bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium after fast‐track hip and knee arthroplasty – a cohort study of 6331 elderly patients
Authors: Petersen P. B. , Jørgensen C. C. , Kehlet H. ,   the Lundbeck Foundation Centre for Fast‐track Hip and Knee Replacement Collaborative Group
Published: July 2017

BackgroundPostoperative delirium (PD) is a well‐known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast‐track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days.MethodsProspective risk assessment study with retrospective analysis of discharge notes or medical records of signs of PD in 6331 elective primary unilateral THA and TKA patients ≥ 70 years, and LOS > 4 days. Preoperative patient characteristics collected from eight high volume centers with similar standardized fast‐track protocols from January 2010 to November 2013.ResultsWe identified 43 (0.7%) cases of PD symptoms mentioned as a reason for LOS > 4 days among the 789 patients with LOS > 4 days (12.5% of all THA and TKA). PD patients had a mean age of 80.7 [[95% CI] 79.3–82.1] years, being 4.0 [[95% CI] 2.5–5.5] years older compared to patients without PD (P < 0.001). LOS was median 10 [[Q2–Q3] 7–14] days in the PD group vs. 3 [2–3] days in the non‐PD group (P < 0.001), without differences in gender or site of arthroplasty (P = 0.139 and 0.499, respectively).ConclusionPostoperative delirium symptoms contributing to LOS > 4 days in fast‐track THA and TKA are rare in elderly patients.
Akt2 ablation prolongs life span and improves myocardial contractile function with adaptive cardiac remodeling: role of Sirt1‐mediated autophagy regulation
Authors: Ren Jun , Yang Lifang , Zhu Li , Xu Xihui , Ceylan Asli F. , Guo Wei , Yang Jian , Zhang Yingmei 
Published: July 2017

SummaryAging is accompanied with unfavorable geometric and functional changes in the heart involving dysregulation of Akt and autophagy. This study examined the impact of Akt2 ablation on life span and cardiac aging as well as the mechanisms involved with a focus on autophagy and mitochondrial integrity. Cardiac geometry, contractile, and intracellular Ca2+ properties were evaluated using echocardiography, IonOptix® edge‐detection and fura‐2 techniques. Levels of Sirt1, mitochondrial integrity, autophagy, and mitophagy markers were evaluated using Western blot. Our results revealed that Akt2 ablation prolonged life span (by 9.1%) and alleviated aging (24 months)‐induced unfavorable changes in myocardial function and intracellular Ca2+ handling (SERCA2a oxidation) albeit with more pronounced cardiac hypertrophy (58.1%, 47.8%, and 14.5% rises in heart weight, wall thickness, and cardiomyocyte cross‐sectional area). Aging downregulated levels of Sirt1, increased phosphorylation of Akt, and the nuclear transcriptional factor Foxo1, as well as facilitated acetylation of Foxo1, the effects of which (except Sirt1 and Foxo1 acetylation) were significantly attenuated or negated by Akt2 ablation. Advanced aging disturbed autophagy, mitophagy, and mitochondrial integrity as evidenced by increased p62, decreased levels of beclin‐1, Atg7, LC3B, BNIP3, PTEN‐induced putative kinase 1 (PINK1), Parkin, UCP‐2, PGC‐1α, and aconitase activity, the effects of which were reversed by Akt2 ablation. Aging‐induced cardiomyocyte contractile dysfunction and loss of mitophagy were improved by rapamycin and the Sirt1 activator SRT1720. Activation of Akt using insulin or Parkin deficiency prevented SRT1720‐induced beneficial effects against aging. In conclusion, our data indicate that Akt2 ablation protects against cardiac aging through restored Foxo1‐related autophagy and mitochondrial integrity.
Factors Associated with Self‐Estimated Breath Alcohol Concentration Among Bar Patrons
Authors: Rossheim Matthew E. , Barry Adam E. , Thombs Dennis L. , Weiler Robert M. , Krall Jenna R. , Stephenson Caroline J. , Walters Scott T. , Reed Mark B. , Clapp John D. , Suzuki Sumihiro , Barnett Tracey E. , Cannell M. Brad 
Published: July 2017

