bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dementia and Outcomes of Mechanical Ventilation
Authors: Lagu Tara , Zilberberg Marya D. , Tjia Jennifer , Shieh Meng‐Shiou , Stefan Mihaela , Pekow Penelope S. , Lindenauer Peter K. 
Published: September 2016

ObjectivesTo describe the effect of dementia on hospital outcomes of individuals requiring invasive mechanical ventilation (IMV).DesignRetrospective cohort study.Setting2011 Nationwide Inpatient Sample.ParticipantsHospitalized individuals with and without dementia undergoing IMV.MeasurementsThe adjusted predicted probability of undergoing IMV was examined in individuals with and without dementia. Then the dataset was limited to individuals who received IMV, and a multivariable logistic regression model was created in which dementia was the primary predictor and mortality was the outcome.ResultsOf the 13,816,586 hospitalizations of older adults in the United States in 2011, 2,204,506 (16%) with a dementia diagnosis code were identified. Individuals with dementia had statistically significantly lower predicted probability of undergoing IMV (5.7%, 95% confidence interval (CI) = 5.6–5.8% than those without (6.5%, 95% CI = 6.4–6.6%). When the dataset was limited to individuals undergoing IMV, those with dementia were older (mean age 80 vs 76, P < .001) and had a higher combined Gagne comorbidity score (4.4 vs 4.1, P < .001) than those without. In a multivariable model, dementia was associated with greater likelihood of survival to hospital discharge (odds ratio (OR) = 0.79, P < .001). Individuals with dementia also had shorter mean length of stay (12.5 ± 0.2 vs 13.1 ± 0.2, P = .01) and lower cost per hospitalization for survivors ($37,213 vs $44,557, P < .001).ConclusionOlder critically ill adults with dementia undergoing IMV had better in‐hospital outcomes than those without dementia. Because a lower adjusted percentage of individuals with dementia underwent IMV, it is likely that patient selection drove outcome differences. These findings suggest that individuals, families, and clinicians are carefully considering prognosis, quality of life, and appropriate use of intensive care unit resources when deciding whether to use IMV in individuals with dementia.
Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults
Authors: Liu Stephen K. , Montgomery Justin , Yan Yu , Mecchella John N. , Bartels Stephen J. , Masutani Rebecca , Batsis John A. 
Published: September 2016

ObjectivesTo evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization.DesignRetrospective cohort study.SettingInpatient unit of a rural academic medical center.ParticipantsHospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014.MeasurementsParticipant age at the time of admission, modified Folstein Mini‐Mental State Examination score, and self‐reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay.ResultsFour hundred twenty‐eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42–8.66).ConclusionIn a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision‐making about post‐acute care needs, and expedite discharge planning.
Is there an association between dietary intake and academic achievement: a systematic review
Authors: Burrows T. , Goldman S. , Pursey K. , Lim R. 
Published: September 2016

AbstractBackgroundThe majority of literature examining the effect of dietary behaviour on academic achievement has focused on breakfast consumption only. Here, we aim to systematically review the literature investigating the broader effects of dietary intake and behaviours on school‐aged children's academic achievement.MethodsA search was undertaken across seven databases using keywords. For studies to be included, they needed to be conducted in: school‐aged children (5–18 years); assess and report: (i) a measure of academic performance; (ii) a measure of dietary intake/behaviour; and (iii) the association between dietary intake/behaviours and academic performance. Forty studies were included in the review.ResultsThe majority of studies were cross‐sectional in design (n = 33) and studied children aged >10 years, with very few reports in younger age groups. More than 30 different dietary assessment tools were used, with only 40% of those using a validated/standardised assessment method. Half the studies collected outcomes of academic achievement objectively from a recognised educational authority, whereas 10 studies used self‐reported measures. The dietary outcomes most commonly reported to have positive associations with academic achievement were: breakfast consumption (n = 12) and global diet quality/meal patterns (n = 7), whereas negative associations reported with junk/fast food (n = 9).ConclusionsThis review highlights that moderate associations exist for dietary intakes characterised by regular breakfast consumption, lower intakes of energy‐dense, nutrient‐poor foods and overall diet quality with respect to outcomes of academic achievement. Future studies should consider the use of validated dietary assessment methods and standardised reporting of academic achievement.
Previous Midlife Oestradiol Treatment Results in Long‐Term Maintenance of Hippocampal Oestrogen Receptor α Levels in Ovariectomised Rats: Mechanisms and Implications for Memory
Authors: Black K. L. , Witty C. F. , Daniel J. M. 
Published: September 2016

