bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study
Authors: Rist P. M. , Buring J. E. , Kase C. S. , Ridker P. M , Kurth T. 
Published: October 2012

Background and purposeSeveral biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women.MethodsProspective cohort study of 27 728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0–1, 2–3, or 4–6.ResultsAfter a mean follow‐up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4–6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18–3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C‐reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes.ConclusionsWhilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.
Historical and modern neutral genetic variability in Mednyi Arctic foxes passed through a severe bottleneck
Authors: Ploshnitsa A. I. , Goltsman M. E. , Happ G. M. , Macdonald D. W. , Kennedy L. J. 
Published: October 2012

AbstractSmall isolated populations often show lower genetic variability. Demographic bottlenecks lead to loss of genetic variation too. Arctic foxes (Vulpes lagopus) have been isolated since the Pleistocene on Mednyi and Bering Islands (Commander Islands). In 1970–1980, the Mednyi population passed through a severe bottleneck due to a mange outbreak. Previous studies showed lack of genetic diversity in the contemporary Mednyi population that could be due to the long history of isolation and/or the recent bottleneck. To test both factors, we analyzed the mtDNA D‐loop fragment and five microsatellites in pre‐bottleneck Mednyi museum samples. Also, contemporary Mednyi, Bering and mainland Alaskan Arctic foxes were analyzed. Registered genetic variability in historical Mednyi was higher than in contemporary Mednyi Arctic foxes, but lower than in contemporary the Bering population. Our data confirms that the bottleneck reduced an already depleted polymorphism in Mednyi Arctic foxes. Lack of genetic variability could be a reason why the Mednyi population did not recover following the outbreak of mange.
Patients and ICU nurses' perspectives of non‐pharmacological interventions for pain management
Authors: Gélinas Céline , Arbour Caroline , Michaud Cécile , Robar Lauren , Côté José 
Published: October 2012

ABSTRACTBackgroundPain is a major stressor for critically ill patients. To maximize pain relief, non‐pharmacological interventions are an interesting avenue to explore.Aims and ObjectivesThe study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non‐pharmacological interventions for pain management in the intensive care unit (ICU).DesignA qualitative descriptive design was used.MethodsPatients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi‐structured discussion guide, participants were asked to share their perspective about non‐pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive‐behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment.ResultsA total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non‐pharmacological interventions were discussed. The top four non‐pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive‐behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning.ConclusionsFour non‐pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. Relevance to clinical practice: While more evidence is required to conclude to their effectiveness, ICU nurses can use non‐pharmacological interventions complementary to pharmacological treatment of pain as they are low cost and safe.
Postacute Rehabilitation Care for Hip Fracture: Who Gets the Most Care?
Authors: Freburger Janet K. , Holmes George M. , Ku Li‐Jung E. 
Published: October 2012

ObjectivesTo determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture.DesignCross‐sectional analysis of 2 years (2005–06) of population‐based hospital discharge data.SettingAll short‐term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI).ParticipantsIndividuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black.MeasurementsWhether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use.ResultsConsidering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18–0.30) and to receive HH (OR = 0.46, 95% CI = 0.30–0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36–3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62–0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC.ConclusionSeveral demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.
The Role of Energetic Cost in the Age‐Related Slowing of Gait Speed
Authors: Schrack Jennifer A. , Simonsick Eleanor M. , Chaves Paulo H.M. , Ferrucci Luigi 
Published: October 2012

