bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic review: the financial burden of surgical complications in patients with ulcerative colitis
Authors: Lindsay J. O. , Bergman A. , Patel A. S. , Alesso S. M. , Peyrin‐Biroulet L.
Published: April 2015

Background

Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced quality of life (QoL), and maybe a considerable economic burden to healthcare systems. Appreciation of these burdens is important to evaluate the cost effectiveness of newer interventions for UC vs. colectomy.

Aim

To identify data representing resource utilisation or costs of complications arising from colorectal procedures in patients with UC, and data representing patient QoL, as reported by health state utility values (HSUVs).

Methods

Embase, MEDLINE and The Cochrane Library were searched for studies (1995–2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings (January 2011–January 2014) were hand‐searched.

Results

Twelve studies reported resource use/costs, and three reported HSUVs data in patients with UC experiencing surgical complications. Additional mean costs of postoperative complications ranged from $18 650/patient with complications at a 6‐month follow‐up (46% incidence) to $34 714/patient with complications over a 5‐year period (49% incidence). Pouchitis, pouch failure and small bowel obstruction carried the greatest burden. Marked reductions in HSUVs were observed for patients with UC experiencing surgical complications, vs. patients with UC in a remission state.

Conclusions

There is a paucity of well reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and of quality of life, with reoperations, physician fees, additional in‐patient hospital stays and infertility treatment being the main cost drivers.
Estimated pulmonary artery systolic pressure and sickle cell disease: a meta‐analysis and systematic review
Authors: Caughey Melissa C. , Poole Charles , Ataga Kenneth I. , Hinderliter Alan L.
Published: April 2015

Many studies report estimated pulmonary artery systolic pressure (ePASP) in patients with sickle cell disease (SCD) screened by echocardiography. To better understand the prevalence and outcomes of elevated ePASP in clinically stable SCD patients, we conducted a random‐effects meta‐analysis. A total of 45 studies, representing 15 countries and including 6109 individuals, met our inclusion criteria. In most (70%) studies, elevated ePASP was defined by a tricuspid regurgitant velocity of 2·5 m/s. The prevalence of elevated ePASP was 21% (17–26%) in children and 30% (26–35%) in adults. After adjustment for sex, SCD genotype, haemoglobin, hydroxycarbamide (hydroxyurea) treatment, country and publication year, age remained associated with elevated ePASP, yielding a 12% (0·4–23%) higher adjusted prevalence in adults. Few studies reported 6‐min walk tests or mortality outcomes, and estimates were highly heterogeneous. In random effects meta‐analyses, patients with elevated ePASP walked an estimated 30·4 (6·9–53·9) metres less than those without elevated ePASP and had an associated mortality hazard ratio of 4·9 (2·4–9·7).
El MercurioLies, andLa TerceraLies More. Political Bias in Newspaper Headlines in Chile, 1994–2010
Authors: NAVIA PATRICIO , OSORIO RODRIGO
Published: April 2015

In this article we examine the presence of bias in Chile's two main daily newspapers,El MercurioandLa Tercera, both of which have historically been associated with the political right. We analyse their principal headlines in the first 100 days of rule ofpresidents Eduardo Frei (1994–2000), Ricardo Lagos (2000–2006), Michelle Bachelet (2006–2010) and Sebastián Piñera (2010–2014). We find thatLa Tercerawas more critical of all these presidents thanEl Mercurio. InLa Tercerawe also identify an ideological bias in favour of Piñera as compared to the centre‐left presidents, and inEl Mercurioa greater bias against Bachelet than the other presidents.
Negative Correlation between Ant and Spider Abundances in the Canopy of a Bornean Tropical Rain Forest
Authors: Katayama Motoki , Kishimoto‐Yamada Keiko , Tanaka Hiroshi O. , Endo Tomoji , Hashimoto Yoshiaki , Yamane Seiki , Itioka Takao
Published: April 2015

In tropical rain forests, high canopy trees have diverse and abundant populations of ants and spiders. However, accessing high trees and their fauna remains difficult; thus, how ants and spiders interact in the canopy remains unclear. To better understand the interspecific interactions between these two dominant arthropod groups, we investigated their spatial distributions at the canopy surface in a tropical rain forest in Borneo. We sampled ants and spiders six times between 2009 and 2011 by sweeping with an insect net at the tree crown surfaces of 190 emergent or tall (≥20 m in height) trees. We collected 438 ant individuals belonging to 94 species and 1850 spider individuals (1630 juveniles and 220 adults) belonging to 142 morphospecies (adults only) from a total of 976 samples. The fact that we collected four times more spider individuals than ant individuals suggests that fewer ants forage at the tree crown surface than previously thought. The number of spider individuals negatively correlated with the number of ant individuals and the number of ant species, indicating significant exclusivity between ant and spider spatial distributions at the tree crown surface. Niche‐overlap between the two taxa confirmed this observation. Although our data do not address the causes of these spatial distributions, antagonistic interspecific interactions such as interference behaviors and intra‐guild predation are ecological mechanisms that give rise to exclusive spatial distributions.
Variation in Canopy Litterfall Along a Precipitation and Soil Fertility Gradient in a Panamanian Lower Montane Forest
Authors: Heineman Katherine D. , Caballero Pedro , Morris Arturo , Velasquez Carmen , Serrano Kiria , Ramos Nelly , Gonzalez Jonathan , Mayorga Luis , Corre Marife D. , Dalling James W.
Published: April 2015

