bluuebunny/crossref_metadata_2025 huggingface dataset:
Macroreentrant atrial tachycardia detouring the epicardium at the anterior wall of the left atrium
Authors: Miyazawa Satoshi , Fukamizu Seiji , Kawamura Iwanari , Hojo Rintaro
Published: October 2018

A 79‐year‐old woman with a history of pulmonary vein isolation for persistent atrial fibrillation was admitted for recurrence of atrial tachycardia, with a tachycardia cycle length of 236 milliseconds. The ultra–high‐resolution mapping system revealed that tachycardia circuit detouring the epicardium at the anterior wall scar and breaking through to the endocardium below the left atrial appendage. Radiofrequency energy was applied to this site, which successfully terminated the tachycardia. This case suggests that epicardial conduction could occur even at the left atrial anterior wall and identifies a variation in epicardial conduction around the left atrium, which could be a tachycardia circuit.
Detailed comparison between the wall thickness and voltages in chronic myocardial infarction
Authors: Takigawa Masateru , Martin Ruairidh , Cheniti Ghassen , Kitamura Takeshi , Vlachos Konstantinos , Frontera Antonio , Martin Claire A. , Bourier Felix , Lam Anna , Pillois Xavier , Duchateau Josselin , Klotz Nicolas , Pambrun Thomas , Denis Arnaud , Derval Nicolas , Hocini Mélèze , Haïssaguerre Michel , Sacher Frédéric , Jaïs Pierre , Cochet Hubert
Published: October 2018

Background

The relationship between the local electrograms (EGMs) and wall thickness (WT) heterogeneity within infarct scars has not been thoroughly described. The relationship between WT and voltages and substrates for ventricular tachycardia (VT) was examined.

Methods

In 12 consecutive patients with myocardial infarction and VT, WT, defined by a multidetector computed tomography, and voltage were compared. In multicomponent EGMs, amplitudes of both far‐ and near‐field components were manually measured, and the performance of the three‐dimensional‐mapping system automatic voltage measurement was assessed.

Results

Of 15 748 points acquired, 2677 points within 5 mm of the endocardial surface were analyzed. In total, 909 (34.0%) multicomponent EGMs were identified; 785 (86.4%) and 883 (97.1%) were distributed in the WT less than 4 and 5 mm, respectively. Far‐field EGM voltages increased linearly from 0.14 mV (0.08‐0.28 mV) in the WT: 0 to 1 mm to 0.70 mV (0.43‐2.62 mV) in the WT: 4 to 5 mm (ρ = 0.430; P < 0.001), and a significant difference was demonstrated between any two WT‐groups (P ≤ 0.001). In contrast, near‐field EGM voltages varied from 0.27 mV (0.11‐0.44 mV) in the WT: 0 to 1 mm to 0.29 mV (0.17‐0.53 mV) in the WT: 4 to 5 mm with a poorer correlation (ρ = 0.062, P = 0.04). The proportion of points where the system automatically measured the voltage on near‐field EGMs increased from less than 10% in areas of WT: 4 to 5 mm to 50% in areas less than 2 mm. Of 21 VTs observed, seven hemodynamically stable VTs were mapped and terminated in WT: 1 to 4 mm area.

Conclusions

Although far‐field voltages gradually increase with the WT, near‐field does not. The three‐dimensional–mapping system preferentially annotates the near‐field components in thinner areas (center of the scar) and the far‐field component in thicker areas when building a voltage map. Critical sites of VT are distributed in WT: 1 to 4 mm areas.
Contribution of pancreatic α‐cell function to insulin sensitivity and glycemic variability in patients with type 1 diabetes
Authors: Takahashi Nobuyuki , Chujo Daisuke , Kajio Hiroshi , Ueki Kohjiro
Published: October 2018

Aims/Introduction

To evaluate the contribution of pancreatic α‐cell function to the dawn phenomenon, insulin sensitivity, hepatic glucose uptake and glycemic variability in patients with type 1 diabetes.

Materials and Methods

In 40 patients with type 1 diabetes, arginine stimulation tests were carried out, and the area under the curve (AUC) of glucagon was measured using radioimmunoassays (AUCglcRIA) and enzyme‐linked immunosorbent assays (AUCglcELISA). The ratio of the insulin dose delivered by an artificial pancreas to maintain euglycemia between 04.00 and 08.00 hours or between 00.00 and 04.00 hours was measured as the dawn index. The glucose infusion rate and hepatic glucose uptake were measured using hyperinsulinemic euglycemic clamp and clamp oral glucose loading tests. Glycemic variability in 96 h was measured by continuous glucose monitoring.

Results

The median dawn index (1.7, interquartile range 1.0–2.8) was not correlated with AUCglcRIA (R2 = 0.03, P = 0.39) or AUCglcELISA (R2 = 0.04, P = 0.32). The median glucose infusion rate (7.3 mg/kg/min, interquartile range 6.4–9.2 mg/kg/min) was significantly correlated with AUCglcRIA (R2 = 0.20, P = 0.02) and AUCglcELISA (R2 = 0.21, P = 0.02). The median hepatic glucose uptake (65.3%, interquartile range 40.0–87.3%) was not correlated with AUCglcRIA (R2 = 0.07, P = 0.26) or AUCglcELISA (R2 = 0.26, P = 0.79). The standard deviation of glucose levels measured by continuous glucose monitoring was significantly correlated with AUCglcRIA (R2 = 0.11, P = 0.049), but not with AUCglcELISA (R2 = 0.01, P = 0.75).

