bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatial reference points for groundfish
Authors: Reuchlin-Hugenholtz Emilie , Shackell Nancy L. , Hutchings Jeffrey A. ,   Handling editor: Valerio Bartolino
Published: July 2016

Abstract
According to density-dependent habitat selection theory, areas of high density can be indicative of high population productivity and have positive individual fitness consequences. Here, we explore six groundfish populations on the Scotian Shelf, Canada, where a decline in areas of high density beyond a certain threshold is associated with disproportionately large declines in Spawning Stock Biomass (SSB). This is evidenced by empirical, concave, positive relationships between high-density areas (HDAs) and SSB. We introduce a methodology to estimate the threshold below which SSB declines increasingly faster per unit of HDA decline. The spatial threshold among these six stocks was remarkably consistent; when stocks lose 70–80% of HDAs, disproportionately large SSB declines are likely to occur. We propose that spatial thresholds could serve as spatial reference points to complement existing SSB limit reference points (LRPs). For some stocks we identify spatial thresholds which correspond to SSB levels that exceed those associated with the designated SSB LRP, suggesting that a review of these SSB LRPs warrants merit. For other stocks, spatial reference points can be used in concert with SSB reference points, strengthening efforts to incorporate a precautionary approach to fisheries management. Our results warrant further research into the general application of HDA as spatial limit and target reference points for fisheries management in addition to other population status indicators within a broad recovery framework.
Chronic exposure of adult, postnatal and in utero rat models to low-dose 137Cesium: impact on circulating biomarkers
Authors: Manens Line , Grison Stéphane , Bertho Jean-Marc , Lestaevel Philippe , Guéguen Yann , Benderitter Marc , Aigueperse Jocelyne , Souidi Maâmar 
Published: July 2016

AbstractThe presence of 137Cesium (137Cs) in the environment after nuclear accidents at Chernobyl and more recently Fukushima Daiichi raises many health issues for the surrounding populations chronically exposed through the food chain. To mimic different exposure situations, we set up a male rat model of exposure by chronic ingestion of a 137Cs concentration likely to be ingested daily by residents of contaminated areas (6500 Bq.l−1) and tested contaminations lasting 9 months for adult, neonatal and fetal rats. We tested plasma and serum biochemistry to identify disturbances in general indicators (lipids, proteins, carbohydrates and electrolytes) and in biomarkers of thyroid, heart, brain, bone, kidney, liver and testis functions. Analysis of the general indicators showed increased levels of cholesterol (+26%), HDL cholesterol (+31%), phospholipids B (+15%) and phosphorus (+100%) in the postnatal group only. Thyroid, heart, brain, bone and kidney functions showed no blood changes in any model. The liver function evaluation showed changes in total bilirubin (+67%) and alkaline phosphatase (–11%) levels, but only for the rats exposed to 137Cs intake in adulthood. Large changes in 17β-estradiol (–69%) and corticosterone (+36%) levels affected steroidogenesis, but only in the adult model. This study showed that response profiles differed according to age at exposure: lipid metabolism was most radiosensitive in the postnatal model, and steroid hormone metabolism was most radiosensitive in rats exposed in adulthood. There was no evidence of deleterious effects suggesting a potential impact on fertility or procreation.
Reimann's “Habitual Hyperthermia” Responding to Hormone Therapy
Authors: Yang Otto O. , Currier Judith S. 
Published: July 2016

Abstract
A 25-year-old woman presented with fever of unknown origin, exhibiting malaise and low-grade fevers in evenings. These fevers exhibited a pattern of starting mid-menstrual cycle with resolution around the onset of menses, matching a pattern of “habitual hyperthermia” reported by H. Reimann in the 1930s. Extensive workup was unremarkable, and the fevers improved on oral synthetic estrogen and progesterone therapy.
Social Network, Surgeon, and Media Influence on the Decision to Undergo Contralateral Prophylactic Mastectomy
Authors: Venetis Maria K. , MacGeorge Erina L. , Baptiste Dadrie F. , Mouton Ashton , Friley Lorin B. , Pastor Rebekah , Hatten Kristen , Lagoo Janaka , Bowling Monet W. , Clare Susan E. 
Published: July 2016

Objectives:
The rate of contralateral prophylactic mastectomy (CPM) has risen sharply in the past decade. The current study was designed to examine social network, surgeon, and media influence on patients’ CPM decision-making, examining not only who influenced the decision, and to what extent, but also the type of influence exerted.

