bluuebunny/crossref_metadata_2025_split huggingface dataset:
Whipple's in the valleys: a case of Whipple's with thrombocytopenia and endocarditis
Authors: Loughran Dafydd , Beale Lee , Lodge Freya , Habboush Husni , Stock David 
Published: January 2014

IntroductionThis case report details the second described case of Whipple's disease-related thrombocytopenia in the medical literature. Whipple's disease is a rare multisystem infection caused by the actinomyceteTropheryma whipplei, first described by George Whipple in 1907. The key clinical manifestations are weight loss, diarrhoea and malabsorption, but arthralgia and endocarditis are also well described.Case presentationA 62-year-old Caucasian female presented with weight loss, anaemia and behavioural changes but denied any abdominal symptoms. Thrombocytopenia subsequently developed rapidly. Bone marrow examination showed abundant megakaryocytes in keeping with peripheral platelet sequestration. In addition, there was significant polyclonal plasmacytosis. She was also found to have a 1.6 cm tricuspid vegetation. The diagnosis was confirmed by presence of foamy macrophages on duodenal biopsy, positive periodic acid-Schiff staining and visualisation ofT whippleiactinomycetes on electron microscopy. Tissue PCR performed mid-treatment showed traces ofT whippleiDNA. The infection was treated with a 2-week intravenous course of ceftriaxone followed by 12 months of oral co-trimoxazole. The thrombocytopenia and anaemia resolved rapidly with antibiotic therapy, her behaviour returned to normal and she remains clinically well.ConclusionsThis report confirms the association of thrombocytopenia with Whipple's disease, likely due to peripheral platelet sequestration, which resolves rapidly with treatment. In patients with a long history of unintended weight loss, Whipple's disease is a rare but important differential diagnosis as it is ultimately fatal if left untreated.
The evolution of One Health: a decade of progress and challenges for the future
Authors: Gibbs E. Paul J. 
Published: January 2014

The One Health concept is gathering momentum and, over the next 12 months, Veterinary Record will be publishing a series of articles to help encourage that process. Written by specialists in a range of fields, the articles will consider the meaning of One Health, the interactions between animal and human health and how a collaborative and interdisciplinary approach could help to solve emerging global problems. To set the scene, Paul Gibbs outlines the recent history of One Health, discusses current challenges and muses on what the future might hold.
An assessment of lithostratigraphy for anthropogenic deposits
Authors: Ford J. R. , Price S. J. , Cooper A. H. , Waters C. N. 
Published: January 2014

Abstract
The deliberate anthropogenic movement of reworked natural and novel manufactured materials represents a novel sedimentary environment associated with mining, waste disposal, construction and urbanization. Anthropogenic deposits display distinctive engineering and environmental properties, and can be of archaeological importance. This paper shows that temporal changes in the scale and lithological character of anthropogenic deposits may be indicative of the Anthropocene. However, the stratigraphy of such deposits is not readily described by existing classification schemes, which do not differentiate separate phases or lithologically distinct deposits beyond a local scale. Lithostratigraphy is a scalable, hierarchical classification used to distinguish successive and lithologically distinct natural deposits. Many natural and anthropogenic deposits exhibit common characteristics; they typically conform to the Law (or Principle) of Superposition and exhibit lithological distinction. The lithostratigraphical classification of surficial anthropogenic deposits may be effective, although defined units may be significantly thinner and far less continuous than those defined for natural deposits. Further challenges include the designation of stratotypes, accommodating the highly diachronous nature of anthropogenic deposits and the common presence of disconformities. International lithostratigraphical guidelines would require significant modification before being effective for the classification of anthropogenic deposits. A practical alternative may be to establish an ‘anthrostratigraphical’ approach, or ‘anthrostratigraphy’.
A novel thromboxane A2 receptor N42S variant results in reduced surface expression and platelet dysfunction
Authors: Nisar Shaista P. , Lordkipanidzé Marie , Jones Matthew L. , Dawood Ban B. , Murden Sherina , Cunningham Margaret R. , Mumford Andrew D. , Wilde Jonathan T. , Watson Steve P. , Lowe Gillian C. , Mundell Stuart J. ,   the UK GAPP Study Group
Published: January 2014

