bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical Issues for Otolaryngology and Surgery in the Elderly
Authors: Seidman Michael D. , Shapiro Donald P. , Shirwany Najeeb A. 
Published: May 2019

Clinical ethics is an intrinsic aspect of medical practice. Concerns for ethical conduct arise in the management of medical benefits, patient preferences, quality of life, and the relationship between patient care and its attendant familial, social, economic, and legal circumstances. Ethical concerns in surgical practice are central to the essence of the Hippocratic doctrine, “First do no harm.” In caring for our patients, particularly in light of the modern practice of medicine, we often use the risk-benefit calculus. The range of ethical concerns for the otolaryngologist who deals with the elderly and infirm covers many diverse situations. Superimposed over this spectrum is the idea of patient autonomy, which is considered to be a cardinal issue in any ethical discussion. Furthermore, increasing medical care costs have created a debate regarding the rationing of healthcare. Ethicists continue the discussion as to whether age should be a decisive factor in the rationing of this care. Definitions of “heroic” and “extraordinary” assume greater significance, and controversies of language become pivotal when the comprehension and cognitive orientation of the patient are compromised by disease and senescence.
Xerostomia: A Prevalent Condition in the Elderly
Authors: Astor Frank C. , Hanft Kendall L. , Ciocon Jerry O. 
Published: May 2019

Although xerostomia is associated with aging, studies have determined that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably not a condition of aging, but most likely one of systemic or extrinsic origin. Saliva seems to undergo chemical changes with aging. As the amount of ptyalin decreases and mucin increases, saliva can become thick and viscous and present problems for the elderly. One of the most prevalent causes of xerostomia is medication. Anticholinergics, such as psychotropic agents and antihistamines, and diuretics can dry the oral mucosa. Chronic mouth breathing, radiation therapy, dehydration, and autoimmune diseases, such as Sjögren's, can also diminish salivation, as can systemic illness such as diabetes mellitus, nephritis, and thyroid dysfunction. Xerostomia can lead to dysgeusia, glossodynia, sialadenitis, cracking and fissuring of the oral mucosa, and halitosis. Oral dryness can affect denture retention, mastication, and swallowing. Dry mouth symptom can be treated with hydration and sialagogues or with artificial saliva substitutes. Because patients are at risk for dental caries, they should be referred to a dentist for preventive care. In patients with Sjögren's syndrome and in those who have undergone radiation therapy, pilocarpine has been used recently with good results.
Tympanoplasty in Geriatric Patients: Surgical Considerations
Authors: Radpour Shokri 
Published: May 2019

The outcomes of tympanoplasty in the elderly are generally no different from those in the young. Although some reports suggest that hearing results were not as good in patients older than 60, the instance of graft failure in these patients did not differ greatly by age. Patients older than 65 do have the highest incidence of perioperative death or complications, with elderly men being at a greater risk than elderly women. The risk is also higher inpatients who have concomitant diseases, such as coronary artery disease, congestive heart failure, myocardial infarction, diabetes mellitus, hypertension, renal disease, chronic obstructive pulmonary disease, cerebral vascular disease, dementia, and peripheral vascular disease. The presence of coexisting disease is more important than age itself although physiologic age is more important than chronological age.
Cochlear Implants in the Geriatric Population: Benefits Outweigh Risks
Authors: Buchman Craig A. , Fucci Michael J. , Luxford William M. 
Published: May 2019

Cochlear implantation has become widely accepted as an effective means of hearing rehabilitation in severely and profoundly deaf individuals. In the elderly, cochlear implantation involves a number of unique issues that can affect patient outcomes. These factors include age-related changes in the auditory system, prolonged durations of deafness, diminished communication abilities, and coexisting medical and psychosocial problems. In general, the results of cochlear implantation in the elderly have been comparable with those of younger adults. Perioperative attention to medical and surgical details allows for safe insertion and a minimum of postoperative complications. Patients older than 65 have obtained excellent results by both audiologic and quality-of-life measures.
Decreasing impact of late relapses on disability worsening in secondary progressive multiple sclerosis
Authors: Ahrweiller Kevin , Rousseau Chloé , Le Page Emmanuelle , Bajeux Emma , Leray Emmanuelle , Michel Laure , Edan Gilles , Kerbrat Anne 
Published: May 2019

