bluuebunny/crossref_metadata_2025 huggingface dataset:
Synergy between 5‐HT4 receptor stimulation and phosphodiesterase 4 inhibition in facilitating acetylcholine release in human large intestinal circular muscle
Authors: Pauwelyn V. , Ceelen W. , Lefebvre R. A.
Published: August 2017

Background

Gastroprokinetic properties of 5‐HT4 receptor agonists, such as prucalopride, are attributed to activation of 5‐HT4 receptors on cholinergic nerves innervating smooth muscle in the gastrointestinal smooth muscle layer, increasing acetylcholine release and muscle contraction. In porcine stomach and colon, phosphodiesterase (PDE) 4 has been shown to control the signaling pathway of these 5‐HT4 receptors. The aim of this study was to investigate the PDE‐mediated control of these 5‐HT4 receptors in human large intestine.

Methods

Circular smooth muscle strips were prepared from human large intestine; after incubation with [³H]‐choline, electrically induced tritium outflow was determined as a measure for acetylcholine release. The influence of PDE inhibition on the facilitating effect of prucalopride on electrically induced acetylcholine release was studied.

Key Results

The non‐selective PDE inhibitor IBMX enhanced the facilitating effect of prucalopride on electrically induced acetylcholine release. The selective inhibitors vinpocetine (PDE1), EHNA (PDE2) and cilostamide (PDE3) did not influence, while rolipram and roflumilast (PDE4) enhanced the prucalopride‐induced facilitation to the same extent as IBMX.

Conclusions & Inferences

In human large intestinal circular muscle, the intracellular pathway of 5‐HT4 receptors facilitating cholinergic neurotransmission to large intestinal circular smooth muscle is controlled by PDE4. If the synergy between 5‐HT4 receptor agonism and PDE4 inhibition is confirmed in a functional assay with electrically induced cholinergic contractions of human large intestinal circular smooth muscle strips, combination of a selective 5‐HT4 receptor agonist with a selective PDE4 inhibitor might enhance the in vivo prokinetic effect of the 5‐HT4 receptor agonist in the large intestine.
A comparative study on the therapeutic effect of TRPV1, TRPA1, and TRPM8 agonists on swallowing dysfunction associated with aging and neurological diseases
Authors: Alvarez‐Berdugo D. , Rofes L. , Arreola V. , Martin A. , Molina L. , Clavé P.
Published: August 2017

Background

Oropharyngeal sensory impairment is a potential target to treat swallowing dysfunction in patients with oropharyngeal dysphagia (OD).

Aim

To assess the therapeutic effect of stimulating oropharyngeal sensory afferents with TRPV1, TRPA1, or TRPM8 agonists vs increasing bolus viscosity in older and neurologic patients with OD by comparing four studies of similar experimental design.

Methods

Swallow function of 142 older patients with impaired safety of swallow at nectar ([50‐350] mPa·s) viscosity was evaluated with videofluoroscopy (VFS) while treated with TRPV1 (150 μmol/L), TRPV1/A1 (150 μmol/L and 1 mmol/L), or TRPM8 (1 mmol/L or 10 mmol/L) agonists or modified starch (MS) at spoon thick viscosity (>1750 mPa·s).

Results

TRPV1 stimulation with capsaicinoids reduced penetrations by 50%, pharyngeal residue by 80%, and LVC time by 24.38% and increased bolus velocity by 36.51%. TRPV1/A1 stimulation with piperine reduced penetrations by 56.32%, LVC time by 25.55% and increased bolus velocity by 23.63%. TRPM8 stimulation with menthol 1 mmol/L reduced penetrations by 37.5% while 10 mmol/L reduced LVC time by 18.44%. Thickeners reduced penetrations by 77.11%, but increased pharyngeal residue by 19.89%, delayed LVC by 41.73%, and reduced bolus velocity by 13.44%.

Conclusion

Natural capsaicinoids have a stronger therapeutic effect on VFS signs and swallow response by stimulating TRPV1 than TRPV1/A1 or TRPM8 agonists. While TRP stimulants increased bolus velocity and reduced swallow response times, thickeners reduced bolus velocity and further delayed the swallow response. This study sets the bases to develop new pharmacologic strategies for older patients with OD, moving away from compensation toward the recovery of swallow function.
Inaccuracy of patient‐reported descriptions of and satisfaction with bowel actions in irritable bowel syndrome
Authors: Halmos E. P. , Biesiekierski J. R. , Newnham E. D. , Burgell R. E. , Muir J. G. , Gibson P. R.
Published: August 2017

Background

Perception of diarrhea and constipation differs greatly. This study aimed to correlate subjective and objective assessment of fecal characteristics in irritable bowel syndrome (IBS) patients.

Methods

Data from two interventional dietary trials with varying FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) or gluten content were interrogated. Subjects rated their dissatisfaction with stool consistency daily using a visual analog scale during the interventions. Subjects collected stools at the end of each intervention. Each stool was scored according to the King's Stool Chart (KSC). Fecal water content (FWC) was measured on pooled feces by freeze drying, with diarrhea defined as ≥78%.

Key Results

Seventy IBS (Rome III) and eight healthy subjects were studied. Each subject's self‐rating of stool consistency during the most symptomatic diet was approximately double that of their least. Degree of dissatisfaction with stool consistency correlated poorly with changes in FWC and KSC. IBS subtype related poorly to objective measures of stool consistency. Sixty percent of IBS‐D subjects had diarrhea on objective measures. Eighty‐five percent with IBS‐C had hard and formed stools but three patients met the criteria for diarrhea. One healthy subject had diarrhea on FWC and KSC, and six had hard, formed stools. No differences in FWC was observed when subjects consumed differing amounts of FODMAPs or gluten (all P > .200).