Conclusions

Pancreatic α‐cell function contributed to insulin sensitivity in patients with type 1 diabetes.
mTORC1 at the crossroad of metabolism and immunity in hidradenitis suppurativa
Authors: De Vita V. , Melnik B.C.
Published: October 2018

Linked article: This article is commented on by J.L. Hernández et al., p. e109 in this issue. To view this article visit https://doi.org/10.1111/jdv.15273
Position statement: topical calcineurin inhibitors in atopic dermatitis
Authors: Remitz A. , De Pità O. , Mota A. , Serra‐Baldrich E. , Vakirlis E. , Kapp A.
Published: October 2018

Background

Atopic dermatitis (AD) is a common inflammatory skin disease in both adults and children. Whilst topical calcineurin inhibitors (TCIs), tacrolimus ointment and pimecrolimus cream, have proven efficacy for the treatment of AD, it is important to involve experts to obtain their opinion on its optimal treatment.

Objective

Using a modified Delphi approach, this project aimed to generate consensus amongst experts on the use of TCIs in the treatment of AD, with a focus on the differentiation between tacrolimus and pimecrolimus.

Methods

Six expert dermatologists from different European countries participated in this project based on their experience with AD and its treatment, which was evaluated by literature analysis and expert opinion. Consensus amongst the experts was generated using a modified Delphi approach, consisting of three distinct phases, during which a web meeting (June 2017), two online rounds of blinded Delphi voting (July–September 2017) and a face‐to‐face meeting (November 2017) were conducted. The consensus statements concerned two main topics: (i) Background of AD; and (ii) TCIs in AD. Hot topics in the treatment of AD not supported by meta‐analysis, clinical trials or large observational studies were also discussed based on clinical experience.

Results

In total, 25 consensus statements were defined and validated: eight statements on the general background of AD and 17 statements on the use of TCIs in AD, including their mechanism of action and therapeutic indications in AD, efficacy in adult and paediatric AD patients, pharmacokinetics, incidence of adverse events and safety concerns. Hot topics on the use of TCIs for the treatment of AD included cream vs. ointment, dosages, TCIs contact allergy, burning sensation management, superinfection and vaccination concerns.

Conclusion

Topical calcineurin inhibitors are a suitable therapy for AD, and selection of the specific TCI should be based on factors which differentiate tacrolimus from pimecrolimus.
Position Statement: Linear prurigo is a subtype of chronic prurigo
Authors: Pereira M.P. , Zeidler C. , Nau T. , Bobko S. , Evers A.W.M. , Garcovich S. , Gonçalo M. , Halvorsen J.A. , Lambert J. , Legat F.J. , Leslie T. , Metz M. , Misery L. , Nordlind K. , Reich A. , Schneider G. , Ständer H. , Streit M. , Szepietowski J.C. , Wallengren J. , Weisshaar E. , Ständer S. ,   the EADV Task Force Pruritus
Published: October 2018

Background

Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG.

Objective

To achieve a consensus on the classification of pruriginous LSSL and establish criteria to differentiate them from similar appearing conditions of different nature.

Methods

Members of the Task Force Pruritus (TFP) of the European Academy of Dermatology and Venereology participated in the consensus conference, discussing representative clinical cases. Using the Delphi method, consensus was reached when ≥75% of members agreed on a statement.

Results

Twenty‐one members of the TFP with voting rights participated in the meeting. It was consented that LSSL occurs due to chronic pruritus and prolonged scratching, and share common pathophysiological mechanisms with CPG. LSSL were thus considered as belonging to the spectrum of CPG and the term ‘linear prurigo’ was chosen to describe this manifestation.

Conclusion

Considering linear prurigo as belonging to the spectrum of CPG has important clinical implications, since both the diagnostic and therapeutic approach of these patients should be performed as recommended for CPG. Importantly, linear prurigo should be differentiated from self‐inflicted skin lesions as factitious disorders or skin picking syndromes. In the latter, artificial manipulation rather than pruritus itself leads to the development of cutaneous lesions, which can show clinical similarities to linear prurigo.
Long‐term efficacy of novel therapies in moderate‐to‐severe plaque psoriasis: a systematic review and network meta‐analysis of PASI response
Authors: Sawyer L.M. , Cornic L. , Levin L.Å. , Gibbons C. , Møller A.H. , Jemec G.B.
Published: October 2018

Background

Patients with moderate‐to‐severe psoriasis require long‐term treatment, yet few trials compare outcomes beyond a short‐term induction period. Quantitative comparisons of long‐term outcomes in patients with psoriasis are limited. To our knowledge, no network meta‐analysis (NMA) of such data has been performed.

Objective

To compare novel systemic therapies, both biologic and non‐biologic, approved for moderate‐to‐severe psoriasis by conducting a systematic review (SR) and NMA of Psoriasis Area and Severity Index (PASI) outcomes measured at or around 1 year.

Methods

An SR was conducted to identify studies reporting PASI 75, PASI 90 and PASI 100 responses. Feasibility of an NMA on maintenance phase endpoints was assessed and sources of heterogeneity considered. Data appropriate for analysis were modelled using a Bayesian multinomial likelihood model with probit link. Wherever possible, data corresponding to an intention‐to‐treat approach with non‐responder imputation were used.

