bluuebunny/crossref_metadata_2025 huggingface dataset:
Personalised discharge care planning for postmyocardial infarction patients through the use of the Personalised Patient Education Protocol – implementing theory into practice
Authors: Lau‐Walker Margaret , Landy Anne , Murrells Trevor
Published: March 2016

Aims and objectives

This study aims to evaluate the service impact of the integration of an evidence‐based instrument – the Personalised Patient Education Protocol – into an existing postmyocardial infarction care pathway.

Background

Recent research indicates that while better patient health outcomes can be achieved when care planning is personalised, delivery staff feel less satisfied and less confident in its provision. To achieve a shift to personalised care, innovations are needed to enable an effective transition for staff.

Design

A service evaluation using a patient survey and nurse interviews.

Method

A longitudinal patient survey measured changes in patient illness beliefs, cardiac diet and exercise self‐efficacy, anxiety, depression and quality of life study of a patient cohort of 74. Paired t‐tests analysed the effects before and after the implementation of the Personalised Patient Education Protocol. Cardiac rehabilitation nurses who implemented the Personalised Patient Education Protocol were interviewed and a patient survey identified perceptions of the usefulness of the service innovation.

Results

Analysis of change from baseline to three months results showed statistically significant changes in Illness Belief component ‘Understanding’ and the Dartmouth Quality of Life ‘General Health’. The integration of the Personalised Patient Education Protocol into the existing discharge process identified service improvements for cardiac nurse training and care pathway delivery, while patients identified the level and frequency of their use of the protocol following discharge.

Conclusion

The introduction of the Personalised Patient Education Protocol succeeded in increasing patient engagement, facilitated a more patient‐centred service by enabling practitioners to systematically provide personalised patient education, and gave patients a postdischarge structure to better follow‐up their illness concerns with health professionals in the community.

Relevance to clinical practice

Integration of the Personalised Patient Education Protocol into an existing postmyocardial infarction care pathway enabled nurses to systematically respond to individual patients’ illness beliefs and expectations.
‘Don't put the parent out’: parents' perspectives of being present during an inter‐hospital transfer
Authors: Masterson Kate , Brenner Maria
Published: March 2016

Aims and objectives

To understand Irish parents' experiences of the inter‐hospital transfer of their acutely ill child from a regional hospital to a tertiary children's hospital.

Background

Much of the literature on inter‐hospital transfer focuses on the medical outcome of children who have been transferred for specialist care. While parental presence during this journey is the focus of discussion papers, little is known about the experience of parents as service users.

Design

A qualitative design using a Husserlian phenomenological approach was adopted for this study.

Methods

Semi‐structured interviews were conducted with ten parents between March and October 2014 to explore their experiences of parental presence during the transfer of an acutely ill child. Data were analysed using the modified Van Kaam method.

Results

Two key themes emerged ‘don't put the parent out’ and ‘being a parent’. Given a choice, all parents interviewed would have wished to stay with their child during transfer and the findings portray the specific contribution of parents during the journey.

Conclusions

Not being permitted to travel with their acutely ill child had a negative effect on parents' perceptions of their ability to continue to parent their child during transfer to specialist paediatric services. To address this there is a need for parents to have the choice, when at all possible, to stay with their child at this time.

Relevance to clinical practice

There is a need to maximise the facilitation of parental presence in an Irish context through the introduction of guidelines to support staff involved in the transfer of an acutely ill child.
Aerothermal Characterization of a Rotating Ribbed Channel at Engine Representative Conditions—Part II: Detailed Liquid Crystal Thermography Measurements
Authors: Mayo Ignacio , Lahalle Aude , Gori Gian Luca , Arts Tony
Published: March 2016

The present two-part work deals with a detailed characterization of the flow field and heat transfer distribution in a model of a rotating ribbed channel performed in a novel setup which allows test conditions at high rotation numbers (Ro). The tested model is mounted on a rotating frame with all the required instrumentation, resulting in a high spatial resolution and accuracy. The channel has a cross section with an aspect ratio of 0.9 and a ribbed wall with eight ribs perpendicular to the main flow direction. The blockage of the ribs is 10% of the channel cross section, whereas the rib pitch-to-height ratio is 10. In this second part of the study, the heat transfer distribution over the wall region between the sixth and seventh ribs is obtained by means of liquid crystal thermography (LCT). Tests were first carried out at a Reynolds number of 15,000 and a maximum Ro of 1.00 to evaluate the evolution of the heat transfer with increasing rotation. On the trailing side (TS), the overall Nusselt number increases with rotation until a limit value of 50% higher than in the static case, which is achieved after a value of the rotation number of about 0.3. On the leading side (LS), the overall Nusselt number decreases with increasing rotation speed to reach a minimum which is approximately 50% of the one found in static conditions. The velocity measurements at Re = 15,000 and Ro = 0.77 provided in Part I of this paper are finally merged to provide a consistent explanation of the heat transfer distribution in this model. Moreover, heat transfer measurements were performed at Reynolds numbers of 30,000 and 55,000, showing approximately the same trend.
Modeling Transport and Deposition Efficiency of Oblate and Prolate Nano- and Micro-particles in a Virtual Model of the Human Airway
Authors: Holmstedt Elise , Åkerstedt Hans O. , Staffan Lundström T. , Högberg Sofie M.
Published: March 2016