Conclusions and Inferences

There are major disparities between patients’ stool descriptions and objective features of constipation and diarrhea. Patient‐reported bowel habits require more interrogation for accurate IBS subtyping. Varying FODMAP or gluten content of the diet is not associated with consistent change in FWC.
Correlation of lanthanum dosage with lanthanum deposition in the gastroduodenal mucosa of dialysis patients
Authors: Hattori Kimiaki , Maeda Tamaki , Nishida Shinya , Imanishi Miyuki , Sakaguchi Masahiro , Amari Yoshifumi , Moriya Takuya , Hirose Yoshinobu
Published: August 2017

Lanthanum (La) deposition has been observed in gastrointestinal mucosa of dialysis patients treated with La carbonate to treat hyperphosphatemia in the 6 years since its authorization in Japan. We investigated gastrointestinal biopsies from 112 dialysis patients, and found 15 cases of histiocytic aggregation with crystalloids and one case of duodenitis with histiocyte aggregation without crystalloids in the 30 patients treated with La carbonate. No histiocytic lesions were observed in the 82 patients without La carbonate administration. So far in total 70 cases of La deposition in the alimentary tract have been reported, including our 16 cases. Neither clinical nor histological findings other than histiocytic aggregation were specific in the patients with La deposition. We also compared the groups with and without La deposition, revealing that the daily and total doses of La carbonate showed statistically significant correlations with La deposition. However the causality with their histologic features, e.g. intestinal metaplasia and degree of inflammation, were inconclusive between the two groups. Although no critical symptoms have been reported, it is necessary to accumulate more cases to clarify the mechanism of La deposition, because dialysis patients must take phosphate buffers for a long period.
Convergent or Divergent? The Hidden Dynamics of Institutional Changes in the Labor Markets and Social Welfare Systems in South Korea and Japan
Authors: Cho Sungik , Choi Yool
Published: August 2017

Dualization explains analogous changes in South Korea and Japan like labor market segmentation and the expansion of social protection for nonstandard workers. This study argues, however, that their institutional structures and underlying dynamics of dualization are more different than they appear, where the subcontracting relations between big businesses and their suppliers come into play. The co‐operative interfirm relations in Japan become a buffer with which firms incrementally adjust to a coupled dualization in the labor market and social welfare system. Thus, Japanese nonstandard workers excluded from the social insurance system exist because of the formally segmented structures of labor markets and social welfare programs. By contrast, the exploitative subcontracting relations in South Korea intensify labor market segmentation and undermine government regulation of labor and social welfare, leading to a decoupled dualization. Those in South Korea persist despite the formally inclusive and unified structures of social welfare programs.

Related Articles

Luckhurst,Jonathan.2012.“.”Politics & Policy40():958‐977.http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2012.00386.x/abstract

Wagle,Udaya R.2013.“.”Politics & Policy41():947‐984.http://onlinelibrary.wiley.com/doi/10.1111/polp.12053/full

Luccisano,Lucy, andAmyRomagnoli.2007. “”Politics & Policy35():716‐751.http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2007.00082.x/abstract

Related Media

Miyamoto,Hiroaki.2016. “.”East Asia Forum.December 23.http://www.eastasiaforum.org/2016/12/23/reforming-japans-dual-labour-market/

Park,S. Nathan.2015. “.”The Wall Street Journal.February 25.https://blogs.wsj.com/korearealtime/2015/02/25/south-koreas-labor-market-reform-struggles/
Frailty in nursing home residents: a scoping review protocol
Authors: De Silva Thanuja , Ahip Sally , Theou Olga , Tufanaru Catalin , Visvanathan Renuka , Umapathysivam Kandiah
Published: August 2017

Objectives and Review questions:

The overall research objective of this scoping review is to determine the current evidence on frailty in nursing homes.

The objectives of the scoping review are to map the following, as reported in international literature:

Fraily tools used in studies on nursing home residents.

Prevalence of frailty in nursing home residents.

Geriatric syndromes (e.g. cognitive impairment, delirium, depression, falls, incontinence, malnutrition and dizziness) associated with frailty in nursing home residents.

Other types of adverse outcomes related to frailty reported.

Diverse treatment modalities of frailty in nursing home residents.

The questions for the scoping review are:

What frailty diagnostic tools have been reported in international literature that have been used in studies on nursing home residents?

What prevalence rates of frailty in nursing home residents have been reported in the literature?

What types of geriatric syndromes have been reported in the literature as being associated with frailty?

What other types of adverse outcomes related to frailty have been reported in the literature?

What treatment modalities for frailty have been reported in the literature?
Textual synthesis of policies and guidance statements for remote healthcare practitioners on managing medical emergencies in the oil and gas industry: a systematic review protocol
Authors: Osakwe Kennedy A. , Cooper Kay , Stewart Derek , Wainwright Cherry L. , Klein Susan
Published: August 2017

Review question/objective:

: The objective of this review is to collate, synthesize and present the available evidence on the policies and guidance statements for remote healthcare practitioners on managing medical emergencies in the offshore oil and gas industry.

More specifically, the review seeks to answer the following questions:

How is the derivation of these policies and guidance statements described?

What is the content and areas of similarity and difference of the policies and guidance statements?

