bluuebunny/crossref_metadata_2025 huggingface dataset:
Which stroke patients gain most from intermittent pneumatic compression: further analyses of the CLOTS 3 trial
Authors: Dennis Martin , Graham Catriona , Smith Joel , Forbes John , Sandercock Peter
Published: August 2015

Background

The CLOTS 3 trial showed that intermittent pneumatic compression (IPC) reduced the risk of DVT and improved survival after stroke.

Aims

To provide additional information which may help clinicians target IPC on the most appropriate patients by exploring the variation in its effects on subgroups defined by predicted prognosis.

Methods

A multicentre, parallel group, randomized trial enrolled immobile acute stroke patients and allocated them to IPC or no IPC. The primary outcome was proximal DVT at 30 days. Secondary outcomes at six-months included survival, disability, quality of life, and hospital costs. We stratified patients into quintiles according to their predicted prognosis at randomization, based on the Six Simple Variable model.

Results

Between December 2008 and September 2012, we enrolled 2876 patients in 94 UK hospitals. Patients with the best predicted outcome had the lowest absolute risk of proximal DVT (6.7%) and death by six-months (9.3%). Allocation to IPC had little effect on DVT, survival, disability, quality of life, hospital length of stay, or costs. In patients with the worst predicted outcomes, the overall risk of DVT and death was 16.0% and 51.3%, respectively. IPC reduced DVT (odds reduction 34%) and improved survival 17% and significantly increased length of stay and hospital costs. In the three intermediate quintiles, IPC reduced the odds of DVT (35-43%) and improved survival (11-13%). Disability and quality of life at six-months depended on baseline severity but was not influenced significantly by IPC.

Conclusions

IPC appears to reduce the risk of DVT and probably improves survival in all immobile stroke patients, other than the fifth with the best prognosis. It therefore seems reasonable to recommend that IPC should be considered in all immobile stroke patients, but that the final decision should be based on a judgment about the individual's prognosis. In some, their prognosis for survival with an acceptable quality of life will be so poor that use of IPC might be considered futile, while at the other end of the spectrum, patients’ risk of DVT, and of dying from VTE, may not be high enough to justify the modest cost and inconvenience of IPC use.
Novel Tia Biomarkers Identified by Mass Spectrometry-Based Proteomics
Authors: George Paul M. , Mlynash Michael , Adams Christopher M. , Kuo Calvin J. , Albers Gregory W. , Olivot Jean-Marc
Published: August 2015

Background

Transient ischemic attacks remain a clinical diagnosis with significant variability between physicians. Finding reliable biomarkers to identify transient ischemic attacks would improve patient care and optimize treatment.

Aim

Our aim is to identify novel serum TIA biomarkers through the use of mass spectroscopy-based proteomics.

Methods

Patients with transient neurologic symptoms were prospectively enrolled. Mass spectrometry-based proteomics, an unbiased method to identify candidate proteins, was used to test the serum of the patients for biomarkers of cerebral ischemia. Three candidate proteins were found, and serum concentrations of these proteins were measured by enzyme-linked immunosorbent assay in a second cohort of prospectively enrolled patients. The Student's t-test was used for comparison. The Benjamini–Hochberg false discovery rate controlling procedure for multiple comparison adjustments determined significance for the proteomic screen.

Results

Patients with transient ischemic attacks ( n = 20), minor strokes ( n = 15), and controls (i.e. migraine, seizure, n = 12) were enrolled in the first cohort. Ceruloplasmin, complement component C8 gamma (C8γ), and platelet basic protein were significantly different between the ischemic group (transient ischemic attack and minor stroke) and the controls ( P = 0·0001, P = 0·00027, P = 0·00105, respectively). A second cohort of patients with transient ischemic attack ( n = 22), minor stroke ( n = 20), and controls' ( n = 12) serum was enrolled. Platelet basic protein serum concentrations were increased in the ischemic samples compared with control (for transient ischemic attack alone, P = 0·019, for the ischemic group, P = 0·046). Ceruloplasmin trended towards increased concentrations in the ischemic group ( P = 0·127); no significant difference in C8γ ( P = 0·44) was found.

Conclusions

Utilizing mass spectrometry-based proteomics, platelet basic protein has been identified as a candidate serum biomarker for transient ischemic attack. This unbiased proteomic approach may be a promising method to identify novel biomarkers to more precisely diagnose transient ischemic attacks.
Multi-Modal CT in Acute Stroke: Wait for a Serum Creatinine before Giving Intravenous Contrast? No!
Authors: Ang Timothy E. , Bivard Andrew , Levi Christopher , Ma Henry , Hsu Chung Y. , Campbell Bruce , Donnan Geoffrey , Davis Stephen M. , Parsons Mark
Published: August 2015

Background

Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling.

Aims

To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population.

Methods

An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100–150 ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80–125 ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days.

Results

We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis.

Conclusions

The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment.
Heart Rate and Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke (Regards) Study
Authors: O'Neal Wesley T. , Qureshi Waqas T. , Judd Suzanne E. , Meschia James F. , Howard Virginia J. , Howard George , Soliman Elsayed Z.
Published: August 2015

Background

The association between resting heart rate and ischemic stroke remains unclear.

