bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glucose response to exercise in the post‐prandial period is independent of exercise intensity
Authors: Shambrook P. , Kingsley M. I. , Wundersitz D. W. , Xanthos P. D. , Wyckelsma V. L. , Gordon B. A. 
Published: October 2017

This study investigated the acute glucose response to low‐intensity, moderate‐intensity, and high‐intensity interval exercise compared to no‐exercise in healthy insufficiently active males using a four‐arm, randomized, crossover design. Ten males (age: 37.3 ± 7.3 years, BMI: 29.3 ± 6.5 kg·m−2) completed four 30‐minute interventions at weekly intervals comprising low‐intensity exercise (LIE) at ~35% O2R, moderate‐intensity exercise (MIE) at ~50% O2R, high‐intensity interval exercise (HIIE) at ~80% O2R, and a no‐exercise control. Participants performed cycle ergometer exercise 30 minutes after finishing breakfast. Glucose response was assessed using a continuous glucose monitor under free‐living conditions with dietary intake replicated. A significant effect for intensity on energy expenditure was identified (P < .001) with similar energy cost in MIE (mean ± SD: 869 ± 148 kJ) and HIIE (806 ± 145 kJ), which were both greater than LIE (633 ± 129 kJ). The pattern of glucose response between the interventions over time was different (P = .02). Glucose was lower 25 minutes into each of the HIIE, MIE and LIE trials respectively (mean difference ± SD: −0.7 ± 1.1; −0.9 ± 1.1; −0.6 ± 0.9 mmol·L−1; P < .05) than in the no‐exercise trial. Glucose response was not different between exercise intensities (P > .05). Twenty‐four‐hour AUC was not affected by exercise intensity (P = .75). There was a significant effect for exercise enjoyment (P = .02), with LIE (69 ± 4) preferred less than HIIE (mean ± SD: 84 ± 14; P = .02), MIE (73 ± 5; P = .03), and no‐exercise (75 ± 4; P = .03). Exercise at any intensity 30 minutes after a meal affects glycemic regulation equally in insufficiently active males. Moderate to vigorous exercise intensities were preferred, and therefore, the exercise guidelines appear appropriate for the prevention of cardiometabolic disease.
Validation of digital photographic reference scales for evaluating facial aging signs
Authors: Jdid Randa , Latreille Julie , Soppelsa Frédérique , Tschachler Erwin , Morizot Frédérique 
Published: October 2017

AbstractBackgroundValidated tools are essential to evaluate facial skin aging for both dermatological and cosmetic investigations. While many visual aging scales have been developed, few have been validated and none in terms of degree of distinguishability (DD). We developed and validated a series of visual scales using a novel digital interface for scoring facial skin aging in Caucasian women.Materials and methodsThree dermatologists independently established scales for 12 distinct aging signs from high‐definition facial photographs of 400 adult women (Fitzpatrick phototypes I‐IV) taken under standardized conditions. They then selected a consensus scale for each individual sign with a representative photo per grade. Scales were integrated into a digital interface allowing simultaneous viewing of all grades of each scale alongside the photograph of a test subject. Next, scales were validated by a different dermatologist, a general practitioner and a non‐medical expert skin evaluator using photos of 350 women which had not been used for establishing the scales.ResultsKappa estimates showed almost perfect agreement for wrinkle and skin aging scales (≥0.85) and moderate to substantial agreement for scales relating to color irregularities (telangiectasia, solar lentigines, freckles) for both inter‐ and intra‐observer reproducibility. Intra‐observer DD estimates were mostly high. Non‐dermatologists performed well on reproducibility for both Kappa (from 0.6 to 0.9) and DD estimates.ConclusionOur work demonstrates that the digital interface scales for 12 distinct aging features are highly suitable for use in clinical and epidemiological studies on skin aging by both dermatologists and non‐dermatologists.
The Danube River inception: Evidence for a 4 Ma continental‐scale river born from segmented ParaTethys basins
Authors: Olariu Cornel , Krezsek Csaba , Jipa Dan C. 
Published: October 2017