What emphasis is placed on the implementation and evaluation within the policies and guidance statements?
Instruments for measuring undergraduate nursing students’ knowledge, attitudes and skills in evidence-based practice: a systematic review protocol
Authors: Cardoso Daniela , Santos Eduardo , Cardoso Maria L. , Oliveira Catarina R. , Rodrigues Manuel A. , Apóstolo João
Published: August 2017

Review question/objective:

: The objective of this systematic review is to identify and assess the properties of instruments for measuring undergraduate nursing students’ knowledge, attitudes and skills in evidence-based practice (EBP).

More specifically, the review questions are as follows:

What are the measurement properties of the available instruments for measuring undergraduate nursing students’ knowledge, attitudes and skills in EBP?

What is the most valid and reliable instrument for measuring undergraduate nursing students’ knowledge, attitudes and skills in EBP?
Draft Genome Sequence of Mycobacterium avium 11
Authors: Yee Michelle , Klinzing David , Wei Jun-Rong , Gengenbacher Martin , Rubin Eric J. , Chien Jung-Yien , Hsueh Po-Ren , Dick Thomas
Published: August 2017

Mycobacterium avium
accounts for most lung disease caused by nontuberculous mycobacteria (NTM). The lack of effective chemotherapy calls for the discovery of new drugs. Here, we report the draft genome sequence of
M. avium
11, a clinical isolate used as a screening strain for NTM-focused drug discovery.
Draft Genome Sequences of Yersinia frederiksenii, Yersinia intermedia, and Yersinia kristensenii Strains from Brazil
Authors: Imori Priscilla Fernanda Martins , Campioni Fábio , Cao Guojie , Kastanis George , Leon Maria Sanchez , Allard Marc William , Falcão Juliana Pfrimer
Published: August 2017

Yersinia enterocolitica-like strains are usually understudied. In this work, we reported the draft genome sequences of twoYersinia frederiksenii, twoYersinia intermedia, and twoYersinia kristenseniistrains isolated from humans, animals, food, and the environment in Brazil. These draft genomes will provide better molecular characterizations of these species.
Whole-Genome Sequence of
Starmerella bacillaris
PAS13, a Nonconventional Enological Yeast with Antifungal Activity
Authors: Lemos Junior Wilson José Fernandes , Treu Laura , da Silva Duarte Vinícius , Carlot Milena , Nadai Chiara , Campanaro Stefano , Giacomini Alessio , Corich Viviana
Published: August 2017

Starmerella bacillaris
is a fermentative yeast commonly found in vineyards. Here, we present the draft genome sequence of
S. bacillaris
PAS13, a nonconventional enological yeast with a potential role as a biocontrol agent. This gene sequence will provide insights into the genetic basis of yeast activity against gray mold disease (
Botrytis cinerea
).
Genome Sequence of
Oceanicola
sp. Strain MCTG156(1a), Isolated from a Scottish Coastal Phytoplankton Net Sample
Authors: Gutierrez Tony , Whitman William B. , Huntemann Marcel , Copeland Alex , Chen Amy , Vargese Neha , Kyrpides Nikos C. , Pillay Manoj , Ivanova Natalia , Mikhailova Natalia , Mukherjee Supratim , Stamatis Dimitrios , Reddy T. B. K. , Ngan Chew Yee , Chovatia Mansi , Daum Chris , Shapiro Nicole , Woyke Tanja
Published: August 2017

Oceanicola
sp. strain MCTG156(1a) was isolated from a phytoplankton net sample collected on the west coast of Scotland and selected based on its ability to degrade polycyclic aromatic hydrocarbons. Here, we present the genome sequence of this strain, which comprises 3,881,122 bp with 3,949 genes and an average G+C content of 62.7%.
Draft Genome Sequence of Thiohalobacter thiocyanaticus Strain FOKN1, a Neutrophilic Halophile Capable of Thiocyanate Degradation
Authors: Oshiki Mamoru , Fukushima Toshikazu , Kawano Shuichi , Nakagawa Junichi
Published: August 2017

A draft genome sequence of a neutrophilic halophile capable of thiocyanate degradation,
Thiohalobacter thiocyanaticus
FOKN1, was determined using a PacBio RSII sequencer. A 3.23-Mb circular genome sequence was assembled, in which 3,026 gene-coding sequences, 45 tRNAs, and 1
rrn
operon were annotated.
Complete Genome Sequence of Anoxybacillus flavithermus Strain 52-1A Isolated from a Heat-Processed Powdered Milk Concentrate
Authors: Tasara Taurai , Morach Marina , Klumpp Jochen , Stephan Roger
Published: August 2017

The thermophilic spore-forming bacterium
Anoxybacillus flavithermus
is responsible for powdered milk product spoilage, and its presence in dairy processing environments is a concern. Here, the complete genome sequence of the
A. flavithermus
strain 52-1A isolated from a heat-processed powdered milk product concentrate in Switzerland is presented.
Massive ascites, pelvic mass, elevated CA-125 and weight loss: think outside the 'ovaries'
Authors: Musleh Jehan Khalid Mohammed , Almulhem Mohammed , Al Qahtani Nourah Hasan
Published: August 2017

A 44-year-old woman presented with 3 months’ history of painless progressive abdominal distension and weight loss of more than 15 kg. Clinically a pelviabdominal mass with ascites was detected. CT scan of the pelvis and abdomen showed a subserosal leiomyoma with huge amount of ascites. Cancer Antigen (CA)-125 was 546 kU/L. Exploratory laparotomy with myomectomy was done and this was followed by dramatic improvement postoperatively.
Portal vein aneurysm in thalassaemia
Authors: Das Simi , Dey Mousam , Kumar Vinay , Lal Hira
Published: August 2017