A model for the motion and deposition of oblate and prolate spheroids in the nano- and microscale was developed. The aim was to mimic the environment of the human lung, but the model is general and can be applied for different flows and geometries for small nonspherical particle Stokes and Reynolds numbers. A study of the motion and orientation of a single oblate and prolate particle has been done yielding that Brownian motion disturbs the Jeffery orbits for small particles. Prolate microparticles still display distinguishable orbits while oblate particles of the same size do not. A statistical study was done comparing the deposition efficiencies of oblate and prolate spheroids of different size and aspect ratio observing that smaller particles have higher deposition rate for lower aspect ratio while larger particles have higher deposition rates for large aspect ratio.
Exact Solutions for Starting and Oscillatory Flows in an Equilateral Triangular Duct
Authors: Wang C. Y.
Published: March 2016

Exact series solutions, some in closed-form, for starting flow and oscillatory flow in an equilateral triangular duct are presented. The complete set of eigenvalues and eigenfunctions of the Helmholtz equation is derived, and the method of eigenfunction superposition is used. Exact solutions are rare, fundamental, and serve as accuracy standards for approximate methods.
Improved resistive switching properties in SiOx-based resistive random-access memory cell with Ti buffer layer
Authors: Kim Sungjun , Cho Seongjae , Park Byung-Gook
Published: March 2016

In this work, low-power bipolar resistive switching is demonstrated in a fully complementary metal–oxide–semiconductor-compatible Ni/Ti/SiOx/p+-Si resistive random-access memory (RRAM) device. The proposed device shows higher nonlinearity in the low-resistance state (LRS), lower reset current (<1 μA), and better endurance cycles in comparison with Ni/SiOx/p+-Si RRAM device without the Ti insertion layer. The self-compliance properties can effectively alleviate current overshoot, thanks to Ti buffer layer acting as a built-in series resistance. TiOx layer from oxygen scavenging ensures nonlinear current–voltage (I−V) characteristics for high-density integration in the cross-point array architecture. It is found that the thermal coefficient of Ti in the LRS provides a clue to switching mechanism underlying the hopping conduction with semiconducting behavior.
Micromachined multiple focused-ion-beam devices
Authors: Yoshida Ryo , Hara Motoaki , Oguchi Hiroyuki , Kuwano Hiroki
Published: March 2016

Micromachined multiple focused-ion-beam devices were developed, which were composed of an array of ion sources, electrostatic extractors, and lenses to achieve concurrent processing of microdevices with high throughput. All of the parts of the devices were fabricated and packaged on the scale of a microchip, employing Si bulk micromachining technologies. Ionic liquids (ILs) were used to generate the ion species instead of conventional liquid metals such as Ga and In. Three types of testing devices were fabricated to comprehensively evaluate the system. The first, device 1, consisted of the emitter arrays and a biased Si target, whereby the etching characteristics of beams generated with several ILs were evaluated. The peaks of SiF+, SiF2+, SiF3+, and SiF4+, which provide evidence for reactive etching of Si, were obtained by in situ monitoring of the gas composition. Compared with a conventional Ga ion source, the ion beams emitted from the IL 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide exhibited a 5.4-fold sputtering yield of 11.9 atom/ion at an acceleration voltage of 5 kV. In device 2, the electrostatic extractor and lens were mounted on the emitter array, and control of the divergence angle of the ion beam was confirmed. In device 3, which has a separated extractor on the electrostatic lens plate, an individual control of ion beams was demonstrated.
Incorporation of Be dopant in GaAs core and core–shell nanowires by molecular beam epitaxy
Authors: Ojha Sai Krishna , Kasanaboina Pavan Kumar , Lewis Reynolds Claude , Rawdanowicz Thomas A. , Liu Yang , White Ryan M. , Iyer Shanthi
Published: March 2016

Effective implementation of doped nanowires (NWs) in nanoscaled devices requires controlled and effective dopant incorporation. The one dimensional configuration of NWs poses a challenge for efficient doping due to the large number of surface states pinning the Fermi level close to the middle of the band gap and thus creating a large depletion layer at the surface. This effectively reduces the effective volume for doping. However, the flexibility of different architectures offered by the NWs, in particular, the core–shell configuration along with different growth mechanisms associated with the core and shell can be strategically used for efficient doping. In this work, the authors report on a catalyst free Ga-assisted approach for the growth of Be-doped GaAs NWs by molecular beam epitaxy. A systematic and a comprehensive study is reported using a variety of characterization techniques to determine the impact of NW configuration, Be cell temperature, and V/III beam equivalent pressure (BEP) ratio individually on doping incorporation in the NWs. Broadening of the photoluminescence spectra in the 1.49–1.51 eV range, as well as the longitudinal optical mode of the corresponding Raman spectra in combination with its red shift that is considered as a signature of higher Be incorporation, was found to occur for the core–shell configuration. Further, a lower V/III BEP ratio has a strong impact on enhancing the dopant incorporation.
Cubic GaN films grown below the congruent sublimation temperature of (0 0 1) GaAs substrates by plasma-assisted molecular beam epitaxy
Authors: Alanís Arturo , Vilchis Heber , López Edgar , Vidal Miguel A.
Published: March 2016

