bluuebunny/crossref_metadata_2025 huggingface dataset:
West Kendall Baptist Hospital: meeting the demand of community-based healthcare in the new (and stormy) regulatory environment
Authors: Weismann Miriam , Hernandez Lichtl Javier , Pierce Heather , Harris Denise , Boue Lourdes , Campbell Cathy
Published: October 2017

Synopsis

The first three years of operation of the West Kendall Baptist Hospital (WKBH) in Miami, Florida provided a “poster child” for efficient and cost effective healthcare delivery to the West Kendall community that it served. The hospital leadership and management team exemplified a quality-oriented staff that moved as a cohesive and dedicated organization. WKBH exceeded every budget prediction and showed a profit in year 3, well before expected. Then came the winds of regulatory change. With the passage of the Affordable Care Act (ACA) and the attendant imposition of new reimbursement metrics, the picture at WKBH changed almost overnight. By the first quarter of 2016, WKBH started to lose money in excess of budget predictions despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis was looming with little relief in sight. The hospital management team began to search for solutions.

Research methodology

The research methodology includes collecting quantitative data: original financial statements and financial data from WKBH, as well as qualitative data: interviews of hospital administrators and historical information.

Relevant courses and levels

Graduate capstone course in a finance course; masters in health administration; and/or the MBA program.

Theoretical bases

While it is clear that the ACA was designed with all good intentions, it has created substantial and perhaps, unanticipated financial burdens for caregivers. These issues are not only faced by WKBH. Most hospitals could relate to one or more of the four questions examined as part of this learning process. Graduate MBA students worked with the hospital to identify, define, focus, and resolve difficult quantitative and qualitative issues faced by the hospital as a result of major changes in the regulatory environment with the passage of the ACA. This case focuses upon the current reimbursement environment that has only recently emerged as a result of the implementation of the ACA.
Comparing two approaches to team building: a performance measurement evaluation
Authors: Ciasullo Maria Vincenza , Cosimato Silvia , Gaeta Matteo , Palumbo Rocco
Published: October 2017

Purpose

This paper reports a study that compares two different team-building approaches. The first one is the traditional top-down management approach. The second one is a hybrid bottom-up approach based on the consensus model. The aim of this paper is to determine which of the two approaches is the most effective across a number of performance measurements.

Design/methodology/approach

A case study is presented using data collected and analysed from a small family-owned vehicle maintenance firm. A mixed methods approach to data collection is utilized, including participant observation, focus groups, survey questionnaires and organizational performance reports. A convenience sample of eight routine maintenance jobs was selected for team performance comparison purposes. The measures used for comparing the two team approaches were lead time, customer satisfaction ratings and employees’ satisfaction ratings.

Findings

The teams assembled using the consensus approach performed better than those selected using the traditional top-down approach across all three performance measures, i.e. the jobs were completed faster and both customers and employees were more satisfied.

Research limitations/implications

This is an exploratory case study limited to one small family-owned business and, as such, findings may not be generalizable.

Practical implications

As an alternative to manager selected work teams, managers should involve and empower employees to select their own teams. This has the potential to offer benefits for both customers and employees of faster delivery times and increase satisfaction, as well as increase productivity for the firm.

Originality/value

This is the first field study to compare the performance of a hybrid, bottom-up approach to team building with the performance of a more traditional management, top-down approach to team building. It paves the way for a wider study to be conducted in the future to test the findings’ generalizability.
Towards enhancing innovation capability of teams: a conceptual perspective
Authors: Tikas Gaurav Dilip , K.B. Akhilesh
Published: October 2017

Purpose

This conceptual paper aims to explain the unidirectional cross-level impact of five “organizational-level” factors on “team-level” innovation capability through two “team-level” mediating factors. This multivariate model consists of five organizational-level factors (higher-level) factors – leadership, culture, structure, networks and knowledge – and team-level (lower-level) factors – “innovation capability”, “team-level focus” and “team-level intensity” towards innovation. Understanding the top-down influence of higher-level factors on lower-level ones gives this study a cross-level and unidirectional nature.

Design/methodology/approach

A keyword-based approach was used to select “relevant” articles from major journals to collect evidences and develop a conceptual model. All factors in the conceptual model were chosen from the organizational- and the team-level literature. Theoretical background for each of the chosen “factors” has been presented under relevant headings.

Findings

First is the conceptualization of team-level mediators – intensity and focus – towards innovation. Second is the conceptualization of innovation capability as a team-level factor, characterized by two sub-dimensions: customer orientation and manifestation.

Research limitations/implications

This conceptual paper does not contain any empirical data analysis. The authors have not considered individual-level factors like individual excellence, personalities, etc., which may impact team-level innovation. They are specifically looking at the top-down “unidirectional” cross-level impact of “higher-level” (organizational-level) factors on “lower-level” (team-level) factor, not the other way around.

Practical implications

Innovation-driven organizations can use this model to build long-term “innovation capabilities” by developing the right kind of “intensity” and “focus” of their R&D teams towards innovation. R&D teams can be encouraged to work closely with their “target” customers and manifest their innovation capabilities (to them) to ensure market success.

Social implications

Top management can design organizational-level policies to improve their leadership, culture, structure, networks and knowledge to encourage better innovation. Future researchers who wish to study the “cross-level” influence of organizational-level factors on team-level innovation capability may find this paper useful.

