bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelets made HLA deficient by acid treatment aggregate normally and escape destruction by complement and phagocytes in the presence of HLA antibodies
Authors: Meinke Stephan , Sandgren Per , Mörtberg Anette , Karlström Cecilia , Kadri Nadir , Wikman Agneta , Höglund Petter 
Published: October 2015

BACKGROUNDThe presence of antibodies against HLA Class I can lead to platelet (PLT) transfusion refractoriness, that is, the repeated failure to achieve adequate posttransfusion PLT count increments. PLT refractoriness can be overcome by transfusion of HLA‐matched donor PLTs. A different approach is to remove HLA from the PLT surface using low pH. Previous case studies using HLA‐stripped PLTs showed encouraging but inconsistent results and lacked information on the biologic effects of acid treatment on PLT function as well as sensitivity to PLT destruction in the presence of HLA antibodies.STUDY DESIGN AND METHODSPLTs prepared from buffy coats were stripped from HLA Class I using a brief incubation at pH 2.9. Kinetics of acid stripping, viability, phenotypic alterations, and sensitivity to complement‐mediated lysis and phagocytosis were determined by flow cytometry. Functional potential was evaluated using a multiplate analyzer.RESULTSAcid‐treated PLTs were viable, upregulated activation markers normally and aggregated to a similar extent as untreated PLTs in response to stimulation with three natural agonists. Acid treatment removed 70% to 90% of HLA Class I complexes from the PLT surface, which led to complete protection from HLA antibody–mediated complement lysis and reduced monocyte‐mediated phagocytosis in the presence of anti‐HLA in vitro.CONCLUSIONOur study fills an important knowledge gap in how acid treatment affects PLT function and interactions with immune cells, paving the way for controlled clinical trials to evaluate acid‐treated PLTs as an alternative to HLA‐matched donors in PLT refractoriness.
Focused assessment with sonography in nontraumatized dogs and cats in the emergency and critical care setting
Authors: McMurray Jantina , Boysen Søren , Chalhoub Serge 
Published: October 2015

AbstractObjectiveTo evaluate the use of abdominal‐ and thoracic‐focused assessment with sonography for trauma (AFAST and TFAST) in nontraumatized dogs and cats in the emergency and critical care setting and to compare prevalence of free fluid identified via these techniques between stable and unstable patients.DesignProspective observational study.SettingUniversity Distributed Veterinary Learning Community.AnimalsOne hundred client‐owned dogs and cats presenting to an emergency service with no evidence of trauma.InterventionsAFAST and TFAST performed within 12 hours of presentation.Measurement and Main ResultsFree fluid was identified on AFAST or TFAST in 33% of dogs and cats in this study. Free fluid was identified in 27 of 36 (75%) cardiovascularly unstable or dyspneic patients, compared to 6 of 64 (9%) stable patients. A significantly greater proportion of unstable patients had free fluid compared to stable patients (P < 0.0001).ConclusionsResults of this study support the use of AFAST and TFAST to detect free fluid in nontraumatized dogs and cats in the emergency and critical care setting, particularly patients that are unstable on presentation.
The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process
Authors: Demirel Gulbahtiyar , Guler Handan 
Published: October 2015