AbstractBefore reaching the Black Sea, the Danube River passes through a string of Para‐Tethyan (Vienna, Pannonian and western and eastern Dacian) basins. The key question is, when and how did the Danube River become a continental‐scale river with a drainage similar to present? New data presented here show that the Late Miocene deepwater strata in the Black Sea have a significant sediment source and depositional style change at about 4 Ma. However, the presence of active Miocene basins within the Danube catchment raises questions about the timing of Danube River inception and whether the upstream palaeogeography would have allowed or disallowed delivery of large sediment volumes to the deepwater Black Sea. Stratigraphic analyses in the Pannonian and Dacian basins reveal a phase of coeval sedimentary fill of the basins along the Danube at about 4 Ma. This multi‐basin observation points to a concurrent basin‐fill model rather than the basin fill‐and‐spill or Messinian‐type lowstand models previously proposed for Danube inception.
The practice of diagnosing and reporting transfusion‐associated circulatory overload: a national survey among physicians and haemovigilance officers
Authors: Bosboom J. J. , Klanderman R. B. , Peters A. L. , van de Weerdt E. K. , Goudswaard E. J. , Binnekade J. M. , Zwaginga J. J. , Beckers E. A. M. , Geerts B. F. , Hollmann M. W. , Zeerleder S. S. , van Kraaij M. , Vlaar A. P. 
Published: October 2017

SUMMARYObjectivesThis study aims at identifying factors that disciplines consider when diagnosing and reporting transfusion‐associated circulatory overload (‘TACO’).BackgroundTACO is a clinical diagnosis based mainly on subjective factors. Therefore, TACO could be an underreported complication of blood transfusion.MethodsA survey was conducted among critical care physicians, anaesthesiologists, haematologists, transfusion medicine physicians and haemovigilance officers using case vignettes and a questionnaire. Factors that may affect diagnosing TACO were investigated using conjoint analysis. A positive B‐coefficient indicates a positive preference for diagnosing TACO. Participants rated factors influencing reporting TACO on a 0‐ to 100‐point scale.ResultsOne hundred and seven surveys were returned (62%). Vignettes showed preferences in favour of diagnosing TACO with the onset of symptoms within 2 h [β 0·4(−0·1–1·0)], positive fluid balance [β 0·9(0·4–1·5)] and history of renal failure [β 0·6(0·1–1·2)]. Compared with transfusion of a single unit of red blood cells (RBC), respondents showed a preference for diagnosing TACO following a single unit of solvent/detergent (S/D) plasma or pooled platelet concentrate (PPC) [β 0·3(−0·2–0·7) resp. 0·5(−0·1–1·2)]. Multiple transfusion (6 RBC + 4 S/D plasma) was a strong preference for diagnosing TACO compared to 1 RBC and 1 S/D plasma [β 0·3(−0·8–1·3)]. Respondents did not fully take into account new hypertension and tachycardia when reporting TACO [median 70 (IQR 50–80) resp. 60 (IQR 50–80)]. No differences were observed between disciplines involved.ConclusionWhen diagnosing and reporting TACO, physicians and haemovigilance officers do consider known risk factors for TACO. Reporting could be improved by increasing the awareness of haemodynamic variables in future education programmes.
Major emerging alien plants in Austrian crop fields
Authors: Follak S , Schleicher C , Schwarz M , Essl F 
Published: October 2017

