bluuebunny/crossref_metadata_2025 huggingface dataset:
TRPV4 in the battle of the sexes
Authors: Sedwick Caitlin
Published: May 2017

New JGP paper explains sexual dimorphism and tissue-specific activity of TRPV4.
The comparison between modeling of edge localized modes with a current relaxation model and experiment on EAST
Authors: Cai J Q , Liang Y , Pearson J , Zhang T , Zang Q , Wu M Q , Huang J
Published: May 2017

The distinctions of edge localized mode (ELM) frequency distributions between moderate and high edge current density cases were observed on the experiment advanced superconducting tokamak. In this paper, a current relaxation model is applied to explain this new observation. It has been demonstrated that the ELM frequency is very sensitive to the edge current density and the edge safety factor by the model predictions. The results also show that, in the large edge current density case, the ELM frequency is subject to a single-peak distribution; while in the moderate edge current density case, the ELM frequency is subject to a roughly multi-peak distribution.
An anisotropic finite element method on polyhedral domains: Interpolation error analysis
Authors: Li Hengguang
Published: May 2017

On a polyhedral domain

Ω
⊂

R

3

\Omega \subset \mathbb R^3

, consider the Poisson equation with the Dirichlet boundary condition. For singular solutions from the non-smoothness of the domain boundary, we propose new anisotropic mesh refinement algorithms to improve the convergence of finite element approximation. The proposed algorithm is simple, explicit, and requires less geometric conditions on the mesh and on the domain. Then, we develop interpolation error estimates in suitable weighted spaces for the anisotropic mesh, especially for the tetrahedra violating the maximum angle condition. These estimates can be used to design optimal finite element methods approximating singular solutions. We report numerical test results to validate the method.
Linear differential equations with slowly growing solutions
Authors: Gröhn Janne , Huusko Juha-Matti , Rättyä Jouni
Published: May 2017

This research concerns linear differential equations in the unit disc of the complex plane. In the higher order case the separation of zeros (of maximal multiplicity) of solutions is considered, while in the second order case slowly growing solutions in

H
∞

H^\infty

,

B
M
O
A

\mathrm {BMOA}

, and the Bloch space are discussed. A counterpart of the Hardy–Stein–Spencer formula for higher derivatives is proved, and then applied to study solutions in the Hardy spaces.
On quadratic forms over semilocal rings
Authors: Gille Stefan
Published: May 2017

Using a recent result of Panin and Pimenov we show that several results, as for instance the linkage principle, in the algebraic theory of quadratic forms over fields also hold for quadratic forms over regular semilocal domains which contain a field of characteristic not 2. As an application we prove that the Arason and Elman presentation of the powers of the fundamental ideal of the Witt ring of a field extends to semilocal rings which contain an infinite field of characteristic not 2.
On patterns and re-use in bioinformatics databases
Authors: Bell Michael J , Lord Phillip
Published: May 2017

Motivation

As the quantity of data being depositing into biological databases continues to increase, it becomes ever more vital to develop methods that enable us to understand this data and ensure that the knowledge is correct. It is widely-held that data percolates between different databases, which causes particular concerns for data correctness; if this percolation occurs, incorrect data in one database may eventually affect many others while, conversely, corrections in one database may fail to percolate to others. In this paper, we test this widely-held belief by directly looking for sentence reuse both within and between databases. Further, we investigate patterns of how sentences are reused over time. Finally, we consider the limitations of this form of analysis and the implications that this may have for bioinformatics database design.

Results

We show that reuse of annotation is common within many different databases, and that also there is a detectable level of reuse between databases. In addition, we show that there are patterns of reuse that have previously been shown to be associated with percolation errors.

Availability and implementation

Analytical software is available on request.
Accelerating high-dimensional clustering with lossless data reduction
Authors: Qaqish Bahjat F , O’Brien Jonathon J , Hibbard Jonathan C , Clowers Katie J
Published: May 2017

Motivation

For cluster analysis, high-dimensional data are associated with instability, decreased classification accuracy and high-computational burden. The latter challenge can be eliminated as a serious concern. For applications where dimension reduction techniques are not implemented, we propose a temporary transformation which accelerates computations with no loss of information. The algorithm can be applied for any statistical procedure depending only on Euclidean distances and can be implemented sequentially to enable analyses of data that would otherwise exceed memory limitations.

Results

The method is easily implemented in common statistical software as a standard pre-processing step. The benefit of our algorithm grows with the dimensionality of the problem and the complexity of the analysis. Consequently, our simple algorithm not only decreases the computation time for routine analyses, it opens the door to performing calculations that may have otherwise been too burdensome to attempt.

Availability and implementation

R, Matlab and SAS/IML code for implementing lossless data reduction is freely available in the Appendix.
Reducing Surgical Infections and Implant Costs via a Novel Paradigm of Enhanced Physician Awareness
Authors: Agarwal Nitin , Agarwal Prateek , Querry Ashley , Mazurkiewicz Anna , Whiteside Brittany , Marroquin Oscar C , Koscumb Stephen F , Wecht Daniel A , Friedlander Robert M
Published: May 2017

BACKGROUND

Studies have demonstrated that physicians are often unaware of prescription drug, laboratory, diagnostic, and surgical supply costs.