Aim

To examine the association between resting heart rate and ischemic stroke.

Methods

A total of 24 730 participants (mean age: 64 ± 9·3 years; 59% women; 41% blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment (2003–2007) were included in this analysis. Resting heart rate was determined from baseline electrocardiogram data. Heart rate was examined as a continuous variable per 10 bpm increase and also as a categorical variable using tertiles (<61 bpm, 61 to 70 bpm, and >70 bpm). First-time ischemic stroke events were identified during follow-up and adjudicated by physician review.

Results

Over a median follow-up of 7·6 years, a total of 646 ischemic strokes occurred. In a Cox regression model adjusted for socio-demographics, cardiovascular risk factors, and potential confounders, each 10 bpm increase in heart rate was associated with a 10% increase in the risk of ischemic stroke (hazard ratio = 1·10, 95% confidence interval = 1·02, 1·18). In the categorical model, an increased risk of ischemic stroke was observed for heart rates in the middle (hazard ratio = 1·29, 95% confidence interval = 1·06, 1·57) and upper (hazard ratio = 1·37, 95% confidence interval = 1·12, 1·67) tertiles compared with the lower tertile. The results were consistent when the analysis was stratified by age, gender, race, exercise habits, hypertension, and coronary heart disease.

Conclusion

In REGARDS, high resting heart rates were associated with an increased risk of ischemic stroke compared with low heart rates. Further research is needed to examine whether interventions aimed to reduce heart rate decrease stroke risk.
Statin use in spontaneous intracerebral hemorrhage: a systematic review and meta-analysis
Authors: Jung Jin-Man , Choi Jeong-Yoon , Kim Hyun Jung , Seo Woo-Keun
Published: August 2015

Background

Nonrandomized observational studies have been conducted to evaluate the effects of statins on clinical outcomes in patients with intracerebral hemorrhage. Several studies on the effects of statin administration in patients with intracerebral hemorrhage have been published recently, but the findings are inconsistent.

Aim

To evaluate the effects of statins administered prior to hospital admission and during hospitalization on mortality and functional outcomes in patients with intracerebral hemorrhage.

Summary of review

We searched for relevant literature using multiple comprehensive databases and performed a systematic review and meta-analysis. Sixteen studies met our selection criteria. Preintracerebral hemorrhage statin use was not associated with mortality (odds ratio: 0.90, 95% confidence interval: 0.63-1.28). However, patients who used statins prior to intracerebral hemorrhage had a decreased risk of mortality at three-months following symptom onset (odds ratio: 0.47, 95% confidence interval: 0.32-0.68) and an increased probability of good functional outcomes (odds ratio: 1.49, 95% confidence interval: 1.01-2.19), as compared with those who did not. In-hospital use of statins was associated with a low risk of mortality (odds ratio: 0.34, 95% confidence interval: 0.26-0.44) irrespective of preadmission statin use or postadmission timepoints. Additionally, we were unable to pool the data on statin withdrawal because of differences in study methodologies.

Conclusions

Although careful interpretation is necessary due to several study limitations, we have demonstrated that statin use in patients with intracerebral hemorrhage is likely associated with improved mortality and functional outcomes.
The emergence of a dual system of dispute resolution: private facilitators in Irish industrial relations
Authors: Roche William K.
Published: August 2015

This article examines the practice of private facilitation in Irish industrial relations, drawing on interviews with key practitioners and on case studies. It explores antecedents of private facilitation, examines the multiple processes involved, identifies influences on the growth of private facilitation and locates the Irish case in comparative context.
Water Diplomacy: Perspectives from a Group of Interdisciplinary Graduate Students
Authors: Read Laura , Garcia Margaret
Published: August 2015

Water management challenges are multifaceted, often involving issues of water availability, quality, access and equity. It is increasingly recognized that professionals trained to work in traditional disciplinary roles are ill‐equipped to address complex issues such as water that transcend both geographic and disciplinary boundaries. A growing number of interdisciplinary doctoral programs, including the Water Diplomacy Integrative Graduate Education and Research Traineeship (IGERT) at Tufts University, have formed to respond to demand for progress in this area. This paper presents a Water Diplomacy IGERT student perspective on the benefits and challenges of interdisciplinary water education. First, we find that articulating a set of shared principles helps to build a strong research community, which in turn shapes the research approach and perspectives of participating students. Second, we recommend students clearly state uncertainties and assumptions to tackle the challenge of working with multidimensional complex systems. Next, we advise that students collaborate with researchers and partner organizations to gain exposure to different approaches outside of their discipline, and to increase breadth of knowledge while maintaining sufficient depth. Finally, we recommend that students take an active role in program leadership to ensure balance between program and student development. These difficulties are not unique to water education, and therefore we hope this discussion can help inform future interdisciplinary education and research efforts.
Water Diplomacy from a Duck's Perspective: Wildlife as Stakeholders in Water Management
Authors: van Rees Charles , Reed J. Michael
Published: August 2015

