bluuebunny/crossref_metadata_2025 huggingface dataset:
Giving voice to all patients: On patients at the margins and their intention and perceived ability to complain
Authors: Salge Torsten Oliver , Antons David , Cichy Patrick , Foege J. Nils , Hannen Julian , Huetten Antje S.J.
Published: October 2016

Background:

It is now widely established that health care organizations are well advised not only to identify and act upon the concerns of all patient groups but also to encourage and enable them to voice their concerns in the first place. That said, research has begun to reveal that patients differ substantially in their readiness to complain, with many deciding to remain silent even after experiencing severe adverse events. Little research has explored whether patients at the margins (e.g., elderly, disabled, or mentally ill patients) are more likely to remain silent.

Purpose:

We examined the extent to which patients’ social (being elderly or poorly educated), physical (having a permanent impairment such as deafness, blindness, or a chronic physical condition), and mental marginality (having a mental illness or learning disability) is associated with their intention and perceived ability to complain.

Methodology:

We matched survey and patient record data for hospital inpatients treated in the English National Health Service in 2007. We then computed two-stage probit selection models to estimate the cross-sectional association between patients’ social, physical, and mental marginality and their intention (Stage 1, N
1 = 58,062) and perceived ability to complain (Stage 2, N
2 = 3,765).

Findings:

Only 6.47% of all patients intended to complain. Of these, only 10.41% indicated that hospital staff provided them with all the information they needed to complain. An additional 14.70% reported to have received at least some of the information needed for this purpose. Patients above 80 not only exhibited significantly lower intentions to complain than their mid-aged counterparts (−1.16%) but also felt considerably less well informed to file a complaint (−5.45%). Similarly, patients suffering from blindness or a severe vision impairment showed a significantly lower perceived ability to complain (−5.20%).

Practice Implications:

Patients at the margins, especially elderly patients and those with a severe vision impairment, will often remain silent and require special attention, if health care organizations are to listen to—and learn from—the voices of all patients. Our results indicate the need for inclusive complaint procedures designed to fuel organizational learning. Dedicated roles such as case managers and complaint officers might help to make such feedback channels accessible to all patients.
Tolerance Limits, Self-understanding, and Stress Resilience in Integrative Recovery of Inflammatory Bowel Disease
Authors: Skrautvol Kari , Nåden Dagfinn
Published: October 2016

People living with chronic inflammatory bowel disease (IBD) experienced that knowledge about their embodied tolerance limits, diet, mental problem solving, and change in lifestyle together with integrative health care could promote recovery from their diagnosed disease in calmer periods of suffering. A hermeneutic approach was used to analyze interviews with patients living with IBD outside hospitals. Thirteen young adults between 18 and 45 years of age in calmer phases of IBD participated in the study. Three main themes emerged from the analysis of the interviews: (1) Understanding limits in embodied tolerance, (2) Restoring balance is creating a new equilibrium, and (3) Creating resilience through integrative care. Anxiety, depression, stress, insomnia, and fatigue are known consequences of IBD and create a lower degree of well-being for the patients. The digestive system is very important in establishing the interface between the body and the external world. Properly functioning digestion, psychosocial stress reduction, and sleep quality are important to rebuild a balanced immune system. Stress resilience during a patient's recovery from IBD requires self-understanding, self-recognition, and psychosocial support from health care professionals at hospital outpatient clinics.
EFFECT OF INTRAVITREAL RANIBIZUMAB ON GANGLION CELL COMPLEX AND PERIPAPILLARY RETINAL NERVE FIBER LAYER IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Zucchiatti Ilaria , Cicinelli Maria V. , Parodi Maurizio Battaglia , Pierro Luisa , Gagliardi Marco , Accardo Agostino , Bandello Francesco
Published: October 2016

Purpose:

To analyze the changes in ganglion cell complex and peripapillary retinal nerve fiber layer thickness, in central macular thickness and choroidal thickness on spectral domain optical coherence tomography in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab injections.

Methods:

All consecutive patients with untreated neovascular age-related macular degeneration received loading phase of three monthly intravitreal ranibizumab, followed by retreatments on a pro re nata protocol for 12 months. Primary outcome: changes in ganglion cell complex and retinal nerve fiber layer at the end of follow-up. Secondary outcome: changes in best-corrected visual acuity, central macular thickness, and choroidal thickness at the end of follow-up. Choroidal thickness was measured at 500 μm, 1000 μm, and 1,500 μm intervals nasally, temporally, superiorly, and inferiorly to the fovea, respectively, on horizontal and vertical line scans centered on the fovea.

Results:

Twenty-four eyes were included. Ganglion cell complex and peripapillary retinal nerve fiber layer thickness did not show statistically significant changes through 12 months (55.6 ± 18.5 and 81.9 ± 9.9 μm at baseline, 52.7 ± 19.3 and 84.6 ± 15.5 μm at month 12, P > 0.05). Central macular thickness showed progressive decrease from baseline to month 12, with maximum reduction at month 3 (P < 0.001). Statistically significant reduction in choroidal thickness was registered in the nasal 500, 1000, and 1,500 μm from the fovea, corresponding to the papillomacular region (from 169.6 ± 45.3 to 153.9 ± 46.9, P < 0.001).

