bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting strategic success through enterprise-wide reputation risk management
Authors: Gatzert Nadine , Schmit Joan
Published: January 2016

Purpose

– The purpose of this paper is to present a coherent and effective enterprise risk management (ERM) framework that includes necessary steps and processes for integrating reputation risk management into an organization’s overall ERM approach which is intended to support corporate strategic success. In particular, reputation creation, enhancement, and protection are critical to an organization’s success, yet highly challenging given the wide ranging and somewhat opaque nature of the concept. These qualities call for a strong ERM approach to reputation that is holistic and integrative, yet existing knowledge of how to do so is limited.

Design/methodology/approach

– The paper evaluates and synthesizes existing reputation literature in developing an enterprise-wide reputation risk management framework incorporating necessary steps, processes, and considerations. We address risk strategy, risk assessment, risk governance, and risk culture as key elements of ERM and conclude with suggestions for future research.

Findings

– The results suggest several important ideas which are of great relevance when integrating reputation risk management into an ERM framework. Among these are the importance of: identifying and understanding the purpose of key stakeholders, appreciating the multidimensional and layered effect of events on organizational reputation and monitoring the influence of technological advances.

Originality/value

– The authors contribute to the literature by developing a framework for enterprise-wide reputation risk management that applies across industries. In contrast to previous work, the authors offer a broader perspective on the underlying causes and consequences of reputation damage based on empirical evidence and insight from the academic literature and provide additional detail in identification of reputation determinants, antecedents, and drivers. While much of this information exists in various places in the literature, it has not been organized into a cohesive framework nor used in developing an ERM strategy.
Exploring senior nurses’ experiences of leading organizational change
Authors: Boyal Amunpreet , Hewison Alistair
Published: January 2016

Purpose

– The aim of this paper is to explore Senior nurses’ experiences of leading organizational change. There is a substantial literature reporting middle-level nurse managers’ experiences of change; however, there is less evidence concerning senior nurses’ perspectives. In view of this, interview data collected from senior nurses, as part of a study of major organizational change, were analysed to redress this imbalance.

Design/methodology/approach

– In-depth semi-structured interviews (n = 14) were conducted with senior nurses (between 2009 and 2012).

Findings

– Senior nurses’ activity centred on leadership and workforce issues, internal influences and external pressures. In periods of change, appropriate leadership was vital, and “weak” leaders were considered to have an adverse effect on teams. Concerns were expressed about financial strictures and their impact on patient care and service provision. The senior nurses were striving to provide the best quality of service delivery with the limited resources available. Concentration on operational matters was necessary to maintain stability in periods of change. However, this prevented senior nurses from influencing strategic decision-making in their organizations.

Practical implications

– If senior nurses are to realise their potential to operate at a strategic level, they need to be given time and support to lead, rather than just react to change. This research emphasises the importance of a “nursing voice” to inform board-level decisions and maintain a focus on patient care.

Originality/value

– This research sheds light on the work of a key group of staff in health-care organizations. Understanding senior nurses’ experience of and contribution to change is a useful contribution to health services research.
Organizing principles and management climate in high-performing municipal elderly care
Authors: Kajonius Petri , Kazemi Ali , Tengblad Stefan
Published: January 2016

Purpose

– Previous research has shown that user-oriented care predicts older persons’ satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The purpose of this study is to investigate the organizing principles and management climate characterizing successful elderly care.

Design/methodology/approach

– The department in one highly ranked municipality was selected and compared with a more average municipality. On-site in-depth semi-structured interviews with department managers and participatory observations at managers’ meetings were conducted in both municipalities.

Findings

– Results revealed three key principles for successful elderly care: organizing care from the viewpoint of the older person; recruiting and training competent and autonomous employees; instilling a vision for the mission that guides operations at all levels in the organization. Furthermore, using climate theory to interpret the empirical material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing the right things characterizing the more average municipality.

Originality/value

– The authors suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the management, that is, the views of the older persons, the co-workers and the mission. These results can guide future care quality developments, and increase the understanding of the importance of organizational climate at the senior management level.
Management and leadership competence in hospitals: a systematic literature review
Authors: Pihlainen Vuokko , Kivinen Tuula , Lammintakanen Johanna
Published: January 2016

Purpose

– The purpose of this study is to describe the characteristics of management and leadership competence of health-care leaders and managers, especially in the hospital environment. Health-care leaders and managers in this study were both nursing and physician managers. Competence was assessed by evaluating the knowledge, skills, attitudes and abilities that enable management and leadership tasks.

Design/methodology/approach

– A systematic literature review was performed to find articles that identify and describe the characteristics of management and leadership competence. Searches of electronic databases were conducted using set criteria for article selection. Altogether, 13 papers underwent an inductive content analysis.

Findings

– The characteristics of management and leadership competence were categorized into the following groups: health-care-context-related, operational and general.

Research limitations/implications

– One limitation of the study is that only 13 articles were found in the literature regarding the characteristics of management and leadership competence. However, the search terms were relevant, and the search process was endorsed by an information specialist. The study findings imply the need to shift away from the individual approach to leadership and management competence. Management and leadership need to be assessed more frequently from a holistic perspective, and not merely on the basis of position in the organizational hierarchy or of profession in health care.

