bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clients who cannot afford to pay
Authors: Fawcett Anne , Chadwick Myles 
Published: January 2018

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Clients who cannot afford to pay’, was submitted and is discussed by Anne Fawcett and Myles Chadwick. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.The series is being coordinated by Dr Steven McCulloch, acting director of the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
‘Porcelain aorta’: a proposed definition and classification of ascending aortic calcification
Authors: Snow Thomas , Semple Thomas , Duncan Alison , Barker Sarah , Rubens Michael , DiMario Carlo , Davies Simon , Moat Neil , Nicol Edward David 
Published: January 2018

Introduction‘Porcelain aorta’ is listed in the second consensus document of the Valve Academic Research Consortium as a risk factor in aortic valve replacement. However, the extent of circumferential involvement is poorly defined with great variability in reported incidence. We present a simple, reproducible classification to describe the extent of aortic calcification and thus appropriately define ‘porcelain aorta’, aiding clinical decision-making and registry data collection.Methods175 consecutive CT aortograms were reviewed. The aorta was divided into three sections, and each section divided into quadrants. These were individually scored using a 5-point scale (0—no calcification, 5—complete contiguous calcification).Results for each quadrant were summated for each segment to provide an indication of the distribution of calcification.ResultsOnly one patient (0.6%) had a ‘true’ porcelain aorta, defined as contiguous calcification across all quadrants at any aortic level. Intraobserver and interobserver variation was excellent for the ascending aorta (K=0.85–0.88 and 0.81–0.96, respectively) while the interobserver variation in the transverse arch was good at 0.75.ConclusionsOur data suggest the incidence of ‘true’ porcelain aorta may be significantly lower than reported in the literature. The predominance of calcification within the anterior wall of the proximal ascending aorta and the superior wall of the transverse arch may be clinically important. Application of this quick, simple and reproducible grading system, with no requirement for advanced software, may provide a tool to support accurate assessment of focal aortic calcification and its relationship to subsequent procedural risk.
Emergency intraoperative transcutaneous pacing in a dog undergoing a high‐pressure balloon inflation to relieve severe subaortic stenosis
Authors: Norgate Daisy Jessica , Pelligand Ludovic 
Published: January 2018

A 23‐week‐old, 25.7 kg Rottweiler presented with a grade V/VI left and right basilar systolic heart murmur with no other clinical signs. Echocardiography revealed severe congenital subaortic stenosis. The dog was given a poor prognosis due to a high risk of sudden death. A high‐pressure balloon valvuloplasty was performed to reduce the pressure gradient. Immediately following the balloon inflation, the dog experienced complete atrioventricular block without a ventricular escape, and a rapid reduction in end‐tidal carbon dioxide. In order to restore cardiac output, the dog was immediately paced transcutaneously. Normal sinus rhythm was restored 15 minutes after initiation of pacing, after which pacing was stopped. The remainder of the anaesthetic was uneventful; the dog recovered well and was discharged 48 hours later with no reoccurrence of atrioventricular block. The ability to perform immediate transcutaneous pacing was instrumental to this dog’s survival.
An introduction to the Triassic: current insights into the regional setting and energy resource potential of NW Europe
Authors: Geluk Mark , McKie Tom , Kilhams Ben 
Published: January 2018

Abstract
A review of recent Triassic research across the Southern Permian Basin area demonstrates the role that high-resolution stratigraphic correlation has in identifying the main controls on sedimentary facies and, subsequently, the distribution of hydrocarbon reservoirs. The depositional and structural evolution of these sedimentary successions was the product of polyphase rifting controlled by antecedent structuration and halokinesis, fluctuating climate, and repeated marine flooding, leading to a wide range of reservoir types in a variety of structural configurations. Triassic hydrocarbon accumulations form an important energy resource across the basin, not only in the established Buntsandstein fairway but also in Rogenstein oolites and Muschelkalk carbonates. In addition, sand-prone sections in the Late Triassic, such as the Schilfsandstein, have the potential to be hydrocarbon reservoirs. Several Triassic intervals are now the focus for developing geothermal projects. A detailed understanding of Triassic reservoir quality and distribution is one of the main keys to efficiently unlocking the geothermal and remaining hydrocarbon potential across the basin.
Synthesis and Characterization of Porous Fly Ash‐Based Geopolymers Using Si as Foaming Agent
Authors: Kioupis D. , Kavakakis Ch. , Tsivilis S. , Kakali G. 
Published: January 2018

