bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug-Induced Thrombophilic or Prothrombotic States: An Underestimated Clinical Problem That Involves Both Legal and Illegal Compounds
Authors: Girolami A. , Cosi E. , Tasinato V. , Santarossa C. , Ferrari S. , Girolami B.
Published: June 2016

Vascular thrombosis, both arterial and venous, is a condition associated with significant morbidity and mortality. There are multiple risk factors for thrombosis, both congenital and acquired, and in the majority of cases, these risk factors are not modifiable. Over the past 2 decades, multiple drugs (both illegal and legal) have been associated with increased risk of thrombosis. However, due to limited scientific literature regarding the prothrombotic tendencies of these drugs, there is a concomitant limited understanding of the pathophysiology of drug-induced thrombosis. As drugs are one of the few modifiable risk factors for thrombosis, further study and dissemination of knowledge regarding drug-associated and drug-induced thrombosis are essential and have the potential to lead to decreased future incidence of thrombosis. The mechanisms at the basis of the thrombophilic activity of these drugs are variable and sometimes still ill recognized. Increased levels of clotting factors, reduction in coagulation natural inhibitors, decreased fibrinolysis, activated clotting factors, increased blood viscosity, endothelial damage, and increased platelet number and activation are the most frequent causes. Arterial steal or coronary arteries no flow has also been implicated. In some cases due to the intake of several drugs, more than one mechanism is present in a given patient. The purpose of the present review is to analyze all the drugs demonstrated to be potentially thrombotic. It is hoped that a prudent use or nonuse of these drugs might result in a reduction of thrombosis-associated diseases.
An Evaluation of the Modified Diagnostic Criteria for DIC Established by the Japanese Society of Thrombosis and Hemostasis
Authors: Aota Takumi , Wada Hideo , Yamashita Yoshiki , Matsumoto Takeshi , Ohishi Kohshi , Suzuki Kei , Imai Hiroshi , Usui Masanobu , Isaji Shuji , Asakura Hidesaku , Okamoto Kohji , Katayama Naoyuki
Published: June 2016

Objective:

We evaluated the modified diagnostic criteria for disseminated intravascular coagulation (DIC), which was published by the Japanese Society of Thrombosis and Hemostasis (JSTH) in 108 patients with suspected infectious DIC.

Material and methods:

The diagnoses of the patients were as follows: DIC (n = 63), pre-DIC (n = 22), and non-DIC (n = 45). The efficacy of the diagnostic criteria for DIC was evaluated using a receiver–operating characteristic analysis.

Results:

Although the area under the curve for global coagulation test (GCT) scores in the diagnosis of “DIC” was high that for the diagnosis of “DIC and pre-DIC” was low, suggesting that the addition of antithrombin (AT), soluble fibrin (SF)/thrombin–AT complex (TAT), and reduced platelet count (PLT) values was required to diagnose “DIC and pre-DIC.” Using GCT score with the AT, SF/TAT, and reduced PLT values, the cutoff value of the DIC score for the diagnosis of “DIC and pre-DIC” was 5 points.

Discussion and conclusion:

The modified JSTH’s diagnostic criteria for DIC, which used the GCT score and the reduced PLT, AT, and TAT/SF values, were useful for diagnosing “DIC and pre-DIC.”
Potential Social and Neurocognitive Benefits of Aerobic Exercise as Adjunct Treatment for Patients With ADHD
Authors: Klil-Drori Sivan , Hechtman Lily
Published: June 2016

Objective: The aim of the article is to review the evidence that aerobic exercise may be a useful adjunct treatment for ADHD. Method: Studies on physical, cognitive, and psychosocial aspects of aerobic exercise that are relevant to ADHD are reviewed and evaluated. Results: Stimulant medication, the main pharmacotherapy for ADHD, and aerobic exercise both act on catecholamine pathways. Aerobic exercise has been shown to be beneficial in preclinical studies on spontaneous hypertensive rats, an animal model of ADHD, and in clinical trials of children with ADHD, as an adjunct treatment to medication. Social and neurocognitive function in children and adults seem to be positively affected by exercise as well. Nevertheless, no controlled clinical trials in adults with ADHD have been conducted. Conclusion: Aerobic exercise may be a useful non-medication adjunct therapy for ADHD. The clinical effectiveness of aerobic exercise for ADHD in children and adults warrants further clinical studies.
The Influence of Socioeconomic Status on Psychological Distress in Canadian Adults With ADD/ADHD
Authors: Pond Emily , Fowler Ken , Hesson Jacqueline
Published: June 2016

Objective: The primary purpose of this study was to examine the relationship between socioeconomic status (SES) and psychological distress in individuals self-reporting a diagnosis of attention deficit disorder (ADD)/ADHD. Method: This correlational study encompasses cross-sectional data from 488 male and female adults (20-64 years) who reported that they have been diagnosed with ADD/ADHD. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). Results: Adults with ADD/ADHD and high incomes have significantly lower K10 scores than Canadians with ADD/ADHD and low incomes. Income, but not education, was significant in predicting psychological distress among the sample. Canadian adults with ADD/ADHD have an increased risk for developing psychological distress and comorbid psychiatric disorders. Conclusion: The findings suggest that negative outcomes associated with ADD/ADHD are not necessarily pervasive. High income may serve as a protective factor for psychological distress among adults with ADD/ADHD.
Realism and resources: Towards more explanatory economic evaluation
Authors: Anderson Rob , Hardwick Rebecca
Published: June 2016

