bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etiology of Shock in the Emergency Department: A 12-Year Population-Based Cohort Study
Authors: Gitz Holler Jon , Jensen Helene Kildegaard , Henriksen Daniel Pilsgaard , Rasmussen Lars Melholt , Mikkelsen Søren , Pedersen Court , Lassen Annmarie Touborg 
Published: December 2016

ABSTRACT

Introduction:
The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology-based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED.

Methods:
Population-based cohort study at a University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first-time ED presentation with shock (n = 1,553) defined as hypotension (systolic blood pressure ≤100 mm Hg) and ≥1 organ failures were included. Discharge diagnoses defined the etiology and were grouped as follows: distributive septic shock (SS), distributive non-septic shock (NS), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS), and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per 100,000 person-years at risk (95% confidence intervals [CIs]), mortality at 0 to 7-, and 0 to 90 days (95% CIs) and hazard rates (HR) at 0 to 7, 8 to 90 days (95% CIs). Poisson and Cox regression models were used for analyses.

Results:
Among 1,553 shock patients: 423 (27.2%) had SS, 363 (23.4%) NS, 217 (14.0%) CS, 479 (30.8%) HS, 14 (0.9%) OS, and 57 (3.7%) OC. The corresponding IRs were 16.2/100,000 (95% CI: 14.8–17.9), 13.9/100,000 (95% CI: 12.6–15.4), 8.3/100,000 (95% CI: 7.3–9.5), 18.4/100,000 (95% CI: 16.8–20.1), 0.5/100,000 (95% CI: 0.3–0.9), and 2.2/100,000 (95% CI: 1.7–2.8). SS IR increased from 8.4 to 28.5/100,000 during the period 2000 to 2011. Accordingly, the 7-, and 90-day mortalities of SS, NS, CS, and HS were 30.3% (95% CI: 25.9–34.7) and 56.2% (95% CI: 50.7–61.5), 12.7% (95% CI: 9.2–16.1) and 22.6% (95% CI: 18.1–27.7), 34.6% (95% CI: 28.2–40.9) and 52.3% (95% CI: 44.6–59.8), 19.2% (95% CI: 15.7–22.7), and 36.8% (95% CI: 33.3–43.3). SS (HR = 1.46 [95% CI: 1.03–2.07]), and CS (HR = 2.15 [95% CI: 1.47–3.13]) were independent predictors of death within 0 to 7 days, whereas SS was a predictor within 8 to 90 days (HR = 1.66 [95% CI: 1.14–2.42]).

Conclusion:
HS and SS are frequent etiological characteristics followed by NS and CS, whereas OS is a rare condition. We confirm the increasing trend of SS, as previously reported. Seven-day mortality ranged from 12.7% to 34.6%, while 90-day mortality ranged from 22.6% to 56.2%. The underlying etiology was an independent predictor of mortality.
Palliative care in pulmonary arterial hypertension
Authors: Gin-Sing Wendy 
Published: December 2016

Purpose of review
Developments in the management of pulmonary arterial hypertension have significantly improved prognosis changing this from an acute to a chronic disease. Despite optimal treatment many patients still have a high-symptom burden both because of the disease and the side-effects of therapy, consequently there is an increasing need for a palliative care approach to improve the quality of life for this patient group. This review article will outline the need for palliative care support for patients with pulmonary arterial hypertension, discuss the barriers that currently exist and suggest how this may be improved.

Recent findings
Studies have been conducted which explore the role of palliative care in pulmonary arterial hypertension including physicians attitudes and the current barriers that exist to prevent its implementation.

Summary
Specialist palliative support is utilized in the minority of patients with pulmonary arterial hypertension despite a need for symptom control. Patients may benefit from the introduction of a palliative care approach as part of their standard care, but to achieve this there needs to be a greater understanding of the role of palliative care by both clinicians and patients and more research into the benefits for patients with pulmonary arterial hypertension.
Opposing transcriptional mechanisms regulateToxoplasmadevelopment
Authors: Hong Dong-Pyo , Radke Joshua B. , White Michael W. 
Published: December 2016