ABSTRACTAimsThe present research study was conducted with the objective of determining the effect of uterine and nipple stimulation on induction with oxytocin and the birth process.MethodsA randomized controlled experiment was conducted at the maternity ward of a state hospital located in the province of Sivas in Turkey. Three hundred ninety pregnant women who were giving birth via vaginal delivery were randomly assigned to three groups (nipple stimulation, uterine stimulation, control). After the birth, the groups were assessed in terms of the birth duration and synthetic induction with oxytocin. Statistical analyses were performed through the use of SPSS 14.0 software and included analysis of variance, Tukey's test, Dunnett's test, Tamhane's T2 test, and chi‐square test.ResultsThe study established statistically significant differences (p < .05) among the groups in terms of the average durations of the first, second and third phases of the action of birth, the status concerning delivery by C‐section and the application of labor induction. The phases of birth were shorter for the nipple stimulation group (first phase: 3.8 hours, second phase: 16 minutes, third phase: 5 minutes) and the uterine stimulation group (first phase: 4.0 hours, second phase: 21 minutes, third phase: 6 minutes) when compared to the control group (first phase: 6.8 hours, second phase: 27 minutes, third phase: 6 minutes). In the control group, 89.2% of the pregnant women were subject to labor induction and 8.5% to cesarean section. No women in the nipple stimulation group or uterine stimulation group had a cesarean section.Linking Evidence to ActionNipple and uterine stimulation reduce the frequency of elective labor induction, the rate of relevant complications, and support normal vaginal birth by providing endogenous labor induction. Therefore, these interventions should be considered for pregnant women in labor.
Protective effect of nitric oxide in aristolochic acid‐induced toxic acute kidney injury: an old friend with new assets
Authors: Declèves Anne‐Émilie , Jadot Inès , Colombaro Vanessa , Martin Blanche , Voisin Virginie , Nortier Joëlle , Caron Nathalie 
Published: October 2015

New Findings

What is the central question of this study?
Despite the fact that the pathogenesis of aristolochic acid (AA) nephropathy is still unclear, we sought to determine whether nitric oxide is involved in the underlying mechanism of AA‐induced acute kidney injury (AKI).

What is the main finding and its importance?
Using a model of progressive tubulointerstitial nephritis, in which AA nephropathy exhibits two interconnected phases, an acute phase and a chronic phase of injury, we demonstrated that maintenance of nitric oxide bioavailability is essential to improve the outcome of AA‐induced AKI.

Aristolochic acid (AA) nephropathy (AAN), a progressive tubulointerstitial injury of toxic origin, is characterized by early and transient acute tubular necrosis. This process has been demonstrated to be associated with reduced nitric oxide (NO) production, which can disrupt the regulation of renal function. In this study, we tested the hypothesis that l‐arginine (l‐Arg) supplementation could restore renal function and reduce renal injury after AA intoxication. C57BL/6 J male mice were randomly subjected to daily i.p. injection of either sterile saline solution or AA (2.5 mg kg−1) for 4 days. To determine whether AA‐induced renal injuries were linked to reduced NO production, l‐Arg, a substrate for NO synthase, was supplemented (5%) in drinking water. Mice intoxicated with AA exhibited features of rapid‐onset acute kidney injury, including polyuria, significantly increased plasma creatinine concentrations, proteinuria and fractional excretion of sodium (P < 0.05), along with severe proximal tubular cell injury and increased NADPH oxidase 2 (Nox2)‐derived oxidative stress (P < 0.05). This was associated with a significant reduction in NO bioavailability. l‐Arg supplementation in AA‐treated mice significantly increased NO bioavailability, which in turn improved renal function (creatininaemia, polyuria, proteinuria, fractional excreted sodium and N‐acetyl‐β‐d‐glucosaminidase enzymuria) and renal structure (tubular necrosis and tubular cell apoptosis). These changes were associated with significant reductions in Nox2 expression and in production of reactive oxygen species and with an increase in antioxidant concentrations. Our results demonstrate that preservation of NO bioavailability leads to renal protection in AA‐induced acute kidney injury by reducing oxidative stress and maintaining renal function.
The Relationship Between Time of Day of Physical Activity and Obesity in Older Women
Authors: Chomistek Andrea K. , Shiroma Eric J. , Lee I-Min 
Published: October 2015

