bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model
Authors: King W. , Teare J. , Vandrevala T. , Cartwright S. , Mohammed K. B. , Patel B.
Published: November 2015

A can't intubate, can't ventilate scenario can result in morbidity and death. Although a rare occurrence (1:50 000 general anaesthetics), it is crucial that anaesthetists maintain the skills necessary to perform cricothyroidotomy, and are well‐equipped with appropriate tools. We undertook a bench study comparing a new device, Surgicric®, with two established techniques; the Melker Emergency Cricothyroidotomy, and a surgical technique. Twenty‐five anaesthetists performed simulated emergency cricothyroidotomy on a porcine model, with the primary outcome measure being insertion time. Secondary outcomes included success rate, tracheal trauma and ease of use. The surgical technique was fastest. The median (IQR [range]) was 81 (62–126 [37–300]) s, followed by the Melker 124 (100–217 [71–300]) s, and the Surgicric 127 (68–171 [43–300]), p = 0.003. The Surgicric device was the most traumatic, as evaluated by a blinded Ear, Nose and Throat surgeon. Subsequently, the authors contacted the device manufacturer, who has now modified the kit in the hope that its clinical application might be improved. Further studies are required to evaluate the revised model.
Hyperbilirubinaemia: its utility in non‐perforated appendicitis
Authors: Sandstrom Anna , Grieve David A.
Published: November 2015

Background

The diagnosis of acute appendicitis is made using clinical findings and investigations. Recent studies have suggested that serum bilirubin, a cheap and simple biochemical test, is a positive predictor in the diagnosis of appendiceal perforation and may be more specific than C‐reactive protein (CRP) and white cell count (WCC). The aim of this study was to investigate the utility of the serum bilirubin level in patients with suspected acute but non‐perforative appendicitis.

Methods

A retrospective chart review of 213 patients who presented with suspected appendicitis in a 6‐month period to Nambour General Hospital was performed. Serum bilirubin, WCC and CRP were recorded and analysed as to their utility in relation to the final diagnosis.

Results

A total of 196 patients underwent an appendicectomy and 41 of these were negative. The specificity of hyperbilirubinaemia for appendicitis overall was 0.83 with a positive predictive value (PPV) of 0.86, compared with CRP (specificity 0.40, PPV 0.75) and WCC (specificity 0.67, PPV 0.85). The area under the receiver operating characteristic curve for bilirubin was 0.6289 compared to 0.6171 for CRP and 0.7219 for WCC. A subgroup analysis of those with complicated appendicitis demonstrated a PPV for bilirubin of 0.66 compared to 0.58 for WCC and 0.34 for CRP in agreement with the literature. Subgroup analysis of hyperbilirubinaemia in simple appendicitis demonstrated a PPV of 0.81 compared to CRP (0.71) and WCC (0.82).

Conclusion

Bilirubin had a higher specificity than CRP and WCC overall in patients with appendicitis. Hyperbilirubinaemia had a high PPV in patients with simple appendicitis.
Colonic transit: what is the impact of a diverting loop ileostomy?
Authors: Huang Sean , Theophilus Mary , Cui Jiamei , Bell Stephen W. , Wale Roger , Chin Martin , Farmer Chip , Warrier Satish K.
Published: November 2015

Background

Diverting loop ileostomy (DLI) is used following low anterior resections (LAR) or ultra‐low anterior resections (ULAR) to reduce anastomotic leak (AL). Preoperative mechanical bowel preparation (MBP) is traditionally used with DLI. However, clearance of the left colon can be achieved with a fleet enema without the physiological compromise of MBP. We aimed to assess colonic transit following DLI in this context.

Methods

A prospective, observational study was performed with patients with rectal cancer undergoing LAR or ULAR in a tertiary colorectal unit with preoperative fleet enema. Radiopaque markers were inserted into the caecum following rectal resection and formation of a DLI with placement confirmed by image intensifier and endoscopy. X‐rays were performed at days 1, 3, 5 and 14 post‐operation with data collected prospectively.

Results

Ten patients (mean age 57, nine males) were enrolled. Mean time to functioning stoma was 1.9 days (range 1–3). There was no movement in the majority of markers in all patients at Day 5 post‐operation. In all seven patients with Day 14 X‐rays, the majority of markers remained in the right colon. Two patients had delayed AL, with markers found within the pelvis in both of these patients.

Conclusions

This is the first study to assess colonic transit following DLI using fleet enema only, with results suggesting colonic motility is abolished in this setting. The use of a fleet enema without MBP may be sufficient prior to rectal resection surgery when DLI is employed. AL may actually increase colonic transit. Further research is warranted.
Cost‐analysis of robotic‐assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia
Authors: Herling Suzanne F. , Palle Connie , Møller Ann M. , Thomsen Thordis , Sørensen Jan
Published: November 2015

Introduction

The aim of this study was to analyse the hospital cost of treatment with robotic‐assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost.

Material and methods

This cost analysis was based on two cohorts: women treated with robotic‐assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity‐based cost analysis including consumables and healthcare professionals’ salaries. As cost‐drivers we included severe complications, duration of surgery, anesthesia and stay at the post‐anesthetic care unit, as well as number of hospital bed‐days. Ordinary least‐squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic‐assisted laparoscopic hysterectomy.