Contemporary water management strategies call for the inclusion of ecological research in the decision‐making process and emphasize environmentally sustainable management solutions. Most ecological information used in water management shares two problematic characteristics; 1) simplistic, phenomenological approaches and aggregated data that may not properly describe system behavior, and 2) a “zero‐sum” perspective treating ecological water needs as constraints to management. We argue that the newly devised Water Diplomacy Framework (WDF) can help overcome these shortcomings. We also provide a simple and intuitive method for integrating ecological factors into the WDF. We suggest that treating ecological phenomena as “surrogate stakeholders” in water negotiations increases opportunities for discovering mutual‐gains solutions and encourages a hypothesis‐based approach to research on the ecology of water management. By differentiating between the “positions” and “interests” of ecological stakeholder surrogates, decision‐makers can make greater use of the potential added value of ecosystem services in water management and avoid costly misunderstandings of the behavior of relevant ecological systems. We outline how the WDF can be applied to better integrate ecological factors into water management, and show how our approach could create synergies between endangered waterbird conservation and sustainable water management on the island of Oahu, Hawaii.
Aligning Climate Change Adaptation Planning with Adaptive Governance: Lessons from Exeter, NH
Authors: Aytur Semra A. , Hecht Jory S. , Kirshen Paul
Published: August 2015

Adaptive governance has been recognized as an integrative approach for analyzing the social, institutional, ecologic, and economic aspects of decision‐making to build resilience against climate change. Although closely aligned with adaptive co‐management and ecosystem management, adaptive governance is a distinct framework that explicitly focuses on decentralized decision‐making through social processes such as collaborative learning, networking, and the promotion of cross‐sectoral partnerships to enhance adaptive capacity. In this paper, we explore an ongoing engagement process for climate change adaptation planning in Exeter, New Hampshire, and its alignment with key principles of adaptive governance. Climate change poses multiple challenges to Exeter, including increased flooding, reduced low flows, water quality degradation, and associated threats to estuarine ecosystems and public health. Engagement strategies include community conversations, workshops, experiential activities, and a community advisory board comprised of different stakeholder representatives (Citizens' Working Group) collaborating with the scientific team on water resources modeling and scenario analysis. We present important lessons about conveying expectations and timeframes of technical modeling to participants, developing multiple forums for interaction between researchers and other stakeholders, and making climate change locally relevant to residents by drawing connections to the community's experiences, cultural memory, values, and upcoming decisions. This study contributes to the literature on adaptive governance and climate change adaptation by evaluating stakeholder involvement in a local institutional setting, an important arena where adaptation decisions must be deliberated. It is also among the first studies to evaluate the ways in which a climate change adaptation stakeholder engagement process aligns with adaptive governance principles, particularly through boundary objects and experiences.
Nanostructured Hybrid Carbon Nanotube/UltraHigh‐Temperature Ceramic Heterostructures: Microstructure Evolution and Forming Mechanism
Authors: Xu Baosheng , Hong Changqing , Zhang Xinghong , Han Jiecai , Han Wenbo , Qin Faxiang
Published: August 2015

An original catalytic method has been proposed to synthesize carbon nanotubes (CNTs)–ZrB2–ZrO2 heterostructures using ZrB2 polymeric precursor. The pyrolysized gases from the ZrB2 polymeric precursor are identified to be the carbon sources for CNTs growth. A parametric study is conducted to control the CNTs growth by optimizing parameters such as synthesis temperature and catalyst content. Observations show that the in situ grown CNTs are homogeneously dispersed in the powders, and the structure and the amount of CNTs are significantly dependent on the synthesis parameters. There are two kinds of grown CNTs existed in the produced hybrid heterostructures: (i) the kinking structured CNTs that are disordered and incomplete graphitization; (ii) the improved and graphitized CNTs. The ZrB2 polymeric precursor during thermal pyrolysis provides capable of supplying substantial carbon source for CNTs nucleation and growth by homogeneous vapor–liquid–solid reactions.
Thermal Expansion of the Orthorhombic Phase in the Ln2TiO5 System
Authors: Seymour Kevin C. , Hughes Robert W. , Kriven Waltraud M.
Published: August 2015

The thermal expansion behavior of the orthorhombic phase in the Ln2TiO5 (Ln = La, Nd, Gd, Dy, and Y) system was evaluated, using synchrotron X‐ray diffraction from room temperature to approximately 1500°C in air. The components of the thermal expansion tensor were calculated from the refined d‐spacings, using the program CTEAS. Subsequent analysis of the thermal expansion and crystallographic information revealed that the mechanism behind the thermal expansion was a result of strained trigonal‐bipyramidal structures overcoming an energy barrier to become more relaxed. The temperature at which a significant shift in the trigonal‐bipyramidal structure manifests was correlated with the size of the rare‐earth cation that dictates the volume of the overall cell. Larger rare‐earth cations with larger cell volumes allow more room for the trigonal‐bipyramidal structures to easily relax.
Structure and Luminescence Characteristics of Eu3+‐Activated Trigonal Layered Perovskite Ba2La2ZnW2O12
Authors: Yu Ruijin , Li Mengxue , Xie Nannan , Wang Ting , Xue Na
Published: August 2015

