Πέμπτη 1 Νοεμβρίου 2018

The association between the SLCO1B1, apolipoprotein E, and CYP2C9 genes and lipid response to fluvastatin: a meta-analysis

imageObjective The aim of this study was to determine the impact of the SLCO1B1, apolipoprotein E (ApoE), and CYP2C9 genotypes on the lipid-lowering efficacy of fluvastatin. Methods We performed electronic searches on the PubMed, Embase, and Cochrane Library databases to identify studies published through October 2017. Studies that reported the effect estimates with 95% confidence intervals (CIs) of total cholesterol (TC), triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein were included so that the different genotype categories could be compared. Weighted mean difference (WMD) was used to summarize the effect estimates. Results Six studies, involving a total of 1171 individuals, were included in the final analysis. We noted that the patient carrier SLCO1B1 521TT was associated with greater change in TC (WMD: −2.98; 95% CI: −5.12 to −0.84; P=0.006) and LDL (WMD: −5.58; 95% CI: −10.64 to −0.52; P=0.031) compared with 521TC or CC. Furthermore, the patient carrier ApoE*2/*3 showed more change in high-density lipoprotein compared with ApoE*3/*3 (WMD: 18.76; 95% CI: 8.97–28.55; P

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Alopurinol-induced TEN and association with HLA B*58: 01 in White patients

No abstract available

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A response letter to allopurinol-induced toxic epidermal necrolysis and association with HLA-B*5801 in White patients

No abstract available

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A Gene Expression Screen in Drosophila melanogaster Identifies Novel JAK/STAT and EGFR Targets During Oogenesis

The Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) and epidermal growth factor receptor (EGFR) signaling pathways are conserved regulators of tissue patterning, morphogenesis, and other cell biological processes. During Drosophila oogenesis, these pathways determine the fates of epithelial follicle cells (FCs). JAK/STAT and EGFR together specify a population of cells called the posterior follicle cells (PFCs), which signal to the oocyte to establish the embryonic axes. In this study, whole genome expression analysis was performed to identify genes activated by JAK/STAT and/or EGFR. We observed that 317 genes were transcriptionally upregulated in egg chambers with ectopic JAK/STAT and EGFR activity in the FCs. The list was enriched for genes encoding extracellular matrix (ECM) components and ECM-associated proteins. We tested 69 candidates for a role in axis establishment using RNAi knockdown in the FCs. We report that the signaling protein Semaphorin 1b becomes enriched in the PFCs in response to JAK/STAT and EGFR. We also identified ADAM metallopeptidase with thrombospondin type 1 motif A (AdamTS-A) as a novel target of JAK/STAT in the FCs that regulates egg chamber shape. AdamTS-A mRNA becomes enriched at the anterior and posterior poles of the egg chamber at stages 6 to 7 and is regulated by JAK/STAT. Altering AdamTS-A expression in the poles or middle of the egg chamber produces rounder egg chambers. We propose that AdamTS-A regulates egg shape by remodeling the basement membrane.



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Walking and balance outcomes for stroke survivors: a randomized clinical trial comparing body-weight-supported treadmill training with versus without challenging mobility skills

Treadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of chal...

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Precise estimation of human corticospinal excitability associated with the levels of motor imagery-related EEG desynchronization extracted by a locked-in amplifier algorithm

Physical motor exercise aided by an electroencephalogram (EEG)-based brain-computer interface (BCI) is known to improve motor recovery in patients with stroke. In such a BCI paradigm, event-related desynchroni...

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Mental Fatigue in Football: Is it Time to Shift the Goalposts? An Evaluation of the Current Methodology

Abstract

Research in football for a long time has focused on the physical nature of fatigue as opposed to its mental aspects. However, since 2016, six original articles have investigated the effects of induced mental fatigue in football on isolated physical, skill and decision-making performance tests, along with physical, technical and tactical performance outcomes in small-sided games. Whilst these studies have overall shown a negative impact of mental fatigue on task performance, this current opinion aims to critically examine the methodological approach to this problem, most notably the lack of ecological validity when inducing mental fatigue and the present approach to measuring mental fatigue using visual analogue scales (VAS). It is suggested that future research on mental fatigue in football may benefit from the use of surveys/interviews to understand the true cognitive demands of elite football players. Additionally, future research should aim to reduce the reliance on using VAS to measure mental fatigue as results from this tool may be confounded by several response biases. In conclusion, this article highlights the need for mentally fatiguing tasks that adequately represent football-associated mental fatigue and assessments of mental fatigue that minimise the confounding effect of response bias.