Results

The average cost of consumables was 12 642 Danish kroner more expensive per patient for robotic‐assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost‐drivers, the analysis showed that the robotic‐assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic‐assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs.

Conclusion

For women with endometrial cancer or atypical complex hyperplasia, robotic‐assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay.
Judicious use of oxytocin augmentation for the management of prolonged labor
Authors: Rossen Janne , Østborg Tilde B. , Lindtjørn Elsa , Schulz Jørn , Eggebø Torbjørn M.
Published: November 2015

Introduction

A protocol including judicious use of oxytocin augmentation was investigated to determine whether it would change how oxytocin was used and eventually influence labor and fetal outcomes.

Material and methods

The population of this cohort study comprised 20 227 delivering women with singleton pregnancies ≥37 weeks, cephalic presentation, spontaneous or induced onset of labor, without previous cesarean section. Women delivering from 2009 to 2013 at Stavanger University Hospital, Norway, were included. Data were collected prospectively. Before implementing the protocol in 2010, oxytocin augmentation was used if progression of labor was perceived as slow. After implementation, oxytocin could only be started when the cervical dilation had crossed the 4‐h action line in the partograph.

Results

The overall use of oxytocin augmentation was significantly reduced from 34.9% to 23.1% (p < 0.01). The overall frequency of emergency cesarean sections decreased from 6.9% to 5.3% (p < 0.05) and the frequency of emergency cesarean sections performed due to fetal distress was reduced from 3.2% to 2.0% (p = 0.01). The rate of women with duration of labor over 12 h increased from 4.4% to 8.5% (p < 0.01) and more women experienced severe estimated postpartum hemorrhage (2.6% vs. 3.7%; p = 0.01). The frequency of children with pH <7.1 in the umbilical artery was reduced from 4.7% to 3.2% (p < 0.01).

Conclusions

The frequency of emergency cesarean section was reduced after implementing judicious use of oxytocin augmentation. Our findings may be of interest in the ongoing discussion of how the balanced use of oxytocin for labor augmentation can best be achieved.
Optimal Bayesian Adaptive Trials When Treatment Efficacy Depends on Biomarkers
Authors: Zhang Yifan , Trippa Lorenzo , Parmigiani Giovanni
Published: November 2015

Clinical biomarkers play an important role in precision medicine and are now extensively used in clinical trials, particularly in cancer. A response adaptive trial design enables researchers to use treatment results about earlier patients to aid in treatment decisions of later patients. Optimal adaptive trial designs have been developed without consideration of biomarkers. In this article, we describe the mathematical steps for computing optimal biomarker-integrated adaptive trial designs. These designs maximize the expected trial utility given any pre-specified utility function, though we focus here on maximizing patient responses within a given patient horizon. We describe the performance of the optimal design in different scenarios. We compare it to Bayesian Adaptive Randomization (BAR), which is emerging as a practical approach to develop adaptive trials. The difference in expected utility between BAR and optimal designs is smallest when the biomarker subgroups are highly imbalanced. We also compare BAR, a frequentist play-the-winner rule with integrated biomarkers and a marker-stratified balanced randomization design (BR). We show that, in contrasting two treatments, BR achieves a nearly optimal expected utility when the patient horizon is relatively large. Our work provides novel theoretical solution, as well as an absolute benchmark for the evaluation of trial designs in personalized medicine.
Multiphoton microscopy for rapid histopathological evaluation of kidney tumours
Authors: Jain Manu , Robinson Brian D. , Aggarwal Amit , Shevchuk Maria M. , Scherr Douglas S. , Mukherjee Sushmita
Published: November 2015

Objective

To explore the potential of multiphoton microscopy (MPM) for rapid evaluation and triaging of ex vivo kidney tissue.

Materials and Methods

Fresh neoplastic and non‐neoplastic tissues from nephrectomy specimens (n = 40) were imaged with MPM and later submitted for routine histopathology.

Results

On MPM, normal kidney architecture was evident and clearly distinguishable from tumour. Forty malignant tumours (20 clear‐cell renal cell carcinomas [RCCs], 10 papillary RCCs, five chromophobe RCCs and five papillary urothelial carcinomas [UCs], as diagnosed by haematoxylin and eosin staining) were imaged and subtyped as non‐papillary and papillary, based on their architecture. Non‐papillary tumours were further classified based on their unique cytoplasmic signatures. Clear‐cell RCCs had a predominant population of cells with fat droplets in cytoplasm. Chromophobe RCCs had cells with non‐fatty/homogeneous cytoplasm and distinct intra‐cytoplasmic granules. Papillary RCCs had single‐cell‐lined papillae with often abundant histiocytes in their core, whereas PUC had multi‐layered urothelium‐lined papillae. The diagnostic accuracy of tumour subtyping by two independent uropathologists was 95%.

