bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic review of youth mental health service integration research
Authors: Kinchin Irina , Tsey Komla , Heyeres Marion , Cadet-James Yvonne
Published: June 2016

Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998–2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12–25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.
A 150-year fire history of mulga (Acacia aneura F. Muell. ex Benth.) dominated vegetation in semiarid Queensland, Australia
Authors: Silcock J. L. , Witt G. B. , Fensham R. J.
Published: June 2016

Changes to fire regimes associated with European colonisation are implicated in declines in biodiversity and productivity in rangelands globally. However, for many areas there is incomplete knowledge of historical fire regimes and purported changes can become accepted wisdom with little empirical evidence. In the Mulga Lands of south-western Queensland, the dominant narrative implicates reduced fire frequency as a cause of woody vegetation thickening. We present a fire history of the Mulga Lands since pastoral exploration in the 1840s based on a review of explorer and early pastoralist journals, newspaper articles, interviews with long-term landholders and collation of satellite imagery. Fires in mulga communities are infrequent and only occur after at least two years of above-average summer rainfall. The assumption of regular pre-pastoral fires is not supported by available evidence. Since pastoral settlement in the 1860s, fire events affecting >1000 km2 have occurred seven times (1891–1892, 1904, 1918, 1950–1951, 1956–1957, 1976–1979 and 2011–2013), with only the 1950s fires affecting a >10% of the total area of mulga-dominated vegetation. We argue that fire is limited by fuel loads, which are in turn limited by rainfall events occurring only a few times a century. Even in the absence of grazing and active fire suppression fire intervals would be extremely long, perhaps 30–50 years in relatively fire-prone communities and much longer throughout most of the region. Combined with quantitative studies of fire and tree and shrub population dynamics, detailed fire histories will allow for more informed and nuanced debates about the role of fire in rangelands subject to abrupt management upheavals.
Birds have primate-like numbers of neurons in the forebrain
Authors: Olkowicz Seweryn , Kocourek Martin , Lučan Radek K. , Porteš Michal , Fitch W. Tecumseh , Herculano-Houzel Suzana , Němec Pavel
Published: June 2016

Significance

Birds are remarkably intelligent, although their brains are small. Corvids and some parrots are capable of cognitive feats comparable to those of great apes. How do birds achieve impressive cognitive prowess with walnut-sized brains? We investigated the cellular composition of the brains of 28 avian species, uncovering a straightforward solution to the puzzle: brains of songbirds and parrots contain very large numbers of neurons, at neuronal densities considerably exceeding those found in mammals. Because these “extra” neurons are predominantly located in the forebrain, large parrots and corvids have the same or greater forebrain neuron counts as monkeys with much larger brains. Avian brains thus have the potential to provide much higher “cognitive power” per unit mass than do mammalian brains.
Late Cenozoic onset of the latitudinal diversity gradient of North American mammals
Authors: Marcot Jonathan D. , Fox David L. , Niebuhr Spencer R.
Published: June 2016

Significance

The number of species declines from the Earth's equator to the poles—a pattern known as the latitudinal diversity gradient (LDG)—for nearly every group of living organisms in which the LDG has been studied. However, our analyses of fossil occurrences demonstrate that the LDG of terrestrial mammals was substantially weaker than it is today, if not absent entirely, for most of the past 65 My. We also show the strength of the LDG varies with global temperature and is weakest during globally warm periods. We find that the modern LDG became established sometime in only in the last 4 My, most likely as a result of declining global temperatures.
Identification of S-phase DNA damage-response targets in fission yeast reveals conservation of damage-response networks
Authors: Willis Nicholas A. , Zhou Chunshui , Elia Andrew E. H. , Murray Johanne M. , Carr Antony M. , Elledge Stephen J. , Rhind Nicholas
Published: June 2016

Significance

The cellular response to DNA damage during DNA replication promotes survival and genome maintenance. It involves a network of kinases that phosphorylate a variety of target proteins. Although the protein kinases involved have been studied extensively in fission yeast, only a handful of their targets have been identified. We used an unbiased approach to profile protein phosphorylation in response to DNA damage during DNA replication. We found target proteins involved in gene expression, stress response, regulation of mitosis and cytokinesis, and DNA replication and repair, many of which are required for resistance to DNA damage. These protein targets are conserved in budding yeast and human cells, demonstrating the deep conservation of the response.
Hepatitis C virus depends on E-cadherin as an entry factor and regulates its expression in epithelial-to-mesenchymal transition
Authors: Li Qisheng , Sodroski Catherine , Lowey Brianna , Schweitzer Cameron J. , Cha Helen , Zhang Fang , Liang T. Jake
Published: June 2016

Significance

Hepatitis C virus (HCV) infects hepatocytes via an intricate series of interactions with the host cell machinery. Recently, we identified E-cadherin as a host dependency factor mediating HCV entry through integrative functional genomics studies. E-cadherin silencing restricted HCV entry and infection in hepatocytes. Mechanistic studies demonstrated that E-cadherin is a prerequisite for the cell-surface localization of claudin-1 and OCLN, two major HCV coreceptors. Moreover, HCV-induced loss of E-cadherin is associated with cancer-related cellular changes. Our study suggests that a dynamic interplay among E-cadherin, tight junction coreceptors, and epithelial-to-mesenchymal transition exists and plays an important role in regulating HCV entry. E-cadherin thereby represents a missing host factor in the comprehensive understanding of the molecular mechanisms and cellular regulatory events underlying HCV entry and pathogenesis.
Rational design and validation of a vanilloid-sensitive TRPV2 ion channel
Authors: Yang Fan , Vu Simon , Yarov-Yarovoy Vladimir , Zheng Jie
Published: June 2016

