bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Caregiving on Health‐Related Quality of Life Among American Indians
Authors: Spencer S. Melinda , Goins R. Turner , Henderson Jeffrey. A. , Wen Yang , Goldberg Jack 
Published: September 2013

Caregiving can have a profound effect on the health of the caregiver, yet research on caregiving among American Indians is limited. The purpose of this study was to examine the influence of caregiving on the health‐related quality of life (HRQoL) of American Indians enrolled in the Education And Research Towards Health (EARTH) study. Participants in the EARTH study represented three different tribes in the Northern Plains and Southwestern regions of the United States who completed self‐administered, computer‐assisted questionnaires between 2003 and 2006. Participants were classified as caregivers if at least one adult relied on them for personal care or as non‐caregivers (n = 3,736). Caregivers were further classified according to type; those caring for an adult with unspecified needs (CAU, n = 482) and those caring for an adult with mental or physical difficulties (CAD, n = 295). HRQoL was measured using the mental and physical health component scores of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Regional differences emerged with regard to caregiver type. Across both regions, non‐caregivers reported significantly better mental and physical health than CAD, and the health of participants classified as CAU did not differ from that of non‐caregivers. The health of American Indian caregivers depends on the kind of care provided, but detailed measures of caregiving are necessary to understand how caregiving influences health. This has implications for the design of effective interventions in tribal communities.
Cystatin C and Frailty in Older Men
Authors: Hart Allyson , Paudel Misti L. , Taylor Brent C. , Ishani Areef , Orwoll Eric S. , Cawthon Peggy M. , Ensrud Kristine E. ,   Osteoporotic Fractures in Men Study Group
Published: September 2013

ObjectivesTo determine whether higher cystatin C would be associated with greater frailty in men aged 65 and older.DesignCross‐sectional cohort study.SettingSix U.S. sites.ParticipantsA random sample of community‐dwelling men aged 65 and older enrolled in the Osteoporotic Fractures in Men (MrOS) Study (mean age 73.8; 9.8% frail and 47.2% intermediate frailty; N = 1,602).MeasurementsSerum cystatin C, creatinine, and frailty were measured. Frailty was analyzed as an ordinal outcome of robust, intermediate frailty, and frail using a multinomial logistic regression model, and the base model was adjusted for age, race, and clinical site.ResultsHigher cystatin C was associated with seven times greater odds of being frail than being robust (odds ratio (OR) quartile 4 vs 1 = 7.12, 95% confidence interval (CI) = 3.76–13.46) and 2.4 times greater odds of intermediate frailty than robust (OR quartile 4 vs 1 = 2.38, 95% CI = 1.70–3.32). The association was attenuated but persisted after adjusting for multiple possible confounders. In contrast, neither higher serum creatinine (OR quartile 4 vs 1 = 1.36, 95% CI = 0.78–2.40) nor lower creatinine‐based estimated glomerular filtration rate (OR quartile 4 vs 1 = 1.01, 95% CI = 0.54–1.87) was associated in a graded manner with greater odds of frailty.ConclusionHigher cystatin C, but not creatinine‐based measures, was associated with greater odds of frailty in this cohort of older men.
Association Between Proportion of Provider Clinical Effort in Nursing Homes and Potentially Avoidable Hospitalizations and Medical Costs of Nursing Home Residents
Authors: Kuo Yong‐Fang , Raji Mukaila A. , Goodwin James S. 
Published: September 2013

ObjectivesTo assess potential avoidable hospitalizations of nursing home (NH) residents as a function of the percentage of clinical effort their primary care provider (PCP) devotes to NH practice.DesignRetrospective cohort study.SettingNHs in Texas.ParticipantsResidents newly admitted to long‐term NHs in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249).MeasurementsThe care that residents received over successive 6‐month periods was measured as a time‐dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months.ResultsSeventy percent of NH residents had a physician as their major PCP, 25% had an advance practice nurse (APN), and 5% had a physician assistant (PA). Physician PCPs who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCPs had providers with 85% or more of Medicare billings generated in NHs. Residents with PCPs who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCPs devoted 85% or more of their clinical effort to NHs (hazard ratio = 1.52, 95% confidence interval = 1.25–1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline.ConclusionThe percentage of clinical effort that providers devote to NHs is associated with risk of avoidable hospitalization.
Continuous Deep Sedation Until Death in Nursing Home Residents with Dementia: A Case Series
Authors: Anquinet Livia , Rietjens Judith A.C. , Vandervoort An , van der Steen Jenny T. , Vander Stichele Robert , Deliens Luc , Van den Block Lieve 
Published: September 2013

