bluuebunny/crossref_metadata_2025 huggingface dataset:
Would Allowing Privately Funded Health Care Reduce Public Waiting Time? Theory and Empirical Evidence from Canadian Joint Replacement Surgery Data
Authors: Chen Hong , Qian Qu , Zhang Anming
Published: August 2014

This study develops a theoretical model and then, using Canadian joint replacement surgery data, empirically tests the relationship between government policies that promote privately funded health care and patients’ waiting time in the public health care system. Two policies are tested: one policy allows opt‐out physicians to extra‐bill private patients, and the other provides public subsidies to private patients. We find that both policies are associated with shorter public waiting time, and that the subsidy policy appears to be more effective in waiting time reduction than the extra‐billing policy. Our findings are consistent with a dominant demand‐side effect in that these policies would provide patients an option, and some incentive, to opt out of the public health system, shifting the demand from the public health system to the private care market.
The transcription factor VvWRKY33 is involved in the regulation of grapevine (Vitis vinifera) defense against the oomycete pathogen Plasmopara viticola
Authors: Merz Patrick R. , Moser Tina , Höll Janine , Kortekamp Andreas , Buchholz Günther , Zyprian Eva , Bogs Jochen
Published: August 2014

Grapevine (Vitis vinifera ssp. vinifera) is one of the most important fruit species; however, it is highly susceptible to various pathogens, which can cause severe crop losses in viticulture. It has been shown that several WRKY class transcription factors (TFs) are part of the signal transduction cascade, which leads to the activation of plant defense reactions against various pathogens. In the present investigation, a full‐length cDNA was isolated from V. vinifera leaf tissue encoding a predicted protein, designated VvWRKY33, which shows the characteristics of group I WRKY protein family. VvWRKY33 induction correlates with the expression of VvPR10.1 (pathogenesis‐related 10.1) gene in the leaves of the resistant cultivar ‘Regent’ after infection with Plasmopara viticola, whereas in the susceptible cultivar ‘Lemberger’ VvWRKY33 and VvPR10.1 are not induced. Corresponding expression of the TF and VvPR10.1 was even obtained in uninfected ripening berries. In planta, analysis of VvWRKY33 has been performed by ectopic expression of VvWRKY33 in grapevine leaves of greenhouse plants mediated via Agrobacterium tumefaciens transformation. In consequence, VvWRKY33 strongly increases resistance to P. viticola in the susceptible cultivar ‘Shiraz’ and reduces pathogen sporulation of about 50–70%, indicating a functional role for resistance in grapevine. Complementation of the resistance‐deficient Arabidopsis thaliana Columbia‐0 (Col‐0) mutant line wrky33‐1 by constitutive expression of VvWRKY33 restores resistance against Botrytis cinerea to wild‐type level and in some complemented mutant lines even exceeds the resistance level of the parental line Col‐0. Our results support the involvement of VvWRKY33 in the defense reaction of grapevine against different pathogens.
The Truthmaking Argument Against Dispositionalism
Authors: Austin Christopher J.
Published: August 2014

According to dispositionalism,de remodality is grounded in the intrinsic natures of dispositional properties. Those properties are able to serve as the ground ofde remodal truths, it is said, because they bear a special relation to counterfactual conditionals, one oftruthmaking. However, because dispositionalism purports to groundde remodalityonlyon theintrinsicnatures of dispositional properties, it had better be the case that they do not play that truthmaking role merely in virtue of their being embedded in some particular, extrinsic causal context. This paper examines a recent argument against dispositionalism that purports to show that the intrinsicality of that relation cannot be maintained, due to theceteris paribusnature of the counterfactuals that dispositions make‐true. When two prominent responses are examined, both are found wanting: at best, they require unjustified special pleading, and at worst, they amount to little more thanad hocconceptual trickery.
Quantum prediction GJR model and its applications
Authors: Wang Feixing , Wang Yingshuai
Published: August 2014

In this paper, a new statistical method to deal with the quantum finance is proposed. Through analyzing the stock data of China Mobile Communication Corporation, we discover its quantum financial effect, and then we innovate the method of testing the existence of the quantum financial effect. Furthermore, the classical normal process of the Glosten–Jagannathan–Runkle (GJR) model has been changed into the quantum wave‐function distribution, which is based on the ‘one‐dimensional infinitely deep square potential well’. The research shows that the quantum GJR model can reveal the interior uncertainty of the financial market and has a better prediction availability.
Cellular Zinc Levels Are Modulated by TRPML1–TMEM163 Interaction
Authors: Cuajungco Math P. , Basilio Luigi C. , Silva Joshua , Hart Thomas , Tringali Jonathan , Chen Cheng‐Chang , Biel Martin , Grimm Christian
Published: August 2014