Methods:
Patients (N=113) who underwent CPM at 4 Indiana University–affiliated hospitals between 2008 and 2012 completed structured telephone interviews in 2013. Questions addressed the involvement and influence of the social network (family, friends, and nonsurgeon health professionals), surgeon, and media on the CPM decision.

Results:
Spouses, children, family, friends, and health professionals were reported as exerting a meaningful degree of influence on patients’ decisions, largely in ways that were positive or neutral toward CPM. Most surgeons were regarded as providing options rather than encouraging or discouraging CPM. Media influence was present, but limited.

Conclusions:
Patients who choose CPM do so with influence and support from members of their social networks. Reversing the increasing choice of CPM will require educating these influential others, which can be accomplished by encouraging patients to include them in clinical consultations, and by providing patients with educational materials that can be shared with their social networks. Surgeons need to be perceived as having an opinion, specifically that CPM should be reserved for those patients for whom it is medically indicated.
Rac1 as a Potential Pharmacodynamic Biomarker for Thiopurine Therapy in Inflammatory Bowel Disease
Authors: Seinen Margien L. , van Nieuw Amerongen Geerten P. , de Boer Nanne K. H. , Mulder Chris J. J. , van Bezu Jan , van Bodegraven Adriaan A. 
Published: July 2016

Background:
Azathioprine and mercaptopurine (MP) are effective in treating patients with inflammatory bowel disease (IBD). Immunosuppressive effects of thiopurines involve T-cell apoptosis after inhibition of GTPase Ras-related C3 botulinum toxin substrate 1 (Rac1). This study aimed to assess whether expression and activity of Rac1 or phosphorylated ezrin-radixin-moesin (pERM) in patients with IBD could provide a useful biomarker for the pharmacodynamic thiopurine effect and might be related to clinical effectiveness.

Methods:
This was a 2-stage study: stage 1 concerned a cross-sectional cohort of patients with IBD clinically in remission and treated with (n = 10) or without stable weight-based thiopurine therapy (n = 11) and healthy controls (n = 6); stage 2 concerned a prospective study regarding IBD patients with clinically active disease who initiated MP therapy (n = 11) compared with healthy controls (n = 11). Expression and activity of Rac1 and ERM and pERM were determined.

Results:
The median Rac1 expression was statistically significantly reduced by thiopurine maintenance therapy {0.54 [interquartile range (IQR) 0.47–0.88] versus 0.80 arbitrary units [IQR 0.64–1.46]} compared with patients without immunosuppressive therapy (P = 0.042), but not Rac1 activity and pERM. In responders to MP therapy (n = 6), both median active Rac1 [93 (IQR 81–151) to 76 ng Rac1/mg protein (IQR 62–98)] and Rac1 expression [16.2 (8.8–29.4) to 1.5 arbitrary units (0.9–5.3)] decreased (P = 0.028). In nonresponders (n = 3), Rac1 expression and activity increased.

Conclusions:
IBD patients treated with thiopurines had a lower expression of Rac1 compared with those not treated with thiopurine. Effective MP therapy led to decreasing concentrations of Rac1-GTP and Rac1 expression. Therefore, Rac1-GTP and expression of Rac1, but not phosphorylation of ERM, form potentially pharmacodynamic markers of therapeutic thiopurine effectiveness in patients with IBD.
Low AMH levels as a marker of reduced ovarian reserve in young women affected by Down's syndrome
Authors: Romualdi Daniela , Proto Caterina , De Cicco Simona , Immediata Valentina , Barone Concetta , Romano Corrado , Lanzone Antonio 
Published: July 2016

Abstract

Objective:
Women with Down's syndrome (DS) experience menopause earlier than healthy women and are twice as likely to undergo premature ovarian insufficiency. Menopause accelerates cognitive decline and is associated with a twofold increased mortality risk in DS women. Nonetheless, no previous studies investigated the ovarian reserve in this population. The aim of the present study was to evaluate the circulating antimullerian hormone (AMH) levels in DS women with regular menstrual cycles, in comparison with those observed in an age-matched group of healthy women.