This paper concerns the synthesis of foamed geopolymers using fly ash and metallic Si as the binder and the porogent agent, respectively. The Taguchi approach was applied in order to study the effect of some significant synthesis parameters such as the Si foaming agent content (% w/w fly ash based), the alkali type (R : Na or K), and the alkalinity (R/Al molar ratio) of the activation solution on the compressive strength and apparent density of the foamed geopolymers. The final products were characterized by means of XRD, FTIR, and SEM, while optical microscopy was applied for the evaluation of the porosity. Lightweight geopolymers with a compressive strength of 2.08–14.88 ΜPa and an apparent density of 0.84–1.55 g/cm3 were prepared by introducing a Si content up to 0.2% w/w on fly ash basis.
T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes
Authors: Cardona Andrea , Zareba Karolina M. , Nagaraja Haikady N. , Schaal Stephen F. , Simonetti Orlando P. , Ambrosio Giuseppe , Raman Subha V. 
Published: January 2018

Background

T‐wave abnormalities are common during the acute phase of non‐
ST
‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐
ST
‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.

Methods and Results

Secondary analysis of a previously enrolled prospective cohort of patients presenting with non‐
ST
‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (
ECG
) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography.
ECG
s were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no
ST
‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated
ST
depression,
ST
depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic
ECG
, 25 isolated T‐wave abnormalities, 11 isolated
ST
depression, and 14
ST
depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic
ECG
s. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%,
P
=0.001). By multivariate analysis, an ischemic
ECG
showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94,
P
<0.0001). Among individual
ECG
profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132,
P
<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.

Conclusions

T‐wave abnormalities in the setting of non‐
ST
‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this
ECG
alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.
Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States
Authors: Lu Yuan , Wang Pei , Zhou Tianna , Lu Jiapeng , Spatz Erica S. , Nasir Khurram , Jiang Lixin , Krumholz Harlan M. 
Published: January 2018

Background
The reasons for China's high stroke prevalence are not well understood. The cardiovascular risk factor profiles of China and the United States have not been directly compared in nationally representative population samples.

Methods and Results

Using data from the CHARLS (China Health and Retirement Longitudinal Study) and the NHANES (
US
National Health and Nutrition Examination Survey), we compared cardiovascular risk factors from 2011 to 2012 among people aged 45 to 75 years between the 2 countries (China, 12 654 people; United States, 2607 people): blood pressure, cholesterol, body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, and high‐sensitivity C‐reactive protein. Compared with the United States, China had a lower prevalence of hypertension but a higher mean blood pressure and a higher proportion of patients with severe hypertension (≥160/100 mm Hg) (10.5% versus 4.5%). China had substantially lower rates of hypertension treatment (46.8% versus 77.9%) and control (20.3% versus 54.7%). Dyslipidemia was less common in China, but lipid levels were not significantly different because dyslipidemia awareness and control rates in China were 3‐ and 7‐fold lower than
US
rates, respectively. High‐sensitivity C‐reactive protein, body mass index, and waist circumference were significantly lower in China than in the United States. Clustering of hypertension with other cardiovascular risk factors was more common in China.

