bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic Disparities in Smoking Behavior and Early Smoking Initiation Among Men in Malawi
Authors: Yaya Sanni , Bishwajit Ghose , Shah Vaibhav , Ekholuenetale Michael
Published: August 2017

Background:

Tobacco smoking is a growing concern for health care systems as it is projected to become the leading cause of death in the developing world. Knowledge of how smoking behavior differs across socioeconomic groups is crucial for designing effective preventive policies and alleviating the disparities. The aim of this study was to report the prevalence of (1) smoking status, (2) early smoking initiation, and (3) association with socioeconomic status (SES) of the 2 among Malawian men.

Methods:

Cross-sectional data on 1693 men aged between 15 and 49 years were collected from the latest 2013-2014 Multiple Indicator Cluster Survey in Malawi. Educational qualification and wealth index quintile were used as the indicators of SES. Outcome variables were smoking status, first age of smoking being below 18 years, and ever using any form of smokeless tobacco products. Multiple logistic regression models were used to see the contribution of SES to smoking status and early smoking initiation.

Results:

Mean age of the sample population was 33.23 years (SD: 8.25). Prevalence of smoking, early initiation, and ever using any form of smokeless tobacco were, respectively, 46.6%, 33.7%, and 6%. Compared with men who had higher education, those who had no formal education, primary-level, and secondary-level qualification had, respectively, 21% (adjusted odds ratio [AOR] = 1.209; 95% confidence interval [CI] = 0.498-2.935), 40% (AOR = 1.4; 95% CI = 0.647-3.029), and 26% (AOR = 1.256; 95% CI = 0.593-2.661) higher odds of being a smoker. Those who had no formal education were 2.7 times (AOR = 2.734; 95% CI = 1.123-6.653) as likely to try smoking before reaching 18 years of age. Compared with the richest, those in the lowest wealth quintile had 32% lower odds (AOR = 0.676; 95% CI = 0.455-1.006) of early onset of smoking, 63% lower odds (AOR = 0.372; 95% CI = 0.201-0.690) of trying other tobacco products.

Conclusions:

Addressing the socioeconomic disparities could play a vital role in delaying early onset and limiting overall consumption of tobacco. Ongoing health policy talks to reduce the prevalence of smoking should take into consideration improving educational and material well-being among men.
The relational ontology of resistance: Hybridity, ventriloquism, and materiality in the production of bike commuting as resistance
Authors: Wilhoit Elizabeth D. , Kisselburgh Lorraine G.
Published: August 2017

Many studies of organizational resistance have focused on a knowing agent who intends to challenge power. In contrast, we suggest that resistance is the product of many agents of varying ontological statuses acting together. Using a study of bicycle commuting in the American Midwest (an activity that takes place at the edges of organizations), actor-network theory, and Cooren’s theory of ventriloquism, we demonstrate that resistance has a relational ontology. We show that bike commuters do not intend to resist through biking to work, decentering human action and intention in resistance. We then highlight three aspects of a relational understanding of resistance. First, bike commuting (and other resistive activity) is produced by a plenum of agencies of all ontological statuses, making resistance a hybrid activity, not limited to human agents. Second, activities of resistance and control come to have these meanings through their relationship with one another. Third, actions that come to mean resistance and control are put into conversation with each other to gain these meanings through ventriloquism. Through these arguments, we expand what can count as resistance, how resistance is produced, and who produces it, demonstrating that resistance is a relational production.
Endocrinopathies in paediatric-onset neuromyelitis optica spectrum disorder with aquaporin 4 (AQP4) antibody
Authors: Hacohen Yael , Messina Silvia , Gan Hoong-Wei , Wright Sukhvir , Chandratre Saleel , Leite Maria Isabel , Fallon Penny , Vincent Angela , Ciccarelli Olga , Wassmer Evangeline , Lim Ming , Palace Jacqueline , Hemingway Cheryl
Published: August 2017

The involvement of the diencephalic regions in neuromyelitis optica spectrum disorder (NMOSD) may lead to endocrinopathies. In this study, we identified the following endocrinopathies in 60% (15/25) of young people with paediatric-onset aquaporin 4-Antibody (AQP4-Ab) NMOSD: morbid obesity ( n = 8), hyperinsulinaemia ( n = 5), hyperandrogenism ( n = 5), amenorrhoea ( n = 5), hyponatraemia ( n = 4), short stature ( n = 3) and central hypothyroidism ( n = 2) irrespective of hypothalamic lesions. Morbid obesity was seen in 88% (7/8) of children of Caribbean origin. As endocrinopathies were prevalent in the majority of paediatric-onset AQP4-Ab NMOSD, endocrine surveillance and in particular early aggressive weight management is required for patients with AQP4-Ab NMOSD.
Air pollution is associated to the multiple sclerosis inflammatory activity as measured by brain MRI
Authors: Bergamaschi Roberto , Cortese Andrea , Pichiecchio Anna , Berzolari Francesca Gigli , Borrelli Paola , Mallucci Giulia , Bollati Valentina , Romani Alfredo , Nosari Guido , Villa Silvia , Montomoli Cristina
Published: August 2017

Background:

Some environmental factors have been already associated to increased risk of multiple sclerosis (MS), but it is plausible that additional factors might play a role.