ObjectivesTo determine whether slow gait represents a compensatory strategy to reduce the energetic cost of walking with age.DesignCross‐sectional analysis.SettingCommunity‐dwelling volunteers from the Baltimore Longitudinal Study of Aging (BLSA).ParticipantsFour hundred twenty community‐dwelling persons aged 32 to 96 (mean 68.1 ± 12.5) who underwent a physical examination, physical function testing, and energy expenditure assessment.MeasurementsEnergy expenditure per minute (mL/kg/min) and per meter (mL/kg/m) during 2.5 minutes of overground walking at customary speed and usual gait speed over 6 m (m/s) were examined. General linear regression models were used to assess the relationship between customary walking energy expenditure and usual gait speed, adjusted for potential confounders including smoking, medical diagnoses, walking‐related pain, and balance difficulty.ResultsUsual gait speed was slower with increasing age after age 65. Energy expenditure per minute during customary walking averaged 13.0 ± 2.8 mL/kg/min and was independent of age (ρ < 0.01, P = .88). In contrast, energy expenditure per meter walked was progressively higher after age 65 (ρ = 0.35, P < .001) and heightened after age 80 (r = 0.57, P < .001), mirroring the observed pattern of usual gait speed. This relationship remained significant after adjusting for multiple impairments and comorbidities.ConclusionThese observations support the hypothesis that slower gait at older ages may reflect a compensatory action to offset the greater energetic cost of walking associated with aging and chronic conditions. Future studies should evaluate the specific mechanisms that contribute to this phenomenon as novel targets for clinical intervention.
Patterns of Multimorbidity in Elderly Veterans
Authors: Steinman Michael A. , Lee Sei J. , John Boscardin W. , Miao Yinghui , Fung Kathy Z. , Moore Kelly L. , Schwartz Janice B. 
Published: October 2012

ObjectivesTo determine patterns of co‐occurring diseases in older adults and the extent to which these patterns vary between the young‐old and the old‐old.DesignObservational study.SettingDepartment of Veterans Affairs.ParticipantsVeterans aged 65 years and older (1.9 million male, mean age 76 ± 7; 39,000 female, mean age 77 ± 8) with two or more visits to Department of Veterans Affairs (VA) or Medicare settings in 2007 and 2008.MeasurementsThe presence of 23 common conditions was assessed using hospital discharge diagnoses and outpatient encounter diagnoses from the VA and Medicare.ResultsThe mean number of chronic conditions (out of 23 possible) was 5.5 ± 2.6 for men and 5.1 ± 2.6 for women. The prevalence of most conditions increased with advancing age, although diabetes mellitus and hyperlipidemia were 11% to 13% less prevalent in men and women aged 85 and older than in those aged 65 to 74 (P < .001 for each). In men, the most common three‐way combination of conditions was hypertension, hyperlipidemia, and coronary heart disease, which together were present in 37% of men. For women, the most common combination was hypertension, hyperlipidemia, and arthritis, which co‐occurred in 25% of women. Reflecting their high population prevalence, hypertension and hyperlipidemia were both present in 9 of the 15 most common three‐way disease combinations in men and in 11 of the 15 most common combinations in women. The prevalence of many disease combinations varied substantially between young‐old and old‐old adults.ConclusionsSpecific combinations of diseases are highly prevalent in older adults and inform the development of guidelines that account for the simultaneous presence of multiple chronic conditions.
Activity Participation and Cognitive Aging from Age 50 to 80 in theGlostrup 1914Cohort
Authors: Gow Alan J. , Mortensen Erik L. , Avlund Kirsten 
Published: October 2012

ObjectivesTo examine the cognitively protective effect of leisure and physical activities while accounting for prior cognitive ability, a rarely considered confounder of the previously reported associations between activity and cognitive aging.DesignLongitudinal cohort study.SettingGlostrup,Denmark.ParticipantsCommunity‐dwelling sample of adults recruited into theGlostrup 1914Cohort (baselineN = 802). All were born in 1914 and were assessed at ages 50, 60, 70, and 80. New participants were recruited during the study to counter attrition.MeasurementsOn each occasion, cognitive ability was assessed using four tests, which defined a general cognitive ability score. Self‐reported participation in leisure and physical activities was also collected. In general, physical activity was summarized on a 3‐ or 4‐point scale, and leisure activity as none versus some (ages 50 and 60) or according to participation in a list of common activities (age 70). The effect of activity—leisure and physical—on the level of cognitive ability and cognitive change over time from age 60 to 80 was examined in growth curve models.ResultsGreater activity (leisure or physical) was consistently associated with a higher level of cognitive ability. Adjusting for baseline cognitive ability (age 50) attenuated these associations, suggesting that associations between activity and cognition reported in old age are largely a consequence of preserved differentiation. A small but significant association remained between greater physical activity at age 60 or 70 and less cognitive decline.ConclusionThe association between more‐frequent leisure activity and less cognitive decline mainly reflects the positive cross‐sectional association between activity and cognition, although the link that remains between greater physical activity and a more‐successful cognitive aging trajectory is of particular relevance to those who are developing interventions.
Stability of Coxiella burnetii in stored human blood
Authors: Kersh Gilbert J. , Priestley Rachael , Massung Robert F. 
Published: October 2012