Significance

Understanding how small molecules regulate activities of ion channels, which form the second largest family of drug targets, is important for both basic and translational research. By learning from how capsaicin activates TRPV1, we have introduced high-affinity binding of both capsaicin and resiniferatoxin to TRPV2 with only four point mutations. This successful outcome not only validated the working model for capsaicin–TRPV1 interactions but also suggested that vanilloids such as resiniferatoxin use a similar structural mechanism. Our findings further revealed previously unrecognized structural requirements for capsaicin-induced TRPV1 activation, which will guide future efforts to design drug candidates targeting this important pain sensor. In addition, the modified TRPV2–resiniferatoxin pair has the potential to be further engineered as a tool for chemogenetic studies.
Natural and anthropogenic drivers of calcium depletion in a northern forest during the last millennium
Authors: Leys Bérangère A. , Likens Gene E. , Johnson Chris E. , Craine Joseph M. , Lacroix Brice , McLauchlan Kendra K.
Published: June 2016

Significance

This research breaks new ground by showing that, contrary to generally accepted theories of ecosystem development, calcium depletion has been occurring for millennia as a natural consequence of long-term ecosystem development. This natural process predisposed forest ecosystems in the region to detrimental responses to acid rain in the 20th century. We also show that nitrogen availability was increasing concurrently with the depletion of calcium. This is the first study, to our knowledge, to reconstruct continuous changes in nutrient availability for a northern forest ecosystem on the millennial time scale. The results alter our assessments of the speed and trajectory of nutrient limitation in forests and suggest that reformulation of global models of forest productivity may be necessary.
Asymmetric partitioning of transfected DNA during mammalian cell division
Authors: Wang Xuan , Le Nhung , Denoth-Lippuner Annina , Barral Yves , Kroschewski Ruth
Published: June 2016

Significance

What happens to foreign DNA in mammalian cells during divisions? We provide evidence that the mitotic machinery helps cope with cytoplasmic clusters of plasmid DNA, a prototype of foreign DNA. The endoplasmic reticulum embraces these clusters, probably restricting their mobility and preventing them from interfering with chromosomal DNA. Subsequently, these clusters predominantly partition into the daughter cell with the young centrosome and with successive divisions end up in a decreasing fraction of cells within the growing population. This process is similar to the partition of noncentromeric DNA in budding yeast and cell fates in stem cells. The behavior difference of the two centrosomes documented here might also facilitate asymmetric partition of other cellular components.
Silicic volcanism on Mars evidenced by tridymite in high-SiO
2
sedimentary rock at Gale crater
Authors: Morris Richard V. , Vaniman David T. , Blake David F. , Gellert Ralf , Chipera Steve J. , Rampe Elizabeth B. , Ming Douglas W. , Morrison Shaunna M. , Downs Robert T. , Treiman Allan H. , Yen Albert S. , Grotzinger John P. , Achilles Cherie N. , Bristow Thomas F. , Crisp Joy A. , Des Marais David J. , Farmer Jack D. , Fendrich Kim V. , Frydenvang Jens , Graff Trevor G. , Morookian John-Michael , Stolper Edward M. , Schwenzer Susanne P.
Published: June 2016

Significance

Tridymite, a SiO
2
mineral that crystallizes at low pressures and high temperatures (>870 °C) from high-SiO
2
materials, was detected at high concentrations in a sedimentary mudstone in Gale crater, Mars. Mineralogy and abundance were determined by X-ray diffraction using the Chemistry and Mineralogy instrument on the Mars Science Laboratory rover
Curiosity
. Terrestrial tridymite is commonly associated with silicic volcanism where high temperatures and high-silica magmas prevail, so this occurrence is the first in situ mineralogical evidence for martian silicic volcanism. Multistep processes, including high-temperature alteration of silica-rich residues of acid sulfate leaching, are alternate formation pathways for martian tridymite but are less likely. The unexpected discovery of tridymite is further evidence of the complexity of igneous petrogenesis on Mars, with igneous evolution to high-SiO
2
compositions.
Closed state-coupled C-type inactivation in BK channels
Authors: Yan Jiusheng , Li Qin , Aldrich Richard W.
Published: June 2016

Significance

Ion channels regulate ion flow by opening and closing their pore gates. K
+
channels commonly possess two pore gates, one at the intracellular end for fast channel activation/deactivation and the other at the selectivity filter for slow C-type inactivation/recovery. The large-conductance calcium-activated potassium (BK) channel lacks a classic intracellular bundle-crossing activation gate and normally show no C-type inactivation. We found conditions to induce BK channels into a C-inactivated state and observed a unique closed state-coupled C-type inactivation, which is contrary to the commonly observed open state-coupled C-type inactivation in other K
+
channels. We propose that the activation gate of BK channels may exist at or near the selectivity filter and that the channel’s normal closing may represent an early conformational stage of C-type inactivation.
Enhancing cellulase production by overexpression of xylanase regulator protein gene, xlnR, in Talaromyces cellulolyticus cellulase hyperproducing mutant strain
Authors: Okuda Naoyuki , Fujii Tatsuya , Inoue Hiroyuki , Ishikawa Kazuhiko , Hoshino Tamotsu
Published: June 2016

