX quality, (b) low authority differentiation weakens the otherwise positive effects of LMX, and (c) high skill differentiation weakens the otherwise positive effects of high LMX quality on performance. We discuss how the role of LMX may be changing in contemporary team‐based work contexts relative to what was true in the historical literature when the construct was originally developed.
Low irradiance compared with conventional photodynamic therapy in the treatment of actinic keratoses
Authors: Gholam Patrick , Bosselmann Ina , Enk Alexander H. , Dick Julika
Published: October 2018

Background

Photodynamic therapy (PDT) is an effective therapy treating photodamaged areas with multiple actinic keratoses (AK). Still pain during therapy is one of the most challenging obstacles for patients. This retrospective study compares pain and efficacy intra‐individual in patients using conventional PDT (c‐PDT) compared to a low irradiance PDT protocol (li‐PDT) with a reduced irradiance to 25% of c‐PDT.

Methods

Thirty‐one patients were enrolled into this retrospective analysis treated with li‐PDT and c‐PDT on comparable fields of actinic damage on the forehead or the cheek. Pain was scored by the patients using a VAS. Moreover, number and time to therapy interruptions were documented. For effectiveness number and grade of AK were counted before and 4 weeks after PDT.

Results

Maintaining a total light dose of 37 J/cm2, a decrease in irradiation in li‐PDT patients resulted in significant less pain (VAS score 2.8 vs 7.6) and fewer therapy interruptions compared to treatment with c‐ PDT (P < 0.0005). No significant difference in treatment outcome was found (P = 0.068).

Conclusion

Our data shows that li‐PDT can reduce pain with at least comparable clinical outcome compared to c‐PDT. Therefore, it is an effective and well‐tolerated treatment for patients with multiple AK.
Identification and characterization ofXanthomonas albilineanscausing sugarcane leaf scald in China using multilocus sequence analysis
Authors: Ntambo M. S. , Meng J.‐Y. , Rott P. C. , Royer M. , Lin L.‐H. , Zhang H.‐L. , Gao S.‐J.
Published: October 2018

Xanthomonas albilineansis the causal agent of leaf scald, a disease that can cause considerable damage to sugarcane industries. This study analysed the phylogenetic relationship of 14 samples ofX. albilineansfrom China and 13 reference strains retrieved from the GenBank database by multilocus sequence analysis (MLSA). To reach this goal, five housekeeping genes ofX. albilineanswere amplified from diseased leaves and sequenced:gyrB,abc,rpoD,atpDandglnA. Based on the concatenated sequence of these genes (4473 nt), the 14 samples ofX. albilineansfrom China had 99.9–100% sequence identity with one another and with five strains of the pathogen from the French West Indies and theUSA(Florida). The 27 samples or strains ofX. albilineanswere distributed in two distinct clades in theMLSA‐based phylogenetic tree. Clade 1 was formed by four strains of the pathogen from Fiji, Papua New Guinea and theUSA. All the other strains from worldwide locations, including the 14 samples from China, were grouped in clade 2. This latter clade included all strains of the pathogen that were associated with outbreaks of leaf scald that have occurred over the last two decades, especially in the Caribbean islands and theUSA. The very low diversity ofX. albilineansin four Chinese provinces suggests recent spread of a single strain (from genetic groupPFGE‐B) of the leaf scald pathogen within China.
Transcriptomic analysis reveals the possible roles of sugar metabolism and export for positive mycorrhizal growth responses in soybean
Authors: Zhao Shaopeng , Chen A. , Chen Chengjie , Li Chengchen , Xia Rui , Wang Xiurong
Published: October 2018

