bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlations Between Hourly Pupillometer Readings and Intracranial Pressure Values
Authors: McNett Molly , Moran Cristina , Janki Clare , Gianakis Anastasia
Published: June 2017

Introduction: Automated pupillometry is emerging as a mainstay in neurocritical care primarily because it overcomes limitations of manual pupillary examinations. Although several recent studies show improved assessment accuracy with a pupillometer, few investigate clinical use, specifically how well parameters correlate with multimodality monitoring and outcomes. The primary aim of this study was to examine correlations between serial pupillometer readings and intracranial pressure (ICP) values among neurocritically ill patients. Design: Prospective cohort, repeated measures. Sample: The study sample was composed of adult patients with neurological injury who were admitted to intensive care unit, requiring hourly neurological assessment and pupillary checks within a level I trauma, urban, academic medical center. Procedures: Hourly pupillometer readings and corresponding ICP values were consecutively recorded for 72 hours after intensive care unit admission. Results: Serial assessments resulted in more than 2100 pupillometer readings from 76 subjects. Mean age of the study sample was 55.4 years, with a mean Glasgow Coma Scale score of 8.9. The mean pupillometer values for the enrolled subjects included left constriction velocity of 1.22, left neurological pupil index of 4.21, left pupil size of 2.69, right constriction velocity of 1.18, right neurological pupil index of 4.18, and right pupil size of 2.57. The mean ICP of the study sample was 12, with mean cerebral perfusion pressure of 77. Pupillometer values significantly correlated with ICP values in bivariate (P < .001, r = 0.13–0.23) and multivariate regression models (F(6) = 17.63, P < .001). Conclusions: Automated pupillometry in neurocritical care is a valuable adjunct to traditional invasive monitoring. Integration of routine pupillometer assessments not only improves accuracy of examinations but also correlates with ICP values.
Establishing Normative Data for Pupillometer Assessment in Neuroscience Intensive Care: The “END-PANIC” Registry
Authors: Olson DaiWai M. , Stutzman Sonja E. , Atem Folefac , Kincaide Julia D. , Ho Thuy-Tien , Carlisle Byron A. , Aiyagari Venkatesh
Published: June 2017

Background: Trained medical practitioners have been assessing the pupillary light reflex for more than 2 millennia. However, the interrater reliability of the pupillary light reflex remains low. To overcome the drawbacks of a subjective interpretation of pupillary size and reactivity, automated pupillometers are becoming increasingly commonplace, but practitioners do not have adequate data from which to judge whether the numerical values provided by the pupillometer are “within reference limits.” Methods: This article details the methods used to create an extensive database of automated pupillometer readings and associated patient data (eg, intracranial pressure). Discussion/Conclusions: The “Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care” Registry will provide a large data set of pupillary size, reactivity, and speed of contraction in a cohort of patients admitted to a neuroscience intensive care unit with a variety of conditions. Analysis of this data set will help establish normative data for pupillometer readings for neurologically impaired patients. Exploratory analysis of this data set may also provide preliminary hypothesis generating data for future prospective studies on pupillary findings and trends in acute neurological conditions.
A Membrane Lung Design Based on Circular Blood Flow Paths
Authors: Fernando Uditha Piyumindri , Thompson Alex J. , Potkay Joseph , Cheriyan Hannah , Toomasian John , Kaesler Andreas , Schlanstein Peter , Arens Jutta , Hirschl Ronald B. , Bull Joseph L. , Bartlett Robert H.
Published: June 2017

Current hollow fiber membrane lungs feature a predominantly straight blood path length across the fiber bundle, resulting in limited O2 transfer efficiency because of the diffusion boundary layer effect. Using computational fluid dynamics and optical flow visualization methods, a hollow fiber membrane lung was designed comprising unique concentric circular blood flow paths connected by gates. The prototype lung, comprising a fiber surface area of 0.28 m2, has a rated flow of 2 L/min, and the oxygenation efficiency is 357 ml/min/m2. The CO2 clearance of the lung is 200 ml/min at the rated blood flow. Given its high gas transfer efficiency, as well as its compact size, low priming volume, and propensity for minimal thrombogenicity, this lung design has the potential to be used in a range of acute and chronic respiratory support applications, including providing total respiratory support for infants and small children and CO2 clearance in adults.
A Pragmatic Approach to the Application of the Code of Ethics in Nursing Education
Authors: Tinnon Elizabeth , Masters Kathleen , Butts Janie
Published: June 2017

The code of ethics for nurses was written for nurses in all settings. However, the language focuses primarily on the nurse in context of the patient relationship, which may make it difficult for nurse educators to internalize the code to inform practice. The purpose of this article is to explore the code of ethics, establish that it can be used to guide nurse educators' practice, and provide a pragmatic approach to application of the provisions.
The Need to Promote Sexual Health in America: A New Vision for Public Health Action
Authors: Ford Jessie V. , Ivankovich Megan B. , Douglas John M. , Hook Edward W. , Barclay Lynn , Elders Joycelyn , Satcher David , Coleman Eli
Published: June 2017