OBJECTIVE

To investigate the effects of increased physician awareness on infection incidence and surgical device cost containment.

METHODS

Within our institution, physicians were informed of individual, independently adjudicated, craniotomy and ventricular shunt infection incidence and rankings among peers, after which a protocol aimed at reducing skin bacterial burden was implemented for craniotomies. Physicians were also made aware of the costs for shunts and dural substitutes as well as available alternatives.

RESULTS

The combined craniotomy and ventricular shunt infection incidence significantly decreased by 37.5% from 3.2% over May 2011 to April 2015 (132 infections/4137 procedures) to 2.1% over May 2015 to April 2016 (26 infections/1250 procedures; P = .041). The average annual cost savings was $234 175 from preventing postoperative craniotomy infections and $121 125 from preventing postoperative ventricular shunt infections. Total supply costs of ventricular shunts significantly decreased by 26% from $2345 per procedure in fiscal year 2015 to $1747 per procedure in fiscal year 2016 (P < .001). Total supply cost of dural grafts significantly decreased by 54% from $191 per procedure in fiscal year 2015 to $88 per procedure in fiscal year 2016 (P < .001). In total, all initiatives in this study resulted in an estimated annual savings of $567 062.

CONCLUSION

Physician awareness of outcomes and costs resulted in increasing the quality of care, while at the same time reducing the cost.
Frontal Lobe Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom, Overall Cognitive and Adaptive Functioning
Authors: Ramantani Georgia , Kadish Navah Ester , Mayer Hans , Anastasopoulos Constantin , Wagner Kathrin , Reuner Gitta , Strobl Karl , Schubert-Bast Susanne , Wiegand Gert , Brandt Armin , Korinthenberg Rudolf , Mader Irina , van Velthoven Vera , Zentner Josef , Schulze-Bonhage Andreas , Bast Thomas
Published: May 2017

BACKGROUND

Although frontal lobe resections account for one-third of intralobar resections in pediatric epilepsy surgery, there is a dearth of information regarding long-term seizure freedom, overall cognitive and adaptive functioning.

OBJECTIVE

To identify outcome predictors and define the appropriate timing for surgery.

METHODS

We retrospectively analyzed the data of 75 consecutive patients aged 10.0 ± 4.9 yr at surgery that had an 8.1 yr mean follow-up.

RESULTS

Etiology comprised focal cortical dysplasia (FCD) in 71% and benign tumors in 16% cases. All patients but one had a magnetic resonance imaging-visible lesion. At last follow-up, 63% patients remained seizure-free and 37% had discontinued antiepileptic drugs. Presurgical predictors of seizure freedom were a shorter epilepsy duration, strictly regional epileptic discharges in electroencephalography (EEG), and an epileptogenic zone and/or lesion distant from eloquent cortex. Postsurgical predictors were the completeness of resection and the lack of early postoperative seizures or epileptic discharges in EEG. Higher presurgical overall cognitive and adaptive functioning was related to later epilepsy onset and to a sublobar epileptogenic zone and/or lesion. Following surgery, scores remained stable in the majority of patients. Postsurgical gains were determined by higher presurgical performance and tumors vs FCD.

CONCLUSION

Our findings highlight the favorable long-term outcomes following frontal lobe epilepsy surgery in childhood and adolescence and underline the importance of early surgical intervention in selected candidates. Early postsurgical relapses and epileptic discharges in EEG constitute key markers of treatment failure and should prompt timely reevaluation. Postsurgical overall cognitive and adaptive functioning is stable in most patients, whereas those with benign tumors have higher chances of improvement.
“Tweak Your Order Set!” Implementation of Modified Laboratory Order Set Improves Hepatitis C Virus Screening Rates in People Living With Human Immunodeficiency Virus
Authors: Wurcel Alysse G. , Chen Daniel D. , Chui Kenneth K. H. , Knox Tamsin A.
Published: May 2017

There are several barriers to annual hepatitis C virus antibody (HCVAb) testing, including lack of provider knowledge of the changing HCV epidemic and provider underestimation of a patient’s risk. We identified low rates of testing for HCVAb in people living with human immunodeficiency virus (HIV) in our outpatient HIV Infectious Diseases clinic, and we developed a quality improvement project to increase rates of HCVAb screening.
Refractory T-Cell Anergy and Rapidly Fatal Progressive Multifocal Leukoencephalopathy After Prolonged CTLA4 Therapy
Authors: Dekeyser Manon , de Goër de Herve Marie-Ghislaine , Hendel-Chavez Houria , Labeyrie Céline , Adams David , Nasser Ghaïdaa Adebs , Gasnault Jacques , Durrbach Antoine , Taoufik Yassine
Published: May 2017

Progressive multifocal leukoencephalopathy (PML) is a deadly demyelinating disease due to central nervous system replication of the human polyomavirus JC virus (JCV) in immunosuppressed patients. The only effective therapeutic approach is to restore anti-JCV T-cell responses. In this study, we describe a case of rapidly fatal PML with JCV T-cell anergy in a renal transplant patient treated with CTLA4-Ig (belatacept, a CD28-B7 costimulation blocker and T-cell anergy inducer). T-cell anergy could not be reversed despite several therapeutic approaches. Progressive multifocal leukoencephalopathy secondary to biotherapy-induced T-cell anergy may thus represent a subset of PML with major resistance to anti-JCV immune recovery.
The Transcondylar Approach to Access Symptomatic Arachnoid Cysts of the Hypoglossal Canal
Authors: Burkhardt Jan-Karl , Bal Christina , Neidert Marian Christoph , Bozinov Oliver
Published: May 2017

BACKGROUND AND IMPORTANCE

A direct transcondylar approach to treat symptomatic arachnoid cysts of the hypoglossal canal has not yet been described in the literature.

