bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults
Authors: Goyal Parag , Anderson Timothy S. , Bernacki Gwen M. , Marcum Zachary A. , Orkaby Ariela R. , Kim Dae , Zullo Andrew , Krishnaswami Ashok , Weissman Arlene , Steinman Michael A. , Rich Michael W.
Published: September 2019

BACKGROUND/OBJECTIVES

Guideline‐based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties.

DESIGN

National cross‐sectional survey.

SETTING

Ambulatory.

PARTICIPANTS

Random sample of geriatricians, general internists, and cardiologists from the American College of Physicians.

MEASUREMENTS

Electronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases.

RESULTS

In each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists).

CONCLUSIONS

While barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician‐physician and physician‐patient communication. J Am Geriatr Soc 68:78–86, 2019
Cognitive Performance Among Older Persons in Japan and the United States
Authors: Saito Yasuhiko , Kim Jung Ki , Davarian Shieva , Hagedorn Aaron , Crimmins Eileen M.
Published: September 2019

OBJECTIVE

To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance.

DESIGN

Nationally representative studies with harmonized collection of data on cognitive functioning.

SETTING

Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study.

PARTICIPANTS

A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older.

MEASUREMENTS

Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s.

RESULTS

Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20‐point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5‐point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years.

CONCLUSION

Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. J Am Geriatr Soc 68:354–361, 2020
Nurses’ Role in Implementing and Sustaining Acute Telemedicine: A Mixed‐Methods, Pre‐Post Design Using an Extended Technology Acceptance Model
Authors: Bagot Kathleen , Moloczij Natasha , Arthurson Lauren , Hair Casey , Hancock Shaun , Bladin Christopher F. , Cadilhac Dominique A.
Published: September 2019

Purpose

Technology‐based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non‐nurses.

Design

A mixed‐methods, pre‐post design with implementation of a new acute stroke telemedicine service.

Methods

A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014–2017). Open‐ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses’ semistructured interviews at the first telemedicine site (2010–2011) was completed to provide greater explanatory detail.

Findings

Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non‐nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non‐nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships).

Conclusions

Important factors for acute stroke telemedicine varied between nurses and non‐nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non‐nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required.

Clinical Relevance

Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence‐based implementation strategies must be tailored over time, and between nurses and non‐nurses, to ensure initial uptake and ongoing use.
Reduced matrix metalloproteinase and collagen transcription mediated by the TGF‐β/Smad pathway in passaged normal human dermal fibroblasts
Authors: Kim Young Il , Kim Kyung Sook , Ahn Hye‐Jin , Kang In‐Hye , Shin Min Kyung
Published: September 2019

Background

Transforming growth factor‐β (TGF‐β) is a major regulator of extracellular matrix (ECM) events, particularly collagen production.

Aim

We explored whether the expression of matrix metalloproteinases (MMPs) and collagen are transcriptionally regulated by the TGF‐β and Smad signaling pathways, and the roles played by NF‐κB and mitogen‐activated protein kinase (MAPK) signaling in normal, aged, human dermal fibroblasts.

Methods

We quantified mRNA and protein expression using real‐time PCR and immunoblotting of proteins from cells in passage 5‐15.

Results

The levels of mRNAs encoding TGF‐β1, TGF‐β3, and TGF‐β receptor type I (TGFβ RI) decreased with increasing passage number. The levels of mRNAs encoding TGF‐β2, TGFβ RII, and TGFβ RIII increased to passage 10 but decreased by passage 15. The levels of mRNAs encoding Smad‐2, ‐3, ‐4, and ‐7 decreased with increasing passage number. The level of mRNA encoding MMP‐1 increased with increasing passage number, and the levels of mRNAs encoding MMP‐2, TIMP‐1, and TIMP‐2 increased to passage 10 but decreased by passage 15. The levels of mRNAs encoding collagen types I and II decreased with increasing passage number. At the protein level, NF‐κB, IκBα, p38, ERK, Akt, and JNK became increasingly phosphorylated at higher passage numbers.