Sexual health is considered to be a state of wellness with physical, emotional, mental, and social dimensions. Sexual health can contribute to our overall well-being in each of these dimensions. However, despite the intrinsic importance and positive aspects of sexuality in our lives, the United States presently faces significant challenges related to the sexual health of its citizens, including human immunodeficiency virus, other sexually transmitted infections, viral hepatitis, unintended pregnancies, sexual violence, sexual dysfunction, and cancers in reproductive tracts with serious disparities among the populations affected. In particular, high rates of poverty, income inequality, low educational attainment, stigma, racism, sexism, and homophobia can make it more difficult for some individuals and communities to protect their sexual health. Given that many pressing public health issues in the United States are related to sexual health and that sexual health has been increasingly recognized as an important national health priority, now is the time to energize and focus our efforts toward optimal sexual health of the population. In this paper, we outline the rationale for addressing sexual health as a means to better promote overall health and address sexuality related morbidities. In addition, we present a logic model outlining an approach for advancing sexual health in the United States, as well as a range of action steps for consideration by public health practitioners, researchers, and policymakers.
Determinants of Antibiotic Tailoring in Pediatric Intensive Care: A National Survey*
Authors: Fontela Patricia S. , Quach Caroline , Karim Mohammad E. , Willson Douglas F. , Gilfoyle Elaine , McNally James Dayre , Gonzales Milagros , Papenburg Jesse , Reynolds Steven , Lacroix Jacques
Published: June 2017

Objectives:

To describe the criteria that currently guide empiric antibiotic treatment in children admitted to Canadian PICUs.

Design:

Cross-sectional survey.

Setting:

Canadian PICUs.

Subjects:

Pediatric intensivists and pediatric infectious diseases specialists.

Interventions:

None.

Measurements and Main Results:

We used focus groups and literature review to design the survey questions and its four clinical scenarios (sepsis, pneumonia, meningitis, and intra-abdominal infections). We analyzed our results using descriptive statistics and multivariate linear regression. Our response rate was 60% for pediatric intensivists (62/103) and 36% for pediatric infectious diseases specialists (37/103). Variables related to patient characteristics, disease severity, pathogens, and clinical, laboratory, and radiologic infection markers were associated with longer courses of antibiotics, with median increment ranging from 1.75 to 7.75 days. The presence of positive viral polymerase chain reaction result was the only variable constantly associated with a reduction in antibiotic use (median decrease from, –3.25 to –8.25 d). Importantly, 67–92% of respondents would still use a full course of antibiotics despite positive viral polymerase chain reaction result and marked clinical improvement for patients with suspected sepsis, pneumonia, and intra-abdominal infection. Clinical experience was associated with shorter courses of antibiotics for meningitis and sepsis (–1.3 d [95% CI, –2.4 to –0.2] and –1.8 d [95% CI, –2.8 to –0.7] per 10 extra years of clinical experience, respectively). Finally, site and specialty also influenced antibiotic practices.

Conclusions:

Decisions about antibiotic management for PICU patients are complex and involve the assessment of several different variables. With the exception of a positive viral polymerase chain reaction, our findings suggest that physicians rarely consider reducing the duration of antibiotics despite clinical improvement. In contrast, they will prolong the duration when faced with a nonreassuring characteristic. The development of objective and evidence-based criteria to guide antibiotic therapy in critically ill children is crucial to ensure the rational use of these agents in PICUs.
Diabetic Myopathy: current molecular understanding of this novel neuromuscular disorder
Authors: Monaco Cynthia M.F. , Perry Christopher G.R. , Hawke Thomas J.
Published: June 2017

Purpose of review

Here we summarize the evidence from human studies of the impairments to the structural, functional, and metabolic capacities in skeletal muscle in those with type 1 diabetes (T1D) – a condition known as diabetic myopathy. Given the importance of skeletal muscle for blood lipid and glucose management, the development and progression of diabetic myopathy would not only lead to increased insulin resistance, but also impact the ability to mitigate dysglycemic/dyslipidemic burdens.

Recent findings

Despite the importance of skeletal muscle in whole-body metabolic control, studies investigating diabetic myopathy are startling limited. Recent findings have demonstrated that those with T1D exhibit decreased force production, increased fatigability, loss of muscle stem cells, and a greater reliance on glycolytic metabolism, as a result of reduced mitochondrial capacity.

We propose a mechanistic model for the development of diabetic myopathy based on the human findings to date. This model suggests that repeated insulin injections in those with T1D leads to recurrent periods of intracellular hyperglycemia in myofibers. Resultant reductions in mitochondrial function lead to greater reliance on glycolytic metabolism and a concomitant shift in fiber type composition. Studies defining the scope and magnitude of diabetic myopathy and testing the veracity of this model are urgently needed in order to develop appropriate therapeutic strategies to maximize muscle health in those with T1D.
Distinct epigenetic shift in a subset of Glioma CpG island methylator phenotype (G-CIMP) during tumor recurrence
Authors: de Souza Camila Ferreira , Sabedot Thais S. , Malta Tathiane M. , Stetson Lindsay , Morozova Olena , Sokolov Artem , Laird Peter W. , Wiznerowicz Maciej , Iavarone Antonio , Snyder James , deCarvalho Ana , Sanborn Zachary , McDonald Kerrie L. , Friedman William A. , Tirapelli Daniela , Poisson Laila , Mikkelsen Tom , Carlotti Carlos G. , Kalkanis Steven , Zenklusen Jean , Salama Sofie R. , Barnholtz-Sloan Jill S. , Noushmehr Houtan
Published: June 2017