BackgroundFew studies have examined the context in which drinkers underestimate their breath alcohol concentration (BrAC) in natural drinking environments. This study examined factors associated with bar patrons’ self‐estimated BrAC in high‐risk college town settings.MethodsGuided interview and BrAC data were collected from 510 participants recruited as they exited bars located close to large universities: 1 in Florida and 1 in Texas.ResultsParticipants with the highest measured BrACs underestimated their BrAC levels the most. Findings from multivariable linear regression analysis indicated that BrAC (std β = 0.014, p < 0.001), number of alcoholic drinks consumed (std β = 0.006, p < 0.01), and perceived drunkenness (std β = 0.024, p < 0.001) had significant positive associations with BrAC self‐estimates, where the regression coefficients were scaled by values approximately equal to each variable's interquartile range. Among the 321 participants with BrAC levels ≥ 0.08 g/dl, 21.2% believed their BrAC was below the legal per se driving limit of 0.08 g/dl. Results from a logistic regression analysis indicated that higher levels of perceived drunkenness were associated with better self‐recognition that one's BrAC level exceeded the legal driving threshold (OR = 3.312, p < 0.001). Further, participants under 26 years of age had reduced odds of recognizing that their BrAC was greater than 0.079 g/dl (OR = 0.245, p < 0.05).ConclusionsThese findings highlight the inaccuracy of self‐estimated BrAC when drinking, particularly among younger drinkers. Adjusting for BrAC, situational factors were strongly associated with self‐estimated BrAC. Future research is needed to better understand how altering drinking environments may improve accuracy of BrAC self‐estimates and deter driving after drinking.
The effects of board gender diversity on a firm's risk strategies
Authors: Chen Linda H. , Gramlich Jeffrey , Houser Kimberly A. 
Published: July 2017

AbstractWe study whether board gender diversity (BGD) affects corporate risk strategies. Specifically, we investigate the association between BGD and firms’ reputation risk and financial risk. Using S&P data from 1997 to 2013, we find that BGD is negatively associated with tax avoidance, suggesting firms with gender‐diverse boards are more cautious about potential reputation risks associated with aggressive tax strategies. However, we find that BGD is positively associated with firms’ financial risk. The combined findings illustrate that BGD aligns a firm's risk exposure closer to risk‐neutral shareholders’ preferences by reducing reputation risk exposure while enabling necessary financial risk exposure.
Cocaine and HIV are independently associated with neural activation in response to gain and loss valuation during economic risky choice
Authors: Meade Christina S. , Addicott Merideth , Hobkirk Andrea L. , Towe Sheri L. , Chen Nan‐Kuei , Sridharan Sriramkumar , Huettel Scott A. 
Published: July 2017

AbstractStimulant abuse is disproportionately common in HIV‐positive persons. Both HIV and stimulants are independently associated with deficits in reward‐based decision making, but their interactive and/or additive effects are poorly understood despite their prevalent co‐morbidity. Here, we examined the effects of cocaine dependence and HIV infection in 69 adults who underwent functional magnetic resonance imaging while completing an economic loss aversion task. We identified two neural networks that correlated with the evaluation of the favorable characteristics of the gamble (i.e. higher gains/lower losses: ventromedial prefrontal cortex, anterior cingulate, anterior and posterior precuneus and visual cortex) versus unfavorable characteristics of the gamble (i.e. lower gains/higher losses: dorsal prefrontal, lateral orbitofrontal, posterior parietal cortex, anterior insula and dorsal caudate). Behaviorally, cocaine and HIV had additive effects on loss aversion scores, with HIV‐positive cocaine users being the least loss averse. Cocaine users had greater activation in brain regions that tracked the favorability of gamble characteristics (i.e. increased activation to gains, but decreased activation to losses). In contrast, HIV infection was independently associated with lesser activation in regions that tracked the unfavorability of gamble characteristics. These results suggest that cocaine is associated with an overactive reward‐seeking system, while HIV is associated with an underactive cognitive control system. Together, these alterations may leave HIV‐positive cocaine users particularly vulnerable to making unfavorable decisions when outcomes are uncertain.
Proliferation of endogenous regulatory T cells improve the pathophysiology associated with placental ischaemia of pregnancy
Authors: Ibrahim Tarek , Przybyl Lukasz , Harmon Ashlyn C. , Amaral Lorena M. , Faulkner Jessica L. , Cornelius Denise C. , Cunningham Mark W. , Hünig Thomas , Herse Florian , Wallukat Gerd , Dechend Ralf , LaMarca Babbette 
Published: July 2017

