bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenology predicts the native and invasive range limits of common ragweed
Authors: Chapman Daniel S. , Haynes Tom , Beal Stephen , Essl Franz , Bullock James M.
Published: September 2013

Accurate models for species' distributions are needed to forecast the progress and impacts of alien invasive species and assess potential range‐shifting driven by global change. Although this has traditionally been achieved through data‐driven correlative modelling, robustly extrapolating these models into novel climatic conditions is challenging. Recently, a small number of process‐based or mechanistic distribution models have been developed to complement the correlative approaches. However, tests of these models are lacking, and there are very few process‐based models for invasive species. We develop a method for estimating the range of a globally invasive species, common ragweed (Ambrosia artemisiifolia L.), from a temperature‐ and photoperiod‐driven phenology model. The model predicts the region in which ragweed can reach reproductive maturity before frost kills the adult plants in autumn. This aligns well with the poleward and high‐elevation range limits in its native North America and in invaded Europe, clearly showing that phenological constraints determine the cold range margins of the species. Importantly, this is a ‘forward’ prediction made entirely independently of the distribution data. Therefore, it allows a confident and biologically informed forecasting of further invasion and range shifting driven by climate change. For ragweed, such forecasts are extremely important as the species is a serious crop weed and its airborne pollen is a major cause of allergy and asthma in humans. Our results show that phenology can be a key determinant of species' range margins, so integrating phenology into species distribution models offers great potential for the mechanistic modelling of range dynamics.
Thrombosis of the great cerebral vein in a hemodialysis patient
Authors: Ratkovic Marina , Basic‐Jukic Nikolina , Gledovic Branka , Radunovic Danilo
Published: September 2013

Cerebral venous thrombosis is a rare condition with various clinical presentations which may delay diagnosis. It is frequently associated with severe consequences. We present the first documented case of thrombosis of the great cerebral vein in a hemodialysis patient. A 29‐year‐old female patient with end‐stage renal disease of unknown etiology was admitted to a hospital with altered consciousness and nausea. Severe headache in the right parietal area had started 2 days before. On examination, she was in the poor overall condition, dysartric, with a severe nystagmus. Urgent brain multislice computerized tomography and magnetic resonance imaging revealed thrombosis of the great cerebral vein with hypodense zones in hypothalamus, thalamus and basal ganglia. She was treated with heparin bolus of 25000 IU with a favorable outcome. Detailed examination demonstrated increased lupus anticoagulant (LA) 1 and LA2 and increased LA1/LA2. Control magnetic resonance imaging performed 1 year later revealed multiple vascular lesions within the brain. Acetylsalicylate was introduced in therapy. Thrombosis of the cerebral veins should be suspected in patients with end‐stage renal disease, altered neurological status and signs of increased intracranial pressure.
Symptomatic hyperammonemia after lung transplantation: Lessons learnt
Authors: Anwar Siddiq , Gupta Diptesh , Ashraf Muhammad A. , Khalid Syed A. , RIZVI Syed M. , Miller Brent W. , Brennan Daniel C.
Published: September 2013

Hyperammonemia, post‐orthotopic lung transplantation, is a rare but mostly fatal complication. Various therapies, including those to decrease ammonia generation, increase nitrogen excretion, and several dialytic methods for removing ammonia have been tried. We describe three lung transplant recipients who developed acute hyperammonemia early after transplantation. Two of the three patients survived after a multidisciplinary approach including discontinuation of drugs, which impair urea cycle, aggressive ammonia reduction with prolonged daily intermittent hemodialysis (HD), and overnight slow low‐efficiency dialysis in conjunction with early weaning of steroids and other therapeutic measures. Our experience suggests that early initiation of dialysis, high dialysis dose, increased frequency, and HD preferably to less efficient modalities increases survival in these patients.
Restoration of the normal Clara cell phenotype after chronic allergic inflammation
Authors: Roth Felix D. , Quintar Amado A. , Leimgruber Carolina , García Luciana , Uribe Echevarría Elisa M. , Torres Alicia I. , Maldonado Cristina A.
Published: September 2013

Bronchiolar Clara cells play a critical role in lung homoeostasis. The main goal of this study was to evaluate the effects of chronic allergy on these cells and the efficacy of budesonide (BUD) and montelukast (MK) in restoring their typical phenotypes after ovalbumin‐induced chronic allergy in mice. Chronic allergy induced extensive bronchiolar Alcian blue‐periodic acid‐Schiff (AB/PAS)‐positive metaplasia. In addition, cells accumulated numerous big electron‐lucent granules negative for Clara cell main secretory protein (CC16), and consequently, CC16 was significantly reduced in bronchoalveolar lavage. A concomitant reduction in SP‐D and CYP2E1 content was observed. The phenotypic changes induced by allergy were pharmacologically reversed by both treatments; MK was more efficient than BUD in doing so. MK decreased AB/PAS reactivity to control levels whereas they remained persistently elevated after BUD. Moreover, most non‐ciliated cells recovered their normal morphology after MK, whereas for BUD normal cells coexisted with ‘transitional’ cells that contained remnant mucous granules and stained strongly for CC16 and SP‐D. Glucocorticoids were also less able to reduce inflammatory infiltration and maintained higher percentage of neutrophils, which may have contributed to prolonged mucin expression. These results show that chronic allergy‐induced mucous metaplasia of Clara cells affects their defensive mechanisms. However, anti‐inflammatory treatments were able to re‐establish the normal phenotype of Clara cell, with MK being more efficient at restoring a normal profile than BUD. This study highlights the role of epithelial cells in lung injuries and their contribution to anti‐inflammatory therapies.
Endothelial nitric oxide synthase gene polymorphisms and prostate cancer risk in Serbian population
Authors: Branković Ana , Brajušković Goran , Nikolić Zorana , Vukotić Vinka , Cerović Snežana , Savić‐Pavićević Dušanka , Romac Stanka
Published: September 2013