Fertilization experiments in tropical forests have shown that litterfall increases in response to the addition of one or more soil nutrients. However, the relationship between soil nutrient availability and litterfall is poorly defined along natural soil fertility gradients, especially in tropical montane forests. Here, we measured litterfall for two years in five lower montane 1‐ha plots spanning a soil fertility and precipitation gradient in lower montane forest at Fortuna, Panama. Litterfall was also measured in a concurrent nitrogen fertilization experiment at one site. Repeated‐measuresANOVAwas used to test for site (or treatment), year, and season effects on vegetative, reproductive and total litterfall. We predicted that total litterfall, and the ratio of reproductive to leaf litterfall, would increase with nutrient availability along the fertility gradient, and in response to nitrogen addition. We found that total annual litterfall varied substantially among 1‐ha plots (4.78 Mg/ha/yr to 7.96 Mg/ha/yr), and all but the most aseasonal plot showed significant seasonality in litterfall. However, litterfall accumulation did not track soil nutrient availability; instead forest growing on relatively infertile soil, but dominated by an ectomycorrhizal tree species, had the highest total litterfall accumulation. In the fertilization plots, significantly more total litter fell in nitrogen addition relative to control plots, but this increase in response to nitrogen (13%) was small compared to variation observed among 1‐ha plots. These results suggest that while litterfall at Fortuna is nutrient‐limited, compositional and functional turnover along the fertility gradient obscure any direct relationship between soil resource availability and canopy productivity.
Large Mammal Distribution in a Transfrontier Landscape: Trade‐offs Between Resource Availability and Human Disturbance
Authors: Selier Jeanetta , Slotow Rob , Di Minin Enrico
Published: April 2015

Understanding factors that affect the persistence of charismatic megafauna in human‐dominated landscapes is crucial to inform conservation decision‐making and reduce human‐wildlife conflict. We assessed the effect of environmental and anthropogenic factors at different landscape and management scales in predicting the distribution of African elephant (Loxodonta africana) within the Greater Mapungubwe Transfrontier Conservation Area in Southern Africa. We combined aerial distribution counts over a 12‐yr period with 14 variables, representing food availability, landscape, and anthropogenic effects, into generalized linear models. Generalized linear models were run for the broader landscape, as well as three separate management units within the broader landscape, namely ecotourism, trophy hunting, and a combination of hunting and ecotourism. Human activities within different management units forced elephant to trade‐off between disturbance avoidance, and good food and water availability. In addition, the important predictors of elephant distribution within each of the management units differed from the predictors at the broader landscape. Overall, our results suggest that at the fine scale, elephant are constraint by factors that may be masked at the broader landscape scale. We suggest that accounting for anthropogenic disturbance is important in determining the distribution of large, wide‐ranging, mammal species in increasingly human‐dominated landscapes, and that modeling needs to be done at the spatial scales at which conservation decisions are made.
Diverse involvement of isoforms and gene aberrations of Akt in human lung carcinomas
Authors: Dobashi Yoh , Tsubochi Hiroyoshi , Matsubara Hirochika , Inoue Jun , Inazawa Johji , Endo Shunsuke , Ooi Akishi
Published: April 2015

Emerging evidence confirms a central role of Akt in cancer. To evaluate the relative contribution of deregulated Akt and their clinicopathological significance in lung carcinomas, overexpression, activation of Akt and AKT gene increases were investigated. Immunohistochemical staining for 108 cases revealed overexpression of total Akt, Akt1, Akt2 and Akt3 in 61.1, 47.2, 40.7 and 23.1%, respectively, and phosphorylated Akt in 42.6% of cases. Expression of total Akt, Akt2 and Akt3 were frequently observed in small cell carcinoma, but phosphorylated Akt and Akt1 were more frequently observed in squamous cell carcinoma. FISH analysis to evaluate gene increases of AKT1‐3 revealed amplification of AKT1 in 4.2% and AKT1 increase by polysomy of chromosome 14 in 27.3% of cases. For AKT2, amplification was observed in 3.2% and polysomy of chromosome 19 in 26.3% of cases. AKT3 increase was observed in 40.0% of cases only by polysomy of chromosome 1. Although “FISH‐positive” AKT1 and AKT2 gene increases (amplification/high‐level polysomy) were found exclusively in the cases overexpressing total Akt, Akt1 or Akt2, respectively, AKT3 increase was irrelevant of Akt3 expression. Statistically, expressions of Akt2, p‐Akt and cytoplasmic‐p‐Akt were correlated with lymph node metastasis (P = 0.0479, P = 0.0371 and P = 0.0310, respectively). Although AKT1 and AKT2 gene increase showed positive correlation with, or trend towards a positive correlation with tumor size (P = 0.0430, P = 0.0590, respectively), AKT3 did not. In conclusion, Akt isoforms are differentially involved in the pathological phenotype of lung carcinoma in a diverse manner. Because abnormality of Akt1/AKT1 and Akt2/AKT2 correlated with clinicopathological profiles, Akt1/2‐specific targeting may open a novel therapeutic window for the group showing Akt deregulation.
Synthesis and Evaluation of Derivatives of the Proteasome Deubiquitinase Inhibitor b‐AP15
Authors: Wang Xin , D'Arcy Pádraig , Caulfield Thomas R. , Paulus Aneel , Chitta Kasyapa , Mohanty Chitralekha , Gullbo Joachim , Chanan‐Khan Asher , Linder Stig
Published: April 2015