Mucolipidosis type IV (MLIV) is caused by loss of function mutations in the TRPML1 ion channel. We previously reported that tissue zinc levels in MLIV were abnormally elevated; however, the mechanism behind this pathologic accumulation remains unknown. Here, we identify transmembrane (TMEM)‐163 protein, a putative zinc transporter, as a novel interacting partner for TRPML1. Evidence from yeast two‐hybrid, tissue expression pattern, co‐immunoprecipitation, mass spectrometry and confocal microscopy studies confirmed the physical association of TMEM163 with TRPML1. This interaction is disrupted when a part of TMEM163's N‐terminus was deleted. Further studies to define the relevance of their interaction revealed that the plasma membrane (PM) levels of TMEM163 significantly decrease when TRPML1 is co‐expressed in HEK‐293 cells, while it mostly localizes within the PM when co‐expressed with a mutant TRPML1 that distributes mostly in the PM. Meanwhile, co‐expression of TMEM163 does not alter TRPML1 channel activity, but its expression levels in MLIV patient fibroblasts are reduced, which correlate with marked accumulation of zinc in lysosomes when these cells are acutely exposed to exogenous zinc (100 μM). When TMEM163 is knocked down or when TMEM163 and TRPML1 are co‐knocked down in HEK‐293 cells treated overnight with 100 nm zinc, the cells have significantly higher intracellular zinc levels than untreated control. Overall, these findings suggest that TMEM163 and TRPML1 proteins play a critical role in cellular zinc homeostasis, and thus possibly explain a novel mechanism for the pathological overload of zinc in MLIV disease.
An update on red blood cell storage lesions, as gleaned through biochemistry and omics technologies
Authors: D'Alessandro Angelo , Kriebardis Anastasios G. , Rinalducci Sara , Antonelou Marianna H. , Hansen Kirk C. , Papassideri Issidora S. , Zolla Lello
Published: August 2014

Red blood cell (RBC) aging in the blood bank is characterized by the accumulation of a significant number of biochemical and morphologic alterations. Recent mass spectrometry and electron microscopy studies have provided novel insights into the molecular changes underpinning the accumulation of storage lesions toRBCsin the blood bank. Biochemical lesions include altered cation homeostasis, reprogrammed energy, and redox metabolism, which result in the impairment of enzymatic activity and progressive depletion of high‐energy phosphate compounds. These factors contribute to the progressive accumulation of oxidative stress, which in turn promotes oxidative lesions to proteins (carbonylation, fragmentation, hemoglobin glycation) and lipids (peroxidation). Biochemical lesions negatively affectRBCmorphology, which is marked by progressive membrane blebbing and vesiculation. These storage lesions contribute to the altered physiology of long‐storedRBCsand promote the rapid clearance of up to one‐fourth of long‐storedRBCsfrom the recipient's bloodstream after 24 hours from administration. While prospective clinical evidence is accumulating, from the present review it emerges that biochemical, morphologic, and omics profiles of storedRBCshave observable changes after approximately 14 days of storage. Future studies will assess whether these in vitro observations might have clinically meaningful effects.
A Study of Iranian Nurses’ and Midwives’ Knowledge, Attitudes, and Implementation of Evidence‐Based Practice: The Time for Change Has Arrived
Authors: Heydari Abbas , Mazlom Seyed Reza , Ranjbar Hossein , Scurlock‐Evans Laura
Published: August 2014

Background

Evidence‐based practice (EBP) leads to enhanced quality of care, and the individual and professional development of nurses and midwives. Therefore, it is important for nurses and midwives as well as all other healthcare providers and stakeholders to inform clinical decision‐making and implement EBP.

Aim

This study aimed to determine the EBP knowledge, attitudes, and practice of clinical nurses and midwives in Mashhad public hospitals in Iran.

Methods

The descriptive cross‐sectional study was conducted with a stratified cluster, random sample of 240 employed nurses and midwives (response rate of 96%) in Mashhad, who held a Bachelor of Science degree and had at least 1 year of clinical experience. Two valid and reliable questionnaires were used to collect demographic and EBP data. Data were analyzed using SPSS version 11.5 software and descriptive and inferential statistics calculated.

Results

Participants’ mean age was 31.0 (SD = 5.5) years and 80% (n = 194) were female. Most participants reported low knowledge or skills and practice of EBP, but moderate attitudes toward EBP. Significant differences between the mean scores on knowledge or skills, attitudes, and practice were identified by field of study. Nurses reported higher knowledge or skills and practice of EBP than midwives (p < .001). Nurses and midwives with master‐s degrees displayed greater knowledge or skills and practice of EBP, and more positive attitudes than nurses with bachelor‐s degrees (p < .001).

Linking Evidence to Action

Although clinical nurses and midwives apply EBP in clinical settings, it is necessary to develop their knowledge or skills and practice. The results of this study can be applied by educational planners, educational managers, and authorities to enhance the quality and consistency of EBP implementation. The results provide a base for future studies in this field.
Effect of BCl3 in chlorine-based plasma on etching 4H-SiC for photoconductive semiconductor switch applications
Authors: Ekinci Huseyin , Kuryatkov Vladimir V. , Mauch Daniel L. , Dickens James C. , Nikishin Sergey A.
Published: August 2014