Genome‐wide association studies (GWAS) have identified over 46 SNPs associated with human prostate cancer (PCa). Some studies have shown correlation of the nitric oxide synthase (NOS) NOS3 gene polymorphisms with the risk and/or progression of PCa. This study aimed to evaluate the association of NOS3 gene polymorphisms (−786T>C, −764A>G, −714G>T, −690C>T, −649G>A and 894G>T) with PCa risk and progression. 150 patients with PCa, 150 patients with BPH and 100 age‐matched healthy controls were recruited in this study. Genotyping of promoter polymorphisms was performed by bi‐directional DNA sequencing, and for 894G>T by RFLP analysis. There was no significant association between the alleles and genotypes of these genetic variants and PCa risk. For −786T>C polymorphism, we found that C allele is associated with absence of metastases, assuming dominant genetic model (P = 0.049; OR, 0.50; 95% CI, 0.25–1.00). It was found that, compared with NOS3 −690C>T variant CC genotype, CT and TT genotypes confer decreased risk of developing metastases (dominant model, P = 0.015, OR, 0.24; 95% CI, 0.07–0.88) and show association with low clinical tumour stage, compared with stages T3 and T4 (dominant model, P = 0.046, OR, 0.20; 95% CI, 0.04–1.02). Genetic variants −764A>G, −714G>T, −649G>A were not detected in our study group. There is evidence of an inverse correlation of the NOS3 894G>T minor allele with high serum PSA (>20 ng/ml) (dominant model, P = 0.013, OR, 0.37; 95% CI, 0.17–0.82). Our results suggest that NOS3 gene polymorphisms are genetic susceptibility factors for the progression of PCa and patient outcome.
Effect of different levels of fat and inulin on the microbial growth and metabolites in probiotic yogurt containing nonviable bacteria
Authors: Shakerian Mansour , Hadi Razavi Seyed , Khodaiyan Faramarz , Ziai Seyed Ali , Saeid Yarmand Mohammad , Moayedi Ali
Published: September 2013

Effects of different levels of fat and inulin on bacterial cell counts, degree of proteolysis and concentrations of organic acids in the yogurt containing inactivated cells of probiotic strains Bifidobacterium animalis and Lactobacillus acidophilus were investigated. Results showed that both L. acidophilus and B. animalis grew well in the yogurt samples reaching cell counts higher than 106 CFU mL−1 at the final pH of 4.5. Inulin at the concentration of 1% had no significant effects on the production of organic acids and cell counts of L. acidophilus, but promoted the growth of B. animalis with a reduction in the degree of proteolysis. Generally, different fat levels showed significant effects on the production of organic acids and nonsignificant effects on the cell counts of probiotic bacteria and degree of proteolysis. In case of lactic acid, the ratio of L‐ (+)to D‐ (−) isomer ranged from 50/50 to 80/20 in yogurt samples.
Preparation of alcalase hydrolysed rice bran protein concentrate and its inhibitory effect on soybean lipoxygenase activity
Authors: Vijitpunyaruk Tawipat , Theerakulkait Chockchai
Published: September 2013

Rice bran protein concentrate (RBPC) was prepared from defatted rice bran and hydrolysed by alcalase at different hydrolysis times. As the hydrolysis times increased, the degree of hydrolysis (DHs) increased. RBPC hydrolysate obtained at 50 min (RBPCH‐50) had the highest inhibitory efficiency on soybean lipoxygenase (LOX) activity (66%). The inhibition kinetics of the reaction analysed by Lineweaver–Burk plots indicates that RBPCH‐50 is a competitive inhibitor. RBPCH‐50 inhibited soybean LOX with an IC50 of 11.73 μg μL−1 RBPCH‐50, and the obtained KI was 4.59 μg μL−1 RBPCH‐50. LOX inhibitory activity of RBPCH‐50 was significantly higher than that of 50 and 100 ppm butylated hydroxyanisole (BHA) and 50, 100, and 200 ppm butylated hydroxytoluene (BHT) (P ≤ 0.05); however, LOX inhibitory activity of RBPCH‐50 was similar to that of 200 ppm BHA (P > 0.05). Therefore, RBPCH might potentially be used as a natural LOX inhibitor.
Autophagy activation by interferon‐γ via the p38 mitogen‐activated protein kinase signalling pathway is involved in macrophage bactericidal activity
Authors: Matsuzawa Takeshi , Fujiwara Eri , Washi Yui
Published: September 2013

