bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anemoside A3 rapidly reverses depression-like behaviors and weakening of excitatory synaptic transmission in mouse models of depression
Authors: Wang Can-Ming , Lin Zhi-Hang , Lin Zhi-Qiang , Yao Qing-Yang , Zhang Yi-Fan 
Published: November 2018

Background and aim: Developing fast-acting antidepressants attracts considerable attention. Anemoside A3, a natural triterpenoid glycoside isolated from Pulsatillae Radix, has been reported to produce antidepressant-like action in the forced swim test. We herein explore the fast-onset antidepressant-like potentials and antidepressant mechanisms of anemoside A3. Methods: The forced swim test and tail suspension test were used to determine the acute antidepressant-like action of anemoside A3. This action of anemoside A3 was confirmed in chronic mild stress and chronic social defeat stress models. In vitro extracellular field potential recordings were conducted to investigate the impact of anemoside A3 on chronic stress-induced alterations at temporoammonic-CA1 synapses. Western blot, whole-cell patch-clamp recordings, and microinjections of α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor antagonists into the stratum lacunosum-moleculare were performed to unravel the contribution of stratum lacunosum-moleculare α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors to anemoside A3’s antidepressant-like activity. In vivo microdialysis and pharmacological depletion of serotonin were implemented to examine the role of the serotonin system in the antidepressant-like effect of anemoside A3. Results: Anemoside A3 administered intraperitoneally displayed acute antidepressant-like effects in the mouse forced swim test and tail suspension test and anemoside A3 treatment (intraperitoneally) for five days was sufficient to reverse depression-related behaviors of mice subjected to chronic stress. Accordingly, chronic social defeat stress-induced weakening of α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor-mediated neurotransmission in the temporoammonic-CA1 pathway and downregulation of synaptic GluA2-lacking α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor expression in the stratum lacunosum-moleculare could both be normalized by five days of anemoside A3 treatment (intraperitoneally). Moreover, intra-stratum lacunosum-moleculare infusion of GluA2-lacking α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor antagonist abolished anemoside A3’s antidepressant-like effect. Lastly, serotonin system was not implicated in anemoside A3’s antidepressant-like effect. Conclusions: Our results suggest that anemoside A3 induces a rapid antidepressant-like response by a stratum lacunosum-moleculare GluA2-lacking α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor-dependent mechanism. In view of this, anemoside A3 represents a promising agent for depression treatment.
Subchronic treatment with St John’s wort produces a positive shift in emotional processing in healthy volunteers
Authors: Warren Matthew B , Cowen Philip J , Harmer Catherine J 
Published: November 2018

Background: The neurocognitive model of antidepressant treatment in depression states that antidepressants work by producing relatively immediate positive shifts in emotional processing, which translate into clinical improvement with time. St John’s Wort has shown antidepressant potential in randomised controlled trials; however, its pharmacological actions are broad and it is unknown whether treatment also produces changes in emotional processing. Aims: We investigated whether short-term treatment with St John’s wort has similar effects on emotional processing to those reported with other antidepressants such as selective serotonergic reuptake inhibitors. Methods: Forty-eight healthy participants were given St John’s wort or placebo treatment for seven days. On day 7 they completed a battery of tasks to measure emotional processing and other elements of cognition. Results: St John’s wort treatment produced similar changes to other antidepressants, for example reducing recognition of disgusted faces and attention to fearful faces, while increasing memory for positive words. We failed to find evidence for an effect of St John’s wort on other aspects of cognition including working memory. Conclusions: These findings lend support to the theory that the production of early positive biases in emotional processing may be a common feature of all clinically effective antidepressants with diverse pharmacological mechanisms.
Preoperative Symptom Duration Is Associated With Outcomes After Hip Arthroscopy
Authors: Basques Bryce A. , Waterman Brian R. , Ukwuani Gift , Beck Edward C. , Neal William H. , Friel Nicole A. , Stone Austin V. , Nho Shane J. 
Published: November 2018