Inductively coupled plasma reactive ion etching (ICP-RIE) of n-type SiC epitaxial layers grown on (0001¯) 4H-SiC semi-insulating substrates has been investigated using chlorine-based plasma. The etch rate and postetching surface morphology have been studied as functions of the plasma composition, ICP power, RIE power, and process pressure. The authors found that the surface smoothness of the epitaxial layer was increased by introducing BCl3 into Cl2/Ar plasma. An optimized process has been developed yielding etch rates of ∼220 nm/min and very smooth surfaces with root mean square roughness of ∼0.3 nm. The spatial-frequency dependence of the one dimensional power spectral density was interpreted using the surface height function h(x) including a low-frequency range, which exhibits saturation and a high-frequency range, which exhibits scaling properties. Through this etching process, the effects of subcontact doping on 4H-SiC photoconductive semiconductor switch (PCSS) performance were investigated. A PCSS was fabricated using this etching process with a 1 μm heavily doped (1.6 × 1018 cm−3 n-type) epitaxial layer beneath the device contacts and compared with a PCSS fabricated with a subcontact doped layer created through laser enhanced diffusion (∼50 nm depth, 2.0 × 1018 cm−3 n-type). The PCSS with the epitaxial layer demonstrated on average a 30% reduction in minimum on-state resistance, and eliminated cracking of the bulk material when switching currents ≤38 A.
A dynamic collimation system for penumbra reduction in spot‐scanning proton therapy: Proof of concept
Authors: Hyer Daniel E. , Hill Patrick M. , Wang Dongxu , Smith Blake R. , Flynn Ryan T.
Published: August 2014

Purpose:

In the absence of a collimation system the lateral penumbra of spot scanning (SS) dose distributions delivered by low energy proton beams is highly dependent on the spot size. For current commercial equipment, spot size increases with decreasing proton energy thereby reducing the benefit of the SS technique. This paper presents a dynamic collimation system (DCS) for sharpening the lateral penumbra of proton therapy dose distributions delivered by SS.

Methods:

The collimation system presented here exploits the property that a proton pencil beam used for SS requires collimation only when it is near the target edge, enabling the use of trimmers that are in motion at times when the pencil beam is away from the target edge. The device consists of two pairs of parallel nickel trimmer blades of 2 cm thickness and dimensions of 2 cm × 18 cm in the beamˈs eye view. The two pairs of trimmer blades are rotated 90° relative to each other to form a rectangular shape. Each trimmer blade is capable of rapid motion in the direction perpendicular to the central beam axis by means of a linear motor, with maximum velocity and acceleration of 2.5 m/s and 19.6 m/s2, respectively. The blades travel on curved tracks to match the divergence of the proton source. An algorithm for selecting blade positions is developed to minimize the dose delivered outside of the target, and treatment plans are created both with and without the DCS.

Results:

The snout of the DCS has outer dimensions of 22.6 × 22.6 cm2 and is capable of delivering a minimum treatment field size of 15 × 15 cm2. Using currently available components, the constructed system would weigh less than 20 kg. For irregularly shaped fields, the use of the DCS reduces the mean dose outside of a 2D target of 46.6 cm2 by approximately 40% as compared to an identical plan without collimation. The use of the DCS increased treatment time by 1–3 s per energy layer.

Conclusions:

The spread of the lateral penumbra of low‐energy SS proton treatments may be greatly reduced with the use of this system at the cost of only a small penalty in delivery time.
A three-dimensional, longitudinally-invariant finite element model for acoustic propagation in shallow water waveguides
Authors: Isakson Marcia J. , Goldsberry Benjamin , Chotiros Nicholas P.
Published: August 2014

A three-dimensional, longitudinally-invariant finite element (FE) model for shallow water acoustic propagation is constructed through a cosine transform of a series of two-dimensional FE models at different values of the out-of-plane wavenumber. An innovative wavenumber sampling method is developed that efficiently captures the essential components of the integral as the out-of-plane wave number approaches the water wavenumber. The method is validated by comparison with benchmark solutions of two shallow water waveguide environments: a flat range independent case and a benchmark wedge.
B cells populating the multiple sclerosis brain mature in the draining cervical lymph nodes
Authors: Stern Joel N. H. , Yaari Gur , Vander Heiden Jason A. , Church George , Donahue William F. , Hintzen Rogier Q. , Huttner Anita J. , Laman Jon D. , Nagra Rashed M. , Nylander Alyssa , Pitt David , Ramanan Sriram , Siddiqui Bilal A. , Vigneault Francois , Kleinstein Steven H. , Hafler David A. , O’Connor Kevin C.
Published: August 2014

In multiple sclerosis patients, B cells mature in the draining cervical lymph nodes before trafficking across the blood-brain barrier.
Immunoglobulin class-switched B cells form an active immune axis between CNS and periphery in multiple sclerosis
Authors: Palanichamy Arumugam , Apeltsin Leonard , Kuo Tracy C. , Sirota Marina , Wang Shengzhi , Pitts Steven J. , Sundar Purnima D. , Telman Dilduz , Zhao Lora Z. , Derstine Mia , Abounasr Aya , Hauser Stephen L. , von Büdingen H.-Christian
Published: August 2014

Ig class-switched B cells connect the periphery and CNS and support peripheral antigen-driven B cell activation in CNS autoimmunity.
Genetic validation of a therapeutic target in a mouse model of ALS
Authors: de Boer A. Sophie , Koszka Kathryn , Kiskinis Evangelos , Suzuki Naoki , Davis-Dusenbery Brandi N. , Eggan Kevin
Published: August 2014

The DP1 receptor mediates toxicity of microglia in human stem cell and transgenic animal models of amyotrophic lateral sclerosis.
Street-Experienced Peripheral B Cells Traffic to the Brain
Authors: Lu Daniel R. , Robinson William H.
Published: August 2014

Deep sequencing of immunoglobulin repertoires in multiple sclerosis patients reveals dysregulation of peripheral B cell immunity (Palanichamy
et al
. and Stern
et al
., this issue).
Stress (In)Flames Atherosclerosis
Authors: Erbay Ebru
Published: August 2014