Results

Twenty‐four studies reporting outcomes at 40–64 weeks were identified, but heterogeneity in study design allowed synthesis of only 17. Four 52‐week randomized controlled trials (RCTs) comprised the primary analysis, which found brodalumab was significantly more efficacious than secukinumab, ustekinumab and etanercept. Secukinumab was also more efficacious than ustekinumab and both outperformed etanercept. In a secondary analysis, evidence from 13 additional studies and 4 further therapies (adalimumab, apremilast, infliximab and ixekizumab) was included by comparing long‐term outcomes from active interventions to placebo outcomes extrapolated from induction. Results were consistent with the primary analysis: brodalumab was most effective, followed by ixekizumab and secukinumab, then ustekinumab, infliximab and adalimumab. Etanercept and apremilast had the lowest expected long‐term efficacy. Results were similar when studies with low prior exposure to biological therapies were excluded.

Conclusion

Results suggest that brodalumab is associated with a higher likelihood of sustained PASI response, including complete clearance, at week 52 than comparators. Further long‐term active‐comparator RCT data are required to better assess relative efficacy across therapies.
The value of dermoscopy in diagnosing eyebrow loss in patients with alopecia areata and frontal fibrosing alopecia
Authors: Waśkiel‐Burnat A. , Rakowska A. , Kurzeja M. , Czuwara J. , Sikora M. , Olszewska M. , Rudnicka L.
Published: October 2018

Introduction

Alopecia areata and frontal fibrosing alopecia are common causes of eyebrow loss (madarosis).

Objective

Assessment of trichoscopic markers of eyebrow loss in alopecia areata and frontal fibrosing alopecia.

Materials and methods

The analysis included 50 patients with scalp alopecia areata with madarosis, 50 patients with scalp frontal fibrosing alopecia with madarosis and 50 healthy controls. In every case, trichoscopy of the eyebrow area was performed.

Results

Empty follicular and eccrine duct openings were observed in all patients and presented predominantly as yellow dots. Exclamation mark hairs were only detected in patients with alopecia areata (30%). Tapered hairs, broken hair, black dots and Pohl–Pinkus constrictions were observed in 14%, 36%, 26% and 4% of patients with alopecia areata, respectively, 4%, 16%, 2% and 0% of patients with frontal fibrosing alopecia, respectively, and they were not present in healthy controls. Dystrophic hairs and whitish areas were observed only in patients with frontal fibrosing alopecia (28% and 32%, respectively). Eyebrow regrowth in distinct directions was present in 32% of patients with frontal fibrosing alopecia, 8% of patients with alopecia areata and 4% of healthy controls. Diffuse erythema was detected in 60% of patients with alopecia areata and frontal fibrosing alopecia and 56% of healthy controls. Vellus hairs and upright regrowing hairs were observed in patients with alopecia areata (62% and 58%, respectively), frontal fibrosing alopecia (60% and 84%, respectively) and healthy controls (100% and 100%, respectively).

Conclusion

Trichoscopy of the eyebrow area is useful in diagnosing patients with isolated eyebrow loss. The most characteristic trichoscopic features of eyebrow loss in alopecia areata include exclamation mark hairs, tapered hairs, broken hairs and black dots. Frontal fibrosing alopecia of the eyebrows is characterized by the presence of dystrophic hairs, white areas and eyebrow regrowth in distinct directions.
Can platform competition support market segmentation? Network externalities versus matching efficiency in equity crowdfunding markets
Authors: Gal‐Or Esther , Gal‐Or Ronen , Penmetsa Nabita
Published: October 2018

We investigate whether, in spite of the existence of cross‐market network externalities, platform competition can lead to segmentation of the two sides of the market served by the platforms. We address this question in the context of competition between two equity crowdfunding platforms that connect startups looking for capital with prospective investors. Given the heterogeneity in the populations of startups and investors in terms of the riskiness of the former population and the degree of risk aversion of the latter population, we investigate whether there exists an equilibrium where the two populations are segmented to ensure an improved match between them. We find that the segmenting equilibrium can arise only when compatibility in terms of their risk profiles is of high importance to both populations, and compatibility is significantly more important than the size of the network externality considered by startups. Segmentation is likely to improve the welfare of both populations when the basic benefit from any kind of match is relatively high.
Seasonal variation in natural mortality factors of Tuta absoluta (Lepidoptera: Gelechiidae) in open‐field tomato cultivation
Authors: Bacci Leandro , da Silva Ézio Marques , Martins Júlio Cláudio , Soares Marianne A. , Campos Mateus Ribeiro de , Picanço Marcelo Coutinho
Published: October 2018

The seasonal variation in natural mortality of phytophagous insects is determined by the relative importance of biotic and abiotic factors in agroecosystems. Knowledge regarding these factors throughout the year represents a key concern for IPM programmes. Seasonal population fluctuations of tomato pinworm, Tuta absoluta, led to an investigation of its natural mortality factors during the rainy season when the population level is low and during the dry season when population peaks occur. The aim of this study was to verify the seasonal variation in T. absoluta mortality factors in tomato crops. Immature stages of T. absoluta were obtained from laboratory‐rearing in the laboratory. These were taken to the field and monitored over two years. The mortality causes for each stage of insect development from egg to adult were assessed daily. Multiple biotic and abiotic mortality factors affected the immature T. absoluta stages such as rainfall, physiological disturbances, diseases, parasitoids and predators. The key T. absoluta mortality factor during summer–spring was predation. In addition, larvae predation correlated positively with temperature, wind velocity, photoperiod and rainfall. Nevertheless, during winter–fall, the key mortality factor was parasitism. Therefore, the critical stage for mortality was 3rd‐ and 4th‐instar larvae, being more vulnerable to natural control factors. Finally, the results showed the importance of vertical and horizontal action on natural mortality factors.
Application of high‐pressure argon for improving postharvest quality of cherry tomato
Authors: Feng Lei , Zhang Min , Adhikari Benu , Guo Zhimei
Published: October 2018