The ubiquitin–proteasome system (UPS) is increasingly recognized as a therapeutic target for the development of anticancer therapies. The success of the 20S proteasome core particle (20S CP) inhibitor bortezomib in the clinical management of multiple myeloma has raised the possibility of identifying other UPS components for therapeutic intervention. We previously identified the small molecule b‐AP15 as an inhibitor of 19S proteasome deubiquitinase (DUB) activity. Building upon our previous data, we performed a structure–activity relationship (SAR) study on b‐AP15 and identified VLX1570 as an analog with promising properties, including enhanced potency and improved solubility in aqueous solution. In silico modeling was consistent with interaction of VLX1570 with key cysteine residues located at the active sites of the proteasome DUBs USP14 and UCHL5. VLX1570 was found to inhibit proteasome deubiquitinase activity in vitro in a manner consistent with competitive inhibition. Furthermore, using active‐site‐directed probes, VLX1570 also inhibited proteasome DUB activity in exposed cells. Importantly, VLX1570 did not show inhibitory activity on a panel of recombinant non‐proteasome DUBs, on recombinant kinases, or on caspase‐3 activity, suggesting that VLX1570 is not an overtly reactive general enzyme inhibitor. Taken together, our data shows the chemical and biological properties of VLX1570 as an optimized proteasome DUB inhibitor.
Anodal transcranial direct current stimulation over premotor cortex facilitates observational learning of a motor sequence
Authors: Wade Stephanie , Hammond Geoff
Published: April 2015

Motor skills, including complex movement sequences, can be acquired by observing a model without physical practice of the skill, a phenomenon known as observational learning. Observational learning of motor skills engages the same memory substrate as physical practice, and is thought to be mediated by the action observation network, a bilateral fronto‐parietal circuit with mirror‐like properties. We examined the effects of anodal transcranial direct current stimulation (tDCS) over premotor cortex, a key node of the action observation network, on observational learning of a serial response time task. Results showed that anodal tDCS during observation of the to‐be‐learned sequence facilitated reaction times in the subsequent behavioral test. The study provides evidence that increasing excitability of the action observation network during observation can facilitate later motor skill acquisition.
Hippocampal antioxidative system in mesial temporal lobe epilepsy
Authors: Ristić Aleksandar J. , Savić Danijela , Sokić Dragoslav , Bogdanović Pristov Jelena , Nestorov Jelena , Baščarević Vladimir , Raičević Savo , Savić Slobodan , Spasojević Ivan
Published: April 2015

Objective

To examine antioxidative system in hippocampi of patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (mTLE‐HS).

Methods

Activity and levels of antioxidative enzymes—catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), manganese superoxide dismutase (MnSOD), and copper‐zinc superoxide dismutase (CuZnSOD)—were assessed in hippocampi of nine pharmacoresistant mTLE‐HS patients (mean age 37.7 ± [standard deviation] 6.6 years) who underwent amygdalohippocampectomy, and in 10 hippocampi obtained via autopsy from five neurologically intact controls (mean age 34.4 ± 9.0 years). Subfield and cellular (neuron/astrocyte) distribution of CAT, GPx, and MnSOD was analyzed in detail using immunohistochemical staining.

Results

Sclerotic hippocampi showed drastically increased activity of hydrogen peroxide–removing enzymes, CAT (p < 0.001), GPx (p < 0.001), and GR (p < 0.001), and significantly higher protein levels of CAT (p = 0.006), GPx (p = 0.040), GR (p = 0.024), and MnSOD (p = 0.004), compared to controls. CAT immunofluorescence was located mainly in neurons in both controls and HS. Control hippocampi showed GPx staining in blood vessels and CA neurons. In HS, GPx‐rich loci, representing bundles of astrocytes, emerged in different hippocampal regions, whereas the number of GPx‐positive vessels was drastically decreased. Neurons with abnormal morphology and strong MnSOD immunofluorescence were present in all neuronal layers in HS. Small autofluorescent deposits, most likely lipofuscin, were observed, along with astrogliosis, in CA1 in HS.