Arterial aneurysms are more common than visceral venous aneurysms. Portal vein aneurysms being the most common type of visceral venous aneurysms. Here, we present an 18-year-old young woman with thalassaemia major, who presented with headache, palpitation, shortness of breath and a recent increase in blood transfusion rate. On clinical examination, she had hepatosplenomegaly. Ultrasonography revealed hepatosplenomegaly with fusiform dilatation of extrahepatic portal vein, which was confirmed to be portal vein aneurysm on contrast enhanced CT. Though portal vein aneurysms were previously thought to be rare, recently they are increasingly diagnosed with the use of cross-sectional imaging. Recognition of this finding can help to avoid potential confusion with other periportal cystic masses of different aetiologies, especially on sonography.
Therapeutic options for bleeding oesophageal varices: cyanoacrylate and balloon-occluded retrograde obliteration (BRTO)
Authors: Frischtak Helena L , Davis Jessica P , Shah Neeral L
Published: August 2017

A 56-year-old male with cirrhosis presented with acute bleeding from cardiofundal gastroesophageal varices (GOV) and was treated with endoscopic cyanoacrylate glue. Glue therapy achieved stabilisation of the patient in the emergent setting. Three months later, the patient suffered rebleeding. At that time, he underwent retreatment with balloon-occluded retrograde obliteration (BRTO), with no recurrence at a follow-up of 14 months.

Available treatments for bleeding GOV include methods to (a) directly obstruct the varices (endoscopic variceal ligation , sclerotherapy and cyanoacrylate glue, BRTO) or to (b) decrease portal pressure (surgical portacaval shunts; transportal intrahepatic portosystemic shunt). No precise guidelines are available regarding when to use which modality, and few centres have experience with all of them. This case report illustrates a setting in which both options of cyanoacrylate glue therapy and BRTO were used for acute gastric variceal bleeding.
Postcardiac injury syndrome and stroke following permanent pacemaker insertion
Authors: Bialy Caitlin , Wee Edmund , Uddin Nizam
Published: August 2017

An 80-year-old woman initially presented with an episode of pleuritic chest pain 10 days after implantation of a dual chamber permanent pacemaker. She returned to hospital a day later with vomiting and fever. She was found to have new atrial fibrillation in addition to right-sided weakness and dysarthria. An infarct in the left anterior inferior cerebellar artery territory was later confirmed on CT. She continued to have recurrent febrile episodes associated with vomiting and dyspnoea. Extensive investigations for infection were negative, and her symptoms were initially attributed to aspiration pneumonia. The patient gradually deteriorated despite antibiotics and became progressively short of breath, with development of large pleural and pericardial effusions. A diagnosis of postcardiac injury syndrome was made after exclusion of other differentials. The patient recovered well after pleurocentesis, pericardiocentesis and a pericardial window, with resolution of symptoms without further medical therapy.
The information problem in global health
Authors: Abimbola Seye
Published: August 2017

Watch the related video:http://bcove.video/2pcyqUy
Severe dysphagia requiring gastrostomy following cervical spine fracture fixation
Authors: Bailey Joanelle A , Lavery Robert F , Adams John M , Livingston Andrew S , DiFazio Lou , Livingston David H
Published: August 2017

Background

The incidence of severe dysphagia requiring gastrostomy tube (GT) placement following operative fixation of traumatic cervical spine fractures is unknown. Risk factors for severe dysphagia are not well identified and GT placement is often delayed due to the belief that it will resolve quickly. We hypothesized that patient and clinical factors could be used to predict severe dysphagia requiring GT placement in this population.

Methods

A retrospective multicenter review of all adult patients requiring operative fixation of cervical spine fractures was performed. Data on demographics, injury severity score, presence of spinal cord injury, operative approach, presence of severe traumatic brain injury, and the need and timing of tracheostomy and GT were collected. The timing, number and results of formal speech, and language pathology examinations were also recorded.

Results

243 patients underwent cervical spine fixation for traumatic fractures, of which 72 (30%) required GT placement. Patients requiring gastrostomy were significantly older, 54 versus 45 years (p=0.002), and had higher injury severity scores at 24 versus 18 (p<0.0001). Tracheostomy was strongly associated with severe dysphagia; GT was required in 83% of patients who underwent tracheostomy versus 5% of those who did not require tracheostomy. 50% of patients underwent tracheostomy and GT on the same day after injury, with the remaining patients having an average of 9 days delay between procedures. The need for gastrostomy placement was also higher in patients undergoing combined operative approach versus anterior or posterior approach alone (p=0.02). There were no GT-related complications.