The purpose of this study was to investigate the effect of high‐pressure argon on postharvest quality of cherry tomatoes. Physicochemical attributes including weight loss, decay incidence, color changes, firmness, respiratory intensity, titratable acidity (TA), malondialdehyde content (MDA), water status, and antioxidant enzyme activities were analyzed. Flavor characteristics of cherry tomatoes were determined by GC–MS. The results showed that decay incidences of cherry tomatoes subjected to high‐pressure argon at 0.4, 0.8, and 1.2 MPa were 27.03, 64.86, and 45.95%, respectively, lower than that of control after 25 days of storage. Throughout the storage, high‐pressure argon was most effective in decreasing weight loss, retaining color, firmness, and TA content, reducing respiration intensity and MDA content, and inhibiting the redistribution of water. Cherry tomatoes treated with high‐pressure argon at 0.8 MPa maintained higher levels of antioxidant enzyme activities including superoxide dismutase, catalase, peroxidase, and ascorbate peroxidase. The results of GC–MS showed that high‐pressure argon treatment remarkably influenced the flavor profiles, characteristics of cherry tomatoes during postharvest storage. Therefore, high‐pressure argon treatment may have potential application in preservation technique of fruit and vegetables.
Quality evaluation of fried soybean oil base on near infrared spectroscopy
Authors: Liu Yangyang , Sun Laijun , Li Yingsong , Zhang Dan , Song Ziwei , Zhang Chen , Pan Xuyang , Li Jinlong , Wang Zhiyu
Published: October 2018

Frying quality of soybean oil gives important effects on the quality of the frying food and consumer health. To evaluate the frying quality of soybean oil, this study proposed a method based on Near Infrared Spectroscopy (NIRS) to quickly identify the frying times which will give an effect on the harmful compounds. A model is established to analyze the relationship between the frying times and the corresponding spectra and the deterioration degree of soybean oil under different frying times is characterized. Ten experiments were set up and the first eight experimental spectra are used to construct a model which is predicted and evaluated by the last unmodeled two experimental spectra. Firstly, the first derivative (D1), the second derivative (D2), and standard normal variables transformation (SNV) are used to process the original spectra. Secondly, the combination of correlation coefficient, differential and standardized methods is considered to form a novel approach to obtain a model. Finally, the predictive accuracy of the frying times could reach 100% within the range of allowable error. The overall results indicated that the frying times of soybean oil can be effectively identified by the characteristic wavelengths, and thus the quality change of fried soybean oil is reflected.

Practical applications

The detection of the frying times can help assess the quality of fried soybean oil. From a practical point of view, the frying times seriously affect the quality of fried soybean oil. Accurately predicting the frying times can effectively reflect the deterioration degree of fried soybean oil and thus improve the quality of fried soybean oil. In this work, the characteristic wavelengths are selected to establish the relationship between the frying times and the corresponding spectra, and the different frying times of fried soybean oil are judged according to different spectral range values. In the follow‐up study, we can use the characteristic wavelengths extracted in this study to develop a portable instrument to detect the frying times of fried soybean oil, and then determine the quality of fried soybean oil.
Characteristics and Patterns of Marijuana Use in Community‐Dwelling Older Adults
Authors: Reynolds Ian R. , Fixen Danielle R. , Parnes Bennett L. , Lum Hillary D. , Shanbhag Prajakta , Church Skotti , Linnebur Sunny A. , Orosz Gretchen
Published: October 2018

Objectives

To understand patterns of marijuana use in community‐dwelling older adults in Colorado.

Design

Anonymous survey.

Setting

Two academic geriatric primary care clinics.

Participants

English‐speaking individuals.

Measurements

We assessed self‐reported characteristics and patterns of marijuana use and effect on targeted symptoms. Survey analysis focused on current users, defined as individuals who had used marijuana in the past 3 years.

Results

Three hundred forty‐five individuals completed the survey (55% response rate); 113 (32%) had used marijuana in the past, of whom 55 (16%) had used since legalization. More than half of current users were aged 75 and older, and one‐quarter were aged 85 and older. Most current users were white women. Of current users, 44% used marijuana products at least weekly for common conditions including chronic pain, depression, anxiety, and insomnia, and most found marijuana helpful for these conditions. Most respondents reported obtaining marijuana recreationally (67%) without a prescription. Nine respondents reported negative side effects attributable to marijuana use.