We obtained strains with the xylanase regulator gene, xlnR, overexpressed (HXlnR) and disrupted (DXlnR) derived from Talaromyces cellulolyticus strain C-1, which is a cellulase hyperproducing mutant. Filter paper degrading enzyme activity and cellobiohydrolase I gene expression was the highest in HXlnR, followed by C-1 and DXlnR. These results indicate that the enhancement of cellulase productivity was succeeded by xlnR overexpression.
The Explanatory Power of Network Models
Authors: Craver Carl F.
Published: June 2016

Network analysis is increasingly used to discover and represent the organization of complex systems. Focusing on examples from neuroscience in particular, I argue that whether network models explain, how they explain, and how much they explain cannot be answered for network models generally but must be answered by specifying an explanandum, by addressing how the model is applied to the system, and by specifying which kinds of relations count as explanatory.
Expert Judgment for Climate Change Adaptation
Authors: Thompson Erica , Frigg Roman , Helgeson Casey
Published: June 2016

Climate change adaptation is largely a local matter, and adaptation planning can benefit from local climate change projections. Such projections are typically generated by accepting climate model outputs in a relatively uncritical way. We argue, based on the IPCC’s treatment of model outputs from the CMIP5 ensemble, that this approach is unwarranted and that subjective expert judgment should play a central role in the provision of local climate change projections intended to support decision-making.
On normal approximations to symmetric hypergeometric laws
Authors: Mattner Lutz , Schulz Jona
Published: June 2016

The Kolmogorov distances between a symmetric hypergeometric law with standard deviation

σ
\sigma

and its usual normal approximations are computed and shown to be less than

1

/

(

8
π

σ
)

1/(\sqrt {8\pi }\,\sigma )

, with the order

1

/

σ

1/\sigma

and the constant

1

/

8
π

1/\sqrt {8\pi }

being optimal. The results of Hipp and Mattner (2007) for symmetric binomial laws are obtained as special cases.

Connections to Berry-Esseen type results in more general situations concerning sums of simple random samples or Bernoulli convolutions are explained.

Auxiliary results of independent interest include rather sharp normal distribution function inequalities, a simple identifiability result for hypergeometric laws, and some remarks related to Lévy’s concentration-variance inequality.
Proteolytic activation of both components of the cation stress–responsive Slt pathway in Aspergillus nidulans
Authors: Mellado Laura , Arst Herbert N. , Espeso Eduardo A.
Published: June 2016

Tolerance of Aspergillus nidulans to alkalinity and elevated cation concentrations requires both SltA and SltB. Transcription factor SltA and the putative pseudokinase/protease signaling protein SltB comprise a regulatory pathway specific to filamentous fungi. In vivo, SltB is proteolytically cleaved into its two principal domains. Mutational analysis defines a chymotrypsin-like serine protease domain that mediates SltB autoproteolysis and proteolytic cleavage of SltA. The pseudokinase domain might modulate the protease activity of SltB. Three forms of the SltA transcription factor coexist in cells: a full-length, 78-kDa version and a processed, 32-kDa form, which is found in phosphorylated and unphosphorylated states. The SltA32kDa version mediates transcriptional regulation of sltB and, putatively, genes required for tolerance to cation stress and alkalinity. The full-length form, SltA78kDa, apparently has no transcriptional function. In the absence of SltB, only the primary product of SltA is detectable, and its level equals that of SltA78kDa. Mutations in sltB selected as suppressors of null vps alleles and resulting in cation/alkalinity sensitivity either reduced or eliminated SltA proteolysis. There is no evidence for cation or alkalinity regulation of SltB cleavage, but activation of sltB expression requires SltA. This work identifies the molecular mechanisms governing the Slt pathway.
Permanent and Temporary Policy Incentives for Conservation under Stochastic Returns from Competing Land Uses
Authors: Shah Payal , Ando Amy W.
Published: June 2016

Rapid conversion of private land for agricultural and urban use has raised concern worldwide over the loss of ecological services. To inform conservation policy, we model privately optimal land use decisions using a real options framework that assumes both the ecological and commercial values of land are stochastic and that land conversion is irreversible. We analyze permanent and temporary land conservation policy incentives using this dynamic framework to guide policy makers interested in designing efficient payment mechanisms to achieve ecological preservation goals. We find that while the financial cost of temporary policy incentives is generally much lower than permanent policy incentives, this difference is very small in scenarios with high discount rates and lower uncertainties in conversion returns and lower expected trend in conservation returns. Alternately, the financial cost of temporary conservation is substantially lower than that of permanent conservation when the expected trend in conservation returns and uncertainties in conservation and conversion returns is high and the discount rate is low. Comparison with net present value and single‐source uncertainty models indicates that the presence of a second uncertainty increases the option value of delaying conversion, and shows that permanent and temporary policy incentives based on either of the two simpler models can be seriously misguided if multiple uncertainties are present. We illustrate the analytical results with a case study of tropical deforestation in Indonesia where private landowners can either conserve forests and earn carbon credits, or convert to palm oil agriculture and earn profits from the sale of palm oil.
Temperature Changes, Household Consumption, and Internal Migration: Evidence from Tanzania
Authors: Hirvonen Kalle
Published: June 2016