Macrophages are involved in many essential immune functions. Their role in cell‐autonomous innate immunity is reinforced by interferon‐γ (IFN‐γ), which is mainly secreted by proliferating type 1 T helper cells and natural killer cells. Previously, we showed that IFN‐γ activates autophagy via p38 mitogen‐activated protein kinase (p38 MAPK), but the biological importance of this signalling pathway has not been clear. Here, we found that macrophage bactericidal activity increased by 4 hr after IFN‐γ stimulation. Inducible nitric oxide synthase (NOS2) is a major downstream effector of the Janus kinase–signal transducer and activator of transcription 1 signalling pathway that contributes to macrophage bactericidal activity via nitric oxide (NO) generation. However, no NO generation was observed after 4 hr of IFN‐γ stimulation, and macrophage bactericidal activity at early stages after IFN‐γ stimulation was not affected by the NOS inhibitors, NG‐methyl‐l‐arginine acetate salt and diphenyleneiodonium chloride. These results suggest that an NOS2‐independent signalling pathway is involved in IFN‐γ‐mediated bactericidal activity. We also found that this macrophage activity was attenuated by the addition of the p38 MAPK inhibitors, PD 169316, SB 202190, and SB 203580, or by the expression of short hairpin RNA against p38α or the essential factors for autophagy, Atg5 and Atg7. Collectively, our results suggest that the IFN‐γ‐mediated autophagy via p38 MAPK, without the involvement of NOS2, also contributes to the ability of macrophages to kill intracellular bacteria. These observations provide direct evidence that p38 MAPK‐mediated autophagy can support IFN‐γ‐mediated cell‐autonomous innate immunity.
Pharmacokinetics‐‐a relevant factor for the choice of a drug?
Authors: Benet LZ , Zech K
Published: September 2013

Pharmacokinetics may be utilized as a tool in the drug development process, either with respect to therapeutics or in allowing a drug's disposition characteristics to be defined. If two drugs of the same class have a similar dose‐efficacy profile, then the favourable/unfavourable balance of the pharmacokinetic characteristics of the drugs may determine the drug of choice. Pantoprazole, a proton pump inhibitor, appears to meet the above criteria and has been found to exhibit reliable, predictable pharmacokinetic characteristics as opposed to other members of the class. The pharmacokinetics of pantoprazole over a range of intravenous and oral doses are described in healthy volunteers and are compared with values obtained for omeprazole. Studies in patients with severe cirrhosis, renal failure, and in the elderly are also described as well as potential interactions due to food and five other drugs.
Long‐term therapy with pantoprazole in patients with peptic ulceration resistant to extended high‐dose ranitidine treatment.
Authors: Brunner G , Harke U
Published: September 2013

Patients (106) with peptic ulceration of the oesophagus, stomach and duodenum, unresponsive to 3 or more months of high‐dose treatment with ranitidine, were initially given pantoprazole (40‐80 mg, p.o.) daily. In 96.7% of the patients ulcers healed within 2 to 8 weeks, and in 2.3% of patients the ulcers healed within 12 weeks. In just one patient with severe oesophagitis, the lesion took more than 6 months to heal. After ulcer healing, patients (98 to date) were treated with pantoprazole (40 mg/day) as long‐term maintenance therapy. Eighty‐eight of the 98 patients have been taking pantoprazole for 6 months to 3 years. During maintenance therapy, peptic disease was kept in remission in most patients with 40 mg pantoprazole. Twelve patients with oesophagitis and two patients with gastric ulcers needed higher doses (80‐120 mg) to control the disease. One female patient developed peripheral oedema which disappeared quickly after stopping treatment. No further drug‐ related adverse effects were observed. Seven patients withdrew from the study and two patients died, all for non‐drug‐related reasons. Routine laboratory tests remained without significant changes in all patients. Mean (+/‐ S.E.M.) serum gastrin levels were already elevated during the initial high‐dose ranitidine treatment (128 +/‐ 23 pg/ml). Within one year of the start of the pantoprazole treatment, serum gastrin levels rose to 3 times normal values (189 +/‐ 32 pg/ml). Thereafter, no further increases in serum gastrin were observed for up to 2.5 years. Enterochromaffin‐like (ECL) cell density increased very slightly from 0.19% to 0.24% within one year.(ABSTRACT TRUNCATED AT 250 WORDS)
CT scan based determination of optimal bone corridor for atlantoaxial ventral screw fixation in miniature breed dogs
Authors: Revés Núria Vizcaíno , Stahl Cristina , Stoffel Michael , Bali Monty , Forterre Franck
Published: September 2013

Objective

To describe the most reliable insertion angle, corridor length and width to place a ventral transarticular atlantoaxial screw in miniature breed dogs.

Study Design

Retrospective CT imaging study.

Sample Population

Cervical CT scans of toy breed dogs (n = 21).

Methods

Dogs were divided into 2 groups—group 1: no atlantoaxial abnormalities; group 2: atlantoaxial instability. Insertion angle in medial to lateral and ventral to dorsal direction was measured in group 1. Corridor length and width were measured in groups 1 and 2. Corridor width was measured at 3 points of the corridor. Each variable was measured 3 times and the mean used for statistical analysis.

Results

Mean ± SD optimal transarticular atlantoaxial insertion angle was determined to be 40 ± 1° in medial to lateral direction from the midline and 20 ± 1° in ventral to dorsal direction from the floor of the neural canal of C2. Mean corridor length was 7 mm (range, 4.5–8.0 mm). Significant correlation was found between corridor length, body weight, and age. Mean bone corridor width ranged from 3 to 5 mm. Statistically significant differences were found between individuals, gender and measured side.