Ovariectomised rats that have received previous administration of oestradiol in midlife display enhanced cognition and increased hippocampal levels of oestrogen receptor (ER)α months after oestradiol treatment ended compared to ovariectomised controls. The present study aimed to investigate the mechanisms by which ERα levels are maintained following midlife oestradiol exposure and the role of ERα in memory in ageing females in the absence of circulating oestrogens. Unliganded ERα has increased interaction with the ubiquitin ligase, C‐terminus of Hsc‐70 interacting protein (CHIP), leading to increased degradation of the receptor. In our first experiment, we tested the hypothesis that midlife oestradiol exposure in ovariectomised rats results in decreased interaction between CHIP and hippocampal ERα, leading to increased levels of ERα. Middle‐aged rats were ovariectomised and received oestradiol or vehicle implants. After 40 days, implants were removed. One month later, rats were killed and hippocampi were processed for whole protein western blotting and co‐immunoprecipitation, in which ERα was immunoprecipitated from lysate. As expected, ERα protein expression was increased in rats previously treated with oestradiol compared to vehicle‐treated rats. In rats treated with oestradiol, there was a decrease in CHIP–ERα interaction, suggesting that previous oestradiol treatment reduces interaction, slowing the degradation of ERα. In a second experiment, we determined the impact on memory of antagonism of ER in the absence of circulating oestrogens. Rats were ovariectomised and implanted with oestradiol capsules. Capsules were removed after 40 days. Rats received chronic i.c.v. infusion of ER antagonist, ICI 182 780, or artificial cerebrospinal fluid vehicle and were tested on a spatial memory radial‐maze task. Rats treated with ICI 182 780 had significantly worse performance (more errors). These experiments provide evidence that previous midlife oestradiol treatment maintains hippocampal ERα by decreasing its interaction with CHIP and that activation of these receptors provides cognitive benefits in the absence of circulating oestrogens.
Meeting the healthcare needs of transgender people within the armed forces: putting UK military policy into practice
Authors: Whybrow Dean , New Chris , Coetzee Rik , Bickerstaffe Paul 
Published: September 2016

Aims and objectivesTo explain how the healthcare needs of transgender personnel are met within the United Kingdom Armed Forces.BackgroundIt may be that when transgender people disclose their gender preference that they are at increased risk of social exclusion. The United Kingdom Armed Forces has an inclusive organisational policy for the recruitment and management of transgender personnel.DesignThis is a position paper about how the healthcare needs of transgender military personnel are met by the United Kingdom Armed Forces.MethodsUnited Kingdom Armed Forces policy was placed into context by reviewing current research, discussing medical terminology and describing the policy. This was followed by an account of how UK AF policy is applied in practice.DiscussionWhere armed forces had an inclusive policy for the management of transgender personnel, there seemed to be little cause for secrecy and zero tolerance of discrimination when compared to nations where this was not the case. Medical terminology has changed to reflect a more inclusive, less stigmatising use of language. The United Kingdom Armed Forces policy has been described as progressive and inclusive. The application of this policy in practice may be dependent upon strong leadership and training. The wider United Kingdom Armed Forces seems capable of adopting a pragmatic and flexible approach to meeting the healthcare needs of transgender personnel.ConclusionThe United Kingdom Armed Forces value diversity within their workforce and have a progressive, inclusive policy for the recruitment and management of transgender personnel.Relevance to Clinical PracticeWhen supporting a transgender military person, healthcare professionals, civilian organisations and military line managers should consider referring to United Kingdom Armed Forces policy as early as possible. Other military and uniformed services may wish to examine the United Kingdom Armed Forces exemplar in order to consider the applicability within their own organisational setting.
Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland
Authors: Snowden Austyn , Kolb Hildegard 
Published: September 2016

Aims and objectivesTo explore the impact of implementing an electronic health record system on staff at a Scottish hospice.BackgroundElectronic health records are broadly considered preferable to paper‐based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice.DesignNaturalistic prospective repeated‐measures mixed‐methods approach.MethodsData on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free‐text comments and focus group. Participants were all 150 employees of a single hospice in Scotland.ResultsBoth system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change.ConclusionsIt took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the ‘J‐curve’ theory of organisational change, and as such, it is both predictable and manageable for other organisations.Relevance to clinical practiceIt is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity (‘J’ curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically.
Group visits to encourage insulin initiation: targeting patient barriers
Authors: Kuo Charlotte R , Quan Judy , Kim Sarah , Tang Audrey Hui‐yu , Heuerman Deborah Payne , Murphy Elizabeth J 
Published: September 2016