SummaryGlobalisation and increasing trade have led to the introduction of alien plants that are highly competitive and difficult to control in agriculture in central Europe. Our study set out to analyse the invasion process and agricultural impact of the six emerging alien plants Abutilon theophrasti, Ambrosia artemisiifolia, Cyperus esculentus, Datura stramonium, Panicum schinzii and Sorghum halepense in Austria, based on a large distribution data set (694 occurrence records in crop fields). We found that all study species have increased in abundance and range, especially after the year 2000. The rate of spread was highest for A. artemisiifolia and lowest for C. esculentus. At present, records of the study species were largely associated with areas of high summer crop concentration in eastern, southern and north‐western Austria. Based on the CORINE land‐cover data set, we found that the agricultural area at risk of being invaded increased over time. At present, it ranges between 45 500 and 168 000 ha (approximately 2.4% and 8.7% of the total agricultural area) depending on the species. The invasion success of the study species is probably associated with frequent human‐mediated dispersal, specific crop‐dominated rotations and herbicide use. Our results suggest that the study species will successfully spread further. We conclude that these emerging alien species will cause substantial impacts on crops in Austria and probably in other countries of central Europe.
High-Definition Mapping of Four Spatially Distinct Neutralizing Epitope Clusters on RiVax, a Candidate Ricin Toxin Subunit Vaccine
Authors: Toth Ronald T. , Angalakurthi Siva Krishna , Van Slyke Greta , Vance David J. , Hickey John M. , Joshi Sangeeta B. , Middaugh C. Russell , Volkin David B. , Weis David D. , Mantis Nicholas J. 
Published: October 2017

ABSTRACTRiVax is a promising recombinant ricin toxin A subunit (RTA) vaccine antigen that has been shown to be safe and immunogenic in humans and effective at protecting rhesus macaques against lethal-dose aerosolized toxin exposure. We previously used a panel of RTA-specific monoclonal antibodies (MAbs) to demonstrate, by competition enzyme-linked immunosorbent assay (ELISA), that RiVax elicits similar serum antibody profiles in humans and macaques. However, the MAb binding sites on RiVax have yet to be defined. In this study, we employed hydrogen exchange-mass spectrometry (HX-MS) to localize the epitopes on RiVax recognized by nine toxin-neutralizing MAbs and one nonneutralizing MAb. Based on strong protection from hydrogen exchange, the nine MAbs grouped into four spatially distinct epitope clusters (namely, clusters I to IV). Cluster I MAbs protected RiVax's α-helix B (residues 94 to 107), a protruding immunodominant secondary structure element known to be a target of potent toxin-neutralizing antibodies. Cluster II consisted of two subclusters located on the “back side” (relative to the active site pocket) of RiVax. One subcluster involved α-helix A (residues 14 to 24) and α-helices F-G (residues 184 to 207); the other encompassed β-strand d (residues 62 to 69) and parts of α-helices D-E (154 to 164) and the intervening loop. Cluster III involved α-helices C and G on the front side of RiVax, while cluster IV formed a sash from the front to back of RiVax, spanning strands b, c, and d (residues 35 to 59). Having a high-resolution B cell epitope map of RiVax will enable the development and optimization of competitive serum profiling assays to examine vaccine-induced antibody responses across species.
Progress toward Development of a Vaccine against Congenital Cytomegalovirus Infection
Authors: Schleiss Mark R. , Permar Sallie R. , Plotkin Stanley A. 
Published: October 2017

ABSTRACTA vaccine against congenital human cytomegalovirus (CMV) infection is a major public health priority. Congenital CMV causes substantial long-term morbidity, particularly sensorineural hearing loss (SNHL), in newborns, and the public health impact of this infection on maternal and child health is underrecognized. Although progress toward development of a vaccine has been limited by an incomplete understanding of the correlates of protective immunity for the fetus, knowledge about some of the key components of the maternal immune response necessary for preventing transplacental transmission is accumulating. Moreover, although there have been concerns raised about observations indicating that maternal seropositivity does not fully prevent recurrent maternal CMV infections during pregnancy, it is becoming increasing clear that preconception immunity does confer some measure of protection against both CMV transmission and CMV disease (if transmission occurs) in the newborn infant. Although the immunity to CMV conferred by both infection and vaccination is imperfect, there are encouraging data emerging from clinical trials demonstrating the immunogenicity and potential efficacy of candidate CMV vaccines. In the face of the knowledge that between 20,000 and 30,000 infants are born with congenital CMV in the United States every year, there is an urgent and compelling need to accelerate the pace of vaccine trials. In this minireview, we summarize the status of CMV vaccines in clinical trials and provide a perspective on what would be required for a CMV immunization program to become incorporated into clinical practice.
Orbital trapdoor fractures: different clinical profiles between adult and paediatric patients
Authors: Takahashi Yasuhiro , Sabundayo Maria Suzanne , Miyazaki Hidetaka , Mito Hidenori , Kakizaki Hirohiko 
Published: October 2017