CLINICAL PRESENTATION

Here, we present a skull base approach in 2 female patients (68 and 38 yr) with progressive dysphagia, dysarthria, half-sided weakness, and atrophy of the tongue due to an arachnoid cyst of the hypoglossal canal. After patient informed consent, both patients were successfully operated on without complications using a transcondylar approach, and their symptoms improved 3 mo after surgery; in both patients, resection of the cyst was confirmed using magnetic resonance imaging. Review of the literature revealed 4 surgically treated cases of hypoglossal cysts operated on through a paramedian suboccipital craniotomy from a medial to lateral surgical corridor.

CONCLUSION

This is the first description of the transcondylar surgical approach to safely operate on symptomatic arachnoid cysts located in the hypoglossal canal. The isolated transcondylar approach is useful in selective cases when the pathology is located within the hypoglossal canal only and the skull base anatomy allows a direct approach.
Effects of Bran Prehydration on Functional Characteristics and Bread‐Baking Quality of Bran and Flour Blends
Authors: Park Eun Young , Fuerst E. Patrick , Baik Byung‐Kee
Published: May 2017

The effect of bran prehydration on the composition and bread‐baking quality was determined using bran and flour of two wheat varieties. Bran was hydrated in sodium acetate buffer (50mM, pH 5.3) to 50% moisture at 25 or 55°C for 1.5 or 12 h. The soluble sugar content in bran increased with prehydration. Decreases in phytate and soluble fiber were observed in prehydrated bran, but insoluble fiber was not affected by prehydration. Likewise, free phenolic content decreased, and there was little change in the content of bound phenolics in prehydrated bran. The compositional changes were greater in the bran prehydrated at 55 than at 25°C, and for 12 than for 1.5 h. Addition of prehydrated bran delayed dough development of bran and flour blends and slightly increased water absorption of dough. A higher loaf volume of fresh bread and lower crumb firmness of bread stored for 10 days were observed in bread containing bran prehydrated at 25°C than in bread containing nonhydrated bran or bran prehydrated at 55°C. The prehydration of bran at 25°C before being incorporated into refined flour for dough mixing improved bread quality by altering bran compositional properties, allowing enough water to be absorbed by fibrous materials in the bran and preventing water competition among dough constituents.
Genetic advances in systemic lupus erythematosus: an update
Authors: Chen Lingyan , Morris David L. , Vyse Timothy J.
Published: May 2017

Purpose of review

More than 80 susceptibility loci are now reported to show robust genetic association with systemic lupus erythematosus (SLE). The differential functional effects of the risk alleles for the majority of these loci remain to be defined. Here, we review current SLE association findings and the recent progress in the annotation of noncoding regions of the human genome as well as the new technologies and statistical methods that can be applied to further the understanding of SLE genetics.

Recent findings

Genome-wide association studies (GWAS) have markedly expanded the catalogue of genetic signals contributing to SLE development; we can now explain more than 50% of the disease's heritability. Expression quantitative trait loci mapping with colocalization analysis of GWAS results help to identify the underlying causal genes. The Encyclopedia of DNA elements, Roadmap Epigenome, and the Blueprint Epigenome projects have jointly annotated more than 80% of the noncoding genome, providing a wealth of information (from healthy individuals) to define the functional elements within the risk loci. Technologies, such as next-generation sequencing, chromatin structure determination, and genome editing, will help elucidate the actual mechanisms that underpin SLE risk alleles.

Gene expression and epigenetic databases provide a valuable resource to interpret genetic association in SLE. Expansion of such resources to include disease status and multiple ancestries will further aid the exploration of the biology underlying the genetics.
A prevalence study of thoracic scoliosis in Chilean patients aged 10–20 years using chest radiographs as a screening tool
Authors: Urrutia Julio , Besa Pablo , Bengoa Francisco
Published: May 2017

To determine the prevalence of thoracic scoliosis in patients 10–20 years old using radiographs as a screening tool, we studied 783 patients who obtained chest radiographs for nonspinal reasons. We measured thoracic curvature in coronal and sagittal planes; we determined whether age, sex, and sagittal curvature predicted the coronal curvature. The prevalence of scoliosis was 9.3%: 7.0% had curvatures 10°–20°; 1.0% had curvatures 20°–30°; and 1.3% had curvatures of at least 30°. Females (13%) presented larger prevalence of scoliosis than males (4.8%) (P<0.01), also with a larger proportion of larger curvatures. Sex and thoracic kyphosis were independent predictors of the coronal curvature, age was not.
Advances in management of hepatocellular carcinoma
Authors: Allaire Manon , Nault Jean-Charles
Published: May 2017

Purpose of review

Hepatocellular carcinoma (HCC) is one of the leading causes of death by cancer worldwide due to a dismal prognosis. The aim of this review is to summarize the main advances in the pathophysiology and management of HCC.