Gallium nitride films were synthesized on GaAs (0 0 1) substrates at temperatures lower than the congruent sublimation temperature of GaAs. By controlling isothermal desorption of the substrate and setting experimental parameters in the early growth stage, the authors obtained cubic GaN films. No nitridation process or growth of a buffer layer was necessary prior to GaN growth of GaN. In situ reflection high-energy electron diffraction (RHEED) and ex situ high-resolution x-ray diffraction were used to study the crystalline qualities of the films. The measured pole diagram of cubic GaN at 2θ = 34.5° was consistent with RHEED results and confirmed the crystalline structure. Photoluminescence measurements showed a strong emission only at 3.21 eV.
A trail of microbes
Authors: Kupferschmidt Kai
Published: March 2016

The unique mix of bacteria you leave behind wherever you go might be used to identify you.
Response to Comment on “Math at home adds up to achievement in school”
Authors: Berkowitz Talia , Schaeffer Marjorie W. , Rozek Christopher S. , Maloney Erin A. , Levine Susan C. , Beilock Sian L.
Published: March 2016

Frank presents an alternative interpretation of our data, yet reports largely similar results to those in our original Report. A critical difference centers on how to interpret and test interaction effects. Frank finds no mistakes in our analyses. We stand by our original conclusions of meaningful effects of the Bedtime Learning Together (BLT) math app on children’s math achievement.
Contribution of a Comparative Western Blot Method to Early Postnatal Diagnosis of Congenital Syphilis
Authors: Marangoni Antonella , Foschi Claudio , Capretti Maria Grazia , Nardini Paola , Compri Monica , Corvaglia Luigi Tommaso , Faldella Giacomo , Cevenini Roberto
Published: March 2016

Serology has a pivotal role in the diagnosis of congenital syphilis (CS), but problems arise because of the passive transfer of IgG antibodies across the placenta. The aim of this study was to assess the diagnostic value of a comparative Western blot (WB) method finalized to match the IgG immunological profiles of mothers and their own babies at birth in order to differentiate between passively transmitted maternal antibodies and antibodies synthesized by the infants againstTreponema pallidum. Thirty infants born to mothers with unknown or inadequate treatment for syphilis were entered in a retrospective study, conducted at St. Orsola-Malpighi Hospital, Bologna, Italy. All of the infants underwent clinical, instrumental, and laboratory examinations, including IgM WB testing. For the retrospective study, an IgG WB assay was performed by blottingT. pallidumantigens onto nitrocellulose sheets and incubating the strips with serum specimens from mother-child pairs. CS was diagnosed in 11 out of the 30 enrolled infants; 9/11 cases received the definitive diagnosis within the first week of life, whereas the remaining two were diagnosed later because of increasing serological test titers. The use of the comparative IgG WB testing performed with serum samples from mother-child pairs allowed a correct CS diagnosis in 10/11 cases. The CS diagnosis was improved by a strategy combining comparative IgG WB results with IgM WB results, leading to a sensitivity of 100%. The comparative IgG WB test is thus a welcome addition to the conventional laboratory methods used for CS diagnosis, allowing identification and adequate treatment of infected infants and avoiding unnecessary therapy of uninfected newborns.
Capsular Typing Method for Streptococcus agalactiae Using Whole-Genome Sequence Data
Authors: Sheppard Anna E. , Vaughan Alison , Jones Nicola , Turner Paul , Turner Claudia , Efstratiou Androulla , Patel Darshana ,   Modernising Medical Microbiology Informatics Group, Walker A. Sarah , Berkley James A. , Crook Derrick W. , Seale Anna C.
Published: March 2016

Group B streptococcus (GBS) capsular serotypes are major determinants of virulence and affect potential vaccine coverage. Here we report a whole-genome-sequencing-based method for GBS serotype assignment. This method shows strong agreement (kappa of 0.92) with conventional methods and increased serotype assignment (100%) to all 10 capsular types.
Acute liver failure due to primary amyloidosis in a nephrotic syndrome: a swiftly progressive course
Authors: Cardoso Brigite Aguiar , Leal Rita , Sá Helena , Campos Mário
Published: March 2016

AL amyloidosis is a clonal plasma cell proliferative disorder characterised by extracellular tissue deposits of insoluble fibrils derived from κ or λ immunoglobulin light chains. The most common organs affected by AL amyloidosis are the kidney, presenting with nephrotic syndrome and/or progressive renal dysfunction, and the heart, with restrictive cardiomyopathy. Hepatic deposition of fibrils occurs in half the cases but the liver is rarely the predominantly affected organ. The most common presentation of hepatic amyloidosis is hepatomegaly with elevated alkaline phosphatase. Acute liver failure with cholestasis and jaundice is a rare complication, with a prevalence of approximately 5%, and is usually associated with a worse prognosis. We report a case of a 39-year-old man admitted to our nephrology department with an unusual presentation of primary amyloidosis with nephrotic syndrome and acute liver failure, complicated by obstructive cholestasis resulting in death 2 months after diagnosis.
Uncommon condition mimicking non-resolving pneumonia and malignancy on radiography that improves dramatically with a course of steroids
Authors: Sanders Alexander , Matonhodze Max
Published: March 2016

A 58-year-old man was seen in a specialist respiratory clinic, with non-resolving pneumonia. Various investigations including CT scan, bronchoscopy and CT-guided biopsy were carried out for suspected malignancy but they could not find any evidence of neoplasia or anything else of significance. The lung mass that persisted for years later resolved with a course of steroids, at which point further investigations for alternative differential diagnoses suggested a surprising conclusion.
Tracking host use by bat ectoparasites with stable isotope analysis
Authors: Hernández-Arciga Ulalume , Herrera M. L. Gerardo , Morales-Malacara Juan B.
Published: March 2016