Conclusion

Our results suggest that reductions in the expression levels of MMPs and collagen types I and III in aging human dermal fibroblasts reflect reduced expression of TGF‐β/Smad and TGF‐β receptors, thus compromising the TGF‐β receptor‐binding capacity of fibroblasts; the NF‐κB and Akt‐JNK/MAPK signaling pathways may play active roles in this process.
Biology of the vernix caseosa: A review
Authors: Nishijima Koji , Yoneda Makoto , Hirai Takayoshi , Takakuwa Koichi , Enomoto Takayuki
Published: September 2019

The vernix caseosa is a complex membranous structure comprising 80% water, 10% protein, and 10% lipids including barrier lipids such as ceramides, free fatty acids, phospholipids and cholesterol, synthesized partly by fetal sebaceous glands during the last trimester of pregnancy in an antero‐posterior and dorsoventral manner. Because of its lipid content, vernix is hydrophobic and protects the skin from excessive water exposure during the development of the stratum corneum. The vernix caseosa has various functions during fetal transition from an intrauterine to an extrauterine environment, including lubrication of the birth canal during parturition, barrier function to prevent water loss, temperature regulation, for innate immunity and for intestinal development. This review discusses the evidence supporting the prenatal and postnatal functions of vernix caseosa, along with its structure, composition, and physical and biological characteristics. Understanding the biology of the vernix may facilitate improved care of preterm infants immediately post‐partum.
Social identity management strategies of women in STEM fields
Authors: Ryan Ann Marie , King Danielle D. , Elizondo Fabian , Wadlington Patrick
Published: September 2019

Recruiting and retaining women in science, technology, engineering, and mathematics (STEM) occupations is seen as challenging, and researchers have begun to consider how women manage their identity in these contexts in response to potential questions of fit. Within identity management theoretical work, there has been little attention to occupational influences. Based on role congruity theory, we investigate occupational characteristics as influences on women's gender identity management, along with individual differences and organizational support influences. Results suggest that engaging in identity management behaviours is unrelated to the gender stereotypicality or gender composition of the field, but that support, fit (i.e., congruence between the interests of the individual and occupation), and personality affect engagement in these behaviours. Implications for enhancing the experiences of women in STEM fields as well as for social identity‐related research more broadly are discussed.

Practitioner points

Individuals may differ in how they choose to address stigmatization at work, based on their personality and fit with the position.

Perceived organizational support is associated with willingness to engage in stigmatization confronting strategies.

Efforts to understand and affect identity management strategy use should consider individual characteristics (i.e., interests and personality).
Heterogeneous impacts of China's economic and development zone program
Authors: Howell Anthony
Published: September 2019

This paper examines the impact of economic and development zones (EDZs) on the productivity of incumbent firms in China. To deal with the selection issue, I first take into account potentially different selection mechanisms across two popular types of EDZs—economic and technological development zones (ETDZs) and high‐tech development zones (HTDZs)—by relying on multiple treatment propensity scores matching techniques. Next, I apply the difference‐in‐differences estimator to the matched sample and conduct an event study analysis. The results show that the respective effects of ETDZs and HTDZs on firm productivity are positive, but subject to a nonlinear trend over time. The size of the productivity gains depends critically on the type of EDZ, however. A new HTDZ (ETDZ) leads to an average productivity gain of up to 30.2% (18.4%) for incumbent firms in the 5 years after the zone was created. These findings suggest that the size of productivity spillovers for spatially targeted firms differ quite significantly depending on the strategic development and policy goals of the EDZ: HTDZs that focus on promoting indigenous‐based factors of learning lead to higher productivity spillovers compared with ETDZs that focus on promoting extra‐local linkages.
Parental Mental Health Associated With Child Overweight and Obesity, Examined Within Rural and Urban Settings, Stratified by Income
Authors: Foster Byron A. , Weinstein Kelsey , Mojica Cynthia M. , Davis Melinda M.
Published: September 2019

Purpose

Rural areas experience greater childhood obesity compared with urban areas. Differences in reported physical activity and dietary intake do not fully explain the disparity. The purpose of this study was to examine the association between parental mental health and childhood obesity within urban and rural areas.

Methods

We used data from the National Survey of Children's Health, 2016, subset to children age 10‐17 with available weight data. We stratified the sample by rural and urban settings and examined whether maternal or paternal mental health was associated with child overweight or obesity, accounting for income stratum (low‐income: ≤200% federal poverty line; high‐income: >200% federal poverty line). We used multivariable analyses to test if associations remained after including covariates of food security, physical activity, and screen time.