Recent findings

Genomic analysis has recently delineated the key signaling pathways aberrantly deregulated in HCC (telomere maintenance, cell cycle gene, Wnt/β-catenin, epigenetic modifier, oxidative stress etc.). Major advances in the clinical care of patients with HCC are helping to refine the diagnosis algorithm and tumor staging. Extension of criteria for liver transplantation, but also for liver resection and percutaneous ablation, aims to increase the number of patients being treated in a curative attempt. Moreover, radioembolization is a competitor for transarterial chemoembolization in Barcelona clinic liver cancer B patients, and sorafenib in Barcelona clinic liver cancer C with tumor portal thrombosis. In advanced HCC, sorafenib is the standard of first-line care and regorafenib as a second line.

New concepts on liver resection, percutaneous ablation or liver transplantation aim to extend the numbers of patients treated for HCC in curative attempts. Moreover, immunotherapy (anti death protein 1) and biotherapy adapted to tumor biology seem promising and are currently being tested in advanced stages.
The Influence of Maternal Pragmatics on the Language Skills of Children with Autism
Authors: Stern Yael S. , Maltman Nell , Roberts Megan Y.
Published: May 2017

Objective:

This study examined the relationship between mothers' pragmatics and child language in autism spectrum disorder (ASD) and non-ASD language delay (LD) mother-child dyads.

Methods:

Participants consisted of 20 dyads of mothers and their toddlers aged 24 to 48 months, with ASD (n = 10) or non-ASD LD (n = 10). Groups were matched on child chronological age, language, and cognition. Maternal pragmatic language was qualified based on the degree of pragmatic violations during a semistructured interview, and was examined in relation to both child language, as measured by the Preschool Language Scale-4 and maternal use of language facilitation strategies during play.

Results:

Lower rates of maternal pragmatic violations were associated with higher expressive language scores in children with ASD, and with higher receptive language scores for children with non-ASD LD. Within ASD dyads, maternal pragmatic violations were negatively related to mothers' use of linguistic expansions.

Conclusion:

These findings indicate that parental pragmatics likely contribute to early language learning, and that the effects of maternal pragmatics on early language in ASD may be indirect (e.g., through parents' use of facilitative strategies). Parent-mediated language interventions for ASD should therefore consider parent pragmatics, especially given that pragmatic differences have been identified in unaffected family members of individuals with ASD.
Validity, cut-points, and minimally important differences for two hot flash-related daily interference scales
Authors: Carpenter Janet S. , Bakoyannis Giorgos , Otte Julie L. , Chen Chen X. , Rand Kevin L. , Woods Nancy , Newton Katherine , Joffe Hadine , Manson JoAnn E. , Freeman Ellen W. , Guthrie Katherine A.
Published: May 2017

Objectives:

To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales.

Methods:

We analyzed baseline and postrandomization patient-reported data pooled across three randomized trials aimed at reducing vasomotor symptoms (VMS) in 899 midlife women. Trials were conducted across five MsFLASH clinical sites between July 2009 and October 2012. We eliminated HFRDIS items based on experts’ content validity ratings and confirmatory factor analysis, and evaluated cut-points and established MIDs by mapping HFRDIS and HFI to other measures.

Results:

The three-item HFI (interference with sleep, mood, and concentration) demonstrated strong internal consistency (alphas of 0.830 and 0.856), showed good fit to the unidimensional “hot flash interference factor,” and strong convergent validity with HFRDIS scores, diary VMS, and menopausal quality of life. For both scales, cut-points of mild (0-3.9), moderate (4-6.9), and severe (7-10) interference were associated with increasing diary VMS ratings, sleep, and anxiety. The average MID was 1.66 for the HFRDIS and 2.34 for the HFI.

Conclusions:

The HFI is a brief assessment of VMS interference and will be useful in busy clinics to standardize VMS assessment or in research studies where response burden may be an issue. The scale cut-points and MIDs should prove useful in targeting those most in need of treatment, monitoring treatment response, and interpreting existing and future research findings.
Ospemifene's effects on lipids and coagulation factors: a post hoc analysis of phase 2 and 3 clinical trial data
Authors: Archer David F. , Altomare Corrado , Jiang Wei , Cort Susannah
Published: May 2017

Objective:

To evaluate the effect of ospemifene 60 mg on the lipid and coagulation parameters of postmenopausal women using data from five phase 2 and 3 clinical trials.

Methods:

Data for lipids and coagulation factors for 2,166 postmenopausal women were pooled from five randomized, placebo-controlled studies. Lipid and coagulation parameters included in this analysis were total cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, activated partial thromboplastin time (aPTT), fibrinogen, antithrombin antigen, protein C Ag, and protein S Ag free.