Conclusions

We showed that MPM can reliably differentiate neoplastic from non‐neoplastic kidney tissue and subtype kidney tumours in fresh, unprocessed tissue, MPM might therefore be useful as a rapid real‐time diagnostic tool for the evaluation of kidney biopsies, and surgical margins in partial nephrectomies, to improve overall patient management.
Synthesis of New ‘Hybrid’ Compounds Based on Benzofuroxans and Aminoalkylnaphthalimides
Authors: Chugunova Elena , Mukhamatdinova Rezeda , Sazykina Marina , Dobrynin Alexey , Sazykin Ivan , Karpenko Alexander , Mirina Elena , Zhuravleva Maria , Gavrilov Nikolai , Karchava Shorena , Burilov Alexander
Published: November 2015

Pathogenic bacteria and fungi eventually develop resistance to existing drugs, and therefore, we need constant development of new drugs. The research is aimed at addressing fundamental scientific problems—the search for new biologically active compounds among several benzofuroxan‐containing ‘hybrid’ products. N‐substituted naphthalimides were chosen as a second pharmacophore. Benzofuroxanes biological effects were studied by means of bacterial lux‐biosensors. Compounds IIIa, IVa, IIIc, and IVc displayed more expressed bacteriotoxic action in comparison with the initial substances Ia‐c and represent a certain interest for using as antibacterial substances.
Circulating serum chemerin levels are elevated in lipodystrophy
Authors: Miehle Konstanze , Ebert Thomas , Kralisch Susan , Hoffmann Annett , Kratzsch Jürgen , Schlögl Haiko , Stumvoll Michael , Fasshauer Mathias
Published: November 2015

Objective

Lipodystrophy (LD) is characterized by loss of adipose tissue, dysregulation of adipokines and severe metabolic complications. Regulation of the insulin resistance‐inducing and proinflammatory adipokine chemerin has not been assessed in LD. Therefore, we determined chemerin serum levels in LD, chemerin mRNA expression in insulin‐sensitive tissues of LD mice, as well as the impact of metreleptin treatment on circulating chemerin in LD patients.

Research Design and Methods

Serum chemerin, as well as clinical and biochemical parameters of glucose metabolism, lipid metabolism, and inflammation, was measured in 37 LD patients and 37 age‐, gender‐ and body mass index‐matched controls. Furthermore, chemerin mRNA expression was determined in LD mice and controls. Moreover, circulating chemerin was assessed at five different time points in 10 LD patients treated with metreleptin over 1 year.

Results

Median serum chemerin levels were significantly higher in 37 subjects with LD (234·3 μg/l) as compared to controls (204·0 μg/l) (P = 0·002). Multiple linear regression analysis showed that circulating chemerin was independently and positively associated with glycosylated haemoglobin A1c (HbA1c) and C‐reactive protein (CRP). Chemerin mRNA expression was significantly increased 2·5‐fold in visceral adipose tissue (VAT) and 5·3‐fold in brown adipose tissue (BAT) of LD mice as compared to controls (P < 0·01). Circulating chemerin was not significantly altered by metreleptin treatment.

Conclusions

Circulating levels of the adipokine chemerin are elevated in LD, as well as independently and positively associated with HbA1c and CRP. Increased chemerin might originate from VAT and BAT.
Muscle hypertrophy as the presenting sign in a patient with a complete FHL1 deletion
Authors: Willis T.A. , Wood C.L. , Hudson J. , Polvikoski T. , Barresi R. , Lochmüller H. , Bushby K. , Straub V.
Published: November 2015

Four and a half LIM protein 1 (FHL1/SLIM1) has recently been identified as the causative gene mutated in four distinct diseases affecting skeletal muscle that have overlapping features, including reducing body myopathy, X‐linked myopathy, X‐linked dominant scapuloperoneal myopathy and Emery–Dreifuss muscular dystrophy. FHL1 localises to the sarcomere and the sarcolemma and is believed to participate in muscle growth and differentiation as well as in sarcomere assembly. We describe in this case report a boy with a deletion of the entire FHL1 gene who is now 15 years of age and presented with muscle hypertrophy, reduced subcutaneous fat, rigid spine and short stature. This case is the first, to our knowledge, with a complete loss of the FHL1 protein and MAP7D3 in combination. It supports the theory that dominant negative effects (accumulation of cytotoxic‐mutated FHL1 protein) worsen the pathogenesis. It extends the phenotype of FHL1‐related myopathies and should prompt future testing in undiagnosed patients who present with unexplained muscle hypertrophy, contractures and rigid spine, particularly if male.
The orientation of disaster donations: differences in the global response to five major earthquakes
Authors: Wei Jiuchang , Marinova Dora
Published: November 2015

This study analyses the influence of gift giving, geographical location, political regime, and trade openness on disaster donation decisions, using five severe earthquakes that occurred between 2008 and 2012 as case studies. The results show that global disaster donation is not dominated by only philanthropy or trade interests, and that the determinants of donation decisions vary with the scale of the natural disaster and the characteristics of the disaster‐affected countries. While gift giving exists in the case of middle‐size earthquakes, political regimes play a very important part in the overall donation process. Countries with higher perceived corruption may donate more frequently, but those that are more democratic may be more generous in their donations. Generosity based on geographical proximity to the calamity is significant in the decision‐making process for most natural disasters, yet it may have a negative effect on donations in Latin America and the Caribbean.
Evidence for the involvement of two heterodisulfide reductases in the energy‐conserving system of Methanomassiliicoccus luminyensis
Authors: Kröninger Lena , Berger Stefanie , Welte Cornelia , Deppenmeier Uwe
Published: November 2015