Originality/value

This study’s original contributions include: first, the conceptualization of a multivariate “cross-level” model to understand team-level innovation capability. Second is proposing the mediating role of “team-level” factors like focus and intensity while building innovation capability. Third is conceptualizing innovation capability as a team-level construct, with sub-dimensions: customer orientation and manifestation.
Productivity dynamics and the cleansing effect of two recessions: Evidence from the manufacturing sector in Korea
Authors: Lee Hun Jun , Lee Jeong‐Dong , Baek Chulwoo
Published: October 2017

In general, recessions provoke the exit of a greater number of firms from the market. Less productive firms are more likely to exit and release their former resources to the remaining, more productive firms. The present study investigates two recessions in Korea: the Asian financial crisis and the global financial crisis. The main objective of the present study is to analyse the process of creative destruction in a recession, specifically the cleansing effect. We measured total factor productivity using micro‐level manufacturing plant data from 1993 to 2013. We decomposed the source of the changes in total factor productivity to measure the cleansing effect in two large recessions. During the first recession in the 1990s, there was no evidence to support a cleansing effect hypothesis. In contrast, during the second recession in the 2000s, there was evidence of a cleansing effect. In addition, we found differences in market selection criteria in the two recessions; by the second crisis, the market selection criteria had changed to enable a more conducive environment for the creative destruction process.
Effect of whey protein‐iron based edible coating on the quality of Paneer and process optimisation
Authors: Jotarkar Parameshwar S , Panjagari Narender R , Singh Ashish K , Arora Sumit
Published: October 2017

Whey protein concentrate (WPC)‐based edible coating containing one of the four different iron salts was used to enhance the nutritional quality of Paneer in the study. Ferric ammonium citrate containing WPC coating solutions decreased the L* but increased a* and b*. Principal component analysis identified three significant principal components that accounted for 88.85% of the variation in the sensory and instrumental colour data. Response surface methodology predicted that maximum iron content in Paneer (93.5 ppm) could be achieved with 100 mL of dipping volume, 1.5 cm of cube size and 10‐min dipping time as processing parameters.
Symbols of priority? How the media selectively report on parties’ election campaigns
Authors: GREENE ZACHARY , LÜHISTE MAARJA
Published: October 2017

Leaders and members of parliament serve as a political party's public face. Their image casts a shadow in which observers interpret policy statements. It is hypothesized in this article that media cover and voters understand policy messages through the lens of prominent party members’ characteristics. Easy‐to‐observe descriptive traits, such as gender or ethnicity, cue parties’ policy priorities. Media are more likely to emphasise party messages on issues historically related to these groups when they are visible in the party's public image. Hypotheses from this theory are tested using data on prominent party members’ descriptive characteristics, policy statements and media coverage of statements from the European Election Studies. Data from the 1999, 2004 and 2009 European elections evidence support for the theory. Parties with more female representatives signal stronger emphasis on gendered issues in media reports. The results hold implications for understanding the ways in which parties deliver and voters receive campaign messages. This research offers an explanation for voters’ limited knowledge of parties’ policy positions; media reinforce existing gender stereotypes and voters’ predispositions by selectively reporting policy statements.
The Relationship Between Gambling Severity and Risk of Criminal Recidivism
Authors: April Laura M. , Weinstock Jeremiah
Published: October 2017

Individuals involved with the criminal justice system have the highest prevalence of gambling disorder. Yet, this is an understudied area, especially in relation to postrelease functioning and recidivism risk. Participants (N = 100) were recruited from a local nonprofit organization and a federal probation office. Participants completed both self‐report and interviewer‐administered questionnaires assessing past‐year and lifetime gambling behaviors and problems, legal history, health, and risk of recidivism. Past‐year (8%) and lifetime (18%) rates of gambling disorder among the current sample are significantly greater than those of the general population and similar to rates found in incarcerated populations. Furthermore, 13% of individuals reported a direct relationship between their gambling and crime, and analyses revealed that increased gambling severity was a significant predictor of increased recidivism risk. Results suggest the need for screening and intervention efforts and call for policy reform among incarcerated and ex‐offender populations.
FGF23 Level and Intima‐Media Thickness Are Elevated From Early Stages of Chronic Kidney Disease
Authors: Figurek Andreja , Spasovski Goce , Popovic‐Pejicic Snjezana
Published: October 2017

Considering high cardiovascular (CV) risk in chronic kidney disease (CKD), the aim of this cross‐sectional study was to assess the association between carotid intima‐media thickness (IMT) and fibroblast growth factor (FGF) 23 as important players in CV pathophysiology. Eighty‐seven patients with mean estimated glomerular filtration rate 40.1 mL/min per 1.73 m2 were involved. FGF23 and IMT were elevated from early stages of CKD. Mean IMT value was 1.10 ± 0.20 mm, being significantly elevated starting from early CKD, showing no correlation with FGF23 (r = −0.01, P = −0.91). Unlike the FGF23 level that followed worsening of kidney function, IMT was increasing only in the initial CKD stages, with no further increase from CKD stage 3 on. Although we found no direct association between current use of vitamin D and statin therapy, this may be associated with the sustained reference values of lipid and vitamin D status under treatment that further preclude worsening of IMT in patients with advanced CKD.
Communicating Value in Simulation: Cost–Benefit Analysis and Return on Investment
Authors: Asche Carl V. , Kim Minchul , Brown Alisha , Golden Antoinette , Laack Torrey A. , Rosario Javier , Strother Christopher , Totten Vicken Y. , Okuda Yasuharu
Published: October 2017

Value‐based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and the economic effects of potentially expensive simulation programs to rationalize the costs. Given the often‐disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Clinical educators need to be able to present thorough economic analyses demonstrating returns on investment and cost‐effectiveness to effectively communicate with administrators.

