bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxigenic Fusarium species on annual medic pastures and reduced feed intake by sheep in Western Australia.
Authors: Barbetti M. J. , Allen J. G.
Published: November 2017

This paper reports a preliminary study of the toxigenicity of the Fusarium spp. and Gibberella spp. isolated from annual Medicago pods associated with reduced feed intakes by sheep and 4 additional isolates collected from Trifolium subterraneum and Hordeum murinum subsp. leporinum in Western Australia. For each isolate, 1 ml, 1 ml of a 1:2 dilution, or 1 ml of a 1:10 dilution of the concentrated extract was injected intraperitoneally into each of 3 rats. The rats were observed regularly, and those convulsing or moribund were euthanized. Control rats were also maintained for comparison. All isolates of F. aveanaceum, F. chlamydosporum, F. equiseti, G. acuminate and G. zeae were toxigenic to rats, except for one isolate of G. zeae. Overall, 77% of rats injected with the highest dose died. Many of the rats that survived appeared depressed for several hours after injection.
Recently encountered poisonous plants of Paraíba, Northeastern Brazil.
Authors: Riet-Correa F. , Medeiros R. M. T. , Pimentel L. A. , Santos J. C. A. , Araújo J. A. S. de , Oliveira O. F. de , Dantas A. F. M.
Published: November 2017

This chapter reports plant intoxications observed between 2001 and 2004 in Paraiba, Brazil. Brief descriptions of nitrite poisoning in cattle (three outbreaks, one caused by Echinochloa polystachya and two by Pennisetum purpureum), intoxication by Ipomoea riedelii and Ipomoea sericophylla in goats, intoxication by Marsdenia spp. in cattle, sheep and goats, intoxication by Leucaena leucocephala in sheep, intoxication by Centratherum brachylepis in cattle, goats and sheep, intoxication by Tephrosia cinerea in sheep and malformations in goats, sheep and cattle associated with Mimosa tenuiflora, are provided.
Heart failure, abortion and neurological signs in cattle and sheep induced by Ateleia glazioviana and Tetrapterys spp. in Brazil.
Authors: Schild A. L. , Raffi M. B. , Riet-Correa G. , Barros C. S. L. , Riet-Correa F.
Published: November 2017

This chapter describes the epidemiology and clinical signs of A. glazioviana, T. acutifolia and T. multiglandulosa poisoning in cattle and sheep in Brazil.
Ergot toxins and animal disease in Australia.
Authors: Cawdell-Smith A. J. , Bakau W. J. K. , Scrivener C. J. , Reed K. F. M. , Blaney B. J. , Bryden W. L.
Published: November 2017

This chapter focuses on ergot alkaloids which have caused significant losses in both grazing and grain-fed animals in Australia. The ergot toxins, the effects of which in general result from their actions as partial agonists or antagonists at adrenergic, dopaminergic and serotogenic receptors, are produced by members of the fungal family Claviciptaceae, including species of the genus Claviceps and the endophyte genus Neotyphodium. The major Claviceps species causing animal disease in Australia include Claviceps paspali which produce the tremorgenic mycotoxin paspalitrem, C. purpurea which produces ergotamine alkaloid, and C. africana which produces dihydroergosine. Neotyphodium lolii produces the tremorgenic mycotoxin lolitrem B and various ergot alkaloids including ergovaline. The article reports outbreaks of the diseases in Australia and its impact on the animal industry.
Business.
Authors: Buckley R.
Published: November 2017

This chapter introduces the components and considerations for assembling and operating a commercial ecotourism business. Business basics, competition, legal issues, permits and licences, green capital, management structures, and staff skills are addressed.
Products.
Authors: Buckley R.
Published: November 2017

This chapter outlines some of the components that a typical ecotourism product contains, and some of the key issues in designing such products. In particular, ecotourism and related industry sectors rely almost entirely on relatively undisturbed outdoor natural environments to provide the primary tourism product and attraction. It is indicated that the particular components that form the attraction, the ways in which they are used, and the ways in which they are packaged as tourism products, can vary enormously.
Accounting.
Authors: Buckley R.
Published: November 2017

Practical protocols for individual ecotourism enterprises to carry out routine triple-bottomline accounting, in the same way as they currently carry out routine financial accounting, are not yet available. This chapter examines the issues involved in producing such protocols, and suggests what factors ecotourism operators, tourism ecocertification programmes and other relevant stakeholders can consider meanwhile in attempting to generate triple-bottom-line accounts for ecotourism. For each issue, analogies are drawn with corresponding issues in financial accounting to illustrate the complexities. Triple-bottom-line approaches attempt to calculate net environmental, social and financial performance independently but concurrently.
Conclusions.
Authors: Buckley R.
Published: November 2017

This concluding chapter identifies and examines four major trends in ecotourism and related sectors, and uses these projections to predict ecotourism business opportunities, policy implications and research priorities for the next decade or so. The four main trends may be summarized as follows. Continuing global urbanization drives continuing growth in outdoor tourism, but the principal focus is on the outdoors as part of tourism products. There is lots of rhetoric about environmental management, but little has changed in reality. Few tour operators currently contribute to conservation, but the number of private reserves is increasing. Links between the outdoor tourism industry and the property, equipment, clothing and entertainment sectors are increasing.
Political ideologies.
Authors: Veal A. J.
Published: November 2017