To elucidate molecular mechanisms controlling differential growth responses to root colonization by arbuscular mycorrhizal (AM) fungi varying in colonization and cooperative behavior, a pot experiment was carried out using two soybean genotypes and three AM inocula. The results showed that inoculation by cooperative Rhizophagus irregularis (Ri) or less cooperative Glomus aggregatum with high AM colonization (Ga‐H) significantly promoted plant growth compared with inoculation by G. aggregatum with low AM colonization (Ga‐L). A comparative RNA sequencing analysis of the root transcriptomes showed that fatty acid synthesis pathway was significantly enriched in all three AM inoculation roots. However, sugar metabolism and transport were significantly enriched only in Ri and Ga‐H inoculation, which was consistent with positive growth responses in these two inoculation treatments. Accordingly, the expression levels of the key genes related to sugar metabolism and transport were also upregulated in Ri and Ga‐H roots compared with Ga‐L roots. Of them, two sugars will eventually be exported transporters (SWEET) transporter genes, GmSWEET6 (Glyma.04G198600) and GmSWEET15 (Glyma.06G166800), and one invertase (Glyma.17G227900) gene were exclusively induced only in Ri and Ga‐H roots. Promoter analyses in transgenic soybean roots further demonstrated that GUS driven by the GmSWEET6 promoter was highly expressed in arbuscule‐containing cortical cells. Additionally, Ri and Ga‐H inoculation increased the contents of sucrose, glucose and fructose in both shoots and roots compared with those of Ga‐L and non‐mycorrhizal. These results imply that positive mycorrhizal growth responses in plants might mostly be due to the stimulation of photosynthate metabolism and transport by AM fungal inoculum with high colonization capabilities.
Breakthrough percepts of famous faces
Authors: Alsufyani Abdulmajeed , Hajilou Omid , Zoumpoulaki Alexia , Filetti Marco , Alsufyani Hamed , Solomon Christopher J. , Gibson Stuart J. , Alroobaea Roobaea , Bowman Howard
Published: October 2018

Recently, we showed that presenting salient names (i.e., a participant's first name) on the fringe of awareness (in rapid serial visual presentation, RSVP) breaks through into awareness, resulting in the generation of a P3, which (if concealed information is presented) could be used to differentiate between deceivers and nondeceivers. The aim of the present study was to explore whether face stimuli can be used in an ERP‐based RSVP paradigm to infer recognition of broadly familiar faces. To do this, we explored whether famous faces differentially break into awareness when presented in RSVP and, importantly, whether ERPs can be used to detect these breakthrough events on an individual basis. Our findings provide evidence that famous faces are differentially perceived and processed by participants’ brains as compared to novel (or unfamiliar) faces. EEG data revealed large differences in brain responses between these conditions.
Object reidentification and the epistemic role of attention
Authors: Das Nilanjan
Published: October 2018

Reidentification scepticism is the view that we cannot knowledgeably reidentify previously perceived objects. Amongst classical Indian philosophers, the Buddhists argued for reidentification scepticism. In this essay, I will discuss two responses to this Buddhist argument. The first response, defended by Vācaspati Miśra (9th century CE), is that our outer senses allow us to knowledgeably reidentify objects. I will claim that this proposal is problematic. The second response, due to Jayanta Bhaṭṭa (9th century CE), is that the manas or the inner sense, functioning as a capacity of attention, helps us knowledgeably reidentify objects. I will explain how this second response answers the Buddhists’ challenge.
Conflict of interest regulation in European parliaments: Studying the evolution of complex regulatory regimes
Authors: Bolleyer Nicole , Smirnova Valeria , Di Mascio Fabrizio , Natalini Alessandro
Published: October 2018

The growing complexity of parliamentary ethics regulation adopted over the last decades makes the systematic examination of its nature and the rationales underpinning regulatory choices an important endeavor. In this paper we introduce conceptualizations and measurements of conflict of interest (COI) regulation directed toward assuring the impartial and unbiased decisionmaking of national parliamentarians. We distinguish the strictness of rules, the nature of enforcement, sanctions, and transparency requirements as core elements defining COI regimes. Applying our framework to 27 European democracies, we select two cases for in‐depth analysis in which legislators chose very different solutions in response to growing pressures to regulate themselves, to inductively explore the drivers underpinning the choice of COI mechanisms: the United Kingdom, which adopted a highly transparency‐oriented regime, and Belgium, which adopted a highly sanction‐oriented COI regime. Echoing neo‐institutionalist perspectives, the longitudinal analyses indicate how the two democracies’ different institutional environments shape distinct answers to similar functional pressures.
Analyzing Disaster Loss Trends: A Comparison of Normalization Methodologies in South Korea
Authors: Choi Donghyun , Kasdan David Oliver , Yoon D. K.
Published: October 2018

Increasing concern for climate change adaptation and disaster risk reduction is driving the need for more accurate and sophisticated tools of analysis to protect populations. Standards of analysis that can normalize measurements under various contexts are particularly valuable in the global arena of disaster management. One concern that may benefit from normalizing is the analysis of disaster loss trends. Previous studies have used a combination of inflation, wealth, and societal factors in their normalization of disaster loss methodologies. This study examines the various normalization methods in previous research and applies a selection of eight formulae to 50 years of disaster data in South Korea. The results show both decreasing and increasing trends in disaster damage losses based on the methods, but there are curious biases under the results that may be artifacts of Korea's unique experiences in economic development. The conclusion discusses how the case of Korea may help to clarify the optimal normalization methodology for other countries.
The ‘China shock,’ exports and U.S. employment: A global input–output analysis
Authors: Feenstra Robert C. , Sasahara Akira
Published: October 2018