To be successfully and sustainably adopted, policy-makers, service managers and practitioners want public programmes to be affordable and cost-effective, as well as effective. While the realist evaluation question is often summarised as what works for whom, under what circumstances, we believe the approach can be as salient to answering questions about resource use, costs and cost-effectiveness – the traditional domain of economic evaluation methods. This paper first describes the key similarities and differences between economic evaluation and realist evaluation. It summarises what health economists see as the challenges of evaluating complex interventions, and their suggested solutions. We then use examples of programme theory from a recent realist review of shared care for chronic conditions to illustrate two ways in which realist evaluations might better capture the resource requirements and resource consequences of programmes, and thereby produce explanations of how they are linked to outcomes (i.e. explanations of cost-effectiveness).
Investigating non-visitors’ intentions to travel to a long-haul holiday destination
Authors: Bianchi Constanza , Milberg Sandra
Published: June 2016

This article aims to expand our understanding of the main drivers of traveler’s intention to visit a long-haul holiday destination drawing on a model of consumer-based brand equity. The authors propose and test a conceptual model using data from a sample of 152 Chilean travelers who have not visited Australia previously. The findings show that the image and value of Australia are positively and significantly related to Chilean traveler’s intention to visit this destination for holidays. Awareness of Australia has only an indirect effect on intentions to visit this destination through its effect on brand image. Finally, perceptions of brand quality were not significantly related to Chilean traveler’s intention to visit Australia for holidays. This study contributes to the tourism and leisure literature by identifying the main drivers for attracting long-haul potential travelers who have not visited the destination previously.
The role of pain, perseverative cognition and goal adjustment in vasculitis-associated fatigue
Authors: Mayor Helen , Reidy John
Published: June 2016

Fatigue is a common symptom associated with vasculitis and contributes significantly to impaired quality of life. Motivational control theory suggests a role for perseverative cognition and goal adjustment in fatigue. Therefore, this study investigated these potential predictors of fatigue in individuals with vasculitis. A total of 249 participants completed online questionnaires assessing fatigue, perseverative cognition, goal disengagement and goal reengagement, in addition to demographic and disease-related variables. Hierarchical regression analysis found only pain, sleep disturbance, disease activity and perseverative cognition to significantly predict fatigue. This highlights the importance of psychological factors in determining fatigue in those with vasculitis.
The relationship between autism symptoms and arousal level in toddlers with autism spectrum disorder, as measured by electrodermal activity
Authors: Prince Emily Barbara , Kim Elizabeth S , Wall Carla Anne , Gisin Eugenia , Goodwin Matthew S , Simmons Elizabeth Schoen , Chawarska Kaisa , Shic Frederick
Published: June 2016

Electrodermal activity was examined as a measure of physiological arousal within a naturalistic play context in 2-year-old toddlers ( N = 27) with and without autism spectrum disorder. Toddlers with autism spectrum disorder were found to have greater increases in skin conductance level than their typical peers in response to administered play activities. In the autism spectrum disorder group, a positive relationship was observed between restrictive and repetitive behaviors and skin conductance level increases in response to mechanical toys, whereas the opposite pattern was observed for passive toys. This preliminary study is the first to examine electrodermal activity levels in toddlers with autism spectrum disorder during play-based, naturalistic settings, and it highlights the potential for electrodermal activity as a measure of individual variability within autism spectrum disorder and early development.
Burden and incidence of human papillomavirus-associated cancers and precancerous lesions in Denmark
Authors: Svahn Malene F. , Munk Christian , von Buchwald Christian , Frederiksen Kirsten , Kjaer Susanne K.
Published: June 2016

Aim: The aim of the study was to investigate the incidence of human papillomavirus (HPV)-associated cancers in Denmark between 1978 and 2011, estimate the current absolute annual number (burden) of HPV-associated cancers (HPVaCa) and their precancerous lesions, and assess whether there is socioeconomic inequality in the risk of HPV-associated cancers. Methods: From four nationwide population-based registries, information was collected on HPVaCa diagnosed during 1978–2011 and age-standardised incidence rate for each site by calendar year and birth cohort was calculated. Furthermore, the current annual burden of HPVaCa and severe precancerous lesions was estimated. Incidence rate ratios and corresponding 95% confidence intervals for HPVaCa were calculated according to socioeconomic status. Results: The age-standardised incidence rate of HPV-associated cancers for the two sexes converged during the study period, and almost identical incidence rates were seen for women and men in the youngest birth cohorts. The current burden of HPV-associated lesions amounted to more than 5000 cases, the vast majority (85%) being severe precancerous lesions. The highest risk for HPV-associated cancers was associated with lower socioeconomic status. Conclusions: The burden of HPV-associated cancers among men will likely surpass that among women in the near future if the incidence trends continue. As many of these cancers and their precancerous lesions are associated with HPV type 16, a substantial proportion of cases are, in theory, preventable by the currently available vaccines.
Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres
Authors: Palm Anna , Olofsson Niclas , Danielsson Ingela , Skalkidou Alkistis , Wennberg Peter , Högberg Ulf
Published: June 2016