Histomorphology and current grading schemes are unable to predict glioma relapse and malignant tumor progression. We reported that the IDH-mutant associated Glioma-CpG Island Methylator Phenotype (G-CIMP) can be further divided into two clinically distinct subtypes independent of histopathological grading (G-CIMP-high and -low) with evidence of correlation with tumor progression. Here we performed a comprehensive epigenomic analysis of 74 longitudinally collected glioma samples (grade II-IV) to understand malignant recurrence from G-CIMP-high to G-CIMP-low. G-CIMP-low recurrence appeared in 12% of all gliomas and resemble IDH-wildtype primary glioblastoma. G-CIMP-low recurrence can be characterized by distinct epigenetic changes at candidate functional tissue enhancers with AP-1/SOX binding elements, stem cell-like epigenomic phenotype, and genomic instability. Finally, we defined a set of candidate biomarker signatures that predict recurrence of G-CIMP-low with clinically relevance on patient outcomes. Our study provides opportunity for refined clinical trial designs and therapeutic targets that limit progression to more aggressive G-CIMP-low phenotype.

HIGHLIGHTS

Indolent G-CIMP-high progresses to aggressive G-CIMP-low phenotype

Incidence of G-CIMP-low recurrent tumors are 3 times greater than G-CIMP-low primary

G-CIMP-low recurrent tumors share epigenomic features with IDH-wildtype primary GBM

Predictive biomarkers of G-CIMP-low progression at primary diagnosis
A Bulky Glycocalyx Fosters Metastasis Formation by Promoting G1 Cell Cycle Progression
Authors: Woods Elliot C. , Barnes J. Matthew , Pickup Michael W. , Pedram Kayvon , Kai FuiBoon , Hollander Michael J. , Weaver Valerie M. , Bertozzi Carolyn R.
Published: June 2017

Metastasis depends upon cancer cell growth and survival within the metastatic niche. Tumors which remodel their glycocalyces, by overexpressing bulky glycoproteins like mucins, exhibit a higher predisposition to metastasize, but the role of mucins in oncogenesis remains poorly understood. Here we report that a bulky glycocalyx promotes the expansion of disseminated tumor cellsin vivoby fostering integrin adhesion assembly to permit G1 cell cycle progression. We engineered tumor cells to display glycocalyces of various thicknesses by coating them with synthetic mucin-mimetic glycopolymers. Cells adorned with longer glycopolymers showed increased metastatic potential, enhanced cell cycle progression, and greater levels of integrin-FAK mechanosignaling and Akt signaling in a syngeneic mouse model of metastasis. These effects were mirrored by expression of the ectodomain of cancer-associated mucin MUC1. These findings functionally link mucinous proteins with tumor aggression, and offer a new view of the cancer glycocalyx as a major driver of disease progression.
Human-specific changes in two functional enhancers ofFOXP2
Authors: Benítez-Burraco Antonio , Torres-Ruiz Raúl , Gelabert Xirinachs Pere , Lalueza-Fox Carles , Rodríguez-Perales Sandra , García-Bellido Paloma
Published: June 2017

Two functional enhancers ofFOXP2,a gene important for language development and evolution, exhibit several human-specific changes compared to extinct hominins that are located within the binding site for different transcription factors. Specifically, Neanderthals and Denisovans bear the ancestral allele in one position within the binding site for SMARCC1, involved in brain development and vitamin D metabolism. This change might have resulted in a different pattern ofFOXP2expression in our species compared to extinct hominins.
Universal Microfluidic System for Analysis and Control of Cell Dynamics
Authors: Zhang Ce , Tu Hsiung-Lin , Jia Gengjie , Mukhtar Tanzila , Taylor Verdon , Rzhetsky Andrey , Tay Savaş
Published: June 2017

Dynamical control of the cellular microenvironment is highly desired for quantitative studies of stem cells and immune signaling. Here, we present an automated microfluidic system for high-throughput culture, differentiation and analysis of a wide range of cells in precisely defined dynamic microenvironments recapitulating cellular niches. This system delivers complex, time-varying biochemical signals to 1,500 independently programmable cultures containing either single cells, 2-D populations, or 3-D organoids, and dynamically stimulates adherent or non-adherent cells while tracking and retrieving them for end-point analysis. Using this system, we investigated the signaling landscape of neural stem cell differentiation under combinatorial and dynamic stimulation with growth factors. Experimental and computational analyses identified “cellular logic rules” for stem cell differentiation, and demonstrated the importance of signaling sequence and timing in brain development. This universal platform greatly enhances capabilities of microfluidic cell culture, allows dissection of previously hidden aspects of cellular dynamics, and enables accelerated biological discovery.
Instantaneous Brain Dynamics Mapped to a Continuous State Space
Authors: Billings Jacob , Medda Alessio , Shakil Sadia , Shen Xiaohong , Kashyap Amrit , Chen Shiyang , Abbas Anzar , Zhang Xiaodi , Nezafati Maysam , Pan Wen-Ju , Berman Gordon , Keilholz Shella
Published: June 2017

