bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis
Authors: Sacco R. , Santangelo G. , Stamenova S. , Bisecco A. , Bonavita S. , Lavorgna L. , Trojano L. , D'Ambrosio A. , Tedeschi G. , Gallo A.
Published: January 2016

Background and purpose

Depression is the most common psychiatric disorder in multiple sclerosis (MS). Self‐report depression scales are frequently used as screening, diagnostic and grading instruments. This study investigated the psychometric properties of the Beck Depression Inventory second edition (BDI‐II) for assessing depressive disorders in a sample of Italian MS patients.

Methods

The sample included 141 consecutive non‐demented MS patients who completed the BDI‐II and the Chicago Multiscale Depression Inventory (CMDI). MS patients also completed a clinical interview, a neurological/neuropsychological examination and a Fatigue Severity Score (FSS) questionnaire in order to assess divergent validity.

Results

The BDI‐II showed good internal consistency (Cronbach's alpha 0.89) and good convergent and divergent validity. With respect to CMDI serving as the ‘gold standard’, the receiver operating characteristic curve revealed that BDI‐II is an adequate diagnostic measure and that the optimum total cut‐off score was 18.5. Such score identified clinically relevant depressive symptoms in 25.5% of our MS sample.

Conclusions

The BDI‐II is a simple, reliable and valid tool for detecting and grading depressive symptoms in Italian MS patients.
The influence of socioeconomic status on health resource utilization in pediatric epilepsy in a universal health insurance system
Authors: Puka Klajdi , Smith Mary Lou , Moineddin Rahim , Snead O. Carter , Widjaja Elysa
Published: January 2016

Objectives

It is unknown if there is a disparity in health resource utilization (HRU) among children with epilepsy in a universal health insurance system. The aims of this study were to evaluate whether socioeconomic status (SES) influenced the pattern of HRU among children with epilepsy, and to determine if neurology visits were associated with emergency department (ED) visits and hospitalizations.

Methods

Health administrative databases were used to identify HRU among children with epilepsy in Ontario, Canada. The frequency of neurology visits, ED visits, and hospitalizations were assessed for 1 year. SES was measured using dissemination area income and deprivation index. The association between SES and HRU was evaluated, adjusting for age, sex, residence, and comorbidities. Subsequently, we assessed whether neurology visits influenced ED visits and hospitalizations, adjusting for age, sex, residence, comorbidities, and SES.

Results

Deprivation index was a more sensitive measure of disparity in HRU than dissemination area income. Status epilepticus–related ED visits and hospitalizations were most expensive but accounted for a small proportion of total costs. Higher deprivation was associated with fewer neurology visits (relative risk [RR] 0.85–0.89), more frequent ED visits (RR 1.08–1.36), and hospitalizations (RR 1.27). Increased neurology visits were associated with more frequent ED visits (RR 1.10) and hospitalizations (RR 1.15). The associations between neurology visits and ED visits as well as hospitalizations varied by deprivation index, in that neurology visits were associated with increased ED visits and hospitalizations and the increase was higher in the most deprived relative to the least deprived (all p < 0.0001).

Significance

We found disparity in HRU by SES despite the universal health insurance system. More frequent neurology visits were associated with more frequent ED visits and hospitalizations after adjusting for SES, probably related to epilepsy severity. Our study identified an at‐risk population for high resource use that may require additional support to reduce ED visits and hospitalizations.
Dermal adipocytes and hair cycling: is spatial heterogeneity a characteristic feature of the dermal adipose tissue depot?
Authors: Kruglikov Ilja L. , Scherer Philipp E.
Published: January 2016

Adipocytes are widely distributed in the dermis, in a unique fat depot referred to as dermal white adipose tissue (dWAT). In rodents, dWAT is present as widespread thin layers, whereas in pigs and humans, it is present in clusters referred to as ‘dermal cones’ around the pilosebaceous units. This distinct layer of fat cells located above the subcutaneous white adipose tissue is important for proper hair follicle (HF) cycling in rodents. Murine HFs produce spatially restricted synchronous patches after their second postnatal cycle which correlates with the spatial heterogeneity of murine dWAT. Similarly, the cycling of HFs in humans may also be related to the spatial distribution of dWAT, making the difference between murine and human HF cycling of more quantitative than of qualitative nature. This should allow the production of small spatially correlated HF patches in human skin, and we propose that this process can be regulated by paracrine signalling involving a number of signalling modules, including the hedgehog pathway. This pathway is an established player in HF cycling, but is also involved in the regulation of adipogenesis and may therefore be a key regulator of the process across species. We also suggest that the spatial heterogeneity of dWAT is connected not only to HF cycling, but may also be related to other physiological and pathological processes in the skin.
Seasonal and inter‐island variation in the foraging strategy of the critically endangered Red‐headed Wood Pigeon Columba janthina nitens in disturbed island habitats derived from high‐throughput sequencing
Authors: Ando Haruko , Setsuko Suzuki , Horikoshi Kazuo , Suzuki Hajime , Umehara Shoko , Yamasaki Michimasa , Hanya Goro , Inoue‐Murayama Miho , Isagi Yuji
Published: January 2016