ObjectivesTo describe the characteristics of continuous deep sedation until death and the prior decision‐making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting sedation guideline recommendations.DesignEpidemiological retrospective study completed using a case series analysis.SettingFlemish nursing homes in 2010.ParticipantsFrom a representative sample of 69 nursing homes, all residents who had dementia and had been continuously and deeply sedated until death over a period of 3 months were selected.MeasurementsQuestionnaires to general practitioners (GPs), nurses, and relatives most involved in the care of the resident regarding the clinical characteristics of the resident, how sedation was decided upon and performed, quality of care, and dying. Advanced dementia was identified using the Global Deterioration and Cognitive Performance Scale. Whether this practice is in conformity with sedation guideline recommendations was also investigated.ResultsEleven of 117 deceased residents with dementia (9.4%, 95% confidence interval (CI) = 4.0–14.8) and nine of 64 residents with advanced dementia (14.1%, 95% CI = 5.3–22.8) were sedated. Two of the 11 sedated residents were not considered to be terminal. Sedation duration ranged from 1 to 8 days. Two received artificial food and fluids during sedation. Five were partly or fully competent at admission and three in the last week. Four had expressed their wishes or had been involved in end‐of‐life decision‐making; for eight residents, the GP discussed the resident's wishes with their relatives. Relatives reported that five of the residents had one or more symptoms while dying. Nurses of three residents reported that the dying process was a struggle. For two residents, sedation was effective.ConclusionContinuous deep sedation until death for nursing home residents does not always guarantee a dying process free of symptoms and might be amenable to improvement.
Poor Oral Health and Quality of Life in Older U.S. Adults with Diabetes Mellitus
Authors: Huang Deborah L. , Chan Kwun Chuen Gary , Young Bessie A. 
Published: September 2013

ObjectiveTo determine the association between health‐related quality of life (HRQOL) and oral health in older U.S. adults with diabetes mellitus (DM).DesignCross‐sectional.SettingData from the U.S. Behavioral Risk Factor Surveillance System 2006, 2008, and 2010.ParticipantsNationally representative sample of 70,363 adults aged 65 and older with DM.ResultsOlder adults with DM were more likely to report permanent tooth loss due to caries or periodontal disease than those without (82.3% vs 74.3%, P < .001) and less likely to receive dental care in the past year (59.0% vs 70.9%, P < .001). Loss of permanent teeth from caries or periodontal disease was associated with 1.25 times greater odds of worse self‐rated general health (95% confidence interval (CI) = 1.13–1.37). Lack of dental care in the preceding 12 months was associated with 1.34 times greater odds of worse self‐rated general health (95% CI = 1.25–1.44) than receiving dental care in the preceding 12 months. Poor dentition and longer time since last dental visit were associated with more physically unhealthy days.ConclusionsPoor dentition and lack of dental care were associated with worse HRQOL in older adults with DM. Further research is needed to determine whether better oral health improves HRQOL in this population.
Sleep Disturbances and Driving Practices of Older Drivers
Authors: Vaz Fragoso Carlos A. , Van Ness Peter H. , Araujo Katy L. B. , Iannone Lynne P. , Marottoli Richard A. 
Published: September 2013