At the 2017 Academic Emergency Medicine Consensus Conference “Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes,” our breakout session critically evaluated the cost‐benefit and return on investment of simulation. In this paper we provide an overview of some of the economic tools that a clinician may use to present the value of simulation training to financial officers and other administrators in the economic terms they understand. We also define three themes as a call to action for research related to cost–benefit analysis in simulation as well as four specific research questions that will help guide educators and hospital leadership to make decisions on the value of simulation for their system or program.
Hypocretin receptor 1 knockdown in the ventral tegmental area attenuates mesolimbic dopamine signaling and reduces motivation for cocaine
Authors: Bernstein David L. , Badve Preeti S. , Barson Jessica R. , Bass Caroline E. , España Rodrigo A.
Published: October 2017

The hypocretin receptor 1 (HCRTr1) is a critical participant in the regulation of motivated behavior. Previous observations demonstrate that acute pharmacological blockade of HCRTr1 disrupts dopamine (DA) signaling and the motivation for cocaine when delivered systemically or directly into the ventral tegmental area (VTA). To further examine the involvement of HCRTr1 in regulating reward and reinforcement processing, we employed an adeno‐associated virus to express a short hairpin RNA designed to knock down HCRTr1. We injected virus into the VTA and examined the effects of HCRTr1 knockdown on cocaine self‐administration and DA signaling in the nucleus accumbens (NAc) core. We determined that the viral approach was effective at reducing HCRTr1 expression without affecting the expression of hypocretin receptor 2 or DA‐related mRNAs. We next examined the effects of HCRTr1 knockdown on cocaine self‐administration, observing delayed acquisition under a fixed‐ratio schedule and reduced motivation for cocaine under a progressive ratio schedule. These effects did not appear to be associated with alterations in sleep/wake activity. Using fast‐scan cyclic voltammetry, we then examined whether HCRTr1 knockdown alters DA signaling dynamics in the NAc core. We observed reduced DA release and slower uptake rate as well as attenuated cocaine‐induced DA uptake inhibition in rats with knockdown of HCRTr1. These observations indicate that HCRTr1 within the VTA influence the motivation for cocaine, likely via alterations in DA signaling in the NAc.
Application of a Simplified Hand‐Sewn Trileaflet Valved Conduit in Right Ventricular Outflow Tract Reconstruction as an Alternative for Bovine Jugular Vein Graft: Single‐Center Experience
Authors: Zhang Hui‐Feng , Ye Ming , Yan Xian‐Gang , Chen Gang , Tao Qi‐Lin , Jia Bing
Published: October 2017

The Bovine jugular vein (BJV) graft for right ventricular outflow tract reconstruction (RVOT) is limited applied due to possible graft failure. In this study, we reported the clinical application of simplified hand‐sewn trileaflet valved conduit as an alternative for BJV graft. We retrospectively included 68 patients underwent 76 conduits implantation including 22 new simplified hand‐sewn trileaflet valved conduits (Group A) and 54 BJV grafts (Group B). For patients in Group A, a hand‐sewn trileaflet valved conduit with valves made of autologous pericardium or expanded polytetrafluoroethylene was applied. Baseline, perioperative, and outcomes were analyzed. No early mortality or perioperative complication occurred in Group A, while 2 patients died and 16 patients suffered from conduits failure due to conduits stenosis (n = 11), stenosis plus regurgitation (n = 3), and regurgitation alone (n = 2) in Group B. Freedom from BJV grafts failure within 1, 3, 5, and 7 years was 98.0%, 88.2%, 83.6% and 83.6% in Group A, and 98.0%, 85.8%, 76.8% and 62.1% in Group B. Endocarditis occurred in 9 patients in Group B, but not in Group A. Subsequent analysis showed that endocarditis is the only significant predictor of BJV grafts failure (odds ratio: 6.202, 95% confidence intervals 1.237∼31.108). The novel simplified hand‐sewn trileaflet valved conduits seems to be associated with lower incidences of perioperative complication, graft failure, and early‐phase mortality, as compared with conventional BJV grafts.
Effects of manipulating tetanic calcium on the curvature of the force‐velocity relationship in isolated rat soleus muscles
Authors: Kristensen A. M. , Nielsen O. B. , Overgaard K.
Published: October 2017

Aim

In dynamically contracting muscles, increased curvature of the force‐velocity relationship contributes to the loss of power during fatigue. It has been proposed that fatigue‐induced reduction in [Ca++]i causes this increased curvature. However, earlier studies on single fibres have been conducted at low temperatures. Here, we investigated the hypothesis that curvature is increased by reductions in tetanic [Ca++]i in isolated skeletal muscle at near‐physiological temperatures.