Originality/value

– The authors’ evaluation of the characteristics of management and leadership competence without a concentrated profession-based approach is original.
Revisiting the ideological congruence controversy
Authors: FERLAND BENJAMIN
Published: January 2016

One of the limits of previous studies using respondents’ self‐placements and subjective party placements to examine levels of citizen‐government congruence is that they were limited to the post‐1995 period. This article extends the number of elections where it is possible to examine levels of citizen‐government ideological congruence with a survey‐based approach. In particular, a unique dataset has been collected that combines data from the Comparative Study of Electoral Systems and several national election studies. The results confirm recent studies that show that levels of citizen‐government ideological congruence are similar under majoritarian and proportional representation (PR) systems. Such studies, however, did not provide evidence that congruence is maintained over the course of a government's mandate. This article introduces, therefore, two measures of citizen‐government congruence that address this issue and that may revive the debate about which electoral systems strengthen the citizen‐government connection: citizen‐government congruence at the end of government mandates and change in congruence between elections. The results indicate that governments stay closer to the median citizens between elections under PR systems than under majoritarian systems. It is found, however, that this decrease in congruence in majoritarian systems is not detrimental to the point of observing smaller levels of congruence at the end of government mandates under majoritarian systems than under PR systems.
Interleukin‐21 administration to aged mice rejuvenates their peripheral T‐cell pool by triggering de novo thymopoiesis
Authors: Al‐Chami E. , Tormo A. , Pasquin S. , Kanjarawi R. , Ziouani S. , Rafei M.
Published: January 2016

The vaccination efficacy in the elderly is significantly reduced compared to younger populations due to thymic involution and age‐related intrinsic changes affecting their naïve T‐cell compartment. Interleukin (IL)‐21 was recently shown to display thymostimulatory properties. Therefore, we hypothesized that its administration to ageing hosts may improve T‐cell output and thus restore a competent peripheral T‐cell compartment. Indeed, an increase in the production of recent thymic emigrants (RTEs) attributable to intrathymic expansion of early thymic progenitors (ETPs), double‐negative (DN), and double‐positive (DP) thymocytes as well as thymic epithelial cell (TEC) was observed in recombinant (r)IL‐21‐treated aged mice. In sharp contrast, no alterations in the frequency of bone marrow (BM)‐derived progenitors were detected following rIL‐21 administration. Enhanced production of naïve T cells improved the T‐cell receptor (TCR) repertoire diversity and re‐established a pool of T cells exhibiting higher levels of miR‐181a and diminished amounts of the TCR‐inhibiting phosphatases SHP‐2 and DUSP5/6. As a result, stimulation of T cells derived from rIL‐21‐treated aged mice displayed enhanced activation of Lck, ZAP‐70, and ERK, which ultimately boosted their IL‐2 production, CD25 expression, and proliferation capabilities in comparison with T cells derived from control aged mice. Consequently, aged rIL‐21‐treated mice vaccinated using a tyrosinase‐related protein 2 (Trp2)‐derived peptide exhibited a substantial delay in B16 tumor growth and improved survival. The results of this study highlight the immunorestorative function of rIL‐21 paving its use as a strategy for the re‐establishment of effective immunity in the elderly.
Aneuploidy shortens replicative lifespan in Saccharomyces cerevisiae
Authors: Sunshine Anna B. , Ong Giang T. , Nickerson Daniel P. , Carr Daniel , Murakami Christopher J. , Wasko Brian M. , Shemorry Anna , Merz Alexey J. , Kaeberlein Matt , Dunham Maitreya J.
Published: January 2016

Aneuploidy and aging are correlated; however, a causal link between these two phenomena has remained elusive. Here, we show that yeast disomic for a single native yeast chromosome generally have a decreased replicative lifespan. In addition, the extent of this lifespan deficit correlates with the size of the extra chromosome. We identified a mutation in BUL1 that rescues both the lifespan deficit and a protein trafficking defect in yeast disomic for chromosome 5. Bul1 is an E4 ubiquitin ligase adaptor involved in a protein quality control pathway that targets membrane proteins for endocytosis and destruction in the lysosomal vacuole, thereby maintaining protein homeostasis. Concurrent suppression of the aging and trafficking phenotypes suggests that disrupted membrane protein homeostasis in aneuploid yeast may contribute to their accelerated aging. The data reported here demonstrate that aneuploidy can impair protein homeostasis, shorten lifespan, and may contribute to age‐associated phenotypes.
Mitochondrial DNA variation of domestic sheep (Ovis aries) in Kenya
Authors: Resende Adriana , Gonçalves Joana , Muigai Anne W. T. , Pereira Filipe
Published: January 2016

The history of domestic sheep (Ovis aries) in Africa remains largely unknown. After being first introduced from the Near East, sheep gradually spread through the African continent with pastoral societies. The eastern part of Africa was important either for the first diffusion of sheep southward or for putative secondary introductions from the Arabian Peninsula or southern Asia. We analysed mitochondrial DNA control region sequences of 91 domestic sheep from Kenya and found a high diversity of matrilines from the widespread haplogroup B, whereas only a single individual from haplogroup A was detected. Our phylogeography analyses of more than 500 available mitochondrial DNA sequences also identified ancestral haplotypes that were probably first introduced in Africa and are now widely distributed. Moreover, we found no evidence of an admixture between East and West African sheep. The presence of shared haplotypes in eastern and ancient southern African sheep suggests the possible southward movement of sheep along the eastern part of Africa. Finally, we found no evidence of an extensive introduction of sheep from southern Asia into Africa via the Indian Ocean trade. The overall findings on the phylogeography of East African domestic sheep set the grounds for understanding the origin and subsequent movements of sheep in Africa. The richness of maternal lineages in Kenyan breeds is of prime importance for future conservation and breeding programmes.
Incidental finding of multiple well‐differentiated papillary mesotheliomas in peritoneum
Authors: Jakobsen Mark , Engvad Birte , Jensen Thor , Marcussen Niels
Published: January 2016