Aims and objectivesTo evaluate the effect of an ‘insulin introduction’ group visit on insulin initiation and A1C in adults with type 2 diabetes.BackgroundThe clinical course of type 2 diabetes involves eventual beta‐cell failure and the need for insulin therapy. Patient psychological insulin resistance, provider‐related delays and system barriers to timely initiation of insulin are common. Group visits are widely accepted by patients and represent a potential strategy for improving insulin initiation.DesignA single two‐hour group visit in English or Spanish, facilitated by advanced practice nurses, addressed psychological insulin resistance and encouraged mock injections to overcome needle anxiety.MethodsA retrospective review of 273 patients referred from 2008–2012, determined characteristics of group attenders, rates of mock self‐injection, rates of insulin initiation and changes in A1C from baseline to 2–6 and 7–12 months postgroup. Change in A1C was compared to patients referred to the group who did not attend (‘nonattenders’).ResultsOf 241 patients eligible for analysis, 87·6% were racial/ethnic minorities with an average A1C of 9·99%. Group attendance rate was 66%; 92% performed a mock injection, 55% subsequently started insulin. By 2–6 months, A1C decreased by 1·37% among group attenders, and by 1·6% in those who did a mock injection and started insulin. Fewer nonattenders started insulin in primary care (40%), experiencing an A1C reduction of 0·56% by 2–6 months. A1C improvements were sustained by 7–12 months among group attenders and nonattenders who started insulin.Relevance to clinical practiceNurses can effectively address patient fears and engage patients in reframing insulin therapy within group visits.ConclusionsThis one‐time nurse‐facilitated group visit addressing psychological barriers to insulin in a predominantly minority patient population resulted in increased insulin initiation rates and clinically meaningful A1C reductions.
Melatonin biosynthesis in plants: multiple pathways catalyze tryptophan to melatonin in the cytoplasm or chloroplasts
Authors: Back Kyoungwhan , Tan Dun‐Xian , Reiter Russel J. 
Published: September 2016

AbstractMelatonin is an animal hormone as well as a signaling molecule in plants. It was first identified in plants in 1995, and almost all enzymes responsible for melatonin biosynthesis had already been characterized in these species. Melatonin biosynthesis from tryptophan requires four‐step reactions. However, six genes, that is, TDC, TPH, T5H, SNAT, ASMT, and COMT, have been implicated in the synthesis of melatonin in plants, suggesting the presence of multiple pathways. Two major pathways have been proposed based on the enzyme kinetics: One is the tryptophan/tryptamine/serotonin/N‐acetylserotonin/melatonin pathway, which may occur under normal growth conditions; the other is the tryptophan/tryptamine/serotonin/5‐methoxytryptamine/melatonin pathway, which may occur when plants produce large amounts of serotonin, for example, upon senescence. The melatonin biosynthetic capacity associated with conversion of tryptophan to serotonin is much higher than that associated with conversion of serotonin to melatonin, which yields a low level of melatonin synthesis in plants. Many melatonin intermediates are produced in various subcellular compartments, such as the cytoplasm, endoplasmic reticulum, and chloroplasts, which either facilitates or impedes the subsequent enzymatic steps. Depending on the pathways, the final subcellular sites of melatonin synthesis vary at either the cytoplasm or chloroplasts, which may differentially affect the mode of action of melatonin in plants.
Melatonin promotes cardiomyogenesis of embryonic stem cells via inhibition of HIF‐1α stabilization
Authors: Kudová Jana , Vašíček Ondřej , Číž Milan , Kubala Lukáš 
Published: September 2016

AbstractMelatonin, a molecule involved in the regulation of circadian rhythms, has protective effects against myocardial injuries. However, its capability to regulate the maturation of cardiac progenitor cells is unclear. Recently, several studies have shown that melatonin inhibits the stabilization of hypoxia‐inducible factors (HIFs), important signaling molecules with cardioprotective effects. In this study, by employing differentiating mouse embryonic stem cells, we report that melatonin significantly upregulated the expression of cardiac cell‐specific markers (myosin heavy chains six and seven) as well as the percentage of myosin heavy chain‐positive cells. Importantly, melatonin decreased HIF‐1α stabilization and transcriptional activity and, in contrast, induced HIF‐2α stabilization. Interestingly, the deletion of HIF‐1α completely inhibited the pro‐cardiomyogenic effect of melatonin as well as the melatonin‐mediated HIF‐2α stabilization. Moreover, melatonin increased Sirt‐1 levels in a HIF‐1α‐dependent manner. Taken together, we provide new evidence of a time‐specific inhibition of HIF‐1α stabilization as an essential feature of melatonin‐induced cardiomyogenesis and unexpected different roles of HIF‐1α stabilization during various stages of cardiac development. These results uncover new mechanisms underlying the maturation of cardiac progenitor cells and can help in the development of novel strategies for using melatonin in cardiac regeneration therapy.
Cancer Disparities in Rural Appalachia: Incidence, Early Detection, and Survivorship
Authors: Yao Nengliang , Alcalá Héctor E. , Anderson Roger , Balkrishnan Rajesh 
Published: September 2016