Conclusion:

Intravitreal ranibizumab injections did not affect retinal nerve fiber layer and ganglion cell complex thickness in 1-year follow-up. Choroidal thickness in papillomacular area and central macular thickness was significantly reduced at the end of treatment. Further studies, with larger sample, longer follow-up, and greater number of injections, are warranted.
Medicolegal Death Investigation and Hospital Patient Safety and Quality Outcomes: A Naturally Synergistic Collaboration
Authors: Drake Stacy A. , Harper Sherhonda , Wolf Dwayne A.
Published: October 2016

The role of medicolegal death investigation (MLDI) systems in the assessment of violent deaths (e.g., gunshots, stab wounds, car crashes) is well known. However, the role of MLDI systems in informing healthcare agencies about potential patient safety and quality improvement activities is less understood and thus the main focus of this article. In this article we describes-one agency's initiatives to identify decedents whose circumstances or cause of death had potential relevance for patient safety and quality outcomes and to communicate those findings to acute care hospitals where the decedents were previously treated. We also describes the evaluation of this communication process and provide preliminary outcomes of these efforts.
Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients
Authors: Ge Lixia , Mordiffi Siti Zubaidah
Published: October 2016

Background:

Caring for elderly cancer patients may cause multidimensional burden on family caregivers. Recognition of factors associated with caregiver burden is important for providing proactive support to caregivers at risk.

Objective:

The aim of this study was to identify factors associated with high caregiver burden among family caregivers of elderly cancer patients.

Methods:

A systematic search of 7 electronic databases was conducted from database inception to October 2014. The identified studies were screened, and full text was further assessed. The quality of included studies was assessed using a checklist, and relevant data were extracted using a predeveloped data extraction form. Best-evidence synthesis model was used for data synthesis.

Results:

The search yielded a total of 3339 studies, and 7 studies involving 1233 family caregivers were included after screening and full assessment of 116 studies. Moderate evidence supported that younger caregivers, solid tumors, and assistance with patient’s activities of daily living were significantly associated with high caregiver burden. Eighteen factors were supported by limited evidence, and 1 was a conflicting factor.

Conclusions:

The scientific literature to date proved that caregiver burden was commonly experienced by family caregivers of elderly cancer patients. The evidence indicated that family caregivers who were at younger age, caring for solid tumor patients, and providing assistance with patient’s activities of daily living reported high caregiver burden.

Implications for Practice:

The data provide evidence in identifying family caregivers at high risk of high caregiver burden. More high-quality studies are needed to clarify and determine the estimates of the effects of individual factors.
Examination of Ricochet Gunshot Wounds From Commonly Encountered Surfaces
Authors: Hlavaty Leigh , Avedschmidt Sarah , Root Kelly , Amley Jeffrey , Sung LokMan
Published: October 2016

Proper interpretation of gunshot wounds is vital for the forensic pathologist and requires experience and expertise, as well as consultation with a firearms and ballistics expert and careful scene investigation in cases of atypical gunshot wounds. This study is the first large-series examining ricochet gunshot wounds involving different firearm calibers. Typical gunshot wounds created from 4 handgun calibers (22 Long Rifle, 9 × 19 mm Parabellum, .40 Smith &Wesson, and .45 Automatic Colt Pistol) and 2 rifle calibers (5.56 and 7.62 mm) were compared with wounds caused by bullets of those same calibers ricocheting off commonly encountered surfaces (concrete, asphalt, aluminum traffic signs, clay brick, and dry wall). Porcine skin, a human skin analog, attached to sheets of cardboard serviced as witness panels for capturing the entrance wounds. Examination of over 150 handgun and rifle entrance wounds established that every caliber and every ricochet surface resulted in atypical features, including irregularity in size or shape, lack of marginal abrasion, or other injuries on the surrounding skin. The most significant factor influencing the variability of the ricochet wounds was the surface the bullet deflected off before striking the body.
Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC
Authors: Vogt Florian , Kalenga Lucien , Lukela Jean , Salumu Freddy , Diallo Ibrahim , Nico Elena , Lampart Emmanuel , Van den Bergh Rafael , Shah Safieh , Ogundahunsi Olumide , Zachariah Rony , Van Griensven Johan
Published: October 2016

Facility-based antiretroviral therapy (ART) provision for stable patients with HIV congests health services in resource-limited countries. We assessed outcomes and risk factors for attrition after decentralization to community-based ART refill centers among 2603 patients with HIV in Kinshasa, Democratic Republic of Congo, using a multilevel Poisson regression model. Death, loss to follow-up, and transfer out were 0.3%, 9.0%, and 0.7%, respectively, at 24 months. Overall attrition was 5.66/100 person-years. Patients with >3 years on ART, >500 cluster of differentiation type-4 count, body mass index >18.5, and receiving nevirapine but not stavudine showed reduced attrition. ART refill centers are a promising task-shifting model in low-prevalence urban settings with high levels of stigma and poor ART coverage.
Unpacking the Influence of Sexual Stigma on HIV Risk: Results From a Prospective Study of Men Who Have Sex With Men in Beijing, China
Authors: Choi Kyung-Hee , Steward Wayne T. , Miège Pierre , Gregorich Steven E.
Published: October 2016

Objective:

We examined the mediating roles of coping, depression, anxiety, and encountering difficult sexual situations in explaining the association between stigma against men who have sex with men (MSM) and HIV risk.