We studied the feeding ecology of the critically endangered Red‐headed Wood Pigeon Columba janthina nitens, a subspecies endemic to a very remote and highly disturbed oceanic island chain, the Ogasawara Islands. An analysis based on high‐throughput sequencing (HTS) was undertaken on 627 faecal samples collected over 2 years from two island habitats, and food availability and the nutrient composition of the major fruits were also estimated. The HTS diet analysis detected 122 food plant taxa and showed clear seasonal and inter‐island variation in the diet of the Pigeons. The results indicated a preference for lipid‐rich fruits, but the diet changed according to the availability of food resources, perhaps reflecting the foraging strategy of the Pigeons in isolated island habitats with poor food resources. Pigeons also frequently consumed introduced plants at certain times of year, perhaps compensating for the lack of preferred native food resources. However, the degree of dependence on introduced plants appeared to differ between the two island habitats, so the different impacts of introduced plant eradication on the foraging conditions for the Pigeons on each island should be considered. HTS diet analysis combined with field data may be useful for monitoring the foraging conditions of endangered species and may also inform an appropriate conservation strategy in oceanic island ecosystems with complicated food webs that include both native and introduced species.
Multiple pathways regulate Cten in colorectal cancer without a Tensin switch
Authors: Thorpe Hannah , Akhlaq Maham , Jackson Darryl , Ghamdi Saleh Al , Storr Sarah , Martin Stewart , Ilyas Mohammad
Published: January 2016

CTEN/TNS4 is a member of the Tensin gene family. It localizes to focal adhesions and induces cell motility. The mechanisms regulating Cten expression are unclear although we have shown regulation by Kras in the colon and pancreas. In normal mammary cell lines, it is reportedly upregulated by epidermal growth factor receptor (EGFR) and STAT3 signalling and upregulation is accompanied by downregulation of Tensin 3 (Tensin switch). In this study, we investigated the roles of EGFR and STAT3 signalling in the regulation of Cten in colorectal cancer (CRC). In addition, we investigated calpain – a regulator of focal adhesion‐associated proteins whose relevance to Cten has not been investigated. CRC cell lines were stimulated with epidermal growth factor (EGF). This resulted in an increase in Cten and Tensin 3 protein. Kras was knocked down and this resulted in downregulation of Cten and Tensin 3. We next investigated the role of STAT3 signalling. Activation and knockdown of STAT3 resulted in downregulation and upregulation, respectively, of Cten. Inhibition of calpain resulted in upregulation of both Cten and Tensin 3. As the regulators of Cten also seemed to regulate Tensin 3, we tested the interaction between Cten and Tensin 3. Cten was forcibly expressed or knocked down resulting, respectively, in upregulation and downregulation of Tensin 3. We conclude that in CRC, Cten is upregulated by EGFR and Kras but downregulated by STAT3. We show that calpain may be a negative regulator of Cten and that a Tensin switch does not occur and, if anything, Cten stabilizes Tensin 3.
Recombinant human brain natriuretic peptide attenuates trauma‐/haemorrhagic shock‐induced acute lung injury through inhibiting oxidative stress and the NF‐κB‐dependent inflammatory/MMP‐9 pathway
Authors: Song Zhi , Zhao Xiu , Liu Martin , Jin Hongxu , Wang Ling , Hou Mingxiao , Gao Yan
Published: January 2016

Acute lung injury (ALI) is one of the most serious complications in traumatic patients and is an important part of multiple organ dysfunction syndrome (MODS). Recombinant human brain natriuretic peptide (rhBNP) is a peptide with a wide range of biological activity. In this study, we investigated local changes in oxidative stress and the NF‐κB‐dependent matrix metalloproteinase‐9 (MMP‐9) pathway in rats with trauma/haemorrhagic shock (TH/S)‐induced ALI and evaluated the effects of pretreatment with rhBNP. Forty‐eight rats were randomly divided into four groups: sham operation group, model group, low‐dosage rhBNP group and high‐dosage rhBNP group (n = 12 for each group). Oxidative stress and MPO activity were measured by ELISA kits. MMP‐9 activity was detected by zymography analysis. NF‐κB activity was determined using Western blot assay. With rhBNP pretreatment, TH/S‐induced protein leakage, increased MPO activity, lipid peroxidation and metalloproteinase (MMP)‐9 activity were inhibited. Activation of antioxidative enzymes was reversed. The phosphorylation of NF‐κB and the degradation of its inhibitor IκB were suppressed. The results suggested that the protection mechanism of rhBNP is possibly mediated through upregulation of anti‐oxidative enzymes and inhibition of NF‐κB activation. More studies are needed to further evaluate whether rhBNP is a suitable candidate as an effective inhaling drug to reduce the incidence of TH/S‐induced ALI.
Treatment with Mesna and n‐3 polyunsaturated fatty acids ameliorates experimental ulcerative colitis in rats
Authors: Triantafyllidis Ioannis , Poutahidis Theofilos , Taitzoglou Ioannis , Kesisoglou Isaak , Lazaridis Charalampos , Botsios Dimitrios
Published: January 2016