Large rural‐urban wage gaps observed in many developing countries are suggestive of barriers to migration that keep potential migrants in rural areas. Using long panel data spanning nearly two decades, I study the extent to which migration rates are constrained by liquidity constraints in rural Tanzania. The analysis begins by quantifying the impact of weather variation on household welfare. The results show how household consumption co‐moves with temperature, rendering households vulnerable to local weather events. These temperature‐induced income shocks are then found to inhibit long‐term migration among men, thus preventing them from tapping into the opportunities brought about by geographical mobility.
CONDOP: an R package for CONdition-Dependent Operon Predictions
Authors: Fortino Vittorio , Tagliaferri Roberto , Greco Dario
Published: June 2016

Summary: The use of high-throughput RNA sequencing to predict dynamic operon structures in prokaryotic genomes has recently gained popularity in bioinformatics. We provide the R implementation of a novel method that uses transcriptomic features extracted from RNA-seq transcriptome profiles to develop ensemble classifiers for condition-dependent operon predictions. The CONDOP package provides a deeper insight into RNA-seq data analysis and allows scientists to highlight the operon organization in the context of transcriptional regulation with a few lines of code.

Availability and Implementation: CONDOP is implemented in R and is freely available at CRAN.

Contact:  vittorio.fortino@helsinki.fi

Supplementary information:  Supplementary data are available at Bioinformatics online.
Web-based network analysis and visualization using CellMaps
Authors: Salavert Francisco , García-Alonso Luz , Sánchez Rubén , Alonso Roberto , Bleda Marta , Medina Ignacio , Dopazo Joaquín
Published: June 2016

Summary: CellMaps is an HTML5 open-source web tool that allows displaying, editing, exploring and analyzing biological networks as well as integrating metadata into them. Computations and analyses are remotely executed in high-end servers, and all the functionalities are available through RESTful web services. CellMaps can easily be integrated in any web page by using an available JavaScript API.

Availability and Implementation: The application is available at: http://cellmaps.babelomics.org/ and the code can be found in: https://github.com/opencb/cell-maps. The client is implemented in JavaScript and the server in C and Java.

Contact:  jdopazo@cipf.es

Supplementary information:  Supplementary data are available at Bioinformatics online.
Investigation of whether in-room CT-based adaptive intracavitary brachytherapy for uterine cervical cancer is robust against interfractional location variations of organs and/or applicators
Authors: Oku Yoshifumi , Arimura Hidetaka , Nguyen Tran Thi Thao , Hiraki Yoshiyuki , Toyota Masahiko , Saigo Yasumasa , Yoshiura Takashi , Hirata Hideki
Published: June 2016

This study investigates whether in-room computed tomography (CT)-based adaptive treatment planning (ATP) is robust against interfractional location variations, namely, interfractional organ motions and/or applicator displacements, in 3D intracavitary brachytherapy (ICBT) for uterine cervical cancer. In ATP, the radiation treatment plans, which have been designed based on planning CT images (and/or MR images) acquired just before the treatments, are adaptively applied for each fraction, taking into account the interfractional location variations. 2D and 3D plans with ATP for 14 patients were simulated for 56 fractions at a prescribed dose of 600 cGy per fraction. The standard deviations (SDs) of location displacements (interfractional location variations) of the target and organs at risk (OARs) with 3D ATP were significantly smaller than those with 2D ATP (P < 0.05). The homogeneity index (HI), conformity index (CI) and tumor control probability (TCP) in 3D ATP were significantly higher for high-risk clinical target volumes than those in 2D ATP. The SDs of the HI, CI, TCP, bladder and rectum D2cc, and the bladder and rectum normal tissue complication probability (NTCP) in 3D ATP were significantly smaller than those in 2D ATP. The results of this study suggest that the interfractional location variations give smaller impacts on the planning evaluation indices in 3D ATP than in 2D ATP. Therefore, the 3D plans with ATP are expected to be robust against interfractional location variations in each treatment fraction.
A Single Quantifiable Viral Load Is Predictive of Virological Failure in Human Immunodeficiency Virus (HIV)-Infected Patients on Combination Antiretroviral Therapy: The Austrian HIV Cohort Study
Authors: Leierer Gisela , Grabmeier-Pfistershammer Katharina , Steuer Andrea , Sarcletti Mario , Geit Maria , Haas Bernhard , Taylor Ninon , Kanatschnig Manfred , Rappold Michaela , Ledergerber Bruno , Zangerle Robert ,   for the Austrian HIV Cohort Study Group, Egle Alexander , Geit Maria , Haas Bernhard , Kanatschnig Manfred , Rieger Armin , Steuer Andrea , Zangerle Robert , Gisinger Martin , Kitchen Maria , Rieser Elisabeth , Rühr Brigitte , Sarcletti Mario , Zangerle Robert , Greil Richard , Schachner Michaela , Taylor Ninon , Berg Jörg , Öllinger Angela , Aichwalder Regina , Grabmeier-Pfistershammer Katharina , Touzeau Veronique , Cichon Piotr , Gartner Manfred , Schmied Brigitte , Steuer Andrea , Haas Bernhard , Kapper Andreas , Wallner Elmar , Puchhammer-Stöckl Elisabeth , Appoyer Heinz , Leierer Gisela , Rappold Michaela , Strickner Stefanie , Schindelwig Klaus , Ledergerber Bruno , Fätkenheuer Gerd
Published: June 2016