This chapter examines competing ideas about the right and proper role of the state in society, and in relation to leisure, sport and tourism in particular, from the point of view of various political ideologies.
A participation-based approach to planning for leisure, sport and tourism.
Authors: Veal A. J.
Published: November 2017

This chapter presents one particular planning model for leisure, sport and tourism-the U-Plan System-which is based on the key concept of participation.
International fisheries governance.
Authors: Meltzer E.
Published: November 2017

This chapter provides a brief historical overview of the governance framework for regulating straddling fish stocks and highly migratory fish stocks. To this end, it examines the establishment of regional fisheries management organizations (RFMOs), recognizing that while there are many bilateral arrangements and understandings in place, implementation under the United Nations Fish Stocks Agreement (UNFSA) is primarily through RFMOs.
The nature of tourism research.
Authors: Smith S.
Published: November 2017

This chapter introduces some of the ways that social scientists think about tourism and how they ask questions about it. A core message of this chapter is that there is no single 'right' way of doing tourism research. However, research can be done well or not so well. Understanding some of the key perspectives (what social scientists call 'paradigms') is important to help one pose questions that can be answered by research and to design a research plan to provide those answers.
How to design a questionnaire.
Authors: Smith S.
Published: November 2017

This chapter covers some of the basic skills associated with designing a questionnaire for tourism research. It considers different types of questions and when to use each. It considers question format in some detail, as well as overall questionnaire structure. It also looks at tactics associated with coding the results from questionnaires for statistical analysis. Finally, it examines the relative merits of different ways of administering surveys and distributing questionnaires.
How to do case studies.
Authors: Smith S.
Published: November 2017

This chapter explores the use of case studies in tourism research. It considers different types of case studies and looks at some of the basic methods used to conduct them, concluding with some comments on how to analyse the findings.
How to do content analysis.
Authors: Smith S.
Published: November 2017

This chapter explores the use of content analysis in tourism research. It first considers the types of questions content analysis can answer as well as the key elements of content analysis. It then looks at research designs and concepts one can use to undertake a content analysis. Finally, the chapter looks at some special issues or problems associated with content analysis of photographs.
Food and wine tourism best practice: case studies from around the world.
Authors: Croce E. , Perri G.
Published: November 2017

This chapter is dedicated to looking at a selection of food and wine enterprises that have successfully incorporated tourism hospitality into their product. The case studies set out in this chapter range from large international brands to small producers and have been selected by the authors based on their own personal experience of the producer's professional approach and efficient organization. Food and wine producers in particular (but also students of gastronomic tourism and other operators in the sector) will find in this chapter many new ideas to help them plan, develop and organize tours to welcome visitors to their wineries, farms and other food or wine enterprises. For those who already organize and manage gastronomic tours, it is hoped that the cases will serve as a valuable benchmark. In the analyses, each production sector (winery, dairy farm, brewery, olive mill, and distillery) is represented by at least one case study with an explanation of how each different phase of the tour is organized. In some cases, alternative ideas for tours have been added to increase tourism potential and to give a more complete idea of possible visitor management and organization.
Supply operators in the food and wine tourism industry.
Authors: Croce E. , Perri G.
Published: November 2017

It is not just food and wine producers who are involved in the organization and management of gastronomic tourism. There are many operators in the tourism sector who find they can increase business and professional satisfaction by stretching their core business to include services for food and wine tourists. Operators discussed in this chapter include: accommodation and hospitality; eating establishments; tourist information centres and bureaus; tour operators; tour guides; and gastronomic culture centres. A number of suggestions are presented that may help these operators in the food and wine tourism business.
Proposal writing.
Authors: Kline S. F.
Published: November 2017

This chapter introduces the importance of writing a research proposal and discusses the elements of a good proposal for scientific inquiry, in the context of leisure, recreation and tourism research. It stresses that research proposals must contain extensive literature reviews and offer convincing support of a need for the research study being proposed. It covers several steps of writing a proposal. The areas such as identification of a research topic, conducting a relevant literature review on the topic, developing propositions and hypotheses, data analysis and designing data collection instruments, reporting and citation styles and related issues are also introduced as elements of writing a research proposal. A short proposal example is also provided.
The methyltransferase NSD3 promotes antiviral innate immunity via direct lysine methylation of IRF3
Authors: Wang Chunmei , Wang Qinlan , Xu Xiaoqing , Xie Bin , Zhao Yong , Li Nan , Cao Xuetao
Published: November 2017

Lysine methylation is an important posttranslational modification, implicated in various biological pathological conditions. The transcription factor interferon regulatory factor 3 (IRF3) is essential for antiviral innate immunity, yet the mechanism for methylation control of IRF3 activation remains unclear. In this paper, we discovered monomethylation of IRF3 at K366 is critical for IRF3 transcription activity in antiviral innate immunity. By mass spectrometry analysis of IRF3-associated proteins, we identified nuclear receptor–binding SET domain 3 (NSD3) as the lysine methyltransferase that directly binds to the IRF3 C-terminal region through its PWWP1 domain and methylates IRF3 at K366 via its SET domain. Deficiency of NSD3 impairs the antiviral innate immune response in vivo. Mechanistically, NSD3 enhances the transcription activity of IRF3 dependent on K366 monomethylation, which maintains IRF3 phosphorylation by promoting IRF3 dissociation of protein phosphatase PP1cc and consequently promotes type I interferon production. Our study reveals a critical role of NSD3-mediated IRF3 methylation in enhancing antiviral innate immunity.
Fabrication of High-Haze Flexible Transparent Conductive PMMA Films Embedded with Silver Nanowires
*
Authors: Zhong Lu , Xu Wei , Yao Mei-Yi , Shen Wen-Feng , Xu Feng , Song Wei-Jie
Published: November 2017