We present a case of multiple well‐differentiated papillary mesotheliomas (WDPM) in the peritoneum found incidentally in a 63‐year‐old man with urothelial carcinoma of the bladder. When multiple tumors are seen, malignant mesothelioma should be excluded by histopathological examination as this may have a similar focal appearance to WDPM. True stromal invasion is by far the most reliable criterion of mesothelial malignancy. In doubtful cases, a conservative diagnostic approach has been recommended. Compared to malignant mesotheliomas, WDPMs are rare and have a relatively indolent clinical course with a good prognosis. Great care is needed when diagnosing mesothelial proliferations, given the crucial nature of a benign vs malignant diagnosis. No standardized treatment has yet been established.
New conditions and intraspecific variation of some muscles of hands and feet of Dendropsophus labialis (Peters, 1863) (Anura, Hylidae)
Authors: Hoyos Julio Mario , Salgar Lina
Published: January 2016

Systematics of frogs have been based on osteological and molecular characters; however, the morphology of the muscles of hands and feet has proven to be an important complement to these studies, but it has not been sufficiently studied. This study presents undescribed conditions based on the origin, insertion or arrangement of 18 muscles of hands and feet of Dendropsophus labialis, and intraspecific variation. Muscles of four specimens (two males and two females) were examined to observe both sides of each specimen determining new conditions, and comparing them with documented species of Dendropsophus. Four intraspecific variant categories were established: Minor, unique, explosive and mimicking. Mainly mimicking, explosive and unique variations were found. Our results show the need to expand intraspecific studies in more species of Dendropsophus and to assess its value in the phylogeny of the genus. The family Hylidae may be identifiable based upon the combination of character states of some of these muscles: the m. flexor indicis superficialis proprius and the group of tendines superficialis digitorum of hands and foot, the m. extensor brevis superficialis Digiti III of the hand, the m. extensor brevis superficialis Digiti IV in hands and the mm. extensores breves profundi Digiti III in hands.
The genetic basis of asymptomatic codon 8 frame‐shift (HBB:c25_26delAA) β0‐thalassaemia homozygotes
Authors: Jiang Zhihua , Luo Hong‐yuan , Huang Shengwen , Farrell John J. , Davis Lance , Théberge Roger , Benson Katherine A. , Riolueang Suchada , Viprakasit Vip , Al‐Allawi Nasir A.S. , Ünal Sule , Gümrük Fatma , Akar Nejat , Başak A. Nazli , Osorio Leonor , Badens Catherine , Pissard Serge , Joly Philippe , Campbell Andrew D. , Gallagher Patrick G. , Steinberg Martin H. , Forget Bernard G. , Chui David H.K.
Published: January 2016

Two 21‐year old dizygotic twin men of Iraqi descent were homozygous for HBB codon 8, deletion of two nucleotides (–AA) frame‐shift β0‐thalassaemia mutation (FSC8; HBB:c25_26delAA). Both were clinically well, had splenomegaly, and were never transfused. They had mild microcytic anaemia (Hb 120‐130 g/l) and 98% of their haemoglobin was fetal haemoglobin (HbF). Both were carriers of Hph α‐thalassaemia mutation. On the three major HbF quantitative trait loci (QTL), the twins were homozygous for G>A HBG2 Xmn1 site at single nucleotide polymorphism (SNP) rs7482144, homozygous for 3‐bp deletion HBS1L‐MYB intergenic polymorphism (HMIP) at rs66650371, and heterozygous for the A>C BCL11A intron 2 polymorphism at rs766432. These findings were compared with those found in 22 other FSC8 homozygote patients: four presented with thalassaemia intermedia phenotype, and 18 were transfusion dependent. The inheritance of homozygosity for HMIP 3‐bp deletion at rs66650371 and heterozygosity for Hph α‐thalassaemia mutation was found in the twins and not found in any of the other 22 patients. Further studies are needed to uncover likely additional genetic variants that could contribute to the exceptionally high HbF levels and mild phenotype in these twins.
Postoperative mortality 90 days after robot‐assisted laparoscopic prostatectomy and retropubic radical prostatectomy: a nationwide population‐based study
Authors: Björklund Johan , Folkvaljon Yasin , Cole Alexander , Carlsson Stefan , Robinson David , Loeb Stacy , Stattin Pär , Akre Olof
Published: January 2016

Objective

To assess 90‐day postoperative mortality after robot‐assisted laparoscopic radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) using nationwide population‐based registry data.