SummaryA small number of thromboxane receptor variants have been described in patients with a bleeding history that result in platelet dysfunction. We have identified a patient with a history of significant bleeding, who expresses a novel heterozygous thromboxane receptor variant that predicts an asparagine to serine substitution (N42S). This asparagine is conserved across all class A GPCRs, suggesting a vital role for receptor structure and function. We investigated the functional consequences of the TP receptor heterozygous N42S substitution by performing platelet function studies on platelet-rich plasma taken from the patient and healthy controls. We investigated the N42S mutation by expressing the wild-type (WT) and mutant receptor in human embryonic kidney (HEK) cells. Aggregation studies showed an ablation of arachidonic acid responses in the patient, whilst there was right-ward shift of the U46619 concentration response curve (CRC). Thromboxane generation was unaffected. Calcium mobilisation studies in cells lines showed a rightward shift of the U46619 CRC in N42S–expressing cells compared to WT. Radioligand binding studies revealed a reduction in BMax in platelets taken from the patient and in N42S–expressing cells, whilst cell studies confirmed poor surface expression. We have identified a novel thromboxane receptor variant, N42S, which results in platelet dysfunction due to reduced surface expression. It is associated with a significant bleeding history in the patient in whom it was identified. This is the first description of a naturally occurring variant that results in the substitution of this highly conserved residue and confirms the importance of this residue for correct GPCR function.
Micropatterned array to assess the interaction of single platelets with platelet factor 4-heparin-IgG complexes
Authors: Medvedev Nikolay , Palankar Raghavendra , Krauel Krystin , Greinacher Andreas , Delcea Mihaela 
Published: January 2014

SummaryWe report a strategy to generate by electron beam lithography high fidelity micropatterned arrays to assess the interaction of single platelets with immobilised ligands. As a proof-of-principle we functionalised the microarrays with platelet factor 4 (PF4)-heparin-IgG complexes. We embedded biotinylated water-soluble quantum dots into polyethylene glycol (PEG)-coated micropatterned arrays and functionalised them via streptavidin to bind biotinylated ligands, here biotinylated-PF4/heparin complexes. The integrity of the PF4/heparin-complexes was shown by binding of anti-PF4/heparin antibodies. Ligand density was quantified by immunofluorescence and immunogold antibody labelling. Real-time calcium imaging was employed for read-out of single platelets activated on micropatterned surfaces functionalised with PF4/heparin-IgG complexes. With the smallest micropatterns (0.5x0.5 µm) we show that single platelets become strongly activated by binding to surface-immobilised PF4/heparin-IgG, while on larger micropatterns (10x10 µm), platelet aggregates formed. These findings that HIT antibodies can cause platelet activation on microarrays illustrate how this novel method opens new avenues to study platelet function at single cell level. Generating functionalized microarray surfaces to which highly complex ligands can be bound and quantified has the potential for platelet and other cell function assays integrated into high-throughput microfluidic microdevices.
New oral anticoagulant agents – general features and outcomes in subsets of patients
Authors: Schulman Sam 
Published: January 2014

SummaryDuring the past four years the phase III trials on stroke prophylaxis in atrial fibrillation and on treatment of venous thromboembolism have been completed for four new oral anticoagulants – dabigatran, apixaban, edoxaban and rivaroxaban. The studies have revealed advantages in terms of a reduced risk of bleeding, most importantly of intracranial bleeding. These anticoagulants also have favourable pharmacokinetics, eliminating the need for routine laboratory monitoring and dose adjustments. There are, however, some differences between the drugs in certain subsets of patients, according to patient characteristics or to indication for treatment. These features are reviewed here. The management of patients in association with invasive procedures or major bleeding is also discussed. Finally, a strategy of how to select patients for warfarin or the new anticoagulants and thereafter possibly also among the latter is outlined.
An Investigation of Warm Rainfall Microphysics in the Southern Appalachians: Orographic Enhancement via Low-Level Seeder–Feeder Interactions
Authors: Wilson Anna M. , Barros Ana P. 
Published: January 2014

Abstract
Observations of the vertical structure of rainfall, surface rain rates, and drop size distributions (DSDs) in the southern Appalachians were analyzed with a focus on the diurnal cycle of rainfall. In the inner mountain region, a 5-yr high-elevation rain gauge dataset shows that light rainfall, described here as rainfall intensity less than 3 mm h−1 over a time scale of 5 min, accounts for 30%–50% of annual accumulations. The data also reveal warm-season events characterized by heavy surface rainfall in valleys and along ridgelines inconsistent with radar observations of the vertical structure of precipitation. Next, a stochastic column model of advection–coalescence–breakup of warm rain DSDs was used to investigate three illustrative events. The integrated analysis of observations and model simulations suggests that seeder–feeder interactions (i.e., Bergeron processes) between incoming rainfall systems and local fog and/or low-level clouds with very high number concentrations of small drops (&lt;0.2 mm) govern surface rainfall intensity through driving significant increases in coalescence rates and efficiency. Specifically, the model shows how accelerated growth of small- and moderate-size raindrops (&lt;2 mm) via Bergeron processes can enhance surface rainfall rates by one order of magnitude for durations up to 1 h as in the observations. An examination of the fingerprints of seeder–feeder processes on DSD statistics conducted by tracking the temporal evolution of mass spectrum parameters points to the critical need for improved characterization of hydrometeor microstructure evolution, from mist formation to fog and from drizzle development to rainfall.
Reference Values for Physical Performance Measures in the Aging Working Population
Authors: Cote Mark , Kenny Anne , Dussetschleger Jeffrey , Farr Dana , Chaurasia Ashok , Cherniack Martin 
Published: January 2014

Objective: The aim of this study was to determine reference physical performance values in older aging workers. Background: Cross-sectional physical performance measures were collected for 736 manufacturing workers to assess effects of work and nonwork factors on age-related changes in musculoskeletal function and health. Method: Participants underwent surveys and physical testing that included bioelectrical impedance analysis, range-of-motion measures, exercise testing, and dynamic assessment. Results: Physical characteristics, such as blood pressure and body fat percentage, were comparable to published values. Dynamic and range-of-motion measurements differed from published normative results. Women had age-related decreases in cervical extension and lateral rotation. Older men had better spinal flexion than expected. Predicted age-related decline in lower-extremity strength and shoulder strength in women was not seen. Men declined in handgrip, lower-extremity strength, and knee extension strength, but not trunk strength, across age groups. There was no appreciable decline in muscle fatigue at the trunk, shoulder, and knee with aging for either gender, except for the youngest age group of women. Conclusion: Normative values may underestimate physical performance in “healthy” older workers, thereby underappreciating declines in less healthy older workers. Work may be preservative of function for a large group of selected individuals. A “healthy worker effect” may be greater for musculoskeletal disease and function than for heart disease and mortality. Application: Clinicians and researchers studying musculoskeletal function in older workers can use a more specific set of reference values.
Non-clinical health services – what do they contribute to patient care and how can we measure their contribution?
Authors: Bain M , Ward HJT 
Published: January 2014

Background and aims Assessing the contribution of ‘support services’ to improving healthcare is challenging. Despite involving a significant part of the NHS budget, there is very little published literature on methods and approaches. This article describes the development of an integrated approach to assessing and measuring the health impact of these services. Methods and results An empirical approach was developed by the main provider of national support services to NHS Scotland. This involved identifying meaningful ways to describe health impact of services several steps removed from patient care, applying this to the full range of national support services provided by NHS National Services Scotland and developing relevant measurement methodologies. Through this approach it was possible to assess the relative health impact of all 63 NSS services and to use this for planning and prioritisation. Conclusion Assessing the contribution of support services to improving patient outcomes is a neglected area, despite the significant dependency of direct patient care services upon these services and the resource involved. The methods described in this article have potential to be used across the range of support services within the NHS to improve quality and efficiency of healthcare services.
Endoscopic Endonasal Transpterygoid Transmaxillary Approach to the Infratemporal and Upper Parapharyngeal Tumors
Authors: Battaglia Paolo , Turri‐Zanoni Mario , Dallan Iacopo , Gallo Stefania , Sica Eleonora , Padoan Giovanni , Castelnuovo Paolo 
Published: January 2014

ObjectivesTo describe the endoscopic transnasal approach to the infratemporal fossa (ITF) and upper parapharyngeal space (UPS) and to analyze the indications and outcomes of this surgical technique in the management of the tumors localized in this critical area.Study DesignCase series with chart review.SettingTertiary‐care referral center.Patients and MethodsRetrospective review of patients with benign and malignant tumors arising in or extending to the ITF and UPS, treated from 2002 to 2012 at a single institute. The tumors were surgically resected using an endoscopic endonasal transpterygoid transmaxillary approach.ResultsThirty‐seven consecutive patients with benign tumors (20 juvenile nasopharyngeal angiofibromas, 2 extracranial trigeminal Schwannomas, 2 meningiomas, 1 cavernous hemangioma) and nonmetastatic malignant tumors (2 adenoid‐cystic carcinoma, 1 mucoepidermoid carcinoma, 1 squamous cell carcinoma, 1 adenocarcinoma, 1 recurrence of chondrosarcoma, and 6 recurrences of undifferentiated carcinoma of nasopharyngeal type) were treated with curative intent. A gross‐total resection was achieved in 35 of 37 patients. Major complications were observed in 1 case (intraoperative internal carotid artery blowout). Postoperatively, 8 patients received some form of adjuvant treatment. Mean follow‐up was 30 months for malignancies and 60 months for benign tumors. All patients are now alive without recurrences. Stable intracranial persistence of disease was reported in 2 cases (1 meningioma and 1 adenoid‐cystic carcinoma).ConclusionThe purely endoscopic endonasal technique may provide a minimally invasive and safe approach to radically resect selected tumors involving the ITF and UPS. Larger case series and longer follow‐up are needed to validate the reproducibility and efficacy of this technique.
An Updated Therapeutic Intervention Scoring System for Critically Ill Children Enables Nursing Workload Assessment With Insight Into Potential Untoward Events
Authors: Trope Randi , Vaz Sandra , Zinger Marcia , Sagy Mayer 
Published: January 2014

Background: To introduce an updated version of the original Therapeutic Intervention Scoring System (TISS) applicable to critically ill children (TISS-C). This version was designed to assess patient acuity and nursing workload (NW) and to determine a relationship between such assessment and the incidence of adverse events. Methods: Reviewing previous versions of TISS, an updated TISS-C was developed. Items inapplicable to pediatric critical care were eliminated; items current to critical care were added; and items still valid were edited. The point system accounts for the wide range of care provided. Random patients from a predetermined period had TISS-C scores calculated. The TISS-C scores were also calculated on patients with documented adverse events. Baseline scores were compared with scores of patients in whom adverse events had occurred. We determined the pediatric intensive care unit (PICU) NW to be the product of the TISS-C score and the patient–nurse ratio (PNR). Results: One hundred twenty-five random patients had a mean TISS-C of 14.6 ± 11.8. Patients with any adverse event (98) had a TISS-C of 19.9 ± 11.6 ( P < .05). Using our PICU mean PNR of 1.4 (20 patients/14 nurses), the NW for patients with more severe events was 33.6 ± 15.9. Conclusions: Critically ill pediatric patients are more vulnerable to experience adverse events when their derived NW values are high. It is postulated that a critical NW exists, where adverse events are more likely to occur.
Comparison of Clinical Outcome of Pronation External Rotation versus Supination External Rotation Ankle Fractures
Authors: Schottel Patrick C. , Berkes Marschall B. , Little Milton T. M. , Garner Matthew R. , Fabricant Peter D. , Lazaro Lionel E. , Helfet David L. , Lorich Dean G. 
Published: January 2014

Background: A pronation external rotation (PER) ankle fracture is a relatively uncommon injury. The purpose of this study was to examine the immediate and short-term clinical outcomes of operatively treated PER IV ankle fractures and compare them with a similarly treated cohort of supination external rotation IV (SER IV) fractures. Methods: 22 PER IV and 108 SER IV fractures were identified from a single surgeon’s prospectively collected database from 2004 to 2010. All patients were treated with fracture fragment and ligament specific fixation during the same time period by the same surgeon. Postoperative radiographs and bilateral ankle computed tomography (CT) scans were reviewed for articular incongruity, syndesmotic malreduction, and loss of reduction. Clinical outcome measures, including the Foot and Ankle Outcome Score (FAOS) and ankle range of motion (ROM), were collected at latest follow-up visit. Results: There was no difference in the rate of wound complications, fracture nonunion, or loss of reduction between the PER IV and SER IV groups. There was no significant difference in the incidence of postoperative articular incongruity (19% vs 8%, P = .23); however, the PER IV cohort was found to have a significantly higher rate of syndesmotic malreduction (40% vs 18%, P = .04). No clinically or statistically significant differences were detected between the 2 groups in regard to all FAOS domains. Conclusion: In a cohort of operatively treated PER IV fractures, fracture fragment and ligament specific fixation resulted in good short-term outcomes that were comparable to those seen in similarly treated patients with an SER IV fracture pattern. However, a notably greater number of syndesmotic malreductions were noted in the PER IV cohort, and therefore heightened scrutiny is recommended in treating this particular injury pattern. Level of Evidence: Level III, retrospective comparative study.
Is the temperature of tumescent anesthesia applied in the endovenous laser ablation important? Comparison of different temperatures for tumescent anesthesia applied during endovenous ablation of incompetent great saphenous vein with a 1470 nm diode laser
Authors: Abud Burcin , Karaarslan Kemal , Turhan Soysal , Karaman Yücel 
Published: January 2014

Introduction We aimed to investigate whether the temperature of tumescent anesthesia is important, if so, to establish an opinion about the ideal temperature. Materials and methods Endovenous laser ablations were performed in 72 patients; 35 patients (Group A) received tumescent anesthesia at +4℃, while other 37 patients (Group B) received tumescent anesthesia at room temperature. The groups were compared in terms of intraoperative pain, postoperative regional pain, ecchymosis, paresthesia, skin burns and necrosis. At month 1, great saphenous vein was evaluated for recanalization and patient satisfaction. Results The survey on intraoperative pain showed that patients receiving tumescent anesthesia at +4℃ experienced much less pain. Interestingly, statistical analysis showed that this difference was not significant ( p = 0.072). No skin burns or necrosis occurred in either group, whereas ecchymosis and paresthesia were the most frequently observed side effects in both groups, but no significant difference was found between the groups. There was no significant difference between pain levels on postoperative days and no significant difference between the groups in terms of satisfaction with endovenous laser ablation procedure and postoperative satisfaction. All venous segments treated with endovenous laser ablation in both groups were occluded. At month 1 no recanalization was observed. Conclusion We conclude that the temperature of tumescent anesthesia solution is not important, while the proper administration of tumescent solution in adequate amounts ensuring delivery of the fluid to all segments appears to be a more significant determinant for the success of the procedure.
The association between organic school food policy and school food environment: results from an observational study in Danish schools
Authors: He Chen , Mikkelsen Bent E 
Published: January 2014

Aims: School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments. Methods: The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The ‘organic’ schools were compared to ‘non-organic’ schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools. Results: Data indicates that 20 ‘organic’ schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school ( p = .032), recommending children to eat healthily ( p = .004). Conclusions: The study suggests that organic food policies in schools may have potential to support a healthier school food environment.