bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cortical Correlates of Binaural Temporal Processing Deficits in Older Adults
Authors: Eddins Ann Clock , Eddins David A. 
Published: November 2017

Objectives:
This study was designed to evaluate binaural temporal processing in young and older adults using a binaural masking level difference (BMLD) paradigm. Using behavioral and electrophysiological measures within the same listeners, a series of stimulus manipulations was used to evaluate the relative contribution of binaural temporal fine-structure and temporal envelope cues. We evaluated the hypotheses that age-related declines in the BMLD task would be more strongly associated with temporal fine-structure than envelope cues and that age-related declines in behavioral measures would be correlated with cortical auditory evoked potential (CAEP) measures.

Design:
Thirty adults participated in the study, including 10 young normal-hearing, 10 older normal-hearing, and 10 older hearing-impaired adults with bilaterally symmetric, mild-to-moderate sensorineural hearing loss. Behavioral and CAEP thresholds were measured for diotic (So) and dichotic (Sπ) tonal signals presented in continuous diotic (No) narrowband noise (50-Hz wide) maskers. Temporal envelope cues were manipulated by using two different narrowband maskers; Gaussian noise (GN) with robust envelope fluctuations and low-noise noise (LNN) with minimal envelope fluctuations. The potential to use temporal fine-structure cues was controlled by varying the signal frequency (500 or 4000 Hz), thereby relying on the natural decline in phase-locking with increasing frequency.

Results:
Behavioral and CAEP thresholds were similar across groups for diotic conditions, while the masking release in dichotic conditions was larger for younger than for older participants. Across all participants, BMLDs were larger for GN than LNN and for 500-Hz than for 4000-Hz conditions, where envelope and fine-structure cues were most salient, respectively. Specific age-related differences were demonstrated for 500-Hz dichotic conditions in GN and LNN, reflecting reduced binaural temporal fine-structure coding. No significant age effects were observed for 4000-Hz dichotic conditions, consistent with similar use of binaural temporal envelope cues across age in these conditions. For all groups, thresholds and derived BMLD values obtained using the behavioral and CAEP methods were strongly correlated, supporting the notion that CAEP measures may be useful as an objective index of age-related changes in binaural temporal processing.

Conclusions:
These results demonstrate an age-related decline in the processing of binaural temporal fine-structure cues with preserved temporal envelope coding that was similar with and without mild-to-moderate peripheral hearing loss. Such age-related changes can be reliably indexed by both behavioral and CAEP measures in young and older adults.
Osmotic Shifts, Cerebral Edema, and Neurologic Deterioration in Severe Hepatic Encephalopathy
Authors: Liotta Eric Michael , Romanova Anna L. , Lizza Bryan D. , Rasmussen-Torvik Laura J. , Kim Minjee , Francis Brandon , Sangha Rajbeer Singh , Carroll Timothy J. , Ganger Daniel , Ladner Daniela P. , Naidech Andrew M. , Paparello James J. , Prabhakaran Shyam , Sorond Farzaneh A. , Maas Matthew B. 
Published: November 2017

Objectives:
We sought to determine the effect of acute electrolyte and osmolar shifts on brain volume and neurologic function in patients with liver failure and severe hepatic encephalopathy.

Design:
Retrospective analysis of brain CT scans and clinical data.

Setting:
Tertiary care hospital ICUs.

Patients:
Patients with acute or acute-on-chronic liver failure and severe hepatic encephalopathy.

Interventions:
Clinically indicated CT scans and serum laboratory studies.

Measurements and Main Results:
Change in intracranial cerebrospinal fluid volume between sequential CT scans was measured as a biomarker of acute brain volume change. Corresponding changes in serum osmolality, chemistry measurements, and Glasgow Coma Scale were determined. Associations with cerebrospinal fluid volume change and Glasgow Coma Scale change for initial volume change assessments were identified by Spearman’s correlations (r
s) and regression models. Consistency of associations with repeated assessments was evaluated using generalized estimating equations. Forty patients were included. Median baseline osmolality was elevated (310 mOsm/Kg [296–321 mOsm/Kg]) whereas sodium was normal (137 mEq/L [134–142 mEq/L]). Median initial osmolality change was 9 mOsm/kg (5–17 mOsm/kg). Neuroimaging consistent with increased brain volume occurred in 27 initial assessments (68%). Cerebrospinal fluid volume change was more strongly correlated with osmolality (r = 0.70; p = 4 × 10–7) than sodium (r = 0.28; p = 0.08) change. Osmolality change was independently associated with Glasgow Coma Scale change (p = 1 × 10–5) and cerebrospinal fluid volume change (p = 2.7 × 10–5) in initial assessments and in generalized estimating equations using all 103 available assessments.