Conclusions

Severe dysphagia requiring GT placement occurs commonly (30%) in patients who undergo operative fixation of cervical spine fractures. Gastrostomy placement was delayed in 50%. Tracheostomy was strongly associated with the need for GT placement. Earlier GT placement, especially in patients requiring tracheostomy, would improve patient care and disposition.
Fellowship training in Acute Care Surgery: from inception to current state
Authors: Davis Kimberly A , Jurkovich Gregory J
Published: August 2017

Recognizing the need for urgent and emergent surgical care across America, the American Association for the Surgery of Trauma developed and implemented, and oversees, the Acute Care Surgery Fellowship Training Program. Now in its 10th year, the fellowship has become an established post-General Surgery Fellowship Training Program, with 20 approved programs and 82 fellows trained. Consistent with the desire to have this non-Accreditation Council for Graduate Medical Education (ACGME) fellowship one with the highest standards, several educational improvements have occurred since its origin. The following is an account of the background and evolution of what has become a significant educational contribution to surgery.
Why scalar–tensor equivalent theories are not physically equivalent?
Authors: Sk Nayem , Sanyal Abhik Kumar
Published: August 2017

Whether Jordan’s and Einstein’s frame descriptions of [Formula: see text] theory of gravity are physically equivalent, is a long standing debate. However, practically none questioned on true mathematical equivalence, since classical field equations may be translated from one frame to the other following a transformation relation. Here, we show that, neither Noether symmetries, Noether equations, nor may quantum equations be translated from one to the other. The reason being, — conformal transformation results in a completely different system, with a different Lagrangian. Field equations match only due to the presence of diffeomorphic invariance. Unless a symmetry generator is found which involves Hamiltonian constraint equation, mathematical equivalence between the two frames appears to be vulnerable. In any case, in quantum domain, mathematical and therefore physical equivalence cannot be established.
The Tangible Desktop
Authors: Baldwin Mark S. , Hayes Gillian R. , Haimson Oliver L. , Mankoff Jennifer , Hudson Scott E.
Published: August 2017

Audio-only interfaces, facilitated through text-to-speech screen reading software, have been the primary mode of computer interaction for blind and low-vision computer users for more than four decades. During this time, the advances that have made visual interfaces faster and easier to use, from direct manipulation to skeuomorphic design, have not been paralleled in nonvisual computing environments. The screen reader–dependent community is left with no alternatives to engage with our rapidly advancing technological infrastructure. In this article, we describe our efforts to understand the problems that exist with audio-only interfaces. Based on observing screen reader use for 4 months at a computer training school for blind and low-vision adults, we identify three problem areas within audio-only interfaces: ephemerality, linear interaction, and unidirectional communication. We then evaluated a multimodal approach to computer interaction called the Tangible Desktop that addresses these problems by moving semantic information from the auditory to the tactile channel. Our evaluation demonstrated that among novice screen reader users, Tangible Desktop improved task completion times by an average of 6 minutes when compared to traditional audio-only computer systems.
Energy-Efficiency Comparison of Multi-Layer Deposited Nanophotonic Crossbar Interconnects
Authors: Li Hui , Beux Sébastien Le , Sepulveda Martha Johanna , O'connor Ian
Published: August 2017

Single-layer optical crossbar interconnections based on Wavelength Division Multiplexing stand among other nanophotonic interconnects because of their low latency and low power. However, such architectures suffer from a poor scalability due to losses induced by long propagation distances on waveguides and waveguide crossings. Multi-layer deposited silicon technology allows the stacking of optical layers that are connected by means of Optical Vertical Couplers. This allows significant reduction in the optical losses, which contributes to improve the interconnect scalability but also leads to new challenges related to network designs and layouts. In this article, we investigate the design of optical crossbars using multi-layer silicon deposited technology. We propose implementations for Ring-, Matrix-, λ-router-, and Snake-based topologies. Layouts avoiding waveguide crossings are compared to those minimizing the waveguide length according to worst-case and average losses. The laser output power is estimated from the losses, which allows us to evaluate the energy efficiency improvement induced by multi-layer technology over traditional planar implementations (33% on average). Finally, networks comparison has been carried out and the results show that the ring topology leads to a 43% reduction in the laser output power.
Why writing short sentences may be short-changing your reader
Authors: Yaffe Philip
Published: August 2017

Each "Communication Corner" essay is self-contained; however, they build on each other. For best results, before reading this essay and doing the exercise, go to the first essay "How an Ugly Duckling Became a Swan," then read each succeeding essay.
Unipolar Endocardial Voltage Mapping in the Right Ventricle
Authors: Venlet Jeroen , Piers Sebastiaan R.D. , Kapel Gijsbert F.L. , de Riva Marta , Pauli Philippe F.G. , van der Geest Rob J. , Zeppenfeld Katja
Published: August 2017

Background—

Low endocardial unipolar voltage (UV) at sites with normal bipolar voltage (BV) may indicate epicardial scar. Currently applied UV cutoff values are based on studies that lacked epicardial fat information. This study aimed to define endocardial UV cutoff values using computed tomography–derived fat information and to analyze their clinical value for right ventricular substrate delineation.

Methods and Results—

Thirty-three patients (50±14 years; 79% men) underwent combined endocardial–epicardial right ventricular electroanatomical mapping and ablation of right ventricular scar–related ventricular tachycardia with computed tomographic image integration, including computed tomography–derived fat thickness. Of 6889 endocardial–epicardial mapping point pairs, 547 (8%) pairs with distance <10 mm and fat thickness <1.0 mm were analyzed for voltage and abnormal (fragmented/late potential) electrogram characteristics. At sites with endocardial BV >1.50 mV, the optimal endocardial UV cutoff for identification of epicardial BV <1.50 mV was 3.9 mV (area under the curve, 0.75; sensitivity, 60%; specificity, 79%) and cutoff for identification of abnormal epicardial electrogram was 3.7 mV (area under the curve, 0.88; sensitivity, 100%; specificity, 67%). The majority of abnormal electrograms (130 of 151) were associated with transmural scar. Eighty-six percent of abnormal epicardial electrograms had corresponding endocardial sites with BV <1.50 mV, and the remaining could be identified by corresponding low endocardial UV <3.7 mV.