Background: Changes in relapse activity during secondary progressive multiple sclerosis (SPMS) need to be accurately characterized in order to identify patients who might benefit from continuing disease-modifying therapies. Objective: To describe relapse occurrence in patients with SPMS during long-term follow-up and assess its impact on disability worsening. Methods: This retrospective cohort study included 506 patients. We assessed the influence of relapses on time from SPMS onset to an Expanded Disability Status Scale score of 6 (EDSS 6), and on irreversible worsening of EDSS scores across different periods. Results: The annualized relapse rate (ARR) decreased with patient’s age (mean reduction of 43% per decade) and SPMS duration (mean reduction of 46% every 5 years). Post-progression relapses were associated with shorter time from secondary progressive (SP) phase onset to EDSS 6 (hazard ratio (HR) = 1.29, 95% confidence interval (CI) = (1.01, 1.64)). Relapse occurrence during the first 3 years and 3–5 years after SP onset was associated with an increased risk of irreversible EDSS worsening (OR = 3.12 (1.54, 6.31) and 2.04 (1.16, 3.58)). This association was no longer significant after 5 years. Conclusion: The occurrence of relapses was a marker of short-term disability progression during early SPMS, but did not have decisive impact in later SPMS.
Young African American women’s participation in an m-Health study in cardiovascular risk reduction: Feasibility, benefits, and barriers
Authors: Kathuria-Prakash N , Moser DK , Alshurafa N , Watson K , Eastwood JA 
Published: May 2019

Background: Young black women have an increased risk of cardiovascular disease, and thus identifying innovative prevention strategies is essential. A potential preventive strategy is mobile health; however, few studies have tested this strategy in young black women. Aim: The purpose of this study was to assess the feasibility of a mobile health intervention through a digital application to reduce cardiovascular disease risk factors in young black women, and identify benefits and barriers to participation. Methods: Forty black women aged 25–45 years completed four sessions of cardiovascular disease risk reduction education and a six-month smartphone cardiovascular disease risk reduction monitoring and coaching intervention, targeting heart-healthy behavior modifications. At follow-up, women responded to a semi-qualitative online survey assessing the user-friendliness and perceived helpfulness of the intervention. Results: Of 40 women, 38 completed the follow-up survey. Sixty per cent of participants reported that the applications were easy or very easy to maintain, 90% reported that the application was easy or very easy to use. Over 60% observed that their family’s nutrition improved “a lot” or “a medium amount,” and many participants noted positive changes in their children’s diets. Only 8% of participants cited time or cost required to prepare healthy foods as barriers to implementing dietary changes. Conclusions: The m-Health intervention was feasible as a means of cardiovascular disease risk reduction for young black women. In addition, we found that targeting women provided indirect benefits for other family members, especially children. Most of the participants did not encounter systemic barriers to participation, suggesting that mobile health interventions can be effective tools to improve health behaviors in vulnerable populations.
Socioeconomic position and intergenerational associations of ideal health behaviors
Authors: Komulainen Kaisla , Mittleman Murray A , Jokela Markus , Laitinen Tomi T , Pahkala Katja , Elovainio Marko , Juonala Markus , Tammelin Tuija , Kähönen Mika , Raitakari Olli , Keltikangas-Järvinen Liisa , Pulkki-Råback Laura 
Published: May 2019