This paper quantifies the impact on U.S. employment from imports and exports during 1995–2011, using the World Input–Output Database. We find that the growth in U.S. exports led to increased demand for 2 million jobs in manufacturing, 0.5 million in resource industries, and a remarkable 4.1 million jobs in services, totaling 6.6 million. Two‐thirds of those service sectors jobs are due to the export of services themselves, whereas one‐third is due to the intermediate demand from manufacturing and resource—or merchandise—exports, so the total labor demand gain due to merchandise exports was 3.7 million jobs. In comparison, U.S. merchandise imports from China led to reduced demand of 1.4 million jobs in manufacturing and 0.6 million in services (with small losses in resource industries), with total job losses of 2.0 million. It follows that the expansion in U.S. merchandise exports relative to imports from China over 1995–2011 created net demand for about 1.7 million jobs. Comparing the growth of U.S. merchandise exports to merchandise imports from all countries, we find a fall in net labor demand due to trade, but comparing the growth of total U.S. exports to total imports from all countries, then there is a rise in net labor demand because of the growth in service exports.
Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed‐methods study based on 45 years of experience
Authors: Vermeiden Tienke , Schiffer Rita , Langhorst Jorine , Klappe Neel , Asera Wolde , Getnet Gashaw , Stekelenburg Jelle , van den Akker Thomas
Published: October 2018

Objective

To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff.

Methods

Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed‐methods design. This included seven in‐depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2‐week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation.

Results

The MWH at Attat Hospital has become a well‐established intervention for high‐risk pregnant women (1987–2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142–832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy‐related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby.

Conclusions

Facilitators for MWH utilisation according to users and staff were perceived high‐quality EmONC, integrated health services, awareness of pregnancy‐related complications and the husband's support in overcoming barriers. If providing high‐quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.
Seroprevalence of sarcocystosis in the local communities of Pangkor and Tioman Islands using recombinant surface antigens 3 (rSAG3) of Sarcocystis falcatula
Authors: Tengku‐Idris Tengku Idzzan Nadzirah , Fong Mun Yik , Lau Yee Ling
Published: October 2018

Objective

To investigate the seroprevalence of Sarcocystosis in the local communities of Pangkor and Tioman islands, Malaysia, by using antigenic recombinant surface antigens 2 and 3 from Sarcocystis falcatula (rSfSAG2 and rSfSAG3) as the target proteins via Western blot and ELISA assays.

Methods

SfSAG2 and SfSAG3 genes were isolated from S. falcatula and expressed in Escherichia coli expression system. A total of 348 serum samples [volunteers from both islands (n = 100), non‐Sarcocystis parasitic infections patients (n = 50) and healthy donors (n = 100)] were collected and tested with purified SfSAGs in Western blot and ELISA assays to measure the seroprevalence of human sarcocystosis.

Results

None of the sera in this study reacted with rSfSAG2 by Western blot and ELISA. For rSfSAG3, relatively high prevalence of sarcocystosis was observed in Tioman Island (75.5%) than in Pangkor Island (34%) by Western blot. In ELISA, the different prevalence rate was observed between Tioman Island (43.8%) and Pangkor Island (37%). The prevalence rate in other parasitic infections (amoebiasis, cysticercosis, filariasis, malaria, toxocariasis and toxoplasmosis) was 30% by Western blot and 26% by ELISA. Only 8% (by Western blot) and 10% (by ELISA) of healthy donors showed reactivity towards rSfSAG3.

Conclusion

This is the first study reporting a seroprevalence of sarcocystosis in Pangkor and Tioman Islands, Malaysia. The combination of Western blot and ELISA is suitable to be used for serodiagnosis of sarcocystosis. With further evaluations, SfSAG3 can potentially be used to confirm infection, asymptomatic screening, surveillance and epidemiological studies.
Transcriptional effects of cadmium on iron homeostasis differ in calamine accessions of Noccaea caerulescens
Authors: Halimaa Pauliina , Blande Daniel , Baltzi Erol , Aarts Mark G. M. , Granlund Lars , Keinänen Markku , Kärenlampi Sirpa O. , Kozhevnikova Anna D. , Peräniemi Sirpa , Schat Henk , Seregin Ilya V. , Tuomainen Marjo , Tervahauta Arja I.
Published: October 2018

Calamine accessions of the zinc/cadmium/nickel hyperaccumulator, Noccaea caerulescens, exhibit striking variation in foliar cadmium accumulation in nature. The Ganges accession (GA) from Southern France displays foliar cadmium hyperaccumulation (>1000 μg g−1 DW), whereas the accession La Calamine (LC) from Belgium, with similar local soil metal composition, does not (<100 μg g−1 DW). All calamine accessions are cadmium hypertolerant. To find out the differences between LC and GA in their basic adaptation mechanisms, we bypassed the cadmium excluding phenotype of LC by exposing the plants to 50 μm cadmium in hydroponics, achieving equal cadmium accumulation in the shoots. The iron content increased in the roots of both accessions. GA exhibited significant decreases in manganese and zinc contents in the roots and shoots, approaching those in LC. Altogether 702 genes responded differently to cadmium exposure between the accessions, 157 and 545 in the roots and shoots, respectively. Cadmium‐exposed LC showed a stress response and had decreased levels of a wide range of photosynthesis‐related transcripts. GA showed less changes, mainly exhibiting an iron deficiency‐like response. This included increased expression of genes encoding five iron deficiency‐regulated bHLH transcription factors, ferric reduction oxidase FRO2, iron transporters IRT1 and OPT3, and nicotianamine synthase NAS1, and decreased expression of genes encoding ferritins and NEET (a NEET family iron‐sulfur protein), which is possibly involved in iron transfer, distribution and/or management. The function of the IRT1 gene in the accessions was compared. We conclude that the major difference between the two accessions is in the way they cope with iron under cadmium exposure.
The proof is in the bulb: glycerol influences key stages of lily development
Authors: Lazare Silit , Bechar Daniel , Fernie Alisdair R. , Brotman Yariv , Zaccai Michele
Published: October 2018

A bulb is a whole plant condensed into an underground organ. A geophyte's bulb comprises both food reserves and important developmental history that may affect its whole growth. In Easter lily (Lilium longiflorum), bulb size is associated with the plant's flowering pathway – vernalization or photoperiod – and also affects sprouting, flower quality and abortion rate. The aim of this study was to investigate the reasons for the major physiological differences between large and small bulbs. Lily bulbs start their development from secondary meristems along the stem, with large bulbs being heavier and bear more scales than small ones. Peeling the outer scales of a large bulb converts its physiological responses into those of a small bulb, implying that the physiological discrepancies in plants developing from large or small bulbs are mediated by factors inherent to the bulb. We therefore performed broad analyses of the metabolite composition in the scales of bulbs subjected to temperature regimes affecting further plant development. We found a striking association between the level of glycerol, a primary metabolite mostly synthesized in the outer scales, and a delay in sprouting and flowering time, and reduction in abortion rate. Exogenous glycerol application to the bulbs before planting corroborated these results. Moreover, transcriptome analyses showed that flowering‐promoting gene expression was downregulated in the bulb after glycerol treatment, while potential flowering inhibitor as well as a dormancy‐related gene expressions were upregulated. Based on these studies, we postulate that glycerol is a major factor influencing both vegetative and reproductive development in lily.
Cascadia Rising: thoughts on a Seattle earthquake disaster exercise
Authors: Hess John R.
Published: October 2018

BACKGROUND

The Cascadia subduction zone off the US Pacific Northwest coast produces a Force 9 earthquake once every 300 years. Cascadia Rising was a regional disaster drill modeled on such an event. Western Washington State has 5 million people and one Level I trauma center.

STUDY DESIGN AND METHODS

The blood response of the trauma center and region were modeled under the conditions laid down in the disaster scenario. The scenario assumed structural damage to the 1931 reinforced concrete building housing the trauma hospital transfusion service with loss of electricity, data services, and water. The regional blood center, in a newer building located six blocks away, suffered less disruption. The regional blood inventory is in a blood component manufacturing facility 18 miles south of downtown.

RESULTS

At best and at risk to life, the trauma center could issue universally compatible components at a rate of 60 components/hr from a damaged but still accessible transfusion service. Usable inventory would be expended in 4 hours with no clear mechanism and rules for resupply. The regional center has additional group O red blood cells and AB or A plasma to sustain that rate of usage for several more hours but no protocols for reestablishing communication or “push” resupply. Regional resources will be gone in less than a day.