Methods:

We conducted path analyses using longitudinal data collected from 493 Chinese MSM in Beijing at baseline, 6 months, and 12 months from 2011 to 2013.

Results:

MSM stigma, specifically anticipations of stigma, had a marginally significant, protective total effect on unprotected anal intercourse at 12 months. This overall association, however, was the byproduct of 5 significant, indirect associations (3 risk enhancing, 2 protective) that routed through coping, anxiety, and difficult sexual situations. Of note, heavier use of avoidant coping principally had a protective effect on risk behavior by decreasing difficult sexual situations.

Conclusions:

Interventions to reduce avoidant coping would be an important tool for improving the emotional well-being of Chinese MSM. Such interventions, however, must be paired with biomedical or behavioral HIV prevention strategies to ensure that their benefit is not undermined by unintended increased HIV transmission risk in response to reduced social isolation among MSM.
Genital—Systemic Chemokine Gradients and the Risk of HIV Acquisition in Women
Authors: Liebenberg Lenine J. P. , Masson Lindi , Arnold Kelly B. , Mckinnon Lyle R. , Werner Lise , Proctor Elizabeth , Archary Derseree , Mansoor Leila E. , Lauffenburger Douglas A. , Abdool Karim Quarraisha , Abdool Karim Salim S. , Passmore Jo-Ann S.
Published: October 2016

Background:

Mucosal and systemic immune mediators have been independently associated with HIV acquisition risk, but the relationship between compartments remains unclear.

Methods:

To address this, the concentrations of 12 cytokines were compared in matched plasma and cervicovaginal lavages (CVLs) from 57 HIV-positive women before their acquisition of HIV (cases) and 50 women who remained uninfected (controls) during the CAPRISA 004 trial.

Results:

Although genital IP-10 concentrations were significantly higher in cases, plasma IP-10 concentrations were inversely associated with HIV risk. Comparing differences in mucosal and systemic cytokine concentrations between cases and controls, mucosa-biased gradients indicating higher cervicovaginal lavage relative to plasma concentrations were observed for all 5 chemokines in the panel. Four were significantly associated with HIV acquisition, including IP-10 (odds ratio [OR] 1.73, 95% confidence interval [CI]: 1.27 to 2.36), macrophage inflammatory protein–1β (OR 1.72, 95% CI: 1.23 to 2.40), interleukin (IL)-8 (OR 1.50, 95% CI: 1.09 to 2.05), and monocyte chemotactic protein-1 (OR 1.36, 95% CI: 1.01 to 1.83). None of the other 7 cytokines tested predicted HIV risk. Decision tree analyses confirmed this association, with gradients of IP-10, IL-8, and granulocyte-macrophage colony-stimulating factor concentrations correctly classifying 77% of HIV outcomes.

Conclusions:

Our findings suggest that mucosa-biased gradients of IP-10, macrophage inflammatory protein–1β, IL-8, and monocyte chemotactic protein-1 are associated with an increased risk of HIV infection.
Conditional Cash Transfers Improve Retention in PMTCT Services by Mitigating the Negative Effect of Not Having Money to Come to the Clinic
Authors: Yotebieng Marcel , Moracco Kathryn E. , Thirumurthy Harsha , Edmonds Andrew , Tabala Martine , Kawende Bienvenu , Wenzi Landry K. , Okitolonda Emile W. , Behets Frieda
Published: October 2016

Objective:

To elucidate the mechanisms by which a cash incentive intervention increases retention in prevention of mother-to-child transmission services.

Methods:

We used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo. Perceptual factors associated with loss to follow-up (LTFU) through 6 weeks postpartum were first identified. Then, binomial models were used to assess interactions between LTFU and identified factors, and the cash incentive intervention.

Results:

Participants were less likely to be LTFU if they perceived HIV as a “very serious” health problem for their baby vs. not [risk difference (RD), −0.13; 95% confidence interval (CI): −0.30 to 0.04], if they believed it would be “very likely” to pass HIV to their baby if they did not take any HIV drug vs. not (RD, −0.15; 95% CI: −0.32 to 0.02), and if they anticipated that not having money would make it difficult for them to come to the clinic vs. not (RD, 0.12; 95% CI: −0.07 to 0.30). The effect of each of the 3 factors on LTFU was antagonistic to that of receiving the cash incentive intervention. The excess risk due to interaction between the cash incentive intervention and the anticipated difficulty of “not having money” to come to the clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, −0.12; 95% CI: −0.35 to 0.10).

Conclusions:

Our analyses show that cash transfers improve retention in prevention of mother-to-child transmission services mainly by mitigating the negative effect of not having money to come to the clinic.
Early Discharge After Colorectal Resection: The Positive Impact of an Enhanced Recovery Program on a Rural Colorectal Surgery Service
Authors: Tebala Giovanni D. , Keane Sean , Osman Abdelsalam , Ip Mina , Khan Abdul Q. , Perrone Luciano
Published: October 2016

Background:

Enhanced recovery (ER) programs are policies and protocols meant to improve postoperative recovery after surgery. As a consequence of a smoother recovery, patients can be discharged early. This paper describes the impact of an ER program in colorectal surgery in a rural hospital.