ABSTRACTTheToxoplasmabiology that underlies human chronic infection is developmental conversion of the acute tachyzoite stage into the latent bradyzoite stage. We investigated the role of two alkaline-stress induced ApiAP2 transcription factors, AP2IV-3 and AP2IX-9, in bradyzoite development. These factors were expressed in two overlapping waves during bradyzoite development with AP2IX-9 increasing expression earlier than AP2IV-3, which peaked as AP2IX-9 expression was declining. Disruption of the AP2IX-9 gene enhanced, while deletion of AP2IV-3 gene decreased tissue cyst formation demonstrating these factors have opposite functions in bradyzoite development. Conversely, conditional overexpression of FKBP-modified of AP2IX-9 or AP2IV-3 with the small molecule Shield 1 had a reciprocal effect on tissue cyst formation confirming the conclusions of the knockout experiments. The AP2IX-9 repressor and AP2IV-3 activator tissue cyst phenotypes were borne out in gene expression studies that determined many of the same bradyzoite genes were regulated in an opposite manner by these transcription factors. A common gene target was the canonical bradyzoite marker, BAG1, and mechanistic experiments determined that like AP2IX-9, AP2IV-3 regulates a BAG1 promoter-luciferase reporter and specific binds the BAG1 promoter in parasite chromatin. Altogether, these results suggest the AP2IX-9 transcriptional repressor and AP2IV-3 transcriptional activator likely compete to control bradyzoite gene expression, which may permitToxoplasmato better adapt to different tissue environments and select a suitable host cell for long term survival of the dormant tissue cyst.IMPORTANCEToxoplasmainfections are life-long due to the development of the bradyzoite tissue cyst, which is effectively invisible to the immune system. Despite the important clinical consequences of this developmental pathway, the molecular basis of the switch mechanisms that control formation of the tissue cyst is still poorly understood. Significant changes in gene expression are associated with tissue cyst development and ApiAP2 transcription factors are an important mechanism regulating this developmental transcriptome. However, the molecular composition of these ApiAP2 mechanisms are not well defined and the operating principles of ApiAP2 mechanisms are poorly understood. Here we establish that competing ApiAP2 transcriptional mechanisms operate to regulate this clinically important developmental pathway.
Aggressive behaviours track transitions in seasonal phenotypes of female Siberian hamsters
Authors: Rendon Nikki M. , Amez Andrea C. , Proffitt Melissa R. , Bauserman Elizabeth R. , Demas Gregory E. 
Published: December 2016

Summary

Seasonally breeding animals exhibit profound physiological and behavioural responses to changes in ambient day length (photoperiod), including changes in reproductive function and territorial aggression.

Species where aggression persists when gonads are regressed and circulating levels of gonadal hormones are low, such as Siberian hamsters (Phodopus sungorus) and song sparrows (Melospiza melodia), challenge the well‐established framework that gonadal hormones are important mediators of aggression.

A solution to this apparent paradox is that a season‐specific increase in sensitivity to hormones in brain areas associated with aggression offsets low gonadal hormone levels during periods of reproductive quiescence.

To test this hypothesis, we manipulated photoperiod to induce natural fluctuations in seasonal phenotype across multiple stages of the annual reproductive cycle in female Siberian hamsters that display increased aggression during short‐day reproductive quiescence, suggesting that behaviour persists independent of gonadal steroids.

Females were housed in long ‘summer’ days or short ‘winter’ days for 10, 24 or 30 weeks to capture gonadal regression, a transition back to a reproductively functional state and full gonadal recrudescence, respectively.

Long‐day animals maintained reproductive functionality and displayed low aggression across all time points. By week 10, short‐day reproductively responsive females underwent gonadal regression and displayed increased aggression; non‐responsive animals showed no such changes. At week 24, animals were in a transitional period and displayed an intermediate phenotype with respect to reproduction and aggression. By week 30, short‐day females were fully recrudesced and returned to long‐day‐like levels of aggression.

Consistent with our hypothesis, gonadally regressed females displayed decreases in 17β‐oestradiol (oestradiol) levels, but site‐specific increases in the abundance of brain oestrogen receptor‐alpha (ERα) in regions associated with aggression, but not reproduction. Increased site‐specific ERα may function as a compensatory mechanism to allow increased responsiveness to oestradiol in regulating aggression in lieu of high circulating concentrations of hormones.

Collectively, these results broaden our understanding of how breeding phenology maps onto social behaviour and the mechanisms that have evolved to coordinate behaviours that occur in non‐breeding contexts.

A lay summary is available for this article.
Extended dispersal kernels in a changing world: insights from statistics of extremes
Authors: García Cristina , Borda‐de‐Água Luís 
Published: December 2016

Summary

Dispersal ecology is a topical discipline that involves understanding and predicting plant community responses to multiple drivers of global change. Propagule movements that entail long‐distance dispersal (LDD) events are crucial for plants to reach and colonize suitable sites across fragmented landscapes. Yet, LDD events are extremely rare, and thus, obtaining reliable estimates of the maximum distances that propagules move across and of their frequency has been a long‐lasting challenge in plant ecology. Recent advances in dispersal ecology have provided reliable records of dispersal distances, but they remain confined to focal populations, limiting our ability to infer the frequency and actual extent of LDD events across landscapes.

