bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of joint hypermobility in Kuwait
Authors: Al‐Jarallah Khaled , Shehab Diaa , Al‐Jaser Munirah T. , Al‐Azemi Khaled M. , Wais Fatma F. , Al‐Saleh Ahmed M. , Al‐Ajmi Abdulhadi S. , Al‐Omairah Hamad A. , Abraham Mini , Sharma Prem N.
Published: December 2014

Aim

To determine the prevalence of joint hypermobility (JH) among young Kuwaiti adults.

Methods

This was a cross‐sectional study of 390 randomly selected healthy undergraduate university students, aged 18–29 years from the Health Sciences Centre, Kuwait University, Safat, Kuwait. Beighton score at four peripheral sites bilaterally (knees, elbows, thumbs and fifth fingers) and forward flexion of the trunk were used to evaluate joint hypermobility. Any student who met four out of the nine criteria was considered hypermobile. Joint pain was documented in all subjects through personal interview.

Results

A total of 390 subjects (male : female ratio 1.0 : 0.9) were assessed. Of those, 87 (22.3%) were found to have JH: 60 (29.4%) males and 27 (14.5%) females, showing a significantly higher male predominance (P < 0.001). Beighton score was inversely correlated with age (ρ = −0.15, P = 0.003). A higher incidence of finger signs was noted in comparison to elbow‐knee hyperextension and hands‐to‐floor. Knee joint, back, neck and shoulder pains, in descending order, were the commonest type of joint complaints, although not statistically significant (P > 0.05) in subjects with and without joint hypermobility. It was also observed that the left side, at all the sites, was slightly more hypermobile in comparison to the right side in hypermobile subjects.

Conclusions

The prevalence of joint hypermobility is not uncommon among young Kuwaiti adults, and was comparable to the data published in other Asian‐Pacific regions. General practitioners should therefore be familiar with the condition and its clinical associations, while assessing musculoskeletal complaints.
Cultural discernment as an ethics framework: An Indigenous Fijian approach
Authors: Meo‐Sewabu Litea
Published: December 2014

The praxis of an Indigenous Fijian researcher who is both an insider/outsider offers some valuable lessons for ethnographic work. This paper introduces ‘cultural discernment’ as a concept used to ensure that the research process is culturally ethical within the research setting. An insider will always require a sense of cultural discernment, recognising that actions taken have implications that are critical and remain with the researcher for life. The paper contextualises the concept of cultural discernment in relation to Fijian epistemology. Although there are risks within any research project with regard to ethics processes and the conduct of research, this paper will illustrate how Western paradigms associated with ‘expert knowledge’ and the ‘lay knowledges’ of an Indigenous population group produce competing understandings about ethical practice. The paper draws on a doctoral research project exploring the cultural conceptualisation of health and well‐being, conducted in Fiji and New Zealand. The research process and steps carried out in this study ensured those actions were culturally appropriate and ethically sound from an Indigenous Fijian perspective.
Changing market culture in the Pacific: Assembling a conceptual framework from diverse knowledge and experiences
Authors: Underhill‐Sem Yvonne , Cox Elizabeth , Lacey Anita , Szamier Margot
Published: December 2014

Addressing the multiple dimensions of gender inequality requires commitments by policy‐makers, practitioners and scholars to transformative practices. One challenge is to assemble a coherent conceptual framework from diverse knowledges and experiences. In this paper, we present a framework that emerged from our involvement in changing market culture in the Pacific, which we name a radical empowerment of women approach. We draw on detailed narratives from women market vendors and women‐led new initiatives in marketplaces to explain this approach. We argue that the primary focus of recently developed projects for marketplaces in the Pacific is technical and infrastructural, which is insufficient for addressing gendered political and economic causes of poor market management and oppressive conditions for women vendors. By exploring the complex array of motives and effects of the desire to transform or improve marketplaces in the Pacific, we caution against simplistic technical or infrastructural solutions. This paper also introduces the practice of working as a cooperative, hybrid research collaboration. The knowledges and analyses that we bring to this issue demonstrate that substantive analysis generated from diverse and shifting ‘locations’ and roles, but underpinned by a shared vision of, and commitment to, gender justice, can provide distinctive policy and research insights.
Practical critique: Bridging the gap between critical and practice‐oriented REDD+ research communities
Authors: McGregor Andrew , Weaver Sean , Challies Edward , Howson Peter , Astuti Rini , Haalboom Bethany
Published: December 2014

Reducing Emissions from Deforestation and Forest Degradation (REDD+) is an ambitious global programme oriented towards improving forest carbon management. It aims to attract new sources of ‘green’ capital to fund emissions reductions from avoided deforestation and sustainable forest management. REDD+ is transforming forest conservation, as a diverse array of new stakeholders become involved. Not surprisingly, REDD+ has proved divisive, as critics concern themselves with issues of power, justice, and commodification, while practice‐oriented researchers tackle similar issues from different perspectives, focusing on benefit sharing, safeguards, additionality, measuring and verification. In this paper we explore the different roles of critical and practical research, and argue that there is a need for greater sharing of knowledge across current divides. We draw on our own experiences of conducting a research project on REDD+ in Indonesia that involved critical and practice‐oriented researchers. We argue that critical research disconnected from practical matters can have perverse outcomes for practitioners who are ultimately working towards similar goals; while uncritical practice‐oriented research has the potential to lead to a dilution of core values of environmental justice and conservation. In contrast, forms of practical critique provide ways of researching REDD+ that have practical value while maintaining critical insights.
‘Governed freedom’ in Oceania: AusAID, subjectivation and the practice of critique in studies of governmentality
Authors: Hodge Paul
Published: December 2014

