bluuebunny/crossref_metadata_2025 huggingface dataset:
Sphingosine Kinase 1 Regulates Inflammation and Contributes to Acute Lung Injury in Pneumococcal Pneumonia via the Sphingosine-1-Phosphate Receptor 2
Authors: Gutbier Birgitt , Schönrock Stefanie M. , Ehrler Carolin , Haberberger Rainer , Dietert Kristina , Gruber Achim D. , Kummer Wolfgang , Michalick Laura , Kuebler Wolfgang M. , Hocke Andreas C. , Szymanski Kolja , Letsiou Eleftheria , Lüth Anja , Schumacher Fabian , Kleuser Burkhard , Mitchell Timothy J. , Bertrams Wilhelm , Schmeck Bernd , Treue Denise , Klauschen Frederick , Bauer Torsten T. , Tönnies Mario , Weissmann Norbert , Hippenstiel Stefan , Suttorp Norbert , Witzenrath Martin
Published: January 2018

Objectives:

Severe pneumonia may evoke acute lung injury, and sphingosine-1-phosphate is involved in the regulation of vascular permeability and immune responses. However, the role of sphingosine-1-phosphate and the sphingosine-1-phosphate producing sphingosine kinase 1 in pneumonia remains elusive. We examined the role of the sphingosine-1-phosphate system in regulating pulmonary vascular barrier function in bacterial pneumonia.

Design:

Controlled, in vitro, ex vivo, and in vivo laboratory study.

Subjects:

Female wild-type and SphK1-deficient mice, 8–10 weeks old. Human postmortem lung tissue, human blood–derived macrophages, and pulmonary microvascular endothelial cells.

Interventions:

Wild-type and SphK1-deficient mice were infected with Streptococcus pneumoniae. Pulmonary sphingosine-1-phosphate levels, messenger RNA expression, and permeability as well as lung morphology were analyzed. Human blood–derived macrophages and human pulmonary microvascular endothelial cells were infected with S. pneumoniae. Transcellular electrical resistance of human pulmonary microvascular endothelial cell monolayers was examined. Further, permeability of murine isolated perfused lungs was determined following exposition to sphingosine-1-phosphate and pneumolysin.

Measurements and Main Results:

Following S. pneumoniae infection, murine pulmonary sphingosine-1-phosphate levels and sphingosine kinase 1 and sphingosine-1-phosphate receptor 2 expression were increased. Pneumonia-induced lung hyperpermeability was reduced in SphK1
–/– mice compared with wild-type mice. Expression of sphingosine kinase 1 in macrophages recruited to inflamed lung areas in pneumonia was observed in murine and human lungs. S. pneumoniae induced the sphingosine kinase 1/sphingosine-1-phosphate system in blood-derived macrophages and enhanced sphingosine-1-phosphate receptor 2 expression in human pulmonary microvascular endothelial cell in vitro. In isolated mouse lungs, pneumolysin-induced hyperpermeability was dose dependently and synergistically increased by sphingosine-1-phosphate. This sphingosine-1-phosphate–induced increase was reduced by inhibition of sphingosine-1-phosphate receptor 2 or its downstream effector Rho-kinase.

Conclusions:

Our data suggest that targeting the sphingosine kinase 1–/sphingosine-1-phosphate–/sphingosine-1-phosphate receptor 2–signaling pathway in the lung may provide a novel therapeutic perspective in pneumococcal pneumonia for prevention of acute lung injury.
Premenstrual Syndrome: Evidence-based Evaluation and Treatment
Authors: APPLETON SARAH M.
Published: January 2018

Premenstrual dysphoric disorder (PMDD) is defined by both physical and psychiatric symptoms that impact a woman significantly during the luteal phase of her menstrual cycle. Diagnostic criteria for PMDD were firmly established in the Diagnostic and Statistical Manual of Mental Disorders V in 2013, but many patients fall short of the diagnosis while still appreciably affected by severe premenstrual symptoms. More recent and robust investigations have evaluated the efficacy of treatment ranging from serotonergic therapy to hormonal treatment as well as lifestyle and herbal remedies. This article reviews the evidence for diagnosis and treatment of PMDD.
PIGMENTED PARAVENOUS CHORIORETINAL ATROPHY
Authors: Shona Olajumoke a , Islam Farrah , Robson Anthony G. , Webster Andrew R. , Moore Anthony T. , Michaelides Michel
Published: January 2018

Purpose:

To review and describe in detail the demographics, functional and anatomical characteristics, and clinical course of pigmented paravenous chorioretinal atrophy in a large cohort of adults and children.

Methods:

This is a retrospective case series of consecutive patients diagnosed with pigmented paravenous chorioretinal atrophy at a single U.K. referral center from 1974 to 2016. Clinical records, retinal imaging (color fundus photography, fundus autofluorescence, and optical coherence tomography), and electrophysiological assessments were reviewed.