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The Efficacy and Safety of Lower-Limb Plyometric Training in Older Adults: A Systematic Review

Abstract

Background

The aging process is associated with a progressive decline of neuromuscular function, increased risk of falls and fractures, impaired functional performance, and loss of independence. Plyometric training may mitigate or even reverse such age-related deterioration; however, little research on the effects of plyometric exercises has been performed in older adults.

Objective

The objective of this systematic review was to evaluate the safety and efficacy of plyometric training in older adults.

Methods

Papers reporting on randomized trials of plyometric training in older adults (≥ 60 years) and published up to December 2017 were sought in the PubMed, SPORTDiscus, Scopus, and EMBASE databases, and their methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis of the findings is presented in this systematic review.

Results

Of the 2236 identified papers, 18 were included in the review, reporting on 12 different studies with a mean PEDro score of 6.0 (range 4–7). Altogether, 289 subjects (176 females and 113 males) were included in 15 intervention groups with plyometric components (n = 8–36 per group); their mean age ranged from 58.4 to 79.4 years. The plyometric training lasted from 4 weeks to 12 months. Muscular strength, bone health, body composition, postural stability, and jump and physical performance were the most often reported outcomes. No study reported increased occurrence of injuries or other adverse events related to plyometric exercises.

Conclusion

Plyometric training is a feasible and safe training option with potential for improving various performance, functional, and health-related outcomes in older persons.



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THE EVOLVING SCENARIO OF HBV INFECTION AND DISEASE: A NEVER-ENDING STORY



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EMS World Expo Quick Take: How pharmacists improve EMS patient care

A pharmacist can help EMS improve patient outcomes, participate in protocol development, and collaborate on EMS research projects

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THE EVOLVING SCENARIO OF HBV INFECTION AND DISEASE: A NEVER-ENDING STORY



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Pulsara launches 12-lead EKG integration as part of expansive Integration strategy

BOZEMAN, Montana — In keeping with the Pulsara integration program, Pulsara is happy to announce the capability to share a diagnostic quality 12-lead ECG directly from ZOLL X Series monitors. Communicating directly with the monitor reduces time, allowing EMS providers to provide needed hospital communication without added steps. This integration refines coordinated treatment between EMS and...

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EMS World Expo Quick Take: 5 ingredients for psychomotor mastery

Competence is the minimum goal for EMT and paramedic students. EMS educators need to put their students on the path to mastery

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The causes of evolvability and their evolution

The causes of evolvability and their evolution

The causes of evolvability and their evolution, Published online: 01 November 2018; doi:10.1038/s41576-018-0069-z

In this article, Payne and Wagner discuss how recent experimental studies are complementing theoretical work to enhance our understanding of the evolvability of diverse biological systems. They highlight phenotypic heterogeneity, robustness and adaptive landscape topography as causes of evolvability, and they additionally discuss evidence for whether evolvability itself can evolve.

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The causes of evolvability and their evolution



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The RNA world of human ageing

Abstract

Ageing is one of the most complex processes in nature; how could we prevent the associated biological changes and chronic diseases that string along with this process, is a challenge in healthcare around the world. Recent advances in next-generation sequencing have reached a stage where it is possible to know from a specific tissue the most abundant transcripts, alternative splicing process and, non-coding RNA molecules (microRNA's, long non-coding RNA's, and circular RNAs). Moreover, our knowledge of several biological processes related to ageing such as senescence and autophagy have dramatically increased in the last years. In the present review, we attempt to summarise the latest scientific advances from the most critical studies performed in human clinical samples, specific to the RNA studies about ageing. Overall, human transcriptomics research indicates that although there are common alterations of the regular expression patterns of the energetic and oxidative metabolism, extracellular matrix regulation and inflammation pathways, ageing seems to be gender and tissue-specific in general. Additionally, there is an age-related implication in several numbers of impaired events on the normal alternative splicing process. On the other hand, there is a direct relation of several non-coding RNA molecules with age-related changes which indicates its possible use as biomarkers for diagnostics and therapeutically purposes. Together, these findings highlight the importance to continue focusing research on RNA studies to improve our knowledge in the pathophysiology of age-related diseases.