Results:

Mean percent changes in HDL and LDL were significantly greater with ospemifene versus placebo at month 3 (HDL: 4.4% vs 0.2%; LDL: −5.2% vs 2.4%), month 6 (HDL: 5.1% vs 1.5%; LDL: −6.7% vs 2.4%), and month 12 (HDL: 2.3% vs −1.9%; LDL: −7.0% vs −2.1%; P < 0.05, for all comparisons). Ospemifene significantly reduced total cholesterol at 6 months (−1.8% vs 1.6%; P = 0.0345 versus placebo), and changes in triglycerides with ospemifene were similar to placebo at all three time points. In subgroup analyses based on age, body mass index, and baseline triglyceride level, ospemifene increased HDL and decreased LDL, but had no significant effect on total cholesterol and triglycerides relative to placebo. Ospemifene significantly improved fibrinogen and protein C antigen levels relative to placebo at months 3 (−8.7% vs −0.8% and −2.7% vs 0.5%, respectively), 6 (−6.0% vs 6.7% and −3.6 vs 8.0%), and 12 (−8.7% vs 7.3% and −4.5% vs 6.6%; P < 0.01, for all). The levels of all coagulation factors remained within the normal range throughout the studies.

Conclusion:

Ospemifene 60 mg does not have a detrimental effect on lipid and coagulation parameters of postmenopausal women with up to 12 months of use.
Trends in governance structure and activities among not-for-profit U.S. hospitals: 2009–2015
Authors: Mazurenko Olena , Collum Taleah , Menachemi Nir
Published: May 2017

Background:

In U.S. hospitals, boards of directors (BODs) have numerous governance responsibilities including overseeing hospital activities and guiding strategic decisions. BODs can help hospitals adapt to changes in their markets including those stemming from a shift from fee-for-service to value-based purchasing. The recent increase in market turbulence for hospitals has brought renewed attention to the work of BODs.

Purpose:

The aim of the study was to examine trends in hospital BOD structure and activities and determine whether these changes are commensurate with approaches designed to respond to market pressures.

Methodology/Approach:

We examined hospital level data from The Governance Institute Survey (2009, 2011, 2013, and 2015) and corresponding years of the American Hospital Association Annual Survey in a pooled, cross-sectional design. We conducted individual multivariate models with adjustments for hospital and market characteristics, comparing the changes in BOD structures, demographics, and activities over time.

Findings:

The sample included 1,811 hospital-year observations, including 682 unique facilities. We found that BODs in 2015 had less internal management (β = −2.25, p < .001) and fewer employed and nonemployed physicians (β = −8.28, p < .001) involved on the BOD. Moreover, compared to 2009, racial and ethnic minorities (2013 β = 2.88, p < .001) and women (2013 β = 1.60, p = .045; 2015 β = 2.06, p = .049) on BODs increased over time. In addition, BODs were significantly less likely to spend time on the following activities in 2015, as compared to 2009: discussing strategy and setting policy (β = −5.46, p = .002); receiving reports from management, board committees, and subsidiaries (β = −29.04, p < .001); and educating board members (β = −4.21, p < .001). Finally, BODs had no changes in the type of committees reported over time.

Practice Implications:

Our results indicate that hospital BODs deploy various strategies to adapt to current market trends. Hospital decision-makers should be aware of the potential effects of board structure on organization’s position in the changing health care market.
Burden of Psychosocial and Cognitive Impairment in Patients With Atrial Fibrillation
Authors: Bostrom John A. , Saczynski Jane S. , Hajduk Alexandra , Donahue Kevin , Rosenthal Lawrence S. , Browning Clifford , Ennis Cynthia , Floyd Kevin C. , Richardson Heather , Esa Nada , Ogarek Jessica , McManus David D.
Published: May 2017

Background:

Impairments in psychosocial status and cognition relate to poor clinical outcomes in patients with atrial fibrillation (AF). However, how often these conditions co-occur and associations between burden of psychosocial and cognitive impairment and quality of life (QoL) have not been systematically examined in patients with AF.

Methods:

A total of 218 patients with symptomatic AF were enrolled in a prospective study of AF and psychosocial factors between May 2013 and October 2014 at the University of Massachusetts Medical Center. Cognitive function, depression, and anxiety were assessed at baseline and AF-specific QoL was assessed 6 months after enrollment using validated instruments. Demographic and clinical information were obtained from a structured interview and medical record review.

Results:

The mean age of the study participants was 63.5 ± 10.2 years, 35% were male, and 81% had paroxysmal AF. Prevalences of impairment in 1, 2, and 3 psychosocial/cognitive domains (eg, depression, anxiety, or cognition) were 75 (34.4%), 51 (23.4%), and 16 (7.3%), respectively. Patients with co-occurring psychosocial/cognitive impairments (eg, >1 domain) were older, more likely to smoke, had less education, and were more likely to have heart failure (all P < 0.05). Compared with participants with no psychosocial/cognitive impairments, AF-specific QoL at 6 months was significantly poorer among participants with baseline impairment in 2 (B = −13.6, 95% CI: −21.7 to −5.4) or 3 (B = −15.1, 95% CI: −28.0 to −2.2) psychosocial/cognitive domains.