Measures of whole-brain activity, from techniques such as functional Magnetic Resonance Imaging, provide a means to observe the brain’s dynamical operations. However, interpretation of whole-brain dynamics has been stymied by the inherently high-dimensional structure of brain activity. The present research addresses this challenge through a series of scale transformations in the spectral, spatial, and relational domains. Instantaneous multispectral dynamics are first developed from input data via a wavelet filter bank. Voxel-level signals are then projected onto a representative set of spatially independent components. The correlation distance over the instantaneous wavelet-ICA state vectors is a graph that may be embedded onto a lower-dimensional space to assist the interpretation of state-space dynamics. Applying this procedure to a large sample of resting and task data (acquired through the Human Connectome Project), we segment the empirical state space into a continuum of stimulus-dependent brain states. We also demonstrate that resting brain activity includes brain states that are very similar to those adopted during some tasks, as well as brain states that are distinct from experimentally-defined tasks. Back-projection of segmented brain states onto the brain’s surface reveals the patterns of brain activity that support each experimental state.
Technology readiness, perceived ubiquity and M-commerce adoption
Authors: Roy Subhadip , Moorthi Y.L.R.
Published: June 2017

Purpose

The purpose of this study is to draw concepts from marketing and information systems research and integrate them in the context of M-commerce. The authors develop a conceptual model of technology readiness (TR) affecting perceived ubiquity (PQ) (of smartphones) and PQ affecting M-commerce adoption (MA) incorporating the moderating effect of privacy concerns (PC) on the relation between PQ and MA along with the constructs perceived usefulness (PU) and perceived ease of use (PEU).

Methodology

The conceptual model was formulated using a set of qualitative research procedures (four focus group discussions) and tested using two questionnaire-based surveys (with 372 and 431 respondents each) in India. Exploratory and confirmatory factor analyses were conducted followed by structural equation modeling for the quantitative data.

Findings

Results from the quantitative study indicate a significant effect of TR on PQ, PU and PEU. All three latter constructs had a significant effect on MA. A significant moderating effect of PC on the relation between PQ and MA was also observed.

Research implications

The study findings enhance the literature on the antecedents of successful adoption of M-commerce and establish the role of PQ as a significant influencer of MA.

Practical implications

The study findings would enable service providers with a new and relevant model of M-commerce adoption.

Originality

The major contribution of the study is the development and validation of a model that has attitudinal variables related to technology usage and their relations to M-commerce adoption.
Antecedents of growth-oriented entrepreneurship before and during the Greek economic crisis
Authors: Giotopoulos Ioannis , Kontolaimou Alexandra , Tsakanikas Aggelos
Published: June 2017

Purpose

The purpose of this paper is to explore potential drivers of high-growth intentions of early-stage entrepreneurs in Greece before and after the onset of the financial crisis of 2008.

Design/methodology/approach

To this end, the authors use individual-level data retrieved from Global Entrepreneurship Monitor annual surveys (2003-2015).

Findings

The results show that high-growth intentions of Greek entrepreneurs are driven by different factors in the crisis compared to the non-crisis period. Male entrepreneurs and entrepreneurs with significant work experience seem to be more likely to be engaged in growth-oriented new ventures during the crisis period. The same appears to hold for entrepreneurs who are motivated by an opportunity and also perceive future business opportunities in adverse economic conditions. On the other hand, the educational level and the social contacts of founders with other entrepreneurs are found to drive ambitious Greek entrepreneurship in the years before the crisis, while they were insignificant after the crisis outbreak.

Originality/value

Based on the concept of ambitious entrepreneurship, this study contributes to the literature by investigating the determinants of entrepreneurial high-growth expectations in the Greek context emphasizing the crisis period in comparison to the pre-crisis years.
Does transitioning from family to non-family controlled firm influence internationalization?
Authors: Monreal-Pérez Joaquín , Sánchez-Marín Gregorio
Published: June 2017

Purpose

The purpose of this paper is to study the internationalization of family firms, exploring specifically if the transition from family control to non-family control (losing family managerial influence) affects a firm’s export activity.

Design/methodology/approach

Based on panel data for Spanish firms from 2006 to 2012, a random effect tobit and probit regression and a propensity score matching were run on a sample of 225 firms moving from family to non-family control (switchers) matched with 4,213 firms remaining under family control (non-switchers).

Findings

Although from a static viewpoint family controlled firms export less than their non-family counterparts, from a dynamic perspective family firms remaining under family control (non-switchers) are associated with a fall in export activity in comparison with family firms transitioning to non-family control (switchers). Both findings are related back to the socioemotional wealth (SEW) perspective.

Research limitations/implications

The findings of this study shed light on the trade-offs that family firms experience in order to balance their desire to increase their internationalization (and the risk associated with it) and their wish to maintain SEW.

Practical implications

The findings should encourage family owners and managers to take long-term strategic decisions leading to internationalization which, although risky, will prevent subsequent loss of SEW in terms of family control.

Originality/value

This work provides evidence concerning family firms’ willingness to undertake risky activities, such as internationalization, considering the threats to their wealth.
Applying “attribution theory” to determine the factors that lead to the failure of entrepreneurial ventures in Colombia
Authors: Pardo Clara , Alfonso William
Published: June 2017

Purpose

The purpose of this paper is to use attribution theory to identify the factors that contribute to the failure of entrepreneurial ventures in Colombia.

Design/methodology/approach

The research study upon which this paper is based involved an online survey. A total of 324 Colombian entrepreneurs who had experienced business failure answered this survey. The study included six factors (financial, organizational, marketing, external environment, operational, and human resources) with their respective attributions as well as a personality test and segmentation questions. Two multivariate techniques were used (principal component analysis and a multinomial distribution model) to analyze the results of the survey.