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Body mass index, calcium supplementation and risk of colorectal adenomas

International Journal of Cancer

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Clinical and histopathological features of immunoglobulin G4-associated autoimmune hepatitis in children

Journal of Gastroenterology and Hepatology

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ADAR RNA editing in innate immune response phasing, in circadian clocks and in sleep

Publication date: Available online 31 October 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Ketty Sinigaglia, Dagmara Wiatrek, Anzer Khan, David Michalik, Nagraj Sambrani, Jiří Sedmík, Dragana Vukić, Mary A. O'Connell, Liam P. Keegan

Abstract

Adenosine deaminases acting on RNA (ADARs) convert adenosine to inosine in dsRNA. ADAR editing in pre-mRNAs recodes open reading frames and alters splicing, mRNA structure and interactions with miRNAs. Here, we review ADAR gene expression, splice forms, posttranslational modifications, subcellular localizations and functions of ADAR protein isoforms. ADAR1 edits cellular dsRNA to prevent aberrant activation of cytoplasmic antiviral dsRNA sensors; ADAR1 mutations lead to aberrant expression of interferon in Aicardi Goutières syndrome (AGS), a human congenital encephalopathy. We review related studies on mouse Adar1 mutant phenotypes, their rescues by preventing signaling from the antiviral RIG-I-like Sensors (RLRs), as well as Adar1 mechanisms in innate immune suppression and other roles of Adar1, including editing-independent effects. ADAR2, expressed primarily in CNS, edits glutamate receptor transcripts; regulation of ADAR2 activity in response to neuronal activity mediates homeostatic synaptic plasticity of vertebrate AMPA and kainite receptors. In Drosophila, synapses and synaptic proteins show dramatic decreases at night during sleep; Drosophila Adar, an orthologue of ADAR2, edits hundreds of mRNAs; the most conserved editing events occur in transcripts encoding synapse-associated proteins. Adar mutant flies exhibit locomotion defects associated with very increased sleep pressure resulting from a failure of homeostatic synaptic processes. A study on Adar2 mutant mice identifies a new role in circadian rhythms, acting indirectly through miRNAs such as let-7 to modulate levels of let-7 target mRNAs; ADAR1 also regulates let-7 miRNA processing. Drosophila ADAR, an orthologue of vertebrate ADAR2, also regulates let-7 miRNA levels and Adar mutant flies have a circadian mutant phenotype.



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Labour politics as public health: how the politics of industrial relations and workplace regulation affect health

Abstract
There are three main areas of social and economic policy that influence health: the welfare state, industrial organization (unions), and labor regulation. Public health literature and analysis traditionally focuses on the taxing and spending of the welfare state. This paper presents highlights from the extensive literature in political economy in order to argue that industrial relations and workplace regulation are political and crucial to public health. The routes by which they influence public health include wage inequality, workplace health and safety, political engagement and investment in human capital. The magnitude of impact can be impressive: the United Kingdom's taxation and spending have about as much redistributive impact as that of Sweden, but that is not enough to compensate for the inequality produced by the UK's liberal labor market. The trend across wealthy countries has been to weaker unions and less workplace regulation and we can see this as a likely cause of public health problems and health inequalities into the future.

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Political analysis in public health: middle-range concepts to make sense of the politics of health

Abstract
Public health is about policy, power, and the public and as such might be thought necessarily political. That does not mean, however, that the place of political analysis and engagement in public health is uncontroversial, and there have been longstanding arguments that to discuss politics sullies the scientific nature of public health. This article, introducing a special issue on political science in public health, argues that rigorous use of middle-range theory can inform our analysis of public health problems and avoid the risks of politicization, excessive abstraction or excessive concreteness. It summarizes key political science concepts discussed in the papers: epistemic communities, interest groups, advocacy coalitions, political parties, institutions, legalism, discourse and the political economy of labour. We hope that the series will provide the public health community with some tools and methods for how to integrate public health knowledge into the sphere of decision making in an appropriate way.

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Legalism and tobacco control in the EU

Abstract
Tobacco control policies rely heavily on law and are steeped in litigation. Examining the creation of tobacco control laws in the European Union, this article lays out the potential costs and benefits of legalism for public health practitioners and advocates. Legalism is a form of governance that relies heavily on the authority of law to settle political disputes, with consequences for the ways in which governments make, and advocates push for, public health policies. To the extent that legalism creates procedural problems and distortions in the content of public health policy, then the content of law and its making is a public health problem. On the other hand, litigation can also be a public health tool, and an enforceable, justiciable right to health is a powerful political and legal weapon in its own right.