Methanomassiliicoccus luminyensis was isolated from the human gut, and requires H2 and methanol or methylamines to produce methane. The organism lacks cytochromes, indicating that it cannot couple membrane‐bound electron transfer reactions with extrusion of H+ or Na+ ions using known methanogenic pathways. Furthermore, M. luminyensis contains a soluble hydrogenase/heterodisulfide reductase complex (MvhAGD/HdrABC) as found in obligate hydrogenotrophic methanogens, but the energy‐conserving methyltransferase (MtrA‐H) is absent. Thus, the question arises as to how this species synthesizes ATP. We present evidence that M. luminyensis uses two types of heterodisulfide reductases (HdrABC and HdrD) in a novel process for energy conservation. Quantitative RT‐PCR studies revealed that genes encoding these heterodisulfide reductases showed high expression levels. Other genes with high transcript abundance were fpoA (part of the operon encoding the ‘headless’ F420H2 dehydrogenase) and atpB (part of the operon encoding the A1Ao ATP synthase). High activities of the soluble heterodisulfide reductase HdrABC and the hydrogenase MvhADG were found in the cytoplasm of M. luminyensis. Also, heterologously produced HdrD was able to reduce CoM‐S‐S‐CoB using reduced methylviologen as an electron donor. We propose that membrane‐bound electron transfer is based on conversion of two molecules of methanol and concurrent formation of two molecules of the heterodisulfide CoM‐S‐S‐CoB. First the HdrABC/MvhADG complex catalyzes the H2‐dependent reduction of CoM‐S‐S‐CoB and formation of reduced ferredoxin. In a second cycle, reduced ferredoxin is oxidized by the ‘headless’ F420H2 dehydrogenase, thereby translocating up to 4 H+ across the membrane, and electrons are channeled to HdrD for reduction of the second heterodisulfide.
Movement Disorders From the Use of Metoclopramide and Other Antiemetics in the Treatment of Migraine
Authors: Wijemanne Subhashie , Jankovic Joseph , Evans Randolph W.
Published: November 2015

Nausea and vomiting are a frequent accompaniment of migraine and anti‐nausea medications are frequently used in its management. The majority of anti‐nausea medications that are used in migraine are dopamine receptor blocking agents and therefore have the potential to cause drug‐induced movement disorders. This article explores the risk of such drug‐induced movement disorders in migraineurs who were treated with these medications.
Effects of different doses of nandrolone decanoate on estrous cycle and ovarian tissue of rats after treatment and recovery periods
Authors: Simão Vinícius Augusto , Berloffa Belardin Larissa , Araújo Leite Gabriel Adan , de Almeida Chuffa Luiz Gustavo , Camargo Isabel Cristina Cherici
Published: November 2015

This study tested the hypothesis that different doses of nandrolone decanoate (ND) will cause changes in the estrous cycle and ovarian tissue of adult rats; and investigated the duration of the recovery period that is sufficient to restore the damage in the animals treated with different doses. Wistar rats were treated with ND at doses of 1.87, 3.75, 7.5 and 15 mg/kg body weight, or received mineral oil (control group) for 15 days, subcutaneously. All animals were divided into three groups according to the treatment periods: (i) ND treatment for 15 days; (ii) ND treatment followed by a 30‐day recovery; and (iii) ND treatment followed by a 60‐day recovery. Estrous cycle was monitored daily, and at the end of each period, the animals were euthanized for histopathological analysis. During ND treatment and after 30‐day recovery, all animals exhibited persistent diestrus. After a 60‐day recovery, persistent diestrus was only maintained in the group that had received the highest dose. Ovarian weight was decreased significantly after the 30‐day recovery, regardless of ND doses, compared with the control group. There was a reduction (P < 0.05) in the number of corpora lutea and antral and growing follicles, in contrast to an increase (P < 0.05) in atretic follicles in a dose‐ and time‐dependent manner. Remarkable histopathological changes occurred in the ovaries of all ND‐treated groups. In conclusion, the different doses of ND caused changes in the estrous cycle and ovarian tissue of rats, and recovery periods (30 and 60 days) were insufficient to completely restore the damage in the animals treated with the highest dose.
The New Left and Health Care Reform in El Salvador
Authors: Clark Mary A.
Published: November 2015

After a decade of civil war and four consecutive conservative administrations, El Salvador's leftist FMLN won its first presidential election in 2009. How has public policy changed under this New Left government, and why? This article addresses the question in the area of public health care. An alliance of health sector leaders with both technocratic and diplomatic abilities capitalized on the policy window opened by the FMLN's electoral victory and worked within the parameters set by President Mauricio Funes, the FMLN, and civil society to universalize health care. The new minister of health, a professional highly esteemed inside and outside the country, was able to engage both a large social movement protesting neoliberal policy and an energetic health diplomat sent by the Pan American Health Organization. In designing its reform, this alliance benefited from international as well as “bottom-up” policy diffusion.
A role for ecology in the evolution of colour variation and sexual dimorphism in Hawaiian damselflies
Authors: Cooper I. A. , Brown J. M. , Getty T.
Published: November 2015

