bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel, palatable paediatric oral formulation of midazolam: pharmacokinetics, tolerability, efficacy and safety
Authors: Salman S. , Tang E. K. Y. , Cheung L. C. , Nguyen M. N. , Sommerfield D. , Slevin L. , Lim L. Y. , von Ungern Sternberg B. S. 
Published: July 2018

SummaryMidazolam is one of many bitter drugs where provision of a suitable oral paediatric formulation, particularly in the pre‐anaesthetic setting, remains a challenge. To overcome this problem, a novel chocolate‐based tablet formulation has been developed with positive pre‐clinical results. To further investigate the potential of this formulation, 150 children aged 3–16 years who were prescribed midazolam as a premedication were randomly assigned to receive 0.5 mg.kg−1 either as the novel formulation or an intravenous solution given orally, which is the current standard at our institution. Tolerability was assessed by each child, parent and nurse using a 5‐point facial hedonic scale and efficacy was determined as the time to onset of sedation. Blood samples for midazolam and 1‐hydroxymidazolam levels were analysed using high‐performance liquid chromatography. Population pharmacokinetics were evaluated using non‐linear mixed effects modelling. The novel formulation had significantly improved tolerability scores from children, parents and nurses (all p < 0.001). Time to effect was not different between the groups (p = 0.140). The pharmacokinetics of midazolam and 1‐hydroxymidazolam were able to be modelled simultaneously. The novel formulation was subject to a higher estimated first‐pass metabolism compared with the intravenous solution (8.6% vs. 5.0%) and a significantly lower relative bioavailability of 82.1% (p = 0.013), with no other significant differences. Exposure relative to dose was in the range previously reported for midazolam syrup. We conclude that the novel chocolate‐based formulation of midazolam provides improved tolerability while remaining efficacious with suitable pharmacokinetics when used as a premedicant for children.
Early discharge of patients with acute pancreatitis to enhanced outpatient care
Authors: Kumar Vineeth V. , Treacy P. John , Li Minghao , Dharmawardane Anoj 
Published: July 2018

BackgroundAcute pancreatitis (AP) is a common cause for hospital admission, but some patients have a prolonged stay. The aim of this study was to identify patients with mild AP who had a prolonged hospital stay, who potentially could be discharged at day 2 to enhanced outpatient care.MethodsData was retrospectively collected on all patients admitted to the Royal Darwin Hospital between May 2016 and February 2017 with a diagnosis of mild AP to identify factors that may safely predict early discharge to enhanced outpatient care.ResultsOf 115 admissions, 62% were male, 50% indigenous and alcohol was causative in 53%. A total of 75 (65%) patients stayed more than 2 days and used 342 bed‐days. Factors identified in the first 2 days of admission associated with a length of stay more than 2 days (R2 = 0.56, P < 0.0001) included pain score >5 (P = 0.034), temperature ≥38°C (P < 0.0001), white blood cell count >18 (P = 0.036), not tolerating oral diet by day 2 (P = 0.002), severe pancreatitis on imaging (P = 0.008) and readmission in the previous 30 days (P = 0.035). Using these criteria, 57% of all admissions and 87% of admissions greater than 2 days could potentially have been transferred to enhanced outpatient care at day 2 for management. This would have saved 277 inpatient bed‐days and an estimated $122 771 over the 9‐month study period.ConclusionsA significant proportion of patients admitted with mild AP, who stay longer than 2 days in hospital, could potentially be identified and discharged early to enhanced outpatient care.
Patients requiring an acute operation: where are the delays in the process?
Authors: de Burlet Kirsten J. , Desmond Brendan , Harper Simon J. , Larsen Peter D. , Dennett Elizabeth R. 
Published: July 2018