High-haze flexible transparent conductive polymethyl methacrylate (PMMA) films embedded with silver nanowires (AgNWs) are fabricated by a low-cost and simple process. The volatilization rate of the solvent in PMMA solution affects the surface microstructures and morphologies, which results in different haze factors of the composite films. The areal mass density of AgNW shows a significant influence on the optical and electrical properties of composite films. The AgNW/PMMA transparent conductive films with the sheet resistance of 5.5Ωsq
−1
exhibit an excellent performance with a high haze factor of 81.0% at 550 nm.
Genome sequence of the small brown planthopper, Laodelphax striatellus
Authors: Zhu Junjie , Jiang Feng , Wang Xianhui , Yang Pengcheng , Bao Yanyuan , Zhao Wan , Wang Wei , Lu Hong , Wang Qianshuo , Cui Na , Li Jing , Chen Xiaofang , Luo Lan , Yu Jinting , Kang Le , Cui Feng
Published: November 2017

Background

Laodelphax striatellus Fallén (Hemiptera: Delphacidae) is one of the most destructive rice pests. L. striatellus is different from 2 other rice planthoppers with a released genome sequence, Sogatella furcifera and Nilaparvata lugens, in many biological characteristics, such as host range, dispersal capacity, and vectoring plant viruses. Deciphering the genome of L. striatellus will further the understanding of the genetic basis of the biological differences among the 3 rice planthoppers.

Findings

A total of 190 Gb of Illumina data and 32.4 Gb of Pacbio data were generated and used to assemble a high-quality L. striatellus genome sequence, which is 541 Mb in length and has a contig N50 of 118 Kb and a scaffold N50 of 1.08 Mb. Annotated repetitive elements account for 25.7% of the genome. A total of 17 736 protein-coding genes were annotated, capturing 97.6% and 98% of the BUSCO eukaryote and arthropoda genes, respectively. Compared with N. lugens and S. furcifera, L. striatellus has the smallest genome and the lowest gene number. Gene family expansion and transcriptomic analyses provided hints to the genomic basis of the differences in important traits such as host range, migratory habit, and plant virus transmission between L. striatellus and the other 2 planthoppers.

Conclusions

We report a high-quality genome assembly of L. striatellus, which is an important genomic resource not only for the study of the biology of L. striatellus and its interactions with plant hosts and plant viruses, but also for comparison with other planthoppers.
The Integral Quantum Loop Algebra of $\mathfrak {gl}_{n}$
Authors: Du Jie , Fu Qiang
Published: November 2017

We will construct the Lusztig form for the quantum loop algebra of $\mathfrak {gl}_{n}$ by proving the conjecture [4, 3.8.6] and establish partially the Schur–Weyl duality at the integral level in this case. We will also investigate the integral form of the modified quantum affine $\mathfrak {gl}_{n}$ by introducing an affine stabilisation property and will lift the canonical bases from affine quantum Schur algebras to a canonical basis for this integral form. As an application of our theory, we will also discuss the integral form of the modified extended quantum affine $\mathfrak {sl}_{n}$ and construct its canonical basis to provide an alternative algebra structure related to a conjecture of Lusztig in [29, §9.3], which has been already proved in [34].
Discovery of radio emission from the symbiotic X-ray binary system GX 1+4
Authors: van den Eijnden J , Degenaar N , Russell T D , Miller-Jones J C A , Wijnands R , Miller J M , King A L , Rupen M P
Published: November 2017

We report the discovery of radio emission from the accreting X-ray pulsar and symbiotic X-ray binary GX 1+4 with the Karl G. Jansky Very Large Array. This is the first radio detection of such a system, wherein a strongly magnetized neutron star accretes from the stellar wind of an M-type giant companion. We measure a 9 GHz radio flux density of 105.3 ± 7.3 μJy, but cannot place meaningful constraints on the spectral index due to a limited frequency range. We consider several emission mechanisms that could be responsible for the observed radio source. We conclude that the observed properties are consistent with shocks in the interaction of the accretion flow with the magnetosphere, a synchrotron-emitting jet, or a propeller-driven outflow. The stellar wind from the companion is unlikely to be the origin of the radio emission. If the detected radio emission originates from a jet, it would show that strong magnetic fields (≥1012 G) do not necessarily suppress jet formation.
Bacterial vaginosis
Authors: Bagnall Paulette , Rizzolo Denise
Published: November 2017

Bacterial vaginosis is a common vaginal infection that causes discharge, odor, and irritation. It can predispose women to sexually transmitted infections (STIs) including HIV. Recurrent bacterial vaginosis may require prolonged treatment to return the vaginal flora to a normal predominately lactobacilli-dominated environment.
A Comparison of Red Cell Rejuvenation versus Mechanical Washing for the Prevention of Transfusion-associated Organ Injury in Swine
Authors: Woźniak Marcin J. , Qureshi Saqib , Sullo Nikol , Dott William , Cardigan Rebecca , Wiltshire Michael , Nath Mintu , Patel Nishith N. , Kumar Tracy , Goodall Alison H. , Murphy Gavin J.
Published: November 2017

Background

We evaluated the effects of two interventions that modify the red cell storage lesion on kidney and lung injury in experimental models of transfusion.