Significance

Antioxidative system is upregulated in HS. This documents, for the first time, that epileptogenic hippocampi are exposed to oxidative stress. Our findings provide a basis for understanding the potential involvement of redox alterations in the pathology of epilepsy, and may open new pharmacologic perspectives for mTLE‐HS treatment.
Aldosterone and testosterone: two steroid hormones structurally related but with opposite electrophysiological properties during myocardial ischemia–reperfusion
Authors: Alexandre Joachim , Milliez Paul , Rouet René , Manrique Alain , Allouche Stéphane , Piccirillo Gianfranco , Schiariti Michele , Puddu Paolo‐Emilio
Published: April 2015

Steroid hormones appear to be a key factor in the gender differences in the rates and severity of cardiovascular diseases. Aldosterone and testosterone have typical steroid ring structure, but despite this, they demonstrate very different properties. During acute myocardial ischemia–reperfusion, the deleterious impact of aldosterone is now well established. Conversely, the electrophysiological impact of testosterone in this context remained unknown. We used female rabbit in vitro models and standard microelectrode technique including right ventricle mimicking the ‘border zone’ existing between normal and ischemic/reperfused areas and isolated right ventricle experiments to assess the acute electrophysiological impact of both aldosterone and testosterone. During ischemia–reperfusion, acute superfusion of 10 and 100 nmol/L testosterone decreased normoxic and reperfused action potential duration at 90% (APD90), systematically induced conduction blocks, and decreased APD90 dispersion between ischemic and nonischemic areas (from 98 ± 4 to 57 ± 7 ms and 66 ± 3 ms, for, respectively, testosterone 10 and 100 nmol/L, P < 0.05). Testosterone 10 and 100 nmol/L concomitantly decreased sustained premature ventricular contraction (PVC) occurrence (from 55 to 0%, P < 0.05). Conversely, aldosterone 10 and 100 nmol/L increased normoxic and reperfused APD90, APD90 dispersion, and reperfusion‐induced PVCs. Furthermore, testosterone demonstrated cycle length‐dependent effects on APD90 for high heart rate, whereas aldosterone did not exhibit any significant effect compared with controls. During acute myocardial ischemia–reperfusion, acute superfusion of physiological concentrations of testosterone seemed to be anti‐arrhythmic by removing a pro‐arrhythmic substrate (APD90 dispersion), inducing conduction blocks and decreasing triggered activities (PVC occurrence). Further experiments are warranted to confirm our results.
Anticardiolipin Antibodies in Children with Helicobacter pylori Infection
Authors: Sarıcı Serdar Umit , Gursel Orhan , Kurekci Emin , Kesik Vural , Atay Avni , Okutan Vedat , Inal Ali , Pekel Aysel , Ozguven Mehmet Ali , Ozcan Okan
Published: April 2015

Background

Anticardiolipin (aCL) antibodies are associated with thrombosis and have an important role in the etiology of diseases such as stroke and myocardial infarction whose etiologies were based on thrombosis. H. pylori has been proposed to be responsible for the pathophysiology of some diseases including stroke, myocardial infarction, thrombosis, and autoimmune diseases. From this point of view, we hypothesized a possible relationship between H. pylori infection and aCL antibodies and initially aimed to determine the prevalence of aCL antibody positivity in children with H. pylori infection.

Materials and Methods

Anticardiolipin antibodies were studied in 84 patients before and after eradication therapy and in a control group including 40 children.

Results

The pretreatment aCL IgA (median 12.78 APL/mL), aCL IgM (median 21.60 MPL/mL), and aCL IgG antibody levels (median 14.22 GPL/mL) were significantly higher than those of post‐treatment results (median 5.38 APL/mL, 7.02 MPL/mL, and 6.64 GPL/mL, respectively) and controls (median 5.90 APL/mL, 4.80 MPL/mL, and 4.81 GPL/mL, respectively). Anticardiolipin antibodies revealed no significant differences between the study group after therapy and the control group.

Conclusions

In our particular experience, H. pylori can cause aCL antibody positivity in children and eradication of H. pylori provides the disappearance of these antibodies.
Validation of the Japanese version of the Chronic Liver Disease Questionnaire for the assessment of health‐related quality of life in patients with chronic viral hepatitis
Authors: Tanaka Atsushi , Kikuchi Kentaro , Miura Ryo , Miura Kotaro , Mikami Masaki , Aiso Mitsuhiko , Takamori Yoriyuki , Takikawa Hajime
Published: April 2015

Aim

Patients with chronic liver diseases (CLD) suffer from a variety of subjective symptoms, and the assessment of health‐related quality of life (HRQOL) is crucial. The Chronic Liver Disease Questionnaire (CLDQ) is the first liver disease‐specific instrument for this purpose. In this study we aimed to develop the Japanese version of CLDQ and to assess its validity and reliability in Japanese patients with chronic viral hepatitis.

Methods

The participants included 135 Japanese patients chronically infected with hepatitis B or C virus. The Japanese version of the CLDQ was developed according to the standard “back‐translation” method. In addition to the Japanese version of the CLDQ, we asked the patients to fill out two other self‐report questionnaires: the Japanese versions of the 36‐Item Short Form Survey (SF‐36) and Hospital Anxiety and Depression Scale (HADS). Then, the internal consistency, convergent and discriminant validity of the Japanese version of CLDQ were statistically examined.

Results

Cronbach's alpha of the Japanese version of the CLDQ was acceptable. The mean score was lower in emotional domains of the CLDQ, compared with those in somatic domains. Pearson correlations between Japanese CLDQ and SF‐36 and HADS were significant. The mean of the CLDQ scores decreased in all domains in patients with liver cirrhosis compared with those in patients with chronic hepatitis.