We used C and N stable isotopes of nectarivorous bats and their ectoparasites to determine the extent to which parasites depend on the host individual for food. The difference in stable isotope values between parasites and host tissues (Δ13C and Δ15N) was used as a proxy of host use. First, we tested the hypothesis that movement among individual Mexican long-tongued bats (Choeronycteris mexicana Tschudi, 1844) is more likely to occur in winged flies than in mites as indicated by higher host–parasite isotopic Euclidian distance (ED). Second, we tested the hypothesis that ectoparasite species in two coexisting bat species representing the C3 (Geoffroy’s tailless bat, Anoura geoffroyi Gray, 1838) and the CAM (lesser long-nosed bat, Leptonycteris yerbabuenae Martínez and Villa-R., 1940) food chains were monoxenous as indicated by their isotopic values. We also examined Δ13C and Δ15N of individual parasites in relation to 13C and 15N reference enrichment factors as an indication of host switching. In general, flies in C. mexicana had higher ED and wider ranges of individual Δ13C and Δ15N than mites, suggesting that host switching occurred to a larger extent. Most ectoparasites species collected in both coexisting bats were monoxenous, but one fly species appears to be oligoxenous. Individual Δ13C and Δ15N values varied widely in these parasite species, suggesting movements within species hosts.
Melnikov Method for a Class of Planar Hybrid Piecewise-Smooth Systems
Authors: Li Shuangbao , Ma Wensai , Zhang Wei , Hao Yuxin
Published: March 2016

In this paper, we extend the well-known Melnikov method for smooth systems to a class of periodic perturbed planar hybrid piecewise-smooth systems. In this class, the switching manifold is a straight line which divides the plane into two zones, and the dynamics in each zone is governed by a smooth system. When a trajectory reaches the separation line, then a reset map is applied instantaneously before entering the trajectory in the other zone. We assume that the unperturbed system is a piecewise Hamiltonian system which possesses a piecewise-smooth homoclinic solution transversally crossing the switching manifold. Then, we study the persistence of the homoclinic orbit under a nonautonomous periodic perturbation and the reset map. To achieve this objective, we obtain the Melnikov function to measure the distance of the perturbed stable and unstable manifolds and present the theorem for homoclinic bifurcations for the class of planar hybrid piecewise-smooth systems. Furthermore, we employ the obtained Melnikov function to detect the chaotic boundaries for a concrete planar hybrid piecewise-smooth system.
Topological Phases with Parafermions: Theory and Blueprints
Authors: Alicea Jason , Fendley Paul
Published: March 2016

We concisely review the recent evolution in the study of parafermions—exotic emergent excitations that generalize Majorana fermions and similarly underpin a host of novel phenomena. First we generalize the intimate connection between the [Formula: see text]-symmetric Ising quantum spin chain and Majorana fermions to [Formula: see text]-symmetric chains and parafermions. In particular, we highlight how parafermion chains host a topological phase featuring protected edge zero modes. We then tour several blueprints for the laboratory realization of parafermion zero modes—focusing on quantum Hall/superconductor hybrids, quantum Hall bilayers, and two-dimensional topological insulators—and describe striking experimental fingerprints that they provide. Finally, we discuss how coupled parafermion arrays in quantum Hall architectures yield topological phases that potentially furnish hardware for a universal, intrinsically decoherence-free quantum computer.
Topological Kondo Insulators
Authors: Dzero Maxim , Xia Jing , Galitski Victor , Coleman Piers
Published: March 2016

This article reviews recent theoretical and experimental work on a new class of topological material—topological Kondo insulators, which develop through the interplay of strong correlations and spin-orbit interactions. The history of Kondo insulators is reviewed along with the theoretical models used to describe these heavy fermion compounds. The Fu-Kane method of topological classification of insulators is used to show that hybridization between the conduction electrons and localized f electrons in these systems gives rise to interaction-induced topological insulating behavior. Finally, some recent experimental results are discussed, which appear to confirm the theoretical prediction of the topological insulating behavior in samarium hexaboride, where the long-standing puzzle of the residual low-temperature conductivity has been shown to originate from robust surface states.
Unitary synaptic connections among substantia nigra pars reticulata neurons
Authors: Higgs Matthew H. , Wilson Charles J.
Published: March 2016