Conclusions:
Acute decline in osmolality was associated with brain swelling and neurologic deterioration in severe hepatic encephalopathy. Minimizing osmolality decline may avoid neurologic deterioration.
Comparison of Alcohol-Related Neurodevelopmental Disorders and Neurodevelopmental Disorders Associated with Prenatal Alcohol Exposure Diagnostic Criteria
Authors: Johnson Sean , Moyer Chelsie Leigh , Klug Marilyn G. , Burd Larry 
Published: November 2017

ABSTRACT:

Objective:
Recently, increased attention has been focused on the diagnosis of the most prevalent category of fetal alcohol spectrum disorders, alcohol-related neurodevelopmental disorders (ARNDs). In 2013, proposed criteria for neurodevelopmental disorders associated with prenatal alcohol exposure (ND-PAE) were included in the appendix of the latest revision of the Diagnostic and Statistical Manual of Mental Disorders. The concordance of the 2 sets of criteria is unknown. This study examines the overlap in diagnostic criteria for ND-PAE and the ARND Behavioral Checklist in children.

Methods:
Clinical charts from June 2013 to July 2016 were reviewed to identify patients with an evaluation for ARNDs and where the criteria for ND-PAE were also available.

Results:
The review found 86 charts with a diagnosis of ARNDs, which included the ARND Checklist and the ND-PAE criteria. We then calculated the sensitivity and specificity comparing the ND-PAE with the ARND Checklist as the comparison standard. The sensitivity was 95.0%, specificity was 75.0%, and the ND-PAE diagnosis correctly classified 89.5% of cases identified as meeting criteria for ARNDs by the checklist. The receiver operating characteristics resulted in a large shared area under the curve of 90.1%.

Conclusion:
The 2 diagnostic constructs of ARNDs and ND-PAE seem to be very similar. Both the ARND and the ND-PAE variables are written in familiar formats and could be widely used by a variety of health care providers.
Effect of Age and Allele Variants of CYP3A5, CYP3A4, and POR Genes on the Pharmacokinetics of Cyclosporin A in Pediatric Renal Transplant Recipients From Serbia
Authors: Cvetković Mirjana , Zivković Maja , Bundalo Maja , Gojković Ivana , Spasojević-Dimitrijeva Brankica , Stanković Aleksandra , Kostić Mirjana 
Published: November 2017

Background:
The interindividual variability of cyclosporin A (CsA) pharmacokinetics might be explained by heterogeneity in the cytochrome P450 3A (CYP3A) subfamily. Altered CYP3A enzyme activity was associated with variant allele of P450 oxidoreductase gene (POR*28). The aim of this study was to assess the impact of age, CYP3A5*3, CYP3A4*22, and POR*28 alleles on CsA pharmacokinetics in pediatric renal transplant recipients.

Methods:
Renal transplant patients receiving CsA (n = 47) were genotyped for CYP3A5*3, CYP3A4*22, and POR*28.

Results:

CYP3A5 nonexpressers had higher overall dose-adjusted predose concentration (C0/dose; ng/mL per mg/kg) compared with expressers (31.48 ± 12.75 versus 22.44 ± 7.12, P = 0.01). CYP3A5 nonexpressers carrying POR*28 allele had a lower overall dose-adjusted concentration (C2/dose) than those with POR*1/*1 genotype (165.54 ± 70.40 versus 210.55 ± 79.98, P = 0.02), with age as covariate. Children aged 6 years and younger had a lower overall C0/dose (18.82 ± 4.72 versus 34.19 ± 11.89, P = 0.001) and C2/dose (106.75 ± 26.99 versus 209.20 ± 71.57, P < 0.001) compared with older children. Carriers of CYP3A5*3 allele aged ≤6 years required higher dose of CsA and achieved lower C0/dose and C2/dose, at most time points, than older carriers of this allele. Carriers of POR*28 allele aged ≤6 years required higher doses of CsA, whereas they achieved lower C0/dose and C2/dose, at most time points, in comparison to older carriers of this allele. The significant effect of age (P < 0.002) and CYP3A5 variation (P < 0.02) was shown for overall C0/dose, whereas age (P < 0.00001) and POR variation (P = 0.05) showed significant effect on C2/dose. Regression summary for overall C2/dose in patients aged 6 years younger showed a significant effect of both CYP3A5 and POR variations (P < 0.016).