Findings

The results showed that the principal attributions of failure for Colombian entrepreneurs were financial and organizational issues, the external environment, and marketing. Specific sub-issues included insufficient income generated to maintain the business, lack of proper financing, problems with the control of the business, as well as legal and economic instability.

Practical implications

These results of this research study are important for the creation and development of policies that promote entrepreneurship in Colombia and other developing countries. The findings may also provide entrepreneurs with an analysis of the attributions that are most frequently associated with failure and related lessons, which could individually and cumulatively increase the probability of success for entrepreneurs who are starting new business ventures.

Originality/value

This study makes an important contribution to the extant entrepreneurship literature by identifying and categorizing factors associated with business failure in Colombia. In developing countries, it is especially important to analyze failure attributions to determine relevant official policy instruments that could promote successful business ventures.
The strategic hybrid orientation and brand performance of B2B SMEs
Authors: Anees-ur-Rehman Muhammad , Saraniemi Saila , Ulkuniemi Pauliina , Hurmelinna-laukkanen Pia
Published: June 2017

Purpose

The purpose of this paper is to learn how strategic hybrid orientation – constructed from brand and market orientations – is related to the brand awareness, brand credibility, and financial performance of business-to-business (B2B) small- and medium-sized enterprises (SMEs).

Design/methodology/approach

The questionnaire was used in a survey to collect data from 250 Finnish B2B SMEs. The sampled firms were categorized into four clusters according to a two-by-two matrix, and their relationships with the brand performance outcomes were examined using one-way ANOVA and multiple regression.

Findings

The results indicate that strategic hybrid orientation is positively related to all three dimensions of brand performance, showing that two dissimilar orientations can complement each other in improving brand performance outcomes. However, the strength of complementary interaction seems to vary depending on the degree to which brand- and market-oriented attributes dominate in a firm’s strategy.

Originality/value

This is one of the first studies to provide empirical evidence to support the concept of strategic hybrid orientation for branding in B2B SMEs. This study aims to contribute to existing research on SME branding by capitalizing on B2B branding and strategic management literatures.
Selective Plasma Exchange for the Removal of Pemphigus Autoantibodies, Fibrinogen, and Factor XIII in Pemphigus Vulgaris
Authors: Miyamoto Satoko , Ohkubo Atsushi , Seshima Hiroshi , Komori Shigeto , Yamamoto Motoki , Maeda Takuma , Itagaki Ayako , Yamamoto Hiroko , Nojima Kohei , Iimori Soichiro , Naito Shotaro , Kurashima Naoki , Sohara Eisei , Rai Tatemitsu , Uchida Shinichi , Okado Tomokazu
Published: June 2017

Pemphigus vulgaris is a serious autoimmune skin disorder associated with desmoglein 1 and 3. Selective plasma exchange (SePE) for pemphigus vulgaris remains unknown. We investigated the removal characteristics of pemphigus autoantibodies, immunoglobulins, and fibrinogen in three cases. When the mean processed volume for SePE was 1.2 plasma volumes, the mean percent reduction was 50.7% for desmoglein 1, 48.9% for desmoglein 3, 50.3% for IgG, 29.8% for IgA, 1.9% for IgM, and 17.6% for fibrinogen. In one case, the percent reduction after four sessions of SePE within eight days was 87.0% for desmoglein 1, 85.1% for desmoglein 3, 76.6% for IgG, 53.5% for IgA, 7.9% for IgM, 41.6% for fibrinogen, and 31.4% for factor XIII. SePE can effectively remove pemphigus autoantibodies and retain coagulation factors, e.g. factor XIII and fibrinogen. In severe cases, SePE can be useful and safe for induction therapy.
Efficacy of Cryofiltration for Treatment of Mixed Cryoglobulinemia: A Report of Four Cases
Authors: Taniyama Yoshihiro , Nakatani Yoshihisa , Matsuoka Toshiaki , Takahashi Miyo , Shimizu Kazuyuki , Yamamoto Sachiyo , Inoue Yuki , Ohnishi Sayoko , Kobayashi Norihiro , Nakano Yukihito , Takami Masahiro , Arima Shuji
Published: June 2017

Cryoglobulinemia can induce systemic vasculitis affecting various organs such as skin, peripheral nerves, and kidney. The disease can induce chronic organ failure and even be life‐threatening. Cryofiltration has been applied for the treatment of cryoglobulinemic vasculitis. We have experienced four cases with mixed cryoglobulinemia showing severe and progressive clinical manifestations, including skin purpura, nephrotic syndrome, acute kidney injury, and peripheral neuropathy. Cryofiltration in conjunction with conventional pharmacological therapies appeared to be safe and effective. After the treatments, plasma cryoglobulins were markedly reduced and the disease was well controlled. Although its efficacy has not yet been well established, this report can be another evidence showing efficacy of cryofiltration for treatment of mixed cryoglobulinemia.
Evaluating the Efficacy of Double‐Filtration Plasmapheresis in Treating Five Patients With Drug‐Resistant Pemphigus
Authors: Higashihara Takaaki , Kawase Masaaki , Kobayashi Maasa , Hara Mizuki , Matsuzaki Hiroyuki , Uni Rie , Matsumura Mimiko , Etoh Takafumi , Takano Hideki
Published: June 2017