CONCLUSIONS

After a major Cascadia earthquake, blood resources may fail immediately, but even with luck, local resources used emergently at maximal issue rates will last 4 to 14 hours.© 2018 AABB
Blood transfusions in preterm infants: changes on perfusion index and intermittent hypoxemia
Authors: Ibonia Katrina T. , Bada Henrietta S. , Westgate Philip M. , Gomez‐Pomar Enrique , Bhandary Prasad , Patwardhan Abhijit , Abu Jawdeh Elie G.
Published: October 2018

BACKGROUND

Red blood cell (RBC) transfusion decreases intermittent hypoxemia (IH) events beyond the first week of life. This benefit may be related to improved perfusion to the respiratory control network. Perfusion index (PI) is a perfusion measure provided by the pulse oximeter. We hypothesized that the benefit in IH after RBC transfusion is associated with an increase in PI. In addition, we assessed the value of PI and clinical measures in predicting the effect of RBC transfusion on IH.

STUDY DESIGN AND METHODS

We prospectively enrolled infants less than 30 weeks' gestation age. PI and oxygen saturation (SpO2) were monitored with high‐resolution pulse oximeters 24 hours before and after RBC transfusion. Data were analyzed at three postnatal periods: Epoch 1, first week of life (1 to 7 days of life); Epoch 2, 2 to 4 weeks of life (8 to 28 days of life); and Epoch 3, 4 to 8 weeks of life.

RESULTS

A total of 118 transfusions were analyzed. IH measures significantly decreased after transfusion in Epochs 2 and 3. PI significantly increased after transfusion, but it did not correlate with the decrease in IH measures. Mechanical ventilation, fraction of inspired oxygen (FiO2), and IH measures influenced the effects on oxygenation.

CONCLUSIONS

RBC transfusion improved IH after the first week of life. The benefit in IH did not correlate with PI increase after transfusion. Pretransfusion respiratory support and IH measures predicted the effect of transfusion on oxygenation.
Complications of a severe autoimmune hemolytic anemia crisis: transfusional iron overload and gangrenous cholecystitis
Authors: Menchetti Isabella , Lin Yulia , Cserti‐Gazdewich Christine , Goldstein Jenette , Law Calvin , Lazarus Alan , Callum Jeannie L.
Published: October 2018

BACKGROUND

Evans syndrome is a rare autoimmune disorder that is defined by the simultaneous or sequential presence of two or more cytopenias without an obvious underlying precipitating cause. Evans syndrome usually follows a chronic relapsing and remitting course and is quite rare, making it difficult to evaluate in clinical studies.

CASE REPORT

A 66‐year‐old male patient with a 17‐year history of Evans syndrome presented with fulminant autoimmune hemolytic anemia (AIHA). He presented with a markedly elevated C‐reactive protein (CRP; 46 mg/L [normal, 0‐5 mg/L]) before onset of a decrease in hemoglobin. He required the transfusion of 20 units of red blood cells while awaiting response to aggressive immunosuppressive therapy including high‐dose corticosteroids, intravenous immunoglobin therapy, and rituximab. He achieved a complete hematologic response.

RESULTS

His postdischarge course was complicated by acute cholecystitis requiring laparoscopic cholecystectomy. In addition, his transfusional iron overload requiring 16 phlebotomies to reduce his ferritin level from 4933 μg/L to 326 μg/L, with phlebotomies ongoing every 2 weeks to achieve a ferritin level of less than 100 μg/L.

CONCLUSION

Neither transfusional iron overload nor acute cholecystitis are well‐recognized complications of a severe episode of AIHA. An elevated CRP has been recently recognized as an important prognostic marker in patients with immune thrombocytopenic purpura and this case suggests a need to evaluate its utility in AIHA.
Repeat whole blood donors with a ferritin level of 30 μg/L or less show functional iron depletion
Authors: Dijkstra Angelique , van den Hurk Katja , Bilo Henk J. G. , Slingerland Robbert J. , Vos Michel J.
Published: October 2018

BACKGROUND

Whole blood donors are screened for iron depletion through hemoglobin measurement alone or in combination with ferritin. Ferritin measurement gives the advantage of earlier detection of iron depletion. In a previous study we identified a ferritin level of 30 μg/L or less as a possible indicator of suboptimal erythropoiesis. In this study, erythropoietic parameters were measured to determine if a ferritin level of 30 μg/L or less is indicative of iron‐deficient erythropoiesis in repeat whole blood donors.