Methods

Rat soleus muscles were stimulated at 60 Hz in standard Krebs‐Ringer buffer, and contraction force and velocity were measured. Tetanic [Ca++]i was in some experiments either lowered by addition of 10 μmol/L dantrolene or use of submaximal stimulation (30 Hz) or increased by addition of 2 mmol/L caffeine. Force‐velocity curves were constructed by fitting shortening velocity at different loading forces to the Hill equation. Curvature was determined as the ratio a/F0 with increased curvature reflecting decreased a/F0.

Results

Compared to control levels, lowering tetanic [Ca++]i with dantrolene or reduced stimulation frequency decreased the curvature slightly as judged from increase in a/F0 of 13 ± 1% (P = < .001) and 20 ± 2% (P = < .001) respectively. In contrast, increasing tetanic [Ca++]i with caffeine increased the curvature (a/F0 decreased by 17 ± 1%; P = < .001).

Conclusion

Contrary to our hypothesis, interventions that reduced tetanic [Ca++]i caused a decrease in curvature, while increasing tetanic [Ca++]i increased the curvature. These results reject a simple causal relation between [Ca++]i and curvature of the force‐velocity relation during fatigue.
Dominant high expression of wild‐type HSP110 defines a poor prognostic subgroup of colorectal carcinomas with microsatellite instability: a whole‐section immunohistochemical analysis
Authors: Oh Hyeon Jeong , Kim Jung Ho , Lee Tae Hun , Park Hye Eun , Bae Jeong Mo , Lee Hye Seung , Kang Gyeong Hoon
Published: October 2017

The aim of this study is to establish heat shock protein 110 (HSP110) as a prognostic biomarker of colorectal carcinomas (CRCs) with microsatellite instability‐high (MSI‐H) by considering the intratumoral heterogeneity of HSP110 expression. We performed whole‐section immunohistochemistry (IHC) for wild‐type HSP110 (HSP110wt) in 164 MSI‐H CRCs. The intensity of the HSP110wt expression in tumor cells was semiquantitatively scored (0/1/2/3), and the HSP110wt expression status of each tumor was classified as low or high using the following four scoring criteria: H‐score, dominant intensity score, lowest intensity score, and highest intensity score. Among the four criteria, only the dominant intensity score‐based dichotomous classification of HSP110wt expression was significantly associated with a difference in disease‐free survival (log‐rank p = 0.035) in 164 MSI‐H CRCs. The HSP110wt‐low MSI‐H CRCs were significantly correlated with larger deletions in the HSP110 T17 mononucleotide repeat (≥4 bp; p < 0.001). In conclusion, the dominant intensity score‐based assessment of HSP110wt IHC can be a simple and useful method for the prognostic stratification of MSI‐H CRCs. It is expected that HSP110wt IHC may be used to identify a subgroup of MSI‐H CRCs with poor prognosis and/or candidates for further treatment, such as immunotherapy using immune checkpoint inhibitors in MSI‐H CRCs.
Aging adult porcine fibroblasts can support nuclear transfer and transcription factor‐mediated reprogramming
Authors: Li Xia , Zhang Pengfei , Jiang Shaoshuai , Ding Biao , Zuo Xiaoyuan , Li Yunsheng , Cao Zubing , Zhang Yunhai
Published: October 2017

Somatic cell nuclear transfer (SCNT) and induced pluripotent stem cells (iPSCs) technology are two classical reprogramming methods. Donor cell types can affect the reprogramming results in the above two methods. We here used porcine embryonic fibroblasts (PEFs) and adult porcine ear skin fibroblasts (APEFs) and adipose‐derived stem cells (ADSCs) as donor cells forSCNTand source cells foriPSCs to study theirin vitrodevelopmental capability and colony‐formation efficiency, respectively. ForSCNT, fusion and cleavage rate has no significant difference amongPEFs,ADSCs andAPEFs. The rate and total cell number of blastocysts in theAPEFgroup were significant lower than that inPEFs andADSCs. For transcription factor‐mediated reprogramming, the reprogramming efficiency ofADSCs were significantly higher thanPEFs andAPEFs and there is no significant difference betweenPEFs andAPEFs. Furthermore,PEFs,APEFs andADSCs can be used to generateiPSCs. Fianlly, somatic cloned pigs could still be successfully generated fromAPEFs, suggesting terminally differentiated aging adult somatic cells could be reprogrammed into a totipotent state. Considering the easy availability of animal tissue and the costs of establishing cell lines, aging porcine ear fibroblasts can support nuclear transfer‐mediated and transcription factor‐based reprogramming.
RISK‐SHARING MATCHING AND MORAL HAZARD
Authors: Chen Pu , Li Sanxi , Ye Bing
Published: October 2017

In this study we model the endogenous relationship formation between risk‐averse principals and agents in a CARA‐normal framework. Agents exert unobservable efforts to increase mean outputs and reduce risks. We show that risk‐reduction efforts are more important than mean‐increasing efforts in determining the matching patterns. Compared to cases without moral hazard, the agency problem in risk reduction induces more positive‐assortative matchings.
Agonism of free fatty acid receptors 1 and 4 generates peptide YY‐mediated inhibitory responses in mouse colon
Authors: Moodaley Runisha , Smith David M , Tough Iain R , Schindler Marcus , Cox Helen M
Published: October 2017

Background and Purpose

Free fatty acid receptors FFA1 and FFA4 are located on enteroendocrine L cells with the highest gastrointestinal (GI) expression in descending colon. Their activation causes the release of glucagon‐like peptide 1 and peptide YY (PYY) from L cells. Additionally, FFA1 agonism releases insulin from pancreatic β cells. As these receptors are modulators of nutrient‐stimulated glucose regulation, the aim of this study was to compare the pharmacology of commercially available agonists (TUG424, TUG891, GW9508) with proven selective agonists (JTT, TAK‐875, AZ423, Metabolex‐36) in mice.