Aim: The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls. Methods: Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of ⩾5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline. Results: Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up. Conclusions: No significant differences in risk drinking between young women who received motivational interviewing and controls were found. There was a large intra-individual mobility in young women’s risk drinking behaviour. This highlights the importance of finding reliable screening tools that can capture the mobility in drinking behaviour in youth. More research is needed before recommendations can be made.
Automatic steering control in tractor semi-trailer vehicles for low-speed maneuverability enhancement
Authors: Abroshan M , Taiebat M , Goodarzi A , Khajepour A
Published: June 2016

In this paper, a controller for an automated steering articulated vehicle with the special capability to reduce off-tracking in low-speed maneuvers is proposed. Conventional tractor–trailers have a large off-tracking in low-speed maneuvers. In the proposed vehicle, all wheels of the tractor and trailer are steerable (all wheel steering). The controllers of the tractor and trailer work independently, and each one consists of two layers. A fuzzy controller and a PID controller are designed in the upper and lower layer, respectively, to control the actuators. The aim of the controller is to ensure that the end points of both the tractor and the trailer exactly follow the path of tractor’s first point. To assess the performance of proposed controller as well as steerability effect of all wheels in low speeds, the TruckSim simulation software is used. The simulation results confirm that the proposed approach improves the maneuverability and accuracy of path tracking not only compared to conventional vehicles but also to the conventional tractor–active trailer scheme, which was previously proposed by a number of studies. Additionally, it reduces lateral tire forces to enhance the working life.
Chaotic study and chaos control in a half-vehicle model with semi-active suspension using discrete optimal Ott–Grebogi–Yorke method
Authors: Abtahi S Mahdi
Published: June 2016

The chaotic dynamics along with the control of chaos in a half-car model with semi-active suspension system is considered in this paper. The time series responses, phase space trajectories, Poincaré sections, and Lyapunov exponent methods are used to analyze the chaotic behavior in the open-loop system. In order to suppress the chaotic responses in the system, a chaos controller is applied based on the development of Ott–Grebogi–Yorke algorithm. In this new control strategy, the Poincaré map of the system is estimated using the support vector machine innovatively. After linearization of the Poincaré map, the optimal discrete-time linear quadratic regulator is designed for the linear map as a main contribution. The discrete optimal Ott–Grebogi–Yorke controller improves the performance of the system along with the rejection of chaos in the responses. This improvement involves the reduction in settling time, control effort, and energy consumption in the suspension system.
The many ways of knowing: Embracing multiplicity in narrative research
Authors: Bhattacharya Anindita
Published: June 2016

In this article, I revisit my roots in pursuit of my epistemology. I write about how my mother’s story significantly shaped my interest in narrative inquiry. By inviting my mother to tell her story and through the process of shared meaning making, I learn that narrations are temporal and complex. Stories are built on our lived experiences and as our perceptions about those experiences change with time, so do our interpretations of the stories that we live with. Exposing my own limited understanding of a story that is so deeply connected to me, I conclude that the essence of narrative inquiry lies in multiple interpretations and in letting participants have a significant say over the shaping, structuring, and telling of their narratives.
Violence, silence, and health service provision in Mexico: An arrangement in parts
Authors: Vargas Laura
Published: June 2016

This article explores the journey of a doctoral student conducting field research in Mexico on how violence affects the provision of health care services and health. Mexico has seen a dramatic increase in violence caused by the Drug Wars in the last decade that has spread to many states throughout the country. Using translations, metaphors, and examples from my field research that refer to violence, I explore the complexity of inhabiting different cultures and languages simultaneously as well as my role as a researcher, translator, and interpreter of what remains hidden or silent. In the process, I am pulled in different directions as I learn to adapt in a reflexive process. I explore whether what I have learned in my academic journey is enough to study the relationship between violence and health care service provision. The journey is a reflection on what I have learned about breaking some of the silences around the topic. I discuss the tension of writing this article on a sensitive topic and my responsibility as a researcher, translator, and interpreter of lived experiences. The text is an arrangement, which can be interpreted as a whole (or in parts).
Colligation in child welfare work: Decision-making in a case on the tipping point
Authors: Skotte Pernille Stornæss
Published: June 2016

