bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure ulcers induced by drug administration: A new concept and report of four cases in elderly patients
Authors: Mizokami Fumihiro , Takahashi Yoshiko , Hasegawa Keiko , Hattori Hideyuki , Nishihara Keiji , Endo Hidetoshi , Furuta Katsunori , Isogai Zenzo
Published: September 2015

Drug‐induced akinesia is a potential cause of pressure ulcers. However, pressure ulcers that are caused by drug‐induced akinesia are not considered an adverse drug reaction (ADR). We propose that drug‐induced pressure ulcers (DIPU) are pressure ulcers that are caused by an external force that is experienced after drug administration, and we considered resolution of these ulcers after drug discontinuation to be a supportive finding. In this report, we reviewed the medical records of pressure ulcer cases from a 300‐bed hospital. Among 148 patients, four patients with pressure ulcers met the criterion for DIPU. In these cases, the suspected DIPU were related to treatment with olanzapine, fluvoxamine, valproic acid, clotiazepam, triazolam and rilmazafone. These drugs were administrated to manage the patients' behavioral and psychological symptoms that accompanied dementia. The DIPU in these patients were categorized as stage IV according to the National Pressure Ulcer Advisory Panel criteria. Discontinuation of the causal drugs led to significant improvements or complete healing of the pressure ulcers, and the patients subsequently recovered their mobility. Therefore, we propose that DIPU are potential ADR that have been overlooked in clinical practice. Thus, recognition of DIPU as an ADR may be important in preventing and appropriately managing pressure ulcers among elderly patients.
Effects of grazing on soil nitrogen spatial heterogeneity depend on herbivore assemblage and pre‐grazing plant diversity
Authors: Liu Chen , Song Xuxin , Wang Ling , Wang Deli , Zhou Xiaomei , Liu Jun , Zhao Xuan , Li Jing , Lin Haijiao
Published: September 2015

The spatial heterogeneity of limiting soil resources is an essential factor determining ecosystem processes and function. It has been reported that large herbivores can strongly impact the variation and spatial distribution pattern of soil nitrogen (N). However, it remains unclear how large herbivores affect soil spatial heterogeneity and whether this influence is dependent on plant community diversity.

Here we examined effects of different herbivore assemblages [no grazing; cattle grazing (CG); sheep grazing (SG); and mixed grazing (MG) of cattle and sheep] on soil N spatial heterogeneity in grasslands with high and low pre‐grazing plant diversity in an eastern Eurasian steppe.

We found that herbivore grazing generated and maintained spatial patterns of soil nutrients, depending on herbivore assemblage and the level of pre‐grazing plant diversity. CG increased the spatial heterogeneity of soil available N in Leymus chinensis‐dominated steppe meadows, which were independent of pre‐grazing plant diversity. However, the effects of SG and MG strongly depended on grassland plant diversity, with an increased spatial heterogeneity of soil available N in the high‐diversity grassland, but not in the low‐diversity grassland.

Synthesis and applications. We concluded that in a L. chinensis‐dominated eastern Eurasian steppe, cattle ranching could be considered as an optimal grazing management protocol to improve soil spatial heterogeneity because cattle grazing (CG) consistently increased soil spatial heterogeneity in the context of both low and high plant diversity. Nevertheless, soil spatial heterogeneity could be improved by any herbivore grazing regime [CG and/or sheep grazing (SG)] when high plant diversity is maintained. These findings highlight the importance of conserving plant diversity to maintain grassland structure and ecosystem function. In grassland systems with high plant diversity, herbivore grazing and plant diversity would jointly improve soil spatial heterogeneity, thus feeding back to maintain higher plant diversity. Therefore, high plant diversity could generate a positive feedback loop of herbivore–plant–soil interactions in grazed grassland systems. Our findings indicate the importance of herbivore assemblages in maintaining spatial heterogeneity in low‐ and high‐diversity grassland systems.
For Slow Research
Authors: Kuus Merje
Published: September 2015

This essay addresses a relatively neglected practical aspect of critical policy studies: the pressure to produce many research outputs. That pressure emanates in part from the fast‐paced policy world studied by the researcher, and in part (perhaps even more significantly) from the university environment of the researcher herself. The essay highlights how the tendency towards output‐driven or fast research operates and what analytical traps it engenders. My goal is to spell out, more explicitly than is commonly done, why the push toward fast research is problematic on analytical grounds and why it ought to be resisted on these same grounds. I call for slow research to underscore that context‐sensitive critical investigation of a social field, such as policy, is a necessarily slow process.
Radical thoracic radiotherapy may provide favorable outcomes for stage IV non‐small cell lung cancer
Authors: Wang Jingbo , Ji Zhe , Wang Xiaozhen , Liang Jun , Hui Zhouguang , Lv Jima , Zhou Zongmei , Yin Weibo , Wang Luhua
Published: September 2015

Background

This study investigates the outcome of synchronous stage IV non‐small cell lung cancer (NSCLC) patients who received radical thoracic radiotherapy (TRT).