Experimental Approach

Mouse mucosa was mounted in Ussing chambers, voltage‐clamped and the resultant short‐circuit current (Isc) was recorded continuously. Pretreatments included antagonists of FFA1, Y1 or Y2 receptors. Glucose sensitivity was investigated by mannitol replacement apically, and colonic and upper GI transit was assessed in vitro and in vivo.

Key Results

FFA1 and FFA4 agonism required glucose and reduced Isc in a PYY‐Y1 receptor‐dependent manner. The novel compounds were more potent than GW9508. The FFA1 antagonists (GW1100 and ANT825) blocked FFA1 activity only and revealed FFA1 tonic activity. The FFA4 agonist, Metabolex‐36, slowed colonic transit in vitro but increased small intestinal transit in vivo.

Conclusions and Implications

The selective FFA1 and FFA4 agonists were more potent at reducing Isc than GW9508, a dual FFA1 and FFA4 agonist. A paracrine epithelial mechanism involving PYY‐stimulated Y1 receptors mediated their responses, which were glucose sensitive, potentially limiting hypoglycaemia. ANT825 revealed tonic activity and the possibility of endogenous FFA1 ligands causing PYY release. Finally, FFA4 agonism induced regional differences in transit.
Characterization of a rat model of bortezomib‐induced painful neuropathy
Authors: Duggett Natalie A , Flatters Sarah J L
Published: October 2017

Background and Purpose

Bortezomib (Velcade®) is a breakthrough treatment for multiple myeloma, significantly improving patient survival. However, its use is limited by painful neuropathy often resulting in dose reduction/cessation of first‐line treatment due to lack of treatment. The aim of this study was to characterize a clinically relevant rat model of bortezomib‐induced painful neuropathy, using established evoked measures and novel ethological techniques, to aid drug discovery.

Experimental Approach

Adult male Sprague–Dawley rats were injected i.p. with 0.1 and 0.2 mg·kg−1 bortezomib, or its vehicle, on days 0, 3, 7 and 10. Multiple behavioural approaches were utilized: mechanical hypersensitivity, cold allodynia, heat hypersensitivity, motor co‐ordination, burrowing and voluntary wheel running. At maximal bortezomib‐induced mechanical hypersensitivity, 200 mg·kg−1 ethosuximide/vehicle and 100 mg·kg−1 phenyl N‐tert‐butylnitrone (PBN)/vehicle were administered i.p. in separate experiments, and mechanical hypersensitivity assessed 1, 3 and 24 h later.

Key Results

Bortezomib induced dose‐related mechanical hypersensitivity for up to 80 days. Bortezomib induced short‐term cold allodynia, but no significant change in heat hypersensitivity, motor co‐ordination, voluntary wheel running and burrowing behaviour compared to vehicle‐treated controls. Systemic PBN and ethosuximide significantly ameliorated bortezomib‐induced mechanical hypersensitivity.

Conclusions and Implications

These data characterize a reproducible rat model of clinical‐grade bortezomib‐induced neuropathy demonstrating long‐lasting pain behaviours to evoked stimuli. Inhibition by ethosuximide and PBN suggests involvement of calcium and/or ROS in bortezomib‐induced painful neuropathy. These drugs could be used as preclinical positive controls to assess novel analgesics. As ethosuximide is widely used clinically, translation to the clinic to treat bortezomib‐induced painful neuropathy may be possible.
Resource tracking and its conservation implications for an obligate frugivore (Procnias tricarunculatus, the three‐wattled bellbird)
Authors: Hamilton Debra , Singleton Rhine , Joslin John D.
Published: October 2017

In Monteverde, Costa Rica, the vulnerable Three‐wattled Bellbird (Procnias tricarunculatus) feeds primarily upon the fruit of Lauraceae species during its reproductive and post‐reproductive seasons. To understand and advance appropriate conservation measures, this study identified the bellbird's foraging challenges in its search for a temporally and spatially fluctuating resource. Although there are at least 96 species of Lauraceae found in the five life zones of Monteverde, the distinct distributions of tree species both among and within life zones require the bellbirds to track seasonal fruiting across the various zones. In this 6‐year study, we monitored the fruiting of tree species and bellbird abundance in 24 study plots within its post‐reproductive life zone, the Premontane Wet forest, to identify preferred bellbird food resources and how the fruiting of these species drives the spatial distribution of the bellbird. Our research revealed phenological patterns of annual, biennial, and triennial fruiting with high levels of fruiting synchrony within several identified key fruit species. Of critical conservation importance is that no single species of Lauraceae produced a consistent food supply for bellbirds each year. Therefore, even within life zones, the bellbird's survival depends on its mobility to search for and obtain fruit, as well as the availability of fruits of multiple tree species. The conservation implications include focused attention on multiple core areas within given life zones, protection of existing forest and remnant trees, and forest restoration with plantings of multiple tree species. We suspect that other tropical frugivorous species face similar conservation challenges.
Infants Distinguish Between Two Events Based on Their Relative Likelihood
Authors: Kayhan Ezgi , Gredebäck Gustaf , Lindskog Marcus
Published: October 2017