Oxidative damage is a central feature of ulcerative colitis. Here, we tested whether the antioxidant Mesna, when administered alone or in combination with n‐3 polyunsaturated fatty acids (n‐3 PUFAs), affects the outcome of dextran sodium sulphate (DSS)‐induced ulcerative colitis in rats. After the induction of colitis, DSS‐treated rats were further treated orally (p.o), intraperitoneally (i.p) or intrarectally (i.r) for either 7 or 14 days with Mesna, n‐3 PUFAs or both. Rats were euthanized at the end of each treatment period. Clinical disease activity index was recorded throughout the experiment. At necropsy colorectal gross lesions were scored. Colitis was scored histologically, and the expression of myeloperoxidase (MPO), caspase‐3, inducible nitric oxide synthase (iNOS) and nuclear factor κB (NF‐κΒ) in colonic tissue was assessed by immunohistochemistry. Mesna alone was sufficient to significantly reduce colorectal tissue damage when administered orally or intraperitoneally. Orally coadministered n‐3 PUFAs enhanced this effect, resulting in the significant suppression of DSS colitis after 7 days, and a remarkable recovery of colorectal mucosa was evident after 14 days of treatment. The amelioration of colon pathology co‐existed with a significant decrease in MPO expression, overexpression of iNOS and reduction of nuclear NF‐κB p65 in inflammatory cells, and the suppression of apoptosis in colonic epithelial cells. The simultaneous administration of Mesna and n‐3 PUFAs is particularly effective in ameliorating DSS colitis in rats, by reducing oxidative stress, inflammation and apoptosis, probably through a mechanism that involves the inhibition of NF‐κB and overexpression of iNOS.
Reduced AMPKα2 protein expression restores glucose‐induced insulin secretion in islets from calorie‐restricted rats
Authors: Amaral Maria Esméria C. , Ribeiro Rosane A. , Vanzela Emerielle C. , Barbosa‐Sampaio Helena C.
Published: January 2016

In a state of caloric restriction (CR), improved insulin action was associated with the activation of AMP‐activated kinase (AMPK). Here, we verified whether AMPK was involved in impaired β‐cell function in islets from rats subjected to CR for 21 days.

Eight‐week‐old male rats were distributed into a control (CTL) group that was fed an isocaloric diet ad libitum or a CR group that received 60% of the food consumed by the CTL group. From days 18–21, CTL and CR rats were treated with sense (CTLS and CRS) or antisense (CTLAS and CRAS) AMPKα2 oligonucleotides.

Caloric restriction was associated with decreased body weight, perigonadal fat pads and insulinaemia, while higher glucose tolerance was observed in CRS rats. Antisense treatment normalized insulinaemia and glucose tolerance in CRAS rats and increased cholesterolaemia in CRAS and CTLAS groups. These effects were associated with reduced pAMPK/AMPK protein expression in the liver of rats treated with antisense oligonucleotides. Additionally, CRS islets showed higher pAMPK/AMPK content and lower glucose‐induced insulin release. As expected, antisense oligonucleotides against AMPKα2 efficiently reduced pAMPK/AMPK protein in CRAS and CTLAS islets. The lower AMPK content in CRAS islets normalized the insulin secretion in islets exposed to 16.7 mM glucose. In addition, CTLAS islets presented higher insulin secretion at 2.8 and 16.7 mM glucose. These findings support the hypothesis that higher AMPK protein expression is involved in impaired β‐cell function in islets from rats subjected to CR for 21 days.
Iridescence in Ancient Glass: A Morphological and Chemical Investigation
Authors: Emami Mohammadamin , Nekouei Safiyeh , Ahmadi Hossein , Pritzel Christian , Trettin Reinhard
Published: January 2016

Visible damage on the surface of historic glass, iridescence, is developed by the influence of environmental factors during time. Iridescence is usually considered as an age indicator in historic glass. Samples from the ancient Sasanian historic site called “Tomb‐e Pargan” in the Boushehr Province of Iran were subjected to microscopic analyzing with ESEM, ICP‐OES, and polarization microscopy to characterize structural damages and its impact on the surface deposition. Chemical–mineralogical studies were also performed. The current investigation suggests that the iridescent layer is developed as the result of alkali ion depletion on the glass surface following the formation of a shelly layer. Due to the porosity of ancient glass surface, ions migrate and deposit continuously on the surface in the form of crust. The phenomenon causes fine lamellar structure on the surface. Samples from Tomb‐e Pargan characteristically contain potassium and magnesium.
Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma
Authors: Yamashita Shinichi , Ito Akihiro , Mitsuzuka Koji , Tochigi Tatsuo , Namima Takashige , Soma Fumihiko , Aizawa Masataka , Ioritani Naomasa , Kaiho Yasuhiro , Arai Yoichi
Published: January 2016

Objectives

To characterize the site and clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma.

Methods

Patients who underwent radical nephroureterectomy for upper urinary tract urothelial carcinoma between 2000 and 2011 at 12 institutions participating in the Tohoku Urological Evidence‐Based Medicine Study Group were included in the present study. Those who underwent prior or simultaneous radical cystectomy were excluded. The site of intravesical recurrence was investigated, and the survival curves after radical nephroureterectomy were analyzed retrospectively using the Kaplan–Meier method. Multivariate analyses of factors predicting survival were carried out.

Results

A total of 534 patients were eligible for the present study. With a median follow up of 47 months, 205 patients (38.4%) had intravesical recurrence. The intravesical recurrence‐free survival rates at 1, 2, and 5 years were 74.6%, 62.5% and 56.3%, respectively. In a subset of 137 patients with intravesical recurrence who did not have bladder cancer before or at the diagnosis of upper urinary tract urothelial carcinoma, the most frequent site of intravesical recurrence was around the cystotomy (52.6%), followed by at the posterior wall (39.4%) and at the bladder neck (35.8%). A total of 36 patients (17.6%) developed muscle‐invasive bladder cancer after radical nephroureterectomy. On multivariate analyses for the subset of patients with non‐muscle invasive (≤pT1) upper urinary tract urothelial carcinoma, intravesical recurrence was an independent predictor of cancer‐specific survival (HR 4.27, P = 0.016) and overall survival (HR 3.00, P = 0.018).