Methods

We retrospectively reviewed the charts of stage IV NSCLC patients treated with TRT between January 2007 and December 2011. Radiotherapy was considered radical if it was the primary therapy with non‐symptom driven intent, or consolidation therapy after initial chemotherapy and the biologically equivalent dose ≥53 Gy halted disease progression. The patients' demographics, disease characteristics, and treatment parameters were uniformly collected.

Results

Eighty‐one patients were irradiated with radical intent, including 52% with more than five metastatic lesions. The minimum follow‐up was 31.5 months for survivors. The median overall survival (OS) was 20.8 months, with three and four‐year OS rates of 23% and 18%, respectively. The median progression‐free survival (PFS) was 8.2 months, with one and two‐year PFS rates of 23% and 9%, respectively. Partial response (PR) after TRT and administration of targeted therapy were predictive of longer OS. The factors associated with favorable PFS included earlier local tunor node stage, absence of concurrent chemotherapy, and post‐TRT PR. No correlation was found between the number of metastatic lesions and survival outcome. Incidences of grade ≥2 toxicities in the lung and esophagus were 9% and 26%, respectively.

Conclusions

Radical TRT may result in advantageous outcomes for selected stage IV NSCLC patients, regardless of the number of metastatic foci. Patients who achieved post‐TRT PR attained the best outcomes.
Therapeutic strategies targeting cancer stem cells
Authors: Yoshida Go J. , Saya Hideyuki
Published: September 2015

Cancer stem cells (CSCs) are undifferentiated cancer cells with a high tumorigenic activity, the ability to undergo self‐renewal, and a multilineage differentiation potential. Cancer stem cells are responsible for the development of tumor cell heterogeneity, a key feature for resistance to anticancer treatments including conventional chemotherapy, radiation therapy, and molecularly targeted therapy. Furthermore, minimal residual disease, the major cause of cancer recurrence and metastasis, is enriched in CSCs. Cancer stem cells also possess the property of “robustness”, which encompasses several characteristics including a slow cell cycle, the ability to detoxify or mediate the efflux of cytotoxic agents, resistance to oxidative stress, and a rapid response to DNA damage, all of which contribute to the development of therapeutic resistance. The identification of mechanisms underlying such characteristics and the development of novel approaches to target them will be required for the therapeutic elimination of CSCs and the complete eradication of tumors. In this review, we focus on two prospective therapeutic approaches that target CSCs with the aim of disrupting their quiescence or redox defense capability.
Matrix metalloproteinase 13‐containing exosomes promote nasopharyngeal carcinoma metastasis
Authors: You Yiwen , Shan Ying , Chen Jing , Yue Huijun , You Bo , Shi Si , Li Xingyu , Cao Xiaolei
Published: September 2015

Nasopharyngeal cancer (NPC) is an endemic type of head and neck cancer with a high rate of cervical lymph node metastasis. Metastasis is the major cause of death in NPC patients. Increasing evidence indicates that exosomes play a pivotal role in promoting cancer metastasis by enhancing angiogenesis and ECM degradation. Matrix metalloproteinase 13 is an important kind of matrix proteinase that is often overexpressed in various tumors and increases the risk of metastasis. However, little is known about the potential role of MMP13‐containing exosomes in NPC. In this study, we found that MMP13 was overexpressed in NPC cells and exosomes purified from conditioned medium (CM) as well as NPC patients’ plasma. Transwell analysis revealed that MMP13‐containing exosomes facilitated the metastasis of NPC cells. Furthermore, siRNA inhibited the effect of MMP13‐containing exosomes on tumor cells metastasis as well as angiogenesis. The current findings provided novel insight into the vital role of MMP13‐containing exosomes in NPC progression which might offer unique insights for potential therapeutic strategies for NPC progressions.
Infants Perceive Three‐Dimensional Illusory Contours as Occluding Surfaces
Authors: Kavšek Michael , Marks Elmira
Published: September 2015

The study assessed the contribution of stereoscopic depth cues to infants' perception of a Kanizsa rectangle as a surface that temporarily occludes a moving object. In Experiment 1, the Kanizsa figure was shifted into the foreground by enriching it with stereoscopic depth information. According to the results, perception of a three‐dimensional Kanizsa figure as an occluding surface emerges between 5 (n = 16) and 7 (n = 16) months of age. Experiment 2 demonstrated that 7‐month‐old (n = 16) infants performed similarly to the 7‐month‐olds who participated in Experiment 1 if the moving object was shifted into the background. These findings suggest that 7‐month‐old infants respond to stereoscopic depth cues and that they exploit it to perceive subjective contours as occluders.
Phylogenetic hypothesis of Sphaerodoridae Malmgren, 1867 (Annelida) and its position within Phyllodocida
Authors: Capa María , Aguado M. Teresa , Bakken Torkild
Published: September 2015