Methods:
Fourteen women with DS and 20 normo-ovulatory volunteers were enrolled in this study. A general physical examination was performed. Hormonal assays, including AMH, fasting insulin levels, and homeostatic model assessment-insulin resistance, were investigated in all participants.

Results:
AMH levels were significantly lower in DS women compared with controls (1.34 ± 1.11 vs 3.01 ± 1.65 ng/mL, P < 0.01). Prolactin concentrations were in the normal range, although higher in DS women compared with controls (P < 0.01). After dividing the participants according to age, AMH was significantly lower in the DS group compared with controls, both below and above 30 years of age (1.77 vs 3.73 ng/mL, P < 0.01; 0.28 vs 2.20 ng/mL, P < 0.01, respectively). AMH was inversely correlated with age in both groups, and directly correlated with testosterone and dehydroepiandrosterone sulfate only in DS women. In the same participants, AMH showed a tendency toward a direct correlation with insulin levels (P = 0.055).

Conclusions:
AMH levels were significantly lower in DS women compared with age-matched controls. A subanalysis of data in DS participants under 30 years of age suggested an early follicular depletion related to trisomy 21.
Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Women's Health Initiative
Authors: LeBlanc Erin S. , Kapphahn Kristopher , Hedlin Haley , Desai Manisha , Parikh Nisha I. , Liu Simin , Parker Donna R. , Anderson Matthew , Aroda Vanita , Sullivan Shannon , Woods Nancy F. , Waring Molly E. , Lewis Cora E. , Stefanick Marcia 
Published: July 2016

Abstract

Objective:
The aim of the study was to understand the association between women's reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk.

Methods:
Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Women's Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes.

Results:
In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37% (95% CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40 y). Women with the longest (45+ y) reproductive periods had a 23% (95% CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95% CI, 0.99-1.09 and HR 1.08; 95% CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment.

Conclusions:
Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.
Longitudinal analysis of high-technology medical services and hospital financial performance
Authors: Zengul Ferhat D. , Weech-Maldonado Robert , Ozaydin Bunyamin , Patrician Patricia A. , O'Connor Stephen J. 
Published: July 2016

Background:
U.S. hospitals have been investing in high-technology medical services as a strategy to improve financial performance. Despite the interest in high-tech medical services, there is not much information available about the impact of high-tech services on financial performance.

Purpose:
The aim of this study was to examine the impact of high-tech medical services on financial performance of U.S. hospitals by using the resource-based view of the firm as a conceptual framework.

Methodology/Approach:
Fixed-effects regressions with 2 years lagged independent variables using a longitudinal panel sample of 3,268 hospitals (2005–2010). It was hypothesized that hospitals with rare or large numbers (breadth) of high-tech medical services will experience better financial performance.

Findings:
Fixed effects regression results supported the link between a larger breadth of high-tech services and total margin, but only among not-for-profit hospitals. Both breadth and rareness of high-tech services were associated with high total margin among not-for-profit hospitals. Neither breadth nor rareness of high-tech services was associated with operating margin. Although breadth and rareness of high-tech services resulted in lower expenses per inpatient day among not-for-profit hospitals, these lower costs were offset by lower revenues per inpatient day.

Practice Implications:
Enhancing the breadth of high-tech services may be a legitimate organizational strategy to improve financial performance, especially among not-for-profit hospitals. Hospitals may experience increased productivity and efficiency, and therefore lower inpatient operating costs, as a result of newer technologies. However, the negative impact on operating revenue should caution hospital administrators about revenue reducing features of these technologies, which may be related to the payer mix that these technologies may attract. Therefore, managers should consider both the cost and revenue implications of these technologies.
Process Improvements to Reduce Cardiac Troponin Turnaround Time in the Emergency Department
Authors: Ison Tracy , Morris Linda , Wilkerson Gloria , Schmidt Carla , Winchester David E. 
Published: July 2016

Background:
An efficient testing process is a key to a timely diagnosis of acute myocardial infarction in the emergency department (ED). This includes a rapid evaluation cardiac biomarkers.