Eu3+‐doped tungstate Ba2La2ZnW2O12 phosphors with perovskite‐structure were prepared by the high temperature solid‐state reaction. The X‐ray powder diffraction (XRD) patterns and structure refinements indicate that the phosphors crystalized in the trigonal layer‐perovskite. The luminescence properties of the phosphors were investigated such as photoluminescence (PL) excitation and emission spectra, decay lifetimes, and color coordinates. It was found that the pure host shows self‐activated emission excited by the UV light. Moreover, Ba2La2ZnW2O12 also shows scintillation characteristics under the X‐ray irradiation. The near‐UV and blue light can efficiently excite Eu3+‐doped Ba2La2ZnW2O12 phosphors inducing the strong orange–red luminescence. The optimal Eu3+ doping concentration in this host is 40 mol%. The luminescence spectra and the luminescence color of the phosphors strongly depend on the doping levels and excitation wavelength. The different luminescence features were discussed on the base of crystal structure. Eu3+ ions have two possible substitutions on A or B sites in this trigonal layered perovskite. The phosphor could act as a candidate for the potential application in near‐UV excited white‐LEDs lighting.
The association between subgingival periodontal pathogens and systemic inflammation
Authors: Winning Lewis , Patterson Christopher C. , Cullen Kathy M. , Stevenson Kathryn A. , Lundy Fionnuala T. , Kee Frank , Linden Gerard J.
Published: August 2015

Aim

To investigate associations between periodontal disease pathogens and levels of systemic inflammation measured by C‐reactive protein (CRP).

Methods

A representative sample of dentate 60–70‐year‐old men in Northern Ireland had a comprehensive periodontal examination. Men taking statins were excluded. Subgingival plaque samples were analysed by quantitative real time PCR to identify the presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia. High‐sensitivity CRP (mg/l) was measured from fasting blood samples. Multiple linear regression analysis was performed using log‐transformed CRP concentration as the dependent variable, with the presence of each periodontal pathogen as predictor variables, with adjustment for various potential confounders.

Results

A total of 518 men (mean age 63.6 SD 3.0 years) were included in the analysis. Multiple regression analysis showed that body mass index (p < 0.001), current smoking (p < 0.01), the detectable presence of P. gingivalis (p < 0.01) and hypertension (p = 0.01), were independently associated with an increased CRP. The detectable presence of P. gingivalis was associated with a 20% (95% confidence interval 4–35%) increase in CRP (mg/l) after adjustment for all other predictor variables.

Conclusion

In these 60–70‐year‐old dentate men, the presence of P. gingivalis in subgingival plaque was significantly associated with a raised level of C‐reactive protein.
Committed to work but vulnerable: self‐perceptions and mental health in NEET 18‐year olds from a contemporary British cohort
Authors: Goldman‐Mellor Sidra , Caspi Avshalom , Arseneault Louise , Ajala Nifemi , Ambler Antony , Danese Andrea , Fisher Helen , Hucker Abigail , Odgers Candice , Williams Teresa , Wong Chloe , Moffitt Terrie E.
Published: August 2015

Background

Labour market disengagement among youths has lasting negative economic and social consequences, yet is poorly understood. We compared four types of work‐related self‐perceptions, as well as vulnerability to mental health and substance abuse problems, among youths not in education, employment or training (NEET) and among their peers.

Methods

Participants were from the Environmental Risk (E‐Risk) longitudinal study, a nationally representative UK cohort of 2,232 twins born in 1994–1995. We measured commitment to work, job‐search effort, professional/technical skills, ‘soft’ skills (e.g. teamwork, decision‐making, communication), optimism about getting ahead, and mental health and substance use disorders at age 18. We also examined childhood mental health.

Results

At age 18, 11.6% of participants were NEET. NEET participants reported themselves as committed to work and searching for jobs with greater diligence than their non‐NEET peers. However, they reported fewer ‘soft’ skills (B = −0.98, p < .001) and felt less optimistic about their likelihood of getting ahead in life (B = −2.41, p < .001). NEET youths also had higher rates of concurrent mental health and substance abuse problems, but these did not explain the relationship with work‐related self‐perceptions. Nearly 60% of NEET (vs. 35% of non‐NEET) youths had already experienced ≥1 mental health problem in childhood/adolescence. Associations of NEET status with concurrent mental health problems were independent of pre‐existing mental health vulnerability.

Conclusions

Our findings indicate that while NEET is clearly an economic and mental health issue, it does not appear to be a motivation issue. Alongside skills, work‐related self‐perceptions and mental health problems may be targets for intervention and service provision among this high‐risk population.
Prevalence of older people with intellectual disability in Sweden: a spatial epidemiological analysis
Authors: Ng N. , Sandberg M. , Ahlström G.
Published: August 2015

Background

The expected increase in longevity of individuals with intellectual disabilities (ID) in many countries of the world is a direct result of medical and social advances, which have also extended the longevity of the general population. It is important to assess the need for social services for people with ID across different administrative levels to ensure sufficient resources are allocated to where they are most needed. This study estimates the annual prevalence of older people with ID from 2004 to 2012 and in different counties and municipalities in Sweden, by sex and age group; identifies proxy indicators related to the care of older people with ID in different counties in 2012 in Sweden and analyses the spatial distribution and clustering of municipalities with a high prevalence of older people with ID.