This article reports on a single-case study of a decision-making process in child welfare. Based on analysis of field notes, research interviews with caseworkers and case documents, the study explored caseworkers’ handling of ambiguity and uncertainty in a case of possible neglect on the tipping point between home-based and out-of-home care. The prospective study followed events and activities in the case of a family consisting of a mother, a father and newborn twins, reflecting real process in real time. Data were gathered in a local frontline child welfare office in a Norwegian town, and decision-making was studied as a process of sequential colligation rather than as a linear and cumulative effort. The findings suggest that the caseworkers’ individual commitment to and felt responsibility for the outcome led to a quest for documentation, making the process of decision-making more challenging. The search for decisive evidence may contribute to prolonged casework and postponed closure in cases on the tipping point.
Encuentro: Feasibility, Acceptability, and Outcomes of a Culturally Tailored Teen–Parent Health Promotion Program
Authors: Sieving Renee E. , Allen Michele L. , Galvan Adriana , Rodriguez-Hager Rosemarie , Beckman Kara , Castillo Marina , Gadea Abigail , Jimbo-Llapa Fanny , Porta Carolyn , Svetaz Maria Veronica
Published: June 2016

The growth of the Latino youth population, combined with the reality that many Latino adolescents live in environments characterized by social disparities, reveals a compelling need to address health inequalities affecting Latinos through effective health promotion programs designed by and for this population. This article presents findings from a pilot study of Encuentro, a health promotion program for young Latino teens and their parents. Developed by a community–university partnership, Encuentro aims to bolster internal assets, familial and cultural supports for young teens’ positive development, and healthy sexual decision making and behaviors. Encuentro was pilot tested with 49 Latino families at 3 community sites in Minneapolis/St. Paul. Families were assigned to a program group or a control group. Pilot study findings confirm program feasibility and acceptability. Compared to the control group, program group youth reported substantially more involvement in activities celebrating Latino culture, and greater communication with their parents about sexual health topics. Parents in the program group reported greater ethnic pride, engaging in more activities to share Latino values and traditions with their teens, greater communication with their teens about sexual health topics, and increased parental monitoring than did parents in the control group. Findings demonstrate the potential of the Encuentro program.
Introducing Genetic Tests With Uncertain Implications in Living Donor Kidney Transplantation
Authors: Ross Lainie Friedman , Thistlethwaite J. Richard
Published: June 2016

Genetic mutations in apolipoprotein L1 (ApoL1) are associated with kidney disease. Apolipoprotein L1 mutations are common in African Americans (∼39% and 12% have 1 and 2 high-risk alleles, respectively). Carrying 2 ApoL1 risk alleles may explain much of the excess rate of kidney failure in African Americans compared to European Americans. Apolipoprotein L1 also has implications for kidney transplantation. Kidney grafts from deceased donors with 2 ApoL1 risk alleles have worse graft survival, but outcomes appear unaffected by recipient ApoL1 status. Unknown is whether donation increases the risk of kidney failure in living donors with 2 ApoL1 risk alleles and whether their donated kidneys have worse graft survival. There are 4 options to consider: (1) remain silent about ApoL1 risk alleles and renal failure and wait for more data; (2) counsel about race, ApoL1, and subsequent renal failure abstractly but remain agnostic about donor testing until more data are available; (3) provide counseling and encourage genotyping of prospective living donors of African ancestry as part of the living donor workup; or (4) mandate testing of all prospective living donors. We support option 3, and recommend, with donor permission, to discuss the results with potential recipients to promote informed decision-making. We also argue for a voluntary donor registry that collects long-term follow-up information. We provide ethical arguments to support these recommendations.
Effects of needle punching and hot pressing on mechanical properties of composite geotextiles
Authors: Lin Jia-Horng , Hsieh Jing-Chzi , Huang Chen-Hung , Hsing Wen-Hao , Huang Chien-Lin , Tan Hsueh-Jen , Lou Ching-Wen
Published: June 2016

This study proposes to make geotextiles from recycled materials. Polyester fibers, recycled polyester fibers, and low melting point polyester fibers are blended and needle punched to make the polyester fabrics, the mechanical properties of which are then evaluated to determine the optimal parameters. The polyester nonwoven fabrics are needle punched with various densities. Afterwards, the resulting polyester nonwoven fabrics, glass fiber woven fabrics, and polypropylene selvages are combined, needle punched, and hot pressed to form geotextiles, the properties of which are tested by tensile strength, tearing strength, burst strength, puncture strength, and water resistance tests. The test results show that polyester fabrics containing 50 wt% of polyester fibers have the optimal mechanical properties. Furthermore, needle punching at 90 needles/cm2 results in a greatest increase in mechanical properties of the polyester nonwoven fabrics. The tensile strength, tearing strength, and water resistance of the geotextiles increase as a result of hot pressing, and the bursting strength and puncture resistance are primarily associated with the needle punching densities. This study successfully creates composite geotextiles with reinforced mechanical properties by needle punching and hot pressing recycled polyester fabrics and polypropylene selvages.
Planning Ahead or Living a Day at a Time? A Family History of AD and Retirement Planning
Authors: Zick Cathleen D. , Smith Ken R. , Mayer Robert N.
Published: June 2016

Background:

We assess whether a family history of Alzheimer’s disease (AD) is associated with the odds that healthy family members’ engage in retirement planning activities.

Methods:

This is a cross-sectional study utilizing individual-level data from the Utah Population Database that have been linked to Medicare records and to responses from a retirement planning survey. Engagement in 3 retirement planning activities was estimated as a function of the number of parents and grandparents diagnosed with AD along with a set of fundamental socioeconomic and demographic covariates.