Conclusions
Hypertension is more common in the United States, but blood pressure levels are higher in China, which may be responsible for China's high stroke prevalence. The low rates of awareness, treatment, and control of hypertension provide an exceptional opportunity for China to reduce risk in its population.
Inhibitory Effect of Vascular Endothelial Growth Factor on the Slowly Activating Delayed Rectifier Potassium Current in Guinea Pig Ventricular Myocytes
Authors: Lin Zhenhao , Xing Wenlu , Gao Chuanyu , Wang Xianpei , Qi Datun , Dai Guoyou , Zhao Wen , Yan Ganxin 
Published: January 2018

Background

Vascular endothelial growth factor (
VEGF
) exerts a number of beneficial effects on ischemic myocardium via its angiogenic properties. However, little is known about whether
VEGF
has a direct effect on the electrical properties of cardiomyocytes. In the present study, we investigated the effects of different concentrations of
VEGF
on delayed rectifier potassium currents (

I
K

) in guinea pig ventricular myocytes and their effects on action potential (
AP
) parameters.

Methods and Results

I
K

and
AP
were recorded by the whole‐cell patch clamp method in ventricular myocytes. Cells were superfused with control solution or solution containing
VEGF
at different concentrations for 10 minutes before recording. Some ventricular myocytes were pretreated with a phosphatidylinositol 3‐kinase inhibitor for 1 hour before the addition of
VEGF
. We found that
VEGF
inhibited the slowly activating delayed rectifier potassium current (

I
K

s
) in a concentration‐dependent manner (18.13±1.04 versus 12.73±0.34, n=5,
P
=0.001; 12.73±0.34 versus 9.05±1.20, n=5,
P
=0.036) and prolonged
AP
duration (894.5±36.92 versus 746.3±33.71, n=5,
P
=0.021). Wortmannin, a phosphatidylinositol 3‐kinase inhibitor, eliminated these
VEGF
‐induced effects.
VEGF
had no significant effect on the rapidly activating delayed rectifier potassium current (

I
K

r
), resting membrane potential,
AP
amplitude, or maximal velocity of depolarization.

Conclusions

VEGF
inhibited

I
K

s
in a concentration‐dependent manner through a phosphatidylinositol 3‐kinase–mediated signaling pathway, leading to
AP
prolongation. The results indicate a promising therapeutic potential of
VEGF
in prevention of ventricular tachyarrhythmias under conditions of high sympathetic activity and ischemia.
Understanding Diabetes-Related Distress Characteristics and Psychosocial Support Preferences of Urban African American Adults Living With Type 2 Diabetes: A Mixed-Methods Study
Authors: Hood Sula , Irby-Shasanmi Amy , de Groot Mary , Martin Elissabeth , LaJoie Andrew S. 
Published: January 2018

Purpose The purpose of this study is to understand diabetes-related distress (DRD) characteristics and identify psychosocial support preferences of urban African American adults living with type 2 diabetes (T2DM). Methods A 2-phase, mixed-methods sequential explanatory study design was used to gather data. In phase 1, a purposive sample of participants (N = 155) was recruited and asked to complete a written survey. The Diabetes Distress Scale (DDS17) was used to assess DRD, including subscales—emotional burden (EB), regimen distress (RD), interpersonal distress (ID), and physician distress (PD). In phase 2, a subset of phase 1 participants (N = 23) volunteered to attend 1 of 4 gender-stratified follow-up focus groups to contextualize the quantitative survey results. Results Survey findings indicate that on average, participants had moderate levels of DRD (aggregate), RD, and EB but had low ID and PD. During follow-up focus groups, participants described RD and EB as their primary distress types and emphasized that clinicians should prioritize the mental health aspects of T2DM similarly to its physical aspects. Participants expressed a desire for culturally appropriate peer support groups as a psychosocial support resource for distress coping and specifically requested the development of gender-stratified groups and groups for young adults. Conclusions Results support the need to screen for and address diabetes-related distress among African American patients with T2DM. Findings also inform the development of culturally appropriate psychosocial support resources to facilitate diabetes-related distress coping.
Association Between Second Metatarsal Length and Forefoot Loading Under the Second Metatarsophalangeal Joint
Authors: Fleischer Adam E. , Hshieh Shenche , Crews Ryan T. , Waverly Brett J. , Jones Jacob M. , Klein Erin E. , Weil Lowell , Weil Lowell Scott 
Published: January 2018