Background: Prolonged disease chronicity has been implicated as a cause of suboptimal clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), possibly due to disease progression, deconditioning, and the development of compensatory pathomechanics. Purpose: To evaluate the effect of increasing duration of preoperative symptoms on patient-reported outcomes, reoperation, and clinical failure of hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed to identify all patients undergoing primary hip arthroscopy between January 1, 2012, and July 30, 2014, by a single surgeon, with minimum follow-up of 2 years. Patient demographics, comorbid medical conditions, and preoperative outcome scores were compared between patients with preoperative symptoms lasting less than 2 years and those with symptoms lasting 2 years or longer. Multivariate regressions were used to compare Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific (HOS-SS), and modified Harris Hip Score (mHHS) between the 2 cohorts at 2 years of follow-up. Results: A total of 624 patients were included, with an average age of 34.0 ± 13.5 years; 235 (37.7%) patients had experienced preoperative symptoms 2 years or longer. Patients with symptoms lasting less than 2 years had statistically significant higher outcome scores than those with symptoms lasting 2 or more years for the HOS-ADL (86.3 ± 16.4 vs 80.3 ± 19.9, respectively), HOS-SS (75.0 ± 25.3 vs 65.1 ± 29.0), and mHHS (79.1 ± 16.6 vs 74.0 ± 18.8), as well as higher satisfaction (82.1 ± 30.7 vs 71.1 ± 31.6) and lower pain scores (2.6 ± 2.3 vs 3.5 ± 2.6). On multivariate analysis, patients with symptoms 2 years or longer had significantly higher visual analog scale–Pain score (β = 0.6, P = .039) and lower HOS-ADL (β = −3.4, P = .033), HOS-SS (β = −6.3, P = .012), and satisfaction (β = −6.7, P = .028) at 2-year follow-up. Patients with longer duration of symptoms also demonstrated less improvement in HOS-SS (β = −10.3, P = .001) at 2 years after surgery. Patients with symptoms for 2 years or longer were significantly less likely to achieve a patient acceptable symptomatic state for HOS-ADL (relative risk [RR] = 0.8, P = .024) and HOS-SS (RR = 0.8, P = .032) at 2 years of follow-up. Patients with symptoms 2 years or longer also demonstrated significantly higher rates of revision arthroscopy (RR = 10.1, P = .046). Conclusion: Patients with untreated, FAIS-related symptoms lasting 2 years or longer before arthroscopic management had significantly worse patient-reported outcomes and higher rates of reoperation at 2 years after surgery when compared with those patients with a shorter duration of preoperative symptoms.
Devices to Reduce the Volume of Blood Taken for Laboratory Testing in ICU Patients: A Systematic Review
Authors: Siegal Deborah M. , Manning Neal , Jackson Chornenki Nicholas L. , Hillis Christopher M. , Heddle Nancy M. 
Published: November 2018

Background: Intensive care unit (ICU) patients are at high risk of anemia, which is associated with adverse clinical outcomes and death. Blood sampling for diagnostic testing is a potentially modifiable contributor to anemia. Methods: We conducted a systematic review by searching MEDLINE and EMBASE from inception to October 5, 2017, for studies reporting the volume of blood taken for laboratory testing using blood sampling conservation devices compared to standard care or another intervention in adult ICU patients. Results: We identified 8 eligible studies (n = 1204 patients) that used 2 types of devices: arterial access devices (n = 5) and reduced-volume blood collection tubes (n = 3). All studies reported a reduction in the volume of blood taken for laboratory testing with devices compared to standard practice (range 19%-80%). The studies were judged to have serious risk of bias, and due to heterogeneity, pooling for meta-analysis was not considered appropriate. Conclusions: Devices used to reduce the volume of blood taken for laboratory testing in ICU patients appear to be effective, although study heterogeneity limited our ability to calculate pooled estimates of efficacy for each device. Further assessment of clinical outcomes may establish clinical benefit with minimal negative consequences for hospitals and laboratories to facilitate the use of small-volume tubes.
Ankle fractures: What role does level of insurance play in recovery and outcomes?
Authors: Bakhsh Wajeeh , Childs Sean , Judd Kyle , Soles Gillian , Humphrey Catherine , Gorczyca John , Ketz John 
Published: November 2018