BackgroundDelays to surgery for patients requiring an acute operation are associated with increased morbidity and mortality. A recent study from our institution observed long waiting times for patients booked for an acute operation. The aim of this study was to evaluate the patient's progress from presentation to arrival in the operating theatre and to identify where delays occurred.MethodsPatients undergoing acute general surgery between July 2016 and May 2017 were studied. Data were obtained for time of presentation, imaging, theatre and booking. A time interval from presentation to booking for theatre of greater than 6 h was defined as a diagnostic delay. A time interval from booking to theatre greater than the category defined time (four‐level priority system) was defined as a logistic delay.ResultsA total of 683 patients were included. A diagnostic delay was observed in 55.1%. This occurred more frequently in patients who required imaging prior to their operation (82.5 versus 41.1%, P < 0.001). Logistic delay occurred in 31.0% of the patients, and this was most common for patients booked as a category 3 (requiring surgery within 6 h, 41.8%, P < 0.001). Patients who had a diagnostic delay were significantly more likely to have a post‐operative complication compared to patients who did not (17.2 versus 10.0%, P = 0.009).ConclusionThere are significant delays associated with patients presenting to the acute general surgery service and their transition to theatre. Addressing both the diagnostic and the logistic delays in our institution should result in a significant improvement in patient care.
“Protect Wisconsin Families”? Rethinking Left Family Values in the 2011 Wisconsin Uprising
Authors: Seitz David K. 
Published: July 2018

AbstractThis article seeks to rethink the trope of the “working family” so prevalent in contemporary politics, with particular attention to its promise and constitutive limits for the Left. It takes up contemporary socialist, feminist, anti‐racist and queer scholarship on the discourse of family, bringing it to bear on the case of “working family” rhetoric in the 2011 Wisconsin Uprising against austerity and public‐sector union‐busting. Reckoning with the term's racist and heteropatriachal valences, and its centrality in privatising social reproduction, I conclude by considering potential alternative horizons for thinking intimacy, labour, and social citizenship for the intersectional Left.
Persistent involvement of anterior mesorectal fascia in carcinoma rectum – extended resection of rectum vs total pelvic exenteration: results from a single‐centre retrospective study
Authors: Verma K. , Engineer R. , Ostwal V. , Kumar S. , Arya S. , Desouza A. L. , Saklani A. P. 
Published: July 2018

AbstractAimInvolvement of the anterior mesorectal fascia (iAMRF) after neoadjuvant treatment leads to either resection of the involved organ alone [extended resection of the rectum (ERR)] or total pelvic exenteration (TPE). The purpose of this study was to compare the rate of recurrence and survival of patients undergoing ERR or TPE for iAMRF after neoadjuvant treatment. The outcome of patients who underwent total mesorectal excision after downstaging was also compared.MethodThis was a retrospective study of primary rectal cancer patients.ResultsOf 237 patients, 61 (21.5%) patients with nonmetastatic carcinoma rectum had iAMRF at baseline. Ten patients defaulted before completion of neoadjuvant chemoradiotherapy. After neoadjuvant chemoradiotherapy, 22 patients (43.1%) developed systemic metastases, seven patients (13.8%) were downstaged to free anterior mesorectal fascia and underwent total mesorectal excision (anterior resection/abdominoperineal resection) and the remaining 22 patients (43.1%) had persistent iAMRF. Thirteen patients with persistent iAMRF underwent ERR, whereas nine patients underwent TPE. The median duration of hospital stay in the TPE group was 13 days (10–26), whereas it was 7 days (5–21) in the ERR group. A clear circumferential resection margin, R0 resection, was achieved in all patients with TPE and ERR. After a median follow‐up of 31.6 months, five patients with TPE (55.6%), four patients with ERR (30.7%) and three patients in the downstaged group (42.9%) developed systemic recurrence. None of the patients with TPE and the downstaged group developed local recurrence, whereas three patients with ERR (23.1%) developed local recurrence. Median disease‐free survival was 12.3 months in the TPE group, 18.9 months in the ERR group and 10.6 months in the downstaged group, whereas mean overall survival was 36.2, 32.8 and 27.9 months, respectively.ConclusionAlthough there is no significant difference in the overall survival and disease‐free survival, ERR is associated with a high risk of local recurrence compared to TPE and the downstaged group.
Up‐scaling local‐habitat models for large‐scale conservation: Assessing suitable areas for the brown bear comeback in Europe
Authors: Scharf Anne K. , Fernández Néstor 
Published: July 2018