BackgroundCoxiella burnetii, an obligate intracellular organism, is the causative agent of the zoonotic disease Q fever. The seroprevalence rate for Q fever in the United States is 3.1%, suggesting a high number of infections each year. However, fewer than 200 cases of Q fever are reported to the CDC annually. This discrepancy is likely the result of underutilized diagnostics and a high percentage (>50%) of asymptomatic infections. The detection of C. burnetii in patient blood during the first 2 to 3 weeks of infection raises the possibility that the organism could be present in donated human blood. The purpose of this study was to determine if extracellular C. burnetii would be stable in blood under normal storage conditions.Study Design and MethodsDonated human blood was separated into whole blood, leukoreduced whole blood, red blood cells, and plasma. Each component was spiked with purified, extracellular C. burnetii strain Nine Mile Phase 1, and the viability and infectivity of the organisms were tested weekly.ResultsC. burnetii did not decrease in viability or the ability to infect cells after storage in any of the blood products, even after 6 weeks of storage at 1 to 6°C.ConclusionsExtracellular C. burnetii can survive and remain infectious in donated blood products.
Association between antimicrobial locks for hemodialysis central venous catheters and antibiotic resistance
Authors: Wolley Martin J. , Taylor Susan L. , Hossain Firoz , Abbas Saib A. , Marshall Mark R. 
Published: October 2012

AbstractAntimicrobial locks (AMLs) are effective in preventing catheter‐associated bloodstream infections (CABSI) in hemodialysis (HD) patients, but may increase antibiotic resistance. In our center, gentamicin‐heparin locks have been used for all HD central venous catheters since July 1, 2004. We previously reported a significant reduction in CABSI rates, but a short‐term trend to increased gentamicin resistance among coagulase‐negative staphylococci (CNS). We present a further 3‐year follow‐up study of bacterial resistance in our dialysis center. We examined the susceptibility of bacterial isolates from CABSI from July 1, 2006 to July 31, 2009, restricting analyses to CNS, gram‐negative bacilli, and Staphylococcus aureus. We compared the frequency of gentamicin resistance in these isolates between four groups: CABSI in HD patients, non‐CABSI in HD patients, peritonitis in peritoneal dialysis (PD) patients, and bloodstream infection in the non–end‐stage kidney failure general population. For CNS isolates, the frequency of gentamicin resistance was similar between the CABSI and PD peritonitis groups, but higher in both groups than the general population. The pattern was similar for S. aureus although the differences were of borderline statistical significance. The frequency of gentamicin resistance among gram‐negative bacilli isolates did not differ between groups. Gentamicin resistance was more common than expected in CNS and possibly S. aureus isolates from CABSI, although this resistance may be part of a generally higher frequency of antibiotic resistance in the dialysis population, rather than a direct result of AML use. AMLs remain a valuable clinical tool although surveillance is needed to ensure that benefits continue to outweigh risks.
Effect of sterilization on solute transport performances of super high‐flux dialyzers
Authors: Yamashita Akihiro C. , Fujita Ryoichiro , Hosoi Nobuyuki 
Published: October 2012

AbstractThe effect of sterilization was quantitatively evaluated for modern super high‐flux dialyzers in terms of solute transport performances for autoclave sterilization (AC), gamma ray sterilization (G‐ray), combination of these two and no sterilization (NS) as reference. A commercial polysulfone dialyzer (Kawasumi Laboratory Co., Tokyo, Japan) was chosen for investigation with six different sterilization processes, i.e., sterilization with AC one time and two times, that with G‐ray using either no additives or an additive, that with AC one time followed by G‐ray using no additive and that with NS. In vitro dialysis and ultrafiltration experiments were performed with aqueous test solution as pseudo blood, varying QB, QD, and QF. Creatinine (MW113), vitamin B12 (MW1355), and α‐chymotrypsin (MW25000) were chosen as test solutes for dialysis experiments. Clearances (CL) calculated from dialysis experiments and the sieving coefficient for albumin (MW66000) from ultrafiltration experiments were compared among six models. A dialyzer with NS showed much lower clearances for all three solutes than those with sterile. Therefore, the sterilization increases the solute transfer performances. Although no significant changes in clearances for creatinine and vitamin B12 were found among five sterile models, much higher clearances for α‐chymotrypsin were found in AC sterile models. Then, the effect of sterilization may become greater with the increase of molecular weight of solutes. According to the results of the sieving coefficient for albumin, AC may have enlarged the pore size of the membrane that could increase clearances for large solutes without changing those for relatively small solutes. The sterilization increases the solute clearance even in so‐called super high‐flux dialyzers and the effect of sterilization may be greater in larger solutes.
Physiologic volume of phosphorus during hemodialysis: Predictions from a pseudo one‐compartment model
Authors: Leypoldt John K. , Akonur Alp , Agar Baris U. , Culleton Bruce F. 
Published: October 2012