Variation in traits that are sexually dimorphic is usually attributed to sexual selection, in part because the influence of ecological differences between sexes can be difficult to identify. Sex‐limited dimorphisms, however, provide an opportunity to test ecological selection disentangled from reproductive differences between the sexes. Here, we test the hypothesis that ecological differences play a role in the evolution of body colour variation within and between sexes in a radiation of endemic Hawaiian damselflies. We analysed 17 Megalagrion damselflies species in a phylogenetic linear regression, including three newly discovered cases of species with female‐limited dimorphism. We find that rapid colour evolution during the radiation has resulted in no phylogenetic signal for most colour and habitat traits. However, a single ecological variable, exposure to solar radiation (as measured by canopy cover) significantly predicts body colour variation within sexes (female‐limited dimorphism), between sexes (sexual dimorphism), and among populations and species. Surprisingly, the degree of sexual dimorphism in body colour is also positively correlated with the degree of habitat differences between sexes. Specifically, redder colouration is associated with more exposure to solar radiation, both within and between species. We discuss potential functions of the pigmentation, including antioxidant properties that would explain the association with light (specifically UV) exposure, and consider alternative mechanisms that may drive these patterns of sexual dimorphism and colour variation.
The suppressive effect of nucleos(t)ide analogue treatment on the incidence of hepatocellular carcinoma in chronic hepatitis B patients
Authors: Hiramatsu Naoki , Yamada Ryoko , Takehara Tetsuo
Published: November 2015

The development of nucleos(t)ide analogues (NA) has influenced hepatitis B virus management. However, the annual incidence rate during NA treatment has been reported to be 0.3–1.2% in non‐cirrhosis cases and 1.8–6.0% in cirrhosis cases, indicating that the suppressive effect of NA treatment on hepatocellular carcinoma (HCC) would be insufficient. Past studies, including one randomized control trial that compared lamivudine treatment with placebo, have revealed that NA treatment could suppress the incidence of HCC in patients with advanced fibrosis. However, it remains unknown whether NA treatment can suppress the incidence of HCC in chronic hepatitis patients without advanced fibrosis. The HCC incidence in patients treated with entecavir was similar to that of those treated with lamivudine, although entecavir exhibits a stronger viral suppression than lamivudine. The following risk factors related to the incidence of HCC during NA treatment have been identified: older age, male gender, pre‐existing cirrhosis, a family clustering of hepatitis B virus, lower platelet counts, and higher hepatitis B core‐related antigens as baseline factors and higher alpha fetoprotein levels as an on‐treatment factor. Conversely, the loss of the hepatitis B surface antigen (HBsAg) by interferon or NA was correlated with a lower HCC incidence rate. Because interferon treatment has much more effects on reducing HBsAg levels compared with NA treatment, a combination treatment with NA and pegylated interferon can bring additional reduction of HBsAg levels compared with NA monotherapy. Further study is needed to clarify this.
A statistical analysis of the distribution of cordierite and biotite in hornfels from the Bugaboo contact aureole: implications for the kinetics of porphyroblast crystallization
Authors: Petley‐Ragan A. , Gaidies F. , Pattison D.R.M.
Published: November 2015

The three‐dimensional disposition of cordierite and biotite crystals in a hornfels from the contact aureole of the Bugaboo Batholith is quantified using high‐resolution X‐ray micro‐computed tomography and global as well as scale‐dependent pattern statistics. The results demonstrate a random distribution of cordierite and biotite crystal sizes for all scales across the entire rock volume studied indicative of interface‐controlled prograde metamorphic reaction kinetics. The reaction considered responsible for the mineral assemblage and the formation of cordierite and biotite in the hornfels is Ms + Chl + Qtz = Crd + And + Bt + . Rock‐specific phase equilibria point to metamorphic conditions of ~520 –550 °C and 3 kbar for this reaction. The common approach to approximate the shape of crystals as spherical underestimates the influence of the Strauss hard‐core process on rock texture and may be misinterpreted to reflect ordering of crystal sizes by inhibition of nucleation and growth commonly associated with diffusion‐controlled reaction kinetics. According to our findings, Strauss hard‐core ordering develops at length scales equal to and less than the average major axis of the crystal population. This is significantly larger than what is obtained if a spherical crystal geometry would be assumed, and increases with deviation from sphericity. For the cordierite and biotite populations investigated in this research, Strauss hard‐core ordering developed at length scales of up to ∼2.2 and 1.25 mm, respectively, which is almost 1 mm longer than the scales that would be obtained if a spherical geometry would have been assumed. Our results highlight the importance of a critical assessment of the geometrical model assumptions commonly applied in the three‐dimensional analysis of crystal size distributions, and underline the need for a quantitative understanding of interface processes in order to appreciate their role in the kinetics of contact metamorphic reactions and rock texture formation.
Morphological analysis of the urethral muscle of the male pig with relevance to urinary continence and micturition
Authors: Ragionieri Luisa , Ravanetti Francesca , Gazza Ferdinando , Botti Maddalena , Ivanovska Ana , Cacchioli Antonio
Published: November 2015