Findings

For the 14,733 children 10‐17 years of age in our sample, family income but not rurality was associated with overweight or obesity. Among high‐income families, positive mental health of either the mother or the father was associated with lower odds of overweight or obesity. In multivariable models, the association between positive maternal mental health and lower odds of child overweight/obesity persisted after adjustment for family food security, child physical activity, and child screen time. For paternal mental health, the association was not significant after adjusting for these covariates.

Conclusions

After stratification by income, there were no differences in childhood overweight/obesity by rurality. Both maternal and paternal mental health are associated with children's weight, though only the maternal association remains after adjusting for covariates.
Debunking the myth that the majority of medical errors are attributed to communication
Authors: Clapper Timothy C , Ching Kevin
Published: September 2019

Context

Many articles, book chapters and presentations begin with a declaration that the majority of medical errors are attributed to communication. However, this statement may not be supported by the research reported in the literature.

Objectives

The purpose of this systematic review is to identify where errors are reported in the research literature.

Methods

A systematised review was conducted of research articles over the last 20 years (1998‐2018) indexed in PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health (CINAHL) using term combinations: medical errors, research and communication. Inclusion was based on reported generalised primary research of medical error and the reported causes.

Results

This systematised review resulted in 2881 research articles, which produced 42 that met the inclusion criteria. Although there was some overlap, three categories of errors were dominant in this research: errors of commission (20 articles; 47.6%), errors of omission (six articles; 14.2%) and errors through communication (four articles; 9.5%). There were 12 (28.5%) articles in which all three categories together significantly contributed to error. Of these 12 articles, errors of commission or omission were dominant in nine articles (21.4%) and errors of communication were prevalent in only three articles (7%).

Conclusions

The assertion that the majority of medical errors can be attributed to miscommunication is not supported by this systematic review. Overwhelmingly, most reported errors are attributed to errors of omission or commission. Intentionally or unintentionally providing misinformation may mislead patient safety initiatives, and research and funding agency priorities.
Medical student views of and responses to expectations of professionalism
Authors: Stubbing Evangeline A , Helmich Esther , Cleland Jennifer
Published: September 2019

Context

To earn society's trust, medical students must develop professional values and behaviours via a transformative process, from lay person to doctor. Yet students are expected to epitomise the values and behaviours of a doctor from the outset of medical school, leading them to feel ‘judged all the time’ (in terms of their professionalism). Our aim, therefore, is to extend knowledge exploring the expectations communicated to and perceived by medical students and to provide a conceptually framed understanding of students’ associated emotional tensions.

Methods

We used a qualitative exploratory case study methodology within a constructivist paradigm to explore the messages communicated about professionalism and students’ perceived expectations of professionalism in one medical school. Data were collected in the form of: (i) regulatory and medical school documents, and (ii) focus groups with 23 participants in their first 2 years at medical school. We used thematic analysis for data interpretation and two theoretical lenses, Amalberti et al.'s framework of system migration for health care and Sinclair's adaptation of Goffman's dramaturgical theory, to critically analyse the results.

Results

We found messages and perceived expectations of knowledge and competence, and the need to ensure trust. We also identified that the expectations of patients, doctors, society, family and friends are just as, if not more, influential than policy and regulatory expectations for early years’ medical students. Moreover, we found tensions, with students feeling that the expectations of them from others were unrealistic for their level of training. With this came a sense of pressure to meet expectations that participants responded to by acting as if already competent.

Conclusions

Our findings suggest that external forces (expectations) drive early years’ students to act as if competent. Although this is part of student identity formation it could also have implications for patient safety and therefore necessitates recognition and support from educators.
Emotional challenges of medical students generate feelings of uncertainty
Authors: Weurlander Maria , Lönn Annalena , Seeberger Astrid , Hult Håkan , Thornberg Robert , Wernerson Annika
Published: September 2019

Objectives

Health care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to in relation to the process of becoming a professional. The purpose of the study was to explore medical students’ main concerns relating to emotionally challenging situations during their medical education.

Methods

A constructivist grounded theory approach was used to explore and analyse medical students’ experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students’ undergraduate programme. A total of 14 medical students participated.

Results

Students’ main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii) perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self‐evident position on the health care team. The first two aspects relate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team.