Conclusion:

Depression, anxiety, and impaired cognition were common in our cohort of patients with symptomatic AF and often co-occurred. Higher burden of psychosocial/cognitive impairment was associated with poorer AF-specific QoL.
Pathway for the Management of Atrial Fibrillation and Atrial Flutter
Authors: Herzog Eyal , Argulian Edgar , Levy Steven B. , Aziz Emad F.
Published: May 2017

Atrial fibrillation (AF) is the most common cardiac rhythm disturbance encountered in clinical practice, and its prevalence is increasing as the population ages. The American College of Cardiology, the American Heart Association, and the European Society of Cardiology established guidelines for the management of patients with AF. Atrial flutter (Afl) is less common and is often associated with or preceded by AF or occurs in an isolated pattern. A major limitation of the currently published guidelines for the management of patients with AF and Afl is their complexity, the fact that official guidelines are published separately for each of these arrhythmias, and that they were published several years ago. To address these deficiencies, we have developed a novel pathway for the management of AF and Afl. The pathway has been designated with the acronym RACE, which reflects the 4 main components in patient management: rate control, anticoagulation therapy, cardioversion, and electrophysiology/antiarrhythmic medication. This pathway is an attempt to incorporate, in a user-friendly format, the key concepts of the initial diagnosis and management of these prevalent arrhythmias. This is followed by a comprehensive guideline for therapy using the RACE acronym.
Acute and Long-Term Effects of LVAD Support on Right Ventricular Function in Children with Pediatric Pulsatile Ventricular Assist Devices
Authors: Iacobelli Roberta , Di Molfetta Arianna , Brancaccio Gianluca , Filippelli Sergio , Morelli Stefano , Natali Benedetta , Toscano Alessandra , Drago Fabrizio , Amodeo Antonio
Published: May 2017

Right ventricular failure (RVF) is a significant issue when considering left ventricular assist device (LVAD) implantation in pediatrics. The aim of this study was to evaluate the effects of LVAD on right ventricular (RV) function in children. We retrospectively reviewed clinical and echocardiographic data of children who underwent Berlin Heart EXCOR LVAD focusing on RV function before and after implantation (1, 3, and 6 month follow-up). An isolated LVAD was used in 27 patients. Median age was 11 months (interquartile range [IQR]: 5–24 months), with a median weight of 6.3 kg (IQR: 5–9 kg). Median time on ventricular assist device (VAD) support was 147 days (IQR: 86–210 days). Twenty patients were successfully bridged to orthotopic heart transplantation (OHT) (74%), six patients died (22%), and also heart function recovered in one patient (4%). Before LVAD implantation, nine patients (33%) showed a RV fractional area change (RVFAC) less than or equal to 30%. After implantation, mean RVFAC increased up until the 3 month follow-up (43.13%; p = 0.033) and then slightly decreased. In a subgroup of 18 patients, the average strain value increased after the 1 month follow-up (p = 0.022). Right ventricular failure developed in 33% of patients before the 1 month follow-up, and 7.4% experienced RVF at the 6 month follow-up. No patient required biventricular assist device (BiVAD). In our population, pulsatile-flow LVAD in children allows optimal RV decompression and function post-LVAD as measured by improvement in RV function at echo particularly at 1 and 3 month follow-up. At long-term follow-up, the beneficial effects of LVAD on RV function seem to be reduced as signs and symptoms of late RVF may develop in some patients despite LVAD support.
Death by Suicide Within 1 Week of Hospital Discharge
Authors: Riblet Natalie , Shiner Brian , Watts Bradley V. , Mills Peter , Rusch Brett , Hemphill Robin R.
Published: May 2017

There is a high risk for death by suicide after discharge from an inpatient mental health unit. To better understand system and organizational factors associated with postdischarge suicide, we reviewed root cause analysis reports of suicide within 7 days of discharge from across all Veterans Health Administration inpatient mental health units between 2002 and 2015. There were 141 reports of suicide within 7 days of discharge, and a large proportion (43.3%,n= 61) followed an unplanned discharge. Root causes fell into three major themes including challenges for clinicians and patients after the established process of care, awareness and communication of suicide risk, and flaws in the established process of care. Flaws in the design and execution of processes of care as well as deficits in communication may contribute to postdischarge suicide. Inpatient teams should be aware of the potentially heightened risk for suicide among patients with unplanned discharges.
Accuracy of Point-of-Care Ultrasonography for Pediatric Ankle Sprain Injuries
Authors: Jones Sarah , Colaco Keith , Fischer Jason , Stimec Jennifer , Kwan Charisse , Boutis Kathy
Published: May 2017

Objectives

In children with radiograph fracture-negative lateral ankle injuries, the main objective of this pilot study was to explore the accuracy, sensitivity, and specificity of point-of-care ultrasound (POCUS) performed by a pediatric emergency physician in diagnosing anterior talofibular ligament injuries, radiographically occult distal fibular fractures, and effusions compared with reference standard magnetic resonance imaging (MRI).

Methods

This was a prospective cohort pilot study. Children aged 5 to 17 years with an isolated, acute lateral ankle injury and fracture-negative ankle radiographs were eligible for enrolment. Within 1 week of the injury, enrolled children returned for MRI and POCUS of both ankles.