BackgroundTo compare clinical findings of orbital trapdoor fractures between adult and paediatric patients.MethodsPaediatric patients were categorised into two groups by age: children (0–9 years) and adolescents (10–19 years). Adult patients were categorised into two groups by age: early (20–44 years) and middle-late adulthood (≥45 years). Demographic data, ocular and periocular complications, CT findings and binocular single vision field (BSVF) were compared among age groups.ResultsThis study included 105 patients (105 sides, 22 children, 59 adolescents, 14 patients in early adulthood and 10 patients in middle-late adulthood). In patients with fractures of the orbital floor and medial wall, both walls presented as trapdoor fractures in paediatric patients, while one wall presented as a non-trapdoor fracture in adult patients (p=0.061). None of the adult patients showed extraocular muscle incarceration, whereas this was present in 8 of 22 children (36.4%) and 7 of 59 adolescents (11.9%) (p=0.005). Hypoesthesia of the infraorbital nerve more frequently occurred in adults (p=0.004). As the preoperative BSVF was larger in adult than in paediatric patients (p=0.007), the percentage of adult patients who underwent surgical reduction of orbital fractures tended to be lower (p=0.058). Postoperative change in BSVF was smaller in adult patients (p=0.005).ConclusionsFracture pattern, type of incarcerated tissue and incidence of hypoesthesia of the infraorbital nerve were different between adult and paediatric patients. Adult patients had a larger preoperative BSVF and less need for surgical reduction; however, there was less improvement in postoperative BSVF.
Views and attitudes towards blood donation: a qualitative investigation of Indian non-donors living in England
Authors: Joshi Dhaara , Meakin Richard 
Published: October 2017

ObjectiveTo explore the views and attitudes of Indians living in England on blood donation.BackgroundIn light of the predicted shortages in blood supply, it is vital to consider ways in which to maximise donation rates. These include addressing the issue of lower donation rates among ethnic minorities, including Indians. However research specifically among minority ethnicities in UK is sparse.SettingGeneral practice in North London.ParticipantsA convenience sample of 12 non-donor Indians living in England.MethodsThis is a qualitative investigation involving semistructured interviews. Themes derived were analysed using thematic framework analysis.ResultsFive key themes emerged from the data, and these concerned participants’ perspectives regarding attitudes towards blood, blood donation as a ‘good thing’, donation disincentives, the recipient matters and the donor matters.ConclusionA variety of attitudes were presented, but were generally positive, and blood was conceptualised in a manner previously found to be consistent with donation. However, lack of awareness and accessibility were prominent barriers, indicating the need for improvement in these capacities. In contrast to this, blood was also greatly associated with family and acted as a symbol of kinship: this ‘emotional charge’ often acted to dissuade participants from separating with their blood through donation. Possibly due to this, there was also a strong preference for donated blood to be distributed within the family, as opposed to strangers. This presents a potential barrier to blood donation for some Indians within the current system in which donations are given to unknown recipients.
Are quality improvement collaboratives effective? A systematic review
Authors: Wells Susan , Tamir Orly , Gray Jonathon , Naidoo Dhevaksha , Bekhit Mark , Goldmann Don 
Published: October 2017