Likelihood estimations are crucial for dealing with the uncertainty of life. Here, infants' sensitivity to the difference in likelihood between two events was investigated. Infants aged 6, 12, and 18 months (N = 75) were shown animated movies of a machine simultaneously drawing likely and unlikely samples from a box filled with different colored balls. In different trials, the difference in likelihood between the two samples was manipulated. The infants' looking patterns varied as a function of the magnitude of the difference in likelihood and were modulated by the number of items in the samples. Looking patterns showed qualitative similarities across age groups. This study demonstrates that infants' looking responses are sensitive to the magnitude of the difference in likelihood between two events.
Childhood Amnesia in Children: A Prospective Study Across Eight Years
Authors: Peterson Carole , Hallett Darcy , Compton‐Gillingham Cassy
Published: October 2017

This was a prospective study of earliest memories across 8 years for 37 children who were of age 4–9 years initially. In three interviews (initial and after 2 and 8 years) children provided their three earliest memories; those from earlier interviews that were not spontaneously provided later were cued. There was little consistency in the earliest memory or overlap across interviews in spontaneous memories. The youngest group also forgot over half their initial memories although few were forgotten by older children. For consistency of content, 25%–32% of information by former 6‐ to 9‐year‐olds was the same after 8 years, but < 10% provided by the youngest children was the same and 22% was contradictory. Emotion and contextual coherence predicted memory retention.
Atopy in people aged 40 years and over: Relation to airflow limitation
Authors: Guevara‐Rattray E. M. , Garden F. L. , James A. L. , Wood‐Baker R. , Abramson M. J. , Johns D. P. , Sonia Buist A. , Burney P. G. J. , Haydn Walters E. , Toelle B. G. , Marks G. B.
Published: October 2017

Background

Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma.

Objective

To establish whether there is any independent association between atopy and post‐bronchodilator airflow limitation in the general population aged 40 years and over.

Methods

A cross‐sectional survey was conducted in a general population sample of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test weal to common aeroallergens ≥4 mm. Airflow limitation was defined as post‐bronchodilator spirometric (FEV1/FVC) ratio <lower limit of normal. Analyses were adjusted for potential confounding due to age, sex, smoking, race and socio‐economic status.

Results

The prevalence of atopy, ever diagnosed asthma and post‐bronchodilator airflow obstruction was 44.8%, 19.3% and 7.5%, respectively. In the population as a whole, atopy was associated with lower FEV₁ (adjusted difference −0.068L, 95% confidence interval (CI) −0.104 to −0.032), FVC (adj. difference −0.043L, 95% CI −0.086 to −0.0009) and post‐bronchodilator FEV₁/FVC ratio (adj. difference −0.011, 95% CI −0.017 to −0.0055). The effect of atopy on lung function was no longer apparent when participants who reported ever diagnosed asthma were excluded (FEV₁ −0.011L, [95% CI −0.05 to 0.028L], FVC −0.012L [95% CI −0.060 to 0.036] and FEV₁/FVC ratio −0.0012 [95% CI −0.0072 to 0.0047L]).

Conclusion and Clinical Relevance

The apparent association between atopy and post‐bronchodilator airflow limitation in the general population appears to be explained by the association between atopy and having ever diagnosed asthma and the effect of asthma on lung function.
Decrease in salivary cortisol levels after glucocorticoid dose reduction in patients with adrenal insufficiency: A prospective proof‐of‐concept study
Authors: Ceccato Filippo , Barbot Mattia , Lizzul Laura , Selmin Elisa , Saller Alois , Albiger Nora , Betterle Corrado , Boscaro Marco , Scaroni Carla
Published: October 2017

Background and aim

Patients with adrenal insufficiency (AI) require lifelong glucocorticoid (GC) replacement therapy. Cortisol measurement in saliva is increasingly being used: we assessed salivary cortisol rhythm in outpatients with AI, to provide new insights regarding the management of GC treatment.

Materials and methods

Nineteen AI outpatients collected six saliva samples from awakening (Fa, before taking the morning GC therapy), during the day (F1.5 h, F6 h before the afternoon GC dose, F8.5 h, F12 h) until bedtime (Fb). We measured daily cortisol exposure by calculating the area under the curve (AUCFa→Fb). Saliva samples were collected at baseline and one year after GG dose reduction (by at least 5 mg of hydrocortisone).

Results

Hydrocortisone equivalents decreased from median 25 mg/d (baseline, interquartile range IQR 20‐27.5) to 15 mg/d (IQR 15‐20, P < .01). As expected, we observed a reduction in both daily cortisol exposure (AUCFa→Fb 23 982 nmol·h/L, IQR 12 635‐45 369, to 14 689 nmol·h/L, IQR 7168‐25 378, P < .001) and salivary cortisol levels at F6 h (24.8 nmol/L, IQR 20.1‐35.7, to 21 nmol/L, IQR 8.7‐29.2, P < .05) and Fb (8.7 nmol/L, IQR 3.4‐20.2, to 3.7 nmol/L, IQR 3.0‐5.8, P < .05). None of the patients developed signs or symptoms consistent with AI after GC reduction. Median diastolic blood pressure (DPB) values fell from baseline to the end of follow‐up (87.5 mm Hg, IQR 80‐90, to 80 mm Hg, IQR 80‐85, P < .05). The AUCFa→Fb of patients at baseline was above the reference value (90th percentile of controls) in 12 patients (60%); after the dosage reduction, 30% of patients normalized their daily cortisol exposure (AUCFa→Fb).