Methods

White–landrace pigs (n = 32) were allocated to receive sham transfusion (crystalloid), 14-day stored allogeneic red cells, 14-day red cells washed using the red cells washing/salvage system (CATS; Fresenius, Germany), or 14-day red cells rejuvenated using the inosine solution (Rejuvesol solution; Zimmer Biomet, USA) and washed using the CATS device. Functional, biochemical, and histologic markers of organ injury were assessed for up to 24 h posttransfusion.

Results

Transfusion of 14 day red cells resulted in lung injury (lung injury score vs. sham, mean difference −0.3 (95% CI, −0.6 to −0.1; P = 0.02), pulmonary endothelial dysfunction, and tissue leukocyte sequestration. Mechanical washing reduced red cell–derived microvesicles but increased cell-free hemoglobin in 14-day red cell units. Transfusion of washed red cells reduced leukocyte sequestration but did not reduce the lung injury score (mean difference −0.2; 95% CI, −0.5 to 0.1; P = 0.19) relative to 14-day cells. Transfusion of washed red cells also increased endothelial activation and kidney injury. Rejuvenation restored adenosine triphosphate to that of fresh red cells and reduced microvesicle concentrations without increasing cell-free hemoglobin release. Transfusion of rejuvenated red cells reduced plasma cell-free hemoglobin, leukocyte sequestration, and endothelial dysfunction in recipients and reduced lung and kidney injury relative to 14-day or washed 14-day cells.

Conclusions

Reversal of the red cell storage lesion by rejuvenation reduces transfusion-associated organ injury in swine.
Targeted Genotyping Identifies Susceptibility Locus in Brain-derived Neurotrophic Factor Gene for Chronic Postsurgical Pain
Authors: Tian Yuanyuan , Liu Xiaodong , Jia Mingzhong , Yu Hui , Lichtner Peter , Shi Yujian , Meng Zhaoyu , Kou Shanglong , Ho Idy H. T. , Jia Bo , Cheng Benny C. P. , Lam Carmen K. M. , Tsang Sharon , Wong Sunny H. , Yu Jun , Cheng Christopher H. K. , Gin Tony , Wu William K. K. , Chen Zheyu , Chan Matthew T. V.
Published: November 2017

Background

The purpose of this study was to evaluate the association between single-nucleotide polymorphisms and chronic postsurgical pain.

Methods

Using GoldenGate genotyping assays, we genotyped 638 polymorphisms within 54 pain-related genes in 1,152 surgical patients who were enrolled in our Persistent Pain after Surgery Study. Patients were contacted by phone to determine whether they had chronic postsurgical pain at 12 months. Polymorphisms identified were validated in a matched cohort of 103 patients with chronic postsurgical pain and 103 patients who were pain free. The functions of targeted polymorphisms were tested in an experimental plantar incisional nociception model using knock-in mice.

Results

At 12 months after surgery, 246 (21.4%) patients reported chronic postsurgical pain. Forty-two polymorphisms were found to be associated with chronic postsurgical pain, 19 decreased the risk of pain, and 23 increased the risk of pain. Patients carrying allele A of rs6265 polymorphism in brain-derived neurotrophic factor (BDNF) had a lower risk of chronic postsurgical pain in the discovery and validation cohorts, with an adjusted odds ratio (95% CI) of 0.62 (0.43 to 0.90) and 0.57 (0.39 to 0.85), respectively. Age less than 65 yr, male sex, and prior history of pain syndrome were associated with an increased risk of pain. Genetic polymorphisms had higher population attributable risk (7.36 to 11.7%) compared with clinical risk factors (2.90 to 5.93%). Importantly, rs6265 is a substitution of valine by methionine at amino acid residue 66 (Val66Met) and was associated with less mechanical allodynia in BDNF
Met/Met mice compared with BDNF
Val/Val group after plantar incision.

Conclusions

This study demonstrated that genetic variant of BDNF rs6265G>A is associated with decreased risk of chronic postsurgical pain.
Efavirenz Therapeutic Range in HIV-1 Treatment-Naive Participants
Authors: Bednasz Cindy J. , Venuto Charles S. , Ma Qing , Daar Eric S. , Sax Paul E. , Fischl Margaret A. , Collier Ann C. , Smith Kimberly Y. , Tierney Camlin , Yang Yang , Wilding Gregory E. , Morse Gene D. ,   on behalf of the AIDS Clinical Trials Group Study A5202 Team
Published: November 2017

Background:

Efavirenz is currently suggested as an alternative to recommended antiretroviral (ARV) regimens by the Department of Health and Human Services for the treatment of HIV-1 in ARV-naive patients. A mid-dosing interval therapeutic range between 1000 and 4000 ng/mL for efavirenz has been proposed in the literature, with patients more likely to experience virologic failure below this range and adverse effects above. The current study reports an analysis of virologic outcome between those above, below, or within the reported efavirenz therapeutic range (1000–4000 ng/mL) and within subgroups.