Conclusions—

For identification of epicardial right ventricular scar, an endocardial UV cutoff value of 3.9 mV is more accurate than previously reported cutoff values. Although the majority of epicardial abnormal electrograms are associated with transmural scar with low endocardial BV, the additional use of endocardial UV at normal BV sites improves the diagnostic accuracy resulting in identification of all epicardial abnormal electrograms at sites with <1.0 mm fat.
Fabry Disease in Families With Hypertrophic Cardiomyopathy
Authors: Adalsteinsdottir Berglind , Palsson Runolfur , Desnick Robert J. , Gardarsdottir Marianna , Teekakirikul Polakit , Maron Martin , Appelbaum Evan , Neisius Ulf , Maron Barry J. , Burke Michael A. , Chen Brenden , Pagant Silvere , Madsen Christoffer V. , Danielsen Ragnar , Arngrimsson Reynir , Feldt-Rasmussen Ulla , Seidman Jonathan G. , Seidman Christine E. , Gunnarsson Gunnar Th.
Published: August 2017

Background—

The screening of Icelandic patients clinically diagnosed with hypertrophic cardiomyopathy resulted in identification of 8 individuals from 2 families with X-linked Fabry disease (FD) caused by
GLA
(α-galactosidase A gene) mutations encoding p.D322E (family A) or p.I232T (family B).

Methods and Results—

Familial screening of at-risk relatives identified mutations in 16 family A members (8 men and 8 heterozygotes) and 25 family B members (10 men and 15 heterozygotes). Clinical assessments, α-galactosidase A (α-GalA) activities, glycosphingolipid substrate levels, and in vitro mutation expression were used to categorize p.D322E as a classic FD mutation and p.I232T as a later-onset FD mutation. In vitro expression revealed that p.D322E and p.I232T had α-GalA activities of 1.4% and 14.9% of the mean wild-type activity, respectively. Family A men had markedly decreased α-GalA activity and childhood-onset classic manifestations, except for angiokeratoma and cornea verticillata. Family B men had residual α-GalA activity and developed FD manifestations in adulthood. Despite these differences, all family A and family B men >30 years of age had left ventricular hypertrophy, which was mainly asymmetrical, and had similar late gadolinium enhancement patterns. Ischemic stroke and severe white matter lesions were more frequent among family A men, but neither family A nor family B men had overt renal disease. Family A and family B heterozygotes had less severe or no clinical manifestations.

Conclusions—

Men with classic or later-onset FD caused by
GLA
missense mutations developed prominent and similar cardiovascular disease at similar ages, despite markedly different α-GalA activities.
What is “Discipline” in the Age of Children’s Rights?
Authors: Durrant Joan E. , Stewart-Tufescu Ashley
Published: August 2017

While the word “discipline” has come to connote control, punishment and obedience, its historic roots are in notions of learning, understanding and gaining knowledge. We trace concepts of discipline through time – from extreme violence to behaviourism to constructivism to relational neuroscience – and arrive at a reframing of discipline as a process of optimising children’s understanding and fostering their evolving capacities to actualise their rights. Drawing on the Convention on the Rights of the Child, we set out a framework for rights-based discipline that is founded on five principles: (1) non-violence; (2) respect for children’s evolving capacities; (3) respect for children’s individuality; (4) engagement of children’s participation; and (5) respect for children’s dignity. We provide examples of evidence-based approaches that implement these principles. Finally, we call for the reclaiming and restoration of the true meaning of “discipline” in order that all children may thrive.
Pointers
Authors: Simons Peter
Published: August 2017

Reference can fail in a way that intentionality cannot. Though the stream of phenomenal experience typically does not fail to target (be about, refer to) objects outside, it may do. How does the mind go about targeting objects beyond itself? The speculative conjecture of this paper is that it does so by a type of process which can be called pointing, and that the acts or act-aspects of pointing can be called pointers. The notion of a pointer has several suggestive roots. One is the familiar physical gesture of pointing. Another is the existence of directional signs such as on roads. The third is the software data types making direct reference to memory locations in computers, also called ‘pointers’. A final source is demonstrative pronouns and other deictic expressions in language, of which Peter Geach wrote, “a demonstrative pronoun … works like a pointer, not like a label”. I suggest that there is in the mental cognitive repertoire a structurally and semantically analogous type of act which pierces the passivity of perception, directs us outside the machine, and prepares the way for drawing others’ minds to the same thing.
Motivation and Horizon
Authors: Walsh Philip J.
Published: August 2017

This paper argues for a Husserlian account of phenomenal intentionality. Experience is intentional insofar as it presents a mind-independent, objective world. Its doing so is a matter of the way it hangs together, its having a certain structure. But in order for the intentionality in question to be properly understood as phenomenal intentionality, this structure must inhere in experience as a phenomenal feature. Husserl’s concept of horizon designates this intentionality-bestowing experiential structure, while his concept of motivation designates the unique phenomenal character of this structure as it is experientially lived through. The way experience hangs together is itself a phenomenal feature of experience.
A new species of shrimp of the genus Periclimenaeus Borradaile, 1915 (Decapoda: Caridea: Palaemonidae) from the southeastern Gulf of Mexico, including a key to the western Atlantic species of the genus
Authors: RAMOS-TAFUR GABRIEL E. , LEMAITRE RAFAEL
Published: August 2017