Materials and Methods:

In total, 132 patients had colorectal resection within the ER program. Data were collected prospectively. The ER pathway affects perioperative management in the following ways in order to: (1) improve patient’s general condition before surgery, (2) minimize intraoperative surgical trauma by using a laparoscopic approach in all cases, and (3) facilitation of a quicker postoperative return of physiological function.

Results:

Most (86.4%) of the patients have been operated as elective cases and for a cancer (73.5%). Laparoscopic resection was performed in 63.6% of patients, with a conversion rate of 10.6%. Total morbidity was 18.2%, leak rate was 1.5%, and 90-day mortality rate was 3%. Overall median postoperative stay was 6.5 days. Total length of in-hospital stay was lower in laparoscopic resections (5.5 d), elective cases (6 d), and in younger patients (6 d). Age and laparoscopic access were independent prognostic factors significantly associated with early discharge in elective patients. Overall readmission rate was 9.1% and this was not affected by any preoperative or intraoperative factor within those in this study.

Conclusions:

The ER program positively impacted the outcome of colorectal resections also in our rural setting. Discharging patients expeditiously did not affect postoperative morbidity or readmission rate.
The Use of Mechanical Bowel Preparation in Pelvic Reconstructive Surgery: A Randomized Controlled Trial
Authors: Adelowo Amos O. , Hacker Michele R. , Modest Anna M. , Apostolis Costa A. , Disciullo Anthony J. , Hanaway Katherine J. , Elkadry Eman E. , Rosenblatt Peter L. , Rogers Kathleen J. , Hota Lekha S.
Published: October 2016

Objective

To compare mechanical bowel preparation (MBP) using oral magnesium citrate with sodium phosphate enema to sodium phosphate (NaP) enema alone during minimally invasive pelvic reconstructive surgery.

Methods

We conducted a single-blind, randomized controlled trial of MBP versus NaP in women undergoing minimally invasive pelvic reconstructive surgery. The primary outcome was intraoperative quality of the surgical field. Secondary outcomes included surgeon assessment of bowel handling and patient-reported tolerability symptoms.

Results

One hundred fifty-three participants were enrolled; 148 completed the study (71 MBP and 77 NaP). Patient demographics, clinical and intraoperative characteristics were similar. Completion of assigned bowel preparation was similar between MBP (97.2%) and NaP (97.4%). The MBP group found the preparation more difficult (P<0.01) and reported more overall discomfort and negative preoperative side effects (all P≤0.01). Quality of surgical field at initial port placement was excellent/good in 80.0% of the MBP group compared with 62.3% in the NaP group (P=0.02). This difference was not maintained by the conclusion of surgery (P=0.18). Similar results were seen in the intent-to-treat population. Surgeons accurately guessed preparation 65.7% of the time for MBP versus 41.6% for NaP (P=0.36). At 2 weeks postoperatively, both reported a median time for return of bowel function of 3.0 (2.0–4.0) days.

Conclusions

Mechanical bowel preparation with oral magnesium citrate before minimally invasive pelvic reconstructive surgery offered initial improvement in the quality of surgical field, but this benefit was not sustained. It was associated with an increase in patient discomfort preoperatively, but did not seem to impact postoperative return of bowel function.

LEVEL OF EVIDENCE

I
Iatrogenic Bladder Diverticulum 11 Years After Sacrospinous Ligament Fixation for Apical Prolapse
Authors: Gephart Laura Faye , Lewis Anthony , Wu Emily , Bird Erin , Wagner Kristofer , Kuehl Thomas J. , Larsen Wilma
Published: October 2016

Introduction

In this case, we describe a bladder diverticulum due to apical vaginal suspension to the sacrospinous ligament presenting 11 years after surgery. This case report explores her signs and symptoms, diagnostic work-up, surgical intervention, and postoperative course.

Case Description

A 71-year-old G2P2 presented with symptoms of urinary urgency. Work-up including cystoscopy and retrograde fistulogram revealed a bladder diverticulum extending to the level of the sacrospinous ligament. Her surgical history was significant for a sacrospinous ligament fixation 11 years before her symptoms. The iatrogenic bladder diverticulum was removed via robotic-assisted laparoscopic excision. Her postoperative course was benign beyond a urinary tract infection. Her urgency symptoms resolved after treatment.

Conclusions

Iatrogenic injuries can present distant from initial surgery. Permanent foreign material, including suture, may increase the risk of complications. A high level of suspicion is necessary to diagnose complications given the subtle presentation.
Relationship of Anatomy and Function: External Anal Sphincter on Transperineal Ultrasound and Anal Incontinence
Authors: Paka Chandhana , Kamisan Atan Ixora , Rios Rebeca , Dietz Hans Peter
Published: October 2016

Objective

The aim of this study was to investigate the association of the anatomic integrity of the external anal sphincter (EAS) detected on transperineal ultrasound (TPUS) with symptoms of anal incontinence (AI) as measured by St Mark’s Incontinence Score (SMIS) and the visual analog scale (VAS).