Patients and Methods

We conducted a cohort study using the National Prostate Cancer Register of Sweden, including 22 344 men with localized prostate cancer of clinical stage T1–T3, whose prostate‐specific antigen levels were <50 μg/mL and who had undergone primary radical prostatectomy in the period 1998–2012. Vital status was ascertained through the Total Population Register. The rates for 90‐day postoperative mortality were analysed using logistic regression analysis, and comparisons of 90‐day mortality with the background population were made using standardized mortality ratios (SMRs).

Results

Of the 14 820 men who underwent RRP, 29 (0.20%) died, and of the 7 524 men who underwent RARP, 10 (0.13%) died. Mortality in the cohort during the 90‐day postoperative period was lower than in an age‐matched background population: SMR 0.57 (95% confidence interval [CI] 0.39–0.75). There was no statistically significant difference in 90‐day mortality according to surgical method: RARP vs RRP odds ratio (OR) 1.14; 95% CI 0.46–2.81. Postoperative 90‐day mortality decreased over time: 2008–2012 vs 1998–2007 OR 0.44; 95% CI 0.21–0.95, mainly because of lower mortality after RARP.

Conclusion

The 90‐day postoperative mortality rates were low after RARP and RRP and there was no statistically significant difference between the methods. Given the long life expectancy among men with low‐ and intermediate‐risk prostate cancer, very low postoperative mortality is a prerequisite for RP, which was fulfilled by both RRP and RARP. The selection of healthy men for RP is highlighted by the lower 90‐day mortality after RP compared with the background population.
Validation of a bone scan positivity risk table in non‐metastatic castration‐resistant prostate cancer
Authors: Freedland Stephen J. , Howard Lauren E. , Hanyok Brian T. , Kadiyala Vishnu K. , Kuang Jameson Y. , Whitney Colette A. , Wilks Floyd R. , Kane Christopher J. , Terris Martha K. , Amling Christopher L. , Cooperberg Matthew R. , Aronson William J. , Moreira Daniel M.
Published: January 2016

Objectives

To test the external validity of a previously developed risk table, designed to predict the probability of a positive bone scan among men with non‐metastatic (M0) castration‐resistant prostate cancer (CRPC), in a separate cohort.

Patients and Methods

We retrospectively analysed 429 bone scans of 281 patients with CRPC, with no known previous metastases, treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision‐curve analysis were used to assess the performance of our previous model to predict a positive scan in the current data.

Results

A total of 113 scans (26%) were positive. On multivariable analysis, the only significant predictors of a positive scan were log‐transformed prostate‐specific antigen (PSA): hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.71–2.66 (P < 0.001) and log‐transformed PSA doubling time (PSADT): HR 0.53; 95% CI 0.41–0.68 (P < 0.001). Among men with a PSA level <5 ng/mL, the rate of positive scans was 5%. The previously developed risk table had an AUC of 0.735 to predict positive bone scan with excellent calibration, and provided additional net benefit in the decision‐curve analysis.

Conclusion

We have validated our previously developed table to predict the risk of a positive bone scan among men with M0/Mx CRPC. Use of this risk table may allow better tailoring of patients' scanning to identify metastases early, while minimizing over‐imaging. Regardless of PSADT, positive bone scans were rare in men with a PSA <5 ng/mL.
Erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) combined responders to tadalafil after 12 weeks of treatment
Authors: Roehrborn Claus G. , Egan Kathryn B. , Miner Martin M. , Ni Xiao , Wong David G. , Rosen Raymond C.
Published: January 2016

Objective

To analyse the proportion of men taking tadalafil 5 mg once daily who experience a combined improvement in symptoms of both erectile dysfunction (ED) and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH).

Materials and Methods

The data from men aged ≥45 years randomized to tadalafil 5 mg once daily or placebo enrolled in one of four randomized, placebo‐controlled LUTS/BPH clinical trials were analysed (N = 927). A novel classification of ‘combined responders’ to ED and LUTS/BPH treatment was defined, based on published criteria for men who showed improvement in both International Index of Erectile Function – Erectile Function domain (IIEF‐EF) score and total International Prostate Symptom Score (IPSS). Descriptive analyses assessed the covariate distribution by responder status. Unadjusted and adjusted logistic regressions provided odds ratios with 95% confidence intervals comparing combined responders with all others (partial and non‐responders).

Results

Among men randomized to tadalafil 5 mg, 40.5% were combined responders (n = 189). Among placebo randomized men, 18.3% were combined responders (n = 84). Combined responders, in the total population, had the highest baseline IPSS and lowest baseline IIEF‐EF scores, corresponding to the highest level of dysfunction. The majority of men were aged ≤65 years, white, non‐obese, non‐smokers, and regular alcohol consumers. Only treatment, baseline IPSS, baseline IIEF‐EF, obesity and psychoactive medication use were significantly associated with responder status (P ≤ 0.05). Tadalafil‐treated men had 2.8 times significantly increased adjusted odds of being combined responders vs non‐responders (P < 0.001). For each unit decrease in baseline IIEF‐EF or alcoholic drink consumption per week there was a 4% significant increase in the adjusted odds of being a combined responder to tadalafil therapy.