Background:Physical activity is important for maintaining healthy weight. The time of day when exercise is performed—a highly discretionary aspect of behavior—may impact weight control, but evidence is limited. Thus, we examined the association between the timing of physical activity and obesity risk in women.Methods:A cross-sectional analysis was conducted among 7157 Women’s Health Study participants who participated in an ancillary study begun in 2011 that is measuring physical activity using accelerometers. The exposure was percentage of total accelerometer counts accumulated before 12:00 noon and the outcome was obesity.Results:Mean (±SD) BMI among participants was 26.1 (±4.9) kg/m2 and 1322 women were obese. The mean activity counts per day was 203,870 (±95,811) of which a mean 47.1% (±11.5%) were recorded in the morning. In multivariable-adjusted models, women who recorded < 39% (lowest quartile) of accelerometer counts before 12:00 noon had a 26% higher odds of being obese, compared with those recording ≥ 54% (highest quartile) of counts before noon (Ptrend = 0.02).Conclusions:These study findings—that women who are less active during morning hours may be at higher risk of obesity—if confirmed can provide a novel strategy to help combat the important health problem of obesity.
The Effect of Increasing Autonomy Through Choice on Young Children’s Physical Activity Behavior
Authors: Sanders Gabriel J. , Juvancic-Heltzel Judith , Williamson Megan L. , Roemmich James N. , Feda Denise M. , Barkley Jacob E. 
Published: October 2015

Background:Increasing autonomy by manipulating the choice of available physical activity options in a laboratory setting can increase physical activity in older children and adults. However, the effect of manipulating the number of physically active choices has yet to be examined in young children in a gymnasium environment.Methods:Twenty children (n = 10 girls, 6.1 ± 1.4 years old) individually participated in 2 [low choice (LC), high choice (HC)] free-choice activity conditions for 30 minutes in a 4360 square foot gymnasium. Children had access to 2 or 8 physical activity options in the LC and HC conditions, respectively. Physical activity behavior was measured via accelerometry.Results:Children’s 30-minute accelerometer counts increased (P < .03) from the LC (2675 ± 294 counts·min-1) to the HC (3224 ± 280 counts·min-1) condition.Conclusions:Providing greater autonomy through choice of a greater number of physically active options increased young children’s physical activity participation by 20.5%.
Developing Point-of-Decision Prompts to Encourage Airport Walking: The Walk to Fly Study
Authors: Frederick Ginny M. , Paul Prabasaj , Watson Kathleen Bachtel , Dorn Joan M. , Fulton Janet 
Published: October 2015

Background:Point-of-decision prompts may be appropriate to promote walking, instead of using a mechanized mode of transport, such as a train, in airports. To our knowledge, no current studies describe the development of messages for prompts in this setting.Methods:In-person interviews were conducted with 150 randomly selected airport travelers who rode the train to their departure gate. Travelers reported various reasons for riding the train to their gate. They were asked about messages that would encourage them to walk. Exploratory factor analysis was conducted for reasons for riding the train. Confirmatory factor analysis was conducted for messages to encourage walking to the departure gate.Results:Travelers reported not knowing walking was an option (23.8%), seeing others riding the train (14.4%), and being afraid of getting lost (9.2%) as reasons for riding the train. Many indicated that directional signs and prompts promoting walking as exercise would encourage them to walk instead of riding the train.Conclusions:Some reasons for riding the train in an airport may be modifiable by installing point-ofdecision prompts. Providing directional signs to travelers may prompt them to walk to their gate instead of riding the train. Similar prompts may also be considered in other community settings.
Subassemblies and Asymmetry in Assembly of Herpes Simplex Virus Procapsid
Authors: Aksyuk Anastasia A. , Newcomb William W. , Cheng Naiqian , Winkler Dennis C. , Fontana Juan , Heymann J. Bernard , Steven Alasdair C. 
Published: October 2015