A new species of symbiotic palaemonid shrimp, Periclimenaeus mcmichaeli sp. nov., is described based on a single male specimen collected near Dry Tortugas, Florida, in the southeastern Gulf of Mexico. This new species, the 14th now known for the genus Periclimenaeus Borradaile 1915 from the western Atlantic, is morphologically most similar to P. wilsoni (Hay, 1917), from which it can be separated by the presence in the new species of two small subdistal teeth on the ventral margin of the rostrum, absence of small spinules or tubercles on ventral margin of the meri of the major and minor chelipeds, presence of three teeth on the cutting edge of the dactylus of the minor chela, and position of dorsal spines on the telson. The presence in this new species of a prominent acute projection on each pleurae of the third and fourth somite is documented, and appears to be a character previously overlooked in the taxonomic literature of species of the genus. This new species is compared with other similar congeners from the western Atlantic as well as other oceanic regions. An updated diagnosis for P. wilsoni, and a key to identify the western Atlantic species of the genus, are also presented.
Health-Illness Transition Experiences With Type 2 Diabetes Self-management of Sub-Saharan African Immigrants in the United States
Authors: Kindarara Désiré M. , McEwen Marylyn M. , Crist Janice D. , Loescher Lois J.
Published: August 2017

Purpose

The purpose of this study was to describe Sub-Saharan African immigrants’ health-illness transition experiences associated with type 2 diabetes mellitus (T2DM) self-management.

Methods

A qualitative description methodology was used in this study. Face-to-face semi-structured in-depth interviews lasting 60 to 90 minutes were conducted with 10 Sub-Saharan African immigrant men and women with T2DM recruited using purposive and snowball sampling. Each interview was audio-taped, transcribed, and analyzed using qualitative content analysis.

Results

Participants’ mean age was 60.3 years (range, 44-76 years), 5 men and 5 women; most had lived in the US for more than 10 years (70%) and with T2DM for more than 5 years (60%). Four overarching domains described the health-illness transition experiences the participants had with T2DM self-management: (1) knowledge of T2DM self-management behaviors, (2) current T2DM self-management behaviors, (3) inhibitors of T2DM self-management, and (4) facilitators of T2DM self-management.

Conclusions

Health professionals should be equipped with an understanding of the properties and conditions of health-illness transition. This understanding is necessary to build a foundation that facilitates healthy adaptation to the T2DM transition requiring the development and mastery of new skills consistent with gaining control of T2DM. Culturally tailored interventions need to be developed to decrease inhibitors of and encourage self-management in daily T2DM care for Sub-Saharan African immigrants with T2DM.
Association Between the 7‐Day Moving Average for Nutrition and Growth in Very Low Birth Weight Infants
Authors: Falciglia Gustave H. , Murthy Karna , Holl Jane , Palac Hannah L. , Oumarbaeva Yuliya , Yadavalli Pratyusha , Woods Donna , Robinson Daniel T.
Published: August 2017

Background: Very low birth weight (VLBW) infants remain at risk for postnatal growth restriction. Clinicians may have difficulty identifying growth patterns resulting from nutrition interventions, impeding prompt management changes intended to increase growth velocity. This study aimed to quantify the association between growth and nutrition intake through 7‐day moving averages (SDMAs). Methods: The first 6 weeks of daily nutrition intake and growth measurements were collected from VLBW infants admitted to a level 4 neonatal intensive care unit (2011–2014). The association between SDMA for energy and macronutrients and subsequent 7‐day growth velocities for weight, length, and head circumference were determined using mixed effects linear regression. Analyses were adjusted for fluid intake, infant characteristics, and comorbid conditions. Results: Detailed enteral and parenteral caloric provisions were ascertained for 115 infants (n = 4643 patient‐days). Each 10‐kcal/kg/d increase over 7 days was independently associated with increased weight (1.7 g/kg/d), length (0.4 mm/wk), and head circumference (0.9 mm/wk; P < .001, for weight and head circumference; P = .041 for length). Each 1 g/kg/d macronutrient increase was also associated with increased weight (protein, P = .027; fat and carbohydrates, P < .001), increased length (fat, P = .032), and increased head circumference (fat and carbohydrates, P < .001). Conclusions: The SDMA identifies clinically meaningful associations among total energy, macronutrient dosing, and growth in VLBW infants. Whether SDMA is a clinically useful tool for providing clinicians with prompt feedback to improve growth warrants further attention.
The Clinical Use of a Fixed-Dose Combination of Insulin Degludec and Liraglutide (Xultophy 100/3.6) for the Treatment of Type 2 Diabetes
Authors: Harris Kira , Nealy Kimberly Lovin
Published: August 2017

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of the fixed-dose combination of insulin degludec and the glucagon-like peptide-I receptor agonist (GLP-1 RA), liraglutide (IDegLira) in the treatment of type 2 diabetes mellitus (T2DM). Data Sources: A PubMed and MEDLINE search (1966 to July 2017) of the keywords insulin degludec, liraglutide, and type 2 diabetes mellitus was conducted. References were reviewed to identify additional citations. Study Selection and Data Extraction: Articles written in English were included if they evaluated the pharmacokinetics, pharmacology, clinical efficacy, or safety of IDegLira in humans. Data Synthesis: IDegLira displayed pharmacokinetic and pharmacodynamic properties similar to that of the individual components. IDegLira has shown significant hemoglobin A1C (A1C) reductions of 1.3% to 1.9% and fasting plasma glucose reductions of 45 to 65 mg/dL when used in patients with T2DM previously receiving oral antihyperglycemic agents (AHAs), GLP-1 RAs, or basal insulin. Weight loss also occurred when IDegLira was started in patients previously receiving oral AHAs or basal insulin. Adverse effects (AEs) tended to be mild and transient. The most common AEs were headache, nasopharyngitis, upper-respiratory infections, and gastrointestinal disorders. Hypoglycemia risk was lower with IDegLira than basal insulin alone but higher than liraglutide alone. Conclusions: IDegLira may provide additional glycemic control with fewer AEs for patients uncontrolled on a GLP-RA or basal insulin alone. Additional studies evaluating use in patients on oral AHAs with higher A1C values and in comparison to bolus insulin are needed.
Effects of Chronic Antihypertensives on Vasopressor Dosing in Septic Shock
Authors: DeMott Joshua M. , Patel Gourang , Lat Ishaq
Published: August 2017