In this study, we view LDD events as extreme values of a dispersal function, and we apply statistics of extremes to derive the frequency and extent of LDD events of simulated and empirical data sets. We first briefly explain the rationale behind statistics of extremes, and we then illustrate how dispersal ecology can benefit conceptually and analytically from applying extreme value analyses. We apply the block maxima approach to simulated seed shadows, and we apply the peak over a threshold method to empirical data sets that contain pollen and seed dispersal distances recorded for a population of Prunus mahaleb, an insect‐pollinated and vertebrate‐dispersed tree species.

Diagnostic plots reveal a distance threshold of υ = 80 m for pollen grains and of υ = 170 m for dispersed seeds. Values that exceed the threshold fit a light‐tailed distribution function for pollen and fit a fat‐tailed Pareto distribution for seed dispersal distances. Both distribution functions estimate a low (but nonzero) conditional probability of reaching distant locations, extending well beyond the borders of our focal population as follows: Pr (X ≥ 1 km) = 9 × 10−5 for pollen grains and Pr (X ≥ 10 km) = 7 × 10−5 for dispersed seeds.

Synthesis. Dispersal ecologists can take the most of their dispersal distance records by applying statistics of extremes to infer the probability of occurrence of extremely rare, but crucial, long distance dispersal events that reach locations well beyond focal populations.
What is long‐distance dispersal? And a taxonomy of dispersal events
Authors: Jordano Pedro 
Published: December 2016

Summary

Dispersal is a key individual‐based process influencing many life‐history attributes and scaling up to population‐level properties (e.g. metapopulation connectivity). A persistent challenge in dispersal ecology has been the robust characterization of dispersal functions (kernels), a fundamental tool to predict how dispersal processes respond under global change scenarios. Particularly, the rightmost tail of these functions, that is the long‐distance dispersal (LDD) events, are difficult to characterize empirically and to model in realistic ways.

But, when is it a LDD event? In the specific case of plants, dispersal has three basic components: (i) a distinct (sessile) source, the maternal plant producing the fruits or the paternal tree acting as a source of pollen; (ii) a distance component between source and target locations; and (iii) a vector actually performing the movement entailing the dispersal event. Here, I discuss operative definitions of LDD based on their intrinsic properties: (i) events crossing geographic boundaries among stands; and (ii) events contributing to effective gene flow and propagule migration.

Strict‐sense long‐distance dispersal involves movement both outside the stand geographic limits and outside the genetic neighbourhood area of individuals. Combinations of propagule movements within/outside these two spatial reference frames result in four distinct modes of LDD.

Synthesis. I expect truncation of seed dispersal kernels to have multiple consequences on demography and genetics, following to the loss of key dispersal services in natural populations. Irrespective of neighbourhood sizes, loss of LDD events may result in more structured and less cohesive genetic pools, with increased isolation by distance extending over broader areas. Proper characterization of the LDD events helps to assess, for example, how the ongoing defaunation of large‐bodied frugivores pervasively entails the loss of crucial LDD functions.
Dispersal processes driving plant movement: challenges for understanding and predicting range shifts in a changing world
Authors: García Cristina , Klein Etienne K. , Jordano Pedro 
Published: December 2016

Summary

Dispersal ecology is a broad topical discipline that tackles important conceptual and applied issues, such as the study of the ability of plants to transmit their propagules across fragmented and managed landscapes.

The relevance of dispersal for plant populations is threefold because: (i) dispersal processes scale from genes and individuals that disperse (or produce propagules to be dispersed) to population dynamics and both local and regional distribution patterns; (ii) by dispersing propagules or individuals and the genes they carry, dispersal inherently links demographic and genetic dynamics across the landscape; and (iii) dispersal elicits key ecological and evolutionary processes that sustain biodiversity, such as species assembly in species‐rich communities. The steady improvement of tracking devices and molecular tools that trace the movement or infer provenance of organisms and the pressing need to address conservation issues have expanded the disciplinary boundaries of dispersal ecology.

The discussion on the main advances on and challenges for dispersal ecology was the main motivation for the organization of a thematic topic session entitled Dispersal processes driving plant movement: challenges for understanding and predicting range shifts in a changing world at the Annual Meeting of the British Ecological Society (2015, Edinburgh). This session brought together researchers with different types of expertise and interests on dispersal processes and their contributions are now included in this special feature together with a few additional articles.