ABSTRACT

The herpes simplex virus 1 (HSV-1) capsid is a massive particle (~200 MDa; 1,250-Å diameter) with T=16 icosahedral symmetry. It initially assembles as a procapsid with ~4,000 protein subunits of 11 different kinds. The procapsid undergoes major changes in structure and composition as it matures, a process driven by proteolysis and expulsion of the internal scaffolding protein. Assembly also relies on an external scaffolding protein, the triplex, an α
2
β heterotrimer that coordinates neighboring capsomers in the procapsid and becomes a stabilizing clamp in the mature capsid. To investigate the mechanisms that regulate its assembly, we developed a novel isolation procedure for the metastable procapsid and collected a large set of cryo-electron microscopy data. In addition to procapsids, these preparations contain maturation intermediates, which were distinguished by classifying the images and calculating a three-dimensional reconstruction for each class. Appraisal of the procapsid structure led to a new model for assembly; in it, the protomer (assembly unit) consists of one triplex, surrounded by three major capsid protein (MCP) subunits. The model exploits the triplexes’ departure from 3-fold symmetry to explain the highly skewed MCP hexamers, the triplex orientations at each 3-fold site, and the T=16 architecture. These observations also yielded new insights into maturation.

IMPORTANCE
This paper addresses the molecular mechanisms that govern the self-assembly of large, structurally complex, macromolecular particles, such as the capsids of double-stranded DNA viruses. Although they may consist of thousands of protein subunits of many different kinds, their assembly is precise, ranking them among the largest entities in the biosphere whose structures are uniquely defined to the atomic level. Assembly proceeds in two stages: formation of a precursor particle (procapsid) and maturation, during which major changes in structure and composition take place. Our analysis of the HSV procapsid by cryo-electron microscopy suggests a hierarchical pathway in which multisubunit “protomers” are the building blocks of the procapsid but their subunits are redistributed into different subcomplexes upon being incorporated into a nascent procapsid and are redistributed again in maturation. Assembly is a highly virus-specific process, making it a potential target for antiviral intervention.
Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study
Authors: Tucker Joseph D , Cheng Yu , Wong Bonnie , Gong Ni , Nie Jing-Bao , Zhu Wei , McLaughlin Megan M , Xie Ruishi , Deng Yinghui , Huang Meijin , Wong William C W , Lan Ping , Liu Huanliang , Miao Wei , Kleinman Arthur 
Published: October 2015

ObjectiveTo better understand the origins, manifestations and current policy responses to patient–physician mistrust in China.DesignQualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust.SettingGuangdong Province, China.ParticipantsOne hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships.ResultsOne of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust.ConclusionsThe blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.
Trends in complementary feeding indicators in Nigeria, 2003–2013
Authors: Ogbo Felix A , Page Andrew , Idoko John , Claudio Fernanda , Agho Kingsley E 
Published: October 2015

ObjectiveThe study aimed to examine secular trends and determinants of changes in complementary feeding indicators in Nigeria.Design, setting and participantsData on 79 953 children aged 6–23 months were obtained from the Nigeria Demographic and Health Surveys (NDHS) for the period spanning 2003–2013. The surveys used a stratified two-stage cluster sample of eligible mothers aged 15–49 years from the six geopolitical zones of Nigeria. Trends in complementary feeding indicators and socioeconomic, health service and individual characteristics including factors associated with complementary feeding indicators were examined using multilevel logistic regression analyses.ResultsMinimum dietary diversity for children aged 6–23 months worsened from 26% in 2003 to 16% in 2013. Minimum meal frequency improved from 43% in 2003 to 56% in 2013 and minimum acceptable diet worsened from 11% to 9%. Among educated mothers, there was a decreasing prevalence of the introduction of solid, semisolid and soft foods in infants aged 6–8 months (67% in 2003 to 57% in 2013); minimum dietary diversity (33% in 2003 to 24% in 2013) and minimum acceptable diet (13% in 2003 to 8% in 2013). Mothers with a higher education level and mothers who reported more health service contacts were more likely to meet the minimum dietary diversity. Similarly, the odds for minimum acceptable diet were higher among mothers from higher socioeconomic status groups and mothers who reported frequent health services use.ConclusionsComplementary feeding practices in Nigeria declined over the study period and are below the expected levels required to ensure adequate growth and development of Nigerian children. National policies and programmes that ensure sustainability of projects post-MDGs and higher health service coverage for mothers, including community-based education initiatives, are proposed to improve complementary feeding practices among Nigerian mothers.
Development of the Serious Illness Care Program: a randomised controlled trial of a palliative care communication intervention
Authors: Bernacki Rachelle , Hutchings Mathilde , Vick Judith , Smith Grant , Paladino Joanna , Lipsitz Stuart , Gawande Atul A , Block Susan D 
Published: October 2015