ProblemPreeclampsia (PE) is associated with inflammation and decreased Treg cells and IL‐10. The reduced uterine perfusion pressure (RUPP) rat model of PE exhibits these characteristics, and we hypothesized that induction of endogenous Tregs by a specific stimulus (CD28 superagonistic monoclonal antibody) would reduce inflammation, vasoactive factors, and hypertension in RUPP rats.Method of studyRUPP was performed at gestation day (GD) 14; CD28 superagonist was administered intraperitoneally GD15; GD18 carotid catheters were inserted, and GD19 MAP and pup weight, blood, and tissues were collected.ResultsMAP (mmHg) in NP rats was 99±5 and 122±2 in RUPPs and was 111±1 mmHg in RUPP+SA. Circulating Tregs were 6±2% in NP rats and 0.77±0.49% in RUPP rats but increased to 11± 3% in RUPP+SA rats. Circulating IL‐6 and IL‐2 were decreased while IL‐10 and TGF‐B were significantly increased in RUPP+SA compared to RUPP controls. Vasoactive pathways such as ET‐1, AT1‐AA, and ROS were all reduced in RUPP+SA compared to RUPP. Pup weight was 2.4±0.05 mg in NP and 1.94±0.062 mg in RUPP and increased to 2.1± 0.05 mg in RUPP+SA.ConclusionThese data suggest that stimulating endogenous Tregs lower factors causing hypertension and can improve fetal weight in response to PE.
Accelerated fetal growth in early pregnancy and risk of severe large‐for‐gestational‐age and macrosomic infant: a cohort study in a low‐risk population
Authors: Simic Marija , Wikström Anna‐Karin , Stephansson Olof 
Published: July 2017

AbstractIntroductionOur objective was to examine the association between fetal growth in early pregnancy and risk of severe large‐for‐gestational‐age (LGA) and macrosomia at birth in a low‐risk population.Material and methodsCohort study that included 68 771 women with non‐anomalous singleton pregnancies, without history of diabetes or hypertension, based on an electronic database on pregnancies and deliveries in Stockholm–Gotland Region, Sweden, 2008–2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5–24.9 kg/m2).ResultsWhen adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second‐trimester scan (adjusted odds ratio 1.80; 95% CI 1.23–2.64 and adjusted odds ratio 2.15; 95% CI 1.55–2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second‐trimester ultrasound was at least 7 days.ConclusionsIn a low‐risk population, ultrasound‐estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant.
Laparoscopic dissection of Merkel cell carcinoma recurrence at the pelvic lymph node
Authors: Watanabe Genki , Fukunaga Yosuke , Nagasaki Toshiya , Akiyoshi Takashi , Konishi Tsuyoshi , Fujimoto Yoshiya , Nagayama Satoshi , Ueno Masashi 
Published: July 2017

AbstractMerkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of the skin. It has a high propensity for recurrence and metastasis, and there is no clearly defined treatment. MCC recurrence at the pelvic lymph node has rarely been reported. Herein, we report a patient with pelvic lymph node recurrence of MCC that was dissected laparoscopically. Nine years before presenting to us, a 76‐year‐old male patient had been diagnosed with MCC, and since then, he had had two recurrences. The most recent recurrence—the third recurrence—involved a tumor that had been detected at the right pelvic lymph node, and MCC recurrence was suspected after several imaging studies. Laparoscopic right pelvic lymph node dissection was conducted, and pathological findings confirmed MCC recurrence. The patient was discharged on postoperative day 8 and had no recurrence for 2 years as detected by imaging. This case report demonstrates the benefits of laparoscopic treatment of MCC recurrence with respect to intraoperative magnified vision and a more comfortable postoperative course for the patient.
Covariate-adjusted Response-adaptive Randomization for Multi-arm Clinical Trials Using a Modified Forward Looking Gittins Index Rule
Authors: Villar Sofía S. , Rosenberger William F. 
Published: July 2017