Conclusion

The Japanese version of the CLDQ is a reliable and valid instrument for assessment of the HRQOL of Japanese patients with chronic viral hepatitis. The results also suggest that the HRQOL of Japanese patients is mainly impaired by emotional factors rather than somatic symptoms, and significantly worsened by progression of the disease.
A Pathological Perspective on the Natural History of Cerebral Atherosclerosis
Authors: Gutierrez Jose , Elkind Mitchell S. V. , Virmani Renu , Goldman James , Honig Lawrence , Morgello Susan , Marshall Randolph S.
Published: April 2015

Background

The natural history of intracranial large artery atherosclerosis has been mainly described from lumen-based imaging studies, and much of what is reported to be known about atherosclerosis is derived from non-cerebral arteries.

Aims

To test the hypothesis that atherosclerosis is only partially represented by stenosis and that advanced atherosclerosis is more common that severe stenosis in noncardioembolic infarcts.

Methods

Cerebral large arteries from 196 autopsy cases were studied. The revised American Heart Association classification for atherosclerosis was used to determine the phenotype in each available artery. Cross-sectional lumen stenosis was obtained as defined by the Glagov's method.

Results

As age of cases increased, there was a progressive increment in the frequency of atherosclerotic lesions, rising from 5% of all arteries at age 20–40, to more than 40% at age 60 or older. Stenosis also increased with age: less than 3% of the arteries in those ≤50 years had >40% stenosis, while one out of five arteries in those >80 years had >40% stenosis. In most cases (80%), atherosclerosis and stenosis were directly related. However, one out of five cases with advanced atherosclerosis had <30% stenosis. In arteries supplying brain areas with noncardioembolic infarcts, the majority of segments exhibiting advanced atherosclerosis had lumen stenosis of <40%.

Conclusion

Although intracranial atherosclerosis is typically associated with stenosis, a substantial minority of cases shows advanced atherosclerosis in the absence of stenosis >40%. Definitions based solely on stenosis may underestimate the extent and role of intracranial large artery atherosclerosis.
Patients’ Evaluations of Complete Denture Therapy and Their Association with Related Variables: A Pilot Study
Authors: Santos Beatriz Ferreira Oliveira , dos Santos Mateus Bertolini Fernandes , Santos Jarbas Francisco Fernandes , Marchini Leonardo
Published: April 2015

Purpose

Patient satisfaction is an important goal in complete denture therapy, and many factors influence this parameter. This study aimed to evaluate expectations before and satisfaction after therapy with complete dentures. As a secondary objective, other variables that may interfere with patient satisfaction were also evaluated.

Material and Methods

A representative sample of 99 patients assigned visual analog scale (VAS) scores to their expectations before and satisfaction after therapy regarding chewing, esthetics, comfort, and phonetics. Demographic data and answers to a questionnaire concerning the dentists’ conduct were recorded. Multiple linear regression was used to evaluate the association among studied variables and patients’ expectation and satisfaction with their dentures.

Results

The average VAS scores were high for both expectations and satisfaction, and satisfaction exceeded expectations. Patients’ expectations about esthetics and comfort were associated with age and self‐reported time of using complete dentures. Patient satisfaction regarding chewing was associated with the number of postdelivery adjustments. Also, patient satisfaction regarding esthetics was associated with gender and esthetic expectations. In regard to phonetic satisfaction, associations were verified among self‐reported time of using complete dentures, comfort and phonetics expectations, and dentists’ explanations. Comfort satisfaction was associated only with educational level.

Conclusions

Patient satisfaction regarding complete dentures exceeded expectations and an expressive majority of positive evaluations of the dentists was noticed. Many patient‐related variables seemed to influence their evaluations of their dentures.
Mental health nurses can increase capability and capacity in primary care by educating practice nurses: an evaluation of an education programme in England
Authors: Hardy S. A. , Kingsnorth R.
Published: April 2015

Accessible summary

The majority of mental health problems in England are dealt with in primary care but most of the healthcare workers in primary care have little knowledge of mental health. We wanted to develop an accessible education programme which was appropriate to the learning needs of this workforce.

Mental health nurses can deliver training in mental health and well‐being (which has been developed by an expert) to practice nurses. This increases the knowledge of both parties and promotes working together. Utilizing mental health nurses as trainers improves both their clinical practice and that of the practice nurses they have taught. As the time mental health nurses need to spend away from practice to carry out education is minimal, it has little impact on their usual workload.

Other health organizations both nationally and internationally could adapt the education programme to suit their particular needs.

Research is required to find out whether training practice nurses in this way has an impact on patients.

Most people with a mental health problem in England are cared for by clinicians in primary care who may have had little or no training in this area. Our aim was to develop an accessible education programme which was appropriate to the learning needs of this workforce. A survey of the mental health and well‐being training needs and preferred learning methods of practice nurses was undertaken, then a programme of education was developed by a primary care mental health expert. Teaching was delivered by mental health nurses who were trained as educators. Both the practice nurses and mental health nurses felt their clinical practice would improve as a result of being involved in this programme. To sustain the learning, mental health nurses were supported by attending and then leading their own action learning sets. This model of education can be adapted and used by health organizations both nationally and internationally. Research is required to find out whether training practice nurses using this programme has an impact on patients.
Dealing with Female Sexuality: Training, Attitude, and Practice of Obstetrics and Gynecology Residents from a Developing Country
Authors: Vieira Teresa Cristina Souza Barroso , de Souza Eduardo , da Silva Ivaldo , Torloni Maria Regina , Ribeiro Meireluci Costa , Nakamura Mary Uchiyama
Published: April 2015

Introduction

There is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy.