Background.  Viral loads (VLs) detectable at low levels are not uncommon in patients on combination antiretroviral therapy (cART). We investigated whether a single quantifiable VL predicted virological failure (VF).

Methods.  We analyzed patients receiving standard regimens with at least 1 VL measurement below the limit of quantification (BLQ) in their treatment history. The first VL measurement after 6 months of unmodified cART served as baseline VL for the subsequent analyses of the time to reach single VL levels of ≥200, ≥400, and ≥1000 copies/mL. Roche TaqMan 2.0 was used to quantify human immunodeficiency virus-1 ribonucleic acid. Factors associated with VF were determined by Cox proportional hazards models.

Results.  Of 1614 patients included in the study, 68, 44, and 34 experienced VF ≥200, ≥400, and ≥1000 copies/mL, respectively. In multivariable analyses, compared with patients who were BLQ, a detectable VL ≤ 50 and VL 51–199 copies/mL predicted VF ≥ 200 copies/mL (hazards ratio [HR] = 2.19, 95% confidence interval [CI] = 1.06–4.55 and HR = 4.21, 95% CI = 2.15–8.22, respectively). In those with VL 51–199 copies/mL, a trend for an increased risk of VF ≥400 and VF ≥1000 copies/mL could be found (HR = 2.13, 95% CI = 0.84–5.39 and HR = 2.52, 95% CI = 0.96–6.60, respectively).

Conclusions.  These findings support closer monitoring and adherence counseling for patients with a single measurement of quantifiable VL <200 copies/mL.
Keloid Management: A Retrospective Case Review on a New Approach Using Surgical Excision, Platelet-Rich Plasma, and In-office Superficial Photon X-ray Radiation Therapy
Authors: Jones Michael E. , Hardy Cherrell , Ridgway Julie
Published: June 2016

OBJECTIVE:

The objective of this retrospective study was to evaluate the efficacy of the authors’ combination therapy protocol for keloid treatment.

DESIGN:

Retrospective.

SETTING:

Plastic surgery office-based outpatient setting in New York City.

PATIENTS:

Forty patients with 44 keloid scars requiring surgical excision.

INTERVENTIONS:

Keloid scars were treated using surgical excision, platelet-rich plasma, and postoperative in-office superficial photon X-ray radiation therapy. Intralesional triamcinolone injections were administered once to 4 patients with poor results on scar scale assessment. Patient follow-up visits ranged from 3 to 11 months to assess for evidence of recurrence and adverse effects.

MAIN OUTCOME MEASURE(S):

For the purpose of this study, recurrence was defined as any sign of extraordinary erythema, induration, and hypertrophy beyond the site of excision.

MAIN RESULTS:

In the 16 keloids treated with 2 fractions, there was no evidence of recurrence. One of 25 keloids treated with 3 fractions demonstrated evidence of recurrence. One of 3 keloids treated with a single fraction displayed signs of recurrence. Postirradiation hyperpigmentation was noted in all patients.

CONCLUSIONS:

Surgical excision combined with platelet-rich plasma and postoperative in-office superficial radiation therapy achieved a 95.5% nonrecurrence rate at 1- to 3-month follow-up. This protocol appears to be a safe and viable option in the management of keloids and merits further randomized controlled study of its comparative efficacy.
Identification of Risk Factors for the Development of Pressure Ulcers Despite Standard Screening Methodology and Prophylaxis in Trauma Patients
Authors: Raff Lauren A. , Waller Holly , Griffin Russell L. , Kerby Jeffrey D. , Bosarge Patrick L.
Published: June 2016

PURPOSE:

To present information about a study of risk factors for development of pressure ulcers (PrUs) in trauma patients.

TARGET AUDIENCE:

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES/OUTCOMES:

After participating in this educational activity, the participant should be better able to:

1. Describe the previous PrU research, scope of the problem, and methodology of the study.

2. Explain the results of the study identifying PrU risk factors for trauma patients.

 OBJECTIVE:Pressure ulceration prevention has been emphasized  over the past several years in inpatient hospital settings with  subsequent decreases in the development of pressure ulcers (PrUs).  However, there remains a subset of trauma and burn patients  that develop PrUs despite standard screening methodology and  prophylaxis. This study determines the conditions that predict  development of pressure ulcers (PrUs) despite conventional  prophylaxis and screening.