Methods

Individuals with ID were identified through the national register based on the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS act) and the national death register. This study focuses on older individuals aged 55+ during the period of 2004–2012. The estimated prevalence was calculated at the county and municipality level and plotted on a municipality‐level map. Moran's I statistics was used to identify any spatial clustering of municipalities with a large number of individuals with ID.

Results

The prevalence of ID among older individuals aged 55+ in Sweden increased from 2004 to 2012. The prevalence was consistently higher among men, and the gender gap increased slightly in recent years. Age‐specific prevalence estimates showed ID to be higher in younger age groups, and the gender gap decreased in older age groups. The prevalence was higher in northern counties in Sweden (over 500 individuals per 100 000 population aged 55+). Higher prevalence areas were clustered in northern municipalities, whereas municipalities with high prevalence of older individuals with ID in the middle and southern regions of Sweden demonstrated a more widespread distribution.

Conclusions

The existence of clusters of counties with a high prevalence of older individuals with ID necessitates further assessment of how resources have been allocated to different counties and municipalities in Sweden. Investigations of the quality of social services provided to individuals with ID across different counties in Sweden are warranted. It is important to ensure that high quality supports are being provided to older individuals with ID in order to grant them the same right to healthy ageing as their counterparts living without ID throughout their life course.
The neonicotinoid imidacloprid, and the pyrethroid deltamethrin, are antagonists of the insect Rdl GABA receptor
Authors: Taylor‐Wells Jennina , Brooke Basil D. , Bermudez Isabel , Jones Andrew K.
Published: August 2015

A mutation in the second transmembrane domain of the GABA receptor subunit, Rdl, is associated with resistance to insecticides such as dieldrin and fipronil. Molecular cloning of Rdl cDNA from a strain of the malaria mosquito, Anopheles gambiae, which is highly resistant to dieldrin revealed this mutation (A296G) as well as another mutation in the third transmembrane domain (T345M). Wild‐type, A296G, T345M and A296G + T345M homomultimeric Rdl were expressed in Xenopus laevis oocytes and their sensitivities to fipronil, deltamethrin, 1,1,1‐trichloro‐2,2‐bis(p‐chlorophenyl) ethane (DDT), imidacloprid and spinosad were measured using two‐electrode voltage‐clamp electrophysiology. Spinosad and DDT had no agonist or antagonist actions on Rdl. However, fipronil, deltamethrin and imidacloprid decreased GABA‐evoked currents. These antagonistic actions were either reduced or abolished with the A296G and the A296G + T345M mutations while T345M alone appeared to have no significant effect. In conclusion, this study identifies another mutation in the mosquito Rdl that is associated with insecticide resistance. While T345M itself does not affect insecticide sensitivity, it may serve to offset the structural impact of A296G. The present study also highlights Rdl as a potential secondary target for neonicotinoids and pyrethroids.

image

We show for the first time that deltamethrin (a pyrethroid insecticide) and imidacloprid (a neonicotinoid insecticide) act directly on the insect GABA receptor, Rdl. Our findings highlight Rdl as a potential secondary target of pyrethroids and neonicotinoids mutations in which may contribute to resistance to these widely used insecticides.
Patient‐reported outcomes in the Swedish National Quality Registers
Authors: Nilsson E. , Orwelius L. , Kristenson M.
Published: August 2015

Patient‐reported outcomes (PROs) are important in the healthcare system to gain understanding of patients' views on the effects of a treatment. There is an abundance of available patient‐reported outcome measures (PROMs), both disease specific and generic. In the Swedish healthcare system, the national quality registers are obliged to incorporate PROs for certification at a high level. A review of the latest annual applications for funding (n = 108) shows that at present, 93 national quality registers include some form of PROM or patient‐reported experience measure (PREM). Half of the registers include some type of generic measure, more than half include disease/symptom‐specific measures, and around 40% include PREMs. Several different measures and combinations of measures are used, the most common of which are the EQ‐5D, followed by the SF‐36/RAND‐36. About one‐fifth of the registers report examples of how patient‐reported data are used for local quality improvement. These examples include enhancing shared decision‐making in clinical encounters (most common), as a basis for care plans, clinical decision aids and treatment guidelines, to improve the precision of indications for surgery (patient and healthcare professional assessments may differ), to monitor complications after the patient has left hospital and to improve patient information. In addition, funding applications reveal that most registers plan to extend their array of PROMs and PREMs in future, and to increase their use of patient‐reported data as a basis for quality improvement.
Melatonin suppresses activation of hepatic stellate cells through RORα‐mediated inhibition of 5‐lipoxygenase
Authors: Shajari Shiva , Laliena Almudena , Heegsma Janette , Tuñón María Jesús , Moshage Han , Faber Klaas Nico
Published: August 2015