Conclusions

In the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role.
PR Prolongation predicts inadequate resynchronization with biventricular pacing in left bundle branch block
Authors: Atwater Brett D. , Emerek Kasper , Sørensen Peter L. , Hansen Steen M. , Loring Zak , Graff Claus , Polcwiartek Christoffer , Kisslo Joseph , Søgaard Peter , Friedman Daniel J.
Published: September 2019

Background

PR interval prolongation is associated with poor outcome after cardiac resynchronization therapy (CRT) among patients with left bundle branch block (LBBB) but the mechanisms are unknown. We investigated clinical outcomes, electrocardiogram (ECG), and echocardiogram changes after CRT by PR interval.

Methods

This is a retrospective study of CRT recipients with a baseline ejection fraction ≤35% and ECG showing sinus rhythm and LBBB. Patients were stratified by baseline PR interval quartile and the primary combined endpoint was time to heart transplantation, left ventricular assist device (LVAD) implantation, or death. ECG, echocardiogram, and clinical variables were compared to identify mechanisms for observed differences in outcomes.

Results

Of 291 eligible patients, the mean age was 65 years, 60% were male, and 19% had prior atrial fibrillation. Patients with PR prolongation (quartile 4, PR > 200 ms) more frequently had a history of atrial fibrillation, coronary artery bypass graft surgery, prior implantable cardioverter defibrillator implantation, and use of amiodarone than patients in PR quartiles 1‐3. A PR > 200ms was associated with an adjusted hazard ratio of 1.7 (95% CI: 1.1‐2.5) for the primary endpoint. Patients with PR > 200 ms had less reduction in QRS duration and QRS area after CRT while having more increase in QT and QTc intervals than patients with PR ≤ 200 ms. No major differences were observed in echocardiography by baseline PR interval quartiles.

Conclusions

PR prolongation predicts shorter survival free of heart transplantation or LVAD implantation in patients with LBBB. This may be due to inadequate ventricular resynchronization.
Fate of full‐house immunofluorescence staining in renal allograft: A case report
Authors: Sawada Anri , Unagami Kohei , Horita Shigeru , Kawanishi Kunio , Okumi Masayoshi , Taneda Sekiko , Ishida Hideki , Hattori Motoshi , Tanabe Kazunari , Honda Kazuho , Uchida Keiko , Shimizu Akira , Koike Junki , Nitta Kosaku , Nagashima Yoji
Published: September 2019

Here, we report the case of a patient with renal allograft with full‐house immunofluorescence staining in the zero‐hour biopsy. Full‐house immunofluorescence staining is a well‐known characteristic of lupus nephritis. Previous studies have reported patients with full‐house immunofluorescence staining, but without other symptoms or serological findings; this condition is referred to as full‐house nephropathy. We identified only one case out of 2203 zero‐hour biopsies over 13 years. Zero‐hour biopsy presented no glomerular changes but showed full‐house immunofluorescence staining. Electron microscopy revealed a nonorganized electron‐dense deposit mainly in the mesangial lesion. Systemic lupus erythematosus (SLE)‐associated antibodies were negative, and complement deficiency was not observed in the donor patients. Deposition of immunoglobulin and complement levels markedly decreased within 1–3 years post transplantation. Neither donor nor recipient developed clinical or biological features of SLE; they showed good renal prognosis.
Orchid seed sensitivity to nitrate reflects habitat preferences and soil nitrate content
Authors: Figura T. , Weiser M. , Ponert J.
Published: September 2019

Orchids are distributed around the world, however, the factors shaping their specific distribution and habitat preferences are largely unknown. Moreover, many orchids are at risk of becoming threatened as landscapes change, sometimes declining without apparent reason. One important factor affecting plant distribution is nutrient levels in the environment. Nitrates can inhibit not only orchid growth and persistence, but also seed germination.

We used in vitro axenic cultures to exactly determine the germination sensitivity of seven orchid species to nitrates and correlated this with soil properties of the natural sites and with the species’ habitat preferences.

We found high variation in response to nitrate between species. Orchids from oligotrophic habitats were highly sensitive, while orchids from more eutrophic habitats were almost insensitive. Sensitivity to nitrate was also associated with soil parameters that indicated a higher nitrification rate.