Results:

Adults who had a parent with AD were 86% more likely to have seen a professional financial advisor and 40% less likely to plan to retire before age 65.

Conclusions:

Caregiving costs and/or knowledge of the familial risk of developing AD may provide adult children with a forewarning of their own future financial needs that, in turn, motivates them to engage in retirement planning.
The Effect of Undiagnosed Diabetes on the Association Between Self-Reported Diabetes and Cognitive Impairment Among Older Mexican Adults
Authors: Downer Brian , Kumar Amit , Mehta Hemalkumar , Al Snih Soham , Wong Rebeca
Published: June 2016

Purpose:

To study the effect of undiagnosed diabetes on the relationship between self-reported diabetes and cognitive impairment.

Methods:

Data were from 1033 participants aged ≥60 from Wave III (2012) of the Mexican Health and Aging Study. Participants were classified as nondiabetic (n = 589), undiagnosed diabetic (n = 201), and self-reported diabetic (n = 243). Multivariate logistic regression models were used to estimate the relationship between self-reported diabetes and severity of cognitive impairment (nonimpaired, moderate impaired, severe impaired).

Results:

Self-reported diabetes was associated with significantly higher odds for severe, but not moderate, cognitive impairment (odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.39-5.32). The association between self-reported diabetes and severe cognitive impairment decreased by 6.3% when undiagnosed diabetics were included in the nondiabetic category and by 30.4% when undiagnosed diabetics were included in the self-reported diabetes category.

Discussion:

The association between self-reported diabetes and severe cognitive impairment is underestimated when undiagnosed diabetics are not differentiated from self-reported diabetics and nondiabetics.
Family History of Alzheimer’s Disease and Cortical Thickness in Patients With Dementia
Authors: Ganske Steffi , Haussmann Robert , Gruschwitz Antonia , Werner Annett , Osterrath Antje , Baumgaertel Johanna , Lange Jan , Donix Katharina L. , Linn Jennifer , Donix Markus
Published: June 2016

A first-degree family history of Alzheimer’s disease reflects genetic risks for the neurodegenerative disorder. Recent imaging data suggest localized effects of genetic risks on brain structure in healthy people. It is unknown whether this association can also be found in patients who already have dementia. Our aim was to investigate whether family history risk modulates regional medial temporal lobe cortical thickness in patients with Alzheimer’s disease. We performed high-resolution magnetic resonance imaging and cortical unfolding data analysis on 54 patients and 53 nondemented individuals. A first-degree family history of Alzheimer’s disease was associated with left hemispheric cortical thinning in the subiculum among patients and controls. The contribution of Alzheimer’s disease family history to regional brain anatomy changes independent of cognitive impairment may reflect genetic risks that modulate onset and clinical course of the disease.
Manual thromboaspiration technique as a first approach for endovascular stroke treatment: A single-center experience
Authors: Romano DG , Cioni S , Leonini S , Gennari P , Vallone IM , Zandonella A , Puliti A , Tassi R , Casasco A , Martini G , Bracco S
Published: June 2016

Background

For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation.

Materials and methods

We analyzed clinical and procedural data of patients treated from April 2014 to August 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months (modified Rankin Scale, mRS).

Results

Overall, 71 patients (mean age of 69.7 years) were treated. Sites of occlusion were anterior circulation (including seven tandem extracranial-intracranial occlusions). In 39 patients i.v. rtPA was attempted. Recanalization of the target vessel was obtained in 87.3% of cases whereas direct aspiration alone was successful in 46/71cases (64.8%) with an average puncture-to-revascularization time of 43.1 minutes. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 5.6%. In total, 38 patients (53.5%) had a good outcome at 90 days follow-up.

Conclusions

In our series, the manual thromboaspiration technique has been shown as fast and safe, with good rates of vessel revascularization in 87.3% of patients and neurological outcome <3 mRS in 53.5% of patients.
Stent retriever thrombectomy with aneurysm in target vessel: Technical note
Authors: Singh Jasmeet , Wolfe Stacey Q
Published: June 2016

Aneurysms within large occluded target vessels can present significant challenges for neuro interventionists because rupture can be catastrophic. We recently encountered a case of left internal carotid artery–middle cerebral artery (MCA) ischemic stroke with an incidental MCA bifurcation aneurysm that we were already aware of. IV tissue plasminogen activator (tPA) with mechanical thrombectomy (MTE) was performed with a stent retriever, proximal to the aneurysm. TICI 2b recanalization was achieved. MTE and IV tPA may not be withheld from patients with acute stroke with known target vessel aneurysms.
Imaging the hip joint in osteoarthritis: A place for ultrasound?
Authors: Sudula SN
Published: June 2016