To investigate whether the pig could be considered a suitable model to study lower urinary tract function and dysfunction, the pelvic urethra of 24 slaughtered male pigs were collected, and the associated muscles were macroscopically, histologically and histochemically analyzed. In cross‐sections of the urethra, a muscular complex composed of an inner layer of smooth muscle and an outer layer of striated muscle that are not separated by fascial planes was observed. A tunica muscularis, composed of differently oriented smooth muscle bundles, is only evident in the proximal part of the pelvic urethra while, in the remaining part, it contributes to form the prostatic fibromuscular stroma. The striated urethral muscle surrounds the pelvic urethra in a horseshoe‐like configuration with a dorsal longitudinal raphe, extending from the bladder neck to the central tendon of perineum. Proximally to the bladder, it is constituted of slow‐twitch and fast‐twitch myofibers of very small diameter, and embedded in an abundant collagen and elastic fiber net. Moving caudally it is gradually encircled and then completely substituted by larger and compact myofibers, principally presenting circular orientation and fast‐twitch histochemical characteristics. So, like in humans, the cranial tract of the muscular system surrounding the pelvic urethra is principally composed of smooth musculature. The striated component cranially may have a role in blocking retrograde ejaculation, while the middle and caudal tracts may facilitate urine and semen flow, and seem especially concerned with the rapid and forceful urethral closure during active continence. Some differences in the morphology and structure between pigs and humans seem due to the different morphology of the ‘secondary’ sexual organs that develop from the urethral wall and to the different effect of gravity on the mechanics of the urinary system in quadruped and bipedal mammals.
Selective loss of alpha motor neurons with sparing of gamma motor neurons and spinal cord cholinergic neurons in a mouse model of spinal muscular atrophy
Authors: Powis Rachael A. , Gillingwater Thomas H.
Published: November 2015

Spinal muscular atrophy (SMA) is a neuromuscular disease characterised primarily by loss of lower motor neurons from the ventral grey horn of the spinal cord and proximal muscle atrophy. Recent experiments utilising mouse models of SMA have demonstrated that not all motor neurons are equally susceptible to the disease, revealing that other populations of neurons can also be affected. Here, we have extended investigations of selective vulnerability of neuronal populations in the spinal cord of SMA mice to include comparative assessments of alpha motor neuron (α‐MN) and gamma motor neuron (γ‐MN) pools, as well as other populations of cholinergic neurons. Immunohistochemical analyses of late‐symptomatic SMA mouse spinal cord revealed that numbers of α‐MNs were significantly reduced at all levels of the spinal cord compared with controls, whereas numbers of γ‐MNs remained stable. Likewise, the average size of α‐MN cell somata was decreased in SMA mice with no change occurring in γ‐MNs. Evaluation of other pools of spinal cord cholinergic neurons revealed that pre‐ganglionic sympathetic neurons, central canal cluster interneurons, partition interneurons and preganglionic autonomic dorsal commissural nucleus neuron numbers all remained unaffected in SMA mice. Taken together, these findings indicate that α‐MNs are uniquely vulnerable among cholinergic neuron populations in the SMA mouse spinal cord, with γ‐MNs and other cholinergic neuronal populations being largely spared.
Predicting dentists’ decisions: a choice‐based conjoint analysis of Medicaid participation
Authors: Kateeb Elham T. , McKernan Susan C. , Gaeth Gary J. , Kuthy Raymond A. , Adrianse Nancy B. , Damiano Peter C.
Published: November 2015

Objectives

Private practice dentists are the major source of care for the dental safety net; however, the proportion of dentists who participate in state Medicaid programs is low, often due to poor perceptions of the program's administration and patient population. Using a discrete choice experiment and a series of hypothetical scenarios, this study evaluated trade‐offs dentists make when deciding to accept Medicaid patients.

Methods

An online choice‐based conjoint survey was sent to 272 general dentists in Iowa. Hypothetical scenarios presented factors at systematically varied levels. The primary determination was whether dentists would accept a new Medicaid patient in each scenario. Using an ecological model of behavior, determining factors were selected from the categories of policy, administration, community, and patient population to estimate dentists’ relative preferences.

Results

62 percent of general dentists responded to the survey. The probability of accepting a new Medicaid patient was highest (81 percent) when reimbursement rates were 85 percent of the dentist's fees, patients never missed appointments, claims were approved on first submission, and no other practices in the area accepted Medicaid. Although dentists preferred higher reimbursement rates, 56 percent would still accept a new Medicaid patient when reimbursement decreased to 55 percent if they were told that the patient would never miss appointments and claims would be approved on initial submission.

Conclusions

This study revealed trade‐offs that dentists make when deciding to participate in Medicaid. Findings indicate that states can potentially improve Medicaid participation without changing reimbursement rates by making improvements in claims processing and care coordination to reduce missed appointments.
High bicarbonate levels in narcoleptic children
Authors: Franco Patricia , Junqua Aurelie , Guignard‐Perret Anne , Raoux Aude , Perier Magali , Raverot Veronique , Claustrat Bruno , Gustin Marie‐Paule , Inocente Clara Odilia , Lin Jian‐Sheng
Published: November 2015