Methods

This is an observational, cross-sectional analysis of 486 women who presented to a tertiary urogynecological center between May 2013 and August 2014. They underwent a standardized interview and an examination that involved 3-dimensional/4-dimensional TPUS. The SMIS and VAS were administered if they answered positively to a question on AI. The association between defects of the EAS and symptoms of AI was evaluated using bivariate tests, as well as adjusting for pertinent covariates using multiple linear regression modeling.

Results

Of the included patients, 17.1% reported AI, and 15.2% had significant EAS defects (≥4 slices) on TPUS imaging. A significant sonographic defect was diagnosed in 23% of women with AI versus 14% of those without (P = 0.033). Women with symptoms of AI were more likely to have a significant defect on TPUS (odds ratio, 1.878; 95% confidence interval, 1.05–3.37). No significant findings were seen when analyzing SMIS, its components, and VAS against sonographic EAS defects.

Conclusions

The symptom of AI is associated with significant EAS defects detected on TPUS. However, this study failed to show an association between significant EAS defects and the SMIS and VAS.
Operationalizing the Measurement of Socioeconomic Position in Our Urogynecology Study Populations: An Illustrative Review
Authors: Heit Michael , Guirguis Nayera , Kassis Nadine , Takase-Sanchez Michelle , Carpenter Janet
Published: October 2016

Objectives

The purpose of this illustrative review is to provide guidance for the measurement of socioeconomic position when conducting health disparities research in urogynecology study populations.

Methods

Deidentified data were extracted from existing investigational review board–approved research databases for illustrative purposes. Attributes collected included the study participant's marital status, level of educational attainment (in number of years of school completed) and occupation as well as the study participant's last/only spouses' level of education and occupation. Average household and female socioeconomic position scores were calculated using two established composite indices: (1) Hollingshead Four Factor Index of Social Position, (2) Green's Socioeconomic Status scores, and 2 single-item indices: (1) Hauser-Warren Socioeconomic Index of Occupation, (2) level of educational attainment.

Results

The Hollingshead Four Factor Index of Social Position more than the Hauser-Warren Socioeconomic Index of Occupation provides researchers with a continuous score that is normally distributed with the least skew from the dataset. Their greater standard deviations and low kurtotic values increase the probability that statistically significant differences in health outcomes predicted by socioeconomic position will be detected compared with Green's socioeconomic status scores.

Conclusions

Collection of socioeconomic data is an important first step in gaining a better understanding of health disparities through elimination of confounding bias, and for the development of behavioral, educational, and legislative strategies to eliminate them. We favor average household socioeconomic position scores over female socioeconomic position scores because average household socioeconomic position scores are more reflective of overall resources and opportunities available to each family member.
Association Between Overactive Bladder Syndrome and Depression Among Older Women
Authors: Alves Aline Teixeira , Jácomo Raquel Henriques , e Silva Renata Cristina Martins , Gomide Liana Barbaresco , Bontempo Albênica Paulino dos Santos , Garcia Patrícia Azevedo
Published: October 2016

Objective:

To evaluate the association between overactive bladder syndrome (OBS) and depression among older women.

Methods:

One hundred sixty-nine older women answered 2 questionnaires: the Overactive Bladder (OAB-V8) and the Yesavage Geriatric Depression Scale.

Results:

One hundred twenty-nine participants (76.3%) had symptoms of OBS (OAB-V8 ≥ 8 points). Among those with OBS, 42.6% exhibited mild or severe depression. A significant correlation was found between OBS and depression (r = 0.354; P = .001).

Conclusions:

A high prevalence rate of OBS was found in older women and a large portion of these women exhibited symptoms of mild and severe depression.
Multimodal Physical Therapy Intervention for Urinary Incontinence and Overactive Bladder in the Older Adult
Authors: Hill Alexandra
Published: October 2016

Urinary incontinence (UI) and overactive bladder (OAB) are health conditions that have higher prevalence rates later in life and can lead to a profound negative effect on UI-related quality of life. Evidence is lacking on the effects of conservative multimodal physical therapy (PT) interventions for UI and OAB in the older population. This case study presents a multimodal PT intervention for a 71-year-old woman with UI and OAB. After 4 sessions, the patient demonstrated improved UI-related quality of life and significantly decreased urinary symptoms. Urinary Distress Index Short Form (UDI-6) scores improved from 54.6 to 16.67. Pelvic floor muscle performance improved with increased strength, endurance, and coordination. This case supports the use of multimodal PT interventions for older patients with UI and OAB.
Use of glacial fronts by narwhals (
Monodon monoceros
) in West Greenland
Authors: Laidre Kristin L. , Moon Twila , Hauser Donna D. W. , McGovern Richard , Heide-Jørgensen Mads Peter , Dietz Rune , Hudson Ben
Published: October 2016