IntroductionEnsuring that patients receive care that is consistent with their goals and values is a critical component of high-quality care. This article describes the protocol for a cluster randomised controlled trial of a multicomponent, structured communication intervention.Methods and analysisPatients with advanced, incurable cancer and life expectancy of <12 months will participate together with their surrogate. Clinicians are enrolled and randomised either to usual care or the intervention. The Serious Illness Care Program is a multicomponent, structured communication intervention designed to identify patients, train clinicians to use a structured guide for advanced care planning discussion with patients, ‘trigger’ clinicians to have conversations, prepare patients and families for the conversation, and document outcomes of the discussion in a structured format in the electronic medical record. Clinician satisfaction with the intervention, confidence and attitudes will be assessed before and after the intervention. Self-report data will be collected from patients and surrogates approximately every 2 months up to 2 years or until the patient's death; patient medical records will be examined at the close of the study. Analyses will examine the impact of the intervention on the patient receipt of goal-concordant care, and peacefulness at the end of life. Secondary outcomes include patient anxiety, depression, quality of life, therapeutic alliance, quality of communication, and quality of dying and death. Key process measures include frequency, timing and quality of documented conversations.Ethics and disseminationThis study was approved by the Dana-Farber Cancer Institute Institutional Review Board. Results will be reported in peer-reviewed publications and conference presentations.Trial registration numberProtocol identifierNCT01786811; Pre-results.
Self-motivated learning with gamification improves infant CPR performance, a randomised controlled trial
Authors: MacKinnon R J , Stoeter R , Doherty C , Fullwood C , Cheng A , Nadkarni V , Stenfors-Hayes T , Chang T P 
Published: October 2015

BackgroundEffective paediatric basic life support improves survival and outcomes. Current cardiopulmonary resuscitation (CPR) training involves 4-yearly courses plus annual updates. Skills degrade by 3–6 months. No method has been described to motivate frequent and persistent CPR practice. To achieve this, we explored the use of competition and a leaderboard, as a gamification technique, on a CPR training feedback device, to increase CPR usage and performance.ObjectiveTo assess whether self-motivated CPR training with integrated CPR feedback improves quality of infant CPR over time, in comparison to no refresher CPR training.DesignRandomised controlled trial (RCT) to assess the effect of self-motivated manikin-based learning on infant CPR skills over time.SettingA UK tertiary children's hospital.Participants171 healthcare professionals randomly assigned to self-motivated CPR training (n=90) or no refresher CPR training (n=81) and followed for 26 weeks.InterventionThe intervention comprised 24 h a day access to a CPR training feedback device and anonymous leaderboard. The CPR training feedback device calculated a compression score based on rate, depth, hand position and release and a ventilation score derived from rate and volume.Main outcome measureThe outcome measure was Infant CPR technical skill performance score as defined by the mean of the cardiac compressions and ventilations scores, provided by the CPR training feedback device software. The primary analysis considered change in score from baseline to 6 months.ResultsOverall, the control group showed little change in their scores (median 0, IQR −7.00–5.00) from baseline to 6 months, while the intervention group had a slight median increase of 0.50, IQR 0.00–33.50. The two groups were highly significantly different in their changes (p<0.001).ConclusionsA significant effect on CPR performance was demonstrated by access to self-motivated refresher CPR training, a competitive leaderboard and a CPR training feedback device.