Results:

Twenty-three patients were identified (13 males and 10 females). The mean age at presentation was 35 years (range 10–67 years). Mean follow-up was 6.7 years (range 0–30 years). There was no family history of similar retinal disease. Thirteen (57%) patients were asymptomatic. Symptoms included photopsia (n = 1.4%), blurred vision (n = 4.17%), peripheral visual field loss (n = 3.13%), and nyctalopia (n = 2.8%). One patient had previous intermediate uveitis. Twenty-one (91%) patients had ≥6/12 in the better seeing eye at final follow-up; visual acuity loss over time was recorded in 2 patients. Color vision was normal in all 14 patients assessed. Paravenous hypoautofluorescence with surrounding increased fundus autofluorescence was characteristically observed. Optical coherence tomography over the retinal changes demonstrated choroidal, retinal pigment epithelium, and outer retinal layer thinning. Peripapillary atrophic changes on fundus photography were evident in 20 (87%) patients. Interocular asymmetry of fundus and electroretinography findings was common. The electroretinography findings showed a similar degree of generalized rod and cone photoreceptor dysfunction in most cases.

Conclusion:

Overall, most patients with pigmented paravenous chorioretinal atrophy maintained stable vision. The lack of other affected family members, slow or absent progression, and interocular asymmetry of the retinal features is suggestive of an acquired rather than inherited retinal disorder, which is generally nonprogressive. We identify that patients commonly have marked interocular asymmetry both on structural and functional assessment.
An occult MRI-negative primary parotid melanoma masquerading as an atypical Bell’s palsy: a surgical case report
Authors: Davies James , Al-Hassani Fawaz , Nduka Charles , Kannan Ruben Y.
Published: January 2018

In this case, reported in line with the SCARE criteria, we describe an acute facial palsy, presenting in a similar manner to Bell’s palsy, albeit with minor differences. Although clinical suspicion for malignancy was raised and gold standard serological and radiologic tests were requested, no abnormalities were found preoperatively. However, as a prelude to a planned babysitter procedure, as the facial nerve was explored, multiple masses were found in both the superficial and deep lobes of the parotid gland. This was later proven to be a malignant melanoma tumor. On review of literature, it is evident that although rare, about 1% of parotid cancers can present with facial paralysis as the sole symptom. Rarer still, is the underlying etiology; primary parotid melanoma in this case, which carries a very poor prognosis. On the basis of this, we propose extra vigilance when dealing with such cases and suggest a clinical protocol for use to aid diagnosis and subsequent surgical management.
Are group size and composition associated with treatment outcomes in group cognitive behavioural therapy for chronic pain?
Authors: Wilson Dianne , Mackintosh Shylie , Nicholas Michael K. , Moseley G. Lorimer , Costa Daniel , Ashton-James Claire
Published: January 2018

This study explored whether group size and group member characteristics (age, sex, and compensation status) were associated with patient outcomes (changes in pain and disability). Retrospective analyses of outcome data obtained from 2 independently run group cognitive behavioural therapy (CBT) programs for chronic pain (Program A: N = 317 and Program B: N = 693) were conducted. Intracluster correlations were significant in both studies, indicating group-level effects on patient outcomes in both group CBT programs for chronic pain. Mixed modelling revealed that group size and group member characteristics (age, sex, and compensation status) were related to patient outcomes, but not consistently across programs. The results of our analyses confirm the contribution of group composition to individual treatment outcomes in group CBT for chronic pain, and highlight factors that have the potential to contribute to group-level variability in patient outcomes. Further research is needed to identify the mechanisms that account for the impact of group characteristics on the efficacy of CBT for chronic pain.
Offsetting Patient-Centered Medical Homes Investment Costs Through Per-Member-Per-Month or Medicare Merit-based Incentive Payment System Incentive Payments
Authors: da Graca Briget , Ogola Gerald O. , Fullerton Cliff , McCorkle Russell , Fleming Neil S.
Published: January 2018

Primary care practices become patient-centered medical homes (PCMHs) to improve care. However, investment costs and opportunities to offset those costs are critical to the decision. We examined potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS) for a network that spent $4 818 260 over 4 years obtaining and renewing PCMH recognition for 57 practices. With PMPM payments of $3.37 to $8.98, “breakeven” requires that 2.4% to 6.4% of the network's 1645 commercially insured patients per physician be covered, while applying MIPS incentive payments of half the maximum available each year to the network's average 2016 Medicare reimbursement of $196 812 per physician showed they would exceed PCMH costs by 2022.
ACTively Integrating Suicide Risk Assessment Into Primary Care Settings
Authors: Finnegan Heather A. , Selwyn Candice N. , Langhinrichsen-Rohling Jennifer
Published: January 2018

Adequate evaluation and response to suicide risk require (i) awareness of need, (ii) comfort gathering key information, and (iii) ongoing training. A survey administered at 2 urban primary care settings in the process of implementing integrated care measured awareness, comfort, and training related to suicide risk assessment among 31 primary care providers (PCPs). Greater PCP comfort asking patients about psychological trauma was associated with more frequent engagement in safety planning with suicidal patients. Findings highlight the need for trauma-informed primary care while showcasing the importance of enhancing PCP training to support their expanded role within the integrated health team.
Management of Chronic Pain in the Elderly: A Review of Current and Upcoming Novel Therapeutics
Authors: Murphy Neal , Karlin-Zysman Corey , Anandan Sam
Published: January 2018

Background:

A significant proportion of the elderly are affected by chronic pain, resulting in a decreased quality of life. Opiate use has become increasingly common in older adult patients. This article reviews both well-established current and novel therapies for management of chronic pain in older adults.