The

inflammatory complications of atherosclerosis can be ameliorated through selective targeting of β3-adrenergic receptors in the hematopoietic stem cell niche.
Exploring the Biology of HPV-Associated Head and Neck Cancer
Authors: Gerber David E.
Published: August 2014

Genomic analysis identifies potentially clinically relevant molecular alterations.
An Olive Branch for Lipid Disorders
Authors: Price Elvin
Published: August 2014

Polyphenol compounds found in olive oil favorably influence the characteristics of HDL, the “healthy” lipoprotein, and its biological functions.
It Takes Two to Tango: How Phagocytes and Innate Lymphoid Cells Control IBD Outcome
Authors: Serezani Henrique
Published: August 2014

IL-23 derived from CX
3
CR1
+
phagocytes induces the generation of innate lymphoid cell 3 to maintain gut homeostasis.
In Vivo
mRNA Profiling of Uropathogenic Escherichia coli from Diverse Phylogroups Reveals Common and Group-Specific Gene Expression Profiles
Authors: Bielecki Piotr , Muthukumarasamy Uthayakumar , Eckweiler Denitsa , Bielecka Agata , Pohl Sarah , Schanz Ansgar , Niemeyer Ute , Oumeraci Tonio , von Neuhoff Nils , Ghigo Jean-Marc , Häussler Susanne
Published: August 2014

mRNA profiling of pathogens during the course of human infections gives detailed information on the expression levels of relevant genes that drive pathogenicity and adaptation and at the same time allows for the delineation of phylogenetic relatedness of pathogens that cause specific diseases. In this study, we used mRNA sequencing to acquire information on the expression of
Escherichia coli
pathogenicity genes during urinary tract infections (UTI) in humans and to assign the UTI-associated
E. coli
isolates to different phylogenetic groups. Whereas the
in vivo
gene expression profiles of the majority of genes were conserved among 21
E. coli
strains in the urine of elderly patients suffering from an acute UTI, the specific gene expression profiles of the flexible genomes was diverse and reflected phylogenetic relationships. Furthermore, genes transcribed
in vivo
relative to laboratory media included well-described virulence factors, small regulatory RNAs, as well as genes not previously linked to bacterial virulence. Knowledge on relevant transcriptional responses that drive pathogenicity and adaptation of isolates to the human host might lead to the introduction of a virulence typing strategy into clinical microbiology, potentially facilitating management and prevention of the disease.

IMPORTANCE
Urinary tract infections (UTI) are very common; at least half of all women experience UTI, most of which are caused by pathogenic
Escherichia coli
strains. In this study, we applied massive parallel cDNA sequencing (RNA-seq) to provide unbiased, deep, and accurate insight into the nature and the dimension of the uropathogenic
E. coli
gene expression profile during an acute UTI within the human host. This work was undertaken to identify key players in physiological adaptation processes and, hence, potential targets for new infection prevention and therapy interventions specifically aimed at sabotaging bacterial adaptation to the human host.
Coronaviruses Induce Entry-Independent, Continuous Macropinocytosis
Authors: Freeman Megan Culler , Peek Christopher T. , Becker Michelle M. , Smith Everett Clinton , Denison Mark R.
Published: August 2014

Macropinocytosis is exploited by many pathogens for entry into cells. Coronaviruses (CoVs) such as severe acute respiratory syndrome (SARS) CoV and Middle East respiratory syndrome CoV are important human pathogens; however, macropinocytosis during CoV infection has not been investigated. We demonstrate that the CoVs SARS CoV and murine hepatitis virus (MHV) induce macropinocytosis, which occurs late during infection, is continuous, and is not associated with virus entry. MHV-induced macropinocytosis results in vesicle internalization, as well as extended filopodia capable of fusing with distant cells. MHV-induced macropinocytosis requires fusogenic spike protein on the cell surface and is dependent on epidermal growth factor receptor activation. Inhibition of macropinocytosis reduces supernatant viral titers and syncytia but not intracellular virus titers. These results indicate that macropinocytosis likely facilitates CoV infection through enhanced cell-to-cell spreading. Our studies are the first to demonstrate virus use of macropinocytosis for a role other than entry and suggest a much broader potential exploitation of macropinocytosis in virus replication and host interactions.

IMPORTANCE
Coronaviruses (CoVs), including severe acute respiratory syndrome (SARS) CoV and Middle East respiratory syndrome CoV, are critical emerging human pathogens. Macropinocytosis is induced by many pathogens to enter host cells, but other functions for macropinocytosis in virus replication are unknown. In this work, we show that CoVs induce a macropinocytosis late in infection that is continuous, independent from cell entry, and associated with increased virus titers and cell fusion. Murine hepatitis virus macropinocytosis requires a fusogenic virus spike protein and signals through the epidermal growth factor receptor and the classical macropinocytosis pathway. These studies demonstrate CoV induction of macropinocytosis for a purpose other than entry and indicate that viruses likely exploit macropinocytosis at multiple steps in replication and pathogenesis.
Do Rumen
Bacteroidetes
Utilize an Alternative Mechanism for Cellulose Degradation?
Authors: Naas A. E. , Mackenzie A. K. , Mravec J. , Schückel J. , Willats W. G. T. , Eijsink V. G. H. , Pope P. B.
Published: August 2014