Methods:
We conducted a quality and process improvement project to reduce troponin-T turnaround time (TAT) in the central laboratory at our facility. An interdisciplinary team, including front-line staff members, reviewed each step of troponin-T processing in both the ED and the central laboratory. A series of improvements were implemented during 2013, including changes to specimen labeling, elimination of duplicate test ordering, and efficiencies within the laboratory. Data from January 2013 to December 2014 on 31,496 patients with troponin tests were included in the analysis.

Results:
Over the 2-year period of the projects, median troponin-T TAT decreased from 74 minutes to consistently less than 60 minutes.

Conclusions:
With an interdisciplinary team of health care professionals, we successfully reduced troponin-T TAT for possible acute coronary syndrome patients in our ED by 19%, consistently achieving laboratory results in less than 60 minutes.
Multicenter Study of a Novel Topical Interleukin-1 Receptor Inhibitor, Isunakinra, in Subjects With Moderate to Severe Dry Eye Disease
Authors: Goldstein Michael H. , Martel Joseph R. , Sall Kenneth , Goldberg Damien F. , Abrams Marc , Rubin Jay , Sheppard John , Tauber Joseph , Korenfeld Michael , Agahigian Jennifer , Durham Todd A. , Furfine Eric 
Published: July 2016

Objectives:
Isunakinra, formerly known as EBI-005, is a novel interleukin (IL)-1 receptor inhibitor developed for topical treatment of patients with dry eye disease (DED). This phase 1b/2a multicenter, double-masked, randomized, vehicle controlled environmental trial assessed the safety and biological activity of isunakinra in patients with moderate to severe DED.

METHODS:
Subjects (N=74) were randomized to vehicle (placebo) or isunakinra (5 or 20 mg/mL) 3×/daily for 6 weeks. Evaluations included safety, tolerability, biological activity for signs (corneal fluorescein staining [CFS]), symptoms (pain or sore eyes and total Ocular Surface Disease Index [OSDI]), and reduction in rescue artificial tear use.

Results:
Topical administration of isunakinra (5 and 20 mg/mL) was safe and well tolerated and resulted in clinically relevant improvements in symptoms (OSDI score, painful/sore eye component of OSDI) and signs (total CFS) compared with baseline with no dose response. OSDI scores improved from baseline by 38% (18.9 points) at 6 weeks and CFS scores improved by 33% (3 points) in the isunakinra groups. These changes were not statistically significant compared with the vehicle. Use of artificial rescue tears was significantly reduced in the isunakinra treatment groups (mean=9 vials) compared with vehicle (mean=31 vials). The differences between isunakinra and vehicle treatments were more pronounced in subjects with OSDI scores less than 50 at baseline.

Conclusions:
Isunakinra was safe, well tolerated and showed clinically meaningful improvements in signs and symptoms of DED. These results encouraged the design of an adequately powered study to characterize the safety and efficacy of isunakinra in ocular surface diseases.
Interexaminer Reliability of Meibography: Upper or Lower Eyelid?
Authors: Dogan Aysun Sanal , Kosker Mustafa , Arslan Nese , Gurdal Canan 
Published: July 2016

Objectives:
To investigate the interexaminer reliability of meibography evaluation and the impact of eyelid selection for the procedure.

Methods:
Meibography images of 30 subjects' right eye, including both lids, were evaluated by three clinicians. Meibomian gland (MG) dropout was noted with respect to both percentage and grading (0–4). The examiners' (E1, E2, and E3) consistency was assessed by the intraclass correlation coefficient for MG loss percent and weighted kappa for grading. Correlations between the meibography findings and the fluorescein tear break-up time (FBUT), ocular surface disease index (OSDI) questionnaire, and noninvasive tear break-up time (NIBUT) data were also analyzed.