Aim

The aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality.

Methods

A cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy.

Main Outcome Measures

Training, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures.

Results

A total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients’ questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic.

Conclusion

The vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents.
Acute Phase Proteins in Racehorses with Inflammatory Airway Disease
Authors: Leclere M. , Lavoie‐Lamoureux A. , Lavoie J.‐P.
Published: April 2015

Background

Systemic inflammation is observed in horses with heaves and could also be present in horses with a lesser degree of pulmonary inflammation.

Hypothesis/Objectives

It was hypothesized that racehorses with inflammatory airway disease (IAD) have increased concentration of circulating acute phase proteins. The objective of this study was to compare serum acute phase proteins of racehorses with and without lower airway inflammation.

Animals

Serum from 21 client‐owned Standardbred racehorses with exercise intolerance and lower airway inflammation and serum from 10 client‐owned Standardbred racehorses with exercise intolerance without lower airway inflammation.

Methods

In a case–control study, serum samples from previously characterized horses presented for exercise intolerance with or without lower airway inflammation based on bronchoalveolar lavage fluid cytology were analyzed for serum amyloid A protein (SAA), C‐reactive protein (CRP), and haptoglobin using commercialELISAs.

Results

There was no significant differences between groups forSAA(non‐IADversusIAD, median (range): 3.47 (0.06–34.94) versus 6.33 (0.06–80) μg/mL,P = .49),CRP(10.87 (2.05–29.03) versus 4.63 (0.02–31.81) μg/mL,P = .23) or haptoglobin (900.36 (607.99–2018.84) versus 749.54 (530.81–1076.95) μg/mL,P = .09).

Conclusions and Clinical Importance

In this population of poorly performing racehorses in training, serumSAA,CRP, and haptoglobin were not helpful in distinguishing between horses withIADfrom horses with exercise intolerance from other causes.
Tor1, Sch9 and PKA downregulation in quiescence rely on Mtl1 to preserve mitochondrial integrity and cell survival
Authors: Sundaram Venkatraghavan , Petkova Mima I. , Pujol‐Carrion Nuria , Boada Jordi , de la Torre‐Ruiz Maria Angeles
Published: April 2015

Here we show that Mtl1, member of the cell wall integrity pathway of Saccharomyces cerevisiae, plays a positive role in chronological life span (CLS). The absence of Mtl1 shortens CLS and causes impairment in the mitochondrial function. This is reflected in a descent in oxygen consumption during the postdiauxic state, an increase in the uncoupled respiration and mitochondrial membrane potential and also a descent in aconitase activity. We demonstrate that all these effects are a consequence of signalling defects suppressed by TOR1 (target of rapamycin) and SCH9 deletion and less efficiently by Protein kinase A (PKA) inactivation. Mtl1 also plays a role in the regulation of both Bcy1 stability and phosphorylation, mainly in response to glucose depletion. In postdiauxic phase and in conditions of glucose depletion, Mtl1 negatively regulates TOR1 function leading to Sch9 inactivation and Bcy1 phosphorylation converging in PKA inhibition. Slt2/Mpk1 kinase partially contributes to Bcy1 phosphorylation, although additional targets are not excluded. Mtl1 links mitochondrial dysfunction with TOR and PKA pathways in quiescence, glucose being the main signalling molecule.
Social functioning and socioeconomic changes after introduction of regular dialysis treatment and impact of dialysis modality: A multi‐centre survey of Japanese patients
Authors: Nakayama Masaaki , Ishida Mari , Ogihara Masahiko , Hanaoka Kazushige , Tamura Masahito , Kanai Hidetoshi , Tonozuka Yukio , Marshall Mark R
Published: April 2015

Aim

Patient socialization and preservation of socioeconomic status are important patient‐centred outcomes for those who start dialysis, and retention of employment is a key enabler. This study examined the influence of dialysis inception and modality upon these outcomes in a contemporary Japanese cohort.

Methods

We conducted a survey of prevalent chronic dialysis patients from 5 dialysis centres in Japan. All patients who had been on peritoneal dialysis (PD) since dialysis inception were recruited, and matched with a sample of those on in‐centre haemodialysis (ICHD). We assessed patients' current social functioning (Short Form 36 Health Survey), and evaluated changes to patient employment status, annual income, and general health condition from the pre‐dialysis period to the current time.

Results

A total of 179 patients were studied (102 PD and 77 ICHD). There were no differences in social functioning by modality. Among them, 113 were employed in the pre‐dialysis period with no difference by modality. Of these, 22% became unemployed after dialysis inception, with a corresponding decline in average working hours and annual income. The odds of unemployment after dialysis inception were 5.02 fold higher in those on ICHD compared to those on PD, after adjustment for covariates. There were no changes for those who were already unemployed in the pre‐dialysis period.