Conclusions

This novel measure of combined response is useful in differentiating patients with clinically relevant symptom improvement for both ED and LUTS/BPH after treatment with tadalafil 5 mg once daily vs placebo. This combined responder measure may be useful in future assessment of treatment benefits across patient groups after various types of treatment intervention (e.g. surgical vs pharmacotherapy vs non‐pharmacological intervention).
Complications after prostate biopsies in men on active surveillance and its effects on receiving further biopsies in the Prostate cancer Research International: Active Surveillance (PRIAS) study
Authors: Bokhorst Leonard P. , Lepistö Inari , Kakehi Yoshiyuki , Bangma Chris H. , Pickles Tom , Valdagni Riccardo , Alberts Arnout R. , Semjonow Axel , Strölin Petra , Montesino Manuel F. , Berge Viktor , Roobol Monique J. , Rannikko Antti
Published: January 2016

Objective

To study the risk of serial prostate biopsies on complications in men on active surveillance (AS) and determine the effect of complications on receiving further biopsies.

Patients and methods

In the global Prostate cancer Research International: Active Surveillance (PRIAS) study, men are prospectively followed on AS and repeat prostate biopsies are scheduled at 1, 4, and 7 years after the diagnostic biopsy, or once yearly if prostate‐specific antigen‐doubling time is <10 years. Data on complications after biopsy, including infection, haematuria, haematospermia, and pain, were retrospectively collected for all biopsies taken during follow‐up in men from several large participating centres. Generalised estimating equations were used to test predictors of infection after biopsy. Competing risk analysis was used to compare the rates of men receiving further biopsies between men with and without previous complications.

Results

In all, 2 184 biopsies were taken in 1 164 men. Infection was reported after 55 biopsies (2.5%), and one in five men reported any form of complication. At multivariable analysis, the number of previous biopsies was not a significant predictor of infection (odds ratio 1.04, 95% confidence interval 0.76–1.43). The only significant predictor for infection was the type of prophylaxis used. Of all men with a complication at the diagnostic or first repeat biopsy, 21% did not have a repeat biopsy at the time a repeat biopsy was scheduled according to protocol, vs 12% for men without a previous biopsy complication.

Conclusion

In our present cohort of men on AS, we found no evidence that repeat prostate biopsy in itself posed a risk of infection. However, complications after biopsy were not uncommon and after a complication men were less likely to have further biopsies. We should aim to safely reduce the amount of repeat biopsies in men on AS.
Wide allelic heterogeneity with predominance of large IDS gene complex rearrangements in a sample of Mexican patients with Hunter syndrome
Authors: Alcántara‐Ortigoza M.A. , García‐de Teresa B. , González‐del Angel A. , Berumen J. , Guardado‐Estrada M. , Fernández‐Hernández L. , Navarrete‐Martínez J.I. , Maza‐Morales M. , Rius‐Domínguez R.
Published: January 2016

Hunter syndrome or mucopolysaccharidosis type II (MPSII) is caused by pathogenic variants in the IDS gene. This is the first study that examines the mutational spectrum in 25 unrelated Mexican MPSII families. The responsible genotype was identified in 96% of the families (24/25) with 10 novel pathogenic variants: c.133G>C, c.1003C>T, c.1025A>C, c.463_464delinsCCGTATAGCTGG, c.754_767del, c.1132_1133del, c.1463del, c.508‐1G>C, c.1006+1G>T and c.(‐217_103del). Extensive IDS gene deletions were identified in four patients; using DNA microarray analysis two patients showed the loss of the entire AFF2 gene, and epilepsy developed in only one of them. Wide allelic heterogeneity was noted, with large gene alterations (e.g. IDS/IDSP1 gene inversions, partial to extensive IDS deletions, and one chimeric IDS‐IDSP1 allele) that occurred at higher frequencies than previously reported (36% vs 18.9–29%). The frequency of carrier mothers (80%) is consistent with previous descriptions (>70%). Carrier assignment allowed molecular prenatal diagnoses. Notably, somatic and germline mosaicism was identified in one family, and two patients presented thrombocytopenic purpura and pancytopenia after idursulfase enzyme replacement treatment. Our findings suggest a wide allelic heterogeneity in Mexican MPSII patients; DNA microarray analysis contributes to further delineation of the resulting phenotype for IDS and neighboring loci deletions.
Atrial average conduction velocity in patients with and without paroxysmal atrial fibrillation
Authors: Zheng Yaxi , Xia Yunlong , Carlson Jonas , Kongstad Ole , Yuan Shiwen
Published: January 2016

Objectives

To evaluate intra‐atrial conduction delay in patients with atrial fibrillation (AF) via calculation of conduction velocities (CVs) of the right and left atria.

Methods

Electroanatomic mapping was performed during sinus rhythm, in the right atrium (RA) in eight patients with paroxysmal AF, in 12 controls with atrioventricular nodal re‐entrant tachycardia (AVNRT) and in the left atrium (LA) in additional 16 AF patients. Three‐dimensional maps of activation sequences of the RA and LA were obtained. Local CVs were specifically calculated in the direction of wave‐front propagation on the activation maps by using 3‐dimensional coordinates and local activation times of triads of sites. Average CVs of each atrium and each of 8 predefined RA and LA regions were calculated.

Results

During sinus rhythm, the average CVs of the RA were significantly slower (P<0·05) in the AF group (0·60 ± 0·12 m s−1) than in the controls (0·83 ± 0·13 m s−1). The average CVs of the RA basal, septal and annulus regions were significantly slower than the corresponding regions in controls (P<0·05). In patients with AF, the average CV of the LA was 0·51 ± 0·11 m s−1, which is significantly slower than that of the RA and than that of LA as previously reported (P<0·05).