Sphaerodoridae is a small, morphologically well‐defined group of annelids, with remarkable spherical tubercles covering their body surface. They have generally been considered as part of Phyllodocida, but there is no consensus about its sister group relationships. Monophyly and internal phylogenetic relationships have never been tested. We present the first phylogenetic analysis of the family, including 33 individuals of 19 species in five genera of Sphaerodoridae, and a wide representation of other Phyllodocida, based on molecular data from nuclear 18SrDNA(2240 bp), mitochondrial 16SrDNA(614 bp), and cytochrome c oxidase subunit I (657 bp). Mitochondrial and nuclear loci were analysed separately and in combination using maximum parsimony, maximum likelihood and Bayesian inference. Results show maximum support for the monophyly of Sphaerodoridae, but sister group relationships remain unclear. The generaSphaerodoropsisandSphaerodoridiumare found to be paraphyletic. Monophyly ofClavodorum,EphesiellaandSphaerodorumcould not be tested because only one species was included for each of these genera. At least six of the morphotypes included in the study do not fit within current species descriptions, suggesting undescribed species. Finally, the transfer ofSphaerodoropsis minutaback toSphaerodoridiumis proposed.
Environmental cost of using poor decision metrics to prioritize environmental projects
Authors: Pannell David J. , Gibson Fiona L.
Published: September 2015

Conservation decision makers commonly use project‐scoring metrics that are inconsistent with theory on optimal ranking of projects. As a result, there may often be a loss of environmental benefits. We estimated the magnitudes of these losses for various metrics that deviate from theory in ways that are common in practice. These metrics included cases where relevant variables were omitted from the benefits metric, project costs were omitted, and benefits were calculated using a faulty functional form. We estimated distributions of parameters from 129 environmental projects from Australia, New Zealand, and Italy for which detailed analyses had been completed previously. The cost of using poor prioritization metrics (in terms of lost environmental values) was often high—up to 80% in the scenarios we examined. The cost in percentage terms was greater when the budget was smaller. The most costly errors were omitting information about environmental values (up to 31% loss of environmental values), omitting project costs (up to 35% loss), omitting the effectiveness of management actions (up to 9% loss), and using a weighted‐additive decision metric for variables that should be multiplied (up to 23% loss). The latter 3 are errors that occur commonly in real‐world decision metrics, in combination often reducing potential benefits from conservation investments by 30–50%. Uncertainty about parameter values also reduced the benefits from investments in conservation projects but often not by as much as faulty prioritization metrics.
A nationwide assessment comparing nonelective open with minimally invasive complex colorectal procedures
Authors: Schlussel A. T. , Lustik M. B. , Johnson E. K. , Maykel J. A. , Champagne B. J. , Damle A. , Ross H. M. , Steele S. R.
Published: September 2015

Aim

The use of minimally invasive colorectal surgery has increased greatly for both benign and malignant disease. Studies evaluating complex procedures have been largely limited to elective indications. We aimed to compare the outcome of a laparoscopic with an open transverse (TC) and total abdominal colectomy (TAC) in the nonelective setting.

Method

Comparative analysis was made using the Nationwide Inpatient Sample (2008–11) of patients undergoing a nonelective TC or TAC identified by ICD‐9‐CM procedure codes. The risk‐adjusted 30‐day outcome was assessed using regression modelling accounting for patient characteristics, comorbidity and surgical procedure.

Results

We identified 7261 admissions including 818 laparoscopic and 6443 open procedures. The mean age of the population was 65 ± 17 years and patients in the laparoscopic group were younger (56 ± 20 vs 66 ± 17 years; P < 0.05). The rate of a single complication was lower in the laparoscopic group (26% vs 38%; P < 0.01), but this did not remain significant following a logistic regression analysis. Mortality was significantly lower in the laparoscopic group (3.1% vs 17%; P < 0.01) and this remained true after adjusting for covariates (OR = 0.62; P < 0.05). Laparoscopic cases were associated with a shorter median length of stay (10 vs 13 days; P < 0.01) and hospital charge ($75 758 vs $98 833; P < 0.01).

Conclusion

A nonelective laparoscopic TC or TAC is associated with an equivalent complication rate and lower mortality compared with an open operation. The results should encourage surgeons with the appropriate skills to consider a laparoscopic approach for nonelective pathology requiring a complex colectomy.
Ventral striatal gamma oscillations are highly variable from trial to trial, and are dominated by behavioural state, and only weakly influenced by outcome value
Authors: Malhotra Sushant , Cross Rob W. , Zhang Anqi , van der Meer Matthijs A. A.
Published: September 2015

The human and rodent ventral striatal local field potentials show striking oscillations in the gamma band (~ 40–100 Hz), which have been linked to aspects of behaviour such as reward anticipation and delivery, movement initiation, learning from feedback, and decision‐making. These oscillations show a rich temporal organization, whose relationship with behavioural variables is not well understood. Here, we show that, in rats performing a conditioned approach task, low‐gamma and high‐gamma oscillations during an immobile reward anticipation epoch were largely insensitive to outcome value, even though rats distinguished behaviourally between different outcomes, and single units encoded outcome value. Behaviour was highly stereotyped, yet we observed large variability from trial to trial in the occurrence and timing of these oscillations. Furthermore, higher‐order features such as high‐gamma power leading low‐gamma power, and phase‐amplitude coupling to lower‐frequency bands, were only marginally modulated by outcome value. Moreover, these patterns closely resembled those found during off‐task rest periods in which no rewards could be earned. These observations suggest a new interpretation of ventral striatal gamma oscillations as reflecting a default or resting state, with only minor and highly variable modulation by specific task‐related variables.
Effect of Sintering Temperature on Thermoelectric Properties of p‐Bi2Te3 Alloys Produced by Gas Atomization
Authors: Madavali Babu , Kim Hyo‐Seob , Choi Min‐Gyu , Park Gi‐Chan , Koo Jar‐Myung , Son Hyeon‐Taek , Hong Soon‐Jik
Published: September 2015