AbstractThe kinetics of plasma phosphorus concentrations during hemodialysis (HD) are complex and cannot be described by conventional one‐ or two‐compartment kinetic models. It has recently been shown by others that the physiologic (or apparent distribution) volume for phosphorus (Vr‐P) increases with increasing treatment time and shows a large variation among patients treated by thrice weekly and daily HD. Here, we describe the dependence of Vr‐P on treatment time and predialysis plasma phosphorus concentration as predicted by a novel pseudo one‐compartment model. The kinetics of plasma phosphorus during conventional and six times per week daily HD were simulated as a function of treatment time per session for various dialyzer phosphate clearances and patient‐specific phosphorus mobilization clearances (KM). Vr‐P normalized to extracellular volume from these simulations were reported and compared with previously published empirical findings. Simulated results were relatively independent of dialyzer phosphate clearance and treatment frequency. In contrast, Vr‐P was strongly dependent on treatment time per session; the increase in Vr‐P with treatment time was larger for higher values of KM. Vr‐P was inversely dependent on predialysis plasma phosphorus concentration. There was significant variation among predicted Vr‐P values, depending largely on the value of KM. We conclude that a pseudo one‐compartment model can describe the empirical dependence of the physiologic volume of phosphorus on treatment time and predialysis plasma phosphorus concentration. Further, the variation in physiologic volume of phosphorus among HD patients is largely due to differences in patient‐specific phosphorus mobilization clearance.
Piperacillin‐induced thrombocytopenia reversed by high‐flux hemodialysis in an uremic patient
Authors: Lin Shang‐Yi , Huang Jiun‐Chi , Shen Mei‐Chiou , Chuang Shu‐Hui , Lee Mei‐Hsuan , Chen Huang‐Chi 
Published: October 2012

AbstractDrug‐induced thrombocytopenia in an infected patient often is overlooked. We present a 74‐year‐old uremic female with continuous renal replacement therapy developed severe thrombocytopenia during the treatment course of piperacillin/tazobactam. Platelet counts recovered rapidly after discontinuing piperacillin/tazobactam and receiving high‐flux hemodialysis. The George criteria indicates piperacillin/tazobactam as the probable cause of thrombocytopenia in this patient. Immediate withdrawal of the causative drug is important for drug‐induced thrombocytopenia. Prompt high‐flux hemodialysis may be an adjunctive management for uremic patients.
Isolated pleural effusion as a presentation of high cardiac output heart failure in a hemodialysis patient
Authors: Dhawan Vibhu , Ariyamuthu Venkatesh , Malhotra Kunal , Dalal Pranav , Bichu Prasad , Dorairajan Smrita 
Published: October 2012

AbstractCongestive heart failure is a well‐recognized complication of hemodialysis arteriovenous fistula. Symptoms of dyspnea are usually associated with signs of congestive heart failure including pulmonary edema, pleural effusions, lower extremity edema, and liver enlargement, to name a few. We present a case of a gentleman with end‐stage renal disease on chronic hemodialysis, which developed acute bilateral transudative pleural effusions in the absence of other signs of systemic venous congestion, associated with pulmonary venous congestion. We also discuss the pathogenesis and role of hemodialysis in management of this patient.
Bath salt intoxication causing acute kidney injury requiring hemodialysis
Authors: Regunath Hariharan , Ariyamuthu Venkatesh Kumar , Dalal Pranavkumar , Misra Madhukar 
Published: October 2012

AbstractTraditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of “bath salts.” They are beta‐ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the “khat” plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. Serious adverse effects reported with intoxication included cardiac, psychiatric, and neurological signs and symptoms. Not much is known about the toxicology and metabolism of these compounds. They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4‐methylenedioxy‐N‐methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of “bath salt” pills that improved with hemodialysis.