AbstractAimLarge carnivore populations in Europe are expanding into new areas. This generates opportunities to improve their conservation status, but also creates a need to address new conflicts with humans. Species management units are constrained by administrative boundaries, but effective conservation and conflict management require a continental‐scale perspective on the opportunities and limitations for expanding populations. We assessed the conservation applicability and the uncertainties of transferring and up‐scaling local habitat suitability models from multiple populations in support of large‐scale, transboundary species conservation.LocationEurope.MethodsWe evaluated the accuracy of local population models to predict European brown bear (Ursus arctos) distribution patterns in other populations and at the continental scale. We also assessed the benefits of combining predictions from multiple local population models, and we evaluated the limitations of transferring models among populations and environmental settings. Last, we estimated the availability of unoccupied suitable habitats in Europe for colonization by expanding populations.ResultsWe found that integrating habitat predictions from multiple populations outperformed predictions from most individual populations. Results showed that about 37% of potentially suitable brown bear habitat in Europe remains unoccupied. As a synthesis of our results, we provide a set of predictive maps for the expansion of brown bears at the continental scale, including predictions from individual habitat models and a multimodel predictive map.Main conclusionsWe show that integrating habitat models from multiple populations provides richer and more reliable information on the distribution of suitable habitats in data deficient areas. This integration yields more reliable predictions compared to those based on individual populations and has important implications to manage species expansions and the associated conflicts. We also identified major limitations in transferring predictions among habitats; therefore, it is critical to enhance the reproducibility of habitat suitability models to apply local‐scale habitat studies to broader‐scale conservation practice.
Water level influences migratory patterns of anadromous brown trout in small streams
Authors: Jonsson Bror , Jonsson Nina , Jonsson Marius 
Published: July 2018

AbstractHabitats modify the population ecology of species. Here, we show how low water level influences abundance and size of adult anadromous brown trout (Salmo trutta) entering a small, South Norwegian stream for spawning. After smolting, the fish appear chiefly to feed within 10 km of the home stream. In the autumn, South Norwegian streams typically flood because of heavy rainfall, when the anadromous brown trout entered from the sea. Mean annual duration of the upstream migration period was 34 days and ended when the flooding ended and the water temperature dropped to below 4°C. During most of the migration period, on average two trout ascended the river per day. The sexes entered the spawning area concurrently, and the male:female ratio of the anadromous trout was 1.27. No fish entered when the water depth just downstream of the spawning area was below 5 cm, and mean number of fish increased with increasing water depth to ca. 30 cm, but not at higher flows when the ascent gradually decreased. Mean and maximum size of the entering spawners increased with water depth between 5 and 16 cm. Among those that had been to sea, most were recaptured in the home stream, 4% in other streams, but only two of the strays were caught close to spawning time. The present results illustrate that population traits of anadromous brown trout from a small stream differ from those in larger rivers, probably because of selection associated with water flow.
Soil microbial community and activity are affected by integrated agricultural practices in China
Authors: Zhu X. C. , Sun L. Y. , Song F. B. , Liu S. Q. , Liu F. L. , Li X. N. 
Published: July 2018