Synthesis. Overall, this special feature illustrates that dispersal ecology spans a broad range of research topics by integrating eight contributions that cover key aspects of this discipline: from conceptual and methodological advances to the study of the ecological and evolutionary outcomes.
Relationships as Medicine: Quality of the Physician–Patient Relationship Determines Physician Influence on Treatment Recommendation Adherence
Authors: Orom Heather , Underwood Willie , Cheng Zinan , Homish D. Lynn , Scott I'Yanna 
Published: December 2016

ObjectiveTo determine whether quality of physician–patient relationships influences uptake of physician treatment recommendations in men with clinically localized prostate cancer (PCa).Study SettingData were collected July 2010 to August 2014 at two cancer centers and three community facilities.Study DesignAnalyses were prospective and cross‐sectional. We modeled associations between quality of the patient–physician relationship and influence of physician recommendations on treatment choice using generalized estimating equations (GEE).Data CollectionData were collected via survey and medical record abstraction.Principal FindingsParticipants (N = 1166) were 14.7 percent minority; 37.1 percent had low‐, 47.5 percent had intermediate‐, and 15.4 percent had high‐risk PCa. Those reporting a better physician–patient relationship perceived that their physician's treatment recommendation was more influential (RR = 1.05, 95 percent CI = 1.04–1.05, p < .001) and were more likely to choose the recommended treatment (OR = 2.92, 95 percent CI = 2.39, 3.58, p < .001). A pattern of interactions emerged indicating that quality of the physician–patient relationship was more strongly associated with influence of recommendations for more, versus less aggressive treatment in those with low‐risk, but not intermediate‐risk disease.ConclusionsPrioritizing quality of the physician–patient relationship through training, practice change, and patient feedback may increase adherence. However, strategies need to align with efforts to reduce physician recommendations for inefficacious treatments to prevent overtreatment.
Changes in Attenuated Total Reflection Fourier Transform Infrared Spectra as Blood Dries Out
Authors: Zhang Yinming , Wang Qi , Li Bing , Wang Zhijun , Li Chengzhi , Yao Yao , Huang Ping , Wang Zhenyuan 
Published: December 2016

AbstractThe time since deposition (TSD) of a bloodstain is a valuable piece of evidence for forensic scientists to determine the time at which a crime took place. The objective of this study was to determine whether attenuated total reflection (ATR) Fourier transform infrared (FTIR) spectroscopy could be used to estimate the TSD of a bloodstain in a relatively early period (from 0 min to the time required for the bloodstain to dry out). For this purpose, we used ATR‐FTIR to study the variation in absorbance at certain wavelengths as rat and human blood sample dried out. The absorbance at 3308/cm (A3308) was found to have a close correlation with the TSD during this time period, and the changes in A3308 during the drying of rat and human blood drops under the same controlled conditions showed similar results. The current study indicates that ATR‐FTIR spectroscopy has potential as a tool for estimating TSD at early time periods of blood deposition.
Severe Retinal Hemorrhages with Retinoschisis in Infants are Not Pathognomonic for Abusive Head Trauma
Authors: Shuman Mark J. , Hutchins Kenneth D. 
Published: December 2016

AbstractThe combination of subdural hemorrhage (SDH), retinal hemorrhage (RH), and encephalopathy, or the presence of severe retinal hemorrhages alone in infants, is often attributed to and has been stated to be pathognomonic for abusive head trauma (AHT) or shaken baby syndrome. These beliefs have been challenged, because the same constellation of findings has been identified in accidental head injuries and natural diseases, and most if not all of the studies that support the concept of diagnostic specificity have serious flaws in their methodology. Presented here are two cases of severe retinal hemorrhages with retinoschisis associated with subdural hemorrhage in a natural disease and with severe cerebral edema in an accidental head injury. These cases challenge the dogma that severe retinal hemorrhages with retinoschisis are pathognomonic for AHT.
Death Due to Decapitation in Two Motorcyclists: A Description of a Unique Case and a Brief Review of the Literature
Authors: Osculati Antonio , Visonà Silvia D. , Della Chiesa Laura , Navarra Filippo , Calbi Andrea , Andrello Luisa 
Published: December 2016

AbstractDeaths due to decapitation, especially related to traffic accidents, are rarely found in forensic practice. The present case involves a man and a woman who died from decapitation due to an unusual mechanism while they were riding on a motorbike down a mountain road. The autopsy, which was completed as a physics study, allowed the accident to be reconstructed as follows: A plastic cable that had detached from a timber‐transporting machine whipped the road and hit the two motorcyclists. The impact resulted in the complete severing of both riders’ heads. Involving different scientists in this accident investigation was crucial to understanding the dynamics of the accident. In fact, in addition to scene inspection and autopsy, a physics study was carried out on the cable and the clamp involved, which led to an explanation for the abrupt movement of the cable and, thus, to a thorough reconstruction of the accident.
Self‐Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review
Authors: Mannarino Victor S. , Pereira Débora C. S. , Gurgel Wagner S. , Costa Carolina B. F. , Valença Alexandre M. , Fontenelle Leonardo F. , Mendlowicz Mauro V. 
Published: December 2016

AbstractSelf‐embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty‐two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two‐thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.