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Using the Advocacy Coalition Framework to understand EU pharmaceutical policy

Abstract
Models of interest group politics can help public health professionals (PHPs) to identify potential allies and establish mechanisms of sustainable political influence. This article focusses on a particular model, known as the Advocacy Coalition Framework (ACF), and its explanations of coalition behaviour, the role of scientific information and the ways in which coalitions can bring about policy change. The analysis illustrates the relevance of the ACF for public health by drawing on examples from the recent policy debate on direct-to-consumer advertising of prescription drugs (DTCA-PD) in the European Union (EU). It explores the strengths and weaknesses of the ACF in explaining why 'control' of particular governmental units was key to the anti-DTCA coalition success, how the evidence base was used strategically and why the pro-DTCA coalition ultimately failed in bringing about major policy change. The article aims to equip PHPs with a tool which can be used to understand and engage with the policy process. Moreover, in offering a more nuanced view of this process, a case is made for moving beyond traditional, linear conceptions of the policy process and engaging in further research which uses political science concepts to inform the study and practice of public health. The article concludes with a set of recommendations for practitioners and researchers, emphasizing the value of political science for the former and the need for the latter to reflect on the accessibility of policy studies for PHPs.

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Public health and politics: how political science can help us move forward

Public health and politics are two sides of the same coin. Just combining the words 'public' and 'health' makes a clear statement that health can only be achieved by the concerted action of many people who must work together in pursuit of a common goal. Acknowledging this raises questions, though: How should they work together? As a voluntary grouping of those with shared interests, where people can join or leave as they desire? Or within an organized state, governed by laws that safeguard rights but demand obligations? Such questions, addressing issues like the relationship between the individual and the state and the distribution of power and resources in society, are at the heart of political science. But they are also crucial to efforts to improve health. Too often, we shy away from politics, instead adopting a narrow and, arguably, easier technocratic approach, setting out why an evidence-based action should be done without asking how it might be done and devising an appropriate implementation strategy.

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Political parties matter: the impact of the populist radical right on health

Abstract
This paper presents the basic political science consensus on parties and their impact on policy, then turns to focus on the impact of the populist radical right (PRR) parties on policy, what PRR parties have done to implement their views and whether they make a difference. Three effects on policy were established: 1) they de-emphasize the issue, preferring to focus on migration, crime and security rather than health and welfare and 2) they prefer to pursue exclusionary policies. 3) it is not clear whether they increase or decrease benefits for the "native" populations they claim to represent. In short PRR parties make a difference whether to migrants or conservative governments, this party group matters.

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Addressing vaccination hesitancy in Europe: a case study in state–society relations

Abstract
In light of recent outbreaks of diseases such as measles in Europe, policymakers and public health practitioners are seeking strategies to address anti-vaccination attitudes and to increase immunization rates. Identifying effective strategies that will not further alienate vaccination sceptics raises challenges that go to the heart of relations between the state and society. Drawing on accounts of state–society relations, this article discusses how the problem of vaccination hesitancy might be explained from a political science perspective. Discourse-analytical approaches emphasize the importance of storylines, politics and social context in explaining a range of phenomena. Given the number and strength of prevailing discourses in groups with anti-vaccination sentiments, the literature on discourse coalitions can offer perspectives on the challenges that arise in designing strategies to address vaccine hesitancy. Paying closer attention to individual reasons why parents are vaccine hesitant might allow for designing strategies that are more suited to address concerns. However, given the pervasiveness of the discourses of anti-vaccination movements, challenges in reaching citizens who are sceptical of vaccines will remain.