Conclusion

Compared to patients with AVNRT, patients with AF are associated with conduction delay in both atria with the delay being more marked in the LA than in the RA, which suggests the involvement of conduction disturbances in the genesis and/or perpetuation of AF.
A novel method for sensitive determination of subclinical right ventricular systolic dysfunction in patients with obstructive sleep apnea
Authors: Zhou Nian‐Wei , Pan Cui‐Zhen , Kong De‐Hong , Li Zheng , Li Wen‐Jing , Gong Xue , Chen Hai‐Yan , Zhao Wei‐Peng , Wang Xiao‐Lin , Li Shan‐Qun , Shu Xian‐Hong
Published: January 2016

Objective

The aim of this study was to evaluate right ventricular (RV) regional systolic function and dyssynchrony in patients with newly diagnosed obstructive sleep apnea using real‐time three‐dimensional (3D) echocardiography.

Methods

Eighty‐two subjects without hypertension, diabetes mellitus or any cardiac or pulmonary disease referred for evaluation of obstructive sleep apnea (OSA) had overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into four groups: group 1: control subjects (AHI < 5, n = 19), group 2: patients with mild OSA (AHI: 5–14, n = 21), group 3: moderate OSA (AHI: 15–30, n = 18), group 4: severe OSA (AHI > 30, n = 24). Real‐time three‐dimensional echocardiographic images were acquired to obtain RV regional (inflow, body and outflow) ejection fraction (EF) and time to minimum systolic volume in all subjects.

Results

Body weight and body mass index were greater in the severe and moderate OSA group than those of mild and controls group (P < 0.05). There was a significant decrease in mean SaO2 and the lowest SaO2 in severe OSA when compared to other groups (P < 0.001). Inflow EF and global EF were significantly lower in moderate and severe OSA patients than in controls (P < 0.05). Inflow EF and global EF were negatively correlated with AHI (r = −0.534 and r = −0.479, respectively, P < 0.001).

Conclusions

In patients with OSA, RV inflow and global systolic function were impaired and were in inverse relationship with AHI. Evaluation of RV regional systolic function using real‐time three‐dimensional echocardiography may play a potential role in the noninvasive assessment of the severity of OSA.
Hospitalisation of multiethnic older patients with AECOPD: exploration of the occurrence of anxiety, depression and factors associated with short‐term hospital readmission
Authors: Al Aqqad Sana’ M.H. , Tangiisuran Balamurugan , Hyder Ali Irfhan Ali , Md. Kassim Razul Md. Nazri , Wong Jyi Lin , Tengku Saifudin Tengku Ismail
Published: January 2016

Introduction

The elderly, with chronic obstructive pulmonary disease (COPD), are at a higher risk of hospitalisation due to acute exacerbation of COPD (AECOPD). They also often encounter multiple co‐morbidities.

Objectives

This study was aimed to explore the occurrence of anxiety, depression and to identify the factors associated with hospital readmission among older patients after AECOPD discharge.

Methods

A multicentre prospective study was conducted in Malaysia (from 1st September 2012 till 31st September 2013) among older patients (≥60 years) hospitalised for AECOPD. Anxiety and depression were assessed on discharge using previously validated questionnaires, Generalized Anxiety Disorder‐7 (GAD‐7 and Geriatric Depression Scale (GDS‐15), respectively. Patients were followed up for a period of 3 months after discharge.

Results

A total of 81 patients with a median age of 72 years (IQR 66.40–78.00) were recruited. Anxiety was observed in 34.57% while 38.27% had depression. Both anxiety and depression were detected in 25.93% of the patients. A history of frequent AECOPD admissions was found to be associated with developing depressive symptoms, while anxiety scores were associated with severe dyspnoea. Severe depression was more commonly identified among patients aged 60–75 and in those with a history of tuberculosis. A high readmission rate (40.74%) during the 3‐month period was noticed. History of frequent AECOPD admissions (OR = 2.87; 95% CI 1.05–7.85, P = 0.040) and ischemic heart disease (IHD) (OR = 4.04; 95% CI 1.1–14.6, P = 0.032) were identified as the factors associated with the risk of hospital readmission.

Conclusions

Anxiety and depression were found to be relatively common among older patients with AECOPD. IHD and history of frequent COPD hospitalisation were associated with short‐term readmission among the elderly.
Immunohistochemical analysis of lichenoid reactions in patients treated with anti‐PD‐L1 and anti‐PD‐1 therapy
Authors: Schaberg Kurt B. , Novoa Roberto A. , Wakelee Heather A. , Kim Jinah , Cheung Christine , Srinivas Sandhya , Kwong Bernice Y.
Published: January 2016

Background

Recent advances in the immunotherapeutic treatment of cancer have led to the development of multiple new directed therapies including monoclonal antibodies that block the immune checkpoint T‐cell receptor programmed death 1 (PD‐1) and the PD‐1 ligand, programmed death ligand 1 (PD‐L1). Various immune‐related toxicities have been associated with these drugs including, most commonly, skin rashes.