Methods:

This analysis examined efavirenz plasma concentrations obtained from participants enrolled in AIDS Clinical Trials Group Study A5202. This investigation divided subjects into those who experienced virologic failure and those who did not. These subjects were further separated to investigate those who had “high,” “within,” or “low” plasma concentrations, based on the therapeutic range. The association between virologic failure and plasma concentration was statistically examined in addition to the variables: race/ethnicity, sex, assigned nucleos(t)ide reverse transcriptase inhibitor backbone, age at study entry, history of intravenous drug use, weight, and screening HIV-1 RNA stratification level.

Results:

In univariate analyses, a statistically significant difference was found when comparing the efavirenz concentration groups, (22 failures among the “low” concentration group [19%], 65 failures among the “within” concentration group [12%], and 11 failures among the “high” concentration group [9%]) when evaluating virologic failure as an outcome (P = 0.04). In addition, the proportion of participants with virologic failure differed across race/ethnicity groups (P = 0.03) with black non-Hispanic participants observed to have the highest rate (17%). Efavirenz concentration group, race/ethnicity, age, weight, and the interaction between efavirenz concentration group and weight were found to be significantly associated with virologic failure in multivariable logistic regression analysis.

Conclusions:

The proposed efavirenz therapeutic range, combined with the impact of a patient's weight, is associated with virologic failure in HIV-infected ARV-naive individuals in the United States. Additional analysis is recommended to determine the most appropriate concentration value that defines the lower limit of the efavirenz therapeutic range.
Unsuccessful Suicide Attempt With Tiapride
Authors: Couderc Sylvain , Mourou Hervé , Monchaud Caroline , Saint-Marcoux Franck
Published: November 2017

To the best of our knowledge, no case has been published in the literature that reports an overdose of tiapride, either alone or in combination with other drugs. We report a self-poisoning case in an 18-year-old girl, with approximately 10 times the usual daily dose (ie, 2.5 g). Although the blood concentration was 20/30-fold higher than usually observed after therapeutic drug intakes (17,300 mcg/L), the patient remained almost asymptomatic.
Acute Intoxications and Fatalities From Illicit Fentanyl and Analogues: An Update
Authors: Pichini Simona , Solimini Renata , Berretta Paolo , Pacifici Roberta , Busardò Francesco Paolo
Published: November 2017

Illicit fentanyl and its analogues are very dangerous synthetic opioids, with high abuse potential and severe adverse effects including coma and death. They are used as adulterants in street heroin, cocaine, and methamphetamine, or as heroin substitutes sold to unaware users with a high risk of overdoses. Fentanyl and its analogues have also been identified in counterfeit medicinal products, such as oxycodone, hydrocodone, and alprazolam tablets, or as components of speedball mixtures together with cocaine or other stimulants. In recent years, a number of epidemics involving acute intoxications and deaths related to illicit fentanyl or its analogues have occurred in the United States, Europe, Canada, Australia, and Japan. In several cases, fatalities involved polysubstance use. A review of the most recent case reports or case series of acute intoxications and fatalities involving illicit fentanyl and its newest analogues is herein provided, together with the available information on intoxication symptoms, eventual death cause, and metabolites detected in different biological fluids and reported concentrations.
Clinical and Physiological Effects of Rollators in Individuals With Chronic Obstructive Pulmonary Disease
Authors: Lee Annemarie L. , Beauchamp Marla K. , Goldstein Roger S. , Brooks Dina
Published: November 2017

Purpose:

To determine the effects of using a rollator in people with chronic obstructive pulmonary disease (COPD).

Methods:

Studies were systematically identified from literature searches of MEDLINE, CINAHL, PEDro, PubMed, EMBASE, and the Cochrane Library databases and the reference lists of included studies. Two reviewers independently selected randomized controlled or crossover studies examining the effects of rollator usage compared with no aid in individuals with COPD. Methodologic quality was assessed by 2 reviewers independently using the Cochrane Risk of Bias tool. Two reviewers also used a customized form to extract characteristics of and outcomes for subjects related to exercise capacity, symptoms, health-related quality of life (HRQOL), physiological, and gait parameters. Weighted mean differences (WMD) with 95% CI were calculated using a fixed-effects model.

Results:

A total of 7 studies (126 participants) were included. Use of a rollator during a 6-Minute Walk Test (6MWT) improved distance walked (WMD = 13 m; 95% CI, 5-22) and lowered end-6MWT dyspnea rating (WMD = 0.97; 95% CI, 0.63-1.32). Longer-term use did not appear to impact exercise capacity or HRQOL, although this may be related to the frequency of use.

Conclusions:

When used in the short-term, rollators resulted in a small increase in 6MWT and a reduction in dyspnea. Details on patient adherence are required to accurately evaluate the longer-term effects of rollator usage.
Validity and Reliability of Accelerometers in Patients With COPD
Authors: Gore Shweta , Blackwood Jennifer , Guyette Mary , Alsalaheen Bara
Published: November 2017

Purpose:

Reduced physical activity is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Accelerometers have greatly improved quantification of physical activity by providing information on step counts, body positions, energy expenditure, and magnitude of force. The purpose of this systematic review was to compare the validity and reliability of accelerometers used in patients with COPD.