ObjectivesTo evaluate the associations between sleep disturbances and driving practices, including driving cessation and trajectories of daily driving mileage (change over time), in older drivers.DesignLongitudinal.SettingNew Haven, Connecticut.ParticipantsFour hundred thirty older drivers, mean age 78.5, recruited from clinic and community sites.MeasurementsBaseline measures included medical history, daily driving mileage, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Clinical Score (SACS). Longitudinal outcomes included at least one episode of driving cessation and trajectories of miles driven per day, as recorded every 6 months over 2 years.ResultsAt baseline, participants drove an average of 22.2 miles per day; 26.0% (112/430) had insomnia (ISI ≥ 8), 19.3% (83/430) had daytime drowsiness (ESS ≥ 10), and 19.9% (84/422) had high sleep apnea risk (SACS > 15). The sleep‐based predictors of insomnia (risk ratio (RR) = 1.20, 95% confidence interval (CI) = 0.65–2.20), daytime drowsiness (RR = 0.94, 95% CI = 0.46–1.95), and high sleep apnea risk (RR = 0.62, 95% CI = 0.27–1.42) did not confer a significantly greater risk of driving cessation. Insomnia was the only sleep‐based predictor that conferred a significant change in driving mileage, yielding an average decrease of 4.5 miles per day over 2 years (P = .01). In the insomnia model, covariates that were associated with less driving mileage were polypharmacy (≥4 medications) and each year of additional age, yielding an average decrease of 8.3 (P = .01) and 0.4 miles per day (P = .02), respectively, over 2 years.ConclusionIn a cohort of older drivers, insomnia and the covariates of polypharmacy and advancing age were longitudinally associated with less daily driving mileage. Because reductions in driving mileage in older persons often occur in response to reductions in driving capacity, these results support a clinical approach that considers insomnia‐based cognitive‐behavioral therapy and reduced polypharmacy as strategies for improving driving capacity in older persons.
Relationship between Cerebral Atherosclerosis and Leukoaraiosis in Aged Patients: Results from DSA
Authors: Li Hua , Xu Gelin , Xiong Yunyun , Zhu Wusheng , Yin Qin , Fan Xiaobing , Liu Wenhua , Duan Zuowei , Liu Xinfeng 
Published: September 2013

ABSTRACTBACKGROUND AND PURPOSEThere are some controversial results on the relationship between cerebral atherosclerosis and leukoaraiosis in the published papers, where cerebral atherosclerosis was often evaluated by ultrasonography, CTA or MRA. We analyzed data in which patients underwent both MRI and DSA to explore the above relationship in the aged people.METHODSThree hundred and thirty‐three patients were enrolled in the study from the Nanjing Stroke Registry. They underwent both cerebral DSA and MRI. Age, sex, and vascular risk factors were collected. Atherosclerosis was scored from grade 0 to 4. Leukoaraiosis was scored from grade 0 to 3.RESULTSCerebral artery stenosis was not correlated with the presence of leukoaraiosis. There were no correlations between the number of cerebral moderately or more severely stenotic arteries and the severity of leukoaraiosis in periventricular, deep, or whole white matter (P = .747, .268, and .608, respectively). Old age (odds ratio = 1.103, P = .027) and hypertension (odds ratio = 2.748, P = .003) were correlated with leukoaraiosis in the periventricular white matter. Old age (odds ratio = 1.073, P = .031) and prior stroke (odds ratio = 2.678, P = .002) were correlated with leukoaraiosis in the deep white matter.CONCLUSIONSNo apparent correlation exists between cerebral artery stenosis and the presence and severity of leukoaraiosis.
Evolving Basilar Artery Stenosis with Watershed Ischemia
Authors: Cho Tae‐Hee , Berthezene Yves , Mechtouff Laura , Derex Laurent , Nighoghossian Norbert 
Published: September 2013

ABSTRACTBasilar artery stenosis where flow restriction constitutes the main pathomechanism are exceptional. Here, we report a case where the lesion progression was characterized by watershed infarct between the anterior inferior—superior cerebellar arteries and deep pontine arteries, indicating a significant hemodynamic impairment.
Doppler Echocardiographic Evaluation of Midventricular Obstruction in Cats with Hypertrophic Cardiomyopathy
Authors: MacLea H.B. , Boon J.A. , Bright J.M. 
Published: September 2013