Conclusions

Optimal placement of a transarticular screw for atlantoaxial joint stabilization is very demanding because the screw path corridor is very narrow.
Differentiating between stopover and staging sites: functions of the southern and northern Yellow Sea for long‐distance migratory shorebirds
Authors: Ma Zhijun , Hua Ning , Peng Hebo , Choi Chiyeung , Battley Phil F. , Zhou Qianyan , Chen Ying , Ma Qiang , Jia Na , Xue Wenjie , Bai Qingquan , Wu Wei , Feng Xuesong , Tang Chendong
Published: September 2013

Evidence‐based protection of migratory birds at flyway levels requires a solid understanding of their use of ‘stopping sites’ during migration. To characterize the site use of northward‐migration great knots Calidris tenuirostris in China, we compared length of stay and fuel deposition during northward migration at areas in the south and the north of the Yellow Sea, a region critical for migrating shorebirds. Radio‐tracking showed that at the southern site great knots stayed for only short periods (2.3 ± 1.9 d, n = 40), and bird captures showed that they did not increase their mean body mass while there. In the north birds stayed for 1 month (31.0 ± 13.6 d, n = 22) and almost doubled their mean body mass. Fuel consumption models suggest that great knots departing from the northern Yellow Sea should be able to fly nonstop to the breeding grounds, whereas those from the south would require a refueling stop further north. These results indicate that the study sites in the northern and southern Yellow Sea serve different roles: the southern site acts as a temporary stopover area that enables birds with low fuel stores to make it to main staging areas further north, while the northern site serves as the critical staging site where birds refuel for the next leg of their migration. The rapid turnover rate in the southern Yellow Sea indicates that many more birds use that area than are indicated by peak counts. Differential use of the southern and northern sites indicates that both play crucial roles in the ability of great knots to migrate successfully.
Identification of micro‐RNA networks in end‐stage heart failure because of dilated cardiomyopathy
Authors: Zhu Xiaoming , Wang Hongjiang , Liu Fan , Chen Li , Luo Weijia , Su Pixiong , Li Weiming , Yu Liping , Yang Xinchun , Cai Jun
Published: September 2013

Micro‐RNAs regulate gene expression by directly binding to the target mRNAs. The goal of the study was to examine the expression profiling of miRNAs in human failing hearts and identify the key miRNAs that regulate molecular signalling networks and thus contribute to this pathological process. The levels of miRNAs and expressed genes were analysed in myocardial biopsy samples from patients with end‐stage heart failure (n = 14) and those from normal heart samples (n = 8). Four networks were built including the Gene regulatory network, Signal‐Network, miRNA‐GO‐Network and miRNA‐Gene‐Network. According to the fold change in the network and probability values in the microarray cohort, RT‐PCR was performed to measure the expression of five of the 72 differentially regulated miRNAs. miR‐340 achieved statistically significant. miR‐340 was identified for the first time in cardiac pathophysiological condition. We overexpressed miR‐340 in cultured neonatal rat cardiomyocytes to identify whether miR‐340 plays a determining role in the progression of heart failure. ANP, BNP and caspase‐3 were significantly elevated in the miR‐340 transfected cells compared with controls (P < 0.05). The cross‐sectional area of overexpressing miR‐340 cardiomyocytes (1952.22 ± 106.59) was greater (P < 0.0001) than controls (1059.99 ± 45.59) documented by Laser Confocal Microscopy. The changes of cellular structure and the volume were statistical significance. Our study provided a comprehensive miRNA expression profiling in the end‐stage heart failure and identified miR‐340 as a key miRNA contributing to the occurrence and progression of heart failure. Our discoveries provide novel therapeutic targets for patients with heart failure.
Adiponectin gene variants, adiponectin isoforms and cardiometabolic risk in type 2 diabetic patients
Authors: Foucan Lydia , Maimaitiming Suliya , Larifla Laurent , Hedreville Segho , Deloumeaux Jacqueline , Joannes Marie‐Odile , Blanchet‐Deverly Anne , Velayoudom‐Céphise Fritz‐Line , Aubert Roberte , Salamon Roger , Donnet Jean‐Paul , Fumeron Frederic
Published: September 2013

Aims/Introduction

The aim of the present study was to examine the associations of rs2241766 (+45T>G), rs1501299 (+276G>T), rs17300539 (−11391G>A) and rs182052 (−10069G>A) in the adiponectin (Ad) gene with adiponectin concentrations, and concomitantly the association of these variants with cardiometabolic risk in type 2 diabetic patients of African ancestry.

Materials and Methods

A cross‐sectional study of 200 patients was carried out. Concentrations of total, high (HMW), middle (MMW) and low (LMW) molecular weight adiponectin isoforms were measured. The four polymorphisms were genotyped.

Results

Decreased values were noted for total Ad in overweight, dyslipidemia and coronary artery disease (CAD), for HMW in overweight and dyslipidemia, for MMW in CAD, for LMW in dyslipidemia and CAD, for the percentage HMW/total in overweight, and for MMW:HMW ratio in patients without hypertriglyceridemic waist (HTGW). Significant associations were noted between total Ad, HMW, and HMW/total Ad and rs182052 under a dominant model (P = 0.04, P = 0.03 and P = 0.04, respectively), and between MMW and rs17300539 (P = 0.006). No significant difference in adiponectin concentrations was noted according to rs2241766 and rs1501299 genotypes. Patients carrying the rs2241766 G allele (TG+GG) had an increased risk of HTGW (odds ratio [OR] 3.1; P = 0.04) and of CAD (OR 3.3; P = 0.01). The odds of having low total adiponectin concentrations (<25th percentile: 3.49 ng/mL) for carrying the rs182052A allele (AA+GA) was: OR 0.40; P = 0.009. The single‐nucleotide polymorphism associated with adiponectin levels was not concomitantly associated with cardiometabolic risk factors.