STUDY DESIGN AND METHODS

Twenty‐one healthy male repeat whole blood donors were divided into two groups according to their predonation ferritin values: 30 μg/L or less (low‐ferritin group) and greater than 30 μg/L (normal‐ferritin group). Ferritin and erythropoietic parameters were measured before whole blood donation and weekly in the 8 weeks after donation.

RESULTS

A significantly lower value was found for hemoglobin, mean corpuscular volume (MCV), reticulocytes, and reticulocyte hemoglobin content on at least three of the nine time points in the low‐ferritin group compared to the normal‐ferritin group (p < 0.05). Of these parameters, MCV and reticulocyte hemoglobin content were significantly lower before donation as well as during all 8 weeks following donation (p < 0.05).

CONCLUSION

Based on the lower values of the erythropoietic parameters in the low‐ferritin group, it can be concluded that repeat whole blood donors with a ferritin value of 30 μg/L or less have iron‐deficient erythropoiesis and therefore require a longer donation interval than the current 56 days.
Ocular abnormalities in a herd of Old Kladruber Horses: A cross‐sectional study
Authors: Andrysikova Radka , Pot Simon , Rüegg Simon , Markova Jitka , Horackova Eliska , Kolos Filip , Voelter Katrin , Spiess Bernhard
Published: October 2018

Objective

To screen a closed herd of the Old Kladruber Horses (OKH) for the prevalence of ocular disorders and report normal ocular variations.

Animals studied

Two hundred and sixty‐one horses, 122 Old Kladruber Gray Horses, and 139 Old Kladruber Black Horses owned by the National Stud Farm Kladruby nad Labem, Czech Republic, were included in the study with signalment and pedigree information recorded.

Procedures

Bilateral ocular examination of manually restrained horses was performed in a darkened environment by a single examiner (RA), using a portable slit‐lamp biomicroscope, direct ophthalmoscope, and monocular indirect ophthalmoscopy using a Finnoff transilluminator and 20 D condensing lens. Fluorescein testing was performed when indicated.

Results

The animal ages ranged from 3 months to 27 years (mean 7.82 years, median 6 years). The gender ratio (males:females) was 109:152. Ophthalmological abnormalities were found in 133 (50.96%) horses; with right and left eyes affected equally. The most common abnormalities were cataract formation (35 horses), iris hyperpigmentation (29 horses), alterations in corpora nigra size (26 horses), nonsenile vitreal degeneration (24 horses), linear keratopathy (11 horses), corneal stromal haze (nine horses) and corneal subepithelial punctate opacities (nine horses). The most frequent variations of normal ocular anatomy were posterior lenticular suture lines (222 horses), tapetal hypoplasia (95 horses) resulting in a multi‐colored tapetal fundus (31 horses), nuclear sclerosis (48 horses), and senile vitreal degeneration (30 horses).

Conclusions

Ocular disorders were relatively common in OKH, but typically not vision threatening and not interfering with the quality of life.
Tear glucose, creatinine, and urea nitrogen concentrations in cats with normal or increased plasma concentrations
Authors: Steinmetz Andrea , Jörn Ulrike , Oechtering Gerhard U. , Heilmann Romy M.
Published: October 2018

Objective

The aim of the study was to determine the lacrimal fluid (LF) contents of glucose, urea nitrogen, and creatinine in cats.

Animal studied

A total of 96 cats were included in the study.

Procedure

Venous blood and LF samples were collected. For LF sampling, three small polyurethane sponges were placed in the ventral fornix of both eyes. Both LF and plasma concentrations of glucose, urea nitrogen, and creatinine were quantitatively analyzed and compared.

Result

Glucose (n = 40) and urea nitrogen concentrations (n = 42) measured in LF from both eyes highly correlated. While there was a very strong correlation (ρ = 0.97) between urea nitrogen concentrations in blood plasma and the corresponding tear levels (with the median LF urea nitrogen being 109% of that measured in plasma), the LF glucose concentrations were significantly lower than the corresponding plasma concentrations (with only 13% of the blood glucose concentration detected in the LF). The creatinine concentrations in tears were much lower than those in plasma, and LF creatinine was detectable in only 12/48 cats (25%). Hence, a comparison of the LF creatinine concentrations between both eyes or with the corresponding plasma creatinine concentration was not possible.