Glacial fronts are important summer habitat for narwhals (
Monodon monoceros
); however, no studies have quantified which glacial properties attract whales. We investigated the importance of glacial habitats using telemetry data from
n
= 15 whales tagged in September of 1993, 1994, 2006 and 2007 in Melville Bay, West Greenland. For 41 marine-terminating glaciers, we estimated (i) narwhal presence/absence, (ii) number of 24 h periods spent at glaciers and (iii) the fraction of narwhals that visited each glacier (at 5, 7 and 10 km) in autumn. We also compiled data on glacier width, ice thickness, ice velocity, front advance/retreat, area and extent of iceberg discharge, bathymetry, subglacial freshwater run-off and sediment flux. Narwhal use of glacial habitats expanded in the 2000s probably due to reduced summer fast ice and later autumn freeze-up. Using a generalized multivariate framework, glacier ice front thickness (vertical height in the water column) was a significant covariate in all models. A negative relationship with glacier velocity was included in several models and glacier front width was a significant predictor in the 2000s. Results suggest narwhals prefer glaciers with potential for higher ambient freshwater melt over glaciers with silt-laden discharge. This may represent a preference for summer freshwater habitat, similar to other Arctic monodontids.
The speed–curvature power law in
Drosophila
larval locomotion
Authors: Zago Myrka , Lacquaniti Francesco , Gomez-Marin Alex
Published: October 2016

We report the discovery that the locomotor trajectories of
Drosophila
larvae follow the power-law relationship between speed and curvature previously found in the movements of human and non-human primates. Using high-resolution behavioural tracking in controlled but naturalistic sensory environments, we tested the law in maggots tracing different trajectory types, from reaching-like movements to scribbles. For most but not all flies, we found that the law holds robustly, with an exponent close to three-quarters rather than to the usual two-thirds found in almost all human situations, suggesting dynamic effects adding on purely kinematic constraints. There are different hypotheses for the origin of the law in primates, one invoking cortical computations, another viscoelastic muscle properties coupled with central pattern generators. Our findings are consistent with the latter view and demonstrate that the law is possible in animals with nervous systems orders of magnitude simpler than in primates. Scaling laws might exist because natural selection favours processes that remain behaviourally efficient across a wide range of neural and body architectures in distantly related species.
Habitat- and season-specific temperatures affect phenotypic development of hatchling lizards
Authors: Pearson P. R. , Warner D. A.
Published: October 2016

Embryonic environments influence phenotypic development, but relatively few experiments have explored the effects of natural environmental variation. We incubated eggs of the lizard
Anolis sagrei
under conditions that mimicked natural spatial and temporal thermal variation to determine their effects on offspring morphology and performance. Incubation temperatures mimicked two microhabitats (open, shade) at two different times of the incubation season (April, July). Egg survival, incubation duration and offspring size were influenced by interactions between habitat- and season-specific nest temperatures, and locomotor performance was influenced primarily by temporal factors. These findings highlight the importance of spatial and temporal environmental variation in generating variation in fitness-related phenotypes.
Pouch brooding marsupial frogs transfer nutrients to developing embryos
Authors: Warne Robin W. , Catenazzi Alessandro
Published: October 2016

Marsupial frogs have a unique reproductive mode in which females carry eggs enclosed in a sealed dorsal brood pouch. While most anurans are considered to be oviparous with lecithotrophic eggs, the extensively vascularized membrane of the brood pouch in marsupial frogs suggests potential opportunities for nutrient transfer. We tested for matrotrophy in the live-bearingGastrotheca excubitor(Hemiphractidae), through feeding insects labelled with a13C-fatty acid and a15N-amino acid to brooding marsupial frogs. We observed significant increases of δ13C and δ15N in both maternal pouch tissues and embryos, suggesting nutrient transfer. Embryo dry mass also increased with developmental stage, providing further direct evidence for matrotrophy. These results suggest that in addition to gas exchange, the vascularized brood pouch membrane ofG. excubitoralso enables maternal nutrient transfer. This finding revealed a suspected but untested trait in the evolution of parental care in marsupial frogs, in contrast to previous work onGastrothecaspecies that release tadpoles, and suggests greater complexity in reproductive and provisioning modes than previously thought.
Relations between morphology, buoyancy and energetics of requiem sharks
Authors: Iosilevskii Gil , Papastamatiou Yannis P.
Published: October 2016

Sharks have a distinctive shape that remained practically unchanged through hundreds of millions of years of evolution. Nonetheless, there are variations of this shape that vary between and within species. We attempt to explain these variations by examining the partial derivatives of the cost of transport of a generic shark with respect to buoyancy, span and chord of its pectoral fins, length, girth and body temperature. Our analysis predicts an intricate relation between these parameters, suggesting that ectothermic species residing in cooler temperatures must either have longer pectoral fins and/or be more buoyant in order to maintain swimming performance. It also suggests that, in general, the buoyancy must increase with size, and therefore, there must be ontogenetic changes within a species, with individuals getting more buoyant as they grow. Pelagic species seem to have near optimally sized fins (which minimize the cost of transport), but the majority of reef sharks could have reduced the cost of transport by increasing the size of their fins. The fact that they do not implies negative selection, probably owing to decreased manoeuvrability in confined spaces (e.g. foraging on a reef).
At odds with the group: changes in lateralization and escape performance reveal conformity and conflict in fish schools
Authors: Chivers Douglas P. , McCormick Mark I. , Allan Bridie J. M. , Mitchell Matthew D. , Gonçalves Emanuel J. , Bryshun Reid , Ferrari Maud C. O.
Published: October 2016