Uncultured and therefore uncharacterized
Bacteroidetes
lineages are ubiquitous in many natural ecosystems which specialize in lignocellulose degradation. However, their metabolic contribution remains mysterious, as well-studied cultured
Bacteroidetes
have been shown to degrade only soluble polysaccharides within the human distal gut and herbivore rumen. We have interrogated a reconstructed genome from an uncultured
Bacteroidetes
phylotype that dominates a switchgrass-associated community within the cow rumen. Importantly, this characterization effort has revealed the first preliminary evidence for polysaccharide utilization locus (PUL)-catalyzed conversion of cellulose. Based on these findings, we propose a further expansion of the PUL paradigm and the saccharolytic capacity of rumen
Bacteroidetes
species to include cellulose, the most abundant terrestrial polysaccharide on Earth. Moreover, the perspective of a cellulolytic PUL lays the foundation for PULs to be considered an alternative mechanism for cellulose degradation, next to cellulosomes and free-enzyme systems.
Dynamic Remodeling of Microbial Biofilms by Functionally Distinct Exopolysaccharides
Authors: Chew Su Chuen , Kundukad Binu , Seviour Thomas , van der Maarel Johan R. C. , Yang Liang , Rice Scott A. , Doyle Patrick , Kjelleberg Staffan
Published: August 2014

Biofilms are densely populated communities of microbial cells protected and held together by a matrix of extracellular polymeric substances. The structure and rheological properties of the matrix at the microscale influence the retention and transport of molecules and cells in the biofilm, thereby dictating population and community behavior. Despite its importance, quantitative descriptions of the matrix microstructure and microrheology are limited. Here, particle-tracking microrheology in combination with genetic approaches was used to spatially and temporally study the rheological contributions of the major exopolysaccharides Pel and Psl in
Pseudomonas aeruginosa
biofilms. Psl increased the elasticity and effective cross-linking within the matrix, which strengthened its scaffold and appeared to facilitate the formation of microcolonies. Conversely, Pel reduced effective cross-linking within the matrix. Without Psl, the matrix becomes more viscous, which facilitates biofilm spreading. The wild-type biofilm decreased in effective cross-linking over time, which would be advantageous for the spreading and colonization of new surfaces. This suggests that there are regulatory mechanisms to control production of the exopolysaccharides that serve to remodel the matrix of developing biofilms. The exopolysaccharides were also found to have profound effects on the spatial organization and integration of
P. aeruginosa
in a mixed-species biofilm model of
P. aeruginosa
-
Staphylococcus aureus
. Pel was required for close association of the two species in mixed-species microcolonies. In contrast, Psl was important for
P. aeruginosa
to form single-species biofilms on top of
S. aureus
biofilms. Our results demonstrate that Pel and Psl have distinct physical properties and functional roles during biofilm formation.

IMPORTANCE
Most bacteria grow as biofilms in the environment or in association with eukaryotic hosts. Removal of biofilms that form on surfaces is a challenge in clinical and industrial settings. One of the defining features of a biofilm is its extracellular matrix. The matrix has a heterogeneous structure and is formed from a secretion of various biopolymers, including proteins, extracellular DNA, and polysaccharides. It is generally known to interact with biofilm cells, thus affecting cell physiology and cell-cell communication. Despite the fact that the matrix may comprise up to 90% of the biofilm dry weight, how the matrix properties affect biofilm structure, maturation, and interspecies interactions remain largely unexplored. This study reveals that bacteria can use specific extracellular polymers to modulate the physical properties of their microenvironment. This in turn impacts biofilm structure, differentiation, and interspecies interactions.
The epidemiology of 1345 shoulder dislocations and subluxations in French Rugby Union players: a five-season prospective study from 2008 to 2013
Authors: Bohu Yoann , Klouche Shahnaz , Lefevre Nicolas , Peyrin Jean-Claude , Dusfour Bernard , Hager Jean-Philippe , Ribaut Aurélie , Herman Serge
Published: August 2014

Background

An understanding of the epidemiology of shoulder dislocation/subluxation in rugby union players could help develop targeted prevention programmes and treatment. We performed a multiyear epidemiological survey of shoulder dislocation/subluxation in a large cohort of rugby players.

Methods

A descriptive epidemiological study was performed prospectively for five playing seasons (2008–2013) in all players licensed in the French Rugby Union. Rugby players were categorised into five groups by age. The player and the team physician reported the injury to the club insurance company if it occurred during training or a match. The goals of the study were to define the rate, type and causes of shoulder dislocation/subluxation.

Results

88 044 injuries were reported, including 1345 (1.5%) episodes of dislocation/subluxation in 1317 men and 28 women, mean age 22.5±5.9 years. About 10/10 000 men and 5/10 000 women reported an episode of shoulder dislocation/subluxation per season, including 83/10 000 senior professionals, 17/10 000 senior amateurs, 21/10 000 juniors, 12/10 000 cadets and <1/10 000 rugby school players. Shoulder dislocation/subluxation was significantly more frequent in senior and junior players (p<0.001). Injuries mainly occurred during a match (66%) in the middle of the season (44%). The most frequent playing position was forwards (56%) and the main mechanism was tackling (69%). When reported, the history of recurrence was found in 66% of injured players, fractures in 22% and acromioclavicular injury in 6.7%. Nerve injury was associated with shoulder dislocation in 6% of cases.