Drawing predominantly on the work of Butler, Rose and Walters, this paper examines the governing rationalities and technologies that characterise one particular site of aid relations. Focusing on key policy documents, economic surveys and performance reports, the paper traces the fashioning of particular subjectivities as constitutive of AusAID's development objectives and the function of problematisation and responsibilisation as central to these practices of subjectivation. While I argue the freedom on offer as part of AusAID's development objectives is a highly governed one – where the ‘free’ economic‐rational subject adopts certain ‘civilised sensibilities’ (Rose, 1999: 78), I show how this process of subjectivation encompasses both ‘a power exerted on a subject’ and ‘a power assumed by the subject’ (Butler, 1997: 11). What becomes apparent through this analysis is the productive and tenuous characteristics of these practices of subject formation. This paper also foregrounds the practice of critique itself, and the very act of research; concepts adopted and explanations made, as far from innocent in their performativity in enacting some worlds and not others.
Evolution of angiosperm seed disperser mutualisms: the timing of origins and their consequences for coevolutionary interactions between angiosperms and frugivores
Authors: Eriksson Ove
Published: December 2014

The origins of interactions between angiosperms and fruit‐eating seed dispersers have attracted much attention following a seminal paper on this topic by Tiffney (1984). This review synthesizes evidence pertaining to key events during the evolution of angiosperm–frugivore interactions and suggests some implications of this evidence for interpretations of angiosperm–frugivore coevolution. The most important conclusions are: (i) the diversification of angiosperm seed size and fleshy fruits commenced around 80 million years ago (Mya). The diversity of seed sizes, fruit sizes and fruit types peaked in the Eocene around 55 to 50 Mya. During this first phase of the interaction, angiosperms and animals evolving frugivory expanded into niche space not previously utilized by these groups, as frugivores and previously not existing fruit traits appeared. From the Eocene until the present, angiosperm–frugivore interactions have occurred within a broad frame of existing niche space, as defined by fruit traits and frugivory, motivating a separation of the angiosperm–frugivore interactions into two phases, before and after the peak in the early Eocene. (ii) The extinct multituberculates were probably the most important frugivores during the early radiation phase of angiosperm seeds and fleshy fruits. Primates and rodents are likely to have been important in the latter part of this first phase. (iii) Flying frugivores, birds and bats, evolved during the second phase, mainly during the Oligocene and Miocene, thus exploiting an existing diversity of fleshy fruits. (iv) A drastic climate shift around the Eocene–Oligocene boundary (around 34 Mya) resulted in more semi‐open woodland vegetation, creating patchily occurring food resources for frugivores. This promoted evolution of a ‘flying frugivore niche’ exploited by birds and bats. In particular, passerines became a dominant frugivore group worldwide. (v) Fleshy fruits evolved at numerous occasions in many angiosperm families, and many of the originations of fleshy fruits occurred well after the peak in the early Eocene. (vi) During periods associated with environmental change altering coevolutionary networks and opening of niche space, reciprocal coevolution may result in strong directional selection formative for both fruit and frugivore evolution. Further evidence is needed to test this hypothesis. Based on the abundance of plant lineages with various forms of fleshy fruits, and the diversity of frugivores, it is suggested that periods of rapid coevolution in angiosperms and frugivores occurred numerous times during the 80 million years of angiosperm–frugivore evolution.
Evolutionary perspectives on human height variation
Authors: Stulp Gert , Barrett Louise
Published: December 2014

Human height is a highly variable trait, both within and between populations, has a high heritability, and influences the manner in which people behave and are treated in society. Although we know much about human height, this information has rarely been brought together in a comprehensive, systematic fashion. Here, we present a synthetic review of the literature on human height from an explicit evolutionary perspective, addressing its phylogenetic history, development, and environmental and genetic influences on growth and stature. In addition to presenting evidence to suggest the past action of natural selection on human height, we also assess the evidence that natural and sexual selection continues to act on height in contemporary populations. Although there is clear evidence to suggest that selection acts on height, mainly through life‐history processes but perhaps also directly, it is also apparent that methodological factors reduce the confidence with which such inferences can be drawn, and there remain surprising gaps in our knowledge. The inability to draw firm conclusions about the adaptiveness of such a highly visible and easily measured trait suggests we should show an appropriate degree of caution when dealing with other human traits in evolutionary perspective.
Cost‐effectiveness and Pricing of Antibacterial Drugs
Authors: Verhoef Talitha I. , Morris Stephen
Published: December 2014

Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost‐effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost‐effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost‐effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost‐effectiveness. Value‐based pricing is a method to determine the price of a drug at which it can be cost‐effective. It is currently unclear what the influence of value‐based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of ‘value’, which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease.
Small Steps to New Drugs for Bugs
Authors: Melander Roberta J. , Selwood David L
Published: December 2014

Governments, academics and industry are beginning to listen to the medical communities call for new anti‐bacterials. This special issue brings together diverse review articles on topics from economics and pricing to new discovery methods.
Synthesis and Antibacterial Activity of Alkylated Diamines and Amphiphilic Amides of Quinic Acid Derivatives
Authors: Rezende Celso O. , Oliveira Larissa A. , Oliveira Bruno A. , Almeida Camila G. , Ferreira Bianca S. , Le Hyaric Mireille , Carvalho Guilherme S. L. , Lourenço Maria Cristina S. , Batista Michel , Marchini Fabricio K. , Silva Vânia L. , Diniz Claudio G. , Almeida Mauro V.
Published: December 2014

Different series of N‐alkylated diamines and their derivatives condensed to quinic acid were synthesized and tested for antibacterial properties against Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. The lipophilic chain and carbohydrate moiety modulate the antibacterial activity and the compounds showed a structure–activity relationship. Overall, 11 compounds displayed better activity than chloramphenicol against Gram‐positive and Gram‐negative bacteria. Monoalkylated amines 2a‐h displayed an activity similar to that of ethambutol against Mycobacterium tuberculosis.
Children infer affiliative and status relations from watching others imitate
Authors: Over Harriet , Carpenter Malinda
Published: December 2014

We investigated whether young children are able to infer affiliative relations and relative status from observing others' imitative interactions. Children watched videos showing one individual imitating another and were asked about the relationship between those individuals. Experiment 1 showed that 5‐year‐olds assume that individuals imitate people they like. Experiment 2 showed that children of the same age assume that an individual who imitates is relatively lower in status. Thus, although there are many advantages to imitating others, there may also be reputational costs. Younger children, 4‐year‐olds, did not reliably make either inference. Taken together, these experiments demonstrate that imitation conveys valuable information about third party relationships and that, at least by the age of 5, children are able to use this information in order to infer who is allied with whom and who is dominant over whom. In doing so, they add a new dimension to our understanding of the role of imitation in human social life.
Inexperienced newborn chicks use geometry to spontaneously reorient to an artificial social partner
Authors: Chiandetti Cinzia , Spelke Elizabeth S. , Vallortigara Giorgio
Published: December 2014

A fundamental process underlying navigation behaviour, shown to occur in every species tested, uses geometric properties of the environment for location memory and orientation. Here we employ a new method to ask whether this basic geometric orientation ability is innately predisposed in the brain or depends on specific experiences navigating in a geometrically rich environment. Using the newborn domestic chick as a model system, we present a working memory task testing reorientation towards a filial imprinting object under rigorous controlled rearing conditions. In the absence of any previous exposure to a geometrically rich environment, newly hatched chicks spontaneously recovered their bearings by making use of distances and directional relations to reorient themselves to an artificial social partner. These findings provide evidence for an innate capacity to navigate by the geometric structure of the environment.
Constraints on statistical computations at 10 months of age: the use of phonological features
Authors: Gonzalez‐Gomez Nayeli , Nazzi Thierry
Published: December 2014

Recently, several studies have argued that infants capitalize on the statistical properties of natural languages to acquire the linguistic structure of their native language, but the kinds of constraints which apply to statistical computations remain largely unknown. Here we explored French‐learning infants' perceptual preference for labial‐coronal (LC) words over coronal‐labial words (CL) words (e.g. preferringbatovertab) to determine whether this phonotactic preference is based on the acquisition of the statistical properties of the input based on a single phonological feature (i.e. place of articulation), multiple features (i.e. place and manner of articulation), or individual consonant pairs. Results from four experiments revealed that infants had a labial‐coronal bias for nasal sequences (Experiment 1) and for all plosive sequences (Experiments 2 and 4) but a coronal‐labial bias for all fricative sequences (Experiments 3 and 4), independently of the frequencies of individual consonant pairs. These results establish for the first time that constellations of multiple phonological features, defining broad consonant classes, constrain the early acquisition of phonotactic regularities of the native language.
Vitamin D is associated with degree of disability in patients with fully ambulatory relapsing–remitting multiple sclerosis
Authors: Thouvenot E. , Orsini M. , Daures J.‐P. , Camu W.
Published: December 2014

Background and purpose

Vitamin D deficiency is a recognized risk factor for multiple sclerosis (MS) and is associated with increased disease activity. It has also been proposed that the lower the vitamin D levels are, the higher is the handicap.

Methods

To refine the links between vitamin D insufficiency and disability in MS patients, a retrospective cohort analysis was performed including 181 patients prospectively followed without previous vitamin D supplementation, and age, gender, age at MS onset, MS type, MS activity, Expanded Disability Status Scale (EDSS) were analysed in correlation with plasma vitamin D levels.

Results

Vitamin D levels were significantly higher in relapsing–remitting MS than in progressive forms of MS in multivariate analyses adjusted for age, ethnicity, gender, disease duration and season (P = 0.0487). Overall, there was a negative correlation between vitamin D level and EDSS score (P = 0.0001, r = –0.33). In relapsing–remitting MS, vitamin D levels were only correlated with disability scores for EDSS < 4 (P = 0.0012). Patients with >20 ng/ml of vitamin D were 2.78 times more likely to have an EDSS < 4 (P = 0.0011, 95% confidence interval 1.49–5.00).

Conclusion

Data support previous work suggesting that vitamin D deficiency is associated with higher risk of disability in MS. Vitamin D levels also correlated with the degree of disability in fully ambulatory patients with relapsing–remitting MS. These additional results support the pertinence of randomized controlled trials analysing the interest of an early vitamin D supplementation in MS patients to influence evolution of disability.
Large‐scale analysis of viral nucleic acid spectrum in temporal lobe epilepsy biopsies
Authors: Esposito Laura , Drexler Jan F. , Braganza Oliver , Doberentz Elke , Grote Alexander , Widman Guido , Drosten Christian , Eis‐Hübinger Anna M. , Schoch Susanne , Elger Christian E. , Becker Albert J. , Niehusmann Pitt
Published: December 2014

Objective

Chronic inflammatory processes are important promotors of temporal lobe epilepsy (TLE) development. Based on human herpesvirus 6 (HHV‐6) DNA detection in brain tissue from patients with TLE, an association of persistent viral infection with TLE has been discussed. Individual studies reported increased HHV‐6 DNA in patients with clinical signs of previous inflammatory brain reaction, that is, febrile seizures or meningoencephalitis. However, detection rates vary considerably between different studies. Here we performed a large‐scale analysis of viral DNA/RNA spectrum in high‐quality TLE biopsies. In addition to all Herpesviridae, we addressed potentially relevant neurotropic RNA viruses.

Methods

DNA and RNA were extracted from 346 fresh‐frozen tissue samples removed by epilepsy surgery. Real‐time polymerase chain reaction (PCR) and nested PCR were performed for Herpesviridae and RNA viruses, respectively. Clinical data were analyzed for earlier signs of inflammatory brain reactions. Fresh‐frozen hippocampal tissue samples from patients without chronic central nervous system (CNS) disease served as controls (n = 62). Seven previous PCR studies with overall 178 TLE patients were additionally analyzed regarding a correlation of clinical parameters and HHV‐6 detection.

Results

PCR revealed HHV‐6B DNA in 34 specimens (9.8%) from TLE patients. HHV‐6B DNA was also present in eight control samples (12.9%; p > 0.05), but showed a lower virus concentration (p < 0.001). Other herpesviruses and RNA viruses were virtually absent. In patients with clinical signs of previous brain inflammation, HHV‐6B DNA was observed in 15.0%, whereas only 6.3% of the samples from patients without febrile seizures or meningoencephalitis were positive for HHV‐6B DNA (p < 0.05). A meta‐analysis of the eight HHV‐6 PCR studies revealed similar results.

Significance

This biopsy‐based study shows no differences in frequency of HHV‐6B DNA detection between TLE patients and controls. These results do not support the hypothesis of a persistent HHV‐6B infection as a major pathogenetic factor in TLE. However, the higher virus load in TLE patients and the increased detection rate of HHV‐6B DNA in patients with previous inflammatory brain reactions require further investigations.
Seizure freedom score: A new simple method to predict success of epilepsy surgery
Authors: Garcia Gracia Camilo , Yardi Ruta , Kattan Michael W. , Nair Dileep , Gupta Ajay , Najm Imad , Bingaman William , Gonzalez‐Martinez Jorge , Jehi Lara
Published: December 2014

Objective

We aim to develop a new scale that predicts seizure outcomes after resective epilepsy surgery.

Methods

We retrospectively reviewed patients who underwent surgery for medically refractory epilepsy at our center between 1999 and 2012. Four predictive outcome indicators were selected: preoperative seizure frequency, history of generalized tonic–clonic seizures, brain magnetic resonance imaging (MRI), and epilepsy duration. A score of 0 or 1 was given if the indicator was associated with poor or good outcome, respectively. A seizure freedom score (SFS) was calculated by adding these four categories (total score ranged from 0 to 4). A modified SFS (m‐SFS) was then calculated with two additional outcome indicators: invasive electroencephalography (EEG) evaluation (IEI) (performed or not performed) and lobe of resection (temporal vs. extratemporal), for a score ranging from 0 to 6. Kaplan‐Meier survival analysis was used to calculate the probability of seizure freedom in the overall group. Statistical significance was tested using the log‐rank test and comparison of 95% confidence intervals (CIs).

Results

The study population included 466 patients with 244 (52%) male. Seizure freedom rates were directly correlated with the SFS score: at 10 years, 36.9% of patients with SFS of 0 were seizure‐free, as opposed to 45% for SFS = 1, 60% for SFS = 2, 72% for SFS 3 or above (p = 0.002). When calculated including the IEI and the localization, the score's performance improved: 24% of patients with a m‐SFS of 0 were seizure‐free at 10 years, as opposed to 38–59% for m‐SFS = 1–3, and 75–79% for m‐SFS of 4–6 (p < 0.001).

Significance

An easily measurable seizure freedom score could be a reliable tool to synthesize multiple seizure outcome predictors into a single simple score to predict postoperative seizure freedom. This tool will help with patient and family counseling and estimation of surgical candidacy at both early (SFS) and advanced (m‐SFS) stages of a surgical evaluation.
The Growth of Urban Building Stock: Unintended Lock‐in and Embedded Environmental Effects
Authors: Reyna Janet L. , Chester Mikhail V.
Published: December 2014

Building stocks constitute enduring components of urban infrastructure systems, but little research exists on their residence time or changing environmental impacts. Using Los Angeles County, California, as a case study, a framework is developed for assessing the changes of building stocks in cities (i.e., a generalizable framework for estimating the construction and deconstruction rates), the residence time of buildings and their materials, and the associated embedded environmental impacts. In Los Angeles, previous land‐use decisions prove not easily reversible, and past building stock investments may continue to constrain the energy performance of buildings. The average age of the building stock has increased steadily since 1920 and more rapidly after the post–World War II construction surge in the 1950s. Buildings will likely endure for 60 years or longer, making this infrastructure a quasi‐permanent investment. The long residence time, combined with the physical limitations on outward growth, suggest that the Los Angeles building stock is unlikely to have substantial spatial expansion in the future. The construction of buildings requires a continuous investment in material, monetary, and energetic resources, resulting in environmental impacts. The long residence time of structures implies a commitment to use and maintain the infrastructure, potentially creating barriers to an urban area's ability to improve energy efficiency. The immotility of buildings, coupled with future environmental goals, indicates that urban areas will be best positioned by instituting strategies that ensure reductions in life cycle (construction, use, and demolition) environmental impacts.
The Distribution of Kisspeptin (Kiss)1‐ and Kiss2‐Positive Neurones and Their Connections with Gonadotrophin‐Releasing Hormone‐3 Neurones in the Zebrafish Brain
Authors: Song Y. , Duan X. , Chen J. , Huang W. , Zhu Z. , Hu W.
Published: December 2014

Kisspeptin is a neuroendocrine hormone with a critical role in the activation of gonadotrophin‐releasing hormone (GnRH) neurones, which is vital for the onset of puberty in mammals. However, the functions of kisspeptin neurones in non‐mammalian vertebrates are not well understood. We have used transgenics to labell kisspeptin neurones (Kiss1 and Kiss2) with mCherry in zebrafish (Danio rerio). In kiss1:mCherry transgenic zebrafish, Kiss1 cells were located in the dorsomedial and ventromedial habenula, with their nerve fibres contributing to the fasciculus retroflexus and projecting to the ventral parts of the interpeduncular and raphe nuclei. In kiss2:mCherry zebrafish, Kiss2 cells were primarily located in the dorsal zone of the periventricular hypothalamus and, to a lesser extent, in the periventricular nucleus of the posterior tuberculum and the preoptic area. Kiss2 fibres formed a wide network projecting into the telencephalon, the mesencephalon, the hypothalamus and the pituitary. To study the relationship of kisspeptin neurones and GnRH3 neurones, these fish were crossed with gnrh3:EGFP zebrafish to obtain kiss1:mCherry/gnrh3:EGFP and kiss2:mCherry/gnrh3:EGFP double transgenic zebrafish. The GnRH3 fibres ascending to the habenula were closely associated with Kiss1 fibres projecting from the ventral habenula. On the other hand, GnRH3 fibres and Kiss2 fibres were adjacent but scarcely in contact with each other in the telencephalon and the hypothalamus. The Kiss2 and GnRH3 fibres in the ventral hypothalamus projected into the pituitary via the pituitary stalk. In the pituitary, Kiss2 fibres were directly in contact with GnRH3 fibres in the pars distalis. These results reveal the pattern of kisspeptin neurones and their connections with GnRH3 neurones in the brain, suggesting distinct mechanisms for Kiss1 and Kiss2 in regulating reproductive events in zebrafish.
Clinical risk scores and blood biomarkers as predictors of long‐term outcome in patients with community‐acquired pneumonia: a 6‐year prospective follow‐up study
Authors: Alan M. , Grolimund E. , Kutz A. , Christ‐Crain M. , Thomann R. , Falconnier C. , Hoess C. , Henzen C. , Zimmerli W. , Mueller B. , Schuetz P. ,   the ProHOSP study group
Published: December 2014

Objective

Prediction of long‐term outcomes in patients with community‐acquired pneumonia (CAP) is incompletely understood. We investigated the value of clinical risk scores [pneumonia severity index (PSI) and CURB‐65] (Confusion, Urea, Respiratory rate, Blood Pressure, Age >65 years) and blood biomarkers of different physiopathological pathways in predicting long‐term survival in a well‐characterized cohort of patients with CAP enrolled in an antibiotic stewardship trial.

Design, setting and subjects

Patients admitted with CAP to six medical centres in Switzerland were prospectively followed for 6 years. Cox regression models and area under the receiver operating characteristics curve (AUC) were used to investigate associations between initial risk assessment and all‐cause mortality.