Objective:

To investigate in MS patients the relationship between inflammatory activity, detected by brain magnetic resonance imaging (MRI) with gadolinium (Gd), and air pollution, namely, particulate matters with diameter less than 10 μm (PM10).

Methods:

We analyzed from 52 remitting MS patients 226 brain MRIs, 34% with (Gd+MRI) and 66% without (Gd-MRI) T1-Gd-enhancing lesions. Daily recording of PM10 in the 30 days before MRI examination was obtained by monitors depending on the residence of subjects.

Results:

PM10 levels in the 5, 10, 15, 20, and 25 days before brain MRIs were higher (plus 16%, 21%, 24%, 25%, and 21%, respectively) with reference to Gd+MRI versus Gd-MRI. There was a significant association between Gd+MRI and PM10 levels ( p = 0.013), independent of immune therapies, smoker status, and season. In patients who had two repeated MRIs with opposite outcomes (Gd-MRI and Gd+MRI), PM10 levels were strongly higher in concurrence with Gd+MRI ( p < 0.0001).

Conclusion:

Our findings suggest that air pollution may be a risk factor for MS favoring inflammatory exacerbations.
Indeterminacy and More-than-human Bodies
Authors: Waterton Claire
Published: August 2017

This article analyses research that has explored the potential of a focus on indeterminate bodies for decision making, policy and politics. Drawing on different ways of conceptualising indeterminacy in scientific and policy domains it describes the Loweswater Care Project, a participatory ‘knowledge collective’ that attempted to avoid converting the complexities of vital cyanobacterial bodies into a purely social or managerial set of questions around water quality. Through a commitment to opening out the nature of ‘things’, participants in this collective honed new questions and avenues of inquiry around cyanobacteria and its relations. The Loweswater Care Project was a kind of ‘open’ in Haraway’s sense, where questions and demands are put to bodies, and to the apparatus that allows us to sense them, in ways that do not shy away from the probabilistic character of entities and their relations. The implications of generating indeterminacies in this setting are explored for environmental decision making, policy and politics.
Will personal values predict the development of smoking and drinking behaviors? A prospective cohort study of children and adolescents in Taiwan
Authors: Nieh Hsi-Ping , Wu Wen-Chi , Luh Dih-Ling , Yen Lee-Lan , Hurng Baai-Shyun , Chang Hsing-Yi
Published: August 2017

This study examined how personal values predict the development of smoking and drinking behaviors in adolescence. The longitudinal data of 1545 adolescents over a 6-year period were analyzed. The results showed that adolescents who valued health and academics had similarly lower odds of reporting cigarette and alcohol use and those who valued friends had significantly higher odds. While the odds increased over time, the trend on alcohol use lessened for adolescents who valued academics, while the trend accelerated for those who valued friends. The finding suggests the important role that personal values play in adolescent risk behavioral development.
Identifying barriers to help-seeking for non-motor symptoms in people with Parkinson’s disease
Authors: Hurt Catherine S , Rixon Lorna , Chaudhuri K Ray , Moss-Morris Rona , Samuel Mike , Brown Richard G
Published: August 2017

Non-motor symptoms of Parkinson’s disease have a significant impact on quality of life. Despite this, many non-motor symptoms remain unreported by patients and consequently untreated. This study explored barriers to help-seeking using two theoretical frameworks, the Common Sense Model of illness perception and Theoretical Domains Framework. A total of 20 participants completed semi-structured interviews to explore symptom beliefs and help-seeking behaviour. Uncertainty about the relationship of non-motor symptoms to Parkinson’s disease and lack of clarity around treatments were common. Embarrassment and communication difficulties were common for potentially sensitive symptoms such as sexual dysfunction. Symptom perceptions and beliefs about help-seeking acted as barriers to reporting non-motor symptoms.
Risk perception, self-efficacy, trust for physician, depression, and behavior modification in diabetic patients
Authors: Imai Hissei , Furukawa Toshiaki A , Hayashi Shin-u , Goto Atsushi , Izumi Kazuo , Hayashino Yasuaki , Noda Mitsuhiko ,   for the J-DOIT2 Study Group
Published: August 2017

We evaluated the associations of risk perception, self-efficacy, and trust with two health promotion behaviors (food habits and exercise) and depressive mood. Diabetic patients aged between 40 and 64 ( n = 1195) were included in the analyses. Risk perception worsened behavioral changes in terms of food habits and depression, whereas self-efficacy and trust improved food habits, exercise, and depression; trust improved exercise and depression. In conclusion, self-efficacy and trust appear to be more beneficial than risk perception for positive behavioral changes and for improving depression in diabetic patients. However, their influence on behavioral changes may be different according to the types of behaviors.
Contestation, instrumental resistance and strategic conformation within the diagnostic process of gender dysphoria in Portugal
Authors: Hilário Ana Patrícia
Published: August 2017