Conclusion

To our knowledge, this is the first study to characterize marijuana use of older adults in a state in which it is legal for medical and recreational use. Marijuana was used for several common geriatric conditions, and respondents reported few side effects. The small number of survey respondents, the lack of generalizability in states where marijuana sales are illegal, and participation bias were the main study limitations. Further research is needed to better understand useful or harmful effects in this population. J Am Geriatr Soc 66:2167–2171, 2018.
Defining and Measuring Nursing Home Placement
Authors: Mor Vincent , Thomas Kali S. , Rahman Momotazur
Published: October 2018

This editorial comments on the articles by James S. Goodwin et al, Amy L. Byers et al, and Jennifer L. Wolff et al.
Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults
Authors: Kata Anna , Sudore Rebecca , Finlayson Emily , Broering Jeanette M. , Ngo Sarah , Tang Victoria L.
Published: October 2018

Objectives

To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP).

Design

Retrospective analysis of clinical demonstration project.

Setting

Preoperative optimization program for older adults undergoing surgery at a 796‐bed academic tertiary hospital.

Participants

Older adults (N=131) who participated in the SWP from February 2015 to August 2017.

Intervention

All SWP participants met with a geriatrician who engaged them in a semistructured ACP discussion. Trained medical and nurse practitioner students were used as health coaches who contacted participants regularly to address and document ACP.

Measurements

Self‐report of ACP engagement before and after participation in the SWP was determined using SWP geriatrician and health coach progress notes. Medical records were examined for scanned documentation. Feasibility data on number of health coach calls were collected.

Results

After completion of the program, the proportion of participants with a designated surrogate increased from 67% to 78% (p<.001), completed advance directive (AD) from 51% to 72% (p<.001), and an AD scanned into the medical record from 14% to 60% (p<.001). Participants who underwent surgery received a median of 4 health coaching calls over a median of 27 days between their clinic visit and surgery. Case examples are presented to highlight how the SWP attends to the many components of the ACP process.

Conclusion

Preoperative optimization programs provide a unique opportunity to engage older adults in ACP.
Trends in Polypharmacy in Japan: A Nationwide Retrospective Study
Authors: Onoue Hiroshi , Koyama Toshihiro , Zamami Yoshito , Hagiya Hideharu , Tatebe Yasuhisa , Mikami Naoko , Shinomiya Kazuaki , Kitamura Yoshihisa , Hinotsu Shiro , Sendo Toshiaki , Ouchi Yasuyoshi , Kano Mitsunobu R.
Published: October 2018

Objectives

To describe and examine trends in polypharmacy according to age in Japan from 2010 to 2016.

Design

Retrospective observational study.

Setting

Outpatient settings.

Participants

Japanese individuals aged 20 and older.

Measurements

We analyzed pharmacy claims data that the Japanese Ministry of Health, Labor, and Welfare provided in the Survey of Medical Care Activities in Public Health Insurance from 2010 to 2016. The use of 5 or more oral prescription medications per month was defined as polypharmacy and of 10 or more as excessive polypharmacy. Regression analysis was used to estimate trends in polypharmacy with annual percentage changes. Using number of medications (polypharmacy vs excessive polypharmacy), trends in polypharmacy and crude and age‐adjusted rates of polypharmacy per 1,000 persons were calculated according to year and age group (20–34, 35–49, 50–64, 65–79, ≥ 80).

Results

We analyzed 240 million pharmacy claims data. The age‐adjusted monthly prevalence rate of polypharmacy increased from 85.2 to 93.8 per 1,000 persons per month and of excessive polypharmacy from 13.6 to 14.0 per 1,000 persons per month from 2010 to 2016 in the entire study population. The highest rate of polypharmacy (per 1,000 persons) was observed in 2016 in those aged 80 and older (326.8), followed by those aged 65 to 79 (167.3). The polypharmacy rate increased by 6.3% (95% confidence interval (CI)=4.0–8.7) per year from 2010 to 2012, then decreased by 0.7% (95% CI=–1.3–0.0) per year from 2012 to 2016. The rate of excessive polypharmacy increased by 4.5% (95% CI=1.1–8.0) per year from 2010 to 2013 and then decreased by 3.7% (95% CI=–6.7 to –0.6) per year from 2013 to 2016.

Conclusion

The overall trend of polypharmacy in Japan increased during the study period, although the increase ceased in 2013 and then declined from 2013 to 2016. Policy changes in Japan might be responsible for some of the changes. J Am Geriatr Soc 66:2267–2273, 2018.
Medical Costs for Osteoporosis‐Related Fractures in High‐Risk Medicare Beneficiaries
Authors: Kapinos Kandice A. , Fischer Shira H. , Mulcahy Andrew , Hayden Orla , Barron Richard
Published: October 2018

OBJECTIVES

To estimate the incremental direct medical care costs associated with first fracture observable in high‐risk older adults.

DESIGN

Retrospective analysis of claims and survey data over a 3‐year period from the Health and Retirement Study (HRS), a nationally representative biennial study of individuals aged 50 and older.

SETTING

United States.

PARTICIPANTS

Participants were HRS respondents who consented to have their Medicare claims data linked to the HRS data, were aged 65 or older, had at least 1 risk factor for fracture observable in the data, and experienced a fracture between 1996 and 2008 (n = 689) and their propensity score–matched controls (n = 689).

MEASUREMENTS

Total Medicare, inpatient, outpatient, emergency department, physician office visit, and prescription drug care expenditures were primary outcomes. Two‐staged generalized linear models were estimated using a difference‐in‐differences model.