Conclusions

Employment status is significantly hampered by dialysis inception, although PD was associated with superior retention of employment and greater income compared to ICHD. This supports a positive role for PD in preservation of socioeconomic status and potentially other patient‐centred outcomes.
Personalized health care beyond oncology: new indications for immunoassay‐based companion diagnostics
Authors: Batrla Richard , Jordan Bruce W.M.
Published: April 2015

Personalized health care (PHC) is an evolving field of medicine aimed at providing the right therapy to the right patient at the right time. This approach often incorporates the use of companion diagnostics (CDx) assays that provide information essential for the safe and effective use of the corresponding drug. In addition to oncology, many other therapy areas, such as cardiovascular, neurological, and infectious and inflammatory diseases, may benefit from PHC, owing to disease complexity and heterogeneity. Furthermore, although most U.S. Food and Drug Administration–approved CDx are based on molecular‐based technologies, immunoassays can provide a significant contribution to the evolution of CDx in patient management. In this review we discuss how the incorporation of biomarker immunoassays into routine diagnostic testing may allow early and definitive detection of Alzheimer's disease and enable population enrichment in clinical trials. In addition, we will describe how biomarker‐based CDx immunoassays have potential utility for stratifying patients with asthma based on their potential response to therapy and for selecting treatment according to phenotypic profile. Continued research into the underlying disease pathology and development of accurate and reliable diagnostic assays may ensure that PHC becomes the future standard for many indications.
Are nocturnal hypoxemia and hypercapnia associated with desaturation immediately after adenotonsillectomy?
Authors: Dalesio Nicholas M. , McMichael Douglas H. , Benke James R. , Owens Sean , Carson Kathryn A. , Schwengel Deborah A. , Schwartz Alan R. , Ishman Stacey L.
Published: April 2015

Background

Children who undergo adenotonsillectomy for sleep‐disordered breathing frequently have postoperative oxygen desaturations. Nocturnal hypoxia has been shown to predict postoperative respiratory complications; however, other gas exchange abnormalities detected on polysomnography (PSG) have not been evaluated.

Aim

We sought to determine whether hypercapnia seen on preoperative nocturnal PSG can predict postoperative hypoxemia.

Methods

We conducted a retrospective review of 319 children who underwent polysomnography before adenotonsillectomy. Saturation levels were recorded for at least 2 h postoperatively, and the primary outcome was desaturation (<90%).

Results

The median patient age was 5 years (range, 5 months–17 years). Patients who desaturated postoperatively had higher median peak endtidal CO2 (EtCO2) levels (55.5 vs 52 mmHg; P = 0.02), lower saturation nadirs (80.5% vs 88%; P = 0.048), and were younger (2 vs 6 years; P < 0.001) than those without desaturation. Age was significantly correlated with peak EtCO2 (r = −0.16), respiratory disturbance index (RDI; r = −0.23), and oxygen saturation nadir (r = 0.25; all P < 0.01). In unadjusted analysis, age <3 years compared to ≥9 years (odds ratio [OR] = 10.09; 95% confidence interval [CI] = 2.13–96.26), peak EtCO2 > 55 mmHg (OR = 3.38; 95% CI = 1.21–9.47), and RDI ≥ 10 (OR = 2.89; 95% CI = 1.05–8.42) were associated with increased odds of desaturation. Multivariable logistic regression on age, race, sex, peak EtCO2, RDI, opioid use, and saturation nadir showed that only age was significantly associated with postoperative desaturation. Patients 0–2 years old were 10.43 (95% CI = 1.89–110.9) times more likely to have desaturation than patients 9–17 years old.

Conclusion

Patients <3 years of age are most likely to have postoperative hypoxemia after adenotonsillectomy. Gas exchange abnormalities did not correlate with postoperative desaturations, although age and peak EtCO2 did strongly correlate.
A signet‐ring cell melanoma arising from a medium‐sized congenital melanocytic nevus in an adult: A case report and literature review
Authors: Tajima Shogo , Koda Kenji
Published: April 2015

Patients with congenital nevus, especially giant congenital melanocytic nevus (CMN) measuring >20 cm, are known to be at elevated risk of developing melanomas, especially during the first and second decades of life. Melanomas rarely develop in patients with small and medium‐sized CMNs, but if they do, they occur during the fourth and fifth decades of life. We present a case of a rapidly enlarging signet‐ring cell melanoma (over 3 months) that arose from a medium‐sized CMN in a 57‐year‐old Japanese man. Only 11 other cases of signet‐ring cell melanomas at the primary site have been reported. On the basis of morphology alone, it is difficult to diagnose a nodule appearing in a CMN as a signet‐ring cell melanoma, because even a benign melanocytic nevus can appear as signet‐ring cell morphology. Moreover, a rapidly growing proliferative nodule (PN) more often develops in a CMN than melanoma; PNs may at times exhibit enough atypia to be comparable to melanomas. In our case, loss of p16 expression in the melanoma distinguished it from the nevus cells and was helpful in making the correct diagnosis. Clinical information, such as the patient's age, was also useful in establishing the diagnosis.
Dyslipidemia in Dialysis Patients
Authors: Qunibi Wajeh Y.
Published: April 2015