Background: Metatarsal length is believed to play a role in plantar plate dysfunction, although the mechanism through which progressive injury occurs is still uncertain. We aimed to clarify whether length of the second metatarsal was associated with increased plantar pressure measurements in the forefoot while walking. Methods: Weightbearing radiographs and corresponding pedobarographic data from 100 patients in our practice walking without a limp were retrospectively reviewed. Radiographs were assessed for several anatomic relationships, including metatarsal length, by a single rater. Pearson correlation analyses and multiple linear regression models were used to determine whether metatarsal length was associated with forefoot loading parameters. Results: The relative length of the second to first metatarsal was positively associated with the ratio of peak pressure beneath the respective metatarsophalangeal joints ( r = 0.243, P = .015). The relative length of the second to third metatarsal was positively associated with the ratios of peak pressure ( r = 0.292, P = .003), pressure-time integral ( r = 0.249, P = .013), and force-time integral ( r = 0.221, P = .028) beneath the respective metatarsophalangeal joints. Although the variability in loading predicted by the various regression analyses was not large (4%-14%), the relative length of the second metatarsal (to the first and to the third) was maintained in each of the multiple regression models and remained the strongest predictor (highest standardized β-coefficient) in each of the models. Conclusions: Patients with longer second metatarsals exhibited relatively higher loads beneath the second metatarsophalangeal joint during barefoot walking. These findings provide a mechanism through which elongated second metatarsals may contribute to plantar plate injuries. Level of Evidence: Level III, comparative study.
Efficacy and Safety of Apremilast Monotherapy for Moderate to Severe Psoriasis: Retrospective Study
Authors: Ighani Arvin , Georgakopoulos Jorge R. , Zhou Linda L. , Walsh Scott , Shear Neil , Yeung Jensen 
Published: January 2018

Background: Apremilast is a new oral drug for the treatment of moderate to severe plaque psoriasis that reduces inflammation by inhibiting phosphodiesterase 4. Its efficacy and safety data are limited; hence, real-world outcomes are important for elucidating the full spectrum of its adverse events (AEs) and expanding generalizability of clinical trial findings. Objective: Assess the efficacy and safety of apremilast monotherapy in real-world practice. Methods: A retrospective chart review was conducted in 2 academic dermatology practices. Efficacy was measured as the proportion of patients achieving a ≥75% reduction from baseline Psoriasis Area and Severity Index score (PASI-75) or a Psoriasis Global Assessment (PGA) score of 0 (clear) or 1 (almost clear) at 16 weeks. Safety was measured as the proportion of patients reporting ≥1 AE at 16 weeks. Results: Thirty-four patients were included. Efficacy: 19 patients (55.9%) achieved PASI-75 or PGA 0/1. Safety: 23 patients (67.6%) experienced ≥1 AEs. Five patients (14.7%) withdrew treatment prior to week 16 due to AEs. One patient withdrew treatment due to mood lability and depression. Common AEs included headache (32.4%), nausea (20.6%), diarrhoea (14.7%), weight loss (8.8%), and loose stool (8.8%). Conclusion: Apremilast monotherapy had higher efficacy with similar safety outcomes in the real world compared to clinical trials. There were higher proportions of reported headaches compared to clinical trials. This study supports the apremilast monotherapy clinical trial findings, suggesting that it has an acceptable safety profile and significantly reduces the severity of moderate to severe plaque psoriasis. Limitations include the retrospective nature of the study.
Disseminated Eczema Following Radiotherapy: A Case Report
Authors: Bosworth Alia , Hull Peter R. 
Published: January 2018