Summary
We introduce a non-myopic, covariate-adjusted response adaptive (CARA) allocation design for multi-armed clinical trials. The allocation scheme is a computationally tractable procedure based on the Gittins index solution to the classic multi-armed bandit problem and extends the procedure recently proposed in Villar et al. (2015). Our proposed CARA randomization procedure is defined by reformulating the bandit problem with covariates into a classic bandit problem in which there are multiple combination arms, considering every arm per each covariate category as a distinct treatment arm. We then apply a heuristically modified Gittins index rule to solve the problem and define allocation probabilities from the resulting solution. We report the efficiency, balance, and ethical performance of our approach compared to existing CARA methods using a recently published clinical trial as motivation. The net savings in terms of expected number of treatment failures is considerably larger and probably enough to make this design attractive for certain studies where known covariates are expected to be important, stratification is not desired, treatment failures have a high ethical cost, and the disease under study is rare. In a two-armed context, this patient benefit advantage comes at the expense of increased variability in the allocation proportions and a reduction in statistical power. However, in a multi-armed context, simple modifications of the proposed CARA rule can be incorporated so that an ethical advantage can be offered without sacrificing power in comparison with balanced designs.
The impact of education on dental health — Ways to measure causal effects
Authors: Grytten Jostein 
Published: July 2017

AbstractTo our knowledge, there are no studies in which a possible causal effect of education on dental health has been examined. Such studies are needed to predict whether more schooling for people with poor dental health improves their dental health. Within social science, and in economics in particular, several methods have been developed to make causal inferences of the relationship between education and general health. These methods, which are based on observational data, are relevant to use for estimating a possible causal effect of education on dental health. This commentary provides an overview of the state of the art of the following methods: the use of instrumental variables, twin studies and a regression discontinuity design. Using these methods, reversed causality and the omission of a third variable that influences both education and dental health can be controlled for. In that way, an unbiased estimate of the effect of education on dental health can be obtained. To implement each of the methods correctly, several criteria have to be fulfilled. These criteria are outlined and discussed below.
Safety and pharmacodynamics of intranasal GSK2245035, a TLR7 agonist for allergic rhinitis: A randomized trial
Authors: Ellis A. K. , Tsitoura D. C. , Quint D. , Powley W. , Lee L. A. 
Published: July 2017

SummaryBackgroundToll‐like receptor 7 (TLR7) stimulation in the airways may reduce responses to aeroallergens by induction of type 1 interferons (IFNs). GSK2245035 is a novel selective TLR7 agonist in pharmaceutical development.ObjectiveAssessment of safety, pharmacodynamics and nasal allergic reactivity following repeated weekly intranasal (i.n.) GSK2245035.MethodsThis randomized, double‐blind, placebo‐controlled study (TL7116958) was conducted over two pollen seasons (2013‐2014) and follow‐up study (204509) conducted 1 year later. Participants with allergic rhinitis (n=42) were randomized to receive eight weekly doses of i.n. GSK2245035 (20 ng [2014 Cohort; n=14] or 80 ng [2013 Cohort; n=14]) or placebo (n=14). Adverse events (AEs) including cytokine release syndrome AEs (CytoRS‐AEs) and nasal symptoms were assessed. Nasal and serum IFN‐inducible protein 10 (IP‐10) were measured after doses 1 and 8, then 1 (follow‐up visit [FUV] 1) and 3 (FUV2) weeks after final dose. Nasal allergen challenges (NACs) and allergic biomarker assessment (nasal, serum) were conducted at baseline, FUV1, FUV2 and at a FUV 1 year after final dose (FUV3; 2014 Cohort only). A Bayesian framework enabled probability statements for mean effect sizes.ResultsGSK2245035 induced CytoRS‐AEs (most commonly headache, median duration <1 day) in 93% of participants at 80 ng, while AE incidence at 20 ng was similar to placebo. There was no evidence of nasal inflammation. Dose‐related increases in nasal and serum IP‐10 were observed 24 hours after doses 1 and 8 (>95% certainty). Both doses showed a trend in reducing total nasal symptom score 15 minutes post‐NAC at FUV1 and FUV2, but there was no reduction evident at FUV3. Nasal levels of selected allergic biomarkers demonstrated trends for reductions at FUV1, FUV2 and FUV3.Conclusions and clinical relevanceWeekly i.n. GSK2245035 20 ng was well tolerated and reduced allergic reactivity to nasal challenge for 3 weeks post‐treatment.
Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk
Authors: Chung Stephanie T. , Ha Joon , Onuzuruike Anthony U. , Kasturi Kannan , Galvan‐De La Cruz Mirella , Bingham Brianna A. , Baker Rafeal L. , Utumatwishima Jean N. , Mabundo Lilian S. , Ricks Madia , Sherman Arthur S. , Sumner Anne E. 
Published: July 2017