Our results indicate that nitrate can affect orchid distribution via direct inhibition of seed germination. Nitrate levels in soils are increasing rapidly due to intensification of agricultural processes and concurrent soil pollution, and we propose this increase could cause a decline in some orchid species.
Differences in Life‐Saving Obstetric Hemorrhage Treatments for Women with Abortion Versus Nonabortion Etiologies in Tanzania
Authors: Smith Lauren , Therrien Michelle Skaer , Harley Kim G. , Mbuyita Selemani , Mtema Zacharia , Kinyonge Iddajovana , Tillya Robert , Mbaruku Godfrey , Miller Suellen
Published: September 2019

Complications from unsafe abortion are among the major causes of preventable maternal morbidity and mortality, which may be compounded by delays and disparities in treatment. We conducted a secondary analysis of women with symptoms of hypovolemic shock secondary to severe obstetric hemorrhage in Tanzania. We compared receipt of three lifesaving interventions among women with abortions versus other maternal hemorrhage etiologies. Interventions included: non‐pneumatic anti‐shock garment (NASG) (N = 393), blood transfusion (N = 249), and referral to a higher‐capacity facility (N = 131). After controlling for severity of disease and other confounders, women with abortion‐related hemorrhage and shock had 78 percent decreased odds of receiving NASG (p < 0.001) and 77 percent decreased odds of receiving a blood transfusion (p < 0.001) compared to women with hemorrhage and shock from other etiologies. Our findings suggest that, in Tanzania, women with abortion‐related hemorrhage received lower quality of care than women with other hemorrhage etiologies.
Experimental models for cutaneous hypertrophic scar research
Authors: Li Jialun , Wang Jiecong , Wang Zhenxing , Xia Yun , Zhou Muran , Zhong Aimei , Sun Jiaming
Published: September 2019

Human skin wound repair may result in various outcomes with most of them leading to scar formation. Commonly seen in many cutaneous wound healing cases, hypertrophic scars are considered as phenotypes of abnormal wound repair. To prevent the formation of hypertrophic scars, efforts have been made to understand the mechanism of scarring following wound closure. Numerous in vivo and in vitro models have been created to facilitate investigations into cutaneous scarring and the development of antiscarring treatments. To select the best model for a specific study, background knowledge of the current models of hypertrophic scars is necessary. In this review, we describe in vivo and in vitro models for studying hypertrophic scars, as well as the distinct characteristics of these models. The choice of models for a specific study should be based on the characteristics of the model and the goal of the study. In general, in vivo animal models are often used in phenotypical scar formation analysis, development of antiscarring treatment, and functional analyses of individual genes. In contrast, in vitro models are chosen to pathway identification during scar formation as well as in high‐throughput analysis in drug development. Besides helping investigators choose the best scarring model for their research, the goal of this review is to provide knowledge for improving the existing models and development of new models. These will contribute to the progress of scarring studies.
Fish skin grafts compared to human amnion/chorion membrane allografts: A double‐blind, prospective, randomized clinical trial of acute wound healing
Authors: Kirsner Robert S. , Margolis David J. , Baldursson Baldur T. , Petursdottir Kristin , Davidsson Olafur B. , Weir Dot , Lantis John C.
Published: September 2019

Chronic, nonhealing wounds consume a great deal of healthcare resources and are a major public health problem, associated with high morbidity and significant economic costs. Skin grafts are commonly used to facilitate wound closure. The grafts can come from the patient's own skin (autograft), a human donor (allograft), or from a different species (xenograft). A fish skin xenograft from cold‐water fish (Atlantic cod, Gadus morhua) is a relatively recent option that shows promising preclinical and clinical results in wound healing. Chronic wounds vary greatly in etiology and nature, requiring large cohorts for effective comparison between therapeutic alternatives. In this study, we attempted to imitate the status of a freshly debrided chronic wound by creating acute full‐thickness wounds, 4 mm in diameter, on healthy volunteers to compare two materials frequently used to treat chronic wounds: fish skin and dHACM. The purpose is to give an indication of the efficacy of the two therapeutic alternatives in the treatment of chronic wounds in a simple, standardized, randomized, controlled, double‐blind study. All volunteers were given two identical punch biopsy wounds, one of which was treated with a fish skin graft and the other with dehydrated human amnion/chorion membrane allograft (dHACM). In the study, 170 wounds were treated (85 wounds per group). The primary endpoint was defined as time to heal (full epithelialization) by blinded assessment at days 14, 18, 21, 25, and 28. The superiority hypothesis was that the fish skin grafts would heal the wounds faster than the dHACM. To evaluate the superiority hypothesis, a mixed Cox proportional hazard model was used. Wounds treated with fish skin healed significantly faster (hazard ratio 2.37; 95% confidence interval: (1.75–3.22; p = 0.0014) compared with wounds treated with dHACM. The results show that acute biopsy wounds treated with fish skin grafts heal faster than wounds treated with dHACM.
Effect of Tool Pin Profile on the Microstructure and Tribological Properties of Friction Stir Processed Al-20 wt% Mg2Si Composite
Authors: Moharrami A. , Razaghian A. , Emamy M. , Taghiabadi R.
Published: September 2019