Dyslipidemia is a well‐established traditional risk factor for cardiovascular events in the general population, particularly those with preexisting cardiovascular disease (CVD). In this population, reductions in total and low density lipoprotein cholesterol (LDL‐C) levels are effective in reducing coronary artery events and mortality. Dyslipidemia is more common in patients with chronic kidney disease (CKD) and is believed to contribute to the high prevalence of CVD in these patients. To date, the treatment of dyslipidemia in patients with CKD followed the guidelines recommended by the US National Cholesterol Education Program Adult Treatment Panel III (ATP III) for the treatment of lipid abnormalities. These guidelines recommend that initiation of lipid‐lowering therapy be based on LDL‐C level and the projected 10‐year risk for coronary artery disease (CAD). However, we now recognize that the relationship between serum cholesterol and CVD is more complex in patients with CKD, particularly those receiving maintenance hemodialysis. This has been demonstrated by the failure of three large randomized clinical trials to show a beneficial effect of lipid‐lowering therapy in reducing mortality in dialysis patients despite significant reduction in LDL‐C levels. These results have caused uncertainty among nephrologists about how best to manage dyslipidemia in their patients. In this review, the role of dyslipidemia as a risk factor for atherosclerosis in ESRD patients and the results of the 3 clinical trials and other studies, including their limitations will be discussed, and a schema for treating dyslipidemia in dialysis patients will be proposed.
The Chronic Kidney Disease—Colonic Axis
Authors: Pahl Madeleine V. , Vaziri Nosratola D.
Published: April 2015

Chronic kidney disease (CKD) has long been known to cause significant gastrointestinal and colonic pathology. Recent advances in understanding of the role of colonic bacterial microbiome and its function and composition in health and disease have revealed previously unappreciated effects of CKD‐associated colonic pathology on the development of uremic complications. CKD can result in profound changes in the microbiome composition and biosynthetic pattern, and the structure and function of the colon. Increases in bacteria that produce urease, uricase, p‐cresol‐ and indole‐forming enzymes and the depletion of bacteria that possess short chain fatty acid forming enzymes have been described in human and animal models. Disruption of the colonic epithelial tight junction in different animal models of CKD has been reported and is largely due to the conversion of luminal urea to ammonia by urease possessing bacteria. Together, these changes contribute to the pathogenesis of systemic inflammation and uremic toxicity by allowing the translocation of endotoxin and microbial fragments into the circulation. Additionally, colonic bacteria are the main source of several well‐known pro‐inflammatory uremic toxins such as indoxyl sulfate, P‐cresol sulfate. This review is intended to provide an overview of the effects of CKD on the colonic microbiome and the intestinal epithelial barrier structure and function and their role in the pathogenesis the systemic inflammation and uremic toxicity.
An Objective Bayesian Criterion to Determine Model Prior Probabilities
Authors: Villa Cristiano , Walker Stephen
Published: April 2015

We discuss the problem of selecting among alternative parametric models within the Bayesian framework. For model selection problems, which involve non‐nested models, the common objective choice of a prior on the model space is the uniform distribution. The same applies to situations where the models are nested. It is our contention that assigning equal prior probability to each model is over simplistic. Consequently, we introduce a novel approach to objectively determine model prior probabilities, conditionally, on the choice of priors for the parameters of the models. The idea is based on the notion of theworthof having each model within the selection process. At the heart of the procedure is the measure of thisworthusing the Kullback–Leibler divergence between densities from different models.
Detection of bacterial contamination in apheresis platelets: is apheresis technology a factor?
Authors: Bravo Marjorie , Shaz Beth H. , Kamel Hany , Vanderpool Sandra , Tomasulo Peter , Custer Brian , Townsend Mary
Published: April 2015

BACKGROUND

Apheresis platelet (AP) contamination may be influenced by manufacturing methods because bacteria are subject to the same forces that permit separation of blood cells. This study assesses whether apheresis technology influences in‐process detection of bacterial contamination.

STUDY DESIGN AND METHODS

Blood Systems, Inc. (BSI) and New York Blood Center (NYBC) use Amicus and Trima devices to collect APs. Manufacturing (arm disinfection and in‐line diversion) was consistent for both devices in the study period. Detection was performed using BacT/ALERT. True‐positive (TP) rates were calculated and significance testing was performed using chi‐square tests separately for BSI and NYBC. For BSI, multivariable logistic regression analysis was also performed to identify factors associated with TP results.

RESULTS

For BSI, there were 49 TPs in 354,946 donations (1.4/10,000): 2.5 per 10,000 for Amicus and 1.0 per 10,000 for Trima (p < 0.05). Multivariable logistic regression analysis showed significant association between TP and devices (odds ratio, 2.8; 95% confidence interval [CI], 1.01‐8.0) and for one collection region. For NYBC, there were 18 TPs in 161,840 donations (1.1/10,000): 2.1 per 10,000 for Amicus and 0.4 per 10,000 for Trima (p < 0.05).

CONCLUSIONS

The TP rate was significantly higher in Amicus collections than in Trima collections at NYBC and BSI. These results do not allow for conclusions regarding the relative clinical risk of PLTs collected by Amicus and Trima. Future evaluations of component quality and clinical outcomes should consider different collection technologies.