BackgroundPromoting ideal cardiovascular health behaviors is an objective of the American Heart Association 2020 goals. We hypothesized that ideal health behaviors of parents are associated with health behaviors of their adult offspring, and that higher socioeconomic position in either generation enhances intergenerational associations of ideal health behaviors.DesignProspective cohort study.MethodsWe included 1856 Young Finns Study participants who had repeated measurements of socioeconomic position (education, income, occupation), smoking status, body mass index, physical activity and diet from 2001, 2007 and 2011, and data on parental socioeconomic position and health behaviors from 1980. We calculated the total number of ideal behaviors in both generations using American Heart Association definitions. Intergenerational associations were examined using ordinal and linear multilevel regression with random intercepts, in which each participant contributed one, two or three measurements of adult health behaviors (2001, 2007, 2011). All analyses were adjusted for offspring sex, birth year, age, parental education and single parenthood.ResultsOverall, parental ideal health behaviors were associated with ideal behaviors among offspring (odds ratio (OR) 1.28, 95% confidence interval 1.17, 1.39). Furthermore, ORs for these intergenerational associations were greater among offspring whose parents or who themselves had higher educational attainment (OR 1.56 for high vs. OR 1.19 for low parental education; P = 0.01 for interaction, OR 1.32 for high vs. OR 1.04 for low offspring education; P = 0.02 for interaction). Similar trends were seen with parental income and offspring occupation. Results from linear regression analyses were similar.ConclusionsThese prospective data suggest higher socioeconomic position in parents or in their adult offspring strengthens the intergenerational continuum of ideal cardiovascular health behaviors.
Salience Network Disruption in U.S. Army Soldiers With Posttraumatic Stress Disorder
Authors: Abdallah Chadi G. , Averill Christopher L. , Ramage Amy E. , Averill Lynnette A. , Goktas Selin , Nemati Samaneh , Krystal John H. , Roache John D. , Resick Patricia A. , Young-McCaughan Stacey , Peterson Alan L. , Fox Peter ,   the STRONG STAR Consortium
Published: May 2019

Background Better understanding of the neurobiology of posttraumatic stress disorder (PTSD) may be critical to developing novel, effective therapeutics. Here, we conducted a data-driven investigation using a well-established, graph-based topological measure of nodal strength to determine the extent of functional dysconnectivity in a cohort of active duty U.S. Army soldiers with PTSD compared to controls. Methods A total of 102 participants with (n = 50) or without PTSD (n = 52) completed functional magnetic resonance imaging at rest and during symptom provocation using subject-specific script imagery. Vertex/voxel global brain connectivity with global signal regression (GBCr), a measure of nodal strength, was calculated as the average of its functional connectivity with all other vertices/voxels in the brain gray matter. Results In contrast to resting state, where there were no group differences, we found a significantly higher GBCr during symptom provocation, in PTSD participants compared to controls, in areas within the right hemisphere, including anterior insula, caudal-ventrolateral prefrontal, and rostral-ventrolateral parietal cortices. Overall, these clusters overlapped with the ventral and dorsal salience networks. Post hoc analysis showed increased GBCr in these salience clusters during symptom provocation compared to resting state. In addition, resting-state GBCr in the salience clusters predicted GBCr during symptom provocation in PTSD participants but not in controls. Conclusion In PTSD, increased connectivity within the salience network has been previously hypothesized, based primarily on seed-based connectivity findings. The current results strongly support this hypothesis using whole-brain network measure in a fully data-driven approach. It remains to be seen in future studies whether these identified salience disturbances would normalize following treatment.
Follicular Regulatory T Cells Are Associated With β-Cell Autoimmunity and the Development of Type 1 Diabetes
Authors: Xu Xinyu , Shen Min , Zhao Ruiling , Cai Yun , Jiang Hemin , Shen Ziyang , Gao Rui , Xu Kuanfeng , Chen Heng , Yang Tao 
Published: May 2019

AbstractObjectiveImpaired follicular regulatory T (Tfr) cells enhance T follicular helper cells activity, resulting in the expansion of autoreactive B cells and autoantibody production. However, the role of Tfr cells in the pathogenesis of type 1 diabetes (T1D) is unclear.DesignWe evaluated the expression and changes in function of circulating Tfr cells by studying patients with T1D alongside those with type 2 diabetes (T2D), first-degree relatives of T1D patients, and healthy controls. We also investigated the effects of Tfr cells on disease development in nonobese diabetic (NOD) mice and in an adoptive transfer model.ResultsTfr cells were significantly decreased in both patient groups. However, they showed different correlations with fasting C-peptide (C-P) and the area under the curve of blood C-P in patients with T1D and T2D. The frequency of Tfr cells was associated with the number of positive autoantibodies and the titer of glutamic acid decarboxylase autoantibody in T1D patients. Furthermore, Tfr cells decreased significantly after 1 year of follow-up. We also observed Tfr cells in four T1D patients treated with rituximab. After rituximab therapy, the frequency of C-X-C motif chemokine receptor 5 (CXCR5)+ programmed death 1+ Tfr cells was decreased and of CXCR5+ inducible costimulator+ Tfr cells was increased in three patients. We also found that Tfr cells were associated with the development of diabetes in NOD mice and an adoptive transfer model.ConclusionsTfr cell deficiency could be involved in the pathogenesis of T1D. Therapy with Tfr cells has potential value for T1D. Modulation of these cells may enhance protective immunity to inhibit autoimmune diabetes.
Mechanisms of intercellular Wnt transport
Authors: Routledge Daniel , Scholpp Steffen 
Published: May 2019