Conclusions

The reduction in GC treatment in patients with AI resulted in better control of daily cortisol rhythm, measured with salivary cortisol, and in an improvement of DPB. Further studies are needed to ascertain if salivary cortisol could be used as a biomarker to manage GC replacement therapy.
Axenfeld‐Rieger syndrome
Authors: Seifi M. , Walter M.A.
Published: October 2017

Axenfeld‐Rieger syndrome (ARS) is a clinically and genetically heterogeneous group of developmental disorders affecting primarily the anterior segment of the eye, often leading to secondary glaucoma. Patients with ARS may also present with systemic changes, including dental defects, mild craniofacial dysmorphism, and umbilical anomalies. ARS is inherited in an autosomal‐dominant fashion; the underlying defect in 40% of patients is mutations in PITX2 or FOXC1. Here, an overview of the clinical spectrum of ARS is provided. As well, the known underlying genetic defects, clinical diagnostic possibilities, genetic counseling and treatments of ARS are discussed in detail.
Malectin gene polymorphisms promote cerebral palsy via M2‐like macrophage polarization
Authors: Shi W. , Zhu Y. , Zhou M. , Ruan Y. , Chen X. , Chen X.
Published: October 2017

The relationship between gene polymorphisms and the pathogenesis of cerebral palsy (CP) is uncovering recently. Here, we suggested that single nucleotide polymorphisms (SNPs) of MLEC gene might take part in the pathogenesis of CP. We genotyped and analyzed 6 SNP positions of MLEC gene in 916 CP patients and 957 healthy people, which are from the Chinese Han population. The results indicated significant associations between the risk of CP and rs10431386 [allele: P‐value = .006, odds ratio (OR) = 1.587, 95% confidence interval (CI) = 1.198‐1.967] and rs7964786 [allele: P‐value = .005, OR = 1.956, 95% CI = 1.238‐2.519] SNP positions of MLEC gene. Further investigations revealed that C alleles of rs10431386 and rs7964786 inhibit the expression of MLEC in blood of CP patients and macrophage cell line. in vitro experiments revealed that MLEC promotes M1 to M2 macrophage polarization. The results of in vitro studies suggest that C alleles of rs10431386 and rs7964786 on MLEC promotes CP by inhibiting M1 to M2 macrophage polarization. Generally, this work suggested the contribution of MLEC gene polymorphisms to the pathogenesis of CP.
Reserve Sizes Needed to Protect Coral Reef Fishes
Authors: Krueck Nils C. , Legrand Christelle , Ahmadia Gabby N. , Estradivari  , Green Alison , Jones Geoffrey P. , Riginos Cynthia , Treml Eric A. , Mumby Peter J.
Published: October 2017

Marine reserves are a commonly applied conservation tool, but their size is often chosen based on considerations of socioeconomic rather than ecological impact. Here, we use a simple individual‐based model together with the latest empirical information on home ranges, densities and schooling behaviour in 66 coral reef fishes to quantify the conservation effectiveness of various reserve sizes. We find that standard reserves with a diameter of 1–2 km can achieve partial protection (≥50% of the maximum number of individuals) of 56% of all simulated species. Partial protection of the most important fishery species, and of species with diverse functional roles, required 2–10 km wide reserves. Full protection of nearly all simulated species required 100 km wide reserves. Linear regressions based on the mean home range and density, and even just the maximum length, of fish species approximated these results reliably, and can therefore be used to support locally effective decision making.
Impact of machine perfusion after long static cold storage on delayed graft function incidence and duration and time to hospital discharge
Authors: Matos Ana Cristina C. , Requiao Moura Lúcio Roberto , Borrelli Milton , Nogueira Mario , Clarizia Gabriela , Ongaro Paula , Durão Marcelino Souza , Pacheco‐Silva Alvaro
Published: October 2017

Delayed graft function (DGF) is very high in our center (70%‐80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion—HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay.
Large variation in measures used to assess outcomes of opioid dependence treatment: A systematic review of longitudinal observational studies
Authors: Wiessing Lucas , Ferri Marica , Darke Shane , Simon Roland , Griffiths Paul
Published: October 2017

Issues

Treatment outcomes for drug users are critical for informing policy and therapeutic practice. The coherence of outcomes, changes and drug use measures from observational studies on opioid use treatment were reviewed.

Approach

Systematic review of the literature for longitudinal observational studies, from 1980 through November 2015, in all languages, with data on treated opioid users, using Pubmed, the Cochrane Library and additional strategies (e.g. Pubmed function ‘related citations’ and checking reference lists of eligible studies).