BackgroundHypertrophic cardiomyopathy (HCM) is heterogeneous in both people and cats, with variability in the distribution of hypertrophy, hemodynamic characteristics, and Doppler echocardiographic findings.ObjectivesTo document the Doppler echocardiographic characteristics of midventricular obstruction in some cats withHCM.AnimalsEight cats with hypertrophic cardiomyopathy.Materials and MethodsRetrospective case series. The medical records of cats presenting to the cardiology service at Colorado State University between February 2009 and January 2012 were reviewed. All cats had a physical examination; Doppler systolic blood pressure measurement; and transthoracic two‐dimensional (2D), M‐mode, and Doppler echocardiography were performed. A more thorough evaluation of the echocardiographic images and measurements was performed. Cats included in this study had echocardiograms of adequate quality to confirm the diagnosis of midventricular obstruction by documentation of left midventricular concentric hypertrophy; a midventricular turbulent Doppler color flow pattern; and high velocity, late‐peaking flow at the area of turbulence. Cats with evidence of systemic hypertension defined as a systolic Doppler blood pressure of greater than 170 mmHg were excluded.ResultsAll 8 cats had left ventricular hypertrophy at the level of the papillary muscles; left, midventricular hypertrophy; and in 4/8 cats there was apical hypertrophy or basilar hypertrophy of the interventricular septum. Color flow Doppler revealed turbulent flow in 8/8 cats and spectral Doppler (continuous and pulsed wave) revealed increased flow velocities and late‐peaking flow profiles at the level of the left midventricle. Two of 8 cats had a bifid midventricular flow profile in which there was a midsystolic decline in left ventricular velocities with elevated velocities extending into early diastole. The peak left ventricular outflow velocity in all 8 cats was normal.Conclusions and Clinical ImportanceA variant ofHCMcharacterized by hypertrophy at the level of the papillary muscles with midventricular obstruction is present in some cats. Recognition of this variant of felineHCMallows identification ofHCMin cats with murmurs where the more classic features ofHCMare not present.
Holarctic phylogeography of the testate amoeba Hyalosphenia papilio (Amoebozoa: Arcellinida) reveals extensive genetic diversity explained more by environment than dispersal limitation
Authors: Heger Thierry J. , Mitchell Edward A. D. , Leander Brian S. 
Published: September 2013

AbstractAlthough free‐living protists play essential roles in aquatic and soil ecology, little is known about their diversity and phylogeography, especially in terrestrial ecosystems. We used mitochondrial cytochrome c oxidase subunit 1 (COI) gene sequences to investigate the genetic diversity and phylogeography of the testate amoeba morphospecies Hyalosphenia papilio in 42 Sphagnum (moss)‐dominated peatlands in North America, Europe and Asia. Based on ≥1% sequence divergence threshold, our results from single‐cell PCRs of 301 individuals revealed 12 different genetic lineages and both the general mixed Yule‐coalescent (GMYC) model and the automatic barcode gap discovery (ABGD) methods largely support the hypothesis that these 12 H. papilio lineages correspond to evolutionary independent units (i.e. cryptic species). Our data also showed a high degree of genetic heterogeneity within different geographical regions. Furthermore, we used variation partitioning based on partial redundancy analyses (pRDA) to evaluate the contributions of climate and dispersal limitations on the distribution patterns of the different genetic lineages. The largest fraction of the variation in genetic lineage distribution was attributed to purely climatic factors (21%), followed by the joint effect of spatial and bioclimatic factors (13%), and a purely spatial effect (3%). Therefore, these data suggest that the distribution patterns of H. papilio genetic lineages in the Northern Hemisphere are more influenced by climatic conditions than by dispersal limitations.
ProA, a transcriptional regulator of fungal fruiting body development, regulates leaf hyphal network development in the Epichloë festucae–Lolium perenne symbiosis
Authors: Tanaka Aiko , Cartwright Gemma M. , Saikia Sanjay , Kayano Yuka , Takemoto Daigo , Kato Masashi , Tsuge Takashi , Scott Barry 
Published: September 2013