Results

Seven children were enrolled, with a mean age 12.1 (SD, 3.0) years. Overall, POCUS agreed with MRI with respect to anterior talofibular ligament injury in 4 (57%) of 7 cases. Of the 2 cases with MRI-confirmed ligament damage, POCUS accurately identified and graded the extent of ligament damage in 1 case. Point-of-care ultrasound falsely identified ligament injuries in 2 cases. Both imaging modalities confirmed the absence of cortical fractures in all 7 cases. For all findings, POCUS sensitivity and specificity were 57% and 86%, respectively.

Conclusions

In this pilot study, we established that POCUS diagnosed the specific pathology of radiograph-negative lateral ankle injuries with poor sensitivity but good specificity. Thus, POCUS could act as a tool to exclude significant ligamentous and radiographically occult bony injury in these cases. A larger study is needed to validate the utility of POCUS for this common injury.
Doppler Ultrasound Evaluation of Circulatory Support Devices
Authors: Nuffer Zachary , Rupasov Andrey , Bhatt Shweta
Published: May 2017

In the setting of mechanical circulatory support devices, including ventricular assist devices, extracorporeal membrane oxygenation, intraaortic balloon pumps, and the total artificial heart, the spectral Doppler waveform is significantly altered, reflecting systemic hemodynamic changes. As the prevalence of these devices increases, a better understanding of both the devices themselves and their associated Doppler ultrasound findings is necessary for accurate image interpretation. This article reviews the clinical indications, pathophysiology, and sonographic findings of these devices, with emphasis on the variation in arterial Doppler waveforms that can be seen with normal function, as well as the major complications.
Differential Diagnostic Value of Obstructive and Nonobstructive Azoospermia by Scrotal Ultrasound
Authors: Liu Jun , Wang Zhiqian , Li Min , Zhou Mingyang , Zhan Weiwei
Published: May 2017

Our objective was to assess the differential diagnostic value of classification of obstructive versus nonobstructive azoospermia by scrotal ultrasound. Forty patients with azoospermia were selected for our study (ages, 23–35; average, 29 ± 5.34 years). Patients were divided into the obstructive (17) or nonobstructive (23) azoospermia category. Twenty “healthy” volunteers were selected for the control group. We observed the testis, epididymis, and vas deferens in all subjects. Testicular volumes were calculated and compared with the control group for both obstructive and nonobstructive groups. Cystic or tubular dilation of the epididymis was found in all patients with obstructive azoospermia. The patients with nonobstructive azoospermia had no significant abnormalities of the epididymis. There was no difference in the testicular volumes between the patients with obstructive azoospermia and healthy controls (P > 0.05). However, the testicular volumes of patients with nonobstructive azoospermia were smaller than those of healthy volunteers (P < 0.05). It is helpful to identify obstructive and nonobstructive azoospermia by scrotal ultrasound, because it is a less invasive method that can be used to isolate probable treatment options.
Modeling Acute Traumatic Hemorrhagic Shock Injury: Challenges and Guidelines for Preclinical Studies
Authors: Tremoleda Jordi L. , Watts Sarah A. , Reynolds Penny S. , Thiemermann Christoph , Brohi Karim
Published: May 2017

Trauma is responsible for a large proportion of the world's burden of disease, and is by far the biggest killer of young adults. Hemorrhage is the leading cause of preventable death and its effects are directly correlated with the incidence multi-organ failure in survivors. Trauma research is challenging due to patient heterogeneity, limited randomized controlled trials, and in vitro studies that fail to mimic the systemic injury response. Preclinical research remains essential for mechanistic and therapeutic discovery. Yet modeling the multifaceted nature of traumatic injury poses important experimental and welfare challenges associated with the onset of injury and prehospital and intra-operative care, the limited inter-species validation of coagulation profiles, the use of anesthesia/analgesia, and its impact on the systemic response to trauma; and the challenge of sustaining intensive care in recovery models. Proper model selection depends on the purpose of a given model and the criteria by which the experimental readouts will be clinically relevant. Such complexity warrants further refinement of experimental methodology and outcome measures to improve its clinical efficacy, while ensuring animal well-being. We review the experimental methodologies currently used for modeling traumatic hemorrhagic shock and addressing their impact on clinical translation. The aim of the review is to improve transparency and form a consensus when reporting methodology in trauma modeling.
Pupil size asymmetries are modulated by an interaction between attentional load and task experience
Authors: Wahn Basil , Ferris Daniel P. , Hairston W. David , König Peter
Published: May 2017