Conclusions

Senior professionals and junior male forward rugby players with a history of shoulder dislocation/subluxation should receive special attention from sports medicine professionals and orthopaedic surgeons.
Age and sex patterns of premature mortality in India
Authors: Dubey Manisha , Mohanty Sanjay K
Published: August 2014

Objectives

To estimate premature mortality by age, sex and cause of death in India.

Background

Studies on premature mortality in India are limited. Although evidence suggests recent reductions in infant and child mortality, little is known about the age and sex patterns of premature deaths in India.

Methods

Secondary data from the Sample Registration System and, census of India and report on cause of death. A set of indices are used to estimate the premature mortality were analysed.

Primary and secondary outcome measures

Standardised years of potential life lost (YPLL), premature years of potential life lost (PYPLL) and working years of potential life lost (WYPLL) for broad age groups and by selected causes of death.

Results

From 1991 to 2011, the age-standardised rate of YPLL (per 1000 population) declined from 310 to 235 for males and from 307 to 206 for females. The estimated YPLL (in millions) declined from 134 to 147 for males and from 123 to 108 for females, the YPLL for adults (aged 15–65) increased by 32% for males and 28% for females, the standardised PYPLL (per 1000 population) declined from 259 to 137 for males and from 258 to 115 for females, the estimated PYPLL increased by 13% for all adult males and by 32% for 30–45-year-old adult males, and the standardised rate of WYPLL declined from 274 to 131 for males and from 295 to 91 for females. These findings suggest a significant improvement in early childhood mortality and increasing mortality trends in 30–45-year-old adult males. The YPLL and WYPLL standardised rates for males and females were highest for cardiovascular disease.

Conclusions

The increasing share of premature deaths among adults and high levels of premature mortality suggest an improvement in child survival increased attention should be given to prevention and treatment of non-communicable diseases in order to avoid premature deaths in India.
Physical activity and risk of fatty liver in people with different levels of alcohol consumption: a prospective cohort study
Authors: Tsunoda Kenji , Kai Yuko , Uchida Ken , Kuchiki Tsutomu , Nagamatsu Toshiya
Published: August 2014

Objective

To investigate whether physical activity affects the future incidence of fatty liver in people with never-moderate and heavy alcohol consumption.

Design

Prospective cohort study.

Setting

Health check-up programme at Meiji Yasuda Shinjuku Medical Center in Shinjuku Ward, Tokyo, Japan.

Population

A total of 10 146 people aged 18 years or older without fatty liver enrolled through baseline surveys conducted from 2005 to 2007. They were grouped into never-moderate alcohol drinkers (n=7803) and heavy alcohol drinkers (n=2343) and followed until 2013.

Main outcome measure

Incident fatty liver diagnosed by ultrasound.

Results

During a mean follow-up of 4.4 years (34 648 person-years), 1255 never-moderate alcohol drinkers developed fatty liver; 520 heavy alcohol drinkers developed fatty liver during a mean follow-up of 4.1 years (9596 person-years). For never-moderate alcohol drinkers, engaging in >3×/week of low-intensity (HR=0.82, 95% CI 0.71 to 0.96) and moderate-intensity (HR=0.56, 95% CI 0.39 to 0.81) physical activity significantly reduced incident fatty liver compared with those who engaged in physical activity <1×/week. For vigorous-intensity physical activity, frequencies of 2×/week (HR=0.57, 95% CI 0.38 to 0.86) and >3×/week (HR=0.55, 95% CI 0.38 to 0.79) were significantly associated with lower risk of incident fatty liver. In propensity-adjusted models, these significant associations still remained. By contrast, in heavy alcohol drinkers, there were no significant associations between the type or frequency of physical activity and incident fatty liver.

Conclusions

Physical activity had an independent protective effect on incident fatty liver only in the never-moderate alcohol drinkers, and the preventive effect increased with higher frequencies and intensities of physical activity.
A reimagined discharge lounge as a way to an efficient discharge process
Authors: Hernandez Natalia , John Dinesh , Mitchell Joan
Published: August 2014

Faced with inherent inefficiencies built into transfer of a patient from emergency department (ED) to an inpatient bed, we determined that the timely availability of an inpatient bed was essential to improving efficiency and flow. Lack of beds early in the day was a major cause for delays and backup in the ED, which in turn placed the ED at risk for overcrowding and diversion. Review of the discharge process revealed that only 33.4% of discharges were completed prior to noon, and on average took 126 minutes from the time a discharge order was written to the time the patient actually left their inpatient bed.

To achieve our goals of improving patient flow and discharge efficiency, we proposed a new project, called the “Discharge Hospitality Center (DHC).” Our previous attempt at creating a ‘discharge lounge” was unsuccessful. However, we learned from that endeavor which then allowed us to completely redesign the new DHC project and incorporate ongoing feedback from all stakeholders, sharing performance metrics regularly, and collectively searching for ways to overcome barriers and improve performance together. Strict eligibility criteria were created, and every patient was screened for DHC eligibility daily at our multidisciplinary discharge planning meeting. This multidisciplinary group made the final decision about eligibility for the DHC, and took responsibility for distributing the list of eligible patients to the acute care nursing floors immediately after their early morning meeting. Using the list of patients appropriate for the DHC, the acute floor nursing teams developed standard work for prioritization of DHC eligible patients for discharge, which more reliably allowed those patients to leave their inpatient beds earlier in the day. We found there was no need for dedicated staff at our DHC, as after discharge all outpatient procedures and policies applied.