Main outcome measure

All‐cause mortality during a 6‐year follow‐up period.

Results

Six‐year mortality in the present cohort (median age 73 years) was 45.1% [95% confidence interval (CI) 41.8–48.3%]. Initial PSI and CURB‐65 scores both had excellent long‐term prognostic accuracy, with a stepwise increase in mortality per risk class. The hazard ratios (95% CI) of the highest PSI and CURB‐65 classes (reference: lowest class) were 38.0 (14.0–103.0) and 7.8 (2.2–14.5), respectively, after 6 years. The addition of inflammatory (pro‐adrenomedullin) and cardiac (pro‐atrial natriuretic peptide) blood biomarkers measured upon hospital admission further improved the prognostic capabilities of the PSI (AUC increase from 0.79 to 0.83; P < 0.0001) and the CURB‐65 score (AUC increase from 0.73 to 0.80; P < 0.001).

Conclusion

Risk assessment using clinical scores allowed accurate long‐term prognostication, which was further improved by the addition of two inflammatory (pro‐adrenomedullin) and cardiac (pro‐atrial natriuretic peptide) blood biomarkers. These data provide a rationale for a more risk‐adapted, ‘personalized’ strategy for long‐term management of patients with CAP.
The Peripheral Halo Effect: Do Academic Spinoffs Influence Universities' Research Income?
Authors: Pitsakis Konstantinos , Souitaris Vangelis , Nicolaou Nicos
Published: December 2014

Extant literature has drawn attention to the ‘halo effect’ of the good reputation of a core organizational activity on the outcome of a peripheral activity. We contribute to the literature on organizational reputation by illustrating a halo effect in the opposite direction – from the periphery to the core. We show that developing a reputation for a peripheral activity (in our context, universities' social impact via spinoffs) may have positive spillovers for core organizational activities (in our context, university research), a phenomenon we term the ‘peripheral halo effect'. We also show that this effect is more prominent for high‐status than for low‐status organizations. Our research also contributes to the academic‐entrepreneurship literature by revealing that spinoff portfolios can generate income for universities not only directly via equity positions but also indirectly via reputational benefits.
Species are hypotheses: avoid connectivity assessments based on pillars of sand
Authors: Pante Eric , Puillandre Nicolas , Viricel Amélia , Arnaud‐Haond Sophie , Aurelle Didier , Castelin Magalie , Chenuil Anne , Destombe Christophe , Forcioli Didier , Valero Myriam , Viard Frédérique , Samadi Sarah
Published: December 2014

Connectivity among populations determines the dynamics and evolution of populations, and its assessment is essential in ecology in general and in conservation biology in particular. The robust basis of any ecological study is the accurate delimitation of evolutionary units, such as populations, metapopulations and species. Yet a disconnect still persists between the work of taxonomists describing species as working hypotheses and the use of species delimitation by molecular ecologists interested in describing patterns of gene flow. This problem is particularly acute in the marine environment where the inventory of biodiversity is relatively delayed, while for the past two decades, molecular studies have shown a high prevalence of cryptic species. In this study, we illustrate, based on marine case studies, how the failure to recognize boundaries of evolutionary‐relevant unit leads to heavily biased estimates of connectivity. We review the conceptual framework within which species delimitation can be formalized as falsifiable hypotheses and show how connectivity studies can feed integrative taxonomic work and vice versa. Finally, we suggest strategies for spatial, temporal and phylogenetic sampling to reduce the probability of inadequately delimiting evolutionary units when engaging in connectivity studies.
As old as the mountains: the radiations of the Ericaceae
Authors: Schwery Orlando , Onstein Renske E. , Bouchenak‐Khelladi Yanis , Xing Yaowu , Carter Richard J. , Linder Hans Peter
Published: December 2014

Mountains are often more species‐rich than lowlands. This could be the result of migration from lowlands to mountains, of a greater survival rate in mountains, or of a higher diversification rate in mountains. We investigated this question in the globally distributed family Ericaceae, which includesc. 4426 species ranging from sea level to > 5000 m. We predict that the interaction of low specific leaf area (SLA) and montane habitats is correlated with increased diversification rates.

A molecular phylogeny of Ericaceae based onrbcL andmatK sequence data was built and dated with 18 fossil calibrations and divergence time estimates. We identified radiations usingbammand correlates of diversification rate changes using binary‐state speciation and extinction (BiSSE) and multiple‐state speciation and extinction (MuSSE) analyses.

Analyses revealed six largely montane radiations. Lineages in mountains diversified faster than nonmountain lineages (higher speciation rate, but no difference in extinction rate), and lineages with lowSLAdiversified faster than high‐SLAlineages. Further, habitat and trait had a positive interactive effect on diversification.

Our results suggest that the species richness in mountains is the result of increased speciation rather than reduced extinction or increased immigration. Increased speciation in Ericaceae was facilitated by lowSLA.
Long term effect of trabeculectomy on retrobulbar haemodynamics in glaucoma
Authors: Kuerten David , Fuest Matthias , Koch Eva C. , Remky Andreas , Plange Niklas
Published: December 2014

Purpose

Previous reports showed increased flow velocities in retrobulbar vessels after glaucoma surgery in the first weeks. Colour Doppler imaging was performed to investigate the long‐term effects of trabeculectomy on retrobulbar haemodynamics in patients with primary open–angle glaucoma (POAG).