The objective of this study was to evaluate the levels of plasma bicarbonate levels in narcoleptic children. Clinical, electrophysiological data and bicarbonate levels were evaluated retrospectively in children seen in our paediatric national reference centre for hypersomnia. The cohort included 23 control subjects (11.5 ± 4 years, 43% boys) and 51 patients presenting de‐novo narcolepsy (N) (12.7 ± 3.7 years, 47% boys). In narcoleptic children, cataplexy was present in 78% and DQB1*0602 was positive in 96%. The control children were less obese (2 versus 47%, P = 0.001). Compared with control subjects, narcoleptic children had higher bicarbonate levels (P = 0.02) as well as higher PCO2 (P < 0.01) and lower venous pH gas (P < 0.01). Bicarbonate levels higher than 27 mmol L−1 were found in 41.2% of the narcoleptic children and 4.2% of the controls (P = 0.001). Bicarbonate levels were correlated with the Adapted Epworth Sleepiness Scale (P = 0.01). Narcoleptic patients without obesity often had bicarbonate levels higher than 27 mmol L −1 (55 versus 25%, P = 0.025). No differences were found between children with and without cataplexy. In conclusion, narcoleptic patients had higher bicarbonate plasma levels compared to control children. This result could be a marker of hypoventilation in this pathology, provoking an increase in PCO2 and therefore a respiratory acidosis, compensated by an increase in plasma bicarbonates. This simple screening tool could be useful for prioritizing children for sleep laboratory evaluation in practice.
The Literary History of World‐Systems, II: World Literature and Deep Time
Authors: Eatough Matthew
Published: November 2015

This essay is the conclusive piece of a two‐part series on the use of world‐systems theory in literary studies. In it, I continue my discussion of literary world‐systems by turning to the field of world literature. As I show, world‐systems theory owes much of its current popularity in literary studies to the “new” world literature, which has borrowed part of its conceptual language from world‐systems theory. This language includes such key terms aslongue durée, circulation, cyclical history, and center and periphery. These terms have helped to revolutionize literary history in a number of ways, three of which I focus on: (1) the pursuit of a more abstract, quantitative account of literary genres; (2) the attempt to reposition European literature within a longer history of global literature; and (3) the theorization of cyclical models of literary history. Taken together, these projects have helped scholars to rewrite the history and geography of world literature in important ways – by reimagining the novel form as a response to risk and insecurity rather than power; by emphasizing Europe's competition with non‐European cultural centers; and by identifying a temporal limit to European and American hegemony.
The influence of household pets on the composition and quantity of allergenic mite fauna within Irish homes: a preliminary investigation
Authors: CLARKE D. , DIX E. , LIDDY S. , GORMALLY M. , BYRNE M.
Published: November 2015

Allergenic mites are responsible for inducing hypersensitive reactions in genetically predisposed people worldwide. Mites in dust from 30 Irish homes with pets (dogs, n = 23; cats, n = 7) were compared with those in 30 homes without pets. House dust mites constituted 78% of all mites recorded, with Dermatophagoides pteronyssinus (Acariformes: Pyroglyphidae) representing 57–72% of mites in furniture and mattresses in both home types compared with only 22% of mites in pet beds. Although storage mites accounted for just 13% of all mites recorded, they represented 46% of mites recorded in pet beds. Median levels of the dust mite allergen Der p 1 (µg/g) in dust samples from mattresses in homes without pets were significantly greater than in mattresses from homes with pets, reflecting the greater densities of D. pteronyssinus found in the former home category. Mite species richness was greater in homes with pets (17 species) than in homes without pets (13 species). This suggests that although the presence of pets can result in a wider variety of epidemiologically important mite species within households, increased competition among mite species may result in a more balanced mite fauna in the home, inhibiting the dominance of any one species and hence lowering allergen‐associated risks.
Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease
Authors: Mello M. D. , Shriver A. R. , Li Y. , Patel A. , Gyawali C. P.
Published: November 2015

Background

Ineffective esophageal motility (IEM) is associated with reflux disease, but its natural history is unclear. We evaluated patients undergoing repeat esophageal high resolution manometry (HRM) for symptomatic presentations after antireflux surgery (ARS) to understand the progression of IEM.

Methods

Patients with repeat HRM after ARS were included. Ineffective esophageal motility was diagnosed if ≥5 sequences had distal contractile integral (DCI) <450 mmHg cm s. Augmentation of DCI following multiple rapid swallows (MRS) was assessed. The esophagogastric junction (EGJ) was interrogated using the EGJ contractile integral (EGJ‐CI). Esophageal motor function was compared between patients with and without IEM.

Key Results

Sixty‐eight patients (53.9 ± 1.8 years, 66.2% female) had pre‐ and post‐ARS HRM studies 2.1 ± 0.19 years apart. Esophagogastric junction‐CI augmented by a mean of 26.3% following ARS. Four IEM phenotypes were identified: 14.7% had persistent IEM, 8.8% resolved IEM after ARS, 19.1% developed new IEM, and 57.4% had no IEM at any point. Patients with IEM had a lower DCI pre‐ and post‐ARS, lower pre‐ARS EGJ CI, and lower pre‐ARS‐integrated relaxation pressure (p ≤ 0.02 for all comparisons); presenting symptoms and other EGJ metrics were similar (p ≥ 0.08 for all comparisons). The IEM phenotypes could be predicted by MRS DCI response patterns (p = 0.008 across groups); patients with persistent IEM had the least DCI augmentation (p = 0.007 compared to no IEM), while those who resolved IEM had DCI augmentation comparable to no IEM (p = 0.08).

Conclusions & Inferences

Distinct phenotypes of IEM exist among symptomatic reflux patients following ARS. Provocative testing with MRS may help identify these phenotypes pre‐ARS.
Effect of a local anesthetic lozenge in relief of symptoms in burning mouth syndrome
Authors: Treldal C , Jacobsen CB , Mogensen S , Rasmussen M , Jacobsen J , Petersen J , Lynge Pedersen AM , Andersen O
Published: November 2015

Objective

Patients with burning mouth syndrome (BMS) often represent a clinical challenge as available agents for symptomatic treatment are few and often ineffective. The aim was to evaluate the effect of a bupivacaine lozenge on oral mucosal pain, xerostomia, and taste alterations in patients with BMS.