RESULTS

Fracture cases’ total Medicare expenditures increased by $13,929 (95% confidence interval (CI)=$11,920–15,938, p <.001) more than those of matched controls from the year before the index or fracture date to 1 year after the index date. Inpatient expenditures of $12,751 (95% CI=$10,790–14,7111, p < .001) more for fracture cases than comparison cases primarily drove this increase. Two and 3 years after fracture, there were no significant differences in growth in expenditures between the two groups. Results did not vary according to whether the fracture was at the hip or other site.

CONCLUSION

Fractures impose a significant economic burden, especially in the first year after the fracture, in Medicare beneficiaries with at least 1 risk factor for fracture. Our sample was limited to community‐dwelling individuals, and we are unable to control for fracture history before the study period. Costs may be greater for those in skilled nursing and similar facilities and for those who have had a previous fracture. J Am Geriatr Soc 66:2298–2304, 2018.
Successful Prehabilitation: A Noble Goal
Authors: Johanning Jason , Hall Daniel
Published: October 2018

This editorial comments on the article by Kata et al.
Reply to Comment on “Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment”
Authors: Caselli Richard J. , Locke Dona E.C. , Woodruff Bryan K. , Langlais Blake T. , Dueck Amylou C.
Published: October 2018

This letter comments on the letter by Luis Aguera‐Ortiz et al.
The Effects of Placental Transfusion on 12‐Month Brain Myelin Content in Term Infants: A Randomized Controlled Trial
Authors: Erickson‐Owens Debra , Mercer Judith S. , Wang Megan
Published: October 2018

Introduction

Immediate cord clamping (ICC) continues to be the standard practice in the United States. This results in leaving about 30% of the fetal‐placental iron‐rich blood behind in the placenta and puts an infant at risk for lower iron stores. Evidence (animal and human) suggests iron is critical to early brain white matter development as it plays a significant role in myelin formation. The purpose of this study was to determine, at 12 months of age, if infants who received a full placental transfusion at birth differ in myelin content and developmental outcomes compared to infants who received no placental transfusion. The hypothesis was that healthy, term infants who received a full placental transfusion via delayed cord clamping (DCC) will have greater brain myelin content and better neurodevelopmental outcomes compared to infants who received no placental transfusion (ICC) at 12 months of age.

Methods

Seventy‐three term pregnant women with singleton fetuses were enrolled in a prospective randomized controlled trial and randomized to either ICC (< 20 s) or DCC (≥ 5 min). At 4 and 12 months, the infants’ hemoglobin and ferritin levels were measured, and the infants underwent a non‐sedated MRI and neurodevelopmental testing.

Results

Maternal and infant demographics were not different between groups. Mean (SD) cord clamping time was 318 (158) seconds in the DCC group versus 10 (5) seconds in the ICC group (P < .0001). At 4 months, infants who received DCC had higher ferritin levels (91 [57] vs 61 [30] ng/mL, P < .04). At 12 months, infants randomized to DCC had significantly greater brain myelin content in the following brain regions: left and right (R) internal capsule, R parietal, R occipital, R frontal, and R orbital areas. The DCC group had a slightly higher social‐emotional performance than the ICC group using the BITSEA Competence score (17 [3] vs 15 [3], P = .08). No differences were seen in ferritin or hemoglobin levels between groups at 12 months.

Discussion

At 12 months, placental transfusion at birth appears to increase brain myelin content in regions involving motor and visual/spatial pathways and sensory processing. Neurodevelopmental testing suggests a trend of better social‐emotional outcomes associated with DCC. In conclusion, the endowment of iron‐rich blood obtained through DCC may offer a longitudinal advantage for early white matter development in the brain.
The Relationship Between Stressful Life Events, Protective Factors, and Depression in Mothers Caring for Young Children in the South Bronx
Authors: Hackley Barbara , Stange Mia , Kavanaugh Monica , Aviles Melanie , Hoffman Arielle , Zero Odette , Shapiro Alan
Published: October 2018

Introduction

Children raised by mothers with maternal depression have poorer physical and mental health, experience more developmental delays, and perform worse in school. The purpose of this cross‐sectional study was to describe predictors of depression in mothers with children aged 5 years of age or younger residing in a low‐income urban community. The specific research questions were to: 1) Describe the prevalence of risk and protective factors associated with depression in mothers in the South Bronx and 2) Determine which social factors are predictive of maternal depression. Understanding factors contributing to maternal depression can improve the development of programs designed to prevent or mitigate maternal depression and its effects on exposed children and families.

Methods

A convenience sample of mothers with young children (N = 151) completed an anonymous waiting room survey composed of items from validated questionnaires on depression (PHQ‐2), anxiety (GAD‐2), stress (2‐item scale by Littman), stress management (subscale of the Health Promoting Lifestyle Profile), adverse life events (Modified ACE, CHADIS Potential Stressors), social support (Bright Futures), and father involvement (Turner) in 2012, while receiving care at a Federally Qualified Health Center located in one of the poorest Congressional districts in the United States.

Results

On average (SD), women in this study were aged 29.7 (6.4) years and had 2.6 (1.5) children living in their household. Half reported no symptoms of depression or anxiety. Multiple regression models found that 6 out of 12 stressors (childcare, housing, relationship problems, insufficient food, legal problems, and health concerns) accounted for 34% of the variance in depression and anxiety as measured by PHQ‐4 scores (F = 10.3 (6,118), P < .001). A second regression analysis was calculated predicting maternal depression based on number of stressful life events and protective factors (ability to handle stress, numbers of individuals providing social support, father involvement, and use of stress management techniques) (R2 = .38, F = 21(3, 98); P < .001). In this model, the number of stressful events and inability to handle stress were predictive of higher symptoms of depression and anxiety, while use of stress management techniques was associated with significantly less symptomatology.