Conclusions:
Younger age, POR*28 allele, and CYP3A5*3 allele were associated with higher CsA dosing requirements and lower concentration/dose ratio. Pretransplant screening of relevant polymorphisms in accordance with age should be considered to adjust therapy.
Traditional Versus Hybrid Outpatient Cardiac Rehabilitation
Authors: Gabelhouse Jacqueline , Eves Neil , Grace Sherry L. , Reid R. Colin , Caperchione Cristina M. 
Published: November 2017

Purpose:
Due to the suboptimal uptake of cardiac rehabilitation (CR), alternative models have been proposed. This study compared the effectiveness of a traditional supervised program in a medical setting versus a hybrid CR model, where patients transition to unsupervised programming.

Methods:
This was a prospective, 2-arm, nonrandomized study. Health-related quality of life (HRQoL), functional capacity, physical activity, diet, smoking, blood pressure, lipids, blood glucose, anthropometrics, and depressive symptoms were assessed before and after the 8-week program models. Program adherence and completion were also recorded. Both models offered outpatient supervised exercise sessions, group health education classes, and a resource manual. The hybrid model involved a blend of supervised and unsupervised, independent home-based exercise, and followup phone calls.

Results:
One hundred twenty-five cardiac patients consented to the study, of whom 72 (57.6%) and 53 chose the traditional and hybrid programs, respectively. One hundred ten (traditional: n = 62, 86.1%; hybrid: n = 48, 92.3%; P > .05) participants completed their program. Significant improvements were observed for both models over time in HRQoL (P < .001), physical activity (P < .001), and diet (P < .001). Significant reductions in smoking (P = .043), systolic blood pressure (P < .001), total cholesterol (P < .001), low-density lipoprotein (P < .001), waist circumference (P < .001), and depressive symptoms (P < .001) were also observed. There were no significant differences pre- and postprograms between models for any outcome.

Conclusions:
Hybrid CR was not significantly different from the traditional model in terms of HRQoL, functional capacity, heart health behaviors, and risk factors, with no differences in completion rates.
Ocular Surface Alterations in the Context of Corneal In Vivo Confocal Microscopic Characteristics in Patients With Fibromyalgia
Authors: Erkan Turan Kadriye , Kocabeyoglu Sibel , Unal-Cevik Isin , Bezci Figen , Akinci Aysen , Irkec Murat 
Published: November 2017

Purpose:
To quantify the morphology of corneal basal epithelium and subbasal nerves and to evaluate the ocular surface alterations in patients with fibromyalgia (FM).

Methods:
Patients with FM (n = 34) and healthy controls (n = 42) were enrolled. All participants underwent ocular surface tests in the following order: corneal sensitivity, tear film breakup time, lissamine green staining, Schirmer test, and the Ocular Surface Disease Index questionnaire. Basal epithelial cells and subbasal nerves were evaluated using in vivo confocal microscopy (IVCM). Demographic characteristics, Visual Analog Scale for Pain (VAS), American College of Rheumatology 1990, the Widespread Pain Index (WPI), and the Symptom Impact Questionnaire (SIQR) scores of patients with FM were obtained.

Results:
Corneal sensitivity was 0.4 g/mm2 (fiber length: 6.0 cm) in all eyes. Patients with FM had a higher Ocular Surface Disease Index (42.2 ± 18.9 vs. 1.2 ± 1.7, P < 0.001), higher lissamine green staining scores (0.5 ± 0.5 vs. 0.05 ± 0.2, P < 0.001), and lower tear breakup time scores (9.0 ± 3.6 vs. 10.3 ± 1.5, P = 0.003) than the controls. Basal epithelial cell density (2709 ± 494 vs. 4491 ± 724), total nerve density (1563 ± 620 vs. 2545 ± 973), long nerve fibers (3.4 ± 1.3 vs. 4.5 ± 1.0), and the number of nerves (5.0 ± 1.8 vs. 10.3 ± 2.1) were all lower in patients with FM compared with those of the controls (P < 0.001 for all). There was a statistically significant negative correlation between the WPI score and Schirmer test results (rho = −0.374, P = 0.03) and between WPI and total nerve density (rho = −0.334, P = 0.054).