Conclusions

Adiponectin concentrations and ADIPOQ variants are implicated in the pathophysiological process leading to cardiovascular diseases, but the genetic effects seem to be independent of adiponectin concentrations in our Afro–Caribbean diabetic patients.
Antifungal Bioassay‐Guided Fractionation of an Oil Extract of Propolis
Authors: Finger Daiane , Machado Christiane Schinieder , Torres Yohandra Reyes , Quináia Sueli Percio , Thomaz Amanda Cristina Godot , Gobbo Angélica Rita , Monteiro Marta Chagas , Ferreira Antonio Gilberto , Sawaya Alexandra Christine Helena Frankland , Eberlin Marcos Nogueira
Published: September 2013

The study aimed to evaluate the antifungal potential of an extract of propolis obtained with edible vegetable oil (ODEP) and to identify antifungal compounds in this extract. Propolis sample was extracted with canola oil. After filtration, the oily liquid extract was submitted to solvent partition and dried to obtain ODEP, which was tested in vitro against Candida albicans strains. ODEP was fractioned on Sephadex and by high‐performance liquid chromatography (HPLC). Active fractions and/or a pure compound were analyzed by nuclear magnetic resonance, liquid chromatographic mass spectrometry (LC–MS) and liquid chromatography‐tandem mass spectrometry (LC–MS/MS) to characterize their chemical composition. Bioassay‐guided fractionation allowed the isolation of dihydrokaempferide, which was also quantified in ODEP by HPLC together with the total flavonoid content. Kaempferide and isosakuranetin were identified by LC–MS and LC–MS/MS in fractions with a potential activity against C. albicans. In vitro assays showed that some fractions from ODEP produced better inhibition of C. albicans than the propolis extract itself.

Practical Applications

Aqueous or ethanolic extracts of propolis (EEP) are widely used in alternative homemade medicine products mainly because of their antimicrobial and healing properties. Edible vegetal oils are known to extract bioactive compounds from propolis. The resulting extract (ODEP) has several advantages over the common EEP, such as the possibility of new pharmaceutical presentations for topical or internal applications. Because of the absence of ethanol in its formulation, edible ODEP are expected to be more tolerated. In this study, ODEP was active in vitro against Candida albicans strains. This supports the use of ODEP as an alternative to EEP and also its potential for topical application in combination with antifungal drugs. In addition, the ingestion of ODEP (e.g., contained in gelatin capsules), which have a high percentage of flavonoids, could be of nutritional value, helping to reach the recommended daily amounts of flavonoids and phenolic compounds.
Patterns and Predictors of Generic Narrow Therapeutic Index Drug Use Among Older Adults
Authors: Gagne Joshua J. , Polinski Jennifer M. , Kesselheim Aaron S. , Choudhry Niteesh K. , Hutchins David , Matlin Olga S. , Tong Angela , Shrank William H.
Published: September 2013

Objectives

To ascertain predictors of initiation of brand‐name versus generic narrow therapeutic index (NTI) drugs.

Design

Retrospective cohort study.

Setting

Data from CVS Caremark were linked to Medicare claims and to U.S. census data.

Participants

Individuals aged 65 and older who initiated an NTI drug in 2006 and 2007 (N = 36,832).

Measurements

Demographic, health service utilization, and geographic predictors of whether participants initiated a generic or brand‐name version of their NTI drug were identified using logistic regression.

Results

Overall, 30,014 (81.5%) participants started on a generic version of their NTI drug. The most commonly initiated NTI drugs were warfarin (n = 17,790; 48%), levothyroxine (n = 10,779; 29%), and digoxin (n = 6,414; 17%). Older age (odds ratio (OR) = 1.12, 95% confidence interval (CI) = 1.02–1.22 comparing aged ≥85 with 65–74), higher burden of comorbidity (OR = 1.05, 95% CI = 1.04–1.07 for each 1‐point increase in comorbidity score), and prior use of any generic drug (OR = 1.55, 95% CI = 1.29–1.87) were positively associated with generic drug initiation. Independent of other predictors, residing in the census block group with the highest generic use was positively associated with greater odds of generic NTI drug initiation (OR = 1.24, 95% CI = 1.14–1.35 compared with the lowest quintile).

Conclusion

Demographic, health service utilization, and geographic characteristics are important determinants of whether individuals initiate treatment with a brand‐name or generic NTI drug. These factors may contribute to disparities in care and highlight potential targets for educational campaigns.
Effects of Care Management and Telehealth: A Longitudinal Analysis Using Medicare Data
Authors: Baker Laurence C. , Macaulay Dendy S. , Sorg Rachael A. , Diener Melissa D. , Johnson Scott J. , Birnbaum Howard G.
Published: September 2013

Objectives

To evaluate mortality and healthcare utilization effects of an intervention that combined care management and telehealth, targeting individuals with congestive heart failure, chronic obstructive pulmonary disease, or diabetes mellitus.

Design

Retrospective matched cohort study.

Setting

Northwest United States.

Participants

High‐cost Medicare fee‐for‐service beneficiaries (N = 1,767) enrolled in two Centers for Medicare and Medicaid Services demonstration participating clinics and a propensity‐score matched control group.

Intervention

The Health Buddy Program, which integrates a content‐driven telehealth system with care management.

Measurements

Mortality, inpatient admissions, hospital days, and emergency department (ED) visits during the 2‐year study period were measured. Cox‐proportional hazard models and negative binomial regression models were used to assess the relationship between the intervention and survival and utilization, controlling for demographic and health characteristics that were statistically different between groups after matching.