This article aims to provide insights into the ways in which trans people (i.e. those whose gender identity or expression do not align with their assigned sex at birth) in Portugal make sense of the diagnosis of gender dysphoria. Drawing upon in-depth interviews with 10 trans men and 9 trans women carried out by the TRANSRIGHTS team, we identified three major themes: (a) contestation of gender dysphoria as a (mental) illness, (b) instrumental resistance to complete demedicalisation of gender dysphoria and (c) strategic conformation to gender essentialism within the diagnostic process of gender dysphoria. We found that the need to access medical treatments leads some trans people to approach the diagnosis strategically. While almost all trans people were in favour of the depathologisation of gender dysphoria and at the same time were against its demedicalisation, mainly for instrumental reasons, a few demonstrated contrasting positions whether by agreeing with the idea of gender dysphoria as a pathology or by rejecting medicalisation. The study offers a more nuanced perspective on gender dysphoria than that described in previous sociological and transgender literature.
Anthropological realism in a scientistic age
Authors: Herzfeld Michael
Published: August 2017

Anthropology is a realist discipline. In this article, I draw a sharp distinction between realism and scientism, or objectivism, arguing that realism requires the recognition of the contexts and contingency of all knowledge, including ethnography, whereas scientism – a rhetoric that invokes science as its source of authority – paradoxically occludes recognition of its own context of production. A realist position, anchored in social experience and aware of the limitations that such an entailment involves, is thus far better situated to explore the political implications of anthropological theory, especially in a world where market consumerism, neoliberalism and audit culture, as well as certain authoritarian regimes, have, to their political advantage, substituted quantitative rhetoric for critical thought.
Effect of strain rate on bending and transmission characteristics of injection molded polyamide 66 spur gears
Authors: Kodeeswaran M , Suresh R , Senthilvelan S
Published: August 2017

Polymer material exhibits time-dependent mechanical behavior due to its viscoelastic characteristics. Thus, unlike steel gears, polymer gears exhibit complex behavior when transmitting loads at various rotational speeds. In general, gear tooth surfaces exhibit complex stress due to their nonconformal geometry. Hence, the nonlinear material and nonlinear geometric aspects of polymer gear mesh prompted an investigation of the bending and transmission characteristics of injection molded polyamide 66 gears at various strain rate conditions. The injection molded tensile specimens made from the gear material were subjected to various rates of loading. The stress–strain performance at various rates of loading was evaluated and used to model linear and nonlinear gear materials for the numerical analysis. The numerical investigation was carried out on the steel–polyamide gear pair with the commercial finite element analysis tool ABAQUS® to predict the bending stress and static transmission error. The predicted static transmission error of the gear pair was compared with the experimental results obtained using an in-house developed gear test rig. The bending stress with the linear material models was higher than that of the nonlinear material models. An increase in bending stress with the strain rate was observed in the case of the nonlinear material models. The static transmission error predicted with the nonlinear material model at a higher strain rate was lower for both the single tooth contact and the double teeth contacts.
Ruins come what may: a trip to the capital of Spainistan
Authors: Arboleda Pablo
Published: August 2017

Seseña is the main residential project in Spain that was interrupted due to the 2008 financial crisis, though some parts of it were actually accomplished and people are now starting to move there. By using the symbolic figure of an ‘archaeological park’, the author recounts a trip he made in May 2016 to reflect on whether such a place ceases to be a ruin only for the fact of being inhabited. The material and sociological aspects of this type of urban development are tackled from an ironic and critical perspective to finally conclude that Seseña is a set of ruins ‘come what may’.
The effect of a peer support intervention on early recovery outcomes in men recovering from coronary bypass surgery: A randomized controlled trial
Authors: Colella Tracey JF , King-Shier Kathryn
Published: August 2017

Background and aim:

Examine the effect of a professionally-guided telephone peer support intervention on recovery outcomes including depression, perceived social support, and health services utilization after coronary artery bypass graft surgery (CABG).

Methods:

A randomized controlled trial was conducted with post-coronary artery bypass graft surgery men ( N=185) who were randomized before hospital discharge. The intervention arm received telephone-based peer support through weekly telephone calls from a peer volunteer over six weeks, initiated within 3–4 days of discharge.

Results:

Although a significant difference was detected in pre-intervention depression scores at discharge, there were no differences between groups in changes in depression scores at six weeks ( p=0.08), 12 weeks (0.49) or over time ( p=0.51); and no significant differences in perceived social support scores over time ( p=0.94). At 12 weeks, the intervention group had significantly lower incidence of health services utilization (family physician ( p=0.02) and emergency room ( p=0.04)).

Conclusions:

Healthcare providers need to continue to investigate novel interventions to enhance social support and reduce depression in cardiac patients.
Somatosensory Feedback to the Cheek During Virtual Visual Feedback Therapy Enhances Pain Alleviation for Phantom Arms
Authors: Ichinose Akimichi , Sano Yuko , Osumi Michihiro , Sumitani Masahiko , Kumagaya Shin-ichiro , Kuniyoshi Yasuo
Published: August 2017