Conclusions

Most intravesical recurrences occur around the site of bladder mucosal injury within 1 year after radical nephroureterectomy, providing important insight into the mechanism of intravesical recurrence. Intravesical recurrence after radical nephroureterectomy had an impact on oncological outcomes of patients with non‐muscle invasive upper urinary tract urothelial carcinoma.
Habitat utilization by the Cape porcupine Hystrix africaeaustralis in a savanna ecosystem
Authors: de Villiers Marienne S. , van Aarde Rudolph J. , Dott Hector M.
Published: January 2016

Habitat utilization on three scales by Cape porcupines (Hystrix africaeaustralis) was investigated in a savanna ecosystem at Nylsvley Nature Reserve in the northern Transvaal, South Africa.

On the macroscale, radiotelemetry indicated that porcupines preferred broad‐leaf Burkea savanna to Acacia savanna. The individual variation in macroscale habitat preferences indicates that porcupines may be constrained in their use of habitats by territoriality.

On the intermediate scale, no specific feeding areas within the home ranges of porcupines could be identified by using overlapping radiotelemetry circles.

On the microscale, observations of two leash‐walked porcupines indicated that feeding patches are not randomly located but correspond to the distribution of certain plant species important in the diet of porcupines. Patches may be identified or protected by means of scent‐marking.
Reproduction and growth of the opossum Monodelphis domestica (Mammalia: Didelphidae) in northeastern Brazil
Authors: Bergallo Helena G. , Cerqueira Rui
Published: January 2016

The reproduction and growth of the grey short‐tailed opossum, Monodelphis domestica were studied at seven localities in semi‐arid northeastern Brazil. Data were gathered from 1031 specimens stored in the Museu National do Rio de Janeiro. The data allowed us to determine the degree of sexual dimorphism, number of embryos, the relationship between post‐partum development and reproduction, and the breeding season. Adult M. domestica have marked sexual dimorphism, but juveniles do not. Females reduce growth when they attain puberty and produce their first litter. However, growth of males is not interrupted during their first reproductive season. This may reflect differences in reproductive investment between sexes. The mean number of embryos was 7–9 with a range from 2 to 16. The species reproduces seasonally probably in response to variation in day length.
Optical Performances of YAG:Re3+ (Re = Ce, Eu) Phosphor Films with Co‐Doping Tb3+ as Energy‐Transfer Sensitizer
Authors: Zhao Yunyun , Xu Huarui , Zhang Xiuyun , Zhu Guisheng , Yan Dongliang , Ling Qia , Chen Minsheng , Yu Aibing
Published: January 2016

The paper investigates the effect of co‐doping Tb3+ as an energy‐transfer sensitizer on optical properties of YAG:Re3+ (where, Re = Ce, Eu) phosphor films synthesized by sol–gel route. The results suggest that, Tb3+ is a promising sensitizer for improving the optical performances of the as‐prepared YAG:Re3+ films, and a Tb3+ co‐doping concentration of 20% was found to be an optimum level on account of Tb3+ concentration quenching. Due to the energy‐transfer processes of Tb3+→Re3+, the as‐prepared Y0.8 Tb0.2AG:Re3+ films displayed strong abilities of absorption in the ultraviolet (UV) light range, and bright green–yellow emission for YAG:Ce3+ or red emission for YAG:Eu3+ under 275 nm irradiation, which could be utilized for UV‐excited WLED and display applications.
ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF‐CHF Analysis
Authors: ANDRADE JASON G. , ROY DENIS , WYSE D. GEORGE , DORIAN PAUL , TALAJIC MARIO , LEDUC HUGUES , CADRIN‐TOURIGNY JULIA , SHOHOUDI AZADEH , MACLE LAURENT , THIBAULT BERNARD , GUERRA PETER G. , RIVARD LÉNA , DUBUC MARC , KHAIRY PAUL
Published: January 2016

ECG and Cardiovascular Outcomes in AF

Background

The association between standard parameters from a simple 12‐lead ECG (i.e., QRS duration and PR, JT, and QT intervals) and adverse cardiovascular outcomes (cardiovascular mortality, all‐cause mortality, arrhythmic mortality, and hospitalizations) in patients with a history of atrial fibrillation (AF) has not been previously studied.

Methods and Results

A pooled analysis of patient‐level data was conducted on 5,436 patients, age 68.2 ± 8.3 years, 34.8% female, with a history of non‐permanent AF randomized in AFFIRM and AF‐CHF trials. The predictive value of ECG parameters was assessed in AF and sinus rhythm in multivariate Cox regression models. During a follow‐up of 40.8 ± 16.3 months, QRS duration >120 milliseconds was independently associated with all‐cause mortality (hazard ratio [HR] 1.46, 95% confidence interval [CI; 1.21–1.76] in AF, P < 0.001), cardiovascular mortality (HR 1.75, 95% CI (1.15–2.65) in sinus rhythm, P = 0.009; HR 1.56, 95% CI [1.27–1.93] in AF, P < 0.001), arrhythmic mortality (HR 1.90, 95% CI [1.09–3.32] in sinus, P = 0.024; HR 1.84, 95% CI [1.35–2.51] in AF, P < 0.001), any hospitalization (HR 1.15, 95% CI [1.02–1.29] in AF, P = 0.027), and cardiovascular hospitalization (HR 1.21, 95% CI [1.06–1.37] in AF; P = 0.004). Increased PR interval (>200 milliseconds) was independently associated with cardiovascular (HR 1.56, 95% CI [1.11–2.21], P = 0.010) and arrhythmic (HR 1.91, 95% CI [1.14–3.18], P = 0.004) mortality. The JT and QTc intervals were not predictive of mortality.