In this research, p‐type Bi2Te3–75% Sb2Te3 thermoelectric alloy powders were produced by gas atomization and subsequently sintered by hot pressing at different temperatures. The grain growth of the hot‐pressed samples was observed with increasing sintering temperature from 380°C to 460°C. The compressive strength increased with increasing hot‐pressing temperature due to the high relative density of bulk samples obtained at high temperatures. The effect of sintering temperature on thermoelectric (TE) properties was studied. The maximum power factor 3.48 mW/mK2 was obtained for the sample hot pressed at 420°C due to the resulting high electrical conductivity and enhanced Seebeck coefficient values.
Video Deficit in Toddlers’ Object Retrieval: What Eye Movements Reveal About Online Cognition
Authors: Kirkorian Heather L. , Lavigne Heather J. , Hanson Katherine G. , Troseth Georgene L. , Demers Lindsay B. , Anderson Daniel R.
Published: September 2015

The purpose of this study was to determine whether toddlers exhibit different eye‐movement patterns when watching real events versus video demonstrations in an object‐retrieval task. Twenty‐four‐month‐olds (N = 36) searched for a sticker on a felt board after watching an experimenter hide it behind a felt object in person or via video. Eye movements during the hiding event were recorded. Compared to those watching in‐person events, children watching video spent more time looking at the target location overall, yet they had relatively poor search performance. Visual attention to the target location predicted search performance in the video condition only; children who watched in‐person hiding events had high success rates even if they paid relatively little visual attention to the correct location. Findings are consistent with the hypothesis that toddlers process information more quickly for in‐person (versus video) events, enabling them to learn as well (or better) despite relatively low selective attention. Thus, relatively poor encoding, as well as memory retrieval, may underlie the video deficit.
What Atypical Adults Can Teach Us about Development
Authors: Maurer Daphne
Published: September 2015

In my presidential address, I described the early trap I fell into of describing the super‐baby capable of one after another adult perceptual ability, then how I discovered that two atypical populations of adults allowed me to study developmental mechanisms, namely, the role of early sensory input in sculpting the nervous system and the biological preparedness that constrains the experiential effects. Specifically, studies of adults who had dense central cataracts during childhood revealed that there are multiple critical periods during which visual input alters the potential of the nervous system for later refinement. Studies of adults with synesthesia generated novel hypotheses, subsequently supported experimentally, about the details of the biological preparedness that bias the child's early learning. Nevertheless, later studies indicated that considerable residual plasticity remains in adulthood.
Phenotype‐associated inbreeding biases estimates of inbreeding depression in a wild bird population
Authors: Becker P. J. J. , Hegelbach J. , Keller L. F. , Postma E.
Published: September 2015

Inbreeding depression is usually quantified by regressing individual phenotypic values on inbreeding coefficients, implicitly assuming there is no correlation between an individual's phenotype and the kinship coefficient to its mate. If such an association between parental phenotype and parental kinship exists, and if the trait of interest is heritable, estimates of inbreeding depression can be biased. Here we first derive the expected bias as a function of the covariance between mean parental breeding value and parental kinship. Subsequently, we use simulated data to confirm the existence of this bias, and show that it can be accounted for in a quantitative genetic animal model. Finally, we use long‐term individual‐based data for white‐throated dippers (Cinclus cinclus), a bird species in which inbreeding is relatively common, to obtain an empirical estimate of this bias. We show that during part of the study period, parents of inbred birds had shorter wings than those of outbred birds, and as wing length is heritable, inbred individuals were smaller, independent of any inbreeding effects. This resulted in the overestimation of inbreeding effects. Similarly, during a period when parents of inbred birds had longer wings, we found that inbreeding effects were underestimated. We discuss how such associations may have arisen in this system, and why they are likely to occur in others, too. Overall, we demonstrate how less biased estimates of inbreeding depression can be obtained within a quantitative genetic framework, and suggest that inbreeding and additive genetic effects should be accounted for simultaneously whenever possible.
Food Sovereignty and Fome Zero: Connecting Public Food Procurement Programmes to Sustainable Rural Development in Brazil
Authors: Wittman Hannah , Blesh Jennifer
Published: September 2015

The global discourse on food sovereignty suggests several mechanisms for improving food security and agricultural livelihoods, including redistributive land reform and restructuring of markets to improve food distribution and access. In Brazil, the Fome Zero (Zero Hunger) social welfare programme has created innovative links between public nutrition and food security programmes and rural development initiatives through mediated market support for the family farm sector. We report on a participatory assessment of the experience of land reform beneficiaries in seven municipalities in Mato Grosso, Brazil, who were contracted to produce food for the Programa de Aquisição de Alimentos (Food Procurement Programme, PAA) and the Programa Nacional de Alimentação Escolar (National School Feeding Programme, PNAE) under the umbrella of Fome Zero. This analysis offers insight into the opportunities and challenges related to participation in mediated ‘farm‐to‐institution’ food procurement programmes, and assesses their influence on key food sovereignty principles, including agro‐ecological transition, increased market stability and farmer autonomy.
Alcohol consumption is associated with a lower incidence of acute myocardial infarction: results from a large prospective population‐based study in Norway
Authors: Gémes K. , Janszky I. , Laugsand L. E. , László K. D. , Ahnve S. , Vatten L. J. , Mukamal K. J.
Published: September 2015