Methods:

An electronic database search of MEDLINE and CINAHL was performed. Study quality was assessed with the Strengthening the Reporting of Observational Studies in Epidemiology checklist while methodological quality was assessed using the modified Quality Appraisal Tool for Reliability Studies.

Results:

The search yielded 5392 studies; 25 met inclusion criteria. The SenseWear Pro armband reported high criterion validity under controlled conditions (r = 0.75-0.93) and high reliability (ICC = 0.84-0.86) for step counts. The DynaPort MiniMod demonstrated highest concurrent validity for step count using both video and manual methods.

Discussion:

Validity of the SenseWear Pro armband varied between studies especially in free-living conditions, slower walking speeds, and with addition of weights during gait. A high degree of variability was found in the outcomes used and statistical analyses performed between studies, indicating a need for further studies to measure reliability and validity of accelerometers in COPD.

Conclusion:

The SenseWear Pro armband is the most commonly used accelerometer in COPD, but measurement properties are limited by gait speed variability and assistive device use. DynaPort MiniMod and Stepwatch accelerometers demonstrated high validity in patients with COPD but lack reliability data.
EXIT STRATEGY IN A TREAT-AND-EXTEND REGIMEN FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Arendt Petra , Yu Siqing , Munk Marion R. , Ebneter Andreas , Wolf Sebastian , Zinkernagel Martin S.
Published: November 2017

Purpose:

To evaluate the outcome of an exit strategy in a treat-and-extend regimen for neovascular age-related macular degeneration.

Methods:

Five hundred and ninety-eight eyes of 488 patients with neovascular age-related macular degeneration receiving intravitreal anti–vascular endothelial growth factor injections according to a treat-and-extend regimen were included in this retrospective study. A treat-and-extend regimen with either interval extension by 2 weeks or shortening by 1 week was used. “Exit criteria” were defined as 3 consecutive injections 16 weeks apart with stable findings after which the patient was exited from treatment and followed up at 3 to 4 monthly intervals without therapy. Best-corrected visual acuity, central retinal thickness at treatment initiation and termination, incidence of recurrence after treatment termination, presence of characteristics in the optical coherence tomography, duration of therapy, number and intervals of injections were analyzed.

Results:

Seventeen percent of all included eyes met the exit criteria. The mean number of anti–vascular endothelial growth factor injections was 23.7 ± 14.7 with a mean treatment duration of 4.5 ± 2.5 years. Twelve percent reached exit with the minimal number of injections. Thirteen percent had recurrent disease after a mean of 37 ± 16 weeks. In the subgroup with recurrent disease, rate of pigment epithelial detachment at treatment termination was significantly higher than without recurrence (77% vs. 30%, P = 0.0018) with a significant higher proportion of serous pigment epithelial detachment (31% vs. 7%, P = 0.0247).

Conclusion:

The high percentage of patients meeting the exit criteria and the relatively low incidence of recurrences underline the usefulness of a predefined exit strategy. However, in a subgroup of patients, continuation of therapy may be advisable.
COMPARISON OF RESOLUTION OF VITREOMACULAR TRACTION AFTER OCRIPLASMIN TREATMENT OR VITRECTOMY
Authors: Scholz Paula , Sitnilska Vasilena , Hess Jelka , Becker Matthias , Michels Stephan , Fauser Sascha
Published: November 2017

Purpose:

To compare the functional and morphologic outcome of patients with vitreomacular traction (VMT) treated with either ocriplasmin treatment or vitrectomy.

Methods:

Retrospective case series of patients treated with ocriplasmin or vitrectomy for VMT. Outcome measures: resolution of VMT, change in outer retinal thickness, integrity of ellipsoid zone, subretinal fluid formation, and best-corrected visual acuity 2 weeks and 4 months after treatment.

Results:

Fourteen eyes received ocriplasmin (Group 1). Vitreomacular traction resolved in 50% (Group 1a), and in 50%, it did not (Group 1b). Ten eyes underwent vitrectomy (Group 2). Vitreomacular traction resolved in 100%. Outer retinal thickness decreased significantly 2 weeks after treatment in Group 1 (P = 0.003) and in 1a (P = 0.018). Two weeks after treatment, Group 1a showed a disruption of the ellipsoid zone (P = 0.001) and subretinal fluid formation (P = 0.01) more often than 1b. Neither was observed 4 months after treatment. Best-corrected visual acuity decreased significantly in Groups 1 (P = 0.034) and 1a (P = 0.026).

Conclusion:

Most patients treated with ocriplasmin for VMT showed a transient reduction of best-corrected visual acuity, accumulation of subretinal fluid, and a loss of the ellipsoid zone after the resolution of VMT. Patients with surgical resolution of VMT did not show these findings. The advantage of a less-invasive intravitreal injection of ocriplasmin must be weighed against the lower success rate, the (transient) morphologic changes, and the uncertain visual benefit.
Novel Method to Detect Corneal Lymphatic Vessels In Vivo by Intrastromal Injection of Fluorescein
Authors: Le Viet Nhat Hung , Hou Yanhong , Horstmann Jens , Bock Felix , Cursiefen Claus
Published: November 2017

Purpose:

Corneal lymphatic vessels are clinically invisible because of their thin walls and clear lymph fluid. There is no easy and established method for in vivo imaging of corneal lymphatic vessels so far. In this study, we present a novel approach to visualize corneal lymphatic vessels in vivo by injecting intrastromal fluorescein sodium.