Conclusions

Simple parameters from standard ECGs are significantly and independently associated with adverse cardiovascular outcomes in patients with a history of AF.
HIF‐1α regulates EMT via the Snail and β‐catenin pathways in paraquat poisoning‐induced early pulmonary fibrosis
Authors: Zhu Yong , Tan Jiuting , Xie Hui , Wang Jinfeng , Meng Xiaoxiao , Wang Ruilan
Published: January 2016

Paraquat (PQ) poisoning‐induced pulmonary fibrosis is one of the primary causes of death in patients with PQ poisoning. Hypoxia‐inducible factor‐1α (HIF‐1α) and epithelial‐mesenchymal transition (EMT) are involved in the progression of pulmonary fibrosis. Snail and β‐catenin are two other factors involved in promoting EMT. However, the relationship among HIF‐1α, Snail and β‐catenin in PQ poisoning‐induced pulmonary fibrosis is not clear. Our research aimed to determine whether the regulation of HIF‐1α in EMT occurs via the Snail and β‐catenin pathways in PQ poisoning‐induced pulmonary fibrosis. Sixty‐six Sprague–Dawley rats were randomly and evenly divided into a control group and a PQ group. The PQ group was treated with an intragastric infusion of a 20% PQ solution (50 mg/kg) for 2, 6, 12, 24, 48 and 72 hrs. A549 and RLE‐6TN cell lines were transfected with HIF‐1α siRNA for 48 hrs before being exposed to PQ. Western blotting, real‐time quantitative PCR, immunofluorescence, immunohistochemistry and other assays were used in our research. In vivo, the protein levels of HIF‐1α and α‐SMA were increased at 2 hrs and the level of ZO‐1 (Zonula Occluden‐1) was reduced at 12 hrs. In vitro, the transient transfection of HIF‐1α siRNA resulted in a decrease in the degree of EMT. The expression levels of Snail and β‐catenin were significantly reduced when HIF‐α was silenced. These data demonstrate that EMT may be involved in PQ poisoning‐induced pulmonary fibrosis and regulated by HIF‐1α via the Snail and β‐catenin pathways. Hypoxia‐inducible factor‐1α may be a therapeutic target for the treatment of PQ poisoning‐induced pulmonary fibrosis.
Phosphatidylserine externalization and procoagulant activation of erythrocytes induced by Pseudomonas aeruginosa virulence factor pyocyanin
Authors: Qadri Syed M. , Donkor David A. , Bhakta Varsha , Eltringham‐Smith Louise J. , Dwivedi Dhruva J. , Moore Jane C. , Pepler Laura , Ivetic Nikola , Nazi Ishac , Fox‐Robichaud Alison E. , Liaw Patricia C. , Sheffield William P.
Published: January 2016

The opportunistic pathogen Pseudomonas aeruginosa causes a wide range of infections in multiple hosts by releasing an arsenal of virulence factors such as pyocyanin. Despite numerous reports on the pleiotropic cellular targets of pyocyanin toxicity in vivo, its impact on erythrocytes remains elusive. Erythrocytes undergo an apoptosis‐like cell death called eryptosis which is characterized by cell shrinkage and phosphatidylserine (PS) externalization; this process confers a procoagulant phenotype on erythrocytes as well as fosters their phagocytosis and subsequent clearance from the circulation. Herein, we demonstrate that P. aeruginosa pyocyanin‐elicited PS exposure and cell shrinkage in erythrocyte while preserving the membrane integrity. Mechanistically, exposure of erythrocytes to pyocyanin showed increased cytosolic Ca2+ activity as well as Ca2+‐dependent proteolytic processing of μ‐calpain. Pyocyanin further up‐regulated erythrocyte ceramide abundance and triggered the production of reactive oxygen species. Pyocyanin‐induced increased PS externalization in erythrocytes translated into enhanced prothrombin activation and fibrin generation in plasma. As judged by carboxyfluorescein succinimidyl‐ester labelling, pyocyanin‐treated erythrocytes were cleared faster from the murine circulation as compared to untreated erythrocytes. Furthermore, erythrocytes incubated in plasma from patients with P. aeruginosa sepsis showed increased PS exposure as compared to erythrocytes incubated in plasma from healthy donors. In conclusion, the present study discloses the eryptosis‐inducing effect of the virulence factor pyocyanin, thereby shedding light on a potentially important mechanism in the systemic complications of P. aeruginosa infection.
Early diversification of sperm size in the evolutionary history of the old world leaf warblers (Phylloscopidae)
Authors: Supriya K. , Rowe M. , Laskemoen T. , Mohan D. , Price T. D. , Lifjeld J. T.
Published: January 2016