Conclusion

Measurement of LF urea nitrogen concentrations in cats appears to be reliable and might have potential clinical utility. Measurement of LF glucose concentrations is less reliable but may still be useful in some cats. Creatinine is not reliably detected in the LF in cats. Further studies determining clinical utility of LF metabolites in cats and other companion animals are warranted.
Migration of retrobulbar wooden foreign body between diagnostic imaging and surgical extraction in a German shepherd dog
Authors: Cherry Rose L. , Johnson Kryssa L. , Hespel Adrien‐Maxence , Tobias Karen M. , Ward Daniel A.
Published: October 2018

A 2‐year‐old, male castrated German shepherd dog was presented to the University of Tennessee Veterinary Medical Center (UTVMC) with periorbital swelling and conjunctival mucopurulent discharge 2 days following removal of a twig from the medial canthus by the owner. Diagnostic imaging was pursued due to the suspicion of a retrobulbar foreign body (FB). A cylindrical FB approximately 3.0 cm in length and 1.0 cm in diameter with concentric rings, suspected to be wooden material, was identified on computed tomography (CT) imaging. An attempt to remove the FB via a stab incision using ultrasound guidance was unsuccessful, and postmanipulation ultrasound confirmed the FB position was unchanged. An exploratory orbitotomy was performed, using the acquired CT images for guidance in locating the FB; however, the FB was not present at the predicted site. The CT imaging was repeated and showed that the FB had migrated rostrally approximately 3.0 cm, compared to the originally acquired study and its same location during attempted ultrasound‐guided removal. A combination of CT‐guided needle placement and contrast injection was then used with repeat imaging in an attempt to better localize the FB and its soft tissue tract. The dog was taken back into the operating room, and the wooden FB was successfully removed.
Effect of management practices for Stylosanthes hamata (L.) Taub. biomass cover on the weed species in different direct‐seeding, mulch‐based cropping systems
Authors: Camara Abib , Dieng Abdoulaye , Diaw Mamadou T. , Mergeai Guy , Bindelle Jérôme
Published: October 2018

Weed management is a major challenge for smallholders’ adoption of conservation agriculture techniques. The phytological composition and weed biomass in five direct‐seeding cropping systems based on the millet–groundnut rotation, with permanent cover provided by Stylosanthes hamata (L.) Taub., were evaluated after 3 years in western Senegal. A transect was used to determine the phytological composition. The weed biomass was measured in five quadrats in the middle and at the end of the plant growth cycle. This study shows that S. hamata ground cover does not allow the effective control of weeds; high weed infestation was recorded in all direct‐seeding cropping systems (58–75% of the ground cover). A high diversity of weed species was observed in all treatments, dominated by Eragrostis ssp. and Dactyloctenium aegyptium Beauv. Cutting back and removing the aboveground biomass reduced the ground cover provided by S. hamata, lowered the weed species diversity and favored heliophilous species such as Eragrostis tremula but did not reduce weed infestation. Animal manure application did not, in the short term, affect the composition or structure of the weed species. However, it favored weed development and increased aboveground biomass. In the long term, this could affect weed seedbank and structure. Cutting back and removing the aboveground biomass of S. hamata resulted in lower weed diversity and higher crop yield. To achieve effective weed control, additional research on management techniques that would focus on the combination of cutting back vegetation and weeding along the crop seeding line will be needed.
Making It Happen: Middle Managers' Roles in Innovation Implementation in Health Care
Authors: Urquhart Robin , Kendell Cynthia , Folkes Amy , Reiman Tony , Grunfeld Eva , Porter Geoffery A.
Published: October 2018

Background

Middle managers are given scant attention in the implementation literature in health care, where the focus is on senior leaders and frontline clinicians.

Aims

To empirically examine the role of middle managers relevant to innovation implementation and how middle managers experience the implementation process.

Methods

A qualitative study was conducted using the methods of grounded theory. Data were collected through semistructured interviews with middle managers (N = 15) in Nova Scotia and New Brunswick, Canada. Participants were purposively sampled, based on their involvement in implementation initiatives and to obtain variation in manager characteristics. Data were collected and analyzed concurrently, using an inductive constant comparative approach. Data collection and analysis continued until theoretical saturation was reached.

Results

Middle managers see themselves as being responsible for making implementation happen in their programs and services. As a result, they carry out five roles related to implementation: planner, coordinator, facilitator, motivator, and evaluator. However, the data also revealed two determinants of middle managers' role in implementation, which they must negotiate to fulfill their specific implementation roles and activities: (1) They perform many other roles and responsibilities within their organizations, both clinical and managerial in nature, and (2) they have limited decision‐making power with respect to implementation and must work within the parameters set by upper levels of the organization.