In a recently published study [1], we investigated how human pupil sizes are modulated by task experience as well as attentional load in a visuospatial task. In particular, participants performed a multiple object tracking (MOT) task while pupil sizes were recorded using binocular eyetracking measurements. To vary the attentional load, participants performed the MOT task either tracking zero or up to five targets. To manipulate the task experience, participants performed the MOT task on three consecutive days. We found that pupil sizes systematically increased with attentional load and decreased with additional task experience. For all these analyses, we averaged across the pupil sizes for the left and right eye. However, findings of a recent study [2] have suggested that also asymmetries in pupil sizes could be related to attentional processing. Given these findings, we further analyzed our data to investigate to what extent pupil size asymmetries are modulated by attentional load and task experience. We found a significant interaction effect between these two factors. That is, on the first day of the measurements, pupil size asymmetries were not modulated by attentional load while this was the case for the second and third day of the measurements. In particular, for the second and third day, pupil size asymmetries systematically increased with attentional load, indicating that attentional processing also modulates pupil size asymmetries. Given these results, we suggest that an increase in task experience (and associated reductions in arousal) uncover modulations in pupil size asymmetries related to attentional processing that are not observable for typical arousal levels. We suggest that these modulations could be a result of right-lateralized attentional processing in the brain that in turn influences structures involved in the control of pupil sizes such as the locus coeruleus. We can exclude a number of possible alternative explanations for this effect related to our experimental setup. Yet, given the novelty of this finding and the arguably speculative explanation of the underlying mechanisms, we suggest that future studies are needed to replicate the present effect and further investigate the underlying mechanisms.
Rainbowfish: A Succinct Colored de Bruijn Graph Representation
Authors: Almodaresi Fatemeh , Pandey Prashant , Patro Rob
Published: May 2017

The colored de Bruijn graph— a variant of the de Bruijn graph which associates each edge (i.e., k-mer) with some set of colors — is an increasingly important combinatorial structure in computational biology. Iqbal et al. demonstrated the utility of this structure for representing and assembling a collection (pop-ulation) of genomes, and showed how it can be used to accurately detect genetic variants. Muggli et al. introduced VARI, a representation of the colored de Bruijn graph that adopts the BOSS representation for the de Bruijn graph topology and achieves considerable savings in space overCortex, albeit with some sacrifice in speed. The memory-efficient representation of VARI allows the colored de Bruijn graph to be constructed and analyzed for large datasets, beyond what is possible withCortex.

In this paper, we introduce Rainbowfish, a succinct representation of the color information of the colored de Bruijn graph that reduces the space usage even further. Our representation also uses BOSS to represent the de Bruijn graph, but decomposes the color sets based on an equivalence relation and exploits the inherent skewness in the distribution of these color sets. The Rainbowfish representation is compressed based on the 0th-order entropy of the color sets, which can lead to a significant reduction in the space required to store the relevant information for each edge. In practice, Rainbowfish achieves up to a 20 × improvement in space over VARI. Rainbowfish is written in C++11 and is available athttps://github.com/COMBINE-lab/rainbowfish.
Yeasts dominate soil fungal communities in three lowland Neotropical rainforests
Authors: Dunthorn Micah , Kauserud Håvard , Bass David , Mayor Jordan , Mahé Frédéric
Published: May 2017

Forest soils typically harbour a vast diversity of fungi, but are usually dominated by filamentous (hyphae-forming) taxa. Compared to temperate and boreal forests, though, we have limited knowledge about the fungal diversity in tropical rainforest soils. Here we show, by environmental metabarcoding of soil samples collected in three Neotropical rainforests, that Yeasts dominate the fungal communities in terms of the number of sequencing reads and OTUs. These unicellular forms are commonly found in aquatic environments, and their hyperdiversity may be the result of frequent inundation combined with numerous aquatic microenvironments in these rainforests. Other fungi that are frequent in aquatic environments, such as the abundant Chytridiomycotina, were also detected. While there was low similarity in OTU composition within and between the three rainforests, the fungal communities in Central America were more similar to each other than the communities in South America, reflecting a general biogeographic pattern also seen in animals, plants, and protists.

Contact

dunthorn@rhrk.uni-kl.de
Bifunctionality of a biofilm matrix protein controlled by redox state
Authors: Arnaouteli Sofia , Ferreira Ana Sofia , Schor Marieke , Morris Ryan J. , Bromley Keith M. , Jo Jeanyoung K. , Cortez Krista L. , Sukhodub Tetyana , Prescott Alan R. , Dietrich Lars E.P. , MacPhee Cait E. , Stanley-Wall Nicola R.
Published: May 2017

Biofilms are communities of microbial cells that are encapsulated within a self-produced polymeric matrix. The matrix is critical to the success of biofilms in diverse habitats, but despite this many details of the composition, structure, and function remain enigmatic. Biofilms formed by the Gram-positive bacteriumBacillus subtilisdepend on the production of the secreted film-forming protein BslA. Here we show that a gradient of electron acceptor availability through the depth of the biofilm gives rise to two distinct functional roles for BslA and that these can be genetically separated through targeted amino acid substitutions. We establish that monomeric BslA is necessary and sufficient to give rise to complex biofilm architecture, while dimerization of BslA is required to render the community hydrophobic. Dimerization of BslA, mediated by disulfide bond formation, depends on two conserved cysteine residues located in the C-terminal region. Our findings demonstrate that bacteria have evolved multiple uses for limited elements in the matrix, allowing for alternative responses in a complex, changing environment.

Significance

The biofilm matrix is a critical target in the hunt for novel strategies to destabilise or stabilise biofilms. Knowledge of the processes controlling matrix assembly is therefore an essential prerequisite to exploitation. Here we highlight that the complexity of the biofilm matrix is even higher than anticipated with one matrix component making two independent functional contributions to the community. The influence the protein exerts is dependent on the local environmental properties, providing another dimension to consider during analysis. These findings add to the evidence that bacteria can evolve multifunctional uses for the extracellular matrix components.