Discussion

Programs are needed that address the most salient adverse life events associated with symptoms of depression and anxiety, such as lack of resources, relationship problems, and health concerns. Further, programs should also develop strategies that enhance mothers’ ability to cope. These approaches may reduce maternal depression and anxiety, thereby safeguarding the health and well‐being of mothers and children.
Developing the Midwifery Practice Climate Scale: Model Misfit and Item Reduction
Authors: Thumm E. Brie
Published: October 2018

Introduction

A supportive practice environment is a key driver of workforce stability, care quality, and professional psychological well‐being. The characteristics of a supportive practice environment unique to certified nurse‐midwives and certified midwives have not been identified or tested. The purpose of this study was to identify the key elements of a supportive midwifery practice environment and develop a reliable, valid, and easy‐to‐administer instrument to measure midwives’ perceptions of their practice environment. Hypotheses were that the newly developed Midwifery Practice Climate Scale (MPCS) will demonstrate adequate internal consistency and content, face, structural, and concurrent validity.

Methods

The MPCS was developed through adaptation of items from related scales and generation of new items specific to midwifery guided by a review of the literature. The scale underwent 3 levels of testing: 1) content validity and face validity were tested with 2 small samples (n = 10 and n = 12, respectively); 2) the structure of the scale was established and confirmed through an iterative process of exploratory factor analysis and confirmatory analysis; and 3) construct validity was established by testing the MPCS in the job demands‐resources model.

Results

The original scale developed was 33 items intended to measure 5 elements of the midwifery practice climate identified in the literature: practice leadership, midwife‐physician relations, work control, resources, and midwifery model of care. The items were reduced from 33 to 10 items due to a high degree of covariance and skew. A parsimonious scale structure emerged with 2 subscales: Practice Leadership and Participation and Midwifery Model of Care. The final 10‐item MPCS demonstrated a good fit (χ2 = 60.397, df = 34; P < .001, RMSEA = 0.49 [CI, 0.028‐0.068]; CFI = 0.987) and excellent reliability (α = .92). The concurrent validity was established with Practice Leadership and Participation and Midwifery Model of Care significantly predicted emotional exhaustion (P < .001), work engagement (P < .001), turnover intention (P < .001), and midwife‐perceived quality of care (P < .001).

Discussion

The support of the midwifery philosophy of care is a unique and important element of the midwifery practice climate. The MPCS is reflective of scales developed to measure the midwifery practice climate in Australia and Sweden. The MPCS enables midwives and administrators to quickly and accurately assess the midwifery practice climate in order to guide cost‐effective interventions with widespread implications.
Dealer Networks
Authors: LI DAN , SCHÜRHOFF NORMAN
Published: October 2018

Dealers in the over‐the‐counter municipal bond market form trading networks with other dealers to mitigate search frictions. Regulatory data show that this network has a core‐periphery structure with 10 to 30 hubs and over 2,000 peripheral broker‐dealers in which bonds flow from periphery to core and partially back. Central dealers charge investors up to double the round‐trip markups compared to peripheral dealers. In turn, central dealers provide immediacy by matching buyers with sellers more directly and prearranging fewer trades, especially during stress times. Investors thus face a trade‐off between execution cost and speed, consistent with network models of decentralized trade.
Dividend Dynamics, Learning, and Expected Stock Index Returns
Authors: JAGANNATHAN RAVI , LIU BINYING
Published: October 2018

We present a latent variable model of dividends that predicts, out‐of‐sample, 39.5% to 41.3% of the variation in annual dividend growth rates between 1975 and 2016. Further, when learning about dividend dynamics is incorporated into a long‐run risks model, the model predicts, out‐of‐sample, 25.3% to 27.1% of the variation in annual stock index returns over the same time horizon, with learning contributing approximately half of the predictability in returns. These findings support the view that investors' aversion to long‐run risks and their learning about these risks are important in determining stock index prices and expected returns.
How Crashes Develop: Intradaily Volatility and Crash Evolution
Authors: BATES DAVID S.
Published: October 2018

This paper explores whether affine models with volatility jumps estimated on intradaily S&P 500 futures data over 1983 to 2008 can capture major daily outliers such as the 1987 stock market crash. Intradaily jumps in futures prices are typically small; self‐exciting but short‐lived volatility spikes capture intradaily and daily returns better. Multifactor models of the evolution of diffusive variance and jump intensities improve fits substantially, including out‐of‐sample over 2009 to 2016. The models capture reasonably well the conditional distributions of daily returns and realized variance outliers, but underpredict realized variance inliers. I also examine option pricing implications.
Leptin impairs the therapeutic effect of ionizing radiation in oral squamous cell carcinoma cells
Authors: da Rocha Rogério Gonçalves , Santos Eliane Macedo Sobrinho , Santos Eloá Mangabeira , Gomes Emisael Stênio Batista , Ramos Guilherme Veloso , Aguiar Karina Marini , Gonçalves Bruno Rodrigues , Santos Sérgio Henrique Sousa , De Paula Alfredo Maurício Batista , Guimarães André Luiz Sena , Farias Lucyana Conceição
Published: October 2018

Purpose

Leptin, an important hormone controlling energy homeostasis, has been linked to the pathogenesis of oral squamous cell carcinoma (OSCC). Evidence indicates that head and neck cancer patients undergoing radiotherapy show decreased leptin levels after radiotherapy treatment. Thus, we investigated, through phenotypic and molecular analyses, whether leptin can compromise the therapeutic effect of ionizing radiation and neoplastic behavior of OSCC cells.