Neurons in substantia nigra pars reticulata (SNr) are synaptically coupled by local axon collaterals, providing a potential mechanism for local signal processing. Because SNr neurons fire spontaneously, these synapses are constantly active. To investigate their properties, we recorded spontaneous inhibitory postsynaptic currents (sIPSCs) from SNr neurons in brain slices, in which afferents from upstream nuclei are severed, and the cells fire rhythmically. The sIPSC trains contained a mixture of periodic and aperiodic events. Autocorrelation analysis of sIPSC trains showed that a majority of cells had one to four active unitary inputs. The properties of the unitary IPSCs (uIPSCs) were analyzed for cells with one unitary input, using a model of periodic presynaptic firing and stochastic synaptic transmission. The inferred presynaptic firing rates and coefficient of variation of interspike intervals (ISIs) corresponded well with direct measurements of spiking in SNr neurons. Methods were developed to estimate the success probability, amplitude distributions, and kinetics of the uIPSCs, while removing the contribution from aperiodic sIPSCs. The sIPSC amplitudes were not increased upon release from halorhodopsin silencing, suggesting that most synapses were not depressed at the spontaneous firing rate. Gramicidin perforated-patch recordings indicated that the average reversal potential of spontaneous inhibitory postsynaptic potentials was −64 mV. Because of the change in driving force across the ISI, the unitary inputs are predicted to have a larger postsynaptic impact when they arrive late in the ISI. Simulations of network activity suggest that this very sparse inhibitory coupling may act to desynchronize the activity of SNr neurons while having only a small effect on firing rate.
VIP+ interneurons control neocortical activity across brain states
Authors: Jackson Jesse , Ayzenshtat Inbal , Karnani Mahesh M. , Yuste Rafael
Published: March 2016

GABAergic interneurons are positioned to powerfully influence the dynamics of neural activity, yet the interneuron-mediated circuit mechanisms that control spontaneous and evoked neocortical activity remains elusive. Vasoactive intestinal peptide (VIP+) interneurons are a specialized cell class which synapse specifically on other interneurons, potentially serving to facilitate increases in cortical activity. In this study, using in vivo Ca2+ imaging, we describe the interaction between local network activity and VIP+ cells and determine their role in modulating neocortical activity in mouse visual cortex. VIP+ cells were active across brain states including locomotion, nonlocomotion, visual stimulation, and under anesthesia. VIP+ activity correlated most clearly with the mean level of population activity of nearby excitatory neurons during all brain states, suggesting VIP+ cells enable high-excitability states in the cortex. The pharmacogenetic blockade of VIP+ cell output reduced network activity during locomotion, nonlocomotion, anesthesia, and visual stimulation, suggesting VIP+ cells exert a state-independent facilitation of neural activity in the cortex. Collectively, our findings demonstrate that VIP+ neurons have a causal role in the generation of high-activity regimes during spontaneous and stimulus evoked neocortical activity.
Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation
Authors: Pelgrim G. J. , Handayani A. , Dijkstra H. , Prakken N. H. J. , Slart R. H. J. A. , Oudkerk M. , Van Ooijen P. M. A. , Vliegenthart R. , Sijens P. E.
Published: March 2016

Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET). This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD), as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.
Effectiveness of a Nutrition Education Program to Improve Children’s Chewing Habits
Authors: Sato Nanae , Hayashi Fumi , Yoshiike Nobuo
Published: March 2016

This quasi-experimental study determined whether the nutrition education program we developed to promote chewing food properly influenced children’s chewing habits successfully. Four kindergarten classes in Japan (150 children, aged 5-6 years) were studied; one class received the educational program in the classroom and at home (Group A) and three classes received the program in the classroom only (Group B). The educational program was integrated into the classes’ daily curriculum for five weeks. It included storytelling with large picture books, chewing consciously while eating lunch, singing a song with gestures, and greetings before and after meals (both groups). Group A also used a paper textbook and was provided information by the leaflet to encourage guardians to implement the program at home. Chewing habits before and after intervention were evaluated: (1) guardians completed seven questionnaire items related to chewing habits and chewing movement and (2) the number of chews and time spent eating the test meal were measured by a portable chewing sensor. Both approaches improved the children’s chewing habits; however, no difference was found between the two groups. We concluded that this intervention could be used to improve chewing habits in young children even without active involvement of their guardians.
Tuberculosis of the Breast: An Initial Presentation of the Metabolic Syndrome with Type 2 Diabetes Mellitus in a Young Nigerian Woman
Authors: Adeiza M. A. , Yusuf R. , Liman A. A. , Abur P. , Bello F. , Abba A. A.
Published: March 2016

Breast tuberculosis is an uncommon presentation of extra pulmonary tuberculosis. A 40-year-old obese woman presented with a right breast abscess which had failed to heal after surgical drainage. There was no family history of breast disease. Biopsy and histology of the lesion showed chronic granulomatous inflammation with positive stains for acid fast bacilli compatible with tuberculosis. Further evaluation confirmed metabolic syndrome with type 2 diabetes mellitus. She was placed on antituberculosis chemotherapy and appropriate therapy for diabetes mellitus with complete resolution of the lesion. We report this case because of its rarity and to highlight the association between tuberculosis an infectious disease and overnutrition in diabetes mellitus, a noncommunicable disease.
A Dietary Treatment Improves Cerebral Blood Flow and Brain Connectivity in Aging apoE4 Mice
Authors: Wiesmann Maximilian , Zerbi Valerio , Jansen Diane , Haast Roy , Lütjohann Dieter , Broersen Laus M. , Heerschap Arend , Kiliaan Amanda J.
Published: March 2016