Areas of Uncertainty:

The number of studies involving management of chronic pain in elderly patients is limited. Managing pain alongside multiple chronic, comorbid conditions presents therapeutic and appropriate drug dosing challenges.

Therapeutic Advances:

Nonsteroidal anti-inflammatory drug nano-formulations have shown promise in clinical trials. These new formulations have similar efficacy to oral nonsteroidal anti-inflammatory drugs, while minimizing adverse effects. TRV130, a new targeted opioid, selectively activates the analgesic pathway of the mu-opioid receptor. The drug has been proven to have analgesic effects similar to morphine with less opioid-induced adverse effects. Mixed opioids agonists, targeting the mu and ORL1 receptors, may prove superior among the opioid class given their effectiveness, improved safety profile, and low abuse potential. In addition, there is ongoing research assessing reduction of pain by targeted and peripherally restricted cannabinoids, attempting to limit activation of the central receptors responsible for addiction and psychotomimetic effects.

Conclusions:

Management of chronic pain in older adults remains challenging with current medication regimens. In facing the opiate epidemic, providers must use multicomponent strategies to find the most effective and safest combinations of pain medications to achieve adequate pain control. Regardless of the variety and complexity of pain medications available, prescribing physicians should start with low doses, titrate slowly, and monitor pain control frequently. Treating chronic pain is a complex and difficult issue that hopefully will become more manageable as pain medication regimens improve and new therapeutics are developed.
Optimizing Medication Management in the Hospitalized Older Adult
Authors: Pisano Michele , Beizer Judith L.
Published: January 2018

Background:

Polypharmacy, which is the use of multiple medications, is of great concern for older adults because of the burden it can place on patients and society. Older adults often necessitate more medications due to the fact that they commonly have multiple chronic conditions.

Areas of Uncertainty:

Multiple medications are often necessary to cure or slow the progression of disease, reduce symptoms of disease, improve quality of life and/or decrease complications. However, they can also lead to adverse consequences in older adults, such as adverse drug events, falls, increase in health care costs, and medication nonadherence.

Therapeutic Advances:

Optimizing the medication regimen of an elderly patient starts with appropriate choice of medications, focusing on minimizing adverse effects, and simplifying the regimen to increase adherence. Medications should be evaluated for potentially inappropriate medications for elderly patients, utilizing Beers criteria and START/STOPP criteria. It is also important to deprescribe medications when appropriate. Deprescribing is the process of tapering or stopping drugs, with the goal of decreasing polypharmacy, decreasing costs, and improving outcomes. Medication reconciliation should be performed at every transition point and any change should be communicated to the patient, caregiver, and primary care provider. The teach-back method can be used to ensure proper comprehension by the patient and/or caregiver.

Conclusion:

The challenge that all health care professionals face is to determine the most appropriate drug therapy regimen that will enhance the patient's quality of life without compromising the patient's ability to function or increase the risk of adverse reactions.
Advancements in the Treatment of Constipation in Hospitalized Older Adults: Utilizing Secretagogues and Peripherally Acting Mu-Opioid Receptor Antagonists
Authors: Moore Jacqueline , Firoozan Sheila , Martinez Nichol
Published: January 2018

Background:

Despite its prevalence among hospitalized older adults, constipation is frequently treated with ineffective agents.

Areas of Uncertainty:

Although data exist to support the use of bulk and osmotic laxatives in geriatric patients, commonly used medications, such as docusate sodium, have been shown to lack clear benefit.

Therapeutic Advances:

Recently, investigators have developed novel agents that rely on alternative mechanisms of action to promote bowel motility. These innovative agents are rapidly becoming powerful tools in the management of constipation in older adults. Randomized control trials have demonstrated that secretory agents, including lubiprostone and linaclotide, are quite effective in the general population for the management of constipation. Limited subgroup analyses of geriatric subjects in these trials did reveal statistically significant improvement in constipation symptoms with minimal adverse effects. Additionally, with the widespread use of opioids to manage chronic pain in the geriatric population, new pharmacologic interventions have entered the market to counter the frequently encountered adverse effect of opioid-induced constipation. These compounds are known as peripherally acting mu-opioid receptor antagonists (PAMORAs) based on their mechanism of action in the gastrointestinal tract. Compounds such as methylnaltrexone and naloxegol are increasingly being used in the hospital setting for elderly patients with constipation associated with the use of opioids; however, further studies are needed to make specific recommendations regarding its use in older adults. Finally, serotonergic agents have also been extensively studied for their potential to augment gut motility, but many have been associated with an increased risk of cardiovascular events and are thus at this time not recommended as first-line therapy.

Conclusions:

Although promising new agents are becoming available for the treatment of this highly prevalent condition, both traditional and innovative therapies for constipation need additional study for their efficacy and safety in the elderly population.
Advances in Managing Type 2 Diabetes in the Elderly: A Focus on Inpatient Care and Transitions of Care
Authors: Myers Alyson , Garnica Patricia , Ling Jason
Published: January 2018

Background:

As the population ages, so does the frequency of chronic illness such as coronary artery disease, hypertension, or diabetes. Type 2 diabetes mellitus (T2DM) has nearly tripled in prevalence among those older than 75 years.

Areas of Uncertainty:

Renal/hepatic failure, poor nutritional status, limited mobility, and cognitive impairment are some of the factors that can predispose elderly patients to hypoglycemia or hyperglycemia. As a result, the diabetes guidelines have been modified to recommend less stringent glycemic control for this vulnerable population.

Therapeutic Advances:

In this review, the authors address the inpatient management of type 2 diabetes, in which patients are transitioned off of their oral antihyperglycemic agents and started on insulin therapy. Insulin dosing has to be adjusted in those with changes in renal function, concomitant steroid use, decreased oral intake, or utilization nonenteral nutrition. In addition, there is a discussion of the transition of inpatient insulin therapy to outpatient care. Medication reconciliation is crucial and has a significant impact on the outcome and quality of care. This review examines established and newer agents such as sodium-glucose cotransporter 2 inhibitors and concentrated insulin. Creatinine clearance is an important factor in the dosing of these agents, as elderly patients can have a normal creatinine with a compromised creatinine clearance. Lastly, this review examines the use of the evolving diabetes therapeutic technology: insulin pumps and sensors. These devices are no longer limited to the outpatient settings, as hospitals are devising insulin pump policies that allow patients to continue to use their device. Its role in the elderly population, however, is poorly understood and requires further research for its applicability.

Conclusions:

As the prevalence of T2DM continues to rise and population continues to age, inpatient care and care transitions remains an essential key in management of elderly persons with T2DM.
Therapeutic Advances in the Perioperative Period for Older Adults
Authors: Solomon Philip , Calabrese Brooke , LaVine Sean
Published: January 2018

Background:

As the population of the United States continues to increase, particularly older than 65 years, the number of adults older than 65 years undergoing surgeries should increase as well.

Areas of Uncertainty:

The inpatient perioperative care of the segment of the population older than 65 years has unique challenges that are not currently well studied or outlined.

Therapeutic Advances:

There have been encouraging data on preoperative risk assessments and screening for geriatric patients in recent years. Although younger patients may not have improved outcomes from a full preoperative evaluation, there are potential benefits for elderly population. However, this must be weighed against the risks of overscreening, unnecessary testing, and potentially dangerous delays in time to surgery. The American College of Cardiology/American Heart Association perioperative guidelines should continue to be used in preoperative evaluation of older adults, as it decreases unnecessary testing. Frailty screening should be done in all geriatric patients to help predict postoperative complications and quality of life. In regards to perioperative medication management, some recommendations are strong and based on high-quality evidence (ie, continuation of beta-blockers) and should be followed in the geriatric population. However, high-quality evidence is lacking for many medication classes, particularly in the geriatric patient population.

Conclusion:

Older adults pose a unique set of challenges during the perioperative period. Therapeutic advances continue to rapidly evolve in the field and should be used in conjunction with a robust individualized risk assessment to help optimize geriatric patients' postoperative outcomes.
Vitamins and Dietary Supplements for the Older Adult: What Works and Why?
Authors: Saad Maha , Fausto Nicolas , Maisch Nicole
Published: January 2018

Background:

The consumption of dietary supplements (DSs), including vitamins and minerals, is significant in older adults; this may be the result of current regulations and ease of introducing supplements into an ever-growing market.

Areas of Uncertainty:

The use of such supplements is not always effective and has been proven to be sometimes harmful.

Therapeutic Advances:

Current evidence does not support the use of vitamin E, vitamin A, and selenium supplements. The use of folic acid and vitamin B supplements is controversial and is only justified in cases of a deficiency. Calcium supplementation has been linked to an increase in cardiovascular (CV) events; however, supplementation within normal limits provides neither CV benefit nor risk in generally healthy adults. Vitamin D is likely to provide benefit in elderly patients at risk of falls and fractures when given in combination with calcium. The evidence with vitamin D supplements is conflicting regarding its effect on total, cancer, CV mortality, or CV risk. Omega-3 fatty acid supplementation is reasonable for secondary prevention of coronary heart disease death and in those with reduced ejection fraction heart failure.

Conclusions:

Health care providers need to remain abreast of emerging evidence and recommendations regarding the use of DSs and counsel patients regarding the potential benefits and adverse effects related to vitamins and other supplements. The DSs' effectiveness in relationship to the cost burden to patients, and potential prescription drug supplement interactions need to be considered.
Innovations in Insomnia Management: A Review of Current Approaches and Novel Targets Including Orexin Receptor Antagonists
Authors: Patel Raj , Quinn Ryann , Silver Jonathan
Published: January 2018

Background:

Sleep disturbances are a source of significant challenge to the care of geriatric hospitalized patients.

Areas of Uncertainty:

Commonly used medications to promote sleep are fraught with side effects especially in the geriatric population. The management of this issue is very important to many patients.

Data Sources:

We reviewed current data on the effectiveness of current pharmacologic and non-pharmacologic strategies to improve insomnia in elderly patients.

Results:

Environmental adjustments to the inpatient setting have been shown to improve sleep with no adverse effects. Cognitive behavioral therapy, has also been shown to improve objective and subjective sleep measures in older patients with similar efficacy to medications. Benzodiazepines are still popular medications despite evidence demonstrating adverse outcomes including falls, fractures, and cognitive decline. Nevertheless they have been shown to have a generally small effect on total sleep time. Nonbenzodiazepine receptor agonists have also been demonstrated to pose significant risks of harms to the elderly patient, including delirium and, again, falls and fractures as the price for a small increase in total sleep time. Ramelteon is also shown to have an even smaller effect on sleep time, however, with a more positive side effect profile. Suvorexant is a new agent that works through a novel mechanism inhibiting the orexin activating system. It has been shown to have similar objective efficacy on sleep as other medications mentioned already and was approved by FDA without major warnings. However, more study is required to determine if it will elude the risks of medications already available.

Conclusions:

Given the lack of adverse consequences, a persuasive case can be made for a comprehensive behavioral approach to sleep promotion before pharmacologic agents are attempted. Studies comparing individual medications are unavailable and thus cannot guide therapy further.
New Innovations in Treatment and Monitoring of Heart Failure With Guidelines on the Use of Sacubitril/Valsartan and Ivabradine
Authors: Thampi Shankar , Sheth Shikha , Madu Chinedu , Chionchio Alicia , Loukas Evangelos
Published: January 2018

Background:

Heart failure is a clinical syndrome that carries a significant burden of morbidity and is associated with poor long-term prognosis. Treatment of heart failure is constantly evolving, with large amounts of research going into the development of new medications, in the hopes of improving symptom management as well as reducing morbidity and mortality.

Area of Uncertainty:

One of the major areas of uncertainty regarding recent advances in heart failure management is the applicability of data from existing trials to the geriatric population. The majority of current research focuses on patients in a younger age group with a median age around 60, and there is a lack of randomized control trials assessing efficacy in the geriatric population specifically.

Therapeutic Advances:

Three new medications are examined in this review: sacubitril/valsartan, ivabradine, and nesiritide. Sacubitril/valsartan is a combination of neprilysin inhibitor and angiotensin receptor blocker that acts to increase natriuretic peptides and block the effect of angiotensin, leading to diuresis and vasodilation. The resultant reduction in systemic blood pressure and intravascular volume leads to decreased cardiac stress. This drug has Class 1B recommendation for the treatment of heart failure with reduced ejection fraction, with superior improvement in cardiovascular mortality and hospitalization rate compared with enalapril. Ivabradine is an If channel inhibitor that allows for selective reduction in heart rate without hindering cardiac contractility. This drug has Class IIa-B recommendation for heart failure with reduced ejection fraction with evidence of reduction in hospital admission rate. Nesiritide is a recombinant human brain natriuretic peptide that causes arterial and venous dilation and suppression of the renin–angiotensin–aldosterone system. Clinical trials have shown that this medication has some positive effect with patients in acute heart failure exacerbation; however, no benefit in long-term management has been shown.

Conclusion:

As the population of the United States continues to age, the number of patients with heart failure will continue to rise. Understanding the wide range of treatment options available to elderly patients is increasingly important for clinicians. Determining whether any of the new therapeutic options is appropriate for a patient will be a collaborative effort between a clinician and patient and will depend heavily on the patient's comorbidities, functional status, and goals of care.
Therapeutic Advances in the Prevention and Treatment of Delirium in the Hospital Setting
Authors: Kluger Courtney , Shah Pooja , Maiti Sutapa , Babalola Olawumi , Mulvany Colm , Sinvani Liron
Published: January 2018

Background:

Delirium is one of the most common, costly, and devastating complications affecting up to 56% of hospitalized older patients, with an associated hospital mortality rate of 25%–33%, and annual health care expenditures exceeding $152 billion.

Areas of Uncertainty:

Despite its high prevalence and poor outcomes, there is a significant gap in therapeutic interventions for the prevention and treatment of delirium.

Therapeutic Interventions:

Nonpharmacologic multicomponent prevention interventions such as the hospital elder life program (HELP) and early mobilization and reorientation remain first line, and they have consistently demonstrated a reduction in the incidence of delirium. There is currently no evidence to support the use of antipsychotics, cholinesterase inhibitors, or psychostimulants for the prevention of delirium across all health care settings, including the intensive care unit. Avoiding sedation, and specifically benzodiazepines, is an important modality to prevent delirium. Given the lack of evidence to support the use of antipsychotics along with the adverse event profile, including a black box warning for an increase in cardiovascular mortality, these medications should only be used for the treatment of delirium with features of severe agitation and psychosis. In the intensive care unit setting, dexmedetomidine in lieu of propofol or other classic sedatives may prevent and shorten the duration of delirium. Finally, dexmedetomidine and general anesthetics, such as sevoflurane and desflurane, are being evaluated in the prevention and treatment of postoperative delirium.

Conclusion:

Multicomponent nonpharmacologic interventions are currently the most effective modality for the prevention and treatment of delirium.
Untapped Potential
Authors: Lima Julie C. , Ogarek Jessica , Mor Vincent
Published: January 2018

Background:

Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care.

Objective:

To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group.

Research Design:

Descriptive retrospective panel study.

Subjects:

HRS respondents between 2002 and 2010 linked to administrative data from the Centers for Medicare and Medicaid Services (CMS).

Measures:

NH use was defined in 3 ways: by survey responses, Medicare SNF claims, and mandatory NH assessments.

Results:

In total, 8.5% of observation periods (ie, time between 2 consecutive survey dates or 2 years before initial survey) reported by the survey and 26.0% reported by administrative data indicated some NH use. There was 98% agreement between survey responses and administrative data when there was no indication of a NH observation in the administrative data. However, there was only 33% agreement between survey responses and administrative data when a NH stay was indicated in the administrative data. NH stays associated with SNF care were responsible for the discrepancy—they were not consistently captured by the HRS survey. Rates of agreement were highest when a proxy respondent was used, and lowest among respondents who rated themselves in excellent overall health. Rates of agreement were higher later in the decade than earlier.

Conclusions:

The HRS-Medicare–linked files enhance the ability of the HRS to examine the growing use of NH for postacute care as well as offer a more comprehensive view of who uses NHs.
Incidentally Detected Transfusion-associated Iron Overload in 3 Children After Cancer Chemotherapy
Authors: Kuo Dennis John , Bhagia Pooja
Published: January 2018

Iron overload is a potential long-term complication among cancer survivors who received transfusions during treatment. Although there are screening guidelines for iron overload in pediatric survivors of hematopoietic stem cell transplant, these do not call for screening of other pediatric oncology patients. In our practice we incidentally discovered 3 patients in a population of 168 cancer survivors over the span of 17 years who were treated for cancer without hematopoietic stem cell transplant who had iron overload. The 3 patients had elevated liver iron on magnetic resonance imaging T2* and 2 received therapeutic phlebotomy. These cases, and others like them, suggest that collaborative groups should consider revisiting the literature to establish screening and treatment guidelines for iron overload after cancer therapy.
Families’ Needs of Patients With Acquired Brain Injury: Acute Phase and Rehabilitation
Authors: de Goumoëns Véronique , Didier Amélia , Mabire Cédric , Shaha Maya , Diserens Karin
Published: January 2018

Purpose

The aim of this study was to identify and compare the needs of families of patients with acquired brain injury (ABI) in acute care and rehabilitation settings.

Design

A descriptive exploratory study was conducted.

Methods

Data were collected in the acute care setting and in the rehabilitation setting during meetings with families (n= 54) of patients with ABI using the Family Needs Questionnaire.

Findings

In both settings, families identified obtaining information about ABI or the patients’ health as the most important need, followed by support from health professionals.

Conclusion

For families, accessing information about the disease situation was important regardless of patients being in the acute care or rehabilitation phase. To provide tailored care for these families, it is important to assess information needs systematically early in the acute phase of hospitalization.

Clinical Relevance

A paradigm shift is desirable to include families in care, identify their needs, and support them in a more tailored way.
Determining the Needs of Family Caregivers of Stroke Patients During Inpatient Rehabilitation Using Interview, Art, and Survey
Authors: Camicia Michelle , Lutz Barbara J. , Markoff Nina , Catlin Anita
Published: January 2018

The purpose of this study is to explore the needs of family members at the bedside of stroke patients (n = 12) admitted to an inpatient rehabilitation facility (IRF). Family members’ needs were determined through semistructured interviews, “Draw a Bridge” art therapy technique, and the Family Inventory of Needs. Family members described a family-centered approach to care that addressed the following needs: assistance with preparing for discharge, staff caring for family members, communication about the plan of care and what to expect postdischarge, and trusting the care provided by IRF staff. Art therapy revealed that stroke was a crisis with many unmet needs for the interviewer to explore. Descriptive statistical analysis of the Family Inventory of Needs revealed that both met and unmet needs were consistent with the interviews and the interpretations of the drawings. These findings inform the need for interventions during IRF to enhance communication, support, and effective caregiver education amidst the crisis of stroke.
Inversion of friction anisotropy in a bio-inspired asymmetrically structured surface
Authors: Tramsen Halvor T. , Gorb Stanislav N. , Zhang Hao , Manoonpong Poramate , Dai Zhendong , Heepe Lars
Published: January 2018

Friction anisotropy is an important property of many surfaces that usually facilitate the generation of motion in a preferred direction. Such surfaces are very common in biological systems and have been the templates for various bio-inspired materials with similar tribological properties. So far friction anisotropy is considered to be the result of an asymmetric arrangement of surface nano- and microstructures. However, here we show by using bio-inspired sawtooth-structured surfaces that the anisotropic friction properties are not only controlled by an asymmetric surface topography, but also by the ratio of the sample–substrate stiffness, the aspect ratio of surface structures, and by the substrate roughness. Systematically modifying these parameters, we were able to demonstrate a broad range of friction anisotropies, and for specific sample–substrate combinations even an inversion of the anisotropy. This result highlights the complex interrelation between the different material and topographical parameters on friction properties and sheds new light on the conventional design paradigm of tribological systems. Finally, this result is also of great importance for understanding functional principles of biological materials and surfaces, as such inversion of friction anisotropy may correlate with gait pattern and walking behaviour in climbing animals, which in turn may be used in robotic applications.
Repartitioning of glycerol between levitated and surrounding deposited glycerol/NaNO
3
/H
2
O droplets
Authors: Gao Xiaoyan , Cai Chen , Ma Jiabi , Zhang Yunhong
Published: January 2018

Repartitioning of semi-volatile organic compounds (SVOCs) between particles is an important process to understand the particle growth and shrinkage in the atmosphere environment. Here, by using optical tweezers coupled with cavity-enhanced Raman spectroscopy, we report the repartitioning of glycerol between a levitated glycerol/NaNO
3
/H
2
O droplet and surrounding glycerol/NaNO
3
/H
2
O droplets deposited on the inner wall of a chamber with different organic to inorganic molar ratios (OIRs). For the high OIR with 3 : 1, no NaNO
3
crystallization occurs both for levitated and deposited droplets in the whole relative humidity (RH) range, the radius of the levitated droplet decreases slowly due to the evaporation of glycerol from the levitated droplet at constant RHs. The levitated droplets radii with OIR of 1 : 1 and 1 : 3 increase with constant RHs that are lower than 45.3% and 55.7%, respectively, indicating that the repartitioning of glycerol occurs. The reason is that NaNO
3
in the deposited droplets is crystallized when RH is lower than 45.3% for 1 : 1 or 55.7% for 1 : 3. So the vapour pressure of glycerol at the surface of deposited droplets is higher than that of the levitated droplet which always remains as liquid droplet without NaNO
3
crystallization, resulting in the transfer of glycerol from the deposited ones to the levitated one. The process of the glycerol repartitioning we discussed herein is a useful model to interpret the repartitioning of SVOCs between the externally mixed particles with different phase states.
Preparation of polypropylene/Mg–Al layered double hydroxides nanocomposites through wet pan-milling: non-isothermal crystallization behaviour
Authors: Zheng Yilei , Chen Yinghong
Published: January 2018

Differential scanning calorimeter was used to extensively investigate the non-isothermal crystallization of polypropylene (PP)/layered double hydroxides (LDHs) nanocomposites prepared through wet solid-state shear milling. The corresponding crystallization kinetics was further investigated by using Ozawa, modified Avrami and combined Avrami–Ozawa method, respectively. The results showed that the Ozawa method could not well describe the crystallization kinetics of pure PP and its nanocomposites. Comparatively, the modified Avrami method as well as the combined Avrami–Ozawa method gives the satisfactory results. Under the effect of pan-milling, the produced LDH nano intercalated/exfoliated particles exhibit the inhibitive effect on the PP nucleation but more remarkable promotion effect on the spherulite growth, leading to enhancement in the overall crystallization rate. This is reflected in increase of the calculated fold surface free energyσeand also the supercooling degree ΔTrequired for crystallization nucleation. In addition, the polarized optical microscopy observation also verifies the higher spherulite growth rate of PP/LDHs nanocomposites than that of pure PP.
Efficiency enhancement of Cu
2
ZnSnS
4
solar cells via surface treatment engineering
Authors: Chen Rongrong , Fan Jiandong , Li Hongliang , Liu Chong , Mai Yaohua
Published: January 2018

Pure-sulphide Cu
2
ZnSnS
4
(CZTS) thin film solar cells were prepared by a low-cost, non-toxic and high-throughput method based on the thermal decomposition and reaction of sol–gel precursor solution, followed by a high temperature sulfurization process in sulphur atmosphere, which usually gave rise to the unexpected Cu-poor and Zn-rich phase after sulfurization. In order to remove the formation of detrimental secondary phases, e.g. ZnS, a novel method with hydrochloric acid solution treatment to the CZTS absorber layer surface was employed. By using this method, a competitive power conversion efficiency as high as 4.73% was obtained, which is a factor of 4.8 of that of the control CZTS solar cell without surface treatment. This presents a customized process for CZTS photovoltaic technologies that is more environmentally friendly and considerably less toxic than the widely used KCN etching approach.
Intra-tropical movements as a beneficial strategy for Palearctic migratory birds
Authors: Koleček Jaroslav , Hahn Steffen , Emmenegger Tamara , Procházka Petr
Published: January 2018

Migratory birds often move significantly within their non-breeding range before returning to breed. It remains unresolved under which circumstances individuals relocate, whether movement patterns are consistent between populations and to what degree the individuals benefit from the intra-tropical movement (ITM). We tracked adult great reed warblersAcrocephalus arundinaceusfrom a central and a southeastern European breeding population, which either stay at a single non-breeding site, or show ITM, i.e. move to a second site. We related ITM to the normalized difference vegetation index (NDVI) describing vegetation conditions and probably reflecting food abundance for these insectivorous birds. Three-quarters of birds showed ITM across the non-breeding range. We found no difference in range values and mean values of NDVI between the single non-breeding sites of stationary birds and the two sites of moving birds. The vegetation conditions were better at the second sites compared to the first sites during the period which moving birds spent at the first sites. Vegetation conditions further deteriorated at the first sites during the period the moving birds resided at their second sites. Our study provides evidence that birds probably benefit from improved conditions after ITM compared to the conditions at the sites from where they departed.
Island- and lake-like parallel adaptive radiations replicated in rivers
Authors: Burress Edward D. , Piálek Lubomír , Casciotta Jorge R. , Almirón Adriana , Tan Milton , Armbruster Jonathan W. , Říčan Oldřich
Published: January 2018

Parallel adaptive radiations have arisen following the colonization of islands by lizards and lakes by fishes. In these classic examples, parallel adaptive radiation is a response to the ecological opportunities afforded by the colonization of novel ecosystems and similar adaptive landscapes that favour the evolution of similar suites of ecomorphs, despite independent evolutionary histories. Here, we demonstrate that parallel adaptive radiations of cichlid fishes arose in South American rivers. Speciation-assembled communities of pike cichlids (Crenicichla) have independently diversified into similar suites of novel ecomorphs in the Uruguay and Paraná Rivers, including crevice feeders, periphyton grazers and molluscivores. There were bursts in phenotypic evolution associated with the colonization of each river and the subsequent expansion of morphospace following the evolution of the ecomorphs. These riverine clades demonstrate that characteristics emblematic of textbook parallel adaptive radiations of island- and lake-dwelling assemblages are feasible evolutionary outcomes even in labile ecosystems such as rivers.
Diversity and disparity of sparassodonts (Metatheria) reveal non-analogue nature of ancient South American mammalian carnivore guilds
Authors: Croft Darin A. , Engelman Russell K. , Dolgushina Tatiana , Wesley Gina
Published: January 2018

This study investigates whether terrestrial mammalian carnivore guilds of ancient South America, which developed in relative isolation, were similar to those of other continents. We do so through analyses of clade diversification, ecomorphology and guild structure in the Sparassodonta, metatherians that were the predominant mammalian carnivores of pre-Pleistocene South America. Body mass and 16 characters of the dentition are used to quantify morphological diversity (disparity) in sparassodonts and to compare them to extant marsupial and placental carnivores and extinct North American carnivoramorphans. We also compare trophic diversity of the Early Miocene terrestrial carnivore guild of Santa Cruz, Argentina to that of 14 modern and fossil guilds from other continents. We find that sparassodonts had comparatively low ecomorphological disparity throughout their history and that South American carnivore palaeoguilds, as represented by that of Santa Cruz, Argentina, were unlike modern or fossil carnivore guilds of other continents in their lack of mesocarnivores and hypocarnivores. Our results add to a growing body of evidence highlighting non-analogue aspects of extinct South American mammals and illustrate the dramatic effects that historical contingency can have on the evolution of mammalian palaeocommunities.
Evolutionary and structural analyses uncover a role for solvent interactions in the diversification of cocoonases in butterflies
Authors: Smith G. , Kelly J. E. , Macias-Muñoz A. , Butts C. T. , Martin R. W. , Briscoe A. D.
Published: January 2018

Multi-omic approaches promise to supply the power to detect genes underlying disease and fitness-related phenotypes. Optimal use of the resulting profusion of data requires detailed investigation of individual candidate genes, a challenging proposition. Here, we combine transcriptomic and genomic data with molecular modelling of candidate enzymes to characterize the evolutionary history and function of the serine protease cocoonase.Heliconiusbutterflies possess the unique ability to feed on pollen; recent work has identifiedcocoonaseas a candidate gene in pollen digestion.Cocoonasewas first described in moths, where it aids in eclosure from the cocoon and is present as a single copy gene. In heliconiine butterflies it is duplicated and highly expressed in the mouthparts of adults. At least six copies ofcocoonaseare present inHeliconius melpomeneand copy number varies acrossH. melpomenesub-populations. Mostcocoonasegenes are under purifying selection, however branch-site analyses suggestcocoonase 3genes may have evolved under episodic diversifying selection. Molecular modelling of cocoonase proteins and examination of their predicted structures revealed that the active site region of each type has a similar structure to trypsin, with the same predicted substrate specificity across types. Variation among heliconiine cocoonases instead lies in the outward-facing residues involved in solvent interaction. Thus, the neofunctionalization ofcocoonaseduplicates appears to have resulted from the need for these serine proteases to operate in diverse biochemical environments. We suggest thatcocoonasemay have played a buffering role in feeding during the diversification ofHeliconiusacross the neotropics by enabling these butterflies to digest protein from a range of biochemical milieux.
Coupling movement and landscape ecology for animal conservation in production landscapes
Authors: Doherty Tim S. , Driscoll Don A.
Published: January 2018

Habitat conversion in production landscapes is among the greatest threats to biodiversity, not least because it can disrupt animal movement. Using the movement ecology framework, we review animal movement in production landscapes, including areas managed for agriculture and forestry. We consider internal and external drivers of altered animal movement and how this affects navigation and motion capacities and population dynamics. Conventional management approaches in fragmented landscapes focus on promoting connectivity using structural changes in the landscape. However, a movement ecology perspective emphasizes that manipulating the internal motivations or navigation capacity of animals represents untapped opportunities to improve movement and the effectiveness of structural connectivity investments. Integrating movement and landscape ecology opens new opportunities for conservation management in production landscapes.