Aims

Compelling evidence suggests that light‐to‐moderate alcohol consumption is associated with a reduced risk of acute myocardial infarction (AMI), but several issues from previous studies remain to be addressed. The aim of this study was to investigate some of these key issues related to the association between alcohol consumption andAMIrisk, including the strength and shape of the association in a low‐drinking setting, the roles of quantity, frequency and beverage type, the importance of confounding by medical and psychiatric conditions, and the lack of prospective data on previous drinking.

Methods

A population‐based prospective cohort study of 58 827 community‐dwelling individuals followed for 11.6 years was conducted. We assessed the quantity and frequency of consumption of beer, wine and spirits at baseline in 1995–1997 and the frequency of alcohol intake approximately 10 years earlier.

Results

A total of 2966 study participants had anAMIduring the follow‐up period. Light‐to‐moderate alcohol consumption was inversely and linearly associated withAMIrisk. After adjusting for major cardiovascular disease risk factors, the hazard ratio for a one‐drink increment in daily consumption was 0.72 (95% confidence interval 0.62–0.86). Accounting for former drinking or comorbidities had almost no effect on the association. Frequency of alcohol consumption was more strongly associated with lowerAMIrisk than overall quantity consumed.

Conclusions

Light‐to‐moderate alcohol consumption was linearly associated with a decreased risk ofAMIin a population in which abstaining from alcohol is not socially stigmatized. Our results suggest that frequent alcohol consumption is most cardioprotective and that this association is not driven by misclassification of former drinkers.
Soil organic matter quantity and quality shape microbial community compositions of subtropical broadleaved forests
Authors: Ding Junjun , Zhang Yuguang , Wang Mengmeng , Sun Xin , Cong Jing , Deng Ye , Lu Hui , Yuan Tong , Van Nostrand Joy D. , Li Diqiang , Zhou Jizhong , Yang Yunfeng
Published: September 2015

As two major forest types in the subtropics, broadleaved evergreen and broadleaved deciduous forests have long interested ecologists. However, little is known about their belowground ecosystems despite their ecological importance in driving biogeochemical cycling. Here, we used Illumina MiSeq sequencing targeting 16S rRNA gene and a microarray named GeoChip targeting functional genes to analyse microbial communities in broadleaved evergreen and deciduous forest soils of Shennongjia Mountain of Central China, a region known as ‘The Oriental Botanic Garden’ for its extraordinarily rich biodiversity. We observed higher plant diversity and relatively richer nutrients in the broadleaved evergreen forest than the deciduous forest. In odds to our expectation that plant communities shaped soil microbial communities, we found that soil organic matter quantity and quality, but not plant community parameters, were the best predictors of microbial communities. Actinobacteria, a copiotrophic phylum, was more abundant in the broadleaved evergreen forest, while Verrucomicrobia, an oligotrophic phylum, was more abundant in the broadleaved deciduous forest. The density of the correlation network of microbial OTUs was higher in the broadleaved deciduous forest but its modularity was smaller, reflecting lower resistance to environment changes. In addition, keystone OTUs of the broadleaved deciduous forest were mainly oligotrophic. Microbial functional genes associated with recalcitrant carbon degradation were also more abundant in the broadleaved deciduous forests, resulting in low accumulation of organic matters. Collectively, these findings revealed the important role of soil organic matter in shaping microbial taxonomic and functional traits.
Under‐recognised co‐morbidities in idiopathic pulmonary fibrosis: A review
Authors: de Boer Kaïssa , Lee Joyce S.
Published: September 2015

Co‐morbidities in idiopathic pulmonary fibrosis are common. These co‐morbidities include obstructive sleep apnoea, gastro‐oesophageal reflux disease, pulmonary hypertension and depression. The presence of co‐morbidities among patients with idiopathic pulmonary fibrosis contributes to worse quality of life, morbidity and mortality. Despite the high prevalence of certain co‐morbidities in idiopathic pulmonary fibrosis, the optimal screening and management of many of these conditions remains unclear. The impact of co‐morbidities on this patient population is becoming more apparent. Their relevance will only increase as significant effort is being made to develop novel therapeutics that will alter the disease trajectory of patients with idiopathic pulmonary fibrosis. The purpose of this review is to focus on the epidemiology, pathophysiology, diagnosis and management of select co‐morbidities, including obstructive sleep apnoea, gastro‐oesophageal reflux disease, pulmonary hypertension and depression, in idiopathic pulmonary fibrosis.
A “Sorted” America? Geographic Polarization and Value Overlap in the American Electorate*
Authors: Strickler Ryan
Published: September 2015

Objective

Geographic political polarization is an increasingly salient topic of academic and popular discourse. Using Bill Bishop's bestseller The Big Sort as a foil, this article tests the claim that America has split into “ideologically inbred” “red” and “blue” communities.