Background. Patients who suffer from phantom limb pain can perceive tactile stimuli applied to the cheek on their affected side as if it were coming from their phantom limb, a phenomenon called “referred sensation.” Objectives. To investigate the analgesic effect produced by tactile feedback provided to the cheek during neurorehabilitation using visual feedback. Methods. Nine participants with phantom upper limb pain performed virtual reality neurorehabilitation exercises in which they repeatedly touched a target object with a virtual representation of their affected limb. We applied tactile feedback to their cheek when their virtual affected limb touched a virtual object (Cheek Condition). We also included 2 control conditions where tactile feedback was either applied to their intact hand (Intact Hand Condition) or not applied at all (No Stimulus Condition). We evaluated pain intensity on an 11-point rating scale and pain quality using the short-form McGill Pain Questionnaire before and after each rehabilitation condition. Results. The median pain-reduction rate in the Cheek Condition (33.3 ± 24.4%) was significantly higher than in the Intact Hand Condition (16.7 ± 12.3%) and the No Stimulus Condition (12.5 ± 13.5%; P < .05). Even patients who did not feel referred sensations reported significant pain reduction after the Cheek Condition. Conclusions. The analgesic effect of neurorehabilitative visual feedback during phantom limb movement is significantly improved by applying somatosensory feedback to the cheek on the affected side. Further studies are needed to extend these findings to objective pain measures and to elucidate the neural mechanisms that underlie the analgesic effect.
A Single Bout of High-Intensity Interval Training Improves Motor Skill Retention in Individuals With Stroke
Authors: Nepveu Jean-Francois , Thiel Alexander , Tang Ada , Fung Joyce , Lundbye-Jensen Jesper , Boyd Lara A. , Roig Marc
Published: August 2017

Background. One bout of high-intensity cardiovascular exercise performed immediately after practicing a motor skill promotes changes in the neuroplasticity of the motor cortex and facilitates motor learning in nondisabled individuals. Objective. To determine if a bout of exercise performed at high intensity is sufficient to induce neuroplastic changes and improve motor skill retention in patients with chronic stroke. Methods. Twenty-two patients with different levels of motor impairment were recruited. On the first session, the effects of a maximal graded exercise test on corticospinal and intracortical excitability were assessed from the affected and unaffected primary motor cortex representational area of a hand muscle with transcranial magnetic stimulation. On the second session, participants were randomly assigned to an exercise or a nonexercise control group. Immediately after practicing a motor task, the exercise group performed 15 minutes of high-intensity interval training while the control group rested. Twenty-four hours after motor practice all participants completed a test of the motor task to assess skill retention. Results. The graded exercise test reduced interhemispheric imbalances in GABAA-mediated short-interval intracortical inhibition but changes in other markers of excitability were not statistically significant. The group that performed high-intensity interval training showed a better retention of the motor skill. Conclusions. The performance of a maximal graded exercise test triggers only modest neuroplastic changes in patients with chronic stroke. However, a single bout of high-intensity interval training performed immediately after motor practice improves skill retention, which could potentially accelerate motor recovery in these individuals.
Moving Rehabilitation Research Forward: Developing Consensus Statements for Rehabilitation and Recovery Research
Authors: Bernhardt Julie , Borschmann Karen , Boyd Lara , Carmichael S. Thomas , Corbett Dale , Cramer Steven C. , Hoffmann Tammy , Kwakkel Gert , Savitz Sean , Saposnik Gustavo , Walker Marion , Ward Nick
Published: August 2017

Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers hamper our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research; biomarkers of recovery; intervention development, monitoring and reporting; and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
Nonlinear Recurrent Dynamics and Long-Term Nonstationarities in EEG Alpha Cortical Activity: Implications for Choosing Adequate Segment Length in Nonlinear EEG Analyses
Authors: Cerquera Alexander , Vollebregt Madelon A. , Arns Martijn
Published: August 2017

Nonlinear analysis of EEG recordings allows detection of characteristics that would probably be neglected by linear methods. This study aimed to determine a suitable epoch length for nonlinear analysis of EEG data based on its recurrence rate in EEG alpha activity (electrodes Fz, Oz, and Pz) from 28 healthy and 64 major depressive disorder subjects. Two nonlinear metrics, Lempel-Ziv complexity and scaling index, were applied in sliding windows of 20 seconds shifted every 1 second and in nonoverlapping windows of 1 minute. In addition, linear spectral analysis was carried out for comparison with the nonlinear results. The analysis with sliding windows showed that the cortical dynamics underlying alpha activity had a recurrence period of around 40 seconds in both groups. In the analysis with nonoverlapping windows, long-term nonstationarities entailed changes over time in the nonlinear dynamics that became significantly different between epochs across time, which was not detected with the linear spectral analysis. Findings suggest that epoch lengths shorter than 40 seconds neglect information in EEG nonlinear studies. In turn, linear analysis did not detect characteristics from long-term nonstationarities in EEG alpha waves of control subjects and patients with major depressive disorder patients. We recommend that application of nonlinear metrics in EEG time series, particularly of alpha activity, should be carried out with epochs around 60 seconds. In addition, this study aimed to demonstrate that long-term nonlinearities are inherent to the cortical brain dynamics regardless of the presence or absence of a mental disorder.
Brain positron emission tomography with 2-18F-2-deoxi-D-glucose of patients with dystonia and essential tremor detects differences between these disorders
Authors: Belenky Vadim , Stanzhevsky Andrei , Klicenko Olga , Skoromets Alexandr
Published: August 2017

We studied patients with dystonia (D) and essential tremor (ET) using positron emission tomography (PET) equipped with Cortex ID software. This allowed PET brain visualisation to be compared to scans of a control group by means of the z-score. The study revealed hypo-metabolism in both D and ET groups, and additionally revealed a difference between these two groups of patients in certain areas of the brain. These two nosological forms overlap in clinical features and are difficult to differentiate. The PET picture may help to provide a differential diagnosis in addition to the biochemical difference in dopamine exchange previously revealed by us in this group of patients.
Music streams, smartphones, and the self
Authors: Nag Wenche
Published: August 2017

In this article, I explore how the interplay between music consumption and self-construction is experienced by Norwegians who frequently use streaming services on smartphones. Accordingly, the interplay unfolds in a situation characterized by (a) an abundance of legally available music tracks and (b) low technical barriers for music listening, discovery, management, and sharing. This implies a major shift when compared to previous conditions for music consumption, and it provides the foundation upon which I developed the analysis. The article relies on qualitative material gathered in focus group discussions with smartphone streaming users in Oslo in September 2013. The findings suggest that the instant access to millions of songs yields a tension between intimacy and detachment in users’ relationship to music. In such an environment of numerous music consumption alternatives, freedom of choice is embraced, but apparently accompanied with a craving for scarcity. These opposing tendencies in the experience of music consumption are interpreted and acted on by the individual in the reflexive and social processes of self-construction. Thus, I propose that the self should be included into what in domestication studies has been coined “the articulations of media technologies.” The articulation of the self equips this analytical framework with a fourth pillar in addition to the previous three: object, content, and context. Moreover, the articulation of the self highlights a dimension that seems crucial to content consumption at large in the smartphone age.
International Publication Trends of Retinopathy of Prematurity Literature Over 40 Years
Authors: Vakharia Paras P. , Huang Natalie T. , Jankowski Michelle , Thomas Benjamin J. , Chan R. V. Paul , Drenser Kimberly A. , Trese Michael T. , Capone Antonio , Yonekawa Yoshihiro
Published: August 2017

Purpose:

The purpose of this study was to conduct a bibliometric analysis to evaluate the publication trends of retinopathy of prematurity (ROP) literature over time, focusing on geographic and economic origins.

Methods:

A search for indexed English abstracts was performed in PubMed using search terms “retinopathy of prematurity” or “retrolental fibroplasia” from 1976 to 2015 and divided into 4 decades. Original research articles involving humans were included. Countries were grouped into high-, middle-, and low-income groups using World Bank criteria, and impact factors (IFs) were gathered from 2014 Thomson Reuters Journal Citation Reports.

Results:

A total of 5425 publications were identified, of which 2045 met the inclusion criteria. The ratios of publications per decade increased over time: 1976 to 1985 (5.4%), 1986 to 1995 (15.8%), 1996 to 2005 (25%), 2006 to 2015 (53.7%; Pearson r = .93, 95% confidence interval: 0.87-0.96). The rates of publications by income group were high—(82.2%), middle—(17.7%), and low—(0.1%). Respective mean (standard deviation) IFs by income group were 2.79 (4.87), 1.23 (1.17), and 0.42 (0.45). Top producing countries were the United States (37%), the United Kingdom (6.7%), India (4.6%), Japan (3.9%), and Turkey (3.5%). There was a significant difference between the time distribution of publications between high- and middle-income groups, where the latter has produced increasing publications in recent years ( P < .001), but in journals with lower IFs overall ( P < .001).

Conclusions:

Publications regarding ROP are increasing in number. Investigators from middle-income countries are increasingly contributing to the ROP literature but, overall, may not be recognized yet in journals with high IFs.
Cancer-associated pathways and biomarkers of venous thrombosis
Authors: Hisada Yohei , Mackman Nigel
Published: August 2017

Cancer patients have an increased risk of venous thromboembolism (VTE). In this review, we summarize common and cancer type–specific pathways of VTE in cancer patients. Increased levels of leukocytes, platelets, and tissue factor–positive (TF+) microvesicles (MVs) are all potential factors that alone or in combination increase cancer-associated thrombosis. Patients with lung or colorectal cancer often exhibit leukocytosis. Neutrophils could increase VTE in cancer patients by releasing neutrophil extracellular traps whereas monocytes may express TF. Thrombocytosis is often observed in gastrointestinal, lung, breast, and ovarian cancer and this could decrease the threshold required for VTE. Soluble P-selectin has been identified as a biomarker of cancer-associated thrombosis in a general cancer population and may reflect activation of the endothelium. P-selectin expression by the endothelium may enhance VTE by increasing the recruitment of leukocytes. Studies in patients with pancreatic or brain cancer suggest that elevated levels of PAI-1 may contribute to VTE. Although elevated levels of TF+ MVs have been observed in patients with different types of cancer, an association between TF+ MVs and VTE has been observed only in pancreatic cancer. Podoplanin expression is associated with VTE in patients with brain cancer and may activate platelets. Future studies should measure multiple biomarkers in each cancer type to determine whether combinations of biomarkers can be used as predictors of VTE. A better understanding of the pathways that increase VTE in cancer patients may lead to the development of new therapies to reduce the morbidity and mortality associated with thrombosis.
Delineation of the timing of second-line therapy post–autologous stem cell transplant in patients with AL amyloidosis
Authors: Hwa Yi L. , Warsame Rahma , Gertz Morie A. , Buadi Francis K. , Lacy Martha Q. , Kumar Shaji K. , Dingli David , Zeldenrust Steve R. , Leung Nelson , Hayman Susanne R. , Kapoor Prashant , Gonsalves Wilson I. , Kourelis Taxiarchis V. , Russell Stephen , Go Ronald S. , Hobbs Miriam A. , Fonder Amie L. , Rajkumar S. Vincent , Dispenzieri Angela
Published: August 2017

Key Points

Organ progression at second-line therapy predicated inferior survival. Patients relapsing from >VGPR had a longer time to develop organ progression.
Fatigue in the general population- associations to age, sex, socioeconomic status, physical activity, sitting time and self-rated health: the northern Sweden MONICA study 2014
Authors: Engberg Isak , Segerstedt Johan , Waller Göran , Wennberg Patrik , Eliasson Mats
Published: August 2017

Background

Fatigue is widespread in the population and a common complaint in primary care. Little is known about prevalence of fatigue in the population and its predictors.

We aimed to describe the pattern of fatigue in the general population and to explore the associations with age, sex, socioeconomic status, self-reported physical activity, sitting time and self-rated health.

Methods

One thousand, five hundred and fifty-seven out of 2500 invited subjects in the Northern Sweden MONICA Study 2014, aged 25–74 years, filled out the Multidimensional Fatigue Inventory (MFI-20), consisting of four subscales: General fatigue (GF), Physical fatigue (PF), Reduced activity (RA) and Mental fatigue (MF). Questions regarding age, sex, socioeconomic status, physical activity, sitting time and self-rated health were also included.

Results

Higher age correlated significantly with lower fatigue scores for the GF and MF subscales. Women had higher fatigue scores than men on all subscales (p < 0.05). Among men, higher socioeconomic status was related to lower fatigue for the GF, PF and RA subscales (age adjusted p < 0.05). Among women, higher socioeconomic status was related to lower fatigue for the PF and MF subscales (age adjusted p < 0.05). Higher physical activity was connected to lower levels of fatigue for all subscales (age and sex adjusted p < 0.001) except for MF. Longer time spent sitting was also related to more fatigue on all subscales (age and sex adjusted p < 0.005) except for MF. Better self-rated health was strongly associated with lower fatigue for all subscales (age and sex adjusted p < 0.001).

Conclusion

Older, highly educated, physically active men, with little sedentary behavior are generally the least fatigued. Self-rated health is strongly related to fatigue. Interventions increasing physical exercise and reducing sedentary behavior may be important to help patients with fatigue and should be investigated in prospective studies.
Postdiagnosis Statin Use and Mortality in Danish Patients With Prostate Cancer
Authors: Larsen Signe Benzon , Dehlendorff Christian , Skriver Charlotte , Dalton Susanne Oksbjerg , Jespersen Christina Gade , Borre Michael , Brasso Klaus , Nørgaard Mette , Johansen Christoffer , Sørensen Henrik Toft , Hallas Jesper , Friis Søren
Published: August 2017

Purpose

Increasing evidence indicates that statin use may reduce mortality from prostate cancer. In this work, we examined whether postdiagnosis statin use was associated with reduced cancer-specific mortality or all-cause mortality among patients with prostate cancer in Denmark.

Material and Methods

From nationwide Danish registries, we identified all patients with incident prostate adenocarcinoma from 1998 to 2011 and retrieved data on tumor and patient characteristics, drug use, and primary treatment. We defined postdiagnosis use (two or more prescriptions) of statins as a time-varying covariate with 1-year lag. Cox proportional hazards regression models used to compute hazard ratios (HRs) for prostate cancer–specific mortality and all-cause mortality through 2013 associated with postdiagnosis statin use. In secondary and sensitivity analyses, we assessed statin use within exposure periods of 1 year or 5 years after prostate cancer diagnosis and evaluated the influence of prediagnosis statin use.

Results

Among 31,790 patients, 7,365 died of prostate cancer and 11,811 died from other causes during a median follow-up of 2.8 years (interquartile range, 1.3 to 5.1 years) from 1 year after diagnosis. Postdiagnosis statin use was associated with adjusted HRs of 0.83 (95% CI, 0.77 to 0.89) for prostate cancer mortality and 0.81 (95% CI, 0.76 to 0.85) for all-cause mortality. Similar results were observed in 1-year and 5-year sensitivity analyses. No substantial effect measure modification was found with estimated dose or type of statin, clinical stage, Gleason score, or with prediagnosis statin use; however, patients who were diagnosed early in the study period or who underwent radical prostatectomy or endocrine therapy exhibited slightly lower HRs for prostate cancer mortality with postdiagnosis statin use than did those in the overall analyses.

Conclusion

Postdiagnosis statin use was associated with reduced mortality from prostate cancer; however, it remains to be established whether this association is causal.
Serum Insulin Bioassay Reflects Insulin Sensitivity and Requirements in Type 1 Diabetes
Authors: Janssen Joseph A M J L , Llauradó Gemma , Varewijck Aimee J , Groop Per-Henrik , Forsblom Carol , Fernández-Veledo Sonia , van den Dungen Elisabeth S R , Vendrell Joan , Hofland Leo J , Yki-Järvinen Hannele
Published: August 2017

Context

Insulin resistance could increase insulin requirements in type 1 diabetes (T1D). Current insulin immunoassays do not detect insulin analogs. Kinase insulin receptor (IR) activation (KIRA) bioassays specific for human IR isoforms A (IR-A) and B (IR-B) permit assessment of all circulating insulin bioactivity. We studied whether IR-A and IR-B KIRA assays are related to direct measures of insulin sensitivity or insulin doses in T1D.

Design

We evaluated 31 adult patients with T1D (age 45.7 ± 1.6 years, body mass index 28.8 ± 0.7 kg/m2). Serum IR-A and IR-B bioactivities were measured by KIRA bioassays. Insulin sensitivity of glucose production (Ra) was measured by the euglycemic hyperinsulinemic clamp technique in which a low insulin dose (0.4 mU/kg/min for 240 minutes) was combined with D-[3-3H] glucose infusion to measure rates of Ra and utilization and insulin action on antilipolysis from suppression of serum free fatty acids.

Results

Baseline circulating IR-A bioactivity was 53 ± 7 pmol/L, and IR-B bioactivity was 81 ± 11 pmol/L. Compared with baseline, insulin infusion significantly increased IR-A (P < 0.001) and IR-B (P < 0.001) bioactivities. Fasting IR-A and IR-B bioactivities were positively related to endogenous Ra (r = 0.44, P = 0.01 and r = 0.38, P < 0.05). Fasting IR-A (r = 0.43, P = 0.02) and IR-B (r = 0.47, P = 0.01) bioactivities were significantly correlated with insulin requirements and glycosylated hemoglobin (IR-A: r = 0.52, P = 0.002; IR-B: r = 0.48, P = 0.006).

Conclusions

Circulating IR-A and IR-B bioactivities are associated with insulin resistance, high insulin requirements, and poor glycemic control in T1D. Measurement of IR bioactivity by KIRA assays provides a tool to assess the amount of biologically active insulin in groups of T1D patients treated with insulin analogs.
Study of oral aniracetam in C57BL/6J mice without pre-existing cognitive impairments
Authors: Reynolds Conner D. , Jefferson Taylor S. , Volquardsen Meagan , Pandian Ashvini , Smith Gregory D. , Holley Andrew J. , Lugo Joaquin N.
Published: August 2017

Background: The piracetam analog, aniracetam, has recently received attention for its cognition enhancing potential, with minimal reported side effects.  Previous studies report the drug to be effective in both human and non-human models with pre-existing cognitive dysfunction, but few studies have evaluated its efficacy in healthy subjects. A previous study performed in our laboratory found no cognitive enhancing effects of oral aniracetam administration 1-hour prior to behavioral testing in naïve C57BL/6J mice.

Methods: The current study aims to further evaluate this drug by administration of aniracetam 30 minutes prior to testing in order to optimize any cognitive enhancing effects. In this study, all naïve C57BL/6J mice were tested in tasks of delayed fear conditioning, novel object recognition, rotarod, open field, elevated plus maze, and marble burying.

Results: Across all tasks, animals in the treatment group failed to show enhanced learning when compared to controls.

Conclusions: These results provide further evidence suggesting that aniracetam conveys no therapeutic benefit to subjects without pre-existing cognitive dysfunction.
Puzzles in modern biology. V. Why are genomes overwired?
Authors: Frank Steven A.
Published: August 2017

Many factors affect eukaryotic gene expression. Transcription factors, histone codes, DNA folding, and noncoding RNA modulate expression. Those factors interact in large, broadly connected regulatory control networks. An engineer following classical principles of control theory would design a simpler regulatory network. Why are genomes overwired? Neutrality or enhanced robustness may lead to the accumulation of additional factors that complicate network architecture. Dynamics progresses like a ratchet. New factors get added. Genomes adapt to the additional complexity. The newly added factors can no longer be removed without significant loss of fitness. Alternatively, highly wired genomes may be more malleable. In large networks, most genomic variants tend to have a relatively small effect on gene expression and trait values. Many small effects lead to a smooth gradient, in which traits may change steadily with respect to underlying regulatory changes. A smooth gradient may provide a continuous path from a starting point up to the highest peak of performance. A potential path of increasing performance promotes adaptability and learning. Genomes gain by the inductive process of natural selection, a trial and error learning algorithm that discovers general solutions for adapting to environmental challenge. Similarly, deeply and densely connected computational networks gain by various inductive trial and error learning procedures, in which the networks learn to reduce the errors in sequential trials. Overwiring alters the geometry of induction by smoothing the gradient along the inductive pathways of improving performance. Those overwiring benefits for induction apply to both natural biological networks and artificial deep learning networks.
Impact of a Safety Huddle–Based Intervention on Monitor Alarm Rates in Low‐Acuity Pediatric Intensive Care Unit Patients
Authors: Dewan Maya , Wolfe Heather , Lin Richard , Ware Eileen , Weiss Michelle , Song Lihai , MacMurchy Matthew , Davis Daniela , MSCE Christopher P. Bonafide MD
Published: August 2017

BACKGROUND

Physiologic monitors generate high rates of alarms in the pediatric intensive care unit (PICU), yet few are actionable.

OBJECTIVE

To determine the association between a huddle‐based intervention focused on reducing unnecessary alarms and the change in individual patients' alarm rates in the 24 hours after huddles.

DESIGN

Quasi‐experimental study with concurrent and historical controls.

SETTING

A 55‐bed PICU.

PARTICIPANTS

Three hundred low‐acuity patients with more than 40 alarms during the 4 hours preceding a safety huddle in the PICU between April 1, 2015, and October 31, 2015.

INTERVENTION

Structured safety huddle review and discussion of alarm causes and possible monitor parameter adjustments to reduce unnecessary alarms.

MAIN MEASUREMENTS

Rate of priority alarms per 24 hours occurring for intervention patients as compared with concurrent and historical controls. Balancing measures included unexpected changes in patient acuity and code blue events.

RESULTS

Clinicians adjusted alarm parameters in the 5 hours following the huddles in 42% of intervention patients compared with 24% of control patients (P = .002). The estimate of the effect of the intervention adjusted for age and sex compared with concurrent controls was a reduction of 116 priority alarms (95% confidence interval, 37‐194) per 24 hours (P = .004). There were no unexpected changes in patient acuity or code blue events related to the intervention.

CONCLUSION

Integrating a data‐driven monitor alarm discussion into safety huddles was a safe and effective approach to reducing alarms in low‐acuity, high‐alarm PICU patients.
Perspectives of Clinicians at Skilled Nursing Facilities on 30‐Day Hospital Readmissions: A Qualitative Study
Authors: Clark Bennett W. , Baron Katelyn , Tynan‐McKiernan Kathleen , Britton Meredith Campbell , Minges Karl E. , Chaudhry Sarwat I.
Published: August 2017

BACKGROUND

Unplanned 30‐day hospital readmissions are an important measure of hospital quality and a focus of national regulations. Skilled nursing facilities (SNFs) play an important role in the readmission process, but few studies have examined the factors that contribute to readmissions from SNFs, leaving hospitalists and other hospital‐based clinicians with limited evidence on how to reduce SNF readmissions.

OBJECTIVE

To understand the perspectives of clinicians working at SNFs regarding factors contributing to readmissions.

DESIGN AND PARTICIPANTS

We prospectively identified consecutive readmissions from SNFs to a single tertiary‐care hospital. Index admissions and readmissions were to the hospital's inpatient general medicine service. SNF clinicians who cared for the readmitted patients were identified and interviewed about root causes of the readmissions using a structured interview tool. Transcripts of the interviews were inductively analyzed using grounded theory methodology.

RESULTS

We interviewed 28 clinicians at 15 SNFs. The interviews covered 24 patient readmissions. SNF clinicians described a range of procedural, technological, and cultural contributors to unplanned readmissions. Commonly cited causes of readmission included a lack of coordination between emergency departments and SNFs, poorly defined goals of care at the time of hospital discharge, acute illness at the time of hospital discharge, limited information sharing between a SNF and hospital, and SNF process and cultural factors.

CONCLUSION

SNF clinicians identified a broad range of factors that contribute to readmissions. Addressing these factors may mitigate patients' risk of readmission from SNFs to acute care hospitals.
Measuring Up? Persistence and Change in Analysts’ Evaluative Schemas Following Technological Change
Authors: Benner Mary J. , Ranganathan Ram
Published: August 2017

We examine shifts in how analysts assess the strategies of incumbent firms following a radical technological change. Specifically, we use an inductive study of earnings conference call transcripts and analyst reports to study how analysts’ evaluative schemas change with technological change in the wireline telecommunications industry. We find three temporal themes. At first, analysts pressure firms to reverse strategic changes that are at odds with the existing “income”-focused metrics and logic that constitute the evaluative schema. Next, schema change unfolds with the ongoing technological change, as firm performance declines when measured with traditional metrics, and as managers frame strategic changes using new “growth”-focused metrics and logic. Finally, a distinct shift in the schema is apparent as analysts’ increasing attention to growth spurs a more positive view of strategic changes that they previously opposed, a less positive view of previously supported strategies that conformed to an income logic, and the application of the growth logic even to a firm not pursuing growth-oriented strategic changes. Results from a supplementary content analysis support these results, showing a temporal shift toward “growth” words in analyst reports and conference calls. Our process model emphasizes the gradual shifts in analysts’ evaluative schemas that ultimately support firm responses to a new technology. We highlight the importance of managerial framing as firms facing technological change pursue strategic responses that initially diverge from stakeholders’ expectations, as well as the possibility that as schemas shift, actions that initially conform to analysts’ expectations may be questioned.

The online appendix is available at https://doi.org/10.1287/orsc.2017.1140 .
Rancangan D-Optimal Model Gompertz dengan Maple
Authors: Widiharih Tatik , Warsito Budi
Published: August 2017

Gompertz model is used in many areas including biological growth studies, animal and husbandry, chemistry, and agricultural. Locally D-optimal designs for Gompertz models with three parameters is investigated. We used the Generalized Equivalence Theorem of Kiefer and Wolvowitz to determine D-optimality criteria. Tchebysheff system is used to decide that the D-optimal design is minimally supported design or nonminimally supported design. The result, D-optimal design for Gompertz model is minimally supported design with uniform weight on its support.Keywords:D-optimal, Generalized Equivalence Theorem, Tchebysheff System,  Minimally Supported, Uniform Weight.