APOEε4 (apoE4) polymorphism is the main genetic determinant of sporadic Alzheimer’s disease (AD). A dietary approach (Fortasyn) including docosahexaenoic acid, eicosapentaenoic acid, uridine, choline, phospholipids, folic acid, vitamins B12, B6, C, and E, and selenium has been proposed for dietary management of AD. We hypothesize that the diet could inhibit AD-like pathologies in apoE4 mice, specifically cerebrovascular and connectivity impairment. Moreover, we evaluated the diet effect on cerebral blood flow (CBF), functional connectivity (FC), gray/white matter integrity, and postsynaptic density in aging apoE4 mice. At 10–12 months, apoE4 mice did not display prominent pathological differences compared to wild-type (WT) mice. However, 16–18-month-old apoE4 mice revealed reduced CBF and accelerated synaptic loss. The diet increased cortical CBF and amount of synapses and improved white matter integrity and FC in both aging apoE4 and WT mice. We demonstrated that protective mechanisms on vascular and synapse health are enhanced by Fortasyn, independent of apoE genotype. We further showed the efficacy of a multimodal translational approach, including advanced MR neuroimaging, to study dietary intervention on brain structure and function in aging.
HER2 Protein Overexpression and Gene Amplification in Plasmacytoid Urothelial Carcinoma of the Urinary Bladder
Authors: Kim Bohyun , Kim Gilhyang , Song Boram , Lee Cheol , Park Jeong Hwan , Moon Kyung Chul
Published: March 2016

Aim. HER2 overexpression has been reported in a minority of urothelial carcinomas, but little is known about HER2 protein expression and gene alterations in plasmacytoid urothelial carcinoma, a rare and aggressive variant. The aim of this study was to clarify the HER2 status in plasmacytoid urothelial carcinomas.Methods. Six cases of plasmacytoid urothelial carcinoma were included, in which we evaluated HER2 protein expression by immunohistochemistry (IHC) andHER2gene amplification by fluorescencein situhybridization (FISH).Results. The patients’ ages ranged from 57 to 83 years (mean age, 71 years). Five patients were male and one was female. The ratio of the plasmacytoid component ranged from 30% to 100% (mean, 77%). HER2 expression score was 3+ in 4 cases, 2+ in one case, and negative in one case. HER2 gene amplification was positive in 3 cases, of which 2 cases showed a 3+ HER2 IHC score but one case was negative for HER2 IHC. Another 2 cases showed equivocal HER2 FISH results, and one remaining case was negative for HER2 FISH.Conclusion. Our observation that plasmacytoid urothelial carcinomas frequently demonstrated HER2 protein overexpression provides supporting evidence that HER2 may be a potential therapeutic target for plasmacytoid urothelial carcinoma.
Quantitative Phosphotyrosine Profiling of Patient-Derived Xenografts Identifies Therapeutic Targets in Pediatric Leukemia
Authors: Dolai Sibasish , Sia Keith C.S. , Robbins Alissa K. , Zhong Ling , Heatley Sue L. , Vincent Tiffaney L. , Hochgräfe Falko , Sutton Rosemary , Kurmasheva Raushan T. , Revesz Tamas , White Deborah L. , Houghton Peter J. , Smith Malcolm A. , Teachey David T. , Daly Roger J. , Raftery Mark J. , Lock Richard B.
Published: March 2016

Activating mutations in tyrosine kinases (TK) drive pediatric high-risk acute lymphoblastic leukemia (ALL) and confer resistance to standard chemotherapy. Therefore, there is urgent need to characterize dysregulated TK signaling axes in patients with ALL and identify actionable kinase targets for the development of therapeutic strategies. Here, we present the first study to quantitatively profile TK activity in xenografted patient biopsies of high-risk pediatric ALL. We integrated a quantitative phosphotyrosine profiling method with “spike-in” stable isotope labeling with amino acids in cell culture (SILAC) and quantified 1394 class I phosphorylation sites in 16 ALL xenografts. Moreover, hierarchical clustering of phosphotyrosine sites could accurately classify these leukemias into either B- or T-cell lineages with the high-risk early T-cell precursor (ETP) and Ph-like ALL clustering as a distinct group. Furthermore, we validated this approach by using specific kinase pathway inhibitors to perturb ABL1, FLT3, and JAK TK signaling in four xenografted patient samples. By quantitatively assessing the tyrosine phosphorylation status of activated kinases in xenograft models of ALL, we were able to identify and validate clinically relevant targets. Therefore, this study highlights the application and potential of phosphotyrosine profiling for identifying clinically relevant kinase targets in leukemia. Cancer Res; 76(9); 2766–77. ©2016 AACR.
IL-10 Induces T Cell Exhaustion During Transplantation of Virus Infected Hearts
Authors: Gassa Asmae , Jian Fu , Kalkavan Halime , Duhan Vikas , Honke Nadine , Shaabani Namir , Friedrich Sarah-Kim , Dolff Sebastian , Wahlers Thorsten , Kribben Andreas , Hardt Cornelia , Lang Philipp A. , Witzke Oliver , Lang Karl S.
Published: March 2016

Background/Aims: Unexpected transmissions of viral pathogens during solid organ transplantation (SOT) can result in severe, life-threatening diseases in transplant recipients. Immune activation contributes to disease onset. However mechanisms balancing the immune response against transmitted viral infection through organ transplantation remain unknown. Methods & Results: Here we found, using lymphocytic choriomeningitis virus (LCMV), that transplantation of LCMV infected hearts led to exhaustion of virus specific CD8+ T cells, viral persistence in organs and survival of graft and recipient. Genetic depletion of Interleukin-10 (IL-10) resulted in strong immune activation, graft dysfunction and death of mice, suggesting that IL-10 was a major regulator of CD8+ T cell exhaustion during SOT. In the presence of memory CD8+ T cells, virus could be controlled. However sufficient antiviral immune response resulted in acute rejection of transplanted heart. Conclusion: We found that virus transmitted via SOT could not be controlled by naïve mice recipients due to IL-10 mediated CD8+ T cell exhaustion which thereby prevented immunopathology and graft failure whereas memory mice recipients were able to control the virus and induced graft failure.
Idiopathic Intracranial Hypertension in a Prepubertal Pediatric Japanese Patient Complicated by Severe Papilledema
Authors: Oka Akiko , Ikesugi Kengo , Kondo Mineo
Published: March 2016