Liver fibrosis is scar tissue resulting from an uncontrolled wound‐healing process in response to chronic liver injury. Liver damage generates an inflammatory reaction that activates hepatic stellate cells (HSC) that transdifferentiate from quiescent cells that control retinol metabolism to proliferative and migratory myofibroblasts that produce excessive amounts of extracellular matrix proteins, in particular collagen 1a1 (COL1A1). Although liver fibrosis is reversible, no effective drug therapy is available to prevent or reverse HSC activation. Melatonin has potent hepatoprotective properties in a variety of acute and chronic liver injury models and suppresses liver fibrosis. However, it remains unclear whether melatonin acts indirectly or directly on HSC to prevent liver fibrosis. Here, we studied the effect of melatonin on culture‐activated rat HSC. Melatonin dose‐dependently suppressed the expression of HSC activation markers Col1a1 and alpha‐smooth muscle actin (αSMA, Acta2), as well as HSC proliferation and loss of lipid droplets. The nuclear melatonin sensor retinoic acid receptor‐related orphan receptor‐alpha (RORα/Nr1f1) was expressed in quiescent and activated HSC, while the membranous melatonin receptors (Mtrn1a and Mtrn1b) were not. The synthetic RORα agonist SR1078 more potently suppressed Col1a1 and αSma expression, HSC proliferation, and lipid droplet loss, while the RORα antagonist SR1001 blocked the antifibrotic features of melatonin. Melatonin and SR1078 inhibited the expression of Alox5, encoding 5‐lipoxygenase (5‐LO). The pharmacological 5‐LO inhibitor AA861 reduced Acta2 and Col1a1 expression in activated HSC. We conclude that melatonin directly suppresses HSC activation via RORα‐mediated inhibition of Alox5 expression, which provides novel drug targets to treat liver fibrosis.
Dispensing good sleep health behaviours not pills – a cluster‐randomized controlled trial to test the feasibility and efficacy of pharmacist‐provided brief behavioural treatment for insomnia
Authors: Fuller Joanne M. , Wong Keith K. , Hoyos Camilla , Krass Ines , Saini Bandana
Published: August 2015

Behavioural therapies are recommended as the first‐line treatment of insomnia; however, sedatives and hypnotics constitute the main treatment modality used in primary care. Community pharmacies provide a unique conduit for identifying and providing appropriate treatment for those with insomnia either purchasing prescription sedatives or seeking over‐the‐counter treatments. A feasibility study using a cluster‐randomized controlled trial, testing the efficacy of trained pharmacists providing behavioural interventions such as stimulus control and sleep restriction to patients with insomnia, in improving insomnia severity was conducted. The intervention involved three pharmacy visits (baseline, 1 and 3 months follow‐up). The control group received usual care and information sheets on insomnia. The primary outcome was the Insomnia Severity Index. Twelve community pharmacists (five control, seven intervention) in New South Wales, Australia were recruited and trained. These pharmacists, in turn, recruited 46 patients (22 control, 24 intervention (mean age 53.7 ± 18.4, 72% females) and delivered a brief behavioural therapy intervention. The overall decrease in Insomnia Severity Index from baseline to the 3‐month follow‐up in the intervention group, n = 17 (7.6 ± 4.3 points), was significantly greater than for the control group, n = 19 (2.9 ± 8.8 points) (mean difference 4.6, 95% confidence interval: 0.005–9.2, P = 0.05). However, when the effect of clustering was taken into account using a mixed‐effects model, the estimated difference in Insomnia Severity Index (change from baseline to visit 3) between the intervention and control groups was not significant (group difference in Insomnia Severity Index change = 3.78, 95% confidence interval: −0.81 to 8.37, P = 0.11; intracluster correlation = 0.18). The study highlights the use of a novel venue to deliver brief behavioural therapies for insomnia using trained non‐psychologist health professionals. Although, when cluster effect was taken into account, the difference in Insomnia Severity Index reduction between the intervention versus control groups was non‐significant, the results highlight that reductions in insomnia severity can be gained using trained pharmacists providing brief behavioural interventions. Future research in this area is warranted, with appropriately sized studies using the conventional, robust randomized trial design.
Association of Vitamin D Status and Clinical Outcome in Dogs with a Chronic Enteropathy
Authors: Titmarsh H. , Gow A.G. , Kilpatrick S. , Sinclair J. , Hill T. , Milne E. , Philbey A. , Berry J. , Handel I. , Mellanby R.J.
Published: August 2015

Background

Dogs with a chronic enteropathy (CE) have a lower vitamin D status, than do healthy dogs. Vitamin D status has been associated with a negative clinical outcome in humans with inflammatory bowel disease.

Objectives

To examine the relationship between serum 25 hydroxyvitamin D (25(OH)D) concentrations at diagnosis and clinical outcome in dogs with a CE.

Animals

Forty‐one dogs diagnosed with CE admitted to the Royal Dick School of Veterinary Studies, Hospital for Small Animals between 2007 and 2013.

Methods

Retrospective review. Serum 25(OH)D concentrations were compared between dogs which were alive at follow up or had died because of non‐CE‐related reasons (survivors) and dogs which died or were euthanized due to their CE (non‐survivors). A binary logistic regression analysis was performed to determine significant predictors of death in dogs with CE.