Methods

In a prospective study 30 patients (mean age 63.2 ± 15.4 years) with POAG were included. Colour Doppler imaging was performed before 1–2 weeks, after 2 months, after 4–6 months, and up to 3 years after trabeculectomy to determine the peak systolic and end–diastolic velocities in the ophthalmic artery, central retinal artery, and the short nasal and temporal posterior ciliary arteries.

Results

Mean follow‐up was 416 ± 246 days. In the first postsurgical period mean intraocular pressure (IOP) decreased after trabeculectomy from 25 ± 6 mmHg to 9 ± 4 mm Hg (p < 0.0001) and then increased in the further follow‐up to 13 ± 3 mmHg (p < 0.05) without any anti–glaucomatous medication. Colour Doppler imaging revealed a significant increase of the end–diastolic velocities of the central retinal artery at all postoperative visits compared to pre–surgery (p < 0.003) and of the end–diastolic velocities in the temporal posterior ciliary arteries (p < 0.003). The change of blood flow parameters that increased during follow‐up was significantly correlated to the change in ocular perfusion pressure and IOP.

Conclusions

End–diastolic velocities of the central retinal artery and of the temporal posterior ciliary arteries increased after successful trabeculectomy and remained stable in a longer period – even if IOP rose significantly in the follow‐up.
Odontogenic myxoma presenting as a spontaneous oro‐nasal fistula: a case report
Authors: Dunphy L. , Shah S. , Halsnad M. , Amel‐Kashipaz R. , Praveen P.
Published: December 2014

Odontogenic myxoma is a rare benign neoplasm with locally aggressive behaviour and a high risk of recurrence. It has a predilection for the mandible and occurs in the 2nd–3rd decade. The authors report a case of an odontogenic myxoma presenting with a spontaneous oro‐nasal fistula in a 29‐year‐old male. Histo‐pathological analysis of the incisional biopsy specimen initially suggested a diagnosis of calcifying epithelial odontogenic tumour. A partial maxillectomy was performed, and following assessment of the resection specimen, a diagnosis of odontogenic myxoma was rendered. A 3 cm bicortical iliac crest bone graft was harvested and inset to the right maxillary defect under general anaesthesia. Rehabilitation will be completed with the placement of implants.
An Examination of the Interpersonal Psychological Theory of Suicidal Behavior in Physicians
Authors: Fink‐Miller Erin L.
Published: December 2014

Physicians are commonly reported to die by suicide more frequently than individuals in the general population. Thus far, few reasons for this elevated suicide risk have been empirically investigated. Although the interpersonal psychological theory of suicidal behavior (IPTS) has been suggested as a fruitful means of explaining physician suicidality, it has yet to be examined quantitatively. Four hundred nineteen Pennsylvania physicians were assessed on a number of demographics, as well as all components of the IPTS. Findings indicated that physician scores on IPTS components are comparable to other groups displaying increased suicidality (e.g., military populations, prior attempters). Perceived burdensomeness was a significant predictor of suicidal ideation, while thwarted belongingness predicted prior suicide attempts. Acquired capability did not distinguish between prior attempters and nonattempters. Preliminary findings indicate the IPTS may be a useful framework for understanding and predicting physician suicidality.
Consumption of high‐energy phosphates during active sodium and potassium interchange in frog muscle
Authors: Dydynska Maria , Harris E. J.
Published: December 2014

1. Potassium‐depleted muscles have been analysed for cations, phosphocreatine, adenosine triphosphate and lactate before or after an exposure to a medium with 10 m
M potassium salt.

2. The net movements of sodium out and potassium in when the system is anaerobic but not otherwise poisoned are accompanied by break‐down of phosphocreatine and formation of lactate.

3. In bicarbonate media oligomycin has little perceptible effect upon these observed changes, which is taken to indicate that mitochondrial phosphorylation is not essential. An inhibition by oligomycin was noted in media buffered with Tris.

4. Dinitrofluorobenzene, which poisons creatine phosphotransferase, leads to the cation changes being accompanied by break‐down of ATP and formation of lactate. This indicates that ATP is more directly concerned with energizing the ion movements than is phosphocreatine.

5. Iodoacetate inhibits the glycolytic process and the ion movement is then accompanied by more phosphocreatine break‐down than in the other conditions; the level of ATP also falls.

6. The mean number of sodium ions moved out is closely equal to the number of potassium ions moved in. Conditions mentioned in (2) and (3) above lead to about 2·5 sodium ions being moved out per high‐energy phosphate bond hydrolysed provided allowance is made for the glycolytic resynthesis of ATP.

7. Some measurements of membrane potential under comparable conditions of ion movement are reported and these are used to calculate the energy requirement of the process of sodium—potassium interchange.
Some differences in uveal reactions between cats and rabbits
Authors: Ambache N. , Kavanagh L. , Whiting Judith
Published: December 2014

1. Miosis was observed after enucleation in unopened eyes from normal or atropinized, atropinesterase‐free rabbits. Such a phenomenon was not seen in enucleated cat eyes, in which the pupils remained widely dilated, whether atropine had been administered or not.