Our outcomes were quite favorable. Four months after the DHC project was launched, ED stays over 6 hours decreased from 24.6 to 15.8%, discharges before noon increased from 33.4 to 41.5%, and time improved from 126 down to 84 minutes from the time a discharge order was written to the time the patients actually left their inpatient bed. We reviewed all patients who went to the DHC on the subject of readmission and found two that were unavoidable (whether or not the DHC was used), and one patient nearly missed his ride home as he sat in the wrong location for transport pickup. In conclusion, a DHC can be successfully designed through integration and collaboration with stakeholders which can be a valuable tool to improve discharge efficiency and patient flow.
Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England
Authors: Mindell J S , Knott C S , Ng Fat L S , Roth M A , Manor O , Soskolne V , Daoud N
Published: August 2014

Background

The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants.

Method

Using HSE 2003–2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28 470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models.

Results

Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96).

Conclusions

SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.
Comparative analysis and meta-analysis of major clinical trials with oral factor Xa inhibitors versus warfarin in atrial fibrillation
Authors: Nunes José Pedro L , Rodrigues Rui Paulo , Gonçalves Francisco Rocha
Published: August 2014

Objectives

A comparative analysis of three major clinical trials with factor Xa inhibitor oral anticoagulant (XOAC) drugs versus warfarin in atrial fibrillation—Rocket-AF (rivaroxaban), Aristotle (apixaban) and Engage AF Timi 48 (edoxaban; two different doses and sets of data)—was carried out.

Methods

Data were extracted from the original reports (study level) and a meta-analysis was carried out.

Results

When compared with warfarin, XOAC therapy was associated with a decrease in haemorrhagic stroke, with a similar pattern for all regimens and meta-analysis showing a risk ratio of 0.488 (95% CI 0.396 to 0.601). Regarding total mortality, a favourable pattern was seen for all four regimens and meta-analysis showed a risk ratio of 0.892 (95% CI 0.840 to 0.947). Major bleeding and gastrointestinal bleeding provided two examples regarding which heterogeneity would seem to exist, when XOAC drugs are compared with warfarin. In what concerns the incidence of myocardial infarction, the primary end point (stroke plus systemic embolism) and ischaemic stroke, the situation is less clear. These results are inconsistent with a putative ‘group effect’ for all the seven parameters under study, and for some of them it would probably be best to look at each of the individual trial data rather than at the meta-analysis data (which seem to lack a clear biological meaning).

Conclusions

Apixaban, rivaroxaban and edoxaban have shown interesting effects, when compared with warfarin in clinical trials, in patients with atrial fibrillation, particularly with regard to haemorrhagic stroke and to the mortality rate. No other consistent conclusions concerning a putative ‘group effect’ can be reached at the present stage. Concerns regarding adherence to therapy, possible drug interactions, cost and current absence of antidotes may be taken into consideration when choosing an anticoagulant drug.
ECG characteristics according to the presence of late gadolinium enhancement on cardiac MRI in hypertrophic cardiomyopathy
Authors: Grall Sylvain , Biere Loïc , Clerfond Guillaume , Mateus Victor , Prunier Fabrice , Furber Alain
Published: August 2014

Background

Late gadolinium enhancement (LGE) on cardiac MRI (CMR) has been described as an independent predictive factor of cardiovascular events among patients with hypertrophic cardiomyopathy (HCM). LGE and Q waves are considered as myocardial scar markers but their relation in the context of HCM is poorly established and has to be more supported. The objective of the study was to compare ECG findings in the presence or absence of LGE.

Methods

42 patients with HCM confirmed by CMR were included in the study. ECG abnormalities including abnormal Q waves and five ECG scores of left ventricular hypertrophy were assessed and compared according to LGE presence and its extension. Some CMR features, such as septal to posterior wall thickness ratio, were also studied according to the presence of LGE and the presence of abnormal Q waves.

Results

Abnormal Q waves were more prevalent in the LGE (+) group (60% vs 12%; p=0.002), but there was no correlation between location of Q waves on ECG and territory of LGE on CMR. Among patients with LGE, quantitative analysis of LGE was not different in the presence or absence of Q waves. In contrast to the LGE mass, septal to posterior wall thickness was higher in patients with abnormal Q waves (2.3±0.7 vs 1.6±0.5; p=0.012).

Conclusions

Although abnormal Q waves were more prevalent in the presence of LGE, no correlation was found with the LGE location and extent. These data suggest that abnormal electrical activation of the hypertrophied ventricular septum represented by a high septal to posterior wall thickness ratio seems to be an important mechanism of abnormal Q waves in HCM.
Endothelial function and left ventricular diastolic functional reserve in type 2 diabetes mellitus
Authors: Leung Melissa , Phan Victoria , Leung Dominic Y
Published: August 2014

Background

Endothelial dysfunction is an early feature of vascular disease. Left ventricular (LV) diastolic reserve is the ability of the left ventricle to augment diastolic function with exercise and may be impaired in patients with diabetes mellitus (DM). It is unclear if endothelial dysfunction is related to impaired LV diastolic reserve and diminished exercise capacity.