Methods

Eighteen patients (4 men and 14 women) aged 39–71 years with BMS were included in this randomized, double‐blinded, placebo‐controlled, crossover trial. Lozenges (containing bupivacaine or placebo) were administrated three times a day for 2 weeks for two separate treatment periods. Assessment of oral mucosal pain, xerostomia, and taste alterations was performed in a patient diary on a visual analog scale (ranging from 0 to 100 mm) before and after the lozenge was dissolved.

Results

The bupivacaine lozenge significantly reduced the burning oral pain (P < 0.001), increased the sense of taste disturbances (P < 0.001), and had no impact on xerostomia, when adjusted for the treatment period.

Conclusions

Our results indicate that the bupivacaine lozenge offers a novel therapeutic modality to patients with BMS, although without alleviating effect on the associated symptoms, taste alterations, and xerostomia.
Oral cancer screening usefulness: between true and perceived effectiveness
Authors: Petti S
Published: November 2015

Screenings, introduced in the 1920s, became rapidly popular in healthcare settings. Chance is an intrinsic screening characteristic. Roughly one half of screened subjects are correctly classified merely by chance, and in high‐prevalence settings, even inaccurate screenings detect several diseased individuals by chance, thus appearing effective. The viewpoint is another variable affecting screening perceived effectiveness. For example, public health officers, who seek for mortality rate reductions, look for high sensitivity, which, in turn, is affected by disease prevalence. The relative mortality rate reduction attributable to screening may therefore be significant in high‐prevalence areas and irrelevant in low‐prevalence areas. This explains why oral cancer visual screening is perceived effective in high‐prevalence countries and ineffective in low‐prevalence countries. Patients seek for reliable outcomes. Therefore, they require screenings with high positive (PV+) and negative (PV−) predictive values. In high‐prevalence areas, PV+ is high, while PV− is low. The reverse occurs in low‐prevalence areas. Thus, even for accurate screenings, the perceived effectiveness due to misclassification is low among false‐negative patients in high‐prevalence areas, who are misclassified as unaffected by the disease, and among false‐positive patients in low‐prevalence areas, who are subjected to psychophysical sufferings. This article explains the reasons for these and other paradoxes engendered by screening.
Prescription patterns, adherence and characteristics of non‐adherence in children with asthma in primary care
Authors: Engelkes Marjolein , Janssens Hettie M. , de Jongste Johan C. , Sturkenboom Miriam C.J.M. , Verhamme Katia M.C.
Published: November 2015

Adherence to treatment remains important for successful asthma management. Knowledge about asthma medication use and adherence in real‐life offers opportunities to improve asthma treatment in children.

Objective

To describe prescription patterns, adherence and factors of adherence to drugs in children with asthma.

Methods

Population‐based cohort study in a Dutch primary care database (IPCI), containing medical records of 176,516 children, aged 5–18 years, between 2000 and 2012. From asthma medication prescriptions, age, gender, seasonal and calendar year rates were calculated. Adherence was calculated using medication possession ratio (MPR) and ratio of controller to total asthma drug (CTT). Characteristics of children with high‐vs.‐low adherence were compared.

Results

The total asthma cohort (n = 14,303; 35,181 person‐years (PY) of follow‐up) was mainly treated with short‐acting β2‐agonists (SABA; 40 users/100 PY) and inhaled corticosteroids (ICS; 32/100 PY). Median MPR for ICS was 56%. Children with good adherence (Q4 = MPR > 87%) were younger at start of ICS, more often visited specialists and had more exacerbations during follow‐up compared to children with low adherence (Q1 = MPR < 37%).

Conclusion

In Dutch primary care children with asthma were mainly prescribed SABA, and ICS. Adherence to ICS was relatively low. Characteristics of children with good adherence were compatible with more severe asthma, suggesting that adherence is driven by treatment need or intensity of medical follow‐up.
Anti‐Immigrant Prejudice in Rising East Asia: A Stereotype Content and Integrated Threat Analysis
Authors: Ramsay Jonathan E. , Pang Joyce S.
Published: November 2015

Immigration is a global phenomenon, yet comparatively few psychological investigations of anti‐immigrant prejudice have been conducted in East Asia, a region of high economic growth that is set to become a leading destination for international migrants. Over two studies, we examined Singaporean attitudes towards four prominent immigrant groups: Chinese, Filipino, South Asian, and Western immigrants. Each immigrant group was found to be associated with a unique attitudinal profile. Chinese immigrants, who are culturally the most closely related to most Singaporeans, were viewed the most negatively in terms of prejudice, stereotyped warmth, and realistic and symbolic threat. Westerners were viewed the most positively despite higher ratings of perceived competence, possibly due to Western cultural influence, whereas South Asians and Filipinos were viewed as being relatively unthreatening, possibly due to their occupation of undesirable social roles. Perceived threat—both realistic and symbolic—proved to be stronger predictors of anti‐immigrant prejudice than stereotypes. Implications for immigration policy in the region are discussed.