Linking Evidence to Action

Middle managers play an important role in translating adoption decisions into on‐the‐ground implementation. Optimizing their capacity to fulfill this role may be key to improving innovation implementation in healthcare organizations.
Non‐human primates as a reservoir for rabies virus in Brazil
Authors: Kotait Ivanete , Oliveira Rafael de Novaes , Carrieri Maria Luiza , Castilho Juliana G. , Macedo Carla Isabel , Pereira Patrícia Mariano Cruz , Boere Vanner , Montebello Lúcia , Rupprecht Charles E.
Published: October 2018

Rabies virus (RABV) does not persist in the environment as it is a very fragile agent. The primary hosts are mammalian species in the orders Carnivora and Chiroptera. Since the late 1980s, RABV has been isolated from non‐human primates, Callithrix jacchus (the white‐tufted marmoset), in four coastal states (Rio Grande do Norte, Ceará, Piauí and Pernambuco) in north‐eastern Brazil, where this species is indigenous. The original habitat of C. jacchus consisted of two Brazilian biomes, the Atlantic Forest and the Caatinga. However, these marmosets have since adapted to other ecosystems as a result of human activities. Between 1988 and 1989, RABV isolates were obtained from white‐tufted marmosets in the state of Rio Grande do Norte, but antigenic and genetic identification studies were not conducted at that time. In the following years, three additional states reported cases (Ceará, Piauí and Pernambuco). In two of these states (Ceará and Piauí), human cases of rabies transmitted by marmosets were reported. According to Brazilian Health Ministry data, at least 19 human cases in which this species was the source of infection were registered in between 1990 and 2016. Recent findings in laboratory tests of 12 rabid samples from humans and marmosets and the regional transmission among these animals for over 20 years, together with the gradual increase in the affected geographic area, support the concept of the emergence of a new RABV reservoir. Regional tourism, the wild animal trade and the cultural practice of maintaining these animals as pets, particularly in coastal regions, appear to be major risk factors for the increase in human cases. Additional epidemiological and ecological studies are required to better understand local disease dynamics and to identify ideal opportunities for prevention and control of this fatal infection.
Corticospinal excitability during shortening and lengthening actions with incremental torque output
Authors: Škarabot Jakob , Tallent Jamie , Goodall Stuart , Durbaba Rade , Howatson Glyn
Published: October 2018

New Findings

What is the central question of this study?

The relationship between motor unit recruitment and firing rate has been related to the size of the corticospinal output with variations in the nervous system gain during isometric contractions. However, corticospinal behaviour with incremental torque output might differ during anisometric contractions owing to differences in neural control of anisometric contraction types.

What is the main finding and its importance?

Corticospinal excitability during lengthening contractions was smaller compared with shortening but increased with incremental torque output in a similar manner between contraction types. The relationship between motor unit recruitment and firing rates is probably the main determinant of the size of an evoked response with variations in system gain.

The modulation of motor evoked potentials (MEPs), an index of corticospinal excitability, has been shown to increase during isometric contractions with incremental torque output in accordance with the contribution between motor unit recruitment and firing rate of the muscle to increases in required torque output. However, the motor unit strategy of the muscle might not be the only factor influencing this behaviour, because differences in pre‐ and postsynaptic control have been reported between lengthening and shortening or isometric contractions. In 30 healthy adults, MEPs were elicited in tibialis anterior during shortening and lengthening contractions at 15, 25, 50 and 80% of contraction‐type‐specific maximal voluntary contraction torque. Background EMG activity increased progressively with greater torque output (P < 0.001) but was similar between contraction types (P = 0.162). When normalized to the maximal muscle response, MEPs were greater during shortening compared with lengthening contractions (P = 0.004) and increased stepwise with increased contraction intensities (P = 0.001). These data show an increase in corticospinal excitability with torque output from lower to higher contraction intensities, suggesting a greater contribution of motor unit recruitment to increased nervous system gain in the tibialis anterior. Despite differences in corticospinal control of shortening and lengthening contractions, the data suggest that the corticospinal responses to increases in torque output are not dependent on contraction type, because corticospinal excitability increased to a similar extent during shortening and lengthening actions. Thus, it is likely that the relationship between motor unit recruitment and firing rate of the muscle is the main determinant of corticospinal output with variations in nervous system gain.