Results

At 2 years, participants offered the Health Buddy Program had 15% lower risk‐adjusted all‐cause mortality (hazard ratio (HR) = 0.85, 95% confidence interval (CI) = 0.74–0.98; P = .03) and had reductions in the number of quarterly inpatient admissions from baseline to the study period that were 18% greater than those of matched controls during this same time period (−0.035 vs −0.003; difference‐in‐differences = −0.032, 95% CI = −0.054 to −0.010, P = .005). No relationship was found between the Health Buddy Program and ED use or number of hospital days for participants who were hospitalized. The Health Buddy Program was most strongly associated with fewer admissions for individuals with chronic obstructive pulmonary disease and mortality for those with congestive heart failure.

Conclusion

Care management coupled with content‐driven telehealth technology has potential to improve health outcomes in high‐cost Medicare beneficiaries.
Influence of Caregiving on Health‐Related Quality of Life Among American Indians
Authors: Spencer S. Melinda , Goins R. Turner , Henderson Jeffrey. A. , Wen Yang , Goldberg Jack
Published: September 2013

Caregiving can have a profound effect on the health of the caregiver, yet research on caregiving among American Indians is limited. The purpose of this study was to examine the influence of caregiving on the health‐related quality of life (HRQoL) of American Indians enrolled in the Education And Research Towards Health (EARTH) study. Participants in the EARTH study represented three different tribes in the Northern Plains and Southwestern regions of the United States who completed self‐administered, computer‐assisted questionnaires between 2003 and 2006. Participants were classified as caregivers if at least one adult relied on them for personal care or as non‐caregivers (n = 3,736). Caregivers were further classified according to type; those caring for an adult with unspecified needs (CAU, n = 482) and those caring for an adult with mental or physical difficulties (CAD, n = 295). HRQoL was measured using the mental and physical health component scores of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Regional differences emerged with regard to caregiver type. Across both regions, non‐caregivers reported significantly better mental and physical health than CAD, and the health of participants classified as CAU did not differ from that of non‐caregivers. The health of American Indian caregivers depends on the kind of care provided, but detailed measures of caregiving are necessary to understand how caregiving influences health. This has implications for the design of effective interventions in tribal communities.
Cystatin C and Frailty in Older Men
Authors: Hart Allyson , Paudel Misti L. , Taylor Brent C. , Ishani Areef , Orwoll Eric S. , Cawthon Peggy M. , Ensrud Kristine E. ,   Osteoporotic Fractures in Men Study Group
Published: September 2013

Objectives

To determine whether higher cystatin C would be associated with greater frailty in men aged 65 and older.

Design

Cross‐sectional cohort study.

Setting

Six U.S. sites.

Participants

A random sample of community‐dwelling men aged 65 and older enrolled in the Osteoporotic Fractures in Men (MrOS) Study (mean age 73.8; 9.8% frail and 47.2% intermediate frailty; N = 1,602).

Measurements

Serum cystatin C, creatinine, and frailty were measured. Frailty was analyzed as an ordinal outcome of robust, intermediate frailty, and frail using a multinomial logistic regression model, and the base model was adjusted for age, race, and clinical site.

Results

Higher cystatin C was associated with seven times greater odds of being frail than being robust (odds ratio (OR) quartile 4 vs 1 = 7.12, 95% confidence interval (CI) = 3.76–13.46) and 2.4 times greater odds of intermediate frailty than robust (OR quartile 4 vs 1 = 2.38, 95% CI = 1.70–3.32). The association was attenuated but persisted after adjusting for multiple possible confounders. In contrast, neither higher serum creatinine (OR quartile 4 vs 1 = 1.36, 95% CI = 0.78–2.40) nor lower creatinine‐based estimated glomerular filtration rate (OR quartile 4 vs 1 = 1.01, 95% CI = 0.54–1.87) was associated in a graded manner with greater odds of frailty.

Conclusion

Higher cystatin C, but not creatinine‐based measures, was associated with greater odds of frailty in this cohort of older men.
Association Between Proportion of Provider Clinical Effort in Nursing Homes and Potentially Avoidable Hospitalizations and Medical Costs of Nursing Home Residents
Authors: Kuo Yong‐Fang , Raji Mukaila A. , Goodwin James S.
Published: September 2013

Objectives

To assess potential avoidable hospitalizations of nursing home (NH) residents as a function of the percentage of clinical effort their primary care provider (PCP) devotes to NH practice.

Design

Retrospective cohort study.

Setting

NHs in Texas.

Participants

Residents newly admitted to long‐term NHs in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249).

Measurements

The care that residents received over successive 6‐month periods was measured as a time‐dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months.

Results

Seventy percent of NH residents had a physician as their major PCP, 25% had an advance practice nurse (APN), and 5% had a physician assistant (PA). Physician PCPs who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCPs had providers with 85% or more of Medicare billings generated in NHs. Residents with PCPs who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCPs devoted 85% or more of their clinical effort to NHs (hazard ratio = 1.52, 95% confidence interval = 1.25–1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline.

Conclusion

The percentage of clinical effort that providers devote to NHs is associated with risk of avoidable hospitalization.
Continuous Deep Sedation Until Death in Nursing Home Residents with Dementia: A Case Series
Authors: Anquinet Livia , Rietjens Judith A.C. , Vandervoort An , van der Steen Jenny T. , Vander Stichele Robert , Deliens Luc , Van den Block Lieve
Published: September 2013

Objectives

To describe the characteristics of continuous deep sedation until death and the prior decision‐making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting sedation guideline recommendations.