 METHODS: Demographic and PrU data were collected over a  5-year period from June 2008 to May 2013. Patients diagnosed  with PrUs upon arrival in the trauma bay were excluded from  analysis. An ordinal logistic regression of PrU stage was used to  estimate odds ratios (ORs) and associated 95% confidence intervals  (CIs) for the association between characteristics of interest and  odds of a PrU. A backward selection process was used to select the  most parsimonious model.

 RESULTS: During the study period, 14,616 trauma patients were  admitted and had available data. A total of 124 patients (0.85%) that met inclusion criteria went on to develop PrUs during their hospital course. Factors associated with the development of PrUs included spine Abbreviated Injury Scale (AIS) >3 (OR, 5.72; CI, 3.63–9.01), mechanical ventilation (OR, 1.95; CI, 1.23–3.10) and age 40 to 64 (OR, 2.09; CI, 1.24–3.52) and age ≥ 65 (OR, 4.48; CI, 2.52–7.95). Interestingly, head injury AIS >3 was protective from the development of PrUs (OR, 0.56; CI, 0.32–0.96). Hypotension and shock defined as systolic BP <90 mm Hg and base deficit less than –6 were not associated with the development of PrUs. In addition, body mass index was not associated with PrU development.

 CONCLUSIONS: Spinal injuries, older than age 40, and mechanical  ventilation predict the development of PrUs for a subset of  patients, despite conventional prophylaxis and screening. Advanced  prevention methods, such as low-air-loss mattresses for these patient  subgroups should be considered immediately upon identification  of these risk factors during the hospital course.
Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial
Authors: Kai Yuko , Nagamatsu Toshiya , Kitabatake Yoshinori , Sensui Hiroomi
Published: June 2016

Objective:

Exercise may help alleviate menopausal and depressive symptoms in middle-aged women, but sufficient evidence does not currently exist to fully support this theory. Whereas frequent moderate- to vigorous-intensity exercise may be associated with the risk of menopausal hot flashes, light-intensity exercise, such as stretching, is not likely to increase the occurrence of hot flashes. Little is, however, known about the effects of light-intensity exercise on menopausal and depressive symptoms. We examined the effects of a 3-week stretching program on the menopausal and depressive symptoms in middle-aged, Japanese women.

Methods:

Forty Japanese women, aged 40 to 61 years, were recruited (mean age, 51.1 ± 7.3 y). The participants were randomly assigned to either a stretching or a control group. The stretching group (n = 20) participated in a 3-week intervention program that involved 10 minutes of daily stretching, just before bedtime. The control group (n = 20) was assigned to a waiting list. Menopausal symptoms were evaluated using the Simplified Menopausal Index, which measures vasomotor, psychological, and somatic symptoms. Depressive symptoms were assessed using the Self-Rating Depression Scale.

Results:

The compliance rate was 75.8% during the 3-week intervention program. The total Simplified Menopausal Index scores, including the vasomotor, psychological, and somatic symptoms, and the Self-Rating Depression Scale scores significantly decreased in the stretching group compared with that in the control group. No adverse events, including increased hot flashes, were reported by the participants during the study period.

Conclusions:

These findings suggest that 10 minutes of stretching before bedtime decreases menopausal and depressive symptoms in middle-aged, Japanese women.
Association between erythrocyte levels of n-3 polyunsaturated fatty acids and depression in postmenopausal women using or not using hormone therapy
Authors: Jin Youri , Kim Tae-Hee , Park Yongsoon
Published: June 2016

Objective:

Epidemiologic and clinical studies have suggested that hormone therapy (HT) and n-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert antidepressant effects through regulation of the serotonergic pathway. The present study was conducted to evaluate the hypothesis that erythrocyte levels of n-3 PUFAs and depression were negatively associated in postmenopausal women, particularly those using HT.

Methods:

A total of 214 postmenopausal women were divided into groups defined by depression and HT status. Depression was defined as a Beck Depression Inventory score of at least 14, and the types and durations of HT were obtained from medical records.

Results:

Erythrocyte levels of EPA, docosapentaenoic acid (DPA), DHA, omega-3 index (sum of EPA + DHA), total n-3 PUFA, and arachidonic acid were significantly higher in women using HT than in those not using HT. There were significant negative correlations between depression and erythrocyte levels of alpha-linolenic acid (r = −0.310), DPA (r = −0.272), DHA (r = −0.209), and total n-3 PUFA (r = −0.234) in women using HT. Multivariate-adjusted logistic regression analysis also showed that depression was negatively associated with the erythrocyte levels of alpha-linolenic acid (P for trend = 0.018), DPA (P for trend = 0.014), and DHA (P for trend = 0.036), only in women using HT.

Conclusions:

Negative associations between erythrocyte levels of n-3 PUFAs and depression were found in Korean postmenopausal women using HT but not in those not using HT, suggesting a synergistic effect of HT and n-3 PUFAs on depression.
The prevalence of endometrial cancer in pre- and postmenopausal Chinese women
Authors: Gao Yifei , Zhao Min , Dai Xujing , Tong Mancy , Wei Jia , Chen Qi
Published: June 2016

Objective:

The incidence of endometrial cancer depends in part on the ethnicity and geographical area in which the woman resides. Menopause status is a well-known risk factor for endometrial cancer and most cases occur after menopause. It is, however, less clear how the menopause status is associated with endometrial cancer including its subtypes in Chinese women.