Background: Radiotherapy-induced acute skin reactions are common and an expected effect of radiotherapy. Eczematous eruptions, however, are rarely reported, with disseminated eczema in particular being infrequently seen and likely underrecognized. Objective: We present a unique case of disseminated vesicular eczema following radiotherapy for ductal carcinoma in situ. Conclusions: The development of a localized vesicular eruption with subsequent dissemination can occur following radiotherapy. The mechanism of autosensitization is poorly understood but likely involves a cell-mediated immune response. Recognition is important to prevent excessive and inappropriate investigation and treatment.
Impact of stochastically generated heterogeneity in hazard rates on individually randomized vaccine efficacy trials
Authors: Kahn Rebecca , Hitchings Matt , Bellan Steven , Lipsitch Marc 
Published: January 2018

Background/aims Network structure and individuals’ level of exposure to a pathogen can impact results from efficacy evaluation studies of interventions against infectious diseases. Heterogeneity in infection risk can cause randomized groups to increasingly differ as a trial progresses and as more high-risk individuals become infected (described in prior work as the “frailty” phenomenon). Here, we show the impact this phenomenon can have on an individually randomized trial of a leaky vaccine in which all participants are exchangeable a priori. Methods We model a vaccine trial by generating a network of individuals grouped into communities, which are connected to a larger main population. We then simulate an epidemic, deterministically and with time-varying transmission rates in the main population and stochastically in the communities. The disease natural history follows a susceptible-exposed-infectious-recovered model. Simulation results are used to estimate vaccine efficacy [Formula: see text] with a Cox proportional hazards model. Results We find downward bias in [Formula: see text] associated with low connectivity between communities in the study population and high force of infection, even when all participants in the trial are exchangeable at the time of randomization. This phenomenon arises because the stochastic dynamics in such a setting randomly lead to community-level variation in the force of infection. Stratifying a Cox model by community alleviates this bias with no loss of power. Conclusion Understanding and accounting for the impact of heterogeneous hazard rates can allow for more accurate estimates of [Formula: see text] in epidemic settings.
The Effects of Timing of Ankle Blocks in Forefoot, Midfoot, or Hindfoot Reconstruction With the Use of an Ankle Tourniquet
Authors: Gwosdz James , Bilbrew Lattisha , Jupiter Daniel , Panchbhavi Vinod 
Published: January 2018

Background. Ankle blocks are used in the ambulatory surgery setting to control postoperative pain, which is often worst in the first 24 hours after surgery. We conducted a trial to determine whether the timing of ankle block administration in relation to ankle tourniquet inflation has an effect on perceived pain and narcotic consumption. Methods. A prospective randomized study was conducted between August 2015 and January 2016. Patients were assigned to three groups. In group A, an ankle block was performed before ankle tourniquet inflation; in group B, immediately after ankle tourniquet inflation; and in group C, immediately after ankle tourniquet inflation with additional local anesthetic placed around the incision at the end of the procedure. Pain was assessed by a visual analogue scale (VAS) score, which was recorded at discharge, 24 hours, 48 hours, and 2 weeks after surgery. Narcotic consumption was recorded at 24 and 48 hours after surgery. Results. The only statistically significant difference in mean VAS scores occurred at 24 hours, when patients who received an ankle block after tourniquet inflation with local incisional anesthetic at closure (group C) had a mean VAS score 2.8 points lower (3.5 vs 6.3; P = .025) than those who received only an ankle block after tourniquet inflation (group B). There was no difference in narcotic consumption between groups at 24 and 48 hours. Conclusions. The timing of ankle block in relation to tourniquet inflation did not have an effect on pain control in forefoot, midfoot, and hindfoot reconstruction. The synergistic effect of an ankle block with additional incisional anesthetic at closure, is more effective than ankle block alone and is the ideal combination for postoperative pain control in foot surgery. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial