bluuebunny/crossref_metadata_2025_split huggingface dataset:
The mechanosensitive Piezo1 channel: structural features and molecular bases underlying its ion permeation and mechanotransduction
Authors: Wang Yubo , Xiao Bailong 
Published: November 2017

AbstractThe evolutionarily conserved Piezo family of proteins, including Piezo1 and Piezo2, encodes the long‐sought‐after mammalian mechanosensitive cation channels that play critical roles in various mechanotransduction processes such as touch, pain, proprioception, vascular development and blood pressure regulation. Mammalian Piezo proteins contain over 2500 amino acids with numerous predicted transmembrane segments, and do not bear sequence homology with any known class of ion channels. Thus, it is imperative, but challenging, to understand how they serve as effective mechanotransducers for converting mechanical force into electrochemical signals. Here, we review the recent major breakthroughs in determining the three‐bladed, propeller‐shaped structure of mouse Piezo1 using the state‐of‐the‐art cryo‐electron microscopy (cryo‐EM) and functionally dissecting out the molecular bases that define its ion permeation and mechanotransduction properties, which provide key insights into clarifying its oligomeric status and pore‐forming region. We also discuss the hypothesis that the complex Piezo proteins can be deduced into discrete mechanotransduction and ion‐conducting pore modules, which coordinate to fulfil their specialized function in mechanical sensing and transduction, ion permeation and selection.
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Increasing the use of patient decision aids in orthopaedic care: results of a quality improvement project
Authors: Mangla Mahima , Cha Thomas D , Dorrwachter Janet M , Freiberg Andrew A , Leavitt Lauren J , Rubash Harry E , Simmons Leigh H , Wendell Emily L , Sepucha Karen R 
Published: November 2017

ObjectiveTo integrate patient decision aid (DA) delivery to promote shared decision-making and provide more patient-centred care within an orthopaedic surgery department for treatment of hip and knee osteoarthritis, lumbar herniated disc and lumbar spinal stenosis.MethodsDifferent strategies were used across three distinct phases to promote DA delivery. First, we used a quality improvement bonus to generate awareness and interest in the DAs among specialists. Second, we adapted the electronic referral management system to enable DA orders at referral to a specialist. Third, we engaged clinic staff and specialists to design workflows that promoted DA delivery. We tracked the number of patients who received a DA, who ordered the DA, and collected usage data from a subset of patients. Our target was to reach 60% of patients with DAs.ResultsIn phase 1, 28% (43/155) of spine patients and 37% (114/308) of hip/knee patients received a DA. In phase 2, 54% (64/118) of spine referrals and 58% (189/324) of hip/knee referrals included a request to send a patient a DA. In phase 3, 56% (90/162) of spine patients and 69% (213/307) of hip/knee patients received a DA, significantly more than in phase 1 (P<0.0001). In phase 3, both more DAs were ordered by clinic staff compared with specialists (56% phase 3 vs 34% phase 1, P<0.001) and sent before the visit (74% phase 3 vs 17% phase 1, P<0.001). Patients were more likely to report reviewing the DA when delivered before the visit (63% before vs 50% after, P=0.005).ConclusionDA implementation into clinic workflow is possible and facilitated by engagement of the entire care team and the support of health information technology.
Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up
Authors: Celeste Roger Keller , Fritzell Johan 
Published: November 2017

BackgroundInequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing.MethodsData were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906–1915 (n=899), 1925–1934 (n=906), 1944–1953 (n=1154), 1957–1966 (n=923) and 1970–1981 (n=1199). The participants were 15–62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations.ResultsAll outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45–64 years, and then they decreased. Relative inequalities were large already in individuals aged 15–25 years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life.ConclusionInequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.
Plasma Nitrate and Incidence of Cardiovascular Disease and All‐Cause Mortality in the Community: The Framingham Offspring Study
Authors: Maas Renke , Xanthakis Vanessa , Göen Thomas , Müller Johannes , Schwedhelm Edzard , Böger Rainer H. , Vasan Ramachandran S. 
Published: November 2017

Background

Nitrate is a dietary component as well as an endogenously formed metabolite and source of the signaling molecule nitric oxide. Harmful as well as beneficial effects of nitrate have been advocated. Data regarding the prognostic relevance of plasma nitrate are limited. The aim of this study was to evaluate the prospective association of plasma nitrate with cardiovascular disease (
CVD
) and all‐cause mortality.

Methods and Results

We assayed plasma nitrate in 2855 Framingham Offspring Study participants (mean age 59 years, 54% women) by gas chromatography–mass spectrometry and evaluated its association with all‐cause mortality and incident
CVD
. On follow‐up (median 17.3 years), 775 participants died and 522 developed new‐onset
CVD
(of 2546 participants free of
CVD
at baseline). In multivariable models adjusting for standard risk factors, plasma nitrate was associated with an increased risk of death in participants (hazard ratio per unit increase in log‐nitrate 1.21; 95% confidence interval, 1.04–1.40 [
P
=0.015]). The strength of the association was attenuated by additional adjustment for estimated glomerular filtration rate (hazard ratio, 1.16; 95% confidence interval, 1.00–1.35 [
P
=0.057]). In contrast, no evidence was found for an association of plasma nitrate with incident
CVD
(multivariable‐adjusted hazard ratio per unit increase log‐nitrate 1.08; 95% confidence interval, 0.89–1.31 [
P
=0.42]).

Conclusions

In our prospective community‐based investigation, a higher plasma nitrate concentration was associated with all‐cause mortality but not with incident
CVD
. The association of nitrate with mortality may at least in part be attributable to its association with renal function.
Variations in Use of Optimal Medical Therapy in Patients With Nonobstructive Coronary Artery Disease: A Population‐Based Study
Authors: Oxner Adam , Elbaz‐Greener Gabby , Qui Feng , Masih Shannon , Zivkovic Nevena , Alnasser Sami , Cheema Asim N. , Wijeysundera Harindra C. 
Published: November 2017

Background

There is a paucity of data on the need for optimal medical therapy (
OMT
) in nonobstructive coronary artery disease . We sought to understand if there was variation in the use of
OMT
between hospitals for patients with nonobstructive coronary artery disease, the factors associated with such variation, and its clinical consequences.

Methods and Results

Using a population‐level clinical registry in Ontario, Canada, we identified all patients >66 years undergoing coronary angiography for the indication of stable angina, who had nonobstructive coronary artery disease between November 1, 2010, and October 31, 2013. Hierarchical multivariable logistic models were developed to identify the factors associated with
OMT
use, with median odds ratio used to quantify the degree of variation between hospitals not explained by the modeled risk factors. Clinical outcomes of interest were all‐cause mortality and rehospitalization, with follow‐up until March 31, 2015. Our cohort consisted of 5413 patients, of whom 2554 (47.2%) were receiving
OMT
within 1 year. There was a 2‐fold variation in
OMT
across hospitals (30.4%–61.8%). The variation between hospitals was fully explained by preangiography medication use (median odds ratio of 1.21 in the null model and 1.03 in the full model). There was no difference in risk‐adjusted mortality (hazard ratio, 0.94; 95% confidence interval, 0.76–1.16); however, patients receiving OMT had a lower risk of all‐cause hospital readmission (hazard ratio, 0.89; 95% confidence interval, 0.84–0.95).

Conclusions

There is wide variation in the use of
OMT
in patients with nonobstructive coronary artery disease, the major driver of which is differences in baseline medication use.
Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension
Authors: Okin Peter M. , Hille Darcy A. , Kjeldsen Sverre E. , Devereux Richard B. 
Published: November 2017

Background

Patients with hypertension with
ECG
left ventricular hypertrophy (
LVH
) have higher cardiovascular morbidity and mortality, but single
ECG
criteria may underestimate risk. Whether continued presence or new development of
ECG LVH
by 2 criteria can further concentrate risk during blood pressure lowering is unclear.

Methods and Results

Incident stroke, myocardial infarction, cardiovascular death, the composite of these outcomes, and all‐cause mortality were examined in relation to the presence of on‐treatment
ECG LVH
by Cornell product and/or Sokolow‐Lyon voltage during a mean of 4.8±0.9 years follow‐up in 9193 patients with hypertension randomized to losartan‐ or atenolol‐based regimens. Patients were categorized into 4 groups according to the presence or absence of
ECG LVH
by each criterion at baseline and yearly during the study. At baseline,
LVH
by both criteria was present in 960 patients (10.4%). Compared with the absence of
ECG LVH
by both criteria, persistence or development of
ECG LVH
by both criteria entered as a time‐varying covariate was associated with >3‐fold increased risks of events in multivariable Cox analyses adjusting for randomized treatment, baseline risk factors, and on‐treatment heart rate and systolic and diastolic blood pressures. Patients with
ECG LVH
by either Cornell product or Sokolow‐Lyon voltage had 45% to 140% higher risks of all end points.

Conclusions

Persistence or development of
ECG LVH
by both Cornell product and Sokolow‐Lyon voltage criteria during antihypertensive therapy is associated with markedly increased risks of cardiovascular end points and all‐cause mortality. Further study is indicated to determine whether additional therapy in these patients can reduce their risk.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
00338260.
Embracing the Lusitanian Legacy
Authors: Geudens Christophe 
Published: November 2017

Abstract
This article puts forward an analysis of the theory of signs contained in the Prodidagmata ad logicam Aristotelis (1627), a compendium on logic written by the Flemish philosopher and Louvain professor Laurentius Ghiffene (1594-1637). Focusing on Ghiffene’s definition and division of a sign and his account of the problem of self-reference, the author argues that Ghiffene positioned himself in the tradition of the Conimbricenses and relied extensively on their influential commentary on Aristotle’s Organon, published in 1606. The aim of the present contribution is to shed new light on the teaching of logic at Louvain during the years immediately preceding the rise of modern philosophy, an episode in the university’s history which remains almost entirely unstudied.
Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care
Authors: Lindley Lisa C. 
Published: November 2017

Background: Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. Objective/Hypothesis: This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Methods: Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. Results: The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. Conclusions: The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.
Ultrasound-Assisted Versus Fluoroscopic-Guided Lumbar Sympathetic Ganglion Block: A Prospective and Randomized Study
Authors: Ryu Jung-Hee , Lee Chang Soon , Kim Yong-Chul , Lee Sang Chul , Shankar Hariharan , Moon Jee Youn 
Published: November 2017

BACKGROUND:
Fluoroscopy (FL)-guided lumbar sympathetic ganglion block (LSGB) is widely performed to diagnose and manage various diseases associated with sympathetically maintained pain. Recently, numerous ultrasound (US)-assisted procedures in pain medicine have been attempted, showing an advantage of low radiation exposure. This randomized, prospective trial compared the procedural outcomes and complications between FL-guided and US-assisted LSGBs.

METHODS:
Fifty LSGBs were randomly divided into 2 groups: FL-guided (FL group) or US-assisted (US group) LSGB group. Both groups received FL-guided or US-assisted LSGB with 10 mL of 0.25% levobupivacaine. The primary end point was the total procedure time. Secondary outcomes were success rate, imaging time, onset time (based on temperature rise), dosage of radiation exposure, other procedure-related outcomes, and complications.

RESULTS:
Total procedure time and success rate were not statistically different between the 2 groups, whereas imaging time of the US group was longer than that of the FL group (P = .012). The onset time was faster in the US group (P = .019), and bone touching during the procedure was less frequent in the US group (P = .001). Moreover, radiation exposure was significantly lower in the US group than in the FL group (P < .001). No serious complications were reported in all patients.

CONCLUSIONS:
US-assisted LSGB appears to be a feasible method with the added benefit of lower radiation exposure. In our study, we did not find an advantage of US-assisted LSGB over FL-guided LSGB in terms of performance time.
Improvement of the Elevated Tryptase Criterion to Discriminate IgE- From Non–IgE-Mediated Allergic Reactions
Authors: Gastaminza Gabriel , Lafuente Alberto , Goikoetxea Maria Jose , D’Amelio Carmen M. , Bernad-Alonso Amalia , Vega Olga , Martinez-Molina Juan Ambrosio , Ferrer Marta , Nuñez-Cordoba Jorge M. 
Published: November 2017

BACKGROUND:
Differentiating between immunoglobulin E (IgE)-dependent and IgE-independent hypersensitivity reactions may improve the etiologic orientation and clinical management of patients with allergic reactions in the anesthesia setting. Serum tryptase levels may be useful to discriminate the immune mechanism of allergic reactions, but the diagnostic accuracy and optimal cutpoint remain unclear.
We aimed to compare the diagnostic accuracy of tryptase during reaction (TDR) alone and the TDR/basal tryptase (TDR/BT) ratio for discriminating IgE- from non–IgE-mediated allergic reactions, and to estimate the best cut point for these indicators.

METHODS:
We included 111 patients (45% men; aged 3–99 years) who had experienced an allergic reaction, even though the allergic reaction could be nonanaphylactic. Allergy tests were performed to classify the reaction as an IgE- or non–IgE-mediated one. The area under the curve (AUC) of the receiver operating characteristic analysis was performed to estimate the discriminative ability of TDR and TDR/BT ratio.

RESULTS:
An IgE-mediated reaction was diagnosed in 49.5% of patients, of whom 56% met anaphylaxis criteria. The median (quartiles) TDR for the IgE-mediated reactions was 8.0 (4.9–19.6) and 5.1 (3.5–8.1) for the non–IgE-mediated (P = .022). The median (quartiles) TDR/BT ratio was 2.7 (1.7–4.5) in IgE-mediated and 1.1 (1.0–1.6) in non–IgE-mediated reactions (P < .001). The TDR/BT ratio showed the greatest ability to discriminate IgE- from non–IgE-mediated reactions compared to TDR (AUC TDR/BT = 0.79 [95% confidence interval (CI), 1.1–2.2] and AUC TDR = 0.66 [95% CI, 1.1–2.2]; P = .003). The optimal cut point for TDR/BT (maximization of the sum of the sensitivity and specificity) was 1.66 (95% CI, 1.1–2.2).

CONCLUSIONS:
The TDR/BT ratio showed a significantly better discriminative ability than TDR to discriminate IgE- from non–IgE-mediated allergic reactions. An optimal TDR/BT ratio threshold of approximately 1.66 may be useful in clinical practice to classify allergic reactions as IgE- or non–IgE-mediated.
Effects of Increasing Airway Pressures on the Pressure of the Endotracheal Tube Cuff During Pelvic Laparoscopic Surgery
Authors: Rosero Eric B. , Ozayar Esra , Eslava-Schmalbach Javier , Minhajuddin Abu , Joshi Girish P. 
Published: November 2017

BACKGROUND:
Tracheal tube cuff pressures exceeding the perfusion pressures of the tracheal mucosa have been associated with complications such as sore throat, tracheal mucosa ulcers, tracheal rupture, and subglottic stenosis. Despite appropriate inflation, many factors can increase the tracheal cuff pressure during mechanical ventilation. This prospective observational cohort study was designed to test the hypothesis that during a clinical model of decreasing respiratory compliance, the pressure within the endotracheal tube cuff will rise in direct relationship to increases in the airway pressures.

METHODS:
Twenty-eight adult obese patients (BMI ≥30 kg/m2) scheduled for elective laparoscopic gynecologic procedures were enrolled. All patients received general anesthesia utilizing endotracheal tubes with low-pressure high-volume cuffs. After baseline adjustment of the cuff pressure to 25 cm H2O, the airway pressures and endotracheal cuff pressures were continuously measured using pressure transducers connected to the anesthesia circuit and cuff pilot, respectively. Data on cuff and airway pressures, mechanical ventilation parameters, intraabdominal pressures, and degree of surgical table inclination were collected throughout the anesthetic procedure. General linear regression models with fixed and random effects were fit to assess the effect of increases in airway pressures on cuff pressure, after adjusting for covariates and the clustered structure of the data.

RESULTS:
The mean (standard deviation) age and body mass index were 42.2 (8.8) years and 37.7 (5.1) kg/m2, respectively. After tracheal intubation, the cuffs were overinflated (ie, intracuff pressures >30 cm H2O) in 89% of patients. The cuff pressures significantly changed after concomitant variations in the airway pressures from a mean (standard error) value of 29.6 (1.30) cm H2O before peritoneal insufflations, to 35.6 (0.68) cm H2O after peritoneal insufflation, and to 27.8 (0.79) cm H2O after peritoneal deflation (P < .0001). The multilevel mixed regression models revealed that after controlling for clustering of the data (at the patient and study phase levels) and covariates, increased peak airway pressures were significantly associated with increased pressures within the endotracheal cuff (coefficient [95% confidence interval], 0.25 [0.14–0.36]; P < .0001). Other variables associated with increasing endotracheal cuff pressure included degree of surgical table inclination (0.08 [0.04–0.12]; P = .0003) and I:E ratio of 1:1 (4.47 [2.10–6.83]; P = .0002).

CONCLUSIONS:
This clinical model of decreased respiratory compliance in mechanically ventilated patients reveals that the pressure within the endotracheal cuff significantly changes in direct relation to changes in the airway pressures. This finding may have clinical relevance in patients requiring prolonged use of high airway pressures.
Η αναγκαιότητα ύπαρξης διευθυντών-ηγετών στους εκπαιδευτικούς οργανισμούς
Authors: Τσούνη Βασιλική , Αναστασόπουλος Ιωάννης , Γονίδου Μαρία , Τσούνης Γεώργιος 
Published: November 2017

Η παρούσα έρευνα έθεσε στο επίκεντρο της μελέτης την εκπαιδευτική μονάδα προκειμένου μέσα από τη μελέτη της λειτουργίας της να καταγράψει ποιες από τις αρχές της Διοίκησης εφαρμόζονται ήδη ή θα μπορούσαν με την συστηματικότερη εφαρμογή τους να συμβάλλουν στην αποτελεσματικότητα . Ορίζοντας αρχικά την αποτελεσματικότητα, αναφερθήκαμε στη συνέχεια στη Διεύθυνση και την Ηγεσία στο χώρο της εκπαίδευσης και παρουσιάσαμε τις διαφορές τους.Βασική επιδίωξή μας είναι να καταγράψουμε τη γνώμη των εκπαιδευτικών σχετικά με το προφίλ των διευθυντών των σχολικών μονάδων της Α Διεύθυνσης Δευτεροβάθμιας Εκπαίδευσης Αθηνών αλλά και τη διοίκηση των εκπαιδευτικών μονάδων από αυτούς προκειμένου να αναδειχθούν τα χαρακτηριστικά εκείνα που διαφοροποιούν τον διευθυντή από τον ηγέτη και να επισημανθεί η ανάγκη για επιμόρφωση των εκπαιδευτικών σε θέματα Ηγεσίας και Διοίκησης. Η έρευνα διεξήχθη με επισκόπηση μικρής κλίμακας μέσω ανωνύμου ερωτηματολογίου προκειμένου να εξασφαλιστεί η αξιοπιστία, το μεγάλο δείγμα και η ευκολία εξαγωγής συμπερασμάτων. Τα συμπεράσματα που αναδείχθηκαν ενίσχυσαν τη θέση για αξιοποίηση των λειτουργιών της Διοίκησης στην εκπαιδευτική διαδικασία. Τόνισαν επίσης την έλλειψη διευθυντών –ηγετών και κατέδειξαν την αδυναμία των σχολικών μονάδων να πραγματώσουν επιμορφωτικές δράσεις αλλά και να καινοτομήσουν. Τέλος η έρευνα ανέδειξε την ανάγκη για συνεχή επιμόρφωση των διευθυντικών στελεχών σε θέματα Διοίκησης και Ηγεσίας πριν αλλά και κατά τη διάρκεια της θητείας τους. Η έρευνα πραγματοποιήθηκε λίγο πριν αλλάξει το πλαίσιο επιλογής των διευθυντών πρωτοβάθμιας και δευτεροβάθμιας.