Methods:

Data on 1,746 women with endometrial cancer including age at diagnosis, age at menopause, and tumor histology from two large obstetrical and gynecological hospitals in China were analyzed.

Results:

The median age of women at diagnosis was 50 years. Fifty-eight percent of women were diagnosed after menopause. Fifty-six percent of women with type 1 and 69% with type 2 were diagnosed after menopause. In addition, in both pre- and postmenopausal women, there was no difference in the age at diagnosis between type 1 (46 vs 46 y) and type 2 endometrial cancer (53 vs 52 y).

Conclusions:

Our data demonstrate that although both type 1 and type 2 endometrial cancers are more likely to occur in Chinese women after menopause than before, the total prevalence of endometrial cancer is lower in our study population than in previous reports from white women (80%). The age at diagnosis did not differ between type 1 and type 2 endometrial cancers regardless of the menopause status in our study population. Our results caution clinicians to be more aware of the importance of abnormal uterine bleeding in premenopausal Chinese women.
An Unusual Case Presentation of the May–Thurner Syndrome
Authors: O’Laughlin Michael C. , Levens Benjamin J. , Levens David J. , Ring David H.
Published: June 2016

A 56-year-old woman underwent abdominoplasty with no immediate complications. She had no known bleeding history nor any relevant past surgical history. Adequate preventive measures for venous thromboembolism were performed, including sequential compression devices, good hydration, and early ambulation. At 17 days post operation, the patient presented to the emergency room complaining of left leg swelling and sharp, shooting pain radiating down her left leg. Workup in the Emergency Room revealed significant venous thrombosis involving complete occlusion of the major veins of the left leg. There were no indications of cardiopulmonary compromise. Angiography revealed an anatomical variant consistent with May-Thurner Syndrome (MTS). This variant first described in 1957 may present in up to one-quarter of patients, more commonly in young women. This case appears to the first reported of MTS occurring in association with a postoperative complication of abdominoplasty. Diagnosis and management considerations are discussed.
Movement Disorders in Adults With Intellectual Disability and Behavioral Problems Associated With Use of Antipsychotics
Authors: Scheifes Arlette , Walraven Sanne , Stolker Joost Jan , Nijman Henk L.I. , Tenback Diederik E. , Egberts Toine C.G. , Heerdink Eibert R.
Published: June 2016

Background

Antipsychotic drugs are prescribed to approximately 30% to 40% of adults with intellectual disability (ID) and behavioral problems despite lack of evidence of effectiveness and potential adverse effects, including movement disorders.

Aims

The aim of this study was to examine the prevalence of movement disorders (dyskinesia, akathisia, dystonia, and parkinsonism) in in-patient adults with mild to borderline ID and behavioral problems associated with use of antipsychotics.

Methods

Prevalence of movement disorders was measured with a standardized protocol. The strength of the association between antipsychotic drug use and movement disorders was assessed using logistic regression analysis.

Results

Almost half (44.0%) of 134 in-patient adults with ID and behavioral problems had any movement disorder. Parkinsonism, dyskinesia, akathisia, and dystonia were present in, respectively, 36.6%, 11.2%, 9.0%, and 0.7% of patients with ID. It appeared that current use of any antipsychotic drug (odds ratio, 3.0; 95% confidence interval, 1.0–8.4) and a dose in target range (odds ratio, 5.5; 95% confidence interval, 1.5–20.4) were significantly associated with the risk of having movement disorders.

Conclusions

The prevalence of movement disorders in people with ID and behavioral problems is high, especially in ID patients using antipsychotics. More attention is needed for these movement disorders and their potential impact.
Racial Disparity in the Sex Distribution, the Prevalence, and the Incidence of Dysplasia in Barrett’s Esophagus
Authors: Thota Prashanthi N. , Zackria Shamiq , Sanaka Madhusudhan R. , Patil Deepa , Goldblum John , Lopez Rocio , Chak Amitabh
Published: June 2016

Goals:

Our aim was to study the prevalence of dysplasia and progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in African Americans (AA) with Barrett’s esophagus (BE) and compare it with that of non-Hispanic white (NHW) controls.

Background:

BE, a precursor of EAC, is a disease of predominantly white men and is uncommon in AA. The prevalence of dysplasia and progression to HGD and EAC in AA patients with BE is not clearly known.

Study:

All AA or NHW patients with confirmed BE, that is specialized intestinal metaplasia, seen between 2002 and 2013 at our institution were included. Variables such as age, gender, medication use, the body mass index, the date of endoscopy, the hiatal hernia size, the BE length, and histologic findings were noted. Progression to HGD/EAC was evaluated.

Results:

Fifty-two AA and 2394 NHW patients with BE were identified. There was a higher percentage of women in the AA cohort (46.2%) than in the NHW cohort (24.9%, P<0.001). Nondysplastic BE was more prevalent in AA than in NHW (80.8% vs. 68.4%, P=0.058). In the surveillance cohort of 20 AA and 991 NHW, no racial differences in progression to HGD/EAC were observed during a median follow-up of 43 months.