ABSTRACT
Wnt proteins are secreted glycoproteins that regulate multiple processes crucial to the development and tissue homeostasis of multicellular organisms, including tissue patterning, proliferation, cell fate specification, cell polarity and migration. To elicit these effects, Wnts act as autocrine as well as paracrine signalling molecules between Wnt-producing and Wnt-receiving cells. More than 40 years after the discovery of the Wg/Wnt pathway, it is still unclear how they are transported to fulfil their paracrine signalling functions. Several mechanisms have been proposed to mediate intercellular Wnt transport, including Wnt-binding proteins, lipoproteins, exosomes and cytonemes. In this Review, we describe the evidence for each proposed mechanism, and discuss how they may contribute to Wnt dispersal in tissue-specific and context-dependent manners, to regulate embryonic development precisely and maintain the internal steady state within a defined tissue.
Association between Bout Duration of Physical Activity and Health: Systematic Review
Authors: JAKICIC JOHN M. , KRAUS WILLIAM E. , POWELL KENNETH E. , CAMPBELL WAYNE W. , JANZ KATHLEEN F. , TROIANO RICHARD P. , SPROW KYLE , TORRES ANDREA , PIERCY KATRINA L. 
Published: May 2019

ABSTRACT

Purpose
This study aimed to conduct a systematic literature review to determine whether physical activity episodes of <10 min in duration have health-related benefits or, alternatively, if the benefits are only realized when the duration of physical activity episodes is ≥10 min.

Methods
The primary literature search was conducted for the 2018 Physical Activity Guidelines Advisory Committee Report and encompassed literature through June 2017, with an additional literature search conducted to include literature published through March 2018 for inclusion in this systematic review.

Results
The literature review identified 29 articles that were pertinent to the research question that used either cross-sectional, prospective cohort, or randomized designs. One prospective cohort study (N = 4840) reported similar associations between moderate to vigorous physical activity (MVPA) and all-cause mortality when examined as total MVPA, MVPA in bouts ≥5 min in duration, or MVPA in bouts ≥10 min in duration. Additional evidence was identified from cross-sectional and prospective studies to support that bouts of physical activity <10 min in duration are associated with a variety of health outcomes. Randomized studies only examined bouts of physical activity ≥10 min in duration.

Conclusions
The current evidence, from cross-sectional and prospective cohort studies, supports that physical activity of any bout duration is associated with improved health outcomes, which includes all-cause mortality. This may suggest the need for a contemporary paradigm shift in public health recommendations for physical activity, which supports total MVPA as an important lifestyle behavior regardless of the bout duration.
The relationship between maternal stress during pregnancy and up to two years after birth and risk of child overweight and obesity: Protocol for a Systematic Review
Authors: Cooney Jennifer , Flannery Caragh , Khashan Ali S. , Huizink Anja C. , Matvienko-Sikar Karen 
Published: May 2019