Many vertebrates are known to show behavioural lateralization, whereby they differentially use one side of their body or either of their bilateral organs or limbs. Behavioural lateralization often manifests in a turning bias in fishes, with some individuals showing a left bias and others a right bias. Such biases could be the source of considerable conflict in fish schools given that there may be considerable social pressure to conform to the group to maintain effective group evasion. Here, we show that predation pressure is a major determinant of the degree of lateralization, both in a relative and absolute sense, in yellow-and-blueback fusiliers (Caesio teres), a schooling fish common on coral reefs. Wild-caught fish showed a bias for right turning. When predation pressure was experimentally elevated or relaxed, the strength of lateralization changed. Higher predation pressure resulted in an increase in the strength of lateralization. Individuals that exhibited the same turning bias as the majority of individuals in their group had improved escape performance compared with individuals that were at odds with the group. Moreover, individuals that were right-biased had improved escape performance, compared with left-biased ones. Plasticity in lateralization might be an important evolutionary consequence of the way gregarious species respond to predators owing to the probable costs associated with this behaviour.
Molecular and cellular bases of adaptation to a changing environment in microorganisms
Authors: Bleuven Clara , Landry Christian R.
Published: October 2016

Environmental heterogeneity constitutes an evolutionary challenge for organisms. While evolutionary dynamics under variable conditions has been explored for decades, we still know relatively little about the cellular and molecular mechanisms involved. It is of paramount importance to examine these molecular bases because they may play an important role in shaping the course of evolution. In this review, we examine the diversity of adaptive mechanisms in the face of environmental changes. We exploit the recent literature on microbial systems because those have benefited the most from the recent emergence of genetic engineering and experimental evolution followed by genome sequencing. We identify four emerging trends: (i) an adaptive molecular change in a pathway often results in fitness trade-off in alternative environments but the effects are dependent on a mutation's genetic background; (ii) adaptive changes often modify transcriptional and signalling pathways; (iii) several adaptive changes may occur within the same molecular pathway but be associated with pleiotropy of different signs across environments; (iv) because of their large associated costs, macromolecular changes such as gene amplification and aneuploidy may be a rapid mechanism of adaptation in the short-term only. The course of adaptation in a variable environment, therefore, depends on the complexity of the environment but also on the molecular relationships among the genes involved and between the genes and the phenotypes under selection.
Paws without claws? Ecological effects of large carnivores in anthropogenic landscapes
Authors: Kuijper D. P. J. , Sahlén E. , Elmhagen B. , Chamaillé-Jammes S. , Sand H. , Lone K. , Cromsigt J. P. G. M.
Published: October 2016

Large carnivores are frequently presented as saviours of biodiversity and ecosystem functioning through their creation of trophic cascades, an idea largely based on studies coming primarily out of relatively natural landscapes. However, in large parts of the world, particularly in Europe, large carnivores live in and are returning to strongly human-modified ecosystems. At present, we lack a coherent framework to predict the effects of large carnivores in these anthropogenic landscapes. We review how human actions influence the ecological roles of large carnivores by affecting their density or behaviour or those of mesopredators or prey species. We argue that the potential for density-mediated trophic cascades in anthropogenic landscapes is limited to unproductive areas where even low carnivore numbers may impact prey densities or to the limited parts of the landscape where carnivores are allowed to reach ecologically functional densities. The potential for behaviourally mediated trophic cascades may be larger and more widespread, because even low carnivore densities affect prey behaviour. We conclude that predator–prey interactions in anthropogenic landscapes will be highly context-dependent and human actions will often attenuate the ecological effects of large carnivores. We highlight the knowledge gaps and outline a new research avenue to study the role of carnivores in anthropogenic landscapes.
Body size and mortality rates in coral reef fishes: a three-phase relationship
Authors: Goatley Christopher Harry Robert , Bellwood David Roy
Published: October 2016

Body size is closely linked to mortality rates in many animals, although the overarching patterns in this relationship have rarely been considered for multiple species. A meta-analysis of published size-specific mortality rates for coral reef fishes revealed an exponential decline in mortality rate with increasing body size, however, within this broad relationship there are three distinct phases. Phase one is characterized by naive fishes recruiting to reefs, which suffer extremely high mortality rates. In this well-studied phase, fishes must learn quickly to survive the many predation risks. After just a few days, the surviving fishes enter phase two, in which small increases in body size result in pronounced increases in lifespan (estimated 11 d mm
–1
). Remarkably, approximately 50% of reef fish individuals remain in phase two throughout their lives. Once fishes reach a size threshold of about 43 mm total length (TL) they enter phase three, where mortality rates are relatively low and the pressure to grow is presumably, significantly reduced. These phases provide a clearer understanding of the impact of body size on mortality rates in coral reef fishes and begin to reveal critical insights into the energetic and trophic dynamics of coral reefs.
Eradicating infectious disease using weakly transmissible vaccines
Authors: Nuismer Scott L. , Althouse Benjamin M. , May Ryan , Bull James J. , Stromberg Sean P. , Antia Rustom
Published: October 2016