Methods:

Six- to eight-week-old female BALB/c mice were used in the mouse model of suture-induced corneal neovascularization. Two weeks after the suture placement, fluorescein sodium was injected intrastromally. The fluorescein, taken up by the presumed lymphatic vessels, was then tracked using a clinically used Spectralis HRA + OCT device. Immunohistochemistry staining with specific lymphatic marker LYVE-1 and pan-endothelial marker CD31 was used to confirm the indirect lymphangiography findings.

Results:

By injecting fluorescein intrastromally, both corneal blood and lymphatic vessels were detected. While the lymphatic vessels were visible as bright vessel-like structures using HRA, the blood vessels appeared as dark networks. Fluorescein-labeled lymphatic vessels were colocalized with LYVE-1 in immunohistochemically stained sections of the same specimen.

Conclusions:

Corneal lymphatic vessels can be easily imaged in vivo in the murine model using intrastromal fluorescein injection.
Role of Hemidivisional Corneal Topographic Astigmatisms (CorTs) in the Regularization and Reduction of Irregular Astigmatism
Authors: Alpins Noel , Ong James K. Y. , Stamatelatos George
Published: November 2017

Purpose:

To demonstrate how the concept of hemidivisional corneal topographic astigmatism (hemiCorT) enables the planning of hemidivisional corneal treatments to reduce irregularity and overall astigmatism.

Methods:

Whole-of-cornea corneal topographic astigmatism (CorT) is calculated from topography data derived from a corneal topographer or tomographer. The cornea is conceptually divided into 2 hemidivisions along the flat meridian of the CorT. For each hemidivision, hemiCorTs are calculated. The regularization treatment for each hemidivision is the treatment required to target the whole-of-cornea CorT, which is a symmetrical orthogonal corneal astigmatism. The regularization is then combined with astigmatism reduction treatment, which could be a conventional refractive treatment or a vector-planned treatment. For each hemidivision, the combined astigmatic effect of the regularization treatment and reduction treatment can be determined through double-angle vector summation. The 2 hemidivisional treatments together regularize and reduce corneal astigmatism.

Results:

A theoretical pair of hemidivisional treatments is derived from an actual example of a cornea displaying idiopathic asymmetric nonorthogonal astigmatism.

Conclusions:

HemiCorTs allow for the design of hemidivisional corneal treatments of asymmetric nonorthogonal astigmatism. Such treatments should be suitable in the routine treatment of commonly occurring irregular astigmatism, while also allowing the spherical refractive error to be treated concurrently.
Plesiomonas shigelloides Gastroenteritis from Freshwater Ingestion in Western Pennsylvania
Authors: Peyko Vincent
Published: November 2017

Plesiomonas shigelloides is a rare etiologic agent of bacterial gastroenteritis. Since the year 2000, there is only one published case report of P. shigelloides gastroenteritis. Presented here is a case reporting the typical presentation and successful oral antibiotic treatment of a rarely reported cause of gastroenteritis in the United States, after ingestion of freshwater from a stream in western Pennsylvania.
Candida krusei Emphysematous Pyelonephritis Possibly Due to Dapagliflozin Therapy
Authors: Fox Lanae , Nelson A. Christie , Ghanem Ghazi
Published: November 2017

Dapagliflozin is a new oral antidiabetic medication from the sodium glucose cotransporter-2 inhibitor class. Sodium glucose cotransporter-2 inhibitors work by preventing reabsorption of glucose in the kidney, thereby wasting it through urine. This unique mechanism increases the risk of urinary tract infections and genital mycotic infections. We present a rare case of fungal emphysematous pyelonephritis in a patient on dapagliflozin.
Neuropathic Pain Experiences of Spinal Cord Injury Patients
Authors: LI Chin-Ching , LIN Hung-Ru , TSAI Ming-Dar , TSAY Shiow-Luan
Published: November 2017

Background:

Neuropathic pain (NP) is a common, severe problem that affects spinal cord injury (SCI) patients. Only SCI patients truly understand the impact and extent of this type of pain.

Purpose:

The aim of this study was to understand the NP experienced by SCI patients and the influence of this type of pain on their daily life.

Method:

A qualitative design was used. An interview guide including a semistructured questionnaire and in-depth interviews was conducted with SCI patients with NP in a neurorehabilitation department at a medical center in northern Taiwan. The data were collected using a purposive sampling method. Content analysis was performed on the interview data, which were obtained from 13 SCI patients with NP.

Results:

Three themes and eight subthemes were identified that described the NP experience of the participants and the influence of NP on their daily life. The three themes included elusive pain (changing and individual pain sensations, erratically haunting threat, and phantom limb sensations), complicated feelings about pain (converting depression into an active attitude toward life, having feelings of anticipation and anxiety about future pain relief, and facing and experiencing pain), and renewed hope (bravely fighting pain and seeking pain relief methods).