SummaryTranscription factors containing a Zn(II)2Cys6 binuclear cluster DNA‐binding domain are unique to fungi and are key regulators of fungal growth and development. The C6‐Zn transcription factor, Pro1, in Sordaria macrospora is crucial for maturation of sexual fruiting bodies. In a forward genetic screen to identify Epichloë festucae symbiosis genes we identified a mutant with an insertion in proA. Plants infected with the proA mutant underwent premature senescence. Hyphae of ΔproA had a proliferative pattern of growth within the leaves of Lolium perenne. Targeted deletion of proA recapitulated this phenotype and introduction of a wild‐type gene complemented the mutation. ΔproA was defective in hyphal fusion. qPCR analysis of E. festucae homologues of S. macrospora genes differentially expressed in Δpro1 identified esdC, encoding a glycogen‐binding protein, as a target of ProA. Electrophoretic mobility shift assay analysis identified two binding sites for ProA in the intergenic region of esdC and a divergently transcribed gene, EF320. Both esdC and EF320 are highly expressed in a wild‐type E. festucae–grass association but downregulated in a proA–mutant association. These results show that ProA is a key regulator of in planta specific growth of E. festucae, and therefore crucial for maintaining a mutualistic symbiotic interaction.
Identification and characterization of the genetic changes responsible for the characteristic smooth‐to‐rough morphotype alterations of clinically persistent Mycobacterium abscessus
Authors: Pawlik Alexandre , Garnier Guillaume , Orgeur Mickael , Tong Pin , Lohan Amanda , Le Chevalier Fabien , Sapriel Guillaume , Roux Anne‐Laure , Conlon Kevin , Honoré Nadine , Dillies Marie‐Agnès , Ma Laurence , Bouchier Christiane , Coppée Jean‐Yves , Gaillard Jean‐Louis , Gordon Stephen V. , Loftus Brendan , Brosch Roland , Herrmann Jean Louis 
Published: September 2013

SummaryMycobacterium abscessus is an emerging pathogen that is increasingly recognized as a relevant cause of human lung infection in cystic fibrosis patients. This highly antibiotic‐resistant mycobacterium is an exception within the rapidly growing mycobacteria, which are mainly saprophytic and non‐pathogenic organisms. M. abscessus manifests as either a smooth (S) or a rough (R) colony morphotype, which is of clinical importance as R morphotypes are associated with more severe and persistent infections. To better understand the molecular mechanisms behind the S/R alterations, we analysed S and R variants of three isogenic M. abscessus S/R pairs using an unbiased approach involving genome and transcriptome analyses, transcriptional fusions and integrating constructs. This revealed different small insertions, deletions (indels) or single nucleotide polymorphisms within the non‐ribosomal peptide synthase gene cluster mps1‐mps2‐gap or mmpl4b in the three R variants, consistent with the transcriptional differences identified within this genomic locus that is implicated in the synthesis and transport of Glyco‐Peptido‐Lipids (GPL). In contrast to previous reports, the identification of clearly defined genetic lesions responsible for the loss of GPL‐production or transport makes a frequent switching back‐and‐forth between smooth and rough morphologies in M. abscessus highly unlikely, which is important for our understanding of persistent M. abscessus infections.
Sulphiredoxin plays peroxiredoxin‐dependent and ‐independent roles via the HOG signalling pathway in Cryptococcus neoformans and contributes to fungal virulence
Authors: Upadhya Rajendra , Kim Hyelim , Jung Kwang‐Woo , Park Goun , Lam Woei , Lodge Jennifer K. , Bahn Yong‐Sun 
Published: September 2013

SummaryMechanisms of oxidative stress resistance are crucial virulence factors for survival and proliferation of fungal pathogens within the human host. In this study we have identified and functionally characterized the role of sulphiredoxin, Srx1, in oxidative stress resistance of Cryptococcus neoformans causing fungal meningoencephalitis and regulation of peroxiredoxins, Tsa1 and Tsa3, and thioredoxins, Trx1 and Trx2. The C. neoformans HOG (High Osmolarity Glycerol response) pathway was essential for the transcriptional regulation of SRX1 under peroxide stress conditions. A gene deletion study revealed that Srx1 was required for cells to counteract peroxide stress, but not other oxidative damaging agents. HOG1 was found to be essential for the induction of adaptive response to peroxide stress with concurrent repression of ergosterol biosynthesis in an SRX1‐independent manner. Consistent with this, phosphorylation of C. neoformans Hog1 was modulated by both low and high doses of exogenous hydrogen peroxide treatment. Immunoblot analysis using the C. neoformans Tsa1 specific antibody revealed that both Srx1 and Trx1 were essential for recycling of oxidized Tsa1. In addition to its role in peroxide sensing and response C. neoformans Srx1 was also found to be required for a peroxiredoxin‐independent function in promoting fungicide‐dependent cell swelling and growth arrest. Finally we showed the importance of C. neoformans Srx1 in fungal pathogenesis by demonstrating its requirement for full virulence using a mouse infection model.