Design

Epidemiological retrospective study completed using a case series analysis.

Setting

Flemish nursing homes in 2010.

Participants

From a representative sample of 69 nursing homes, all residents who had dementia and had been continuously and deeply sedated until death over a period of 3 months were selected.

Measurements

Questionnaires to general practitioners (GPs), nurses, and relatives most involved in the care of the resident regarding the clinical characteristics of the resident, how sedation was decided upon and performed, quality of care, and dying. Advanced dementia was identified using the Global Deterioration and Cognitive Performance Scale. Whether this practice is in conformity with sedation guideline recommendations was also investigated.

Results

Eleven of 117 deceased residents with dementia (9.4%, 95% confidence interval (CI) = 4.0–14.8) and nine of 64 residents with advanced dementia (14.1%, 95% CI = 5.3–22.8) were sedated. Two of the 11 sedated residents were not considered to be terminal. Sedation duration ranged from 1 to 8 days. Two received artificial food and fluids during sedation. Five were partly or fully competent at admission and three in the last week. Four had expressed their wishes or had been involved in end‐of‐life decision‐making; for eight residents, the GP discussed the resident's wishes with their relatives. Relatives reported that five of the residents had one or more symptoms while dying. Nurses of three residents reported that the dying process was a struggle. For two residents, sedation was effective.

Conclusion

Continuous deep sedation until death for nursing home residents does not always guarantee a dying process free of symptoms and might be amenable to improvement.
Poor Oral Health and Quality of Life in Older U.S. Adults with Diabetes Mellitus
Authors: Huang Deborah L. , Chan Kwun Chuen Gary , Young Bessie A.
Published: September 2013

Objective

To determine the association between health‐related quality of life (HRQOL) and oral health in older U.S. adults with diabetes mellitus (DM).

Design

Cross‐sectional.

Setting

Data from the U.S. Behavioral Risk Factor Surveillance System 2006, 2008, and 2010.

Participants

Nationally representative sample of 70,363 adults aged 65 and older with DM.

Results

Older adults with DM were more likely to report permanent tooth loss due to caries or periodontal disease than those without (82.3% vs 74.3%, P < .001) and less likely to receive dental care in the past year (59.0% vs 70.9%, P < .001). Loss of permanent teeth from caries or periodontal disease was associated with 1.25 times greater odds of worse self‐rated general health (95% confidence interval (CI) = 1.13–1.37). Lack of dental care in the preceding 12 months was associated with 1.34 times greater odds of worse self‐rated general health (95% CI = 1.25–1.44) than receiving dental care in the preceding 12 months. Poor dentition and longer time since last dental visit were associated with more physically unhealthy days.

Conclusions

Poor dentition and lack of dental care were associated with worse HRQOL in older adults with DM. Further research is needed to determine whether better oral health improves HRQOL in this population.
Sleep Disturbances and Driving Practices of Older Drivers
Authors: Vaz Fragoso Carlos A. , Van Ness Peter H. , Araujo Katy L. B. , Iannone Lynne P. , Marottoli Richard A.
Published: September 2013

Objectives

To evaluate the associations between sleep disturbances and driving practices, including driving cessation and trajectories of daily driving mileage (change over time), in older drivers.

Design

Longitudinal.

Setting

New Haven, Connecticut.

Participants

Four hundred thirty older drivers, mean age 78.5, recruited from clinic and community sites.

Measurements

Baseline measures included medical history, daily driving mileage, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Clinical Score (SACS). Longitudinal outcomes included at least one episode of driving cessation and trajectories of miles driven per day, as recorded every 6 months over 2 years.

Results

At baseline, participants drove an average of 22.2 miles per day; 26.0% (112/430) had insomnia (ISI ≥ 8), 19.3% (83/430) had daytime drowsiness (ESS ≥ 10), and 19.9% (84/422) had high sleep apnea risk (SACS > 15). The sleep‐based predictors of insomnia (risk ratio (RR) = 1.20, 95% confidence interval (CI) = 0.65–2.20), daytime drowsiness (RR = 0.94, 95% CI = 0.46–1.95), and high sleep apnea risk (RR = 0.62, 95% CI = 0.27–1.42) did not confer a significantly greater risk of driving cessation. Insomnia was the only sleep‐based predictor that conferred a significant change in driving mileage, yielding an average decrease of 4.5 miles per day over 2 years (P = .01). In the insomnia model, covariates that were associated with less driving mileage were polypharmacy (≥4 medications) and each year of additional age, yielding an average decrease of 8.3 (P = .01) and 0.4 miles per day (P = .02), respectively, over 2 years.

Conclusion

In a cohort of older drivers, insomnia and the covariates of polypharmacy and advancing age were longitudinally associated with less daily driving mileage. Because reductions in driving mileage in older persons often occur in response to reductions in driving capacity, these results support a clinical approach that considers insomnia‐based cognitive‐behavioral therapy and reduced polypharmacy as strategies for improving driving capacity in older persons.
Relationship between Cerebral Atherosclerosis and Leukoaraiosis in Aged Patients: Results from DSA
Authors: Li Hua , Xu Gelin , Xiong Yunyun , Zhu Wusheng , Yin Qin , Fan Xiaobing , Liu Wenhua , Duan Zuowei , Liu Xinfeng
Published: September 2013

BACKGROUND AND PURPOSE

There are some controversial results on the relationship between cerebral atherosclerosis and leukoaraiosis in the published papers, where cerebral atherosclerosis was often evaluated by ultrasonography, CTA or MRA. We analyzed data in which patients underwent both MRI and DSA to explore the above relationship in the aged people.