Conclusions:
To the best of our knowledge, this is the first study that evaluated ocular surface alterations in the context of corneal IVCM characteristics. Patients with FM should be evaluated in terms of ocular surface diseases. IVCM may be used in FM to assess small fiber neuropathy.
Impact of Phlebotomist-Only Venipuncture and Central Line Avoidance for Blood Culture in a Large Tertiary Care University Hospital
Authors: Santos Carlos A.Q. , Shimasaki Teppei , Kishen Ekta , Won Sarah , Hanson Amy , Marinakos Gigi , Tomich Alexander , Hota Bala , Segreti John 
Published: November 2017

Background
Drawing blood for culture from central vascular access sites may increase rates of blood culture contamination and central line–associated bloodstream infection.

Methods
We examined the impact of phlebotomist-only blood draws and central line avoidance for blood culture in a large university hospital that also cares for patients with cancer, stem cell transplants, and solid-organ transplants. Policy enforcement began in September 2013. The preimplementation era was defined from January 2012 to June 2013, and the postimplementation era was defined from January 2014 to September 2015. Outcomes in preimplementation and postimplementation eras were compared using time-series analyses, t tests, and Wilcoxon rank sum tests.

Results
Policy implementation led to 29%, 31%, and 38% decreases in blood culture performance, positivity, and contamination, respectively; an 86% decrease in blood cultures drawn from central lines; and a 66% decrease in central line–associated bloodstream infections. Our policy coincided with an 11% decrease in intravenous vancomycin, daptomycin, or linezolid use, whereas there was no change in piperacillin-tazobactam, cefepime/ceftazidime, or carbapenem use. Hospital lengths of stay and mortality rates were unchanged in the general hospital population and were stable or improved in patients with kidney disease, liver disease, cancer, and abdominal solid-organ transplants.

Conclusions
Our findings suggest that having phlebotomists draw blood for culture almost exclusively by venipuncture resulted in decreased blood culture positivity that did not translate into harm as measured by length of stay or inpatient death even among immunocompromised hosts.
Clinical Manifestations and Seasonality of Pertussis in Azerbaijan, Iran
Authors: Mohammadzadeh Asl Yalda , Akhi Mohammad Taghi , Soroush Mohammad Hossein , Sefidan Fatemeh Yeganeh , Mousapour Jafar , Hejazi Mohammad Esmaeil , Sabbaghi Babak Ghalibaf , Sharifi Akbar , Jabari Yalda , Ghotaslou Reza 
Published: November 2017

Background
Nowadays, a shift in age distribution and the increasing incidence of pertussis among adolescents and adults have been reported in the world. The aim of this study was to evaluate the prevalence, clinical characteristics, and seasonality of pertussis in Azerbaijan, Iran.

Methods
A total of 368 nasopharyngeal swabs of 184 patients were taken for culture and polymerase chain reaction (PCR). Simultaneously, 2 blood samples from 111 participants aged 12 to 70 years were obtained to perform enzyme-linked immunosorbent assay (ELISA) test. Whooping cough cases were considered as being the level of anti–pertussis toxin (anti-PT) immunoglobulin G higher than 24 IU/mL or positive culture and PCR positive.

Results
Of 184 patients, the PT gene was detected in 23.37% (43/184) by PCR test, whereas only 4.35% (8/184) by culture were positive. The overall seropositive rate of immunoglobulin G–PT was 62.16% (69/111). The highest positivity of the PCR and ELISA was detected in the age group 31 to 40 years. Paroxysmal cough (100%), inspiratory whoop (63.6%), and posttussive vomiting (45.5%) in children with pertussis were the most frequent symptoms reported. These symptoms in adolescents and adults were prolonged cough (100% and 94.9%, respectively) and gagging (38.5% and 30.5%, respectively).