SummarySustainable agricultural management practices improve soil processes, prevent soil erosion and consequently enhance crop productivity. The integrated agricultural practice (IP) developed in northeast China, by altering row spacing of planting, adopting no‐tillage and returning all crop residues, showed great benefit in sustaining crop yield. However, its effect on the soil microbiome remains largely elusive. This study evaluated the effect of 12‐year integrated agricultural practice on the structure and activity of the soil microbial community at different soil depths in China's Mollisols zone. The experiment consisted of integrated agricultural practice and conventional practice (CP) treatments in a split‐plot arrangement. The soil microbial community was characterized by MiSeq sequencing. The results showed that agricultural practices affected 12 phyla, 24 classes, 32 orders and 75 families in the bacterial community and one phyla, four classes, 12 orders and 18 families in the fungal community. Integrated agricultural practice resulted in greater bacterial richness and diversity, and increased the relative abundances of Actinobacteria, Gemmatimonadetes, Verrucomicrobia and Ascomycota, but reduced Bacteroidetes, Firmicutes and Basidiomycota in the dominant bacterial and fungal phyla. These findings suggested that integrated agricultural practice modified the soil physiochemical properties and consequently altered microbial community structure and diversity, which in turn affected soil microbial biomass and enzyme activities. These changes under integrated agricultural practice could have contributed to the enhanced crop yield, suggesting that IP is a sustainable agricultural practice.Highlights
How does soil microbial community change in the IP and CP soils?
IP affected the soil microbial community and activity.
Bacterial and fungal community structure correlated significantly with soil physiochemical properties.
IP is a promising sustainable agricultural practice.
Feasibility and effectiveness of home‐based exercise programs on physical performance and health‐related quality of life of the older people dwelling on an isolated, doctor‐less island
Authors: Akihiro Shintaro , Taira Yaeko , Maeda Keita , Natsume Keisuke , Sakakima Harutoshi 
Published: July 2018

AimTo promote preventive care among older individuals dwelling on an isolated, doctor‐less island, we investigated the feasibility and the efficacy of a home‐based exercise program, depending on their functional status and health‐related quality of life.MethodsA total of 23 older (mean age 72.6 years) participants were assigned to a home‐based exercise program (intervention group), and 34 older (mean age 74.2 years) participants were assigned to a group without any intervention (control group). The participants of the intervention group attended the exercise program three times a week for 3 months. The exercise program consisted of various exercises involving stretching, muscle strengthening, balance retraining and walking. The physical performance, Functional Independence Measure and Short‐Form 36‐item health survey were used to assess the physical and the mental wellbeing of the participants.ResultsThere was no significant difference between the changes in physical performance at baseline and post 3 months in both groups. However, the motor and the cognitive Functional Independence Measure scores significantly improved in the intervention group post 3 months. The domains of the Short‐Form 36‐item health survey improved post 3 months; particularly, significant improvement was observed in the physical functions, general health, vitality, mental health and mental component summary.ConclusionsAlthough an isolated island has several problems to support preventive care services, such as a lack of medical resources and availability of only a few healthcare workers, the present study provides evidence on the feasibility and efficacy of nurse‐led home‐based exercise programs for improving the physical and mental health of the older people dwelling on an isolated, doctor‐less island. Geriatr Gerontol Int 2018; 18: 1313–1317.
Recognition of Regional Water Table Patterns for Estimating Recharge Rates in Shallow Aquifers
Authors: Gilmore Troy E. , Zlotnik Vitaly , Johnson Mason 
Published: July 2018

AbstractWe propose a new method for groundwater recharge rate estimation in regions with stream‐aquifer interactions, at a linear scale on the order of 10 km and more. The method is based on visual identification and quantification of classically recognized water table contour patterns. Simple quantitative analysis of these patterns can be done manually from measurements on a map, or from more complex GIS data extraction and curve fitting. Recharge rate is then estimated from the groundwater table contour parameters, streambed gradients, and aquifer transmissivity using an analytical model for groundwater flow between parallel perennial streams. Recharge estimates were obtained in three regions (areas of 1500, 2200, and 3300 km2) using available water table maps produced by different methods at different times in the area of High Plains Aquifer in Nebraska. One region is located in the largely undeveloped Nebraska Sand Hills area, while the other two regions are located at a transition zone from Sand Hills to loess‐covered area and include areas where groundwater is used for irrigation. Obtained recharge rates are consistent with other independent estimates. The approach is useful and robust diagnostic tool for preliminary estimates of recharge rates, evaluation of the quality of groundwater table maps, identification of priority areas for further aquifer characterization and expansion of groundwater monitoring networks prior to using more detailed methods.
TERT promoter mutations in solitary fibrous tumour
Authors: Demicco Elizabeth G , Wani Khalida , Ingram Davis , Wagner Michael , Maki Robert G , Rizzo Anthony , Meeker Alan , Lazar Alexander J , Wang Wei‐Lien 
Published: July 2018