Introduction A number of factors including socioeconomic status have been correlated with post-operative outcomes in orthopedic trauma. The objective of this study is to compare post-operative courses and patient-reported outcomes following operatively managed ankle fractures taking into account a patient's level of insurance coverage. Methods A retrospective cohort study was performed at a single level I trauma center. Patients were identified by billing code for operative intervention of ankle fractures (OTA 44) from January 2014 to January 2015. Study outcomes included narcotic refills, compliance with follow-up visits, visual analog scale (VAS) pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) survey data, and perioperative complication rates. Statistical analysis included mean comparison between insurance groups and multivariate regression modeling. Results From January 2014 to January 2015, 209 patients met the inclusion criteria (45 patients under/uninsured vs. 164 fully insured). No differences were found amongst demographic data or fracture characteristics. The underinsured group had a higher average number of narcotic prescriptions (2.6 refills vs. 1.5 refills, p < 0.05). The underinsured group also demonstrated a significantly greater number of missed post-operative clinic visits (0.8 vs. 0.3 visits p < 0.05); the total number of post-operative visits were similar (6.4 vs. 6.9, p = 0.38). At one-year follow-up, the underinsured group had higher pain scores (VAS 3.8 vs. 2.1, p < 0.05), and significantly worse PROMIS scores with respect to mood (54 vs. 49.1, p < 0.05), pain (59.6 vs. 55.5, p < 0.05), and functional outcomes (38 vs. 44.7, p < 0.05). There was no difference in perioperative complication rates. Multivariate regression modeling found insurance (p < 0.05), age (p < 0.05), and smoking (p < 0.05) to be significant determinants of post-operative outcomes. Conclusion Despite similar demographic and fracture characteristics, patients with decreased insurance coverage demonstrated higher narcotic requirements and missed more appointments. They had worse subjective and objective outcomes. As physician reimbursement becomes increasingly dependent on outcomes, further understanding of the psychosocial factors of this subset of patients is needed to establish realistic expectations and identify avenues for further intervention.
Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis
Authors: Fischer Hendrik S. , Schmölzer Georg M. , Cheung Po-Yin , Bührer Christoph 
Published: November 2018

Sustained inflations and avoidance of endotracheal mechanical ventilation (eMV) are delivery room interventions aimed at preventing bronchopulmonary dysplasia (BPD). Their effectiveness is the subject of the present meta-analysis.The databases MEDLINE, EMBASE and CENTRAL were searched for randomised controlled trials (RCTs) of preterm infants that compared: 1) sustained inflations with intermittent positive-pressure ventilation; and 2) a non-intubated strategy of respiratory support with one that prescribed eMV at an earlier stage. Data extraction and analysis followed the standard methods of the Cochrane Collaboration. The primary outcome was death or BPD, defined as need for oxygen or positive pressure treatment at 36 weeks' postmenstrual age.Avoiding eMV (nine RCTs, 3486 infants) reduced the risk of death or BPD, with a risk ratio of 0.90 (95% CI 0.84–0.97) and a number needed to treat of 35. After sustained inflations (six RCTs, 854 infants), the risk ratio was 0.85 (95% CI 0.65–1.12). A current multicentre RCT of sustained inflations in very preterm infants was halted for increased early mortality in the sustained inflations arm.While strategies aimed at avoiding eMV had a small but significant impact on preventing BPD, sustained inflations had no effect and may even increase mortality in very preterm infants.
Electronic cigarette marketing and smoking behaviour in adolescence: a cross-sectional study
Authors: Hansen Julia , Hanewinkel Reiner , Morgenstern Matthis 
Published: November 2018