Double‐filtration plasmapheresis is an effective and safe treatment for pemphigus. We retrospectively evaluated the decrease in autoantibody titer and pemphigus disease area index following double‐filtration plasmapheresis in five patients with moderate to severe pemphigus, who were physically and/or serologically unresponsive to 1.0 mg/kg per day of prednisolone and other supportive drugs and ointments. The percentage reduction in autoantibodies 85.6 ± 14.4% (P = 0.00014), and that in pemphigus disease area index was 75.4 ± 24.3% (P = 0.0023). No side‐effects were observed. All patients exhibited clinical improvement after undergoing double‐filtration plasmapheresis, and the prednisolone dose was reduced by 41 ± 8.9 mg (P = 0.0005) approximately 3 months after double‐filtration plasmapheresis. To our knowledge, this is the first report evaluating the efficacy of double‐filtration plasmapheresis with pemphigus disease area index, and it demonstrated that double‐filtration plasmapheresis is a safe “subtracting” treatment for patients with drug‐resistant pemphigus.
Using Press Ganey Provider Feedback to Improve Patient Satisfaction: A Pilot Randomized Controlled Trial
Authors: Newgard Craig D. , Fu Rongwei , Heilman James , Tanski Mary , Ma O. John , Lines Alan , Keith French L.
Published: June 2017

Objective

The objective was to conduct a pilot randomized controlled trial to assess the feasibility, logistics, and potential effect of monthly provider funnel plot feedback reports from Press Ganey data and semiannual face‐to‐face coaching sessions to improve patient satisfaction scores.

Methods

This was a pilot randomized controlled trial of 25 emergency medicine faculty providers in one urban academic emergency department. We enrolled full‐time clinical faculty with at least 12 months of baseline Press Ganey data, who anticipated working in the ED for at least 12 additional months. Providers were randomized into intervention or control groups in a 1:1 ratio. The intervention group had an initial 20‐minute meeting to introduce the funnel plot feedback tool and standardized feedback based on their baseline Press Ganey scores and then received a monthly e‐mail with their individualized funnel plot depicting cumulative Press Ganey scores (compared to their baseline score and the mean score of all providers) for 12 months. The primary outcome was the difference in Press Ganey “doctor‐overall” scores between treatment groups at 12 months. We used a weighted analysis of covariance model to analyze the study groups, accounting for variation in the number of surveys by provider and baseline scores.

Results

Of 36 eligible faculty, we enrolled 25 providers, 13 of whom were randomized to the intervention group and 12 to the control group. During the study period, there were 815 Press Ganey surveys returned, ranging from four to 71 surveys per provider. For the standardized overall doctor score over 12 months (primary outcome), there was no difference between the intervention and control groups (difference = 1.3 points, 95% confidence interval = –2.4 to 5.9, p = 0.47). Similarly, there was no difference between groups when evaluating the four categories of doctor‐specific patient satisfaction scores from the Press Ganey survey (all p > 0.05).

Conclusions

In this pilot trial of monthly provider funnel plot Press Ganey feedback reports, there was no difference in patient satisfaction scores between the intervention and control groups after 12 months. While this study was not powered to detect outcome differences, we demonstrate the feasibility, logistics, and effect sizes that could be used to inform future definitive trials.
Photo‐response: Approaching participatory photography as a more‐than‐human research method
Authors: Alam Ashraful , McGregor Andrew , Houston Donna
Published: June 2017

There is growing interest in “more‐than‐human” influences on places and practices. However, while the theoretical thinking in this field is well developed, methodology and methods lag behind. Borrowing insights from feminist geographers’ articulation of “response”, we explore how participatory photography can be used to examine more‐than‐human processes through a case study of marginal homemaking in Khulna city in Bangladesh. Our photo‐response method focuses on performances of seeing, telling and being together to enhance the co‐production of “knowledges”. We conclude that analysing three stages of “response” within participatory photography provides new insights for conducting research in, with and as more‐than‐human worlds.
Assessing Africa‐Wide Pangolin Exploitation by Scaling Local Data
Authors: Ingram Daniel J. , Coad Lauren , Abernethy Katharine A. , Maisels Fiona , Stokes Emma J. , Bobo Kadiri S. , Breuer Thomas , Gandiwa Edson , Ghiurghi Andrea , Greengrass Elizabeth , Holmern Tomas , Kamgaing Towa O. W. , Ndong Obiang Anne‐Marie , Poulsen John R. , Schleicher Judith , Nielsen Martin R. , Solly Hilary , Vath Carrie L. , Waltert Matthias , Whitham Charlotte E. L. , Wilkie David S. , Scharlemann Jӧrn P.W.
Published: June 2017

Overexploitation is one of the main pressures driving wildlife closer to extinction, yet broad‐scale data to evaluate species’ declines are limited. Using African pangolins (Family: Pholidota) as a case study, we demonstrate that collating local‐scale data can provide crucial information on regional trends in exploitation of threatened species to inform conservation actions and policy. We estimate that 0.4‐2.7 million pangolins are hunted annually in Central African forests. The number of pangolins hunted has increased by ∼150% and the proportion of pangolins of all vertebrates hunted increased from 0.04% to 1.83% over the past four decades. However, there were no trends in pangolins observed at markets, suggesting use of alternative supply chains. The price of giant (Smutsia gigantea) and arboreal (Phataginus sp.) pangolins in urban markets has increased 5.8 and 2.3 times respectively, mirroring trends in Asian pangolins. Efforts and resources are needed to increase law enforcement and population monitoring, and investigate linkages between subsistence hunting and illegal wildlife trade.
Degranulation and shrinkage of dark cells in eccrine glands and elevated serum carcinoembryonic antigen in patients with acquired idiopathic generalized anhidrosis
Authors: Sano K. , Asahina M. , Uehara T. , Matsumoto K. , Araki N. , Okuyama R.
Published: June 2017

Background

Acquired idiopathic generalized anhidrosis (AIGA) is characterized by anhidrosis/hypohidrosis without other autonomic and neurological dysfunctions. Pathologically, AIGA is considered to usually present no significant morphological alterations in eccrine glands, the secretory portion which consists of clear cells, dark cells, and myoepithelial cells. AIGA patients recently have been reported to show high serum concentrations of carcinoembryonic antigen (CEA).

Objective

Our aim is to reveal morphological abnormalities of dark cells and investigate their relationship with serum CEA.

Methods

We performed comparative analysis of eccrine glands between sweat‐preserved and non‐sweating skin in four AIGA patients. Serum CEA concentrations in 22 cases with AIGA were measured with healthy volunteers. Furthermore, we semiquantitatively investigated dermcidin, FoxA1 and CEA expression in eccrine glands of 12 cases with AIGA and 5 cases with non‐AIGA.

Results

Marked degranulation and shrinkage of dark cells consistently occurred in AIGA. Furthermore, high serum CEA concentrations were found in 14 of 22 AIGA patients (over 60%), but serum CEA levels were not correlated with CEA expression in eccrine glands. Dermcidin expression in dark cells apparently decreased in AIGA patients, severely in those with high serum CEA and moderately in those with low serum CEA, while well‐preserved expression was found in non‐AIGA subjects.

Conclusion

Our study suggests morphological damage and molecular dysregulation of dark cells, leading to impairment of their functions in AIGA patients. Severely damaged dark cells correspond to high serum CEA. Accordingly, these pathological changes in eccrine dark cells may be involved in anhidrosis/hypohidrosis of AIGA.
Genetic predisposition for chronic venous insufficiency in several genes for matrix metalloproteinases (MMP‐2, MMP‐9, MMP‐12) and their inhibitor TIMP‐2
Authors: Slonková V. , Slonková V. , Vašků A. , Vašků V.
Published: June 2017

Objective

The project was scheduled as a case–control study to investigate the correlation between MMP‐2 (rs243864), MMP‐9 (3918242), MMP‐12 (rs7123600) and TIMP‐2 (rs8176329) polymorphisms and chronic venous disease (CVD) risk. The genotype and phenotype research envisages the testing of possible associations between MMP and TIMP‐2 genotypes and phenotypes of CVD.

Material and Methods

150 patients with CVD and 227 controls were enrolled into the study. The MMPs and TIMP‐2 genotypes were identified by the PCR method and restriction analysis according to standard protocols.

Results

The G allele of MMP‐2 ‐790 T/G was 1.85 times more frequent in men with CVD than in the control group (P = 0.008). The T allele of MMP‐9 ‐1562 C/T was observed 2.571 times more frequently in patients with CVD than in the control individuals (both in men and women) with clinically significant specificity (P = 0.0000009). The G allele of MMP‐12 rs7123600 was determined 2.082 times more frequently in female patients with CVD than in the control group with clinically significant specificity (P = 0.02). No significant result in TIMP‐2 rs8176329 polymorphism in the case–control study was observed. CVD women with G allele in MMP‐2 ‐790 T/G in the genotype–phenotype study are seen to develop ulceration 2.539 times more frequently (P = 0.003). The G allele of MMP‐12 rs7123600 was detected 3.167 times more frequently in CVD women with ulceration compared with CVD women without ulceration (P = 0.007). In CVD men in C6 stage, the incidence of AG genotype in rs7123600 MMP‐12 polymorphism was found to be 4.675 times higher compared to CVD women with C6 staging (P = 0.005). The AG genotype in TIMP 2 rs8176329 polymorphism was found to be associated with higher risk of tumour (P = 0.01).

Conclusion

Studying these polymorphisms can contribute to better identification of patients at higher risk of developing CVD, while providing the most appropriate prevention and treatment strategies for limiting the progression and complications of CVD.
Decreased Glutamate Levels in Patients with Amnestic Mild Cognitive Impairment: An sLASER Proton MR Spectroscopy and PiB‐PET Study
Authors: Zeydan Burcu , Deelchand Dinesh K. , Tosakulwong Nirubol , Lesnick Timothy G. , Kantarci Orhun H. , Machulda Mary M. , Knopman David S. , Lowe Val J. , Jack Clifford R. , Petersen Ronald C. , Öz Gülin , Kantarci Kejal
Published: June 2017

BACKGROUND AND PURPOSE

Glutamate levels may be informative about the declining neuronal health in the central nervous system. We used an advanced proton MR spectroscopy (1H‐MRS) protocol composed of semi‐localization by adiabatic selective refocusing (sLASER) localization and FAST(EST)MAP shimming for detection of alterations in brain glutamate concentrations in patients with amnestic mild cognitive impairment.

METHODS

Participants with amnestic mild cognitive impairment (n = 14; median age = 80) and age‐ and sex‐matched clinically normal controls (n = 32; median age = 79) from the population‐based Mayo Clinic Study of Aging were recruited prospectively to the 3T single‐voxel 1H‐MRS study that examined metabolite changes in the posterior cingulate gyri. To be included, controls had to have low β‐amyloid load on [11C] Pittsburgh Compound B (PiB)‐PET (standard uptake value ratio; SUVr < 1.42) and patients with amnestic mild cognitive impairment had to have high β‐amyloid load (SUVr ≥ 1.42).

RESULTS

Glutamate concentration and the glutamate/myo‐inositol ratio were lower in patients with amnestic mild cognitive impairment than clinically normal controls (P < .05). Higher global cortical PiB‐PET SUVr correlated with lower glutamate/myo‐inositol (r = –.3, P = .04).

CONCLUSIONS

The advanced sLASER with FAST(EST)MAP shimming is a promising protocol for identifying glutamate alterations. Advanced 1H‐MRS protocols may add to the understanding of early Alzheimer's disease pathophysiology through detection of glutamate concentration in posterior cingulate gyri of individuals with amnestic mild cognitive impairment.
Maternal help‐seeking for child developmental concerns: Associations with socio‐demographic factors
Authors: Eapen Valsamma , Walter Amelia , Guan Jane , Descallar Joseph , Axelsson Emma , Einfeld Stewart , Eastwood John , Murphy Elisabeth , Beasley Deborah , Silove Natalie , Dissanayake Cheryl , Woolfenden Sue , Williams Katrina , Jalaludin Bin , The ‘Watch Me Grow’ Study Group
Published: June 2017

Aim

To examine socio‐demographic factors associated with maternal help‐seeking for child developmental concerns in a longitudinal birth cohort study. An understanding of these factors is critical to improving uptake of services to maximise early identification and intervention for developmental concerns.

Methods

A birth cohort was recruited from the post‐natal wards of two teaching hospitals and through community nurses in South Western Sydney, Australia, between November 2011 and April 2013. Of the 4047 mothers approached, 2025 consented to participate (response rate = 50%). Socio‐demographic and service use information was collected after the child's birth and when the child was 18 months of age. Sources of help were divided into three categories (formal health services, other formal services and informal supports) and compound variables were created by summing the number of different sources identified by mothers.

Results

Significantly more sources of help were intended to be used and/or actually accessed by mothers born in Australia, whose primary language was English, with higher levels of education and annual household income, and among mothers of first‐born children.

Conclusions

Developmental concerns are known to increase with increased psychosocial adversity. Our findings of reduced intent to access and use of services by socio‐economically disadvantaged families and those from culturally and linguistically diverse backgrounds suggests that an inverse care effect is in operation whereby those children with the greatest health needs may have the least access to services. Possible explanations for this, and recommendations for improving service accessibility for these populations through targeted and culturally appropriate services, are discussed.
Do E‐cigarettes induce weight changes and increase cardiometabolic risk? A signal for the future
Authors: Verhaegen A. , Van Gaal L.
Published: June 2017

The prevalence of non‐cigarette tobacco use in electronic cigarettes, also called vaping, is rapidly increasing, especially in adolescents and young adults, due to attractive marketing techniques promoting them as healthier alternatives to conventional tobacco cigarettes.

Although smoking is associated with weight loss, it increases insulin resistance and attributes to other features of the metabolic syndrome, increasing the cardiometabolic risk profile.

Whether vaping has the same deleterious effects on metabolic parameters as regular cigarette smoke has not yet been studied thoroughly in humans. However, animal model experiments attribute comparable effects of e‐cigarette smoking, even without nicotine exposure, on weight and metabolic parameters as compared to smoking cigarettes.

In this review paper, we want to give an overview of published data on the effects on weight and cardiometabolic parameters of e‐cigarette use and formulate some mechanistic hypotheses.
Assessing the Cost of Large‐Scale Power Outages to Residential Customers
Authors: Baik Sunhee , Davis Alexander L. , Morgan M. Granger
Published: June 2017

Residents in developed economies depend heavily on electric services. While distributed resources and a variety of new smart technologies can increase the reliability of that service, adopting them involves costs, necessitating tradeoffs between cost and reliability. An important input to making such tradeoffs is an estimate of the value customers place on reliable electric services. We develop an elicitation framework that helps individuals think systematically about the value they attach to reliable electric service. Our approach employs a detailed and realistic blackout scenario, full or partial (20 A) backup service, questions about willingness to pay (WTP) using a multiple bounded discrete choice method, information regarding inconveniences and economic losses, and checks for bias and consistency. We applied this method to a convenience sample of residents in Allegheny County, Pennsylvania, finding that respondents valued a kWh for backup services they assessed to be high priority more than services that were seen as low priority ($0.75/kWh vs. $0.51/kWh). As more information about the consequences of a blackout was provided, this difference increased ($1.2/kWh vs. $0.35/kWh), and respondents' uncertainty about the backup services decreased (Full: $11 to $9.0, Partial: $13 to $11). There was no evidence that the respondents were anchored by their previous WTP statements, but they demonstrated only weak scope sensitivity. In sum, the consumer surplus associated with providing a partial electric backup service during a blackout may justify the costs of such service, but measurement of that surplus depends on the public having accurate information about blackouts and their consequences.
Contributions of Oliver Hart and Bengt Holmström to Contract Theory
Authors: Schmidt Klaus M.
Published: June 2017

Oliver Hart and Bengt Holmström were awarded the 2016 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel for their fundamental contributions to contract theory. This article offers a short summary and discussion of their path‐breaking work.