Methods

Five cases of lichenoid dermatitis, including one case of lichenoid mucositis and one case of lichen sclerosus, associated with anti‐PD‐L1 and anti‐PD1 therapy were compared with three biopsies of non‐drug‐related lichen planus (LP) and three lichen planus‐like keratoses (LPLK) used as controls.

Results

Histopathologic and immunophenotypic analysis of these lichenoid lesions demonstrated significantly greater histiocytic infiltrates than observed in control lichenoid reactions (p = 0.0134). We also observed increased spongiosis and epidermal necrosis. No significant differences were seen in expression of CD3, CD4:CD8, CD20, PD‐1, CD25, Foxp3, CXCL13 and PD‐L1 expression.

Conclusions

These findings expand the literature of immune‐related toxicities of PD‐L1 and PD‐1 blockade to include lichenoid dermatitis and lichenoid mucositis. Of note, these cutaneous side effects were amenable to topical treatment, without the need for medication dose reduction or discontinuation.
Utilization of polarized microscopy to differentiate deep penetrating nevus from equine type melanomas
Authors: Cleaver Nathan , Parikh Kruti , Kazlouskaya Viktoryia , Elston Dirk
Published: January 2016

Equine type melanoma can mimic deep penetrating nevus (DPN), making histologic diagnosis challenging. We sought to investigate if the pattern of collagen polarization could be helpful in this setting. A total of 52 specimens were reviewed with polarized microscopy to determine whether refractile collagen was present within melanocytic nests vs. surrounding but not within the nests. Seven of eight (87.5%) equine type melanomas demonstrated refractile collagen within melanocytic nests in part or all of the lesion. In contrast, DPN showed no refractile collagen within the melanocytic nests. Instead, 12 (100%) DPNs and 14 of 16 (87.5%) common combined nevi (DPN plus banal nevus) demonstrated refractile collagen only surrounding melanocytic nests. The entrapment of refractile collagen, as seen with polarized microscopy, within melanocytic nests can support a diagnosis of equine type melanoma.
Limitations of Ber‐EP4 for distinction of Bowen disease from basal cell carcinoma
Authors: Kogut Marta , Toberer Ferdinand , Enk Alexander H. , Hassel Jessica C.
Published: January 2016

Background

Diagnostic differentiation between Bowen disease a variant of squamous cell carcinoma in situ (SCCIS) and basal cell carcinoma (BCC) can be difficult on the basis of hematoxylin and eosin (routine) staining in small or fragmented biopsy samples. Ber‐EP4 staining is diagnostically reliable for differentiation between BCC and cutaneous squamous cell carcinoma [Dasgeb et al. Biomark Cancer, 5: 7, (2013); Tellechea et al. Am J Dermatopathol, 15: 452 (1993)]. The objective of this study was to determine the usefulness of Ber‐EP4 staining for differentiation of SCCIS from BCC.

Methods

Here, we performed immunohistochemistry with a Ber‐EP4 antibody in 76 cases of Bowen type of SCCIS. As positive controls we selected 16 cases of BCC.

Results

A positive reaction was obtained for Ber‐EP4 in the secretory portion of eccrine and apocrine glands and in follicular germinative cells at the lower end of catagen hairs of normal skin tissue. All BCC samples tested were positive. Of the Bowen type SCCIS samples, 26.3% reacted positively (at least 5% positive staining of neoplastic cells). In 3/76 cases (3.9%) more than 50% of the tumor cells expressed Ber‐EP4.

Conclusion

We conclude that Ber‐EP4 expression is not always helpful to distinguish between Bowen type of SCCIS and BCC, as Ber‐EP4 expression in Bowen type SCCIS is not infrequent.
Strabismus, a preventable barrier to social participation: a short report
Authors: Blair Eve , Smithers‐Sheedy Hayley ,   the Australian Cerebral Palsy Register Group
Published: January 2016

Isolated strabismus does not significantly impair visual functionality and has traditionally been considered a primarily cosmetic defect of little importance. However, even in the absence of strabismus amblyopia, manifest strabismus and its non‐surgical treatments can render the person less socially acceptable, creating a barrier to participation and resulting in psychosocial disadvantage that has been documented in the typically developing population. The Australian Cerebral Palsy Register traditionally recorded strabismus only if it were not accompanied by visual impairment; however, even these data indicate that the proportion of cerebral palsy registrants with strabismus is many times higher than in comparable population samples, compounding their challenges to achieve participation. It is therefore inappropriate to continue to consider strabismus as merely a cosmetic defect, but one that deserves surgical correction early in life.
A special supplement: findings from the Australian Cerebral Palsy Register, birth years 1993 to 2006
Authors: Smithers‐Sheedy Hayley , McIntyre Sarah , Gibson Catherine , Meehan Elaine , Scott Heather , Goldsmith Shona , Watson Linda , Badawi Nadia , Walker Karen , Novak Iona , Blair Eve ,   The Australian Cerebral Palsy Register Group
Published: January 2016

Aim

To briefly outline the strengths and limitations of cerebral palsy (CP) registers, and to report on findings of the Australian Cerebral Palsy Register (ACPR) pertaining to a population cohort of children with CP.

Method

De‐identified data were extracted from the ACPR for people with CP in birth years 1993 to 2006, from South Australia, Victoria, and Western Australia. Live birth prevalence of CP was estimated and risk factors described.