Method

Drawing on Bishop's concept of “landslide” Democratic and Republican counties, the article uses survey data to measure the overlap in opinion between respondents from opposing “landslide” counties. This is done both graphically and with a quantitative measure developed by Levendusky and Pope (2011).

Results

Across economic, social, and cultural value dimensions, there is vastly more common ground than difference between respondents from “landslide” Democratic and Republican counties.

Conclusion

Hyperbolic claims of a “sorted” country aside, geographic polarization in the United States is limited at best. Partisan polarization could be a real and consequential phenomenon in the electorate, but it has little geographic, “red versus blue” manifestation.
To treat or not to treat: a rare case of pseudo‐thrombotic thrombocytopenic purpura in a Jehovah's Witness
Authors: Malla Midhun , Seetharam Mahesh
Published: September 2015

BACKGROUND

Thrombotic thrombocytopenic purpura (TTP) is a rare microvascular occlusive disorder characterized by systemic intravascular aggregation of platelets, thrombocytopenia, and mechanical injury to red blood cells. We report a rare case of pernicious anemia presenting as TTP in a Jehovah's Witness.

CASE REPORT

A 46‐year‐old Jehovah's Witness female presented with epigastric pain, vomiting, and diarrhea for 2 days and fatigue and paresthesias for 4 weeks. Initial laboratory evaluation showed severe anemia and thrombocytopenia with elevated total bilirubin and lactate dehydrogenase. Peripheral blood smear showed schistocytes, macroovalocytes, and hypersegmented neutrophils. TTP was suspected and plasmapheresis was offered. The patient refused it due to her religious beliefs. Due to the presence of macroovalocytes and hypersegmented neutrophils, vitamin B12 level was checked and found to be extremely low. Anti‐intrinsic factor antibodies and anti‐parietal cell antibodies were also positive; hence a diagnosis of pernicious anemia was established. Treatment with intramuscular vitamin B12 was initiated, which resulted in dramatic neurologic and hematologic improvement.

DISCUSSION

Vitamin B12 deficiency can lead to elevated levels of homocysteine in the blood. Homocysteine can cause endothelial dysfunction, which can lead to formation of microvascular thrombi. Due to this phenomenon, vitamin B12 deficiency can rarely present with schistocytes and thrombocytopenia, which combined with other stigmata of vitamin B12 deficiency, can be misdiagnosed as TTP.
Masitinib monotherapy in canine epitheliotropic lymphoma
Authors: Holtermann N. , Kiupel M. , Kessler M. , Teske E. , Betz D. , Hirschberger J.
Published: September 2015

This study evaluated efficacy and side effects of masitinib in canine epitheliotropic lymphoma. Complete remission occurred in 2 of 10 dogs and lasted for median 85 days. Five dogs went into partial remission for median 60.5 days. Three pretreated dogs did not respond to therapy. Side effects occurred in six dogs and were mostly mild to moderate. Immunohistochemistry was available for eight dogs.KITreceptor was negative in all of them, six of eight lymphomas stained strongly positive for stem cell factor (SCF). platelet‐derived growth factor (PDGF)‐AAwas weakly positive in two and negative in six.PDGF‐BBwas negative in four tumours, weakly positive in one and strongly positive in three. One was strongly positive for PDGF receptor (PDGFR)‐β, seven were negative for that receptor. Five showed strong expression ofPDGFR‐α, two showed weak expression, one was negative. In conclusion, masitinib is effective in treating canine epitheliotropic lymphoma. But its effects are most likely not generated through theKITreceptor.
A Single Mutation in the Gene Responsible for the Mucoid Phenotype of Bifidobacterium animalis subsp. lactis Confers Surface and Functional Characteristics
Authors: Hidalgo-Cantabrana Claudio , Sánchez Borja , Álvarez-Martín Pablo , López Patricia , Martínez-Álvarez Noelia , Delley Michele , Martí Marc , Varela Encarna , Suárez Ana , Antolín María , Guarner Francisco , Berger Bernard , Ruas-Madiedo Patricia , Margolles Abelardo
Published: September 2015

Exopolysaccharides (EPS) are extracellular carbohydrate polymers synthesized by a large variety of bacteria. Their physiological functions have been extensively studied, but many of their roles have not yet been elucidated. We have sequenced the genomes of two isogenic strains of
Bifidobacterium animalis
subsp.
lactis
that differ in their EPS-producing phenotype. The original strain displays a nonmucoid appearance, and the mutant derived thereof has acquired a mucoid phenotype. The sequence analysis of their genomes revealed a nonsynonymous mutation in the gene Balat_1410, putatively involved in the elongation of the EPS chain. By comparing a strain from which this gene had been deleted with strains containing the wild-type and mutated genes, we were able to show that each strain displays different cell surface characteristics. The mucoid EPS synthesized by the strain harboring the mutation in Balat_1410 provided higher resistance to gastrointestinal conditions and increased the capability for adhesion to human enterocytes. In addition, the cytokine profiles of human peripheral blood mononuclear cells and
ex vivo
colon tissues suggest that the mucoid strain could have higher anti-inflammatory activity. Our findings provide relevant data on the function of Balat_1410 and reveal that the mucoid phenotype is able to alter some of the most relevant functional properties of the cells.
Expansion of the Tetracycline-Dependent Regulation Toolbox for Helicobacter pylori
Authors: Debowski Aleksandra W. , Sehnal Miriam , Liao Tingting , Stubbs Keith A. , Marshall Barry J. , Benghezal Mohammed
Published: September 2015