Key Findings

Twenty‐seven studies were included (11 countries, 85 publications, recruitment 1962–2009). Baseline n was >65 686 and median follow‐up 34.5 months (21 studies) or 51.4 person‐months (10 studies). Eight outcome domains were identified: ‘drug use’ (21/27 studies), ‘crime’ (13), ‘health’ (13), ‘treatment‐related’ outcomes (16), ‘social functioning’ (13), ‘harms’ (8), ‘mortality’ (13) and ‘economic estimates’ (2 studies). All studies using drug use outcomes included a binary (abstinence) category in at least one measure. Studies typically reported outcomes on less than half (on average 3.7 or 46%) of the eight outcome domains, while the average was 5.1 (64%) in seven studies initiated since 2000.

Implications and Conclusion

Wide variation exists in outcome measures found in longitudinal observational studies of treatment of opioid users. This reduces replicability of studies and suggests a lack of common expectations on treatment success. Future studies should consider using all or most of eight outcome domains identified (excluding economic analyses if unfeasible), non‐binary measures and amount/value of drugs used and consensus meetings with joint ownership of scientific, treatment and patient communities.
High sensitivity and specificity in proposed clinical diagnostic criteria for anti‐N‐methyl‐D‐aspartate receptor encephalitis
Authors: Ho Alvin C C , Mohammad Shekeeb S , Pillai Sekhar C , Tantsis Esther , Jones Hannah , Ho Reena , Lim Ming , Hacohen Yael , Vincent Angela , Dale Russell C
Published: October 2017

Aim

To determine the validity of the proposed clinical diagnostic criteria for anti‐N‐methyl‐d‐aspartate receptor (NMDAR) encephalitis in paediatric patients.

Method

The diagnostic criteria for anti‐NMDAR encephalitis proposed by Graus et al. (2016) use clinical features and conventional investigations to facilitate early immunotherapy before antibody status is available. The criteria are satisfied if patients develop four out of six symptom groups within 3 months, together with at least one abnormal investigation (electroencephalography/cerebrospinal fluid) and reasonable exclusion of other disorders. We evaluated the validity of the criteria using a retrospective cohort of paediatric patients with encephalitis. Twenty‐nine patients with anti‐NMDAR encephalitis and 74 comparison children with encephalitis were included.

Results

As expected, the percentage of patients with anti‐NMDAR encephalitis who fulfilled the clinical criteria increased over time. During the hospital inpatient admission, most patients (26/29, 90%) with anti‐NMDAR encephalitis fulfilled the criteria, significantly more than the comparison group (3/74, 4%) (p<0.001). The median time of fulfilling the criteria in patients with anti‐NMDAR encephalitis was 2 weeks from first symptom onset (range 1–6). The sensitivity of the criteria was 90% (95% confidence interval 73–98) and the specificity was 96% (95% confidence interval 89–99).

Interpretation

The proposed diagnostic criteria for anti‐NMDAR encephalitis have good sensitivity and specificity. Incomplete criteria do not exclude the diagnosis.

What this paper adds

The proposed clinical diagnostic criteria for anti‐N‐methyl‐d‐aspartate receptor (NMDAR) encephalitis by Graus et al. (2016) have high sensitivity and specificity in paediatric patients.

The median time of fulfilling the criteria in patients with anti‐NMDAR was 2 weeks from first symptom onset.
Work‐related traumatic dental injuries: Prevalence, characteristics and risk factors
Authors: Ugolini Alessandro , Parodi Giovanni Battista , Casali Claudia , Silvestrini‐Biavati Armando , Giacinti Flavio
Published: October 2017

Background/Aims

The prevalence of work‐related oral trauma is underestimated because minor dental injuries are often not reported in patients with several injuries in different parts of the body. In addition, little data are available regarding their characteristics. The aim of this epidemiological study was to determine the prevalence, types, and characteristics of occupational traumatic dental injuries (TDIs) in a large working community.

Materials and Methods

Work‐related TDIs that occurred during the period between 2011 and 2013 in the District of Genoa (Northwest of Italy, 0.86 million inhabitants) were analyzed. Patients’ data were obtained from the National Institute for Insurance against Accidents at Work database.

Results

During the 2 year period, 112 TDIs (345 traumatized teeth) were recorded. The prevalence was 5.6‰ of the total amount of occupational trauma. The highest prevalence was found in the fourth and fifth decades of life (OR=3.6, P < .001), and males were injured more often than females (70.5% vs 29.5%, OR=2.8, P < .001). Service and office workers represented 52% of the sample, and construction/farm/factory workers and craftsmen were 48%. TDIs involved only teeth and surrounding tissue in 66% of cases, or in combination with another maxillofacial injury in 34%. They were statistically associated with construction/farm/factory workers group (Chi squared P < .01). Crown fracture was recorded in 34.5% of cases, subluxation/luxation in 10.7%, avulsion in 9%, root fracture in 3.8%, and concussion in 3.5%. Thirty‐two subjects (28.6%, 133 teeth, OR=4.3, P < .001) presented at least 1 traumatized tooth with previous dental treatment. Among 212 (61.4%) traumatized teeth, 67.5% were upper incisors, 17.5% were lower incisors, 3.3% were upper canines, 1.9% were lower canines, and 9.9% were bicuspids and molars.

Conclusions

Work‐related TDIs had a low overall prevalence, and fractures were the most frequent dental injury. Age, gender, and preexisting dental treatments represented risk factors for work‐related TDIs.