Methods

96 patients with type 2 DM and 10 controls had brachial artery reactivity testing, followed by exercise echocardiography. The brachial artery diameter was measured at rest and during reactive hyperaemia. LV diastolic reserve was measured as Δe′ with exercise and diastolic reserve index (Δe′/rest e′). Exercise capacity was calculated by metabolic equivalents (METs).

Results

Compared with controls, patients with DM had lower rest e′ (7 vs 9 cm/s, p=0.002), lower Δe′(1 vs 4 cm/s, p=0.023), lower Δe′/rest e′ (0.20 vs 0.47, p=0.003) and reduced flow mediated dilation (FMD, 5 vs 15%, p<0.001). FMD was correlated with Δe′ (r=0.65, p<0.001), diastolic reserve index (r=0.61, p<0.001) and post-exercise septal E/e′ (r=−0.50, p<0.001), but not with rest e′ (r=0.13, p=0.177). FMD was an independent predictor of Δe′ (β=0.002, p<0.001, R2=0.47) and diastolic reserve index (β=0.030, p<0.001, R2=0.41). Younger age (p<0.001), male gender (p=0.014), lower body mass index (p<0.001), lower rest E/e′ (p=0.042) and higher FMD (p=0.025) were independent predictors of higher METs (R2=0.52, p<0.001).

Conclusions

Patients with DM had impaired endothelial function and LV diastolic dysfunction. LV diastolic reserve and exercise capacity are linked to endothelial function. Targeting vascular risk factors to improve endothelial function may improve LV diastolic reserve and exercise capacity.
Capture of farmed Nile crocodiles (Crocodylus niloticus): comparison of physiological parameters after manual capture and after capture with electrical stunning
Authors: Pfitzer S. , Ganswindt A. , Fosgate G. T. , Botha P. J. , Myburgh J. G.
Published: August 2014

The electric stunner (e‐stunner) is commonly used to handle Nile crocodiles (Crocodylus niloticus) on commercial farms in South Africa, but while it seems to improve handling and safety for the keepers, no information regarding physiological reactions to e‐stunning is currently available. The aim of this study was therefore to compare various physiological parameters in farmed C niloticus captured either manually (noosing) or by using an e‐stunner. A total of 45 crocodiles were captured at a South African farm by either e‐stunning or noosing, and blood samples were taken immediately as well as four hours after capture. Parameters monitored were serum corticosterone, lactate, glucose, as well as alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase and creatine kinase. Lactate concentrations were significantly higher in noosed compared with e‐stunned animals (P<0.001). No other blood parameter differed significantly between the two methods of capture. In addition, recorded capture time confirmed that noosing takes significantly longer time compared with e‐stunning (P<0.001), overall indicating that e‐stunning seems to be the better option for restraint of especially large numbers of crocodiles in a commercial setup because it is quicker, safer and did not cause a significant increase in any of the parameters measured.
Functional interdependence of NHE1 and merlin in human melanoma cells
Authors: Frontzek Fabian , Nitzlaff Svenja , Horstmann Malte , Schwab Albrecht , Stock Christian
Published: August 2014

Upregulation of the Na+/H+exchanger isoform 1 (NHE1) has been correlated with tumor malignancy. In contrast, moesin-radixin-ezrin–like protein (merlin) is a tumor suppressor that protects from cancerogenesis. Merlin is highly related to the members of the ezrin, radixin, and moesin (ERM) protein family that are directly attached to and functionally linked with NHE1. In addition, merlin inhibits the MAPK cascade and the Rho-GTPases known to activate NHE1 activity. The present study investigates whether NHE1 expression and activity affect merlin or, conversely, whether merlin has an impact on NHE1 in human melanoma (MV3) cells. Indeed, features of merlin-deficient MV3 cells point to a functional link: merlin-deficient cells showed a decreased NHE1 expression and, paradoxically, an increase in NHE1 activity as measured upon cytosolic acidification (NH4Cl prepulse method). Loss of merlin also led to an elevated cell motility that could be further increased by NHE1 overexpression, whereas NHE1 overexpression alone had no effect on migration. In contrast, neither NHE1 expression nor its activity had an impact on merlin expression. These results suggest a novel tumor suppressor function of merlin in melanoma cells: the inhibition of the proto-oncogenic NHE1 activity, possibly including its downstream signaling pathways.
Existence and stability of modulated dust-acoustic wave packets in the presence of nonthermal ions
Authors: Alinejad H. , Mahdavi M.
Published: August 2014

The effects of dust temperature and energetic (nonthermal) ions are incorporated in the study of modulated instability of dust-acoustic (DA) waves in a dusty plasma containing warm adiabatic dust grains, isothermal electrons and hot ions obeying a nonthermal distribution. Based on the multiple space and time scales perturbation, a nonlinear Schrödinger equation is derived with a solution showing a new relationship between the modulated DA wave packets and ion nonthermality. It is shown that as the population of fast ions increases, the transition from stable dark envelope solitons to unstable ones shifts to the smaller wavelength regions. The instability growth rate reduces owing to the presence of nonthermal ions. It is also found that the effects of dust temperature and electron concentration modify the criteria for the modulational instability of DA waves. The results could be useful for understanding the properties of modulated wave packets and their evolution in space and laboratory dusty plasmas, such as those in and around the Earth’s foreshock.