Conclusions:

This study includes the largest number of AA with histologically confirmed BE reported so far. About 46.2% of the AA cohort with BE in our study consisted of women. There was a trend toward a higher prevalence of nondysplastic BE in AA compared with NHW.
Proposal for An Algorithm for Screening for Undernutrition in Hospitalized Children
Authors: Huysentruyt Koen , De Schepper Jean , Bontems Patrick , Alliet Philippe , Peeters Ellen , Roelants Mathieu , Van Biervliet Stephanie , Hauser Bruno , Vandenplas Yvan ,   Voedingscel van Vlaamse Vereniging voor Kindergeneeskunde, VVK
Published: June 2016

The prevalence of disease‐related undernutrition in hospitalized children has not decreased significantly in the last decades in Europe. A recent large multicentric European study reported a percentage of underweight children ranging across countries from 4.0% to 9.3%. Nutritional screening has been put forward as a strategy to detect and prevent undernutrition in hospitalized children. It allows timely implementation of adequate nutritional support and prevents further nutritional deterioration of hospitalized children. In this article, a hands‐on practical guideline for the implementation of a nutritional care program in hospitalized children is provided. The difference between nutritional status (anthropometry with or without additional technical investigations) at admission and nutritional risk (the risk of the need for a nutritional intervention or the risk for nutritional deterioration during hospital stay) is the focus of this article. Based on the quality control circle principle of Deming, a nutritional care algorithm, with detailed instructions specific for the pediatric population was developed and implementation in daily practice is proposed. Further research is required to prove the applicability and the merit of this algorithm. It can, however, serve as a basis to provide European or even wider guidelines.
Strategies for Medical Management of Pediatric Eosinophilic Esophagitis
Authors: Chawla Neha , Deshmukh Mangesh , Sharma Ajay , Patole Sanjay
Published: June 2016

Objective:

Eosinophilic esophagitis (EoE) is associated with significant morbidity in children. Strategies for optimizing its outcomes are hence essential. We aimed to review the strategies for medical management of EoE in children.

Methods:

We conducted a systematic review of randomized controlled trials (RCTs) of medical interventions in children with EoE, using the Cochrane methodology. Databases including PubMed, EMBASE, CINAHL, Cochrane Central Library, and Google scholar were searched up to March 2016. Primary outcomes included histological (peak eosinophil count) and symptomatic remission. Secondary outcomes were improvement in endoscopic and other histological parameters and adverse effects.

Results:

A total of 5 RCTs (N = 448) with low to unclear risk of bias were included. The interventions included topical oral steroids, swallowed enteral steroids and anti‐ interleukin (IL)5 agent. Pooling of data from all trials was not possible owing to significant heterogeneity in interventions. Meta‐analysis of data (N = 141) from 3 RCTs (oral viscous budesonide: 2, fluticasone: 1) showed significant histological remission in the intervention versus control group participants (risk difference: 10.32 [95% confidence interval: 3.04, 35.03]; P = 0.0002), level of evidence—low. Compared with anti‐IL5 agent, the trials assessing steroids reported high rates of clinical remission. Clinical remission did not correlate with histological improvement in any trial. Except for systemic corticosteroids, there were no significant adverse effects related to other interventions.

Conclusions:

Limited low‐quality evidence exists on the effects of various interventions in children with EoE. The beneficial effects of swallowed steroid need to be confirmed in large well‐designed RCTs.
Utility of Routine Colonic Biopsies in Pediatric Colonoscopic Polypectomy for Benign Juvenile Hamartomatous Polyps
Authors: Malandra Michael , Kaur Sunpreet , Chogle Ashish
Published: June 2016

Introduction:

Benign juvenile hamartomatous polyps are common in pediatric gastrointestinal practice. We hypothesize that in the absence of gross mucosal abnormalities, the likelihood of histologic abnormalities from routine random colonic biopsies is low.

Methods:

We performed a retrospective chart review identifying patients ages 1 to 18 years who underwent complete colonoscopy and polypectomy for suspected colorectal polyps from January 1, 2004 to July 1, 2014. Indication, age, number of polyps, gross and histologic findings, and any management changes resulting from endoscopy were recorded. Exclusion criteria included history of polyposis syndrome, >5 polyps on colonoscopy, inflammatory bowel disease, and incomplete documentation. Practice patterns were assessed by online survey distributed via Pediatric Gastroenterology listserv.

Results:

A total of 141 patients underwent colonoscopy with anticipated polypectomy. Seventy‐two (63% male) were included. Mean age was 6.5 years. Indication was hematochezia in 71. Findings other than polyps were found in 7 (10%). Juvenile hamartomatous polyps were documented by histologic examination in 68 patients (94%). Routine colonic biopsies were performed in 55 patients (76%). In 8 (15%), histologic abnormalities were seen that did not result in management changes. Seventy‐three providers responded to the online survey; 56% reported not taking ileocolonic biopsies in the absence of other mucosal abnormalities; 45% routinely biopsied from the terminal ileum and/or colon. None would biopsy the terminal ileum only.

Conclusions:

In children with benign juvenile hamartomatous polyps, routine colonic biopsies are not required in the absence of mucosal abnormalities. Overuse of pathology services, increased procedural time, risk, and cost can be avoided.