Osteoarthritis has traditionally been imaged with conventional radiographs; this has been regarded as the reference technique in osteoarthritis for a long time. However, in recent years, innovative imaging techniques such as ultrasonography have been used to obtain a better understanding of this disease. This is mainly due to tremendous technical advances and progressive developments of ultrasound equipment occurring over the past decade. Ultrasonography has been demonstrated to be a valuable imaging technique in the diagnosis and management of osteoarthritis of the hip joint. Application of this imaging methodology for osteoarthritis has improved the understanding of the disease process and may aid in the assessment of the efficacy of future therapies. The execution of ultrasound-guided procedures with safety and reliability has a relevant significance in patient management of osteoarthritis of the hip joint. This paper reviews the use of ultrasound as an imaging technique for the evaluation and treatment of osteoarthritis hip joint.
Building a Patient Safety Toolkit for use in general practice
Authors: Bell Brian G , Spencer Rachel , Marsden Kate , Perryman Katherine , Campbell Stephen M , Avery Anthony J
Published: June 2016

Despite 340 000 000 primary care consultations annually in the UK, most of the literature on patient safety has focused on hospital-based services. To improve safety in primary care settings, we must know what methods, tools and indicators are available to measure and monitor patient safety. In collaboration with patient safety experts at the University of Dundee, we were able to identify a number of existing tools, and many of these were adopted for use in the Patient Safety Toolkit.
Blood Glucose Levels of Subelite Athletes During 6 Days of Free Living
Authors: Thomas Felicity , Pretty Chris G. , Desaive Thomas , Chase J. Geoffrey
Published: June 2016

Background:

Continuous glucose monitoring (CGM) devices, with their 1-5 min measurement interval, allow blood glucose (BG) concentration dynamics to be captured more frequently and less invasively than traditional BG measures. One cohort CGM could provide insight is athletes. This study investigates what impact their heightened energy expenditure and dietary intake may have on their ability to achieve optimal BG.

Methods:

Ten subelite athletes (resting HR<60 bpm, training>6 hrs per week) were recruited. Two Ipro2 CGM devices (Medtronic Minimed, Northridge, CA) were inserted into the abdomen and remained in place for ~6 days. Time in band was calculated as the percentage of CGM BG measurements with in the 4.0-6.0 mmol/L. Fasting glucose was calculated using CGM calibration BG measurements and postprandial glucose response was also calculated using the CGM values.

Results:

4/10 athletes studied spent more than 70% of the total monitoring time above 6.0 mmol/L even with the 2-hour period after meals is excluded. Fasting BG was also in the ADA defined prediabetes range for 3/10 athletes. Only 1 participant spent substantial time below 4.0 mmol/L which was largely due to significantly lower energy intake compared to recommendations.

Conclusions:

Contrary to expectations high BG appears to be more of a concern for athletes then low BG even in those with the highest energy expenditure and consuming below the recommended carbohydrate intake. This study warrants further investigation on the recommended diets and the BG of athletes to better determine the causes and impact of this hyperglycemia on overall athlete health.
Glycemic Control, Renal Complications, and Current Smoking in Relation to Excess Risk of Mortality in Persons With Type 1 Diabetes
Authors: Ahlén Elsa , Pivodic Aldina , Wedel Hans , Dahlqvist Sofia , Kosiborod Mikhail , Lind Marcus
Published: June 2016

Background:

A substantial excess risk of mortality still exists in persons with type 1 diabetes. The aim of this study was to evaluate the excess risk of mortality in persons with type 1 diabetes without renal complications who target goals for glycemic control and are nonsmokers. Furthermore, we evaluated risk factors of death due to hypoglycemia or ketoacidosis in young adults with type 1 diabetes.

Methods:

We evaluated a cohort based on 33 915 persons with type 1 diabetes and 169 249 randomly selected controls from the general population matched on age, sex, and county followed over a mean of 8.0 and 8.3 years, respectively. Hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality for persons with type 1 diabetes versus controls were estimated.

Results:

The adjusted HRs for all-cause and CVD mortality for persons with type 1 diabetes without renal complications (normoalbuminuria and eGFR ≥ 60 ml/min) and HbA1c ≤ 6.9% (52 mmol/mol) compared to controls were 1.22 (95% CI 0.98-1.52) and 1.03 (95% CI 0.66-1.60), respectively. The HRs increased with higher updated mean HbA1c. For nonsmokers in this group, the HRs for all-cause and CVD mortality were somewhat lower: 1.11 (95% CI 0.87-1.42) and 0.89 (95% CI 0.53-1.48) at updated mean HbA1c ≤ 6.9% (52 mmol/mol). HRs for significant predictors for deaths due to hypoglycemia or ketoacidosis in persons < 50 years were male sex 2.40 (95% CI 1.27-4.52), smoking 2.86 (95% CI 1.57-5.22), lower educational level 3.01 (95% CI 1.26-7.22), albuminuria or advanced kidney disease 2.83 (95% CI 1.63-4.93), earlier hospital diagnosis of hypoglycemia or ketoacidosis 2.30 (95% CI 1.20-4.42), and earlier diagnosis of intoxication 2.53 (95% CI 1.06-6.04).

