bluuebunny/crossref_metadata_2025 huggingface dataset:
Small Rural Hospitals Have a Harder Time Achieving Success in Continuous Quality Improvement: An Example From a Stroke Care Network
Authors: Elkins Kelley , Bellamy Lisa , Guo Jing , Dobbs Michael R.
Published: June 2017

Background:

University of Kentucky HealthCare established a Stroke Care Network (SCN) in 2008 to address the challenges of rural stroke care and improve care quality.

Methods:

The SCN collects quality data from each affiliate that include volumes, mortality, length of stay, turnaround times, rt-PA door-to-needle time, 8 stroke core measures, and dysphagia screen measure. Characteristics of affiliate hospital studies include number of beds, Stroke Disease-Specific Care (DSC) certification by The Joint Commission, Appalachian designated county or not, time dedicated to stroke coordinator, submission of quality data for the calendar year, success of data, and utilization of American Heart Association's Get With the Guidelines.

Results:

Seventeen of 23 (74%) affiliate hospitals submitted data. Highest scoring quality measures were antithrombotic by discharge (96%), antithrombotic by end of day 2 (93%), and assessed for rehabilitation (92%). Hospitals with DSC certification were more likely to succeed in stroke quality than those without (P = .0357). Hospitals in Appalachian counties were less likely to succeed in quality measures than those in non-Appalachian designated counties (P = .02).

Conclusions:

Our results demonstrate successful collection of quality data among hospitals bound only by an affiliation agreement. Areas to improve quality identified are door to computed tomographic interpretation, thrombolytic therapy, and dysphagia screening. We suspect that DSC certification is driving quality success in our network hospitals. That Appalachian affiliate hospitals are less likely to succeed could be due to a number of reasons such as the fewer resources available in Appalachian counties and may reflect the financial plight of rural hospitals more generally.
Fiat money: from the current Islamic finance scholars’ perspective
Authors: Jaffar Syammon , Abdullah Adam , Meera Ahamed Kameel Mydin
Published: June 2017

Purpose

This paper aims to discuss the opinions of currentShariahscholars on the concept of debt money in the present-day fiat money system.

Design/methodology/approach

Research design of this paper is a quantitative investigation ofShariahexperts by distributing a questionnaire to them. As majority ofShariahscholars are alsoShariahadvisory of the current banking system, it is important to find out their level of knowledge on the issue of debt money created by the commercial banking system through the fractional-reserve banking (FRB) system.

Findings

Based on this investigation, mostShariahscholars are unaware of and confused about the mechanics underpinning the creation of money, especially with respect to FRB as it is practiced by the conventional and Islamic banking systems.

Originality/value

Based on this research, it is recommended that these scholars should improve their understanding of the operation of the fiat money system and its consequences. It is recommended that, in future,Shariahscholars should think “outside of the box” by creating Islamic financial instruments that do not resemble those of the conventional system.
Identifying and overcoming barriers to deployment of information technology projects in hotels
Authors: Okumus Fevzi , Bilgihan Anil , Ozturk Ahmet Bulent , Zhao Xinyuan (Roy)
Published: June 2017

Purpose

The purpose of this paper is to investigate potential barriers to deployment of information technology (IT) projects and evaluate strategies to overcome them in hotel companies.

Design/methodology/approach

Empirical data were collected through a series of in-depth semi-structured interviews from IT managers, chief information officers, and hotel general managers.

Findings

The research findings demonstrate that barriers to IT implementation occur in three different stages. They are pre-implementation (cost and return on investment, resistance by owners/executives); during the implementation (integration, time delays, vendor communication problems, and resistance by employees); and post-implementation (inadequate training and resistance from customers).

Research limitations/implications

The research findings suggest a contingency approach where organizations should employ various specific strategies depending on the situation to overcome these barriers. Multiple theoretical perspectives should be utilized to evaluate potential barriers to IT projects and utilize specific strategies to overcome them.

Originality/value

This is one of the first empirical studies which provide specific theoretical and practical implications on barriers when implementing IT projects in hotels.
Do micro and small business enterprises economically empower women in developing countries? Evidences from Mekelle city, Tigray, Ethiopia
Authors: Mezgebo Gidey Kidu , Ymesel Tesga , Tegegne Girma
Published: June 2017

Purpose

Today the number of women entrepreneurs is increasing. However, their power in use and control over the household and business-related resource are still limited. The purpose of this paper is to assess women’s economic empowerment in terms of their use and control over resources after participating in micro and small enterprises (MSEs) in Mekelle city.

Design/methodology/approach

A survey on 162 women-owned enterprises from two sectors, namely, manufacturing and service sectors belonging to three sub-cities of the study area was taken for this study. Questionnaire and interview data collection tools were employed, and the systematic random sampling technique was used to select respondents of questionnaires.

Findings

The results of the study revealed that MSEs in Mekelle city are found to have a profound effect on empowering women economically in terms of access to use and control of resources in business and at household, participation in social network and community undertakings. However, limited access to credit, high interest rate, complicated loan application procedures of bank, lack of work place, poor information and technology and basic infrastructure were still found the bottlenecks for women working in MSEs.

Research limitations/implications

MSEs are vital to empower women economically, but they should be accompanied by the improved and fast delivery of services such as credit, enabling work place and technology, which plays a decisive role in economic empowerment of women working in MSEs.