BackgroundQuality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.MethodWe searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review. We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 standards.ResultsOf the 220 studies meeting QIC criteria, 64 met EPOC study design standards for inclusion. There were 10 cluster randomised controlled trials, 24 controlled before-after studies and 30 interrupted time series studies. QICs encompassed a broad range of clinical settings, topics and populations ranging from neonates to the elderly. Few reports fully described QIC implementation and methods, intensity of activities, degree of site engagement and important contextual factors. By care setting, an improvement was reported for one or more of the study’s primary effect measures in 83% of the studies (32/39 (82%) hospital based, 17/20 (85%) ambulatory care, 3/4 nursing home and a sole ambulance QIC). Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative. Collaboratives reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline.ConclusionsQICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.
Dimple on the shoulder after a ski injury
Authors: Khodaee Morteza , Vidal Armando , Gutierrez Greg 
Published: October 2017

Clinical introductionA 74-year-old woman was brought to the ski clinic shortly after a fall on her left shoulder while skiing. She did not remember the exact fall mechanism. She felt a popping sensation in her left shoulder and was unable to move her left arm due to severe pain. Her medical and social histories were unremarkable. On physical examination, she had a deformity in her left shoulder (figure 1). Her neurovascular examination was intact.Figure 1Photograph of the left shoulder on arrival showing an anterior ‘dimple’.QuestionWhat is the most likely diagnosis of the injury?An acromioclavicular joint (ACJ) sprain (shoulder separation)A proximal humerus fractureA distal clavicle fractureA posterior glenohumeral dislocation
Using an alumni survey to target improvements in an emergency medicine training programme
Authors: Gaeta Theodore , Mahalingam Gowtham , Pyle Matthew , Dam Aaron , Visconti Annette 
Published: October 2017

IntroductionThe Accreditation Council for Graduate Medical Education (ACGME) is the governing body responsible for accrediting graduate medical training programme in the USA. The Emergency Medicine Milestones (EM-Milestones) were developed by the ACGME and American Board of Emergency Medicine as a guide and monitoring tool for the knowledge, skills, abilities and experiences to be acquired during training. Alumni surveys have been reported as a valuable resource for training programme to identify areas for improvement; however, there are few studies regarding programme improvement in emergency medicine. We aimed to use the EM-Milestones, adapted as an alumni self-assessment survey, to identify areas for training programme improvement.MethodsThis study was conducted at an urban, academic affiliated, community hospital in New York city with an emergency medicine training programme consisting of 30 residents over 3 years. Alumni of our emergency medicine training programme were sent an EM-Milestones-based self-assessment survey. Participants evaluated their ability in each EM-Milestones subcompetency on a Likert scale. Data were analysed using descriptive statistics.ResultsResponse rate was 74% (69/93). Alumni reported achieving the target performance in 5/6 general competencies, with Systems-Based Practice falling below the target performance. The survey further identified 6/23 subcompetencies (Pharmacotherapy, Ultrasound, Wound Management, Patient Safety, Systems-Based Management and Technology) falling below the target performance level.DiscussionAlumni self-evaluation of competence using the EM-Milestones provides valuable information concerning confidence to practice independently; these data, coupled with regular milestone evaluation of existing trainees, can identify problem areas and provide a blueprint for targeted programme improvement.
SIFD as a novel cause of severe fetal hydrops and neonatal anaemia with iron loading and marked extramedullary haemopoiesis
Authors: Barton Chris , Kausar Sabiha , Kerr Deborah , Bitetti Stefania , Wynn Rob 
Published: October 2017

SIFD describes a heritable, syndromic condition characterised principally by sideroblastic anaemia (SA) with immunodeficiency, fevers and developmental delay, arising in mutations within the TRNT1 gene. Other clinical manifestations of SIFD include cardiomyopathy, seizures, sensorineural hearing loss, renal dysfunction, metabolic abnormalities, hepatosplenomegaly and retinitis pigmentosa.Presentation of SIFD is variable but typically in early childhood with SA or with fever. In this report, we extend the described SIFD phenotype. We describe a kindred in which the index case presented with fetal hydrops, and early neonatal death, and the second child had severe anaemia at delivery. Both cases had prominent extramedullary erythropoiesis and numerous circulating nucleated red blood cells.