This study was undertaken with the aim of modifying the microstructure and improving the tribological properties of in situ Al-20Mg2Si composite. For this purpose, friction stir processing (FSP) was applied on the composite at constant travel and rotation speeds of 110 mm/min and 1500 rpm, respectively, using three different tool pin profiles: threaded tapered cylindrical, triangular tapered, and triangular threaded tapered. The sliding wear tests were conducted using a pin-on-disc apparatus under the applied load of 30 N and sliding distance of 1000 m at room temperature. The results showed that FSP substantially improved tribological properties of the as-cast composite. The best result was observed in the sample processed by the threaded triangular tapered tool, where compared with the as-cast composite, its wear rate and average friction coefficient decreased by almost 40% and 18%, respectively. This improvement can be attributed to the significant refinement and uniform redistribution of Mg2Si intermetallics, especially the coarse irregular-shaped primary crystals, the formation of ultrafine grains, and elimination of casting defects from the substrate microstructure of the processed sample, which improves its hardness and increased its potential in supporting the oxide tribolayer on the composite surface.
The relative size of auditory scenes of multiple talkers
Authors: Yost William A. , Pastore M. Torben , Pulling Kathryn R.
Published: September 2019

Normal hearing listeners discriminated a change in the number of talkers speaking consonant-vowel pairs between two auditory scenes. The number of talkers (n = 2, 4, 6, or 8) in one scene was incremented by Δn talkers (Δn = 1–8 talkers, depending on n) in the other scene. The perceptual size of the auditory scene seems to be small, as discrimination performance reached an approximate 0.75 proportion correct asymptote for n > 4. The independent variable of overall level differences affected performance, but both spatial configuration and talker similarity had very little effect.
Aero-tactile integration during speech perception: Effect of response and stimulus characteristics on syllable identification
Authors: Derrick Donald , Madappallimattam Jilcy , Theys Catherine
Published: September 2019

Integration of auditory and aero-tactile information during speech perception has been documented during two-way closed-choice syllable classification tasks [Gick and Derrick (2009). Nature 462, 502–504], but not during an open-choice task using continuous speech perception [Derrick, O'Beirne, Gorden, De Rybel, Fiasson, and Hay (2016). J. Acoust. Soc. Am. 140(4), 3225]. This study was designed to compare audio-tactile integration during open-choice perception of individual syllables. In addition, this study aimed to compare the effects of place and manner of articulation. Thirty-four untrained participants identified syllables in both auditory-only and audio-tactile conditions in an open-choice paradigm. In addition, forty participants performed a closed-choice perception experiment to allow direct comparison between these two response-type paradigms. Adaptive staircases, as noted by Watson [(1983). Percept. Psychophys. 33(2), 113–120] were used to identify the signal-to-noise ratio for identification accuracy thresholds. The results showed no significant effect of air flow on syllable identification accuracy during the open-choice task, but found a bias towards voiceless identification of labials, and towards voiced identification of velars. Comparison of the open-choice results to those of the closed-choice task show a significant difference between both response types, with audio-tactile integration shown in the closed-choice task, but not in the open-choice task. These results suggest that aero-tactile enhancement of speech perception is dependent on response type demands.
Consecutive aquatic jump-gliding with water-reactive fuel
Authors: Zufferey R. , Ancel A. Ortega , Farinha A. , Siddall R. , Armanini S. F. , Nasr M. , Brahmal R. V. , Kennedy G. , Kovac M.
Published: September 2019

Lightweight robots are capable of repeated aquatic jump-gliding through high-powered jet propulsion with water-reactive fuel.
Ventricular stroke work and vascular impedance refine the characterization of patients with aortic stenosis
Authors: Ben-Assa Eyal , Brown Jonathan , Keshavarz-Motamed Zahra , de la Torre Hernandez Jose M. , Leiden Benjamin , Olender Max , Kallel Faouzi , Palacios Igor F. , Inglessis Ignacio , Passeri Jonathan J. , Shah Pinak B. , Elmariah Sammy , Leon Martin B. , Edelman Elazer R.
Published: September 2019