Results:
The patients' mean age was 49.2±13.4 years, and the male/female ratio distribution was 15/15. Mean FBUT was 9.6±3.1 sec. OSDI and NIBUT were not correlated with meibography findings. FBUT measurements were correlated with the MG loss assessments of all examiners for the upper lid (Spearman correlation test, E1: r=−0.617, P<0.001; E2: r=–0.428, P<0.018; E3: r=−0.429, P=0.018) but not for the lower lid. Weighted kappa statistics based on MG dropout grading revealed moderate-to-good agreement for the upper lid (E1–E2: κ=0.516, P<0.001; E1−E3: κ=0.621, P<0.001; E2−E3: κ=0.650, P<0.001) and fair-to-moderate agreement for the lower lid (E1–E2: κ=0.212; E1–E3: κ=0.272; E2–E3: κ=0.530).

Conclusions:
Meibography is an objective tool for the detection of MG loss. Because of the correlation with FBUT and better interexaminer agreement on dropout by grading, the upper lid might be the preferred lid to make an evaluation.
Early Versus Delayed Colonoscopy in Hospitalized Patients With Lower Gastrointestinal Bleeding
Authors: Sengupta Neil , Tapper Elliot B. , Feuerstein Joseph D. 
Published: July 2016

Background:
Early colonoscopy is recommended for patients with severe lower gastrointestinal bleeding (LGIB). There is limited data as to whether this is associated with improved outcomes.

Methods:
We performed a meta-analysis of studies comparing early (<24 h) versus delayed colonoscopy (>24 h). PubMed, Embase, and Web of Science were searched for manuscripts using colonoscopy as a diagnostic/treatment modality for patients hospitalized with LGIB. Studies were included if data were available on outcomes comparing early and delayed colonoscopy. Articles were reviewed for time to colonoscopy, rebleeding, mortality, length of stay (LOS), surgery, interventions, localization of LGIB, and number of packed red blood cells. Pooled measures were reported using the Mantel-Haenszel method.

Results:
A total of 8491 studies were assessed of which 6 were included. There were 422 patients in the early arm and 479 in the delayed arm. There were no differences in age (64.2 vs. 65.7, P=0.85), admission hemoglobin (10.3 vs. 10.3 g/dL, P=0.96), LOS (5.21 vs. 6.09, P=0.52), and packed red blood cells transfusion (2.37 vs. 2.35, P=0.92) between the groups. In hospital mortality [odds ratio (OR), 1.64; 95% confidence interval (CI), 0.51-5.32], rebleeding (OR, 1.38; 95% CI, 0.85-2.23) and need for surgery (OR, 0.89; 95% CI, 0.42-1.89) were not different in delayed versus early colonoscopy. Early colonoscopy was associated with a higher detection of bleeding source (OR, 2.97; 95% CI, 2.11-4.19) and endoscopic intervention (OR, 3.99; 95% CI, 2.59-6.13).

Conclusions:
Early colonoscopy is not associated with reduced rebleeding, LOS, or surgery but is associated with a higher rate of source localization and endoscopic intervention.
Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules
Authors: Papini Enrico , Gugliemi Rinaldo , Pacella Claudio Maurizio 
Published: July 2016

Purpose of review
The majority of benign thyroid nodules are nearly asymptomatic, remain stable in size, and do not require treatment. However, a minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation.

Recent findings
The timely use of ultrasound-guided minimally invasive procedures can change the natural history of benign enlarging thyroid nodules. The procedures produce persistent shrinkage of thyroid nodules and are associated with improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts. In solid nonfunctioning nodules, laser and radiofrequency ablation produces a more than 50% reduction in nodular volume that remains persistent over several years. For hyperfunctioning nodules, thermal ablation techniques are not appropriate unless radioactive iodine is contraindicated or not accessible.

Summary
MITs are best suited for the management of medium or large-sized nodules that are sonographically well visualized. Conversely, large nodules or nodular goiters that extend into the chest are difficult to treat. MITs are performed in outpatient clinics, are less expensive, and have a lower risk of complications, compared to surgery, and usually do not induce thyroid dysfunction. However, malignancy should be ruled out with a dedicated ultrasound neck assessment and repeat fine needle aspiration of the lesion before treatment.