Originality/value

This paper fills the gap in the literature, as there is limited evidence on the role of MSEs in women’s economic empowerment and the challenges faced especially in developing countries in general and Mekelle city in particular.
Branding efforts and SME performance – an empirical investigation of variations across firm sizes and business sectors
Authors: Odoom Raphael , Mensah Priscilla , Asamoah George
Published: June 2017

Purpose

This paper aims to draw on the organizational ecology theory to examine variations in branding efforts and performance of small and medium-sized enterprises (SMEs) across enterprises sizes and business operating sectors.

Design/methodology/approach

A four-stage analysis involving principal component analysis, Pearson correlation, ANOVA and logistic regressions was used on a sample of 430 SMEs within an emerging market.

Findings

Principal component analysis identified four brand marketing efforts relevant to the SMEs. These efforts were used in fluctuating extents among small-sized versus medium-sized enterprises, as well as manufacturing versus services SMEs. Additionally, proportionate levels of performance corollaries were found to be accruable across the enterprise sizes and operating sectors.

Originality/value

The paper first identifies four brand-building efforts germane to SMEs within an emerging market and examines their precise contributions to firm performance within enterprise sizes and business operating sectors. It further reinforces the relevance of brand marketing programs to the growth of SMEs by establishing the likelihood and extent to which brand-building efforts impact on SME performance across enterprise sizes, as well as operating sectors. The study also presents issues of potential research and managerial interest from an emerging market, offering insightful implications to researchers and SME managers.
Do Rural Migrants Divide Ethnically in the City? Evidence from an Ethnographic Experiment in India
Authors: Thachil Tariq
Published: June 2017

Despite rapid urbanization across the Global South, identity politics within rural‐urban migrant communities remains understudied. Past scholarship is divided over whether village‐based ethnic divisions will erode or deepen within diverse poor migrant populations. I assess these divergent predictions through an ‘ethnographic survey experiment’ (N=4,218) among unique samples of poor migrants in India. Contra conventional expectations, I find intra‐class ethnic divisions are neither uniformly transcended nor entrenched across key arenas of migrant life. Instead, I observe variation consistent with situational theories predicting ethnic divisions will be muted only in contexts triggering a common identity among migrants. I pinpoint urban employers and politicians as these triggers. Poor migrants ignore ethnic divisions when facing these elites, who perceive and treat them in class terms. However, migrants remain divided in direct interactions with each other. These bifurcated findings imply poor migrants may be available for both class‐based and ethnic mobilization in the city.
Case of giant paraesophageal hiatal hernia associated with Morgagni hernia
Authors: Ozawa Hiroki , Shinozaki Hiroharu , Kimata Masaru , Ozawa Soji
Published: June 2017

Simultaneous paraesophageal and Morgagni hernias are very rare. Here, we report a case involving a 91‐year‐old woman with simultaneous paraesophageal and Morgagni hernias. Both hernias were repaired laparoscopically. The postoperative course was uneventful. Laparoscopic repair for hernias seems to be feasible and minimally invasive, but only a few reports have described such repairs of hernial orifices.
Population pharmacokinetics of human antithrombin concentrate in paediatric patients
Authors: Moffett Brady S. , Diaz Rosa , Galati Marianne , Mahoney Donald , Teruya Jun , Yee Donald L.
Published: June 2017

Aims

Antithrombin is increasingly used in paediatric patients, yet there are few age‐specific pharmacokinetic data to guide dosing. We aimed to describe the pharmacokinetic profile of human (plasma‐derived) antithrombin concentrate in paediatric patients.

Methods

A 5‐year retrospective review was performed of patients <19 years of age admitted to our institution who received antithrombin concentrate, were not on mechanical circulatory support and had baseline (predose) and postdose plasma antithrombin activity levels available for analysis. Demographic and laboratory variables, antithrombin dosing information and data on the use of continuous infusion unfractionated heparin were collected. Population pharmacokinetic analysis was performed with bootstrap analysis. The model developed was tested against a validation dataset from a cohort of similar patients, and a predictive value was calculated.

Results

A total 184 patients met the study criteria {46.7% male, median age [years] 0.35 [interquartile range (IQR) 0.07–3.9]}. A median of two antithrombin doses (IQR 1–4) were given to patients (at a dose of 46.3 ± 13.6 units kg–1), with median of three (IQR 2–7) postdose levels per patient. Continuous infusion unfractionated heparin was administered in 87.5% of patients, at a mean dose of 34.1 ± 22.7 units kg–1 h–1. A one‐compartment exponential error model best fit the data, and significant covariates included allometrically scaled weight on clearance and volume of distribution, unfractionated heparin dose on clearance, and baseline antithrombin activity level on volume of distribution. The model resulted in a median −1.75% prediction error (IQR –11.75% to 6.5%) when applied to the validation dataset (n = 30).