Results

Serum concentrations of 25(OH)D at the time a CE was diagnosed were significantly lower in nonsurvivors (n = 15) (median nonsurvivors 4.36 ng/mL, interquartile range 1.6–17.0 ng/mL), median survivors (n = 26) (24.9 ng/mL interquartile range 15.63–39.45 ng/mL, P < .001). Serum 25(OH)D concentration was a significant predictor of death in dogs with CE (odds ratio 1.08 [95% CI 1.02–1.18)]).

Conclusions

Serum 25(OH)D concentrations at diagnosis are predictive of outcome in dogs with CE. The role of vitamin D in the initiation and outcome of chronic enteropathies in dogs is deserving of further study.
Jugular venipuncture and other innovative approaches to phlebotomy among people who inject drugs
Authors: Ferguson Catherine , Higgs Peter , Olsen Anna
Published: August 2015

In their recent paper on patient experiences of accessing phlebotomy services in hospital outpatient clinics, Clements and colleagues state that there is a real need to better understand the responses of people who inject drugs to phlebotomy. They discuss the reasons why people who inject drugs might not be accessing healthcare services, especially in relation to treatment for hepatitis C. Their research is a welcome addition to the literature that emphasizes the stigma and discrimination faced by people who inject drugs, including within healthcare settings, and outlines the need to promote effective partnerships between healthcare workers and patients so as to deliver the best health outcomes.
Seed dormancy responses to temperature relate toNothofagusspecies distribution and determine temporal patterns of germination across altitudes in Patagonia
Authors: Arana María V. , Gonzalez‐Polo Marina , Martinez‐Meier Alejandro , Gallo Leonardo A. , Benech‐Arnold Roberto L. , Sánchez Rodolfo A. , Batlla Diego
Published: August 2015

Seeds integrate environmental cues that modulate their dormancy and germination. Although many mechanisms have been identified in laboratory experiments, their contribution to germination dynamics in existing communities and their involvement in defining species habitats remain elusive.

By coupling mathematical models with ecological data we investigated the contribution of seed temperature responses to the dynamics of germination of threeNothofagusspecies that are sharply distributed across different altitudes in the Patagonian Andes.

Seed responsiveness to temperature of the threeNothofagusspecies was linked to the thermal characteristics of their preferred ecological niche. In their natural distribution range, there was overlap in the timing of germination of the species, which was restricted to mid‐spring. By contrast, outside their species distribution range, germination was temporally uncoupled with altitude. This phenomenon was described mathematically by the interplay between interspecific differences in seed population thermal parameters and the range in soil thermic environments across different altitudes.

The observed interspecific variations in seed responsiveness to temperature and its environmental regulation, constitute a major determinant of the dynamics ofNothofagusgermination across elevations. This phenomenon likely contributes to the maintenance of patterns of species abundance across altitude by placing germinated seeds in a favorable environment for plant growth.
Spatial patterns of sapling mortality in a moist tropical forest: consistency with total density‐dependent effects
Authors: Velázquez Eduardo , Kazmierczak Martin , Wiegand Thorsten
Published: August 2015

Density‐dependent mortality (DDM) is major driver of species coexistence in tropical forests. We assessed the occurrence and strength of this mechanism among saplings (i.e. trees with a diameter of 1–4 cm) in the moist tropical forest of Barro Colorado Island (BCI), Panama, over six inter‐census periods (26 years), by using spatial point pattern analysis. We considered conspecific density‐dependent mortality, but also total DDM (i.e. the effects of conspecific and heterospecific neighbours all together) upon saplings of all species (i.e. at the community level), and on saplings of light‐demanding and shade‐tolerant ones, separately (i.e. at the light‐guild level). We also analysed the effects of conspecific DDM at the community and light‐guild levels. Conspecific density‐dependent mortality affected a lower proportion of species than was to be expected. Its strength was not significantly related with species abundance, and it had relatively weak effects at the community and light guild levels. Conversely, we detected a significant spatial signature of total DDM among all saplings, and among saplings of the light‐demanding and shade‐tolerant species, but its strength showed pronounced temporal variation. Total DDM among light‐demanding saplings was stronger than among shade‐tolerant ones and its effects were particularly marked 10–15 years after the occurrence of unusually severe droughts associated with El Niño events. Our study indicates that conspecific DDM is relatively unimportant among saplings in comparison with total DDM at community and light‐guild levels. This finding contrasts strongly with the results for seedlings, where conspecific DDM was constituted the dominant process. The pronounced temporal variations observed in the occurrence and strength of total DDM among saplings indicate that time‐varying events associated with climatic disturbances such as canopy openings or episodes of high recruit emergence might be important drivers of this process. They also emphasize the importance of considering time frames longer than one decade to study density‐dependent effects among saplings in tropical forests.
Musculoskeletal Ultrasonography to Distinguish Muscle Changes in Complex Regional Pain Syndrome Type 1 from Those of Neuropathic Pain: An Observational Study
Authors: Vas Lakshmi , Pai Renuka
Published: August 2015

Musculoskeletal ultrasonography (MSK USG) can identify myofascial structural lesions. We describe in this retrospective report the observational findings of USG data of muscles from limbs affected with neuropathic pain in 7 patients and compare them with muscles affected with complex regional pain syndrome type 1 (CRPS‐1) in 7 patients. We highlight findings that distinguish between the 2 conditions.