Background: Childhood obesity presents a significant public health challenge globally. The period from conception to two years after birth, the first 1000 days, represents a critical period during which the experience of maternal stress may be related to the development of childhood obesity. Research to date suggests some positive associations between maternal stress during the first 1000 days and childhood obesity, but findings are inconsistent and have not yet been comprehensively synthesised. The purpose of this review is to systematically examine the association between maternal stress during the first 1000 days and the risk of child overweight and obesity. Methods: The following electronic databases will be searched from inception using a detailed search strategy: the Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, Maternity and Infant Care, and Web of Science. Cohort, case-control, and cross-sectional studies examining maternal stress during the first 1000 days and child overweight and obesity up to the age of 10 years will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies. A standardised data extraction form will be used to extract data including: study design; maternal stress exposure; child outcome; exclusion criteria; participant characteristics; and assessment methods. The Cochrane Collaboration’s bias classification tool for observational studies will be used to assess study quality. This protocol is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol (PRISMA-P) checklist, and the systematic review will be conducted and reported following the PRISMA checklist. If possible, random effects models will be used to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study as it will not involve conducting experimental research, nor include identifying personal data. The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018100363
Molecular characterization of rotavirus group A strains circulating prior to vaccine introduction in rural coastal Kenya, 2002-2013
Authors: Owor Betty E. , Mwanga Mike J. , Njeru Regina , Mugo Robert , Ngama Mwanajuma , Otieno Grieven P. , Nokes D.J. , Agoti C.N. 
Published: May 2019

Background: Kenya introduced the monovalent Rotarix® rotavirus group A (RVA) vaccine nationally in mid-2014. Long-term surveillance data is important prior to wide-scale vaccine use to assess the impact on disease and to investigate the occurrence of heterotypic strains arising through immune selection. This report presents baseline data on RVA genotype circulation patterns and intra-genotype genetic diversity over a 7-year period in the pre-vaccine era in Kilifi, Kenya, from 2002 to 2004 and from 2010 to 2013. Methods: A total of 745 RVA strains identified in children admitted with acute gastroenteritis to a referral hospital in Coastal Kenya, were sequenced using the di-deoxy sequencing method in the VP4 and VP7 genomic segments (encoding P and G proteins, respectively). Sequencing successfully generated 569 (76%) and 572 (77%) consensus sequences for the VP4 and VP7 genes respectively. G and P genotypes were determined by use of BLAST and the online RotaC v2 RVA classification tool. Results: The most common GP combination was G1P[8] (51%), similar to the Rotarix® strain, followed by G9P[8] (15%) , G8P[4] (14%) and G2P[4] (5%). Unusual GP combinations—G1P[4], G2P[8], G3P[4,6], G8P[8,14], and G12P[4,6,8]—were observed at frequencies of <5%. Phylogenetic analysis showed that the infections were caused by both locally persistent strains as evidenced by divergence of local strains occurring over multiple seasons from the global ones, and newly introduced strains, which were closely related to global strains. The circulating RVA diversity showed temporal fluctuations both season by season and over the longer-term. None of the unusual strains increased in frequency over the observation period. Conclusions: The circulating RVA diversity showed temporal fluctuations with several unusual strains recorded, which rarely caused major outbreaks. These data will be useful in interpreting genotype patterns observed in the region during the vaccine era.
Salinización de suelos de textura fina por ascenso capilar a partir del acuífero freático hipersalino somero (Bahía Blanca, Argentina)
Authors: Scherger Leonardo Ezequiel , Lexow Claudio , Zanello Victoria , Castoldi Micaela Carbajo 
Published: May 2019

O setor sudoeste da cidade de Bahia Blanca, Argentina é caracterizado pela presença de solos de textura fina e um aquífero hipersalino raso, condições que causam a acumulação de sais nos níveis superficiais do solo. Este estudo tem por objetivo determinar os principais mecanismos de mobilidade e acumulação de sais em um solo limo-argiloso, aplicando o software HYDRUS 2D/3D. O movimento de sais no perfil do solo está ligado à hidrodinâmica naturais da zona não saturada, onde os processos de capilaridade e evapotranspiração são o principal acumulador de agentes solutos. Os períodos de maior acumulação correspondem aos meses quentes e secos, com alta demanda de umidade na atmosfera. Nestas condições, concentrações salinas são geradas nos níveis superficiais do solo de até 18.000 mg.L-1. A precipitação pluviométrica permite o ingresso de água de baixa salinidade ao perfil do solo, causando os processos de lavagem e diluição. Os sais são transportados para os níveis mais baixos da zona não saturada, efeito visível em anos pluviométricamente húmidos. As concentrações simuladas na franja capilar manteve-se na gama de entre 3000 mg.L-1 e 10 000 mg.L-1. Conhecer o processo de salinização do solo em áreas urbanas é fundamental para mitigar as consequências das áreas afetadas.