Sperm morphological traits are highly variable among species and are commonly thought to evolve by post‐copulatory sexual selection. However, little is known about the evolutionary dynamics of sperm morphology, and whether rates of evolutionary change are variable over time and among taxonomic groups. Here, we examine sperm morphology from 21 species of Old World leaf warblers (Phylloscopidae), a group of generally dull, sexually monochromatic birds, which are known to have high levels of extra‐pair paternity. We found that sperm length differs markedly across species, spanning about 40% of the range observed across a larger selection of passerine birds. Furthermore, we found strong support for an ‘early‐burst’ model of trait evolution, implying that the majority of divergence in sperm length has occurred early in the evolutionary history of this clade with subsequent evolutionary stasis. This large early divergence matches the early divergence reported in ecological traits (i.e. body size and feeding behaviour). Our findings demonstrate that rates of evolution in sperm morphology can change over time in passerine taxa, and that evolutionary stasis in sperm traits can occur even in species exhibiting characteristics consistent with moderate‐to‐high levels of sperm competition. It remains a major challenge to identify the selection mechanisms and possible constraints responsible for these variable rates of sperm evolution.
Establishing a New SpeciesEncephalitozoon pogonaefor the Microsporidian Parasite of Inland Bearded DragonPogona vitticepsAhl 1927 (Reptilia, Squamata, Agamidae)
Authors: Sokolova Yuliya Y. , Sakaguchi Kanako , Paulsen Daniel B.
Published: January 2016

The microsporidium parasitizing Inland Bearded DragonsPogona vitticeps, and developing primarily in macrophages within foci of granulomatous inflammation of different organs, is described as a new speciesEncephalitozoon pogonae. Establishing the new species was based on sequencing theITS‐SSUrDNAregion of the ribosomal gene and consequentSSUrDNA‐inferred phylogenetic analyses, as well as on comparison of pathogenesis, host specificity, and ultrastructure amongEncephalitozoonspecies and isolates. The new species is closely related toE. lacertaeandE. cuniculi. Analysis of the literature suggests that this microsporidium has been reported previously as an unidentified microsporidian species or isolate ofE. cuniculiand may represent a common infection in bearded dragons. All stages ofE. pogonaedevelop in parasitophorous vacuoles. Uninucleate spores on methanol‐fixed smears measured 2.1 × 1.1 μm, range 1.7–2.6 × 0.9–1.7 μm; on ultrathin sections spores measured 0.8–1.1 × 1.8–2.2 μm. Ultrastructural study revealed 3–6 polar filament coils, a mushroom‐shaped polar disk, and a polar sac embracing half of the volume occupied by the lamellar polaroplast. In activated spores, polar filament everted eccentrically. The overall morphology and intracellular development ofE. pogonaewere similar to otherEncepahalitozoonspp. We also review the existing data on microsporidia infecting reptiles.
Evaluation of an Automated Falls Detection Device in Nursing Home Residents
Authors: Lipsitz Lewis A. , Tchalla Achille E. , Iloputaife Ikechukwu , Gagnon Margaret , Dole Kiran , Su Zhen Zhong , Klickstein Lloyd
Published: January 2016

Objectives

To determine the concordance between falls recorded using an investigational fall detection device and falls reported by nursing staff in a nursing home.

Design

Six‐month prospective study.

Setting

Hebrew SeniorLife nursing home units in Boston, Massachusetts.

Participants

Nursing home residents with a documented history of at least one fall within 12 months before consent (N = 62, mean age 86.2 ± 8.1, 66% female).

Intervention

Subjects continuously wore an automated falls detection device on a pendant around their neck. The device contained triaxial accelerometers set to detect a rapid change in position that was interpreted as a fall.

Measurements

Healthcare staff reported daily falls, defined as unexpected events in which residents were found on the floor, and the number of these falls was compared with the number of falls recorded according to the device.

Results

Seven of 37 residents whom nursing staff found on the floor had a fall recorded according to the device (19%). The device did not identify any of the clinical fall events in 23 of the 37 fallers (62%). The device detected 17 of 89 total falls that nursing staff recorded (sensitivity 19%) within an 8‐hour time window. Of 128 fall events that the device recorded, 17 were concordant with nursing reports (13%) within an 8‐hour time window, and 111 (87%) were false positives.

Conclusion

There is poor concordance between falls recorded using the investigational fall detection device and falls to the floor that nursing home staff report.
Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors
Authors: Johnson Miriam J. , Bland J. Martin , Gahbauer Evelyne A. , Ekström Magnus , Sinnarajah Aynharan , Gill Thomas M. , Currow David C.
Published: January 2016

Objectives

To investigate relationships between age, clinical characteristics, and breathlessness sufficient to have people spend at least half a day a month in bed or to cut down on their usual activities (restricting breathlessness) during the last year of life.

Design

Secondary data analysis.

Setting

General community.

Participants

Nondisabled persons aged 70 and older (N = 754).

Measurements

Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was percentage of months with restricting breathlessness reported during the last year of life.

Results

Data regarding breathlessness were available for 548 of 589 (93.0%) participants who died (mean age 86.7, range 71–106; 38.8% male) between enrollment (March 1998 to October 1999) and June 2013; 311 of these (56.8%) reported restricting breathlessness at some point during the last year of life, but none reported it every month. Frequency increased in the months closer to death, irrespective of cause. Restricting breathlessness was associated with anxiety (0.25 percentage points greater in months with breathlessness per percentage point months reported anxiety, 95% confidence interval (CI) = 0.16–0.34, P < .001), depression (0.14, 95% CI = 0.05–0.24, P = .003), and mobility problems (0.07, 0.03–0.1, P < .001). Percentage months of restricting breathlessness was greater if chronic lung disease was noted at the most‐recent comprehensive assessment (6.62 percentage points, 95% CI = 4.31–8.94, P < .001), heart failure (3.34 percentage points, 95% CI = 0.71–5.97, P = .01), and ex‐smoker status (3.01 percentage points, 95% CI = 0.94–5.07, P = .004) but decreased with older age (−0.19 percentage points, 95% CI = −0.37 to −0.02, P = .03).

Conclusion

Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis.
High Level of Depressive Symptoms at Repeated Study Visits and Risk of Coronary Heart Disease and Stroke over 10 Years in Older Adults: The Three‐City Study
Authors: Péquignot Renaud , Dufouil Carole , Prugger Christof , Pérès Karine , Artero Sylvaine , Tzourio Christophe , Empana Jean‐Philippe
Published: January 2016

Backround

Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease (CVD).

Objectives

Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease (CHD) and stroke events in older adults.

Design

A population‐based prospective observational study.

Setting

Participants were randomly selected from the electoral rolls of three large French cities.

Participants

A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years.

Measurements

High levels of depressive symptoms (HLDS) were defined as a score ≥16 on the 20‐item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models.

Results

There were 7,313 participants (36.6% males) aged 73.8 ± 5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow‐up of 8.4 years (SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15‐fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow‐up.

Conclusion

Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events.
Training Tomorrow's Doctors to Safeguard the Patients of Today: Using Medical Student Simulation Training to Explore Barriers to Recognition of Elder Abuse
Authors: Fisher James M. , Rudd Matthew P. , Walker Richard W. , Stewart Jane
Published: January 2016

In recognition of the fact that elder abuse is a global problem that doctors underrecognize and underreport, a simulation training session for undergraduate medical students was developed. The primary objective of this qualitative study was to examine barriers to and drivers of medical students making a diagnosis of elder abuse in simulated practice, with the goal of refining teaching methods and informing future teaching sessions for other clinical teachers. Third‐year medical students (Newcastle University, United Kingdom) undertook a simulation scenario with a high‐fidelity mannequin representing an elder abuse victim. After the simulation scenario, students underwent a semistructured debriefing. A tripartite approach to data collection was employed that included audio recordings of the simulation, data sheets capturing students' thoughts during the scenario, and postscenario debriefing. A different researcher analyzed each data set in isolation before discussions were held to triangulate findings from the data sets. Forty‐six students undertook the scenario; none declined to participate. A number of barriers to students diagnosing elder abuse were identified. Students held a low index of suspicion for elder abuse and were overly optimistic regarding the etiology of the individual's injuries. Students lacked the confidence to raise concerns about possible elder abuse, believing that certainty was required before doing so. There was widespread confusion about nomenclature. These findings provide clinical teachers with important topic areas to address in future teaching sessions. Simulation, as a method to teach about elder abuse in a reproducible and immersive fashion, is recommended to clinical teachers.
Longitudinal Pressure Ulcer Rates After Adoption of Culture Change in Veterans Health Administration Nursing Homes
Authors: Hartmann Christine W. , Shwartz Michael , Zhao Shibei , Palmer Jennifer A. , Berlowitz Dan R.
Published: January 2016

Objectives

To examine facility‐level pressure ulcer (PrU) development rates and variations in these rates after a system‐wide adoption of culture change in Veterans Health Administration (VHA) nursing homes.

Design

Four‐year retrospective longitudinal design.

Setting

VHA facilities (N = 109) representing 132 nursing homes known as community living centers (CLCs).

Participants

VHA nursing home residents.

Measurements

PrUs were identified using fiscal year (FY) 2008–11 Minimum Data Set (MDS) data. PrU development was defined as a Stage 2 or larger PrU on an MDS assessment with no PrU on the previous assessment. A risk adjustment model was developed using 105,274 MDS observations to predict the likelihood of PrUs (c‐statistic = 0.72). A Bayesian hierarchical model that adjusted for differences in the precision of PrU rates from different‐size facilities was used to calculate smoothed risk‐adjusted (SRA) rates for each facility. The statistical significance of the trend over the 4 years was determined by examining the 95% interval estimate for the slope.

Results

Over the 4‐year period, the beginning of which coincided with the VHA's system‐wide adoption of culture change as a performance measure, median SRA facility PrU development rates were fairly consistent at approximately 4%. The range in SRA rates declined over the years, from a 14.8‐percentage point spread to 10.1‐percentage point spread. Some facilities had significantly improving SRA rates (e.g., declined steadily from 5.5% to 3.9%) and some had significantly worsening SRA rates (e.g., increased steadily from 5.1% to 7.9%). Seven sites had significantly improving rates (P < .001) that were below the median across all 4 years.

Conclusion

A system‐wide culture change implementation did not affect CLC PrU development rates, but there was significant variation in facility rates, and some facilities had sustained high performance.
Rehabilitation of Older Adults with Dementia After Hip Fracture
Authors: Seitz Dallas P. , Gill Sudeep S. , Austin Peter C. , Bell Chaim M. , Anderson Geoffrey M. , Gruneir Andrea , Rochon Paula A.
Published: January 2016

Objectives

To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fracture.

Design

Retrospective cohort study.

Setting

Ontario, Canada.

Participants

Community‐dwelling adults with dementia who underwent hip fracture surgery between 2003 and 2011. Participants were categorized as no rehabilitation, complex continuing care (CCC), home‐care based rehabilitation (HCR), and inpatient rehabilitation (IPR).

Measurements

Time to long‐term care (LTC) placement, mortality, and risk of repeat hip fracture and falls.