In an effort to gain greater understanding of the biology and infection processes of
Helicobacter pylori
, we have expanded the functionality of the tetracycline-dependent gene regulation (
tet
) system to provide more improved and versatile genetic control and facilitate the generation of conditional mutants to study essential genes. Second-generation tetracycline-responsive
H. pylori
uPtetO
5 promoters were based on the mutated core
ureA
promoter. Single point mutations at either the ribosomal binding site or the start codon were introduced to shift the regulatory range of three
uPtetO
5 derivatives. All promoters were tested for regulation by TetR and revTetR using
dapD
, a gene essential to peptidoglycan biosynthesis, as a reporter. All
tet
promoters were effectively regulated by both TetR and revTetR, and their regulation windows overlapped so as to cover a broad range of expression levels.
tet
promoters
uPtetO
5m1 and
uPtetO
5m2 could be sufficiently silenced by both TetR and revTetR so that the conditional mutants could not grow in the absence of diaminopimelic acid (DAP). Furthermore, through the use of these inducible promoters, we reveal that insufficient DAP biosynthesis results in viable cells with altered morphology. Overall, the development and optimization of
tet
regulation for
H. pylori
will not only permit the study of essential genes but also facilitate investigations into gene dosage effects on
H. pylori
physiology.
The Safety of Obstetric Acupuncture: Forbidden Points Revisited
Authors: Carr David John
Published: September 2015

Background/Aim

Although the safety of acupuncture per se in pregnancy is reasonably well accepted, there remains debate regarding needling at points historically considered to be ‘forbidden’ during pregnancy. This article reviews the scientific literature on this topic.

Main Findings

There is no objective evidence of harm following needling at forbidden points, summarised by the following four lines of evidence. (1) In 15 clinical trials (n=823 women receiving n=4549–7234 acupuncture treatments at one or more forbidden points) rates of preterm birth (PTB) and stillbirth following are equivalent to those in untreated control groups and consistent with background rates of these complications in the general population. (2) Observational studies, including a large cohort of 5885 pregnant women needled at forbidden points at all stage of pregnancy, demonstrate that rates of miscarriage, PTB, preterm prelabour rupture of membranes (PPROM), and preterm contractions (preterm labour (PTL) or threatened PTL) are comparable with untreated controls and/or consistent with their anticipated incidence. (3) There is no reliable evidence that acupuncture/electroacupuncture (EA) can induce miscarriage/labour, even under otherwise favourable circumstances such as post-dates pregnancy or intrauterine fetal death. (4) Laboratory experiments using pregnant rats have demonstrated that repeated EA at forbidden points throughout gestation does not influence rates of post-implantation embryonic demise or cause miscarriage, fetal loss or resorption.

Conclusions

These findings are reassuring and will help individualised risk:benefit assessment before treating pregnant women. Given the numerous evidence-based indications for obstetric acupuncture and lack of evidence of harm, risk:benefit assessments will often fall in favour of treatment.
External validity of a randomised controlled trial on the treatment of severe infections caused by MRSA
Authors: Paul Mical , Bronstein Ella , Yahav Dafna , Goldberg Elad , Bishara Jihad , Leibovici Leonard
Published: September 2015

Objectives

To assess the external validity of a pragmatic, investigator-initiated RCT on treatment of severe infections caused by methicillin-resistantStaphylococcus aureus(MRSA), we compared patient characteristics and treatment effect estimates for patients included in the RCT versus those excluded.

Participants and outcomes

The RCT included hospitalised patients with documented or highly-probable invasive MRSA infections who were randomised to vancomycin versus trimethoprim-sulfamethoxazole (TMP-SMX) treatment, between 2007 and 2014. A concomitant observational study prospectively included all consecutive patients, between 2008 and 2011, who were excluded from the RCT due to no consent, meningitis, left-sided endocarditis, severe neutropaenia, chronic renal dialysis or treatment with study medications for longer than 48 h. The primary outcomes were clinical failure at day 7 and 30-day mortality for both studies. We compared baseline and infection characteristics, outcome rates and treatment effect estimates for included versus excluded patients.

Results

The RCT included 252 patients who were compared with 220 excluded patients who were observed. Inability to provide informed consent was the main reason for patient exclusion. Excluded patients’ functional and cognitive performance was significantly poorer than that of included patients. Sepsis was more severe among excluded patients (higher rates of mechanical ventilation, indwelling catheters, septic shock and organ failure). Clinical failure occurred in 83/252 (32.9%) versus 175/220 (79.5%) and deaths in 32 (12.7%) versus 64 (29.1%) for included versus excluded patients, p<0.001 for both comparisons. Comparing vancomycin to TMP-SMX, in the RCT mortality, was non-significantly lower with vancomycin (OR 0.76, 95% CIs 0.36 to 1.62), while in the observational analysis of excluded patients, mortality was significantly higher with vancomycin (OR 2.63, 1.04 to 6.65), p=0.04 for the difference.