The aim of this study was to investigate the association between exposure to electronic cigarette (e-cigarette) advertisements and use of e-cigarettes, combustible cigarettes and hookahs.A cross-sectional survey of 6902 German students (mean age 13.1 years, 51.3% male) recruited in six German states was performed. Exposure to e-cigarette advertisements was measured with self-rated contact frequency to three advertising images. Multilevel mixed-effect logistic regression models were used to assess associations between exposure to e-cigarette advertisement and use of e-cigarettes, combustible cigarettes and hookahs (ever and past 30 days).Overall, 38.8% of the students were exposed to e-cigarette advertisements; ever-use of e-cigarettes was 21.7%, of combustible cigarettes was 21.8% and of hookahs was 23.2%, and poly-use of all three products was 12.4%. Exposure to e-cigarette advertisements was positively related to ever and past 30-day use of e-cigarettes, combustible cigarettes, hookahs and combined use.We concluded that a considerable number of German teenagers are exposed to e-cigarette advertisement. There was a clear exposure–behaviour link, indicating that advertising contact was associated with different kinds of “vaping” and also smoking behaviour. Although causal interpretation is not possible due to the cross-sectional design, findings raise concerns about the current tobacco control policies.
The role of employment interruptions and part-time work for the rise in wage inequality
Authors: Biewen Martin , Fitzenberger Bernd , de Lazzer Jakob 
Published: November 2018

Abstract
The incidence of employment interruptions and temporary part-time work has grown strongly among full-time workers, yet little is known about the impact on wage inequality. This is the first study showing that such episodes play a substantial role for the rise in inequality of full-time wages, considering the case of Germany. While there are also strong composition effects of education for males and of age and experience for females, changes in industry and occupation explain fairly little of the inequality rise. Extending the analysis to total employment reveals substantial negative selection into part-time work.

JEL-Classification: J31, J20, J60
Improving PROMs collection rate in an outpatient palliative care clinic.
Authors: Chua Isaac S. , Siegel Jocelyn , Hayne Victoria , McCleary Nadine Jackson 
Published: November 2018

105 Background: From January 2018 to March 2018, Dana Farber Cancer Institute (DFCI) launched a pilot to collect Patient-Reported Outcomes of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) within the adult palliative care (APC) clinic using smart tablets. We had a limited response rate—only 20% of patients attempted to complete the questionnaire. After the pilot ended on March 2018, smart tablets were discontinued and were replaced with a paper version of PRO-CTCAE from April to June 2018. Our aim was to increase the patient attempt and collection rate of the paper PRO-CTCAE from 20% to 50%. Methods: Our primary outcome measure was the percentage of paper PRO-CTCAE attempted and collected. Eligible patients were established patients scheduled to see a provider in the APC clinic. We implemented several Plan-Do-Study-Act (PDSA) cycles including the implementation of the paper version of the questionnaire, training and educating front desk staff, and posting provider reminders in exam rooms. We used a statistical process control (SPC) chart to track percentage of attempted and collected questionnaires over time and to differentiate between special cause and common cause variation. Results: From April 2018 to June 2018, the PRO-CTCAE collection rate improved from 20% to 48%. Special cause variation was associated with implementation of the paper version of the PRO-CTCAE and increased front desk staff engagement. Increased provider satisfaction was also associated with the paper version of the PRO-CTCAE. Conclusions: Implementing a high-reliability process for collecting patient reported outcome measures in an outpatient palliative care clinic is complex and requires cohesive multi-disciplinary teamwork, a user-friendly patient-facing and provider-facing interface, and a streamlined workflow. The electronic version of PRO-CTCAE will resume in September 2018. We will implement lessons learned from the paper PRO-CTCAE implementation, including ongoing front desk staff engagement and an enhanced provider view in the electronic medical record.
Feasibility of a massive online open course to teach skills in primary palliative care for a global audience.
Authors: Kerkar Ashwini Prafulla , DeNofrio Jan , Tribett Erika Lauren , Ramchandran Kavitha 
Published: November 2018

111 Background: Palliative Care Always (PCA) is a massive open online course (MOOC), through Stanford Online, that teaches primary palliative care. Our goal was to provide an accessible avenue for palliative care education on a global level. This is to address persistent and considerable gaps in primary palliative care due to lack of specialist trained experts and training opportunities. Methods: A team of providers including palliative care physician, advanced care nurse practitioner, priest and social worker developed 12 modules covering the scope of palliative care across their specialties. Topics ranged from communication of bad news to hospice initiation, while following the case of an oncology patient. Components include (1) Reflection on assigned readings (2) Patient scenes (3) Multiple choice assessments and (4) Group discussions. Participants were surveyed prior to and on completion of the 12-week course. Results: PCA enrolled 721 applicants from 56 countries. Participants from the US represented 51% of the total cohort. Next highest enrollment was from Brazil, India and Canada. Median age was 40 years. 51% of surveyed participants held advanced degrees and 38% held bachelor’s degrees. At the time of enrollment, 70% of participants were employed, 76% of whom worked in healthcare or social assistance industries. 44% of participants identified themselves as having some level of teaching experience. 75% of teachers reported never covering material on palliative care. The most popular reasons for taking the course included general interest, personal growth and relevance to employment. Post assessment surveys showed 95% of enrollees had a positive experience and were satisfied with what they learned; the most useful module was communication of bad news. Conclusions: Based on participant reports, effective palliative care training and exposure on a global level is feasible and acceptable with a MOOC such as PCA. Participants were from diverse backgrounds and found the course relevant and helpful. Future directions include specialty-specific courses, with a Hepatology course currently underway, evaluation of the impact on practice outcomes, and customized cases for individualized training.
Differences in the way patient and partner experience the metastatic disease.
Authors: Bergerot Cristiane Decat , Clark Karen L. , Bergerot Paulo Gustavo , Pedras Renata Nunes , Manhaes Maria Fernanda , Bitz Courtney , Loscalzo Matthew J. , Pal Sumanta K. 
Published: November 2018

115 Background: In Brazil, 60.5% of patients are diagnosed with an advanced stage of cancer. Patients with incurable cancer and their partners experience high rates of distress. This study aimed to assess problem-related distress among patients with stage IV cancer and their partners. Methods: A descriptive study was conducted at a large public hospital. Patients and their partners completed the 33-item SupportScreen-Couples Distress, on a five Likert scale, which contains questions related to emotional and physical symptoms, relationship issues and concerns around diagnosis, treatment, prognosis, and end-of-life. The McNemar’s test was used to compare rates of problem-related distress between patients and their partners. Results: A total of 64 patients (median 56 yrs old; 57.8% male; 51.6% white; 87.5% Eastern Cooperative Oncology Group < 2) and 64 partners (median 56 yrs old; 53.1% white; 93.8% primary caregiver) were enrolled. Couples were married for a median of 27.3 yrs. Patients reported higher levels of distress related to fatigue (42.1% vs 29.7%; P = 0.02), worry about the future (28.1% vs 20.3%; P = 0.08), sleep problems (28.1% vs 20.3%; P = 0.07) and feeling depressed (26.6% vs 15.6%; P = 0.03) compared to their associated partners. Partners reported more anxiety (37.5% vs 28.1%) and financial concerns (25.1% vs 17.2%) compared to associated patients (P < 0.01 for both). Patients and partners had a similar understanding that curative treatment is unlikely and that the goal of treatment was disease control (51.6% and 56.2%, respectively). Patients (versus their partners) were generally more worried about how their family was coping with their cancer diagnosis (42.2% vs 15.6%) and demonstrated hesitancy in talking about fears related to the end of life (60.9% vs 14.1%) (P < 0.001 for both). Conclusions: We identify key differences in psychosocial issues experience by patients and their partners. Furthermore, patients and partners demonstrate unique concerns related to the spectrum of oncology care. Our findings can be used to tailor unique supportive care interventions for patients and partners.