Conclusions
The most sensitive assay for pertussis detection is the ELISA. The continuous presence of pertussis is alarming to health care professionals. Our findings suggest a high prevalence of pertussis in Azerbaijan indicates that childhood national immunization program may not provide adequate protective immunity in the population. Booster vaccination is necessary in adolescence and adulthood and development of highly efficacious pertussis vaccine.
Back to Basics
Authors: Cole Jennifer L. , Stark Jennifer E. 
Published: November 2017

Abstract
The procalcitonin assay is a popular tool among antimicrobial stewardship programs. There are procalcitonin algorithms and further guidance in the medical literature to aid clinicians in decision making regarding antibiotic therapy initiation and duration. Diagnostic utility of procalcitonin levels is a matter of debate and should be interpreted only in conjunction with the context of the patient's clinical picture. Researchers present a case of ambiguous procalcitonin findings along with a stepwise approach in reviewing the medical literature. Although not listed as a common cause of false-positive procalcitonin results, it was felt that advanced non–Hodgkin lymphoma coupled with worsening renal function was ultimately the cause of this patient's elevated procalcitonin levels.
Lifestyle in Visually Impaired or Blind Massage Therapists: A Preliminary Study
Authors: HUNG Shu-Ling , CHEN Mei-Fang , LIN Yu-Hua , KAO Chia-Chan , CHANG Ya-Wen , CHAN Hui-Shan 
Published: November 2017

ABSTRACT

Background:
Lifestyle is among the most important factors affecting individual health status. Limited access to health information may limit the ability of people with visual impairment or blindness to practice healthy lifestyles. However, no studies have investigated how lifestyle practices affect health specifically in visually impaired and blind populations.

Purpose:
The aim of this study was to investigate the lifestyle behaviors of visually impaired and blind massage therapists (VIBMTs) in Taiwan.

Methods:
This exploratory study used a purposive sampling technique to recruit 50 VIBMTs who were employed at massage stations in southern Taiwan. All of the participants completed the Health-Promoting Lifestyle Profile II (HPLP-II) and a survey of demographic characteristics. Descriptive and inferential statistical tests, including the Mann–Whitney U test and the Kruskal–Wallis H test, were used. Statistical significance was defined as p < .05 in two-tailed tests.

Results:
Fifty participants completed both the HPLP-II and the demographic survey. The mean subscale score for the HPLP-II was 2.52 ± 0.37. The lowest scores were on the physical activity (2.09 ± 0.67) and nutrition (2.35 ± 0.39) subscales, and the highest scores were on the spiritual growth (2.89 ± 0.56) and interpersonal relations (2.79 ± 0.46) subscales. Scores on the stress management and physical activity subscales were significantly higher in men than in women (p < .05). In addition, mean HPLP-II scores were significantly higher in VIBMTs who exercised regularly compared with those who did not (p < .05). Compared with nonsmokers, current smokers had significantly higher scores on the stress management subscale (p < .05).

Conclusions/Implications for Practice:
The low physical activity scores in this population may be improved by developing physical activity programs for the home and workplace and by establishing community recreational and exercise facilities for visually impaired populations. The low scores for nutrition may be improved by establishing nutrition education programs that are designed specifically for VIBMTs to increase their consumption of fresh produce and other healthy foods and by requiring food manufacturers to use labels that may be easily read or understood by visually impaired populations.
Characterization of the Human Pancreas Side Population as a Potential Reservoir of Adult Stem Cells
Authors: Augstein Petra , Loudovaris Thomas , Bandala-Sanchez Esther , Heinke Peter , Naselli Gaetano , Lee Lily , Hawthorne Wayne J. , Góñez L. Jorge , Neale Alana M. , Vaillant François , Thomas Helen E. , Kay Thomas W. , Banakh Ilia , Harrison Leonard C. 
Published: November 2017

Objectives
The side population (SP) contains cells with stem cell/progenitor properties. Previously, we observed that the mouse pancreas SP expanded after pancreatic injury. We aimed to characterize the SP in human pancreas as a potential source of stem cells.

Methods
Human organ donor pancreata were fractionated into islets and exocrine tissue, enriched by tissue culture and dispersed into single cells. Cells were phenotyped by flow cytometry, and the SP was defined by efflux of fluorescent dye Hoechst 33342 visualized by ultraviolet excitation. Cells were flow sorted, and their colony-forming potential measured on feeder cells in culture.

Results
An SP was identified in islet and exocrine cells from human organ donors: 2 with type 1 diabetes, 3 with type 2 diabetes, and 28 without diabetes. Phenotyping revealed that exocrine SP cells had an epithelial origin, were enriched for carbohydrate antigen 19-9+ ductal cells expressing stem cell markers CD133 and CD26, and had greater colony-forming potential than non-SP cells. The exocrine SP was increased in a young adult with type 1 diabetes and ongoing islet autoimmunity.

Conclusions
The pancreatic exocrine SP is a potential reservoir of adult stem/progenitor cells, consistent with previous evidence that such cells are duct-derived and express CD133.