Conclusions

Antithrombin pharmacokinetics are significantly influenced by the concurrent use of unfractionated heparin and baseline antithrombin activity.
Mood symptoms in pregnant and postpartum women with bipolar disorder: a naturalistic study
Authors: Driscoll Kara E , Sit Dorothy K Y , Moses‐Kolko Eydie L , Pinheiro Emily , Yang Amy , Ciolino Jody D , Eng Heather F , Luther James F , Clark Crystal T , Wisniewski Stephen R , Wisner Katherine L
Published: June 2017

Objective

We conducted a prospective naturalistic study of pregnant women with bipolar disorder (BD) to evaluate symptoms of BD across childbearing and assess whether pharmacotherapy reduced their severity.

Methods

Assessments were scheduled at 20, 30, and 36 weeks' gestation and 2, 12, 26, and 52 weeks postpartum. Symptoms were assessed using the Structured Interview Guide for the Hamilton Depression Rating Scale–Atypical Depression Supplement (SIGH‐ADS) and Mania Rating Scale (MRS).

Results

Pregnant women (N=152) with BD were evaluated; 88 women (58%) were treated and 64 untreated (42%) with psychotropic drugs during pregnancy. Among the 88 women treated, 23 (26%) discontinued their medication in the first trimester and the remaining 65 (74%) were exposed throughout pregnancy or in the second and third trimesters. More than two‐thirds (73%) of the women who remained in the study took psychotropic agents postpartum. The mean scores on the SIGH‐ADS were in the mild range of depressive symptoms in both the psychotropic‐treated and untreated groups in both pregnancy and postpartum. The majority of women had no or few symptoms of mania. Of the pregnant women treated with psychotropic agents, 66% received a guideline‐concordant drug, and 34% received either antidepressant monotherapy (for BD I) or mono‐ or polypharmacy with a variety of other agents.

Conclusions

This sample of perinatal women with BD was characterized by mild residual symptoms of depression independent of pharmacotherapy, which poses a risk for recurrence and impaired parenting. The treatment of childbearing women with BD deserves urgent clinical and research attention to improve psychiatric outcomes.
Regression away from the mean: Theory and examples
Authors: Schwarz Wolf , Reike Dennis
Published: June 2017

Using a standard repeated measures model with arbitrary true score distribution and normal error variables, we present some fundamental closed‐form results which explicitly indicate the conditions under which regression effects towards (RTM) and away from the mean are expected. Specifically, we show that for skewed and bimodal distributions many or even most cases will show a regression effect that is in expectation away from the mean, or that is not just towards but actually beyond the mean. We illustrate our results in quantitative detail with typical examples from experimental and biometric applications, which exhibit a clear regression away from the mean (‘egression from the mean’) signature. We aim not to repeal cautionary advice against potentialRTMeffects, but to present a balanced view of regression effects, based on a clear identification of the conditions governing the form that regression effects take in repeated measures designs.
Limitations of the interpretation and extrapolation of clinical trial data in kidney transplant recipients
Authors: de Oliveira Nagilla I. , Paula Mayara I. , Felipe Claudia R. , Tedesco‐Silva Helio , Medina‐Pestana Jose O.
Published: June 2017

Objective

The risks and benefits of the participation of kidney transplant recipients in randomized clinical trials (RCTs) investigating new immunosuppressive therapies are unknown.

Design and Setting

We included patients from 12 prospective phaseII/III RCTs randomized to the experimental (G1, n=319) or standard‐of‐care internal control group (G2, n=118). We constructed two additional external control groups with (G3, n=319) or without (G4, n=319) matching inclusion/exclusion criteria based on transplant date. The primary outcome analysis was the composite clinical efficacy failure, defined as biopsy‐proven acute rejection (BPAR), graft loss, death, or loss to follow‐up 12 months after kidney transplantation.

Results

Survival free of composite clinical efficacy failure was higher among participants inRCT, without difference between experimental or standard‐of‐care therapy (80∙3 vs 78∙0 vs 69∙9 vs 66∙1%,P<.001), respectively. Patient (98.1 vs 99.2 vs 96.9 vs 91.8P<.001) and graft (94.0 vs 98.3 vs 90.9 vs 82.4) survivals were also higher in G1 compared to G4, but no differences in survival free ofBPARwere observed (85.3 vs 78.8 vs 82.8 vs 81.2P>.05), respectively.

Conclusion

These findings suggested that new treatments investigated in kidney transplant recipients are not associated with detectable harm compared to standard of care.
What do employers think their role is in ensuring language proficiency of internationally trained pharmacists
Authors: Ziaei Zainab , Hassell Karen , Schafheutle Ellen I
Published: June 2017

Objectives

Until 2016, internationally trained pharmacists (ITPs) from the European Economic Area (EEA) did not need to prove sufficient language proficiency to the pharmacy regulator upon registration. Pharmacists themselves have a professional responsibility to ensure they can communicate and work effectively, but some responsibility also rests with employers, yet very little research has explored this. The aim of this study was to explore employer views of the communicative proficiency of ITPs whose first language was not English, their role as employers and potential implications for patient safety.

Methods

Semi-structured, telephone interviews were conducted with seven community and two hospital employers with experience of employing EEA pharmacists, between May and July 2010. Verbatim interview transcripts were coded and analysed in NVivo using the framework approach.

Key findings

All participants mentioned the importance of having processes in place to assure EEA pharmacists’ linguistic competency in the workplace. During recruitment, different strategies were used to assure language competency. Some employers only conducted interviews while others required candidates to pass English language assessments. Participants were most familiar with the International English Language Testing System, which was described as too general and not unique to pharmacy. Other pharmacy-specific tests such as the University of Bath English Language Test and Linguarama English Assessment Test for Pharmacists were alternatives.

Conclusions

Currently, there is no one standard procedure in place to check the communicative competency of EEA pharmacists. The findings from this study suggest that there is need to establish a uniform assessment system so all the EEA pharmacists could be tested justly and consistently.
Hepatic expression of cytochrome P450 enzymes in non‐human primate species
Authors: Uehara Shotaro , Uno Yasuhiro , Yamazaki Hiroshi
Published: June 2017

Cytochromes P450 (P450) largely remain to be characterized in great apes. Comparative immunochemical detection of drug metabolizing forms of P450s 1A, 2A, 2B, 2C, 2D, 2E, 2J, 3A, 4A, and 4F in liver microsomes from chimpanzees, gorillas, orangutans, gibbons, cynomolgus and rhesus macaques, and common marmosets were carried out.
Uptake and metabolism of sulphated steroids by the blood–brain barrier in the adult male rat
Authors: Qaiser M. Zeeshan , Dolman Diana E. M. , Begley David J. , Abbott N. Joan , Cazacu‐Davidescu Mihaela , Corol Delia I. , Fry Jonathan P.
Published: June 2017

Little is known about the origin of the neuroactive steroids dehydroepiandrosterone sulphate (DHEAS) and pregnenolone sulphate (PregS) in the brain or of their subsequent metabolism. Using rat brain perfusion in situ, we have found 3H‐PregS to enter more rapidly than 3H‐DHEAS and both to undergo extensive (> 50%) desulphation within 0.5 min of uptake. Enzyme activity for the steroid sulphatase catalysing this deconjugation was enriched in the capillary fraction of the blood–brain barrier and its mRNA expressed in cultures of rat brain endothelial cells and astrocytes. Although permeability measurements suggested a net efflux, addition of the efflux inhibitors GF120918 and/or MK571 to the perfusate reduced rather than enhanced the uptake of 3H‐DHEAS and 3H‐PregS; a further reduction was seen upon the addition of unlabelled steroid sulphate, suggesting a saturable uptake transporter. Analysis of brain fractions after 0.5 min perfusion with the 3H‐steroid sulphates showed no further metabolism of PregS beyond the liberation of free steroid pregnenolone. By contrast, DHEAS underwent 17‐hydroxylation to form androstenediol in both the steroid sulphate and the free steroid fractions, with some additional formation of androstenedione in the latter. Our results indicate a gain of free steroid from circulating steroid sulphates as hormone precursors at the blood–brain barrier, with implications for ageing, neurogenesis, neuronal survival, learning and memory.

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Participation of hypothalamic CB1 receptors in reproductive axis disruption during immune challenge
Authors: Surkin P. N. , Di Rosso M. E. , Correa F. , Elverdin J. C. , Genaro A. M. , De Laurentiis A. , Fernández‐Solari J.
Published: June 2017

Immune challenge inhibits reproductive function and endocannabinoids (eCB) modulate sexual hormones. However, no studies have been performed to assess whether the eCB system mediates the inhibition of hormones that control reproduction as a result of immune system activation during systemic infections. For that reason, we evaluated the participation of the hypothalamic cannabinoid receptor CB1 on the hypothalamic‐pituitary‐gonadal (HPG) axis activity in rats submitted to immune challenge. Male adult rats were treated i.c.v. administration with a CB1 antagonist/inverse agonist (AM251) (500 ng/5 μL), followed by an i.p. injection of lipopolysaccharide (LPS) (5 mg/kg) 15 minutes later. Plasmatic, hypothalamic and adenohypophyseal pro‐inflammatory cytokines, hormones and neuropeptides were assessed 90 or 180 minutes post‐LPS. The plasma concentration of tumour necrosis factor α and adenohypophyseal mRNA expression of Tnfα and Il1β increased 90 and 180 minutes post i.p. administration of LPS. However, cytokine mRNA expression in the hypothalamus increased only 180 minutes post‐LPS, suggesting an inflammatory delay in this organ. CB1 receptor blockade with AM251 increased LPS inflammatory effects, particularly in the hypothalamus. LPS also inhibited the HPG axis by decreasing gonadotrophin‐releasing hormone hypothalamic content and plasma levels of luteinising hormone and testosterone. These disruptor effects were accompanied by decreased hypothalamic Kiss1 mRNA expression and prostaglandin E2 content, as well as by increased gonadotrophin‐inhibitory hormone (Rfrp3) mRNA expression. All these disruptive effects were prevented by the presence of AM251. In summary, our results suggest that, in male rats, eCB mediate immune challenge‐inhibitory effects on reproductive axis at least partially via hypothalamic CB1 activation. In addition, this receptor also participates in homeostasis recovery by modulating the inflammatory process taking place after LPS administration.
Host‐specific associations affect the microbiome of Philornis downsi, an introduced parasite to the Galápagos Islands
Authors: Ben‐Yosef Michael , Zaada Doron S. Y. , Dudaniec Rachael Y. , Pasternak Zohar , Jurkevitch Edouard , Smith Renee J. , Causton Charlotte E. , Lincango Maria Piedad , Tobe Shanan S. , Mitchell James G. , Kleindorfer Sonia , Yuval Boaz
Published: June 2017