Conclusions

Patient characteristics, outcome event rates and treatment effects differed significantly in the setting of a RCT, despite its pragmatic design, compared to patients treated outside the trial settings.
Understanding trends in blood pressure and their associations with body mass index in Chinese children, from 1985 to 2010: a cross-sectional observational study
Authors: Dong Bin , Wang Zhiqiang , Song Yi , Wang Hai-Jun , Ma Jun
Published: September 2015

Objective

Understanding trends in blood pressure (BP) in childhood is crucial to addressing and reducing the burden of adulthood hypertension and associated mortality in the future. In view of growing obesity in Chinese children, we sought to investigate the trends in BP and the influence of body mass index (BMI) on them.

Design, setting and participants

We included 1 010 153 children aged 8–17 years, with completed records from a large national successive cross-sectional survey, the Chinese National Survey on Students’ Constitution and Health, between 1985 and 2010.

Main outcome measurements

BP was measured according to the recommendation of the National High Blood Pressure Education Program Working Group, and the elevated BP was based on sex-, age- and height-specific 95th centile of the recommendation.

Results

The adjusted mean systolic BP in boys and girls decreased by 3.9 and 5.6 mm Hg between 1985 and 2005, and increased by 1.3 and 1.0 mm Hg between 2005 and 2010, respectively. Corresponding adjusted prevalence of elevated systolic BP in boys and girls declined from 5.1% and 5.5% to 3.5% and 2.5% between 1985 and 2005, and increased to 4.9% and 3.5% in 2010, respectively. Adjusted mean BMI of boys and girls in 2010 was 2.0 and 1.2 kg/m2higher than those in 1985, respectively. The prevalence of obesity rose from 0% to 3.4% in boys and 0.9% in girls. Further adjusting for BMI did not change these trends in systolic BP. A similar pattern was also observed in diastolic BP.

Conclusions

After declining for 20 years, BP levels in Chinese children started to climb upwards. These trends in BP cannot be fully explained by BMI. The investigation of other determinants of BP may provide additional opportunity to curb the current upward BP trend in Chinese children.
Training in General Surgery Ward Call: A Resident-Student Buddy System
Authors: Maurice Andrew , Hann Angus
Published: September 2015

There is a paucity of literature regarding medical student experiences of after hours hospital ward call. It was observed at our institution that medical students had minimal experience in ward call, yet were required to undertake such shifts as interns after graduation. We implemented a buddy system in which a medical student shadowed a general surgery resident for a ward call shift.

Final year medical students were recruited from the local university at a tertiary teaching hospital after institutional approval. Each student attended a 4 hour evening shift on a general surgery ward with a supervising resident. A survey detailing attitudes and expectations of ward call was completed before and after the experience.

Nine students enrolled in the project. Familiarity of expectations of what is required of an intern on a ward call shift improved significantly after the experience (3.1/5 to 4.1/5, p = 0.002). After hours work experience was reported as useful both before and after the study (4.5/5 to 4.7/5, p = 0.47). Students and doctors involved unanimously felt the experience was worthwhile.

After hours ward call experience is useful for a final year medical student. More studies are required to further define the role of after hours ward call experiences during medical training.
Improving the completion of Quality Improvement projects amongst psychiatry core trainees
Authors: Ewins Liz
Published: September 2015

Quality Improvement (QI) projects are seen increasingly as more valuable and effective in developing services than traditional audit. However, the development of this methodology has been slower in the mental health field and QI projects are new to most psychiatrists. This project describes a way of engaging trainees across Avon and Wiltshire Mental Health Partnership (AWP) Trust and the Severn School of Psychiatry in QI projects, using QI methodology itself.

Through the implementation and development of training sessions and simple, low cost and sustainable interventions over a 10 month period, two thirds of core trainees and over a half of the advanced psychiatry trainees in the School are now participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. As an additional positive outcome, specialty doctors, consultants, foundation doctors, GP trainees, medical students, as well as the wider multidisciplinary team, have all become engaged in QI projects alongside trainees, working with service users and their families to identify problems to tackle and ideas to test.
A multifaceted approach to prevention of delirium on intensive care
Authors: Hanison James , Conway Daniel
Published: September 2015

Delirium is a frequent complication of critical illness with an increased risk of death which is difficult to treat effectively. We describe a seven year quality improvement programme that aimed to reduce rates of delirium on intensive care (ICU). We completed two PDSA programmes with a number of changes including alterations to sedation practice and environmental changes to the ICU itself.

Rates of delirium reduced from 70% to 44% after the first cycle of change. Rates of delirium were further reduced to 29% after the second cycle of change. The rates are now lower than predicted by the validated prediction tool PRE-DELIRIC.

This project demonstrates that a multifaceted approach to prevention of delirium on ICU can deliver sustained reductions in rates of delirium. The impact of the second cycle of change was less than the first, suggesting that further reductions may prove more challenging.