Conclusions:

This study revealed three important themes of NP experienced by SCI patients, including elusive pain, complicated feelings about pain, and renewed hope. Nurses should understand the nature of NP, provide a thorough pain assessment, and design a proper pain management plan to care effectively for patients with NP.
Avoiding Small Intestinal Biopsies for Diagnosis of Celiac Disease in Children
Authors: Araya Magdalena , Díaz Julia , Oyarzun Amaya , Lucero Yalda , Alarcon Teresa , González Mónica , Canales Paulina , Fierro Liliana , Pérez‐Bravo Francisco
Published: November 2017

Background:

Current reports applying ESPGHAN exception criteria (EEC) to diagnose celiac disease (CD) without duodenal biopsies indicate that a high percentage of patients with CD may be identified when applied correctly in specialized settings. Application of the EEC, however, in “daily life conditions” at the different levels of medical services is not clear.

Methods:

EEC was applied to 130 pediatric patients evaluated for CD at 5 public hospitals in Santiago, Chile, during 2010 to 2015. Clinical presentation, serum anti‐tissue transglutaminase 2 and anti‐endomysium antibodies (EMA), genotyping, and small intestinal histology were obtained from clinical charts.

Results:

A total of 78 of 130 patients reviewed had some of the data required for analysis, but EMA was determined in 54% and genotyping in 2.3% of patients, limiting the study. After offering free genotyping, only 12 of 78 (15%) had all data required for EEC application. In this small group, 10 of 12 (83.3%) patients could avoid duodenal biopsies and 2 (16.7%) with potential CD were misdiagnosed. Main reasons for not doing EMA and genotyping were that they are expensive, unavailable in the local health care center, and considered “not necessary” for diagnosis.

Conclusion:

Limited resources in clinical settings reduce availability of EMA and genotyping, making application of EEC criteria difficult and only possible only in 15% of our patients. Within this subgroup, biopsies could be avoided in 83.3%, and 16.7% of patients with potential CD were misdiagnosed. Insufficient studies and incorrect interpretation of EEC contributed to incomplete assessment in 52 of 130 (40%) patients. The Chilean public health system is likely representative of several others present in developing and developed countries.
Refractive Error in a Sample of Black High School Children in South Africa
Authors: Wajuihian Samuel Otabor , Hansraj Rekha
Published: November 2017

SIGNIFICANCE

This study focused on a cohort that has not been studied and who currently have limited access to eye care services. The findings, while improving the understanding of the distribution of refractive errors, also enabled identification of children requiring intervention and provided a guide for future resource allocation.

PURPOSE

The aim of conducting the study was to determine the prevalence and distribution of refractive error and its association with gender, age, and school grade level.

METHODS

Using a multistage random cluster sampling, 1586 children, 632 males (40%) and 954 females (60%), were selected. Their ages ranged between 13 and 18 years with a mean of 15.81 ± 1.56 years. The visual functions evaluated included visual acuity using the logarithm of minimum angle of resolution chart and refractive error measured using the autorefractor and then refined subjectively. Axis astigmatism was presented in the vector method where positive values of J0 indicated with-the-rule astigmatism, negative values indicated against-the-rule astigmatism, whereas J45 represented oblique astigmatism.

RESULTS

Overall, patients were myopic with a mean spherical power for right eye of −0.02 ± 0.47; mean astigmatic cylinder power was −0.09 ± 0.27 with mainly with-the-rule astigmatism (J0 = 0.01 ± 0.11). The prevalence estimates were as follows: myopia (at least −0.50) 7% (95% confidence interval [CI], 6 to 9%), hyperopia (at least 0.5) 5% (95% CI, 4 to 6%), astigmatism (at least −0.75 cylinder) 3% (95% CI, 2 to 4%), and anisometropia 3% (95% CI, 2 to 4%). There was no significant association between refractive error and any of the categories (gender, age, and grade levels).

CONCLUSIONS

The prevalence of refractive error in the sample of high school children was relatively low. Myopia was the most prevalent, and findings on its association with age suggest that the prevalence of myopia may be stabilizing at late teenage years.
Case Report: Masquerading Large-vessel Giant Cell Arteritis
Authors: Jacquier Paul , Wuarin Raphael , Chizzolini Carlo , Thumann Gabriele , Steffen Heimo , Chronopoulos Argyrios
Published: November 2017

SIGNIFICANCE

Large-vessel giant cell arteritis (GCA) can be a diagnostic dilemma for the eye care provider because it may not involve the typical cranial arteries. When any of its potential ocular complications are diagnosed, it is important to consider this unusual form of GCA.

PURPOSE

To report an unusual ophthalmic presentation of large-vessel GCA with sequential bilateral anterior ischemic optic neuropathy and branch retinal artery occlusion.

METHODS

A 65-year-old previously healthy woman experienced sequential bilateral anterior ischemic optic neuropathy with branch retinal artery occlusion in the absence of other signs and symptoms suggestive of cranial GCA.

RESULTS

Extensive workup, including temporal artery biopsy, failed to demonstrate vascular inflammation suggestive of GCA or vascular abnormalities, such as atheromatous plaques, but coincidentally revealed a breast tumor, which was excised. Positron emission tomography scan was performed revealing distinct hypermetabolism of the thoracic and abdominal aorta consistent with large-vessel GCA, and corticosteroid therapy was initiated.

CONCLUSIONS

Large-vessel GCA is an underdiagnosed and undertreated type of GCA that does not typically affect the cranial arteries but rather larger proximal aortic branches. When associated with ocular complications, it can be a puzzling diagnostic dilemma for the eye care provider.