Conclusions:

If currently recommended HbA1c targets can be reached, renal complications and smoking avoided in persons with type 1 diabetes, the excess risk of mortality will likely converge substantially to that of the general population.
In Silico Testing of an Artificial-Intelligence-Based Artificial Pancreas Designed for Use in the Intensive Care Unit Setting
Authors: DeJournett Leon , DeJournett Jeremy
Published: June 2016

Background:

Effective glucose control in the intensive care unit (ICU) setting has the potential to decrease morbidity and mortality rates which should in turn lead to decreased health care expenditures. Current ICU-based glucose controllers are mathematically derived, and tend to be based on proportional integral derivative (PID) or model predictive control (MPC). Artificial intelligence (AI)–based closed loop glucose controllers may have the ability to achieve control that improves on the results achieved by either PID or MPC controllers.

Method:

We conducted an in silico analysis of an AI-based glucose controller designed for use in the ICU setting. This controller was tested using a mathematical model of the ICU patient’s glucose-insulin system. A total of 126 000 unique 5-day simulations were carried out, resulting in 107 million glucose values for analysis.

Results:

For the 7 control ranges tested, with a sensor error of ±10%, the following average results were achieved: (1) time in control range, 94.2%, (2) time in range 70-140 mg/dl, 97.8%, (3) time in hyperglycemic range (>140 mg/dl), 2.1%, and (4) time in hypoglycemic range (<70 mg/dl), 0.09%. In addition, the average coefficient of variation (CV) was 11.1%.

Conclusions:

This in silico study of an AI-based closed loop glucose controller shows that it may be able to improve on the results achieved by currently existing ICU-based PID/MPC controllers. If these results are confirmed in clinical testing, this AI-based controller could be used to create an artificial pancreas system for use in the ICU setting.
Elotuzumab: the first approved monoclonal antibody for multiple myeloma treatment
Authors: Magen Hila , Muchtar Eli
Published: June 2016

Elotuzumab is a monoclonal antibody directed against the SLAMF7 receptor, expressed on normal and malignant plasma cells with a lower expression on other lymphoid cells such as natural killer (NK) cells. Elotuzumab has no significant antimyeloma activity when given as a single agent to patients with relapsed or refractory multiple myeloma (RRMM). However, when combined with other antimyeloma agents, it results in improved response and outcome. Owing to the results from the landmark ELOQUENT-2 phase III clinical trial, which compared lenalidomide and dexamethasone with or without elotuzumab in patients with RRMM, elotuzumab in combination with lenalidomide and dexamethasone was approved by the American Food and Drug Administration (FDA) in November 2015 for multiple myeloma (MM) patients who received one to three prior lines of therapy. This review will give a brief description of the signaling lymphocytic activation molecule (SLAM) family receptors, the unique SLAMF7 receptor and the mechanism of action of elotuzumab. Thereafter, we will give an overview on its antimyeloma activity in preclinical and clinical trials, including its toxicity profile and management thereof.
Ibrutinib in Waldenström macroglobulinemia: latest evidence and clinical experience
Authors: Castillo Jorge J. , Palomba M. Lia , Advani Ranjana , Treon Steven P.
Published: June 2016

Ibrutinib is an oral Bruton’s tyrosine kinase (BTK) inhibitor, which has recently gained approval by the United States (US) Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of patients with symptomatic Waldenström macroglobulinemia (WM). Herein, we review the role of BTK in the pathophysiology of WM, and present the results of the preclinical and clinical studies that led to the initial investigation and later approval of ibrutinib in WM. We also discuss aspects associated with ibrutinib therapy in WM patients, especially focusing on genomic profiling and the impact on response to ibrutinib, and the management of adverse events.
Prevalence of Cytauxzoon felis infection in healthy free-roaming cats in north-central Oklahoma and central Iowa
Authors: Nagamori Yoko , Slovak Jennifer E , Reichard Mason V
Published: June 2016

Case summary Cytauxzoonosis is a tick-borne disease of cats, and Oklahoma (OK), USA, is considered an enzootic state. To determine the prevalence of Cytauxzoon felis, blood was collected from free-roaming cats, as they are frequently exposed to tick vectors. Our objective was to determine the prevalence of C felis infection in free-roaming cats in north-central Oklahoma and central Iowa (IA). Infection with C felis was determined using DNA extracted from blood and PCR amplification. Blood was collected from 380 free-roaming cats between January and April in 2014 in OK. DNA from C felis was detected in 3/380 (0.8%; 95% confidential interval [CI] 0.22–2.3%). In IA, 292 blood samples were collected between 2012 and 2014. No C felis-infected cats were detected (0; 95% CI 0–0%).