Purpose: To report a rare case of idiopathic intracranial hypertension (IIH) in a prepubertal pediatric patient. Case Report: The patient was an 11-year-old Japanese boy. Initially, an ophthalmologist found severe papilledema, and the patient was diagnosed with IIH. He was unresponsive to conservative therapy, and a ventriculoperitoneal shunt was inserted in the Neurosurgery Department because the visual impairment was severe. Twelve months after the shunt, the improvement in vision was limited due to optic disc atrophy. Conclusion: Ophthalmologists need to be more aware of II, especially in cases with severe papilledema that can lead to permanent reduction of vision.
Laparoscopic Transperitoneal Lateral Adrenalectomy for Large Adrenal Tumors
Authors: Natkaniec Michał , Pędziwiatr Michał , Wierdak Mateusz , Major Piotr , Migaczewski Marcin , Matłok Maciej , Budzyński Andrzej , Rembiasz Kazimierz
Published: March 2016

Background: Laparoscopic adrenalectomy is the gold standard for treatment of benign adrenal lesions. Tumor size is a factor that might influence decision-making concerning the use of laparoscopic approach. The aim of this study was to analyze the results of adrenalectomy for tumors ≥6 cm in diameter. Methods: Two groups of patients were analyzed: first group comprised 441 patients with tumors <6 cm in diameter and second group consisted of 89 patients with tumors ≥6 cm. Both groups were compared with regard to the duration of surgery, intraoperative blood loss, conversion and complications rate. Results: Median duration of surgery in groups 1 and 2 amounted to 86.6 and 111.9 min (p < 0.0001), respectively. Median intraoperative blood loss in groups 1 and 2 was 56.5 and 172.8 ml (p < 0.0001), respectively. There was a linear relationship between tumor size and the duration of surgery, and between tumor size and intraoperative blood loss (p < 0.0001). There were 2 (0.5%) and 6 (6.7%) conversions in groups 1 and 2, respectively. There were 41 (9.3%) and 14 (15.7%) complications in groups 1 and 2 (p = 0.0692), respectively. Conclusions: Laparoscopic adrenalectomy of tumors ≥6 cm is more difficult, but it can be regarded safe and beneficial for patients.
RRx-001 in Refractory Small-Cell Lung Carcinoma: A Case Report of a Partial Response after a Third Reintroduction of Platinum Doublets
Authors: Carter Corey A. , Oronsky Bryan T. , Caroen Scott Z. , Scicinski Jan J. , Degesys Aiste , Kim Michelle M. , Oronsky Arnold L. , Lybeck Harry , Cabrales Pedro , Oronsky Neil , Reid Tony , Roswarski Joseph , Brzezniak Christina
Published: March 2016

RRx-001 is a pan-active, systemically nontoxic epigenetic inhibitor under investigation in advanced non-small cell lung cancer, small-cell lung cancer and high-grade neuroendocrine tumors in a Phase II clinical trial entitled TRIPLE THREAT (NCT02489903), which reexposes patients to previously effective but refractory platinum doublets after treatment with RRx-001. The purpose of this case study is first to report a partial response to carboplatin and etoposide in a patient with small-cell lung cancer pretreated with RRx-001, indicating episensitization or resensitization by epigenetic mechanisms, and second to discuss the literature related to small-cell lung cancer and episensitization.
Impact of Spironolactone on Longitudinal Changes in Health-Related Quality of Life in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial
Authors: Lewis Eldrin F. , Kim Hae-Young , Claggett Brian , Spertus John , Heitner John F. , Assmann Susan F. , Kenwood Christopher T. , Solomon Scott D. , Desai Akshay S. , Fang James C. , McKinlay Sonia A. , Pitt Bertram A. , Pfeffer Marc A.
Published: March 2016

Background—

Heart failure (HF) with preserved ejection fraction patients have equally impaired health-related quality of life (HRQL) compared with those with HF with reduced ejection fraction, but limited studies have evaluated the impact of therapies on changes in HRQL.

Methods and Results—

Patients ≥50 years of age, with symptomatic HF and left ventricular ejection fraction ≥45%, were enrolled in Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) and randomized to spironolactone or placebo. Patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ), which was the primary HRQL instrument, and EQ5D visual analog scale at baseline, 4 months, 12 months, and annually thereafter. McMaster Overall Treatment Evaluation was assessed at 4 and 12 months to assess global change scores. Change scores (+SD) were calculated to determine between-group differences, and multivariable repeated-measures models were created to identify other factors associated with change scores. Paired KCCQ data were available for 91.7% of 3445 TOPCAT patients. By 4 months, the mean change in KCCQ was 7.7±16 and mean change in EQ5D visual analog scale was 4.7±16. Adjusted mean changes in KCCQ for the spironolactone group were significantly better than those for the placebo group at 4-month (1.54 better;
P
=0.002), 12-month (1.35 better;
P
=0.02), and 36-month (1.86 better;
P
=0.02) visits. No between-group differences in EQ5D visual analog scale change scores or McMaster Overall Treatment Evaluation were noted. Older age, obesity, current smoking, New York Heart Association class III/IV, and comorbid illnesses were associated with declines in KCCQ scores. Use of spironolactone was an independent predictor of improved KCCQ scores.