Musculoskeletal ultrasonography of muscles in CRPS was characterized by a variable or/and global intramuscular structural disruption with loss of muscle bulk. Adjacent muscles coalesced with one another to present an uniform hyperechogenic mass of tissue. Muscle edema was found in some patients. In comparison, MSK USG in muscles affected by neuropathic pain exhibited structural normalcy, but also showed considerable reduction in muscle bulk.

Musculoskeletal ultrasonography shows promise as a diagnostic modality to distinguish between these 2 conditions which presently have only clinical diagnostic criteria to aid diagnosis.
Mesophyll conductance to CO2 and Rubisco as targets for improving intrinsic water use efficiency in C3 plants
Authors: Flexas J. , Díaz‐Espejo A. , Conesa M. A. , Coopman R. E. , Douthe C. , Gago J. , Gallé A. , Galmés J. , Medrano H. , Ribas‐Carbo M. , Tomàs M. , Niinemets Ü.
Published: August 2015

Water limitation is a major global constraint for plant productivity that is likely to be exacerbated by climate change. Hence, improving plant water use efficiency (WUE) has become a major goal for the near future. At the leaf level, WUE is the ratio between photosynthesis and transpiration. Maintaining high photosynthesis under water stress, while improving WUE requires either increasing mesophyll conductance (gm) and/or improving the biochemical capacity for CO2 assimilation—in which Rubisco properties play a key role, especially in C3 plants at current atmospheric CO2.

The goals of the present analysis are: (1) to summarize the evidence that improving gm and/or Rubisco can result in increased WUE; (2) to review the degree of success of early attempts to genetically manipulate gm or Rubisco; (3) to analyse how gm, gsw and the Rubisco's maximum velocity (Vcmax) co‐vary across different plant species in well‐watered and drought‐stressed conditions; (4) to examine how these variations cause differences in WUE and what is the overall extent of variation in individual determinants of WUE; and finally, (5) to use simulation analysis to provide a theoretical framework for the possible control of WUE by gm and Rubisco catalytic constants vis‐à‐vis gsw under water limitations.
Understanding Barriers for Communicating Injury Prevention Messages and Strategies Moving Forward: Perspectives from Community Stakeholders
Authors: Mack Diane E. , Aymar Matt , Cosby Jarold , Wilson Philip M. , Bradley Christina , Walters Gray Casey
Published: August 2015

Objectives

The primary objective of this study was to elicit the perspectives of direct care providers on barriers and facilitators to communicating injury prevention messages to parents/caregivers of children under 4 years of age. The secondary objective was to examine characteristics of an injury prevention messaging strategy preferred by direct care providers.

Design and Sample

This qualitative study was conducted across four regions in Ontario Canada. Fifty‐nine direct care providers were purposefully sampled and data interpreted using focus group analysis.

Measures

Transcripts were analyzed verbatim using content and discourse analysis.

Results

Several barriers to communicating injury prevention messages were identified encompassing (a) role, (b) parental, (c) social determinants, and (d) evidence impediments. In an effort to offset some of these barriers, participants endorsed the development of a tailored multicomponent injury prevention strategy adopting action‐based messages.

Conclusion

The results of this study provide an in‐depth exploration of direct care providers perceptions that can inform the design of materials and dissemination strategies to help increase and optimize access to injury prevention information. Injury prevention messages should be action‐oriented, specifically tailored to the stage of child development, and disseminated through both face‐to‐face interactions and mobile technology.
Franchise Contracting: The Effects of The Entrepreneur's Timing Option and Debt Financing
Authors: Babich Volodymyr , Tang Christopher S.
Published: August 2015

We solve a sequential‐moves game that involves three players: the franchisor, the entrepreneur, and the banks. The franchisor chooses the contract terms (a one‐time franchise fee and a royalty rate for on‐going payments). The entrepreneur dynamically decides when to sign this contract, open a store, and apply for debt financing to cover the initial investment. In response to the entrepreneur's application, banks competitively determine loan rates. We find that the franchisor should use royalty cash flows and not the franchise fee to extract value from the entrepreneur. This is a new explanation of empirical evidence that franchise contracts favor royalties over franchise fees. To account for the possibility of the entrepreneur's bankruptcy and bankruptcy costs, the franchisor should decrease the royalty rate. However, despite a lower rate, the threshold for the entrepreneur to open the store is higher in the model with financing than in the model without financing. This threshold is much higher than it would have been for the integrated system, which in turn is higher than the static break‐even‐NPV threshold. If a franchisor ignores financing considerations, she will suffer from having to wait longer for the store opening and from a higher bankruptcy probability. We predict that the franchisor is the main beneficiary of the entrepreneur's greater initial wealth and that the franchisor will benefit more if she assumes a greater share of the store's operating costs.