SummaryContextMorphological characteristics of the glucose curve during an oral glucose tolerance test (OGTT) (time to peak and shape) may reflect different phenotypes of insulin secretion and action, but their ability to predict diabetes risk is uncertain.ObjectiveTo compare the ability of time to glucose peak and curve shape to detect prediabetes and β‐cell function.Design and participantsIn a cross‐sectional evaluation using an OGTT, 145 adults without diabetes (age 42±9 years (mean±SD), range 24‐62 years, BMI 29.2±5.3 kg/m2, range 19.9‐45.2 kg/m2) were characterized by peak (30 minutes vs >30 minutes) and shape (biphasic vs monophasic).Main outcome measuresPrediabetes and disposition index (DI)—a marker of β‐cell function.ResultsPrediabetes was diagnosed in 36% (52/145) of participants. Peak>30 minutes, not monophasic curve, was associated with increased odds of prediabetes (OR: 4.0 vs 1.1; P<.001). Both monophasic curve and peak>30 minutes were associated with lower DI (P≤.01). Time to glucose peak and glucose area under the curves (AUC) were independent predictors of DI (adjR2=0.45, P<.001).ConclusionGlucose peak >30 minutes was a stronger independent indicator of prediabetes and β‐cell function than the monophasic curve. Time to glucose peak may be an important tool that could enhance prediabetes risk stratification.
Developing a national colorectal educational agenda: a survey of the Association of Coloproctology of Great Britain and Ireland
Authors: Francis N. K. , Curtis N. J. , Weegenaar C. , Boorman P. A. , Brook A. , Thorpe G. , Keogh K. , Grainger J. , Davies J. , Wheeler J. , Brown S. R. , Steele R. J. , Dawson P. ,   the ACPGBI Education Training Committee
Published: July 2017

AbstractAimIn order to develop its education agenda, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) sought the opinion of its members on current coloproctology training needs. The aims of this study were to canvass multidisciplinary needs and explore the perceived gaps and barriers to meeting them.MethodA learner‐needs analysis was performed between July 2015 and October 2016. A bespoke electronic survey was sent to 1453 colorectal healthcare professionals [ACPGBI membership (1173), colorectal nurse specialists and allied health professionals (NAHPs) (261) and regional chapter‐leads (19)] seeking their needs, experiences and barriers to training across the coloproctology disciplines.ResultsIn all, 390 responses were received [26.8% overall; 180 consultants/trainees (15%); 196 NAHPs (75%); 14 (74%) chapter‐leads]. Lack of funding and difficulties in obtaining study leave were the most frequently reported barriers to course and conference attendance. Transanal total mesorectal excision and laparoscopic training were the top educational needs for consultants and trainees respectively. 79% of NAHP respondents reported education gaps on a broad range of clinical and non‐clinical topics. NAHPs lacked information on relevant training opportunities and 27% felt available courses were insufficient to meet their educational needs. Wide heterogeneity in ACPGBI chapter composition and activity was reported. All groups felt the ACPGBI should increase the number of courses offered with coloproctology knowledge updates commonly requested.ConclusionA series of training needs across the coloproctology disciplines have been identified. These will underpin the development of the educational agenda for the ACPGBI.