Viral vaccines have had remarkable positive impacts on human health as well as the health of domestic animal populations. Despite impressive vaccine successes, however, many infectious diseases cannot yet be efficiently controlled or eradicated through vaccination, often because it is impossible to vaccinate a sufficient proportion of the population. Recent advances in molecular biology suggest that the centuries-old method of individual-based vaccine delivery may be on the cusp of a major revolution. Specifically, genetic engineering brings to life the possibility of a live, transmissible vaccine. Unfortunately, releasing a highly transmissible vaccine poses substantial evolutionary risks, including reversion to high virulence as has been documented for the oral polio vaccine. An alternative, and far safer approach, is to rely on genetically engineered and weakly transmissible vaccines that have reduced scope for evolutionary reversion. Here, we use mathematical models to evaluate the potential efficacy of such weakly transmissible vaccines. Our results demonstrate that vaccines with even a modest ability to transmit can significantly lower the incidence of infectious disease and facilitate eradication efforts. Consequently, weakly transmissible vaccines could provide an important tool for controlling infectious disease in wild and domestic animal populations and for reducing the risks of emerging infectious disease in humans.
Exact probabilities for the indeterminacy of complex networks as perceived through press perturbations
Authors: Koslicki David , Novak Mark
Published: October 2016

We consider the goal of predicting how complex networks respond to chronic (press) perturbations when characterizations of their network topology and interaction strengths are associated with uncertainty. Our primary result is the derivation of exact formulas for the expected number and probability of qualitatively incorrect predictions about a system’s responses under uncertainties drawn form arbitrary distributions of error. These formulas obviate the current use of simulations, algorithms, and qualitative modeling techniques. Additional indices provide new tools for identifying which links in a network are most qualitatively and quantitatively sensitive to error, and for determining the volume of errors within which predictions will remain qualitatively determinate (i.e. sign insensitive). Together with recent advances in the empirical characterization of uncertainty in ecological networks, these tools bridge a way towards probabilistic predictions of network dynamics.
Uncovering the underlying mechanisms and whole-brain dynamics of therapeutic deep brain stimulation for Parkinson’s disease
Authors: Saenger Victor M. , Kahan Joshua , Foltynie Tom , Friston Karl , Aziz Tipu Z. , Green Alexander L. , van Hartevelt Tim J. , Stevner Angus B. A. , Fernandes Henrique M. , Mancini Laura , Thornton John , Yousry Tarek , Limousin Patricia , Zrinzo Ludvic , Hariz Marwan , Kringelbach Morten L. , Deco Gustavo
Published: October 2016

Deep brain stimulation (DBS) for Parkinson’s disease is a highly effective treatment in controlling otherwise debilitating symptoms yet the underlying brain mechanisms are currently not well understood. We used whole-brain computational modeling to disclose the effects of DBS ON and OFF during collection of resting state fMRI in ten Parkinson’s Disease patients. Specifically, we explored the local and global impact of DBS in creating asynchronous, stable or critical oscillatory conditions using a supercritical bifurcation model. We found that DBS shifts the global brain dynamics of patients nearer to that of healthy people by significantly changing the bifurcation parameters in brain regions implicated in Parkinson’s Disease. We also found higher communicability and coherence brain measures during DBS ON compared to DBS OFF. Finally, by modeling stimulation we identified possible novel DBS targets. These results offer important insights into the underlying effects of DBS, which may in time offer a route to more efficacious treatments.
Growth-independent cross-feeding modifies boundaries for coexistence in a bacterial mutualism
Authors: McCully Alexandra L. , LaSarre Breah , McKinlay James B.
Published: October 2016

Nutrient cross-feeding can stabilize microbial mutualisms, including those important for carbon cycling in nutrient-limited anaerobic environments. It remains poorly understood how nutrient limitation within natural environments impacts mutualist growth, cross-feeding levels, and ultimately mutualism dynamics. We examined the effects of nutrient limitation within a mutualism using theoretical and experimental approaches with a synthetic anaerobic coculture pairing fermentativeEscherichia coliand phototrophicRhodopseudomonas palustris. In this coculture,E. coliandR. palustrisresemble an anaerobic food web by cross-feeding essential carbon (organic acids) and nitrogen (ammonium), respectively. Organic acid cross-feeding stemming fromE. colifermentation can continue in a growth-independent manner during nutrient limitation, while ammonium cross-feeding byR. palustrisis growth-dependent. When ammonium cross-feeding was limited, coculture trends changed yet coexistence persisted under both homogenous and heterogenous conditions. Theoretical modeling indicated that growth-independent fermentation was crucial to sustain cooperative growth under conditions of low nutrient exchange. We also show that growth-independent fermentation sets the upperE. colicell density at which this mutualism is supported. Thus, growth-independent fermentation can conditionally stabilize or destabilize a mutualism, indicating the potential importance of growth-independent metabolism for nutrient-limited mutualistic communities.

Conflict of interest

The authors declare no conflict of interest.