High left ventricular stroke work and low vascular impedance predict better quality of life after valve intervention in patients with aortic stenosis.
The hunt for a cure for Alzheimer’s disease receives a timely boost
Authors: Yadav Vikramaditya G.
Published: September 2019

Therapeutic strategy based on inhibition of tau hyperphosphorylation performs better than glutamate uptake by astrocytes in a mouse model.
Strain-Specific Differences in Survival of
Campylobacter
spp. in Naturally Contaminated Turkey Feces and Water
Authors: Good Lesley , Miller William G. , Niedermeyer Jeffrey , Osborne Jason , Siletzky Robin M. , Carver Donna , Kathariou Sophia
Published: September 2019

Campylobacter jejuni
and
Campylobacter coli
are leading foodborne pathogens, with poultry as a major reservoir. Due to their growth requirements, these
Campylobacter
spp. may be unable to replicate once excreted by their avian hosts, but their survival in feces and the environment is critical for transmission in the farm ecosystem. Reducing the prevalence of
Campylobacter
-positive flocks can have major impacts in controlling both contamination of poultry products and environmental dissemination of the pathogens. However, understanding the capacity of these pathogens to survive in transmission-relevant vehicles such as feces and farmhouse water remains poorly understood, and little information is available on species- and strain-associated differences in survival. Here, we employed model conditions to investigate the survival of
C. jejuni
and
C. coli
from naturally colonized turkey flocks, and with diverse genotypes and antimicrobial resistance profiles, in turkey feces and in farmhouse water.
Solar and Climate Effects Explain the Wide Variation in Legionellosis Incidence Rates in the United States
Authors: Han Xiang Y.
Published: September 2019

Legionellosis, caused by the environmental bacteria
Legionella
spp., has become a significant public health problem in the United States in recent years, with ∼6,000 cases annually. The present study showed, through a series of correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours, that these environmental conditions strongly influence the legionellosis incidence rates across the United States in mixed and dynamic fashions. The incidence rates varied remarkably by region, with the highest in Ohio and New York and the lowest in Alaska. A precipitation threshold above 750 mm was required for elevated legionellosis activity. Regression models and dividing lines between regions were established to show the promotive effect of temperature, as well as the inhibitive effects of solar UV and sunshine hours. These findings explain the wide variation of legionellosis incidence rates in the United States. They may also offer insights into potential exposure to and prevention of infection.
Complete Genome Sequence of Cupriavidus necator H16 (DSM 428)
Authors: Little Gareth T. , Ehsaan Muhammad , Arenas-López Christian , Jawed Kamran , Winzer Klaus , Kovacs Katalin , Minton Nigel P.
Published: September 2019

The hydrogen-utilizing strain
Cupriavidus necator
H16 (DSM 428) was sequenced using a combination of PacBio and Illumina sequencing. Annotation of this strain reveals 6,543 protein-coding genes, 263 pseudogenes, 64 tRNA genes, and 15 rRNA genes.
Birth asphyxia following delayed recognition and response to abnormal labour progress and fetal distress in a 31-year-old multiparous Malawian woman
Authors: Löwensteyn Yvette N , Housseine Natasha , Masina Thokozani , Browne Joyce L , Rijken Marcus J
Published: September 2019

Reducing neonatal mortality is one of the targets of Sustainable Development Goal 3 on good health and well-being. The highest rates of neonatal death occur in sub-Saharan Africa. Birth asphyxia is one of the major preventable causes. Early detection and timely management of abnormal labour progress and fetal compromise are critical to reduce the global burden of birth asphyxia. Labour progress, maternal and fetal well-being are assessed using the WHO partograph and intermittent fetal heart rate monitoring. However, in low-resource settings adherence to labour guidelines and timely response to arising labour complications is generally poor. Reasons for this are multifactorial and include lack of resources and skilled health care staff. This case study in a Malawian hospital illustrates how delayed recognition of abnormal labour and prolonged decision-to-delivery interval contributed to birth asphyxia, as an example of many delivery rooms in low-income country settings.
Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata
Authors: Bashar Abul Khair Mohammad , Akter Khaleda , Chaudhary Govind Kumar , Rahman Asifur
Published: September 2019

Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with sinus tract can be conservatively healed with endodontic treatment alone.
Imatinib-induced pericardial effusion in a child
Authors: Terry Charlotte , Avery Pascale , Morton Sarah , Aron Jon
Published: September 2019

A 12-year-old boy presented with central chest pain, shortness of breath and type 1 respiratory failure. He had a background of graft versus host disease (GvHD), which was currently managed with imatinib therapy. A focused bedside ultrasound scan was performed revealing a large pericardial effusion. The child was referred to a tertiary paediatric cardiology centre where he underwent emergency pericardiocentesis, draining a total of 800 mL of pericardial fluid. Fluid analysis excluded infection, and with no other concerns for a GvHD flare the diagnosis of an imatinib-induced pericardial effusion was made. On terminating the therapy, the pericardial collection did not reaccumulate. Tyrosine kinase inhibitor-induced pericardial and/or pleural effusion should be considered as a differential diagnosis in paediatric patients on this therapy presenting in a similar manner.
Adrenal lymphoma presenting as primary hypoadrenalism in the elderly
Authors: Bhargava Raghav , Dixon Anthony
Published: September 2019

Adrenal lymphoma causing primary hypoadrenalism in the elderly is a very rare finding. We describe a case of an 85-year-old man who was admitted to our hospital. He had a short history of hypotension and unresponsiveness. He was referred to the endocrine team, after a CT scan of his thorax abdomen and pelvis demonstrated significant enlargement of both his adrenal glands with associated lymphadenopathy. This scan was originally done to rule out an occult intra-abdominal malignancy. In addition, a tetracosactide (short Synacthen) test demonstrated adrenal insufficiency. This case demonstrates that adrenal lymphoma should be considered as an important differential when there is evidence of adrenal gland hyperplasia, lymphadenopathy and adrenal insufficiency.
Suprapubic versus prepubic sinus: a literature review
Authors: Mostafa Mohamed Saber , Darwish Ahmed AbdElhamid
Published: September 2019

Urachal sinus usually presents with umbilical discharge and the opening can rarely be located between the umbilicus and the symphysis pubis and the so called suprapubic sinus (SPS). There is another different entity of cases reported in literature with a similar presentation but with an opening anywhere between the umbilicus and symphysis pubis but differs from SPS in the pathway of the tract and the epithelial lining. We report a case of a 2-year-old boy presenting with a prepubic sinus that was managed with surgical excision. After a thorough literature review, we compare our case to other prepubic and SPS.
Simultaneous acute appendicitis in identical twin boys
Authors: Kovler Mark L , Jelin Eric B
Published: September 2019

Acute appendicitis is one of the most common causes of abdominal pain in children but remains a diagnostic challenge, and insight into the aetiology of the condition is lacking. A case of simultaneous acute appendicitis in monozygotic twin boys is reported here. Familial aggregation in acute appendicitis has been described, but the underlying causes for this are not well understood. The patients reported here were both genetically identical and lived a mostly identical lifestyle. Their simultaneous presentation would be exceedingly rare if explained entirely by chance, suggesting a role for both genetic and environmental influences. Increased knowledge of this occurrence may assist in prompt diagnosis and reporting on the incidence and timing of appendicitis in monozygotic twins could better elucidate the genetic and environmental factors that predispose to this disease.
Risk factors for further sick leave among Japanese workers returning to work after an episode of major depressive disorder: a prospective follow-up study over 1 year
Authors: Hori Hikaru , Katsuki Asuka , Atake Kiyokazu , Yoshimura Reiji , Nakamura Jun , Baune Bernhard T
Published: September 2019

Objectives

We aimed to investigate the risk factors for further sick leave episodes among Japanese workers returning to work after time off with a major depressive disorder.

Design

A prospective study with 1 year of follow-up.

Participants

We recruited 103 workers who had returned to work after taking sick leave with a major depressive disorder. Adjusted HRs with 95% CIs were calculated using Cox proportional hazard models to examine the risk of further sick leave.

Results

In the adjusted analysis, we show that Social Adaptation Self-evaluation Scale scores (HR 0.95; p=0.019), 3-back correct response rate (N-back test) (HR 0.97; p<0.001) and benzodiazepine dosage (diazepam equivalent) (HR1.07; p=0.014) were associated with further episodes of sick leave.

Conclusions

Poorer social and cognitive functioning, together with higher diazepam dosages, were associated with an increased likelihood of additional sick leave.