Conclusions—

In symptomatic HF with preserved ejection fraction patients, use of spironolactone was associated with an improvement in HF-specific HRQL. Several modifiable risk factors were associated with HRQL deterioration.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00094302.
Traditional Chinese Exercise for Cardiovascular Diseases: Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Authors: Wang Xue‐Qiang , Pi Yan‐Ling , Chen Pei‐Jie , Liu Yu , Wang Ru , Li Xin , Chen Bing‐Lin , Zhu Yi , Yang Yu‐Jie , Niu Zhan‐Bin
Published: March 2016

Background

Traditional Chinese exercise (
TCE
) has widespread use for the prevention and treatment of cardiovascular disease; however, there appears to be no consensus about the benefits of
TCE
for patients with cardiovascular disease. The objective of this systematic review was to determine the effects of
TCE
for patients with cardiovascular disease.

Methods and Results

Relevant studies were searched by PubMed, Embase, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the China National Knowledge Infrastructure. We covered only published articles with randomized controlled trials. The outcome measures included physiological outcomes, biochemical outcomes, physical function, quality of life, and depression. A total of 35 articles with 2249 cardiovascular disease patients satisfied the inclusion criteria. The pooling revealed that
TCE
could decrease systolic blood pressure by 9.12 mm Hg (95%
CI
−16.38 to −1.86,
P
=0.01) and diastolic blood pressure by 5.12 mm Hg (95%
CI
−7.71 to −2.52,
P
<0.001). Patients performing
TCE
also found benefits compared with those in the control group in terms of triglyceride (standardized mean difference −0.33, 95%
CI
−0.56 to −0.09,
P
=0.006), 6‐minute walk test (mean difference 59.58 m, 95% CI −153.13 to 269.93,
P
=0.03), Minnesota Living With Heart Failure Questionnaire results (mean difference −17.08, 95% CI −23.74 to −10.41,
P
<0.001), 36‐Item Short Form physical function scale (mean difference 0.82, 95% CI 0.32–1.33,
P
=0.001), and Profile of Mood States depression scale (mean difference −3.02, 95% CI −3.50 to −2.53,
P
<0.001).

Conclusions

This study demonstrated that
TCE
can effectively improve physiological outcomes, biochemical outcomes, physical function, quality of life, and depression among patients with cardiovascular disease. More high‐quality randomized controlled trials on this topic are warranted.
Association Between Severe Hypoglycemia and Cardiovascular Disease Risk in Japanese Patients With Type 2 Diabetes
Authors: Goto Atsushi , Goto Maki , Terauchi Yasuo , Yamaguchi Naohito , Noda Mitsuhiko
Published: March 2016

Background

It remains unclear whether severe hypoglycemia is associated with cardiovascular disease (
CVD
) in Asian populations with type 2 diabetes (T2D). Furthermore, no study in Japan, where the prescription patterns differ from those in other countries, has examined this association.

Methods and Results

We retrospectively included 58 223 patients (18–74 years old) with T2D. First, we examined the potential predictors of severe hypoglycemia. Then, we investigated the association between severe hypoglycemia and
CVD
risk. Finally, we performed an updated systematic review and meta‐analysis to incorporate our findings and recently published studies into the previous systematic review and meta‐analysis. During 134 597 person‐years from cumulative observation periods, 128 persons experienced severe hypoglycemia and 550 developed
CVD
events. In a multivariate Cox proportional hazard model, severe hypoglycemia was strongly and positively associated with the risk of
CVD
(multivariate‐adjusted adjusted hazard ratio, 3.39; 95%
CI
, 1.25–9.18). In a propensity score–matched cohort that had similar baseline characteristics for patients with severe hypoglycemia and those without, severe hypoglycemia was more strongly associated with the risk of
CVD
. An updated systematic review and meta‐analysis that included 10 studies found that severe hypoglycemia was associated with an ≈2‐fold increased risk of
CVD
(pooled relative risk, 1.91; 95%
CI
, 1.69–2.15).

Conclusions

Our results suggest that severe hypoglycemia is strongly associated with an increased risk of
CVD
in Japanese patients with T2D, further supporting the notion that avoiding severe hypoglycemia may be important in preventing
CVD
in this patient population.
Invoking the Prophet Muhammad through Word, Sound, and Image
Authors: Blair Sheila
Published: March 2016

Objects associated with the practice of the Muslim faith are often inscribed with Qurʾanic verses specifically chosen to reflect their spiritual functions and project the piety of the patrons who ordered them and the believers who used them. This essay focuses on one such Qurʾanic passage: the invocation of the Prophet Muhammad in Qurʾan 33: 56, a verse saying that God and His angels bless the Prophet and that believers should bless him too and give him greetings of peace. The article analyses the use of this verse on buildings and objects of various media in five different places from early Islamic to pre-modern times to show how words, sounds, and images could be used to elaborate different aspects of Muhammad’s persona, ranging from his unique position as beautiful model to his roles as intercessor, miracle-worker, and protagonist in the miraculous night journey and ascension.