Relevance and novel information The prevalence of C felis (0.8%) in north-central OK reported herein was lower than the previously reported 3.4% in domestic cats in OK. Our study supports that the prevalence in a given enzootic area can vary by location and from the pool of cats sampled. None of 291 (0%) cats were infected with C felis in central IA. To date, only one case of cytauxzoonosis in a domestic cat has been reported in IA. It is important to monitor cats for C felis infections in northern US states, as geographic distribution of Amblyomma americanum expands northward. As free-roaming cats have more contact with the tick vectors of C felis, this population allows us to monitor the expansion of C felis distribution.
Psychometric Evaluation of the Japanese Version of the Posttraumatic Stress Disorder Checklist in Community Dwellers Following the Fukushima Daiichi Nuclear Power Plant Incident
Authors: Iwasa Hajime , Suzuki Yuriko , Shiga Tetsuya , Maeda Masaharu , Yabe Hirooki , Yasumura Seiji ,   on behalf of the Mental Health Group of the Fukushima Health Management Survey, Niwa Ohtsura , Matsui Shiro , Ohira Tetsuya , Mashiko Hirobumi , Kunii Yasuto , Itagaki Shuntaro , Miura Itaru , Nakayama Yoko , Ohta Misao , Goto Aya , Hisata Mitsuru , Kawakami Norito , Hosoya Mitsuaki , Harigane Mayumi , Yagi Akiko , Oikawa Yu-ichi , Ueda Yuki , Horikoshi Naoko
Published: June 2016

We investigated the psychometric properties of the Japanese version of the Posttraumatic Stress Disorder Checklist–Stressor Specific Version (PCL-S) using baseline data from the Fukushima Health Management Survey. A total of 26,332 men and 33,516 women aged 16 and above participated in this study. Participants lived in the Fukushima evacuation zone in Japan and experienced the Great East Japan Earthquake and nuclear power plant (NPP) incident. The PCL-S was used to assess participants’ posttraumatic stress disorder (PTSD) symptoms. In addition, we described participants and tested the validity of the PCL-S by administering the Kessler Six-item Screening Scale for Psychological Distress (K6) and assessing education; employment; self-rated health; sleep satisfaction; experiencing the earthquake, tsunami, and NPP incident; and bereavement as a result of the disaster. PCL-S scores exhibited a positively skewed, slightly leptokurtic distribution. Confirmatory factor analysis revealed that the five-factor model was a better fit than were the three- or four-factor models. The PCL-S and its subscales had high Cronbach’s alpha coefficients. The PCL-S scores had weak-to-moderate correlations with history of mental illness, bereavement, experiencing the tsunami, experiencing the NPP incident, self-rated health, and sleep satisfaction, as well as a strong correlation with psychological distress. There were significant gender and age differences in PCL-S scores. Overall, this study confirmed the psychometric properties of the PCL-S, including the score distribution, factor structure, reliability, validity, and gender and age differences. Thus, the Japanese version of the PCL-S would be a useful instrument for assessing the PTSD symptoms of community dwellers who have experienced traumatic events.
Modeling altered T-cell development with induced pluripotent stem cells from patients with RAG1-dependent immune deficiencies
Authors: Brauer Patrick M. , Pessach Itai M. , Clarke Erik , Rowe Jared H. , Ott de Bruin Lisa , Lee Yu Nee , Dominguez-Brauer Carmen , Comeau Anne M. , Awong Geneve , Felgentreff Kerstin , Zhang Yuhang H. , Bredemeyer Andrea , Al-Herz Waleed , Du Likun , Ververs Francesca , Kennedy Marion , Giliani Silvia , Keller Gordon , Sleckman Barry P. , Schatz David G. , Bushman Frederic D. , Notarangelo Luigi D. , Zúñiga-Pflücker Juan Carlos
Published: June 2016

Key Points

Upon in vitro differentiation, iPSCs obtained from patients with SCID and OS show a similar block in T-cell development. Presence of unresolved single-strand DNA breaks in developing T cells from OS patient-derived iPSCs affects their differentiation.
Setdb1 maintains hematopoietic stem and progenitor cells by restricting the ectopic activation of nonhematopoietic genes
Authors: Koide Shuhei , Oshima Motohiko , Takubo Keiyo , Yamazaki Satoshi , Nitta Eriko , Saraya Atsunori , Aoyama Kazumasa , Kato Yuko , Miyagi Satoru , Nakajima-Takagi Yaeko , Chiba Tetsuhiro , Matsui Hirotaka , Arai Fumio , Suzuki Yutaka , Kimura Hiroshi , Nakauchi Hiromitsu , Suda Toshio , Shinkai Yoichi , Iwama Atsushi
Published: June 2016

Key Points

Setdb1, an H3K9 histone methyltransferase, is essential for the maintenance of HSPCs. Setdb1 restricts the activation of nonhematopoietic genes, such as gluconeogenic pathway genes, to maintain HSPCs.
Do Different Funding Mechanisms Produce Different Results? The Implications of Family Planning for Fiscal Federalism
Authors: McFarlane Deborah R. , Meier Kenneth J.
Published: June 2016

The 104th Congress considered massive structural changes in federal aid to the states. Not only would federal categorical grants be consolidated into block grants, but entitlement programs would be converted to block grants too. Using family planning as a case study, this article examines whether program impacts change if different grant mechanisms are employed. Findings from a pooled time series analysis of state family planning expenditures show that categorical funding (here, title X of the Public Health Service Act) is the most cost effective in producing desired outcomes, such as lowering infant mortality. Policies using entitlement grants are generally more cost effective than those that rely upon block grants. We discuss the implications of these findings for health policy more broadly and for fiscal federalism in general.