Methods

The human OSCC‐derived cell lines SCC9 and SCC4 were treated with human recombinant leptin and exposed to 6 Gy of irradiation. We performed the in vitro assays of cell migration, death, proliferation, and colony‐forming ability. The reactive oxygen species (ROS) levels and proteome analysis by mass spectrometry were also conducted.

Results

Leptin was able to increase cell proliferation, migration, and colony‐forming ability, despite the suppressive effect induced by irradiation. Furthermore, the leptin promoted a significant reduction of ROS intracellular accumulation, and increased expression of the cancer‐related proteins, as ACTC1, KRT6A, and EEF2 in irradiated OSCC cells.

Conclusions

Our findings suggest that leptin impairs responsivity of OSCC cells to the ionizing radiation, reducing the suppressive effects of irradiation on the neoplastic phenotype, and increasing protein expression critical to carcinogenesis.
Role of synovium‐derived fibrous cartilage in temporomandibular joint synovial chondromatosis
Authors: Li Yingjie , Feng Yaping , Cao Pinyin , Ke Jin , Fang Wei , Cai Hengxing , Deng Mohong , Long Xing
Published: October 2018

Background

Synovial chondromatosis (SC) of temporomandibular joint (TMJ) occupies 3% SC cases. In other joints like hip and knee which were composed hyaline cartilage (HC), loose bodies (LBs) were reported to be a HC feature. However, condyle surface and disc in TMJ are fibrous cartilage (FC). Therefore, we proposed a different pathogenesis of TMJSC.

Methods

LBs and synovium were collected from seven TMJSC patients, and histological and immunohistological examinations were performed.

Results

Three ways of HC formation were discovered: regular‐shaped cartilaginous nodules (CNs) in sublining layer (SL) of vascularized synovium, regional chondrification of SL, and finger‐like tissue with a tail attaching to synovium. Detached LBs could fuse and were only positively stained by aggrecan. Without synovium attachment to LBs, fused LBs remained a hyaline extracellular matrix (ECM). However, after synovium attachment, transformation from HC to FC occurred. Two types of FC were observed. First type FC was featured by vertical‐distributed type I collagen fibers imbedding few chondrocytes, suggesting mature phase with superior mechanical features. Second type FC was featured by medium‐density chondrocytes with type I collagen and aggrecan‐positive ECM, suggesting primary phase. The transformation process started in appearance of 2nd type FC deriving from synovium covering LB, and gradually replaced HC from periphery to center.

Conclusions

Three ways of HC formation were closely related. Different with SC in other joints, hyaline ECM in LBs of TMJSC could be replaced by FC deriving from synovium, during which 2nd type FC first replaced HC and then transformed to 1st type FC.
External preference mapping: A guide for a consumer‐driven approach to apple breeding
Authors: Bowen Amy J. , Blake Amy , Tureček Jessica , Amyotte Beatrice
Published: October 2018

This research enabled the creation of a predictive tool to determine consumer preference based on sensory characteristics and to understanding consumer liking for a large and genetically‐diverse apple population. Over two consecutive years, 71 and 83 apples were profiled using descriptive analysis for aroma, taste, and texture attributes. Sensory maps were created, which clustered apples into four groups with common profiles: aromatic‐sweet, acidic, balanced, and mealy. Acceptance data from 219 consumers was collected on a representative subset of 19 apples and related to the sensory properties through external preference mapping. Two consumers groups were identified both preferring juicy, crisp apple but differing in preference for fresh red apple aroma and sweetness (Group 1, 89%) versus more acidic apples with fresh green apple aroma (Group 2, 11%). For both groups, mealy texture was a strong detractor of liking. Preferred sensory characteristics did not differ based on consumer age, gender, or ethnic heritage.

Practical applications

Understanding consumer preference for fresh apples is key to developing and selecting novel cultivars that will achieve marketplace success. Results are discussed with relevance to a consumer‐driven approach to apple breeding and evaluation of new varieties for commercialization to meet the needs of an evolving apple market.
Children who soil: A review of the assessment and management of faecal incontinence
Authors: Trajanovska Misel , King Sebastian K , Gibb Susan , Goldfeld Sharon
Published: October 2018

Soiling is a common and distressing condition affecting children. In the vast majority of patients, it is associated with constipation. Most constipation is functional and is best thought of as difficulty achieving adequate bowel emptying. In a small minority of patients, there is no associated constipation, so‐called non‐retentive faecal incontinence. The aetiology of this latter condition in children remains unclear. The mainstay of management in all cases is a regular toileting programme, together with laxatives as required. This must be individualised considering the diagnosis, the age of the child and the psychosocial factors affecting the child and family. The diagnosis is made with a thorough history and examination, supplemented in some cases with targeted investigations. Engaging the child and family in a long‐term treatment programme (at least 6 months to 2 years) is essential for treatment success. The following clinical practice guideline and algorithm for the assessment and management of children who soil represents consensus opinion using available evidence.