Results

The overall birth prevalence of CP (including those whose CP was postneonatally acquired) for the 1993 to 2006 birth cohort was 2.1 per 1000 live births (95% confidence interval [CI] 2.0–2.2). Excluding cases with a known postneonatal cause, the birth prevalence for pre/perinatally acquired CP was 2.0 per 1000 live births (95% CI 1.9–2.1). A downward trend in rates of CP in those born extremely preterm was evident over at least three consecutive periods across all three regions. Most (58.6%) children were born at term (≥37wks). Male sex, early gestational age, low birthweight, and multiple birth were risk factors for CP.

Interpretation

Overall rates of CP did not change during this period. The proportion of those with CP born extremely preterm decreased. The ACPR Group will investigate whether this pattern continues when data pertaining to the next birth cohort for all three regions becomes available.
A three dimensional free body analysis describing variation in the musculoskeletal configuration of the cynodont lower jaw
Authors: Reed D. A. , Iriarte‐Diaz J. , Diekwisch T. G. H.
Published: January 2016

The evolution of the middle ear from the cynodont craniomandibular bones is one of the key mammalian innovations, and the mechanics underlying this anatomical transformation represents an intriguing paradox. Because the jaw joint of nonmammalian cynodonts was functionally coupled to the inner ear, auditory performance would favor low joint reaction forces. However, this could not be achieved at the expense of feeding performance, favoring high bite forces. The balance of these two seemingly incompatible performance criteria in the context of the morphological diversity of the cynodont lower jaw is poorly understood. Here we derive a series of equations using three dimensional free body analysis that describe the relationship between the orientation and position of the jaw elevator muscles, the position of the jaw articulation relative to the bite point, the joint reaction forces and the bite force in the lower jaw of the nonmammalian cynodontProbainognathus. These equations permit the effects of variation in each variable to be tested independently, yielding three terms that act to limit joint reaction forces without substantially impacting bite force: the reorientation of the resultant muscle force more vertically, shifting the position of the bite point medial to the jaw articulation, and elevating the jaw articulation above the level with the tooth row only when the muscles are oriented principally in the anterior direction. The predictions from our equations provide insights for functional interpretations of patterns of morphological diversity in the cynodont fossil record. They also illustrate that the musculoskeletal configuration of the cynodont lower jaw can be evolutionarily labile without negatively impacting the dual performance criteria of the auditory and feeding system.
Teaching mandibular implant‐Supported overdentures in dental schools in North America – a survey
Authors: Ben‐Gal G. , Ziv Y. , Weiss E. I. , Zabrovsky A.
Published: January 2016

Introduction

Mandibular two‐implant overdentures are considered the minimum standard of care for edentulous patients and provide an excellent performance, as well as satisfaction to the patients. Dental schools are required to promote the teaching of current treatment options in order to enable students to master state‐of‐the‐art procedures.

Aims

The purpose of this study was to examine how the theoretical and practical aspects of mandibular two‐implant overdentures are taught in dental schools in North America.

Methods

Data were collected via an online questionnaire that included questions regarding the theoretical and clinical courses, surgical procedure and imaging method.

Results

Of 75 schools, 36 responded to the survey. Almost all the schools teach the subject theoretically, but it is not mandatory for students to perform in most of the schools. Only a minority (23%) of the mandibular dentures made by students are implant‐supported. Almost all of the schools (94%) use two implants to support overdentures, and Locator abutment is used almost exclusively. The prevalent imaging for the surgical procedure is CT scans, although 30% of the schools use panoramic radiograph. None of the schools loads the implants immediately after surgery.

Conclusion

Some clear trends are apparent in the current survey: the use of two implants, no use of bar connectors and delayed loading of the implants. It is likely that graduates will not have sufficient clinical skills and will need continuing education to be familiar with the required procedures, both surgical and prosthetic.
Long‐lasting deficits in hedonic and nucleus accumbens reactivity to sweet rewards by sugar overconsumption during adolescence
Authors: Naneix Fabien , Darlot Florence , Coutureau Etienne , Cador Martine
Published: January 2016

Adolescence is a critical period characterized by major neurobiological changes. Chronic stimulation of the reward system might constitute an important factor in vulnerability to pathological development. In spite of the dramatic increase in the consumption of sweet palatable foods during adolescence in our modern societies, the long‐term consequences of such exposure on brain reward processing remain poorly understood. Here, we investigated in rats the long‐lasting effects of sugar overconsumption during their adolescence on their adult reactivity to the hedonic properties of sweet rewards. Adolescent rats with continuous access to 5% sucrose solution (from postnatal day 30–46) showed escalating intake. At adulthood (post‐natal day 70), using two‐bottle free choice tests, sucrose‐exposed rats showed lower intake than non‐exposed rats suggesting decreased sensitivity to the rewarding properties of sucrose. In Experiment 1, we tested their hedonic‐related orofacial reactions to intraoral infusion of tasty solutions. We showed that sucrose‐exposed rats presented less hedonic reactions in response to sweet tastes leaving the reactivity to water or quinine unaltered. Hence, in Experiment 2, we observed that this hedonic deficit is associated with lower c‐Fos expression levels in the nucleus accumbens, a brain region known to play a central role in hedonic processing. These findings demonstrate that a history of high sucrose intake during the critical period of adolescence induces long‐lasting deficits in hedonic treatment that may contribute to reward‐related disorders.