AimsTERT promoter mutations have been reported in 22% of solitary fibrous tumours (SFT) and have been associated with poor outcomes. We performed testing for TERT hot‐spot mutations in a large series of SFT in order to confirm this finding and explore clinicopathological correlates of mutation status.Methods and resultsPCR for TERT hot‐spot mutations C250T and C228T was performed on DNA extracted from 216 SFT and mutation status correlated with clinicopathological factors, including predicted risk for metastasis using a previously published model. Testing was successful in 189 tumours from 172 patients, and mutations were present in 29%. The presence of TERT promoter mutation was associated with larger primary tumour size, necrosis and older patient age. TERT promoter mutations were most common in high‐risk tumours (nine of 20, 45%), and were present in 11 of 26 (42%) moderate‐risk tumours and 14 of 67 (21%) low‐risk tumours (P = 0.004). Overall, TERT mutations were associated with shorter time to first metastasis (P = 0.04), but had no impact on overall survival. TERT promoter mutation status was found not to provide additional prognostic information in low‐ and high‐risk SFT, but did identify a group of patients with intermediate risk SFT who had an increased risk of metastasis.ConclusionsTERT promoter mutations were more frequent in SFT with higher risk of metastasis, but TERT promoter mutation status was not a reliable predictor of clinical outcome by itself. However, mutations in the TERT promoter may be useful in further stratifying patients with intermediate risk tumours.
Association between smoking status assessed with plasma‐cotinine and inflammatory and endothelial biomarkers in HIV‐positive and HIV‐negative individuals
Authors: Ahlström MG , Knudsen A , Ullum H , Gerstoft J , Kjaer A , Lebech A‐M , Hasbak P , Obel N 
Published: July 2018

ObjectivesSmoking is a major contributor to mortality and morbidity in HIV‐positive individuals. Our primary objective was to evaluate the association between smoking status determined by plasma cotinine (P‐cotinine) concentration and inflammatory and endothelial biomarkers in HIV‐positive versus HIV‐negative individuals.MethodsWe studied eight inflammatory/endothelial biomarkers [high‐sensitivity C‐reactive protein (hsCRP), E‐selectin, soluble vascular cell adhesion molecule 1 (sVCAM‐1), soluble intercellular adhesion molecule 1 (sICAM‐1), matrix metallopeptidase 9 (MMP‐9), myeloperoxidase (MPO), tissue type plasminogen activator inhibitor 1 (tPAI) and endothelin] in 105 HIV‐positive individuals and 105 HIV‐negative individuals matched on age, sex and self‐reported smoking status. Smoking status was determined using P‐cotinine (a concentration > 14 ng/mL was defined as demonstrating exposure to smoke). We used linear regression models to (1) examine the association between smoking status and inflammatory/endothelial biomarkers in HIV‐positive compared with HIV‐negative individuals, and (2) to determine whether there was evidence to suggest that the impact of smoking status on the biomarkers differed between HIV‐positive and HIV‐negative individuals.ResultsOf the eight biomarkers, smokers had increased hsCRP, sICAM‐1 and MMP‐9 concentrations irrespective of HIV status and increasing P‐cotinine concentration was associated with increasing hsCRP concentration. We found no interaction between smoking and HIV status. HIV infection was associated with increased hsCRP, E‐selectin, sVCAM‐1, sICAM‐1 and MMP‐9 concentrations. Self‐reported smoking status differed substantially from smoking status assessed with P‐cotinine.ConclusionsSeveral biomarkers were associated with smoking status and HIV status. However, our data do not indicate that the effects of smoking on the biomarkers differ between HIV‐positive and HIV‐negative individuals.