METHODS

Three hundred and thirty‐three patients were enrolled in the study from the Nanjing Stroke Registry. They underwent both cerebral DSA and MRI. Age, sex, and vascular risk factors were collected. Atherosclerosis was scored from grade 0 to 4. Leukoaraiosis was scored from grade 0 to 3.

RESULTS

Cerebral artery stenosis was not correlated with the presence of leukoaraiosis. There were no correlations between the number of cerebral moderately or more severely stenotic arteries and the severity of leukoaraiosis in periventricular, deep, or whole white matter (P = .747, .268, and .608, respectively). Old age (odds ratio = 1.103, P = .027) and hypertension (odds ratio = 2.748, P = .003) were correlated with leukoaraiosis in the periventricular white matter. Old age (odds ratio = 1.073, P = .031) and prior stroke (odds ratio = 2.678, P = .002) were correlated with leukoaraiosis in the deep white matter.

CONCLUSIONS

No apparent correlation exists between cerebral artery stenosis and the presence and severity of leukoaraiosis.
Evolving Basilar Artery Stenosis with Watershed Ischemia
Authors: Cho Tae‐Hee , Berthezene Yves , Mechtouff Laura , Derex Laurent , Nighoghossian Norbert
Published: September 2013

Basilar artery stenosis where flow restriction constitutes the main pathomechanism are exceptional. Here, we report a case where the lesion progression was characterized by watershed infarct between the anterior inferior—superior cerebellar arteries and deep pontine arteries, indicating a significant hemodynamic impairment.
Doppler Echocardiographic Evaluation of Midventricular Obstruction in Cats with Hypertrophic Cardiomyopathy
Authors: MacLea H.B. , Boon J.A. , Bright J.M.
Published: September 2013

Background

Hypertrophic cardiomyopathy (HCM) is heterogeneous in both people and cats, with variability in the distribution of hypertrophy, hemodynamic characteristics, and Doppler echocardiographic findings.

Objectives

To document the Doppler echocardiographic characteristics of midventricular obstruction in some cats withHCM.

Animals

Eight cats with hypertrophic cardiomyopathy.

Materials and Methods

Retrospective case series. The medical records of cats presenting to the cardiology service at Colorado State University between February 2009 and January 2012 were reviewed. All cats had a physical examination; Doppler systolic blood pressure measurement; and transthoracic two‐dimensional (2D), M‐mode, and Doppler echocardiography were performed. A more thorough evaluation of the echocardiographic images and measurements was performed. Cats included in this study had echocardiograms of adequate quality to confirm the diagnosis of midventricular obstruction by documentation of left midventricular concentric hypertrophy; a midventricular turbulent Doppler color flow pattern; and high velocity, late‐peaking flow at the area of turbulence. Cats with evidence of systemic hypertension defined as a systolic Doppler blood pressure of greater than 170 mmHg were excluded.

Results

All 8 cats had left ventricular hypertrophy at the level of the papillary muscles; left, midventricular hypertrophy; and in 4/8 cats there was apical hypertrophy or basilar hypertrophy of the interventricular septum. Color flow Doppler revealed turbulent flow in 8/8 cats and spectral Doppler (continuous and pulsed wave) revealed increased flow velocities and late‐peaking flow profiles at the level of the left midventricle. Two of 8 cats had a bifid midventricular flow profile in which there was a midsystolic decline in left ventricular velocities with elevated velocities extending into early diastole. The peak left ventricular outflow velocity in all 8 cats was normal.

Conclusions and Clinical Importance

A variant ofHCMcharacterized by hypertrophy at the level of the papillary muscles with midventricular obstruction is present in some cats. Recognition of this variant of felineHCMallows identification ofHCMin cats with murmurs where the more classic features ofHCMare not present.
Holarctic phylogeography of the testate amoeba Hyalosphenia papilio (Amoebozoa: Arcellinida) reveals extensive genetic diversity explained more by environment than dispersal limitation
Authors: Heger Thierry J. , Mitchell Edward A. D. , Leander Brian S.
Published: September 2013

Although free‐living protists play essential roles in aquatic and soil ecology, little is known about their diversity and phylogeography, especially in terrestrial ecosystems. We used mitochondrial cytochrome c oxidase subunit 1 (COI) gene sequences to investigate the genetic diversity and phylogeography of the testate amoeba morphospecies Hyalosphenia papilio in 42 Sphagnum (moss)‐dominated peatlands in North America, Europe and Asia. Based on ≥1% sequence divergence threshold, our results from single‐cell PCRs of 301 individuals revealed 12 different genetic lineages and both the general mixed Yule‐coalescent (GMYC) model and the automatic barcode gap discovery (ABGD) methods largely support the hypothesis that these 12 H. papilio lineages correspond to evolutionary independent units (i.e. cryptic species). Our data also showed a high degree of genetic heterogeneity within different geographical regions. Furthermore, we used variation partitioning based on partial redundancy analyses (pRDA) to evaluate the contributions of climate and dispersal limitations on the distribution patterns of the different genetic lineages. The largest fraction of the variation in genetic lineage distribution was attributed to purely climatic factors (21%), followed by the joint effect of spatial and bioclimatic factors (13%), and a purely spatial effect (3%). Therefore, these data suggest that the distribution patterns of H. papilio genetic lineages in the Northern Hemisphere are more influenced by climatic conditions than by dispersal limitations.