The composition and diversity of bacteria forming the microbiome of parasitic organisms have implications for differential host pathogenicity and host–parasite co‐evolutionary interactions. The microbiome of pathogens can therefore have consequences that are relevant for managing disease prevalence and impact on affected hosts. Here, we investigate the microbiome of an invasive parasitic fly Philornis downsi, recently introduced to the Galápagos Islands, where it poses extinction threat to Darwin's finches and other land birds. Larvae infest nests of Darwin's finches and consume blood and tissue of developing nestlings, and have severe mortality impacts. Using 16s rRNA sequencing data, we characterize the bacterial microbiota associated with P. downsi adults and larvae sourced from four finch host species, inhabiting two islands and representing two ecologically distinct groups. We show that larval and adult microbiomes are dominated by the phyla Proteobacteria and Firmicutes, which significantly differ between life stages in their distributions. Additionally, bacterial community structure significantly differed between larvae retrieved from strictly insectivorous warbler finches (Certhidea olivacea) and those parasitizing hosts with broader dietary preferences (ground and tree finches, Geospiza and Camarhynchus spp., respectively). Finally, we found no spatial effects on the larval microbiome, as larvae feeding on the same host (ground finches) harboured similar microbiomes across islands. Our results suggest that the microbiome of P. downsi changes during its development, according to dietary composition or nutritional needs, and is significantly affected by host‐related factors during the larval stage. Unravelling the ecological significance of bacteria for this parasite will contribute to the development of novel, effective control strategies.
Abrupt changes in the composition and function of fungal communities along an environmental gradient in the high Arctic
Authors: Grau Oriol , Geml József , Pérez‐Haase Aaron , Ninot Josep M. , Semenova‐Nelsen Tatiana A. , Peñuelas Josep
Published: June 2017

Fungi play a key role in soil–plant interactions, nutrient cycling and carbon flow and are essential for the functioning of arctic terrestrial ecosystems. Some studies have shown that the composition of fungal communities is highly sensitive to variations in environmental conditions, but little is known about how the conditions control the role of fungal communities (i.e., their ecosystem function). We usedDNAmetabarcoding to compare taxonomic and functional composition of fungal communities along a gradient of environmental severity in Northeast Greenland. We analysed soil samples from fell fields, heaths and snowbeds, three habitats with very contrasting abiotic conditions. We also assessed within‐habitat differences by comparing three widespread microhabitats (patches with high cover ofDryas,Salix, or bare soil). The data suggest that, along the sampled mesotopographic gradient, the greatest differences in both fungal richness and community composition are observed amongst habitats, while the effect of microhabitat is weaker, although still significant. Furthermore, we found that richness and community composition of fungi are shaped primarily by abiotic factors and to a lesser, though still significant extent, by floristic composition. Along this mesotopographic gradient, environmental severity is strongly correlated with richness in all fungal functional groups: positively in saprotrophic, pathogenic and lichenised fungi, and negatively in ectomycorrhizal and root endophytic fungi. Our results suggest complex interactions amongst functional groups, possibly due to nutrient limitation or competitive exclusion, with potential implications on soil carbon stocks. These findings are important in the light of the environmental changes predicted for the Arctic.
A toxic imbalance of Hsp70s in Saccharomyces cerevisiae is caused by competition for cofactors
Authors: Keefer Kathryn M. , True Heather L.
Published: June 2017

Molecular chaperones are responsible for managing protein folding from translation through degradation. These crucial machines ensure that protein homeostasis is optimally maintained for cell health. However, ‘too much of a good thing’ can be deadly, and the excess of chaperones can be toxic under certain cellular conditions. For example, overexpression of Ssa1, a yeast Hsp70, is toxic to cells in folding‐challenged states such as [PSI+]. We discovered that overexpression of the nucleotide exchange factor Sse1 can partially alleviate this toxicity. We further argue that the basis of the toxicity is related to the availability of Hsp70 cofactors, such as Hsp40 J‐proteins and nucleotide exchange factors. Ultimately, our work informs future studies about functional chaperone balance and cautions against therapeutic chaperone modifications without a thorough examination of cofactor relationships.
Evolution of Spitz Nevi
Authors: Emiroglu Nazan , Yıldız Pelin , Biyik Ozkaya Dilek , Bahalı Anıl Gulsel , Su Ozlem , Onsun Nahide
Published: June 2017

Background/Objectives

Spitz nevi are melanocytic lesions with clinical, dermoscopic, and histopathologic presentations that may resemble those of melanoma. The evolution of Spitz nevi is a well‐known feature. The objectives of this study were to investigate the clinical and dermoscopic features of Spitz nevi and define their evolution.

Methods

A retrospective observational study was performed and 70 Spitz nevi were analyzed using clinical and dermoscopic examination.

Results

Seventy patients were included in the study. The most common dermoscopic pattern was globular (n = 35 [50%]) followed by starburst (n = 24 [34.3%]), reticular (n = 8 [11.4%]), and homogeneous (n = 3 [4.3%]). Follow‐up data were available for 27 of 70 patients. Of these, 21 demonstrated evolution on the follow‐up images. A stable pattern (no evolution) was noted in 6 of 27 lesions. The patients who exhibited evolution were younger on average than the stable group (p = 0.04).

Conclusion

Based on our study, the most common biologic behavior for Spitz nevi is evolution. Although no significant differences were observed in other clinical features, the inverse relationship between evolution and age is important to consider when attempting to differentiate Spitz nevus from melanoma.
Not Simply in the Eye of the Beholder: Authenticity as a Product of Candidate Preference and Unfettered Speech
Authors: Pillow David R. , Crabtree Meghan A. , Galvan Manuel J. , Hale Willie J.
Published: June 2017

Authenticity has emerged over recent decades as a prominent theme in both the press and in political research—and peaked in the 2016 presidential contest that pitted Donald Trump against Hillary Clinton, Bernie Sanders, Marco Rubio, and Ted Cruz. In this context, we attempted to answer the question: How do voters judge a presidential candidate's authenticity? Here we use motivated reasoning and correspondent inference theory as theoretical frameworks to examine how partisan preference combines with perceptions of unfettered speech and strategic impression management to influence voter judgments of a candidate's authenticity. An online survey of 525 respondents demonstrated that individuals' partisan preferences influenced both judgments of a candidate's authenticity and their perceptions of behaviors signifying authenticity (use of unfettered speech versus strategic impression management). These behavioral signals partially mediated the relation between candidate preferences and authenticity judgments. Moreover, voters, given their partisan preferences, differentially weighted candidates' use of unfettered speech and strategic impression management tactics in their judgments of authenticity. Finally, unfiltered/politically incorrect speech was found to have both positive and negative effects on authenticity judgments. Findings further elucidate the nature of authenticity as perceived in others and identify intermediary variables and boundary conditions that influence those perceptions.
Integrative analysis of circRNAs acting as ceRNAs involved in ethylene pathway in tomato
Authors: Wang Yunxiang , Wang Qing , Gao Lipu , Zhu Benzhong , Luo Yunbo , Deng Zhiping , Zuo Jinhua
Published: June 2017

Circular RNAs (circRNAs) are a large class of non‐coding endogenous RNAs that could act as competing endogenous RNAs (ceRNAs) to terminate the mRNA targets' suppression of miRNAs. To elucidate the intricate regulatory roles of circRNAs in the ethylene pathway in tomato fruit, deep sequencing and bioinformatics methods were performed. After strict screening, a total of 318 circRNAs were identified. Among these circRNAs, 282 were significantly differentially expressed among wild‐type and sense‐/antisense‐LeERF1 transgenic tomato fruits. Besides, 1254 target genes were identified and a large amount of them were found to be involved in ethylene pathway. In addition, a sophisticated regulatory model consisting of circRNAs, target genes and ethylene was set up. Importantly, 61 circRNAs were found to be potential ceRNAs to combine with miRNAs and some of the miRNAs had been revealed to participate in the ethylene signaling pathway. This research further raised the possibility that the ethylene pathway in tomato fruit may be under the regulation of various circRNAs and provided a new perspective of the roles of circRNAs.
Does triacylglycerol (TAG) serve a photoprotective function in plant leaves? An examination of leaf lipids under shading and drought
Authors: Marchin Renée M. , Turnbull Tarryn L. , Deheinzelin Audrey I. , Adams Mark A.
Published: June 2017

Plant survival in many ecosystems requires tolerance of large radiation loads, unreliable water supply and suboptimal soil fertility. We hypothesized that increased production of neutral lipids (triacylglycerols, TAGs) in plant leaves is a mechanism for dissipating excess radiation energy. In a greenhouse experiment, we combined drought and shade treatments and examined responses among four species differing in life form, habitat, and drought‐ and shade‐tolerance. We also present a lipid extraction protocol suitable for sclerophyllous leaves of native Australian trees (e.g. Acacia, Eucalyptus). Fluorescence measurements indicated that plants exposed to full sunlight experienced mild photoinhibition during our experiment. Accumulation of TAGs did not follow photosynthetic capacity, but instead, TAG concentration increased with non‐photochemical quenching. This suggests that plants under oxidative stress may increase biosynthesis of TAGs. Moderate drought stress resulted in a 60% reduction in TAG concentration in wheat (Triticum aestivum). Shading had no effect on TAGs, but increased concentrations of polar lipids in leaves; for example, acclimation to shade in Austrodanthonia spp., a native Australian grass, resulted in a 60% increase in associated polar lipids and higher foliar chlorophyll concentrations. Shading also reduced the digalactosyldiacylglycerol:monogalactosyldiacylglycerol (DGDG:MGDG) ratio in leaves, with a corresponding increase in the degree of unsaturation and thus fluidity of thylakoid membranes of chloroplasts. Our results suggest that prevention of photodamage may be coordinated with accumulation of TAGs, although further research is required to determine if TAGs serve a photoprotective function in plant leaves.
Mechanistic differences in the uptake of salicylic acid glucose conjugates by vacuolar membrane‐enriched vesicles isolated from Arabidopsis thaliana
Authors: Vaca Elizabeth , Behrens Claire , Theccanat Tiju , Choe Jun‐Yong , Dean John V.
Published: June 2017

Salicylic acid (SA) is a plant hormone involved in a number of physiological responses including both local and systemic resistance of plants to pathogens. In Arabidopsis, SA is glucosylated to form either SA 2‐O‐β‐d‐glucose (SAG) or SA glucose ester (SGE). In this study, we show that SAG accumulates in the vacuole of Arabidopsis, while the majority of SGE was located outside the vacuole. The uptake of SAG by vacuolar membrane‐enriched vesicles isolated from Arabidopsis was stimulated by the addition of MgATP and was inhibited by both vanadate (ABC transporter inhibitor) and bafilomycin A1 (vacuolar H+‐ATPase inhibitor), suggesting that SAG uptake involves both an ABC transporter and H+‐antiporter. Despite its absence in the vacuole, we observed the MgATP‐dependent uptake of SGE by Arabidopsis vacuolar membrane‐enriched vesicles. SGE uptake was not inhibited by vanadate but was inhibited by bafilomycin A1 and gramicidin D providing evidence that uptake was dependent on an H+‐antiporter. The uptake of both SAG and SGE was also inhibited by quercetin and verapamil (two known inhibitors of multidrug efflux pumps) and salicin and arbutin. MgATP‐dependent SAG and SGE uptake exhibited Michaelis–Menten‐type saturation kinetics. The vacuolar enriched‐membrane vesicles had a 46‐fold greater affinity and a 10‐fold greater transport activity with SGE than with SAG. We propose that in Arabidopsis, SAG is transported into the vacuole to serve as a long‐term storage form of SA while SGE, although also transported into the vacuole, is easily hydrolyzed to release the active hormone which can then be remobilized to other cellular locations.
The Penn Effect revisited: New evidence from Latin America
Authors: Njindan Iyke Bernard
Published: June 2017

In this paper, we examine the role of relative productivity growth in real misalignment of exchange rates in Latin American countries. Specifically, we verify the validity of the Penn Effect for selected countries in this region. Our sample consists of 15 countries for the period 1951 to 2010. We employ both short‐ and long‐panel data techniques, which allow us to experiment with estimators suitable for short and long time dimensions of panel data. The Penn Effect is found to be supported for the entire sample, and for subsamples. Relative productivity growth is dominant in the real exchange rate movement during periods of mild or weak speculative attacks, as compared with periods of severe speculative attacks. To correct for real misalignment of currencies in Latin America under speculative attacks, relative productivity growth must be sizeable.
Giving Context to Non‐self‐marker Theories of Immune Responsiveness
Authors: Cohn M.
Published: June 2017

In 2001, long ago by modern standards, Matzinger changed the emphasis of her Danger theory from one that downplayed the self‐non‐self discrimination to one that concerned itself with the regulation of effector class. This gave her theory a measure of validity that the other non‐self‐marker theorists have yet to confront. However, precision and clarity are still lacking.
Complement C5a‐Induced Changes in Neutrophil Morphology During Inflammation
Authors: Denk S. , Taylor R. P. , Wiegner R. , Cook E. M. , Lindorfer M. A. , Pfeiffer K. , Paschke S. , Eiseler T. , Weiss M. , Barth E. , Lambris J. D. , Kalbitz M. , Martin T. , Barth H. , Messerer D. A. C. , Gebhard F. , Huber‐Lang M. S.
Published: June 2017

The complement and neutrophil defence systems, as major components of innate immunity, are activated during inflammation and infection. For neutrophil migration to the inflamed region, we hypothesized that the complement activation product C5a induces significant changes in cellular morphology before chemotaxis. Exposure of human neutrophils to C5a dose‐ and time‐dependently resulted in a rapid C5a receptor‐1 (C5aR1)‐dependent shape change, indicated by enhanced flow cytometric forward‐scatter area values. Similar changes were observed after incubation with zymosan‐activated serum and in blood neutrophils during murine sepsis, but not in mice lacking the C5aR1. In human neutrophils, Amnis high‐resolution digital imaging revealed a C5a‐induced decrease in circularity and increase in the cellular length/width ratio. Biomechanically, microfluidic optical stretching experiments indicated significantly increased neutrophil deformability early after C5a stimulation. The C5a‐induced shape changes were inhibited by pharmacological blockade of either the ‐exchanger or the Cl−‐channel. Furthermore, actin polymerization assays revealed that C5a exposure resulted in a significant polarization of the neutrophils. The functional polarization process triggered by ATP–P2X/Y‐purinoceptor interaction was also involved in the C5a‐induced shape changes, because pretreatment with suramin blocked not only the shape changes but also the subsequent C5a‐dependent chemotactic activity. In conclusion, the data suggest that the anaphylatoxin C5a regulates basic neutrophil cell processes by increasing the membrane elasticity and cell size as a consequence of actin‐cytoskeleton polymerization and reorganization, transforming the neutrophil into a migratory cell able to invade the inflammatory site and subsequently clear pathogens and molecular debris.
Simultaneous pancreas/kidney transplant recipients are predisposed to tissue‐invasive cytomegalovirus disease and concomitant infectious complications
Authors: Schachtner Thomas , Zaks Marina , Otto Natalie M. , Kahl Andreas , Reinke Petra
Published: June 2017

Background

Infections have increased in simultaneous pancreas/kidney transplant recipients (SPKTRs) with cytomegalovirus (CMV) infection being the most important viral infection with adverse impact on patient and allograft outcomes.

Methods

We studied all primary SPKTRs and deceased‐donor kidney transplant recipients (KTRs) between 2008 and 2015 for the development of CMV infection. A total of 21/62 SPKTRs (33.9%) and 90/335 KTRs (26.9%) were diagnosed with CMV infection. A control group of 41 SPKTRs without CMV infection was used for comparison.

Results

SPKTRs showed an increased incidence of CMV infection compared with KTRs. SPKTRs were more likely to develop CMV disease, CMV pneumonia, recurrent CMV infection, higher initial and peak CMV loads, and more need for intravenous antiviral therapy compared with KTRs (P<.05). High‐risk CMV serostatus (D+R−) and 2 HLA‐B/‐DR mismatches increased the risk of CMV infection in SPKTRs (P<.05). No differences were observed for patient and allograft outcomes (P>.05). SPKTRs with CMV infection were more likely to show concomitant Epstein‐Barr virus (EBV) viremia compared with SPKTRs without CMV infection (P<.05). SPKTRs with CMV infection showed higher incidences of concomitant BK polyomavirus‐associated nephropathy, EBV viremia, and sepsis compared with KTRs with CMV infection (P<.05).

Conclusion

Our results suggest a higher incidence and more severe course of CMV infection in SPKTRs compared with KTRs. The increased incidence of concomitant infectious complications among SPKTRs with CMV infection suggests an overall impaired immunity, and calls for more intense screening.
Impact of China's essential medicines scheme and zero‐mark‐up policy on antibiotic prescriptions in county hospitals: a mixed methods study
Authors: Wei Xiaolin , Yin Jia , Walley John D. , Zhang Zhitong , Hicks Joseph P. , Zhou Yu , Sun Qiang , Zeng Jun , Lin Mei
Published: June 2017

Objective

To evaluate the impact of the national essential medicines scheme and zero‐mark‐up policy on antibiotic prescribing behaviour.

Methods

In rural Guangxi, a natural experiment compared one county hospital which implemented the policy with a comparison hospital which did not. All outpatient and inpatient records in 2011 and 2014 were extracted from the two hospitals. Primary outcome indicator was antibiotic prescribing rate (APR) among children aged 2–14 presenting in outpatients with a primary diagnosis of upper respiratory tract infection (URTI). We organised independent physician reviews to determine inappropriate prescribing for inpatients. Difference‐in‐difference analyses based on multivariate regressions were used to compare APR over time after adjusting potential confounders. We conducted 12 in‐depth interviews with paediatricians, hospital directors and health officials.

Results

A total of 8219 and 4142 outpatient prescriptions of childhood URTIs were included in the intervention and comparison hospitals, respectively. In 2011, APR was 30% in the intervention and 88% in the comparison hospital. In 2014, the intervention hospital significantly reduced outpatient APR by 21% (95% CI:−23%, −18%), intravenous infusion by 58% (95% CI: −64%, −52%) and prescription cost by 31 USD (95% CI: −35, −28), compared with the controls. We collected 251 inpatient records, but did not find reductions in inappropriate antibiotic use. Interviews revealed that the intervention hospital implemented a thorough antibiotics stewardship programme containing training, peer review of prescriptions and restrictions for overprescribing.

Conclusion

The national essential medicines scheme and zero‐mark‐up policy, when implemented with an antimicrobial stewardship programme, may be associated with reductions in outpatient antibiotic prescribing and intravenous infusions.
Draft Genome Sequence of Pseudomonas koreensis CI12, a Bacillus cereus “Hitchhiker” from the Soybean Rhizosphere
Authors: Lozano Gabriel L. , Bravo Juan I. , Handelsman Jo
Published: June 2017

Pseudomonas koreensis
CI12 was coisolated with
Bacillus cereus
from a root of a soybean plant grown in a field in Arlington, WI. Here, we report the draft genome sequence of
P. koreensis
CI12 obtained by Illumina sequencing.
T-piece versus self-inflating bag ventilation in preterm neonates at birth
Authors: Guinsburg Ruth , de Almeida Maria Fernanda Branco , de Castro Junia Sampel , Gonçalves-Ferri Walusa Assad , Marques Patricia Franco , Caldas Jamil Pedro Siqueira , Krebs Vera Lucia Jornada , Souza Rugolo Ligia Maria Suppo de , de Almeida João Henrique Carvalho Leme , Luz Jorge Hecker , Procianoy Renato S , Duarte José Luiz Muniz Bandeira , Penido Marcia Gomes , Ferreira Daniela Marques de Lima Mota , Alves Filho Navantino , Diniz Edna Maria de Albuquerque , Santos Juliana Paula , Acquesta Ana Lucia , Santos Cristina Nunes dos , Gonzalez Maria Rafaela Conde , da Silva Regina PG Vieira Cavalcanti , Meneses Jucile , Lopes José Maria de Andrade , Martinez Franciscó Eulógio
Published: June 2017

Objective

To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities.

Design

Pragmatic prospective cohort study.

Setting

20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014–2015 ventilated at birth with 23–33’ weeks gestation and birth weight 400–1499 g without malformations. Patients transferred until the 27th day after birth were excluded.

Interventions

Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist’s discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome.

Results

1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695).

Conclusion

This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.