2. Pre‐treatment of the animals with reserpine did not alter this difference between the species.

3. The difference does not appear to be due to absence of irins from the cat iris, since aqueous extracts of cat irides contained a smooth‐muscle‐contracting activity (cat irin) extractable into ether at pH 3 and therefore consisting of lipid acid(s).

4. The difference is not due to insensitivity of the cat sphincter pupillae muscle to irins, since injections of ether‐purified cat or rabbit irins into the anterior chamber of enucleated cat eyes kept at room temperature constricted the pupil; injections of histamine were ineffective.

5. In experiments on animals treated with atropine ± mepyramine I.V., photographic measurements revealed a further difference, namely in the speed of miosis after stroking the iris in vivo. The response started later in the cat, and developed more slowly, but often to a fuller extent than in the rabbit.

6. In a proportion of cat eyes there was little or no change in intraocular pressure after irritation of the iris adequate to induce maximum pupillary constriction; this was so whether mepyramine had been administered or not.

7. Possible reasons for the above species differences are discussed.
The origin of the early receptor potential of the retina
Authors: Brindley G. S. , Gardner-Medwin A. R.
Published: December 2014

1. The early receptor potential of the isolated retina of the frog has the following properties:

(a) It is unaffected by reversing the direction of incidence of the light, and by soaking the retina in isotonic solutions of salts containing neither sodium nor chloride.

(b) Soaking the retina in solutions containing high concentrations of salts or glycerol greatly alters its time course.

(c) Soaking the retina in solutions containing formaldehyde or N‐ethyl maleimide slightly shortens its time course but does not otherwise much affect it.

2. We argue that the early receptor potential depends on displacements of charge within the monolayers of visual pigment as they undergo a sequence of chemical changes after absorbing light. The time course of the observed response must differ from that of the movement of charge because of filtering by the resistance‐capacity network in the receptors. Changes in the resistive components of this filter will partly or wholly account for the effects of salts and glycerol on the early receptor potential, but cannot explain those of temperature. It seems that at least two successive movements of charge must occur, the second of them strongly influenced by temperature. Neither movement requires the presence of free amino or thiol groups.

3. The above hypothesis requires that all or most of the monolayers of visual pigment in a receptor be orientated the same way; they cannot face alternately in opposite directions.
Cation movements in perfused giant axons
Authors: Shaw T. I.
Published: December 2014

1. The net movements of Na and K into resting squid giant axons perfused with a K2SO4 artificial axoplasm have been determined. Na enters at a rate of 131 ± 25 p‐mole/cm2.sec. The K leakage from the fibre is 942 ± 566 p‐mole/cm2.sec; clearly this latter figure shows how large is the uncertainty in the exact value for the potassium leakage.

2. The net entry of sodium associated with activity in such fibres has been measured and is 5·7 ± 0·7 p‐mole/cm2.impulse.
A movement receptor of the small intestine
Authors: Bessou P. , Perl E. R.
Published: December 2014

1. The characteristics of a mechanoreceptor of the small intestinal region of the cat were studied by recording potentials from single afferent fibres in filaments dissected from mesenteric nerves. Forty‐six fibres were examined in detail. Each of these was excited by light mechanical stimulation of the mesentery or small bowel, but none responded to sinusoidal vibration at frequencies above 100/sec. A ‘spontaneous’ discharge was regularly observed and it appeared to be related to peristaltic intestinal activity. On the other hand, non‐propulsive motor contractions of the intestinal musculature were poorly correlated with discharge frequency.

2. The region of maximal sensitivity of each fibre was determined by light pressure applied with a fine probe. Under these conditions the receptive field always resolved itself into 1‐5 sensitive points (smaller than 1 mm in diameter). Each such point lay upon or immediately adjacent to a branch of the mesenteric artery supplying the area. Commonly, one or more sensitive spots were located at the place where a mesenteric artery entered the intestinal musculature. Localized pressure to one sensitive spot evoked a low frequency discharge (under 30/sec) which adapted within several seconds. A movement of the mesentery or the intestine distorting the region near one of the sensitive points regularly evoked a near maximal response. The dynamic phase of distension of the intestine by an intraluminal ballon also evoked a response. During inflation or deflation of the intestinal balloon, the frequency of discharge was positively correlated with both the rate of inflation and the pressure reached at the end of the dynamic phase. There was little relation between static distension and the discharge frequency.

3. The conduction velocity of each afferent fibre was determined by electrical stimulation of its mesenteric nerve. The majority of the fibres studied had conduction velocities between 5 and 10 m/sec, the range being 2‐21 m/sec. These figures were taken to indicate that the fibres were myelinated and of small diameter. Histological determination of myelinated fibre diameter in the mesenteric nerves from which the recordings were taken suggested that the numerical factor relating fibre diameter in μ to conduction velocity in m/sec was under 6.

4. It was concluded that these receptors signalled movement of the intestine, regardless of its origin.