AbstractPurposeTo document cancer‐related health disparities in Appalachia.MethodsThe current study investigated disparities in cancer incidence, mortality, and staging between rural Appalachians and those living outside of rural Appalachia. To accomplish this, mortality data for the United States from 1969 to 2011 were obtained from the National Center for Health Statistics (NCHS) using SEER*Stat. These data were used to compare trends in mortality between rural Appalachians, urban Appalachians, rural non‐Appalachians, and urban non‐Appalachians. Cancer incidence trends, staging, and survivorship data were compared across regions using the SEER‐18 Program, which represented 28% of the US population and includes 2 Appalachian states: Georgia and Kentucky.ResultsCancer mortality rates declined in all regions, but disparities remained such that rural Appalachia has the highest incidence, while urban non‐Appalachia has the lowest. In all but 1 state, rural Appalachians had higher cancer mortality rates than urban non‐Appalachians. Cancer incidence declined for all regions except rural Appalachia. Rural Appalachians had lower rates of early stage breast cancer diagnoses than their urban non‐Appalachian counterparts. Finally, rural Appalachians had lower 3‐ and 5‐year survival rates than their urban non‐Appalachian counterparts.ConclusionsRural Appalachians are faced with poorer cancer‐related health outcomes across the continuum of cancer care. A systematic effort is needed to reduce the burden of cancer for rural Appalachia. Additional research should explore reasons for the disparities that were observed.
Hyperspectral mapping of alteration assemblages within a hydrothermal vug at the Haughton impact structure, Canada
Authors: Greenberger Rebecca N. , Mustard John F. , Osinski Gordon R. , Tornabene Livio L. , Pontefract Alexandra J. , Marion Cassandra L. , Flemming Roberta L. , Wilson Janette H. , Cloutis Edward A. 
Published: September 2016

AbstractMeteorite impacts on Earth and Mars can generate hydrothermal systems that alter the primary mineralogies of rocks and provide suitable environments for microbial colonization. We investigate a calcite–marcasite‐bearing vug at the ~23 km diameter Haughton impact structure, Devon Island, Nunavut, Canada, using imaging spectroscopy of the outcrop in the field (0.65–1.1 μm) and samples in the laboratory (0.4–2.5 μm), point spectroscopy (0.35–2.5 μm), major element chemistry, and X‐ray diffraction analyses. The mineral assemblages mapped at the outcrop include marcasite; marcasite with minor gypsum and jarosite; fibroferrite and copiapite with minor gypsum and melanterite; gypsum, Fe3+ oxides, and jarosite; and calcite, gypsum, clay, microcline, and quartz. Hyperspectral mapping of alteration phases shows spatial patterns that illuminate changes in alteration conditions and formation of specific mineral phases. Marcasite formed from the postimpact hydrothermal system under reducing conditions, while subsequent weathering oxidized the marcasite at low temperatures and water/rock ratios. The acidic fluids resulting from the oxidation collected on flat‐lying portions of the outcrop, precipitating fibroferrite + copiapite. That assemblage then likely dissolved, and the changing chemistry and pH resulting from interaction with the calcite‐rich host rock formed gypsum‐bearing red coatings. These results have implications for understanding water–rock interactions and habitabilities at this site and on Mars.
Superficial Epidermolytic Ichthyosis—Hypertrichosis as a Clue to Diagnosis
Authors: Gameiro Ana , Cabral Rita , Moreno Ana , Tellechea Oscar 
Published: September 2016

AbstractSuperficial epidermolytic ichthyosis (SEI) is an autosomal dominant disorder caused by a mutation in the keratin 2 gene and clinically characterized by mild hyperkeratosis, superficial blisters and shedding, referred to as the moulting phenomenon. We report a case of SEI in an 18‐month‐old girl presenting with marked hypertrichosis. Although not invariably present, we believe that hypertrichosis can be an important clue for diagnosis.
Cutaneous Manifestations of Mucopolysaccharidoses
Authors: Tran Mimi C. , Lam Joseph M. 
Published: September 2016

AbstractMucopolysaccharidoses (MPSs) are a group of inherited lysosomal storage disorders characterized by deficiencies in specific enzymes involved in the catabolism of glycosaminoglycans (GAGs). These deficiencies cause excessive metabolites to accumulate in multiple organs. There are eight differentMPSdisorders, contributing to the wide variation in clinical presentation. Depending on the severity and subtype of the disease, some children live normal life spans, while others have a more grim prognosis. Children withMPScan present with neurologic, behavioral, skeletal, cardiovascular, gastrointestinal, or respiratory abnormalities. Cutaneous manifestations are mostly nonspecific and can include coarse facial features, thickened skin, and excessive hair growth. More specific skin findings include ivory‐colored “pebbly” papules found in Hunter syndrome and extensive dermal melanocytosis found in Hurler and Hunter syndromes. Early diagnosis ofMPSdisorders is extremely important to minimize the progression of the disease and for early initiation of appropriate treatment.