Background: In septic shock, chronic antihypertensive medications are held acutely. Vasopressors are often required to maintain blood pressure. The effect of chronic exposure to antihypertensive therapies on vasopressor dosing in septic shock is not known. Objective: To determine the effects of chronic exposure to antihypertensive therapies, specifically β-blockers and angiotensin-converting enzyme (ACE) inhibitors, on cumulative vasopressor dosing in septic shock. Methods: This was a retrospective cohort review, with data collected from routine care. Patients admitted to the medical intensive care unit with septic shock and vasopressor use were included and divided into 4 groups based on chronic medication use: (1) no β-blocker or ACE inhibitor, (2) β-blocker only, (3) ACE inhibitor only, and (4) β-blocker and ACE inhibitor. Cumulative vasopressor dose at 48 hours was assessed. Demographics, comorbid conditions, suspected site of infection, disease severity, mortality, and concomitant therapies were evaluated between groups. Results: A total of 133 patients with septic shock treated with vasopressors were included. No difference in cumulative vasopressor dose at 48 hours was detected between the 4 groups, respectively (median norepinephrine milligram equivalents [interquartile range (IQR)]: no β-blocker or ACE inhibitor, 13.7 mg [6.0-35.7]; β-blocker only, 13.1 mg [5.4-23.9]; ACE inhibitor only, 13.2 mg [1.2-36.7]; β-blocker and ACE inhibitor, 11.3 mg [4.7-42.9]; P = 0.669). Total time on vasopressors differed between groups (median hours [IQR]: no β-blocker or ACE inhibitor, 30h [17-60]; β-blocker only, 24h [10-69]; ACE inhibitor only, 19h [6-25]; β-blocker and ACE inhibitor, 30h [15-58]; P = 0.031). Comorbid conditions, suspected infection sites, disease severity, mortality, and concomitant therapies were similar. Conclusions: Chronic β-blocker, ACE inhibitor use, or the combination of both did not affect cumulative vasopressor dose at 48 hours in septic shock. However, prior-to-admission medications may affect total time of vasopressor use.
Standardizing Sustainable Development
Authors: Gallagher Kevin P. , Yuan Fei
Published: August 2017

There is a sense of urgency in emerging market and developing countries in general, and Latin America in particular, for international development banks to generate a pipeline of infrastructure projects in order to reboot lagging economies and to meet broader sustainable development goals. In meeting those goals, it is important to also ensure that such efforts are socially inclusive and environmentally sustainable. To draw lessons for this new wave of development finance, this article conducts a comparative analysis of social and environmental safeguards across international development banks. We find a significant divergence in safeguard policy across development banks operating in the region, with Western-backed development banks requiring that borrowers harmonize to developed country standards to others such as China's and Brazil’s banks deferring to host country standards. On the basis of this research, we develop a framework that allows analysts to better empirically examine the impact of different safeguard regimes on environment, social, and development outcomes.
Maternal Perspectives of Well Siblings’ Adjustment to Family Life With a Technology-Dependent Child
Authors: Toly Valerie Boebel , Blanchette Julia E. , Sikorski Shannon , Musil Carol M. , Al-Hamed Arwa
Published: August 2017

Technology-dependent (TD) children require complex care and are dependent on medical technology. Approximately 75% of families, in the United States, who are caring for a TD child, also care for a well child. Well siblings are likely to be affected by the experience of living with a TD sibling as the process of family normalization is described as a family affair. The experiences of well siblings are not well described. The purpose of this qualitative analysis was to describe the experiences of well siblings who are living in a family with a TD child. Mothers were interviewed about the experiences of their well children and were digitally audio recorded. The interviews were transcribed, and content analysis was conducted. Content analysis from the interviews revealed the major themes of well sibling adjustment within the family unit, upside (altruistic, prosocial behaviors) and downside (negative internal and external processing behaviors). These results can be applied to advance the delivery of family nursing care offered to these families.
The Disease-Modifying Effects of Hyaluronan in the Osteoarthritic Disease State
Authors: Nicholls Mathew A , Fierlinger Anke , Niazi Faizan , Bhandari Mohit
Published: August 2017

Hyaluronic acid (HA) has been a treatment modality for patients with knee osteoarthritis (OA) for many years now. Since HA was first introduced for the treatment of painful knee OA, much has been elucidated regarding both the etiology of this disease and the mechanisms by which HA may mitigate joint pain and tissue destruction. The objectives of this article are to (1) describe the etiology and pathophysiology of OA including both what is known about the genetics and biochemistry, (2) describe the role of HA on disease progression, (3) detail the antinociceptive and anti-inflammatory actions of HA in OA, and (4) present evidence of disease-modifying effects of HA in the preservation and restoration of the extracellular matrix. These data support that HA is not only just a simple device used for viscosupplementation but also a biologically active molecule that can affect the physiology of articular cartilage.