Results

Of 11,200 individuals with dementia who experienced a hip fracture during the study period, 4,494 (40.1%) received no rehabilitation, 2,474 (22.1%) were admitted to CCC, 1,157 (10.3%) received HCR, and 3,075 (27.4%) received IPR. HCR and IPR were associated with less risk of LTC admission after discharge from hospital than no rehabilitation. All three forms of rehabilitation were associated with lower risk of mortality than no rehabilitation, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls than no rehabilitation (P = .03); there were no other significant between‐group differences in risk of falls or repeat fractures (P > .05).

Conclusion

Postfracture rehabilitation for older adults with dementia is associated with lower risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve postfracture outcomes.
Leveraging the Experiences of Informal Caregivers to Create Future Healthcare Workforce Options
Authors: Phillips Sara S. , Ragas Daiva M. , Hajjar Nadia , Tom Laura S. , Dong XinQi , Simon Melissa A.
Published: January 2016

The objective of this study was gather pilot data from informal caregivers regarding the potential for a training program to assist current or past caregivers in reentering the job market, and thus offering a pathway to economic resilience. In an effort that could foster a sustainable and competent caregiving market to help meet the needs of an aging America, whether training informal caregivers might help them transition into a paid caregiving or other health service role was explored. Caregivers (N = 55) of a chronically or terminally ill family member or friend in a suburban county near Chicago were interviewed. The interview guide addressed household economic effect of illness, emotional burden, and training program interest. Fifty‐six percent of caregivers were interested in training to work outside the home, caring for people in other households, 84% indicated a desire to learn more about health care, and 68% reported a desire to explore job possibilities in health care. Eighty‐two percent were experienced in working with an individual aged 50 and older. Informal caregivers' interest in a training program to bolster their qualifications for a role in the healthcare workforce, including the option of a formal caregiver position, supports the demand for such a program. Considering the need for healthcare workers to serve the growing elderly population and the desire of informal caregivers to find gainful employment, these informal caregivers could provide the impetus to invest in informal caregiver training.
Revisiting the Surveillance Epidemiology and End Results Cancer Registry and Medicare Health Outcomes Survey (SEER‐MHOS) Linked Data Resource for Patient‐Reported Outcomes Research in Older Adults with Cancer
Authors: Kent Erin E. , Malinoff Rochelle , Rozjabek Heather M. , Ambs Anita , Clauser Steven B. , Topor Marie A. , Yuan Gigi , Burroughs James , Rodgers Anne B. , DeMichele Kimberly
Published: January 2016

Researchers and clinicians are increasingly recognizing the value of patient‐reported outcome (PRO) data to better characterize people's health and experiences with illness and care. Considering the rising prevalence of cancer in adults aged 65 and older, PRO data are particularly relevant for older adults with cancer, who often require complex cancer care and have additional comorbid conditions. A data linkage between the Surveillance Epidemiology and End Results (SEER) cancer registry and the Medicare Health Outcomes Survey (MHOS) was created through a partnership between the National Cancer Institute and the Centers for Medicare and Medicaid Services that created the opportunity to examine PROs in Medicare Advantage enrollees with and without cancer. The December 2013 linkage of SEER‐MHOS data included the linked data for 12 cohorts, bringing the number of individuals in the linked data set to 95,723 with cancer and 1,510,127 without. This article reviews the features of the resource and provides information on some descriptive characteristics of the individuals in the data set (health‐related quality of life, body mass index, fall risk management, number of unhealthy days in the past month). Individuals without (n = 258,108) and with (n = 3,440) cancer (1,311 men with prostate cancer, 982 women with breast cancer, 689 with colorectal cancer, 458 with lung cancer) were included in the current descriptive analysis. Given increasing longevity, advances in effective therapies and earlier detection, and population growth, the number of individuals aged 65 and older with cancer is expected to reach more than 12 million by 2020. SEER‐MHOS provides population‐level, self‐reported, cancer registry–linked data for person‐centered surveillance research on this growing population.
Characteristics of United States Emergency Department Visits for Traumatic Amputations in the Elderly Adult from 2010 to 2013
Authors: Bandzar Sean , Gupta Shabnam , Atallah Hany , Pitts Stephen R.
Published: January 2016

Background

Elderly adults (65 years of age and older) are of particular concern for traumatic amputations due to age‐related changes in vision and coordination, making them more susceptible to injury.

Objectives

The objective of this study is to describe the epidemiology of traumatic amputations in the elderly adults treated in United States emergency departments (ED).

Design

A retrospective analysis using data from the National Electronic Injury Surveillance System from 2010 to 2013.

Participants

People aged 65 years and older treated in U.S. hospital EDs for traumatic amputations from 2010 to 2013.

Results

There were 15,611 elderly patients treated for amputations from 2010 to 2013, averaging 3,902 amputations per year in the United States. The frequency of amputations declined with increasing age. The mean age was 74 years old. Males represented 84% of the cohort. The majority of the injuries that were recorded took place at home (71%). The most common associated consumer products were saws, lawnmowers, and doors. Saws accounted for approximately 45% of amputations. In females, doors were the most common consumer product associated with amputations. Approximately 45% of amputations were complete amputations. The most common digit to be amputated was the thumb (24%). Approximately 72% of the cases in the cohort were treated and released from the ED.

Conclusion

Traumatic amputations in elderly adults were frequently due to saws and lawnmowers. An increase in injury prevention efforts in this patient population is warranted.