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Comparative institutional analysis for public health: governing voluntary collaborative agreements for public health in England and the Netherlands

Abstract
Democratic institutions and state-society relations shape governance arrangements and expectations between public and private stakeholders about public health impact. We illustrate this with a comparison between the English Public Health Responsibility Deal (RD) and the Dutch 'All About Health…' (AaH) programme. As manifestations of a Whole-of-Society approach, in which governments, civil society and business take responsibility for the co-production of economic utility and good health, these programmes are two recent collaborative platforms based on voluntary agreements to improve public health. Using a 'most similar cases' design, we conducted a comparative secondary analysis of data from the evaluations of the two programmes. The underlying rationale of both programmes was that voluntary agreements would be better suited than regulation to encourage business and civil society to take more responsibility for improving health. Differences between the two included: expectations of an enforcing versus facilitative role for government; hierarchical versus horizontal coordination; big business versus civil society participants; top-down versus bottom-up formulation of voluntary pledges and progress monitoring for accountability versus for learning and adaptation. Despite the attempt in both programmes to base voluntary commitments on trust, the English 'shadow of hierarchy' and adversarial state-society relationships conditioned non-governmental parties to see the pledges as controlling, quasi-contractual agreements that were only partially lived up to. The Dutch consensual political tradition enabled a civil society-based understanding and gradual acceptance of the pledges as the internalization by partner organizations of public health values within their operations. We conclude that there are institutional limitations to the implementation of generic trust-building and learning-based models of change 'Whole-of-Society' approaches.

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Epistemic communities and experts in health policy-making

Abstract
The role of evidence and expertise in policy-making has been of interest to public health professionals and political scientists alike. The public health community often sees its efforts as part of a linear knowledge transfer process and tends to blame itself for inadequate communication or translation of its arguments to policy-makers' language when its efforts fail. Political science, especially theories of the policy process, offer alternative perspectives to explain the success or failure of experts' preferred policy goals. This paper focuses on the concept of epistemic communities (groups of experts with a common policy goal derived from their shared knowledge) in policy-making, drawing on examples from the field of health technology assessment in Europe. By combining the parsimony and the central focus on experts of the linear knowledge transfer model with the recognition of complexity of political science, the epistemic communities concept provides a useful structure for the public health community to analyze its efforts to influence policy.

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Utility of human leukocyte antigen-B*58: 01 genotyping and patient outcomes

Aim Human leukocyte antigen (HLA-B*58:01) allele screening before allopurinol administration is recommended to prevent gene-mediated severe cutaneous adverse reactions (SCARs). The objective of the analysis was to examine the clinical utility and effects of HLA-B*58:01 genotyping on patient's outcomes in a practice setting. Patients and methods The electronic medical records covering diagnosis, laboratory results, and prescription dispensing for patients who were newly treated with allopurinol or tested for HLA-B*58:01 were obtained from a large medical organization in Taiwan between 2010 and 2014. The uptake of HLA-B*58:01 testing, incidence of allopurinol-associated SCAR, and changes in urate-lowering agent utilization were assessed. Results A total of 17 532 allopurinol new users were identified from 2010 to 2014, and the HLA-B*58:01 test was ordered for 2844 (21.76%) of 13 069 new users when available between 2011 and 2014 in the study. The allopurinol-related SCAR events decreased from 0.21% (22/4460) to 0 (0/2167) after the introduction of HLA-B*58:01 testing, accompanied by a gradual increase from 8% (326/4207) to 31% (674/2167) in genotype testing rate. However, the HLA-B*58:01 testing performed before allopurinol prescription was 60.34%, and ~40% of patients were tested after already taking allopurinol. A shift from allopurinol to other urate-lowering agent regimens appeared among new allopurinol users. Conclusion HLA-B*58:01 test was associated with the prevention of allopurinol-induced SCAR. The clinical utility of genotype testing may not be consistent with recommendations for testing, and treatment alternatives are a competitive intervention associated with effective implications in a real-world setting. Correspondence to Chien-Ning Hsu, PhD, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, 123 Dabi Road, Kaohsiung 833, Taiwan Tel: +886 77 317 123 x6131; fax: +886 73 535 566; e-mail: chien_ning_hsu@hotmail.com Received April 16, 2018 Accepted October 10, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Human eye conditions: insights from the fly eye

Abstract

The fruit fly Drosophila melanogaster has served as an excellent model to study and understand the genetics of many human diseases from cancer to neurodegeneration. Studying the regulation of growth, determination and differentiation of the compound eyes of this fly, in particular, have provided key insights into a wide range of diseases. Here we review the regulation of the development of fly eyes in light of shared aspects with human eye development. We also show how understanding conserved regulatory pathways in eye development together with the application of tools for genetic screening and functional analyses makes Drosophila a powerful model to diagnose and characterize the genetics underlying many human eye conditions, such as aniridia and retinitis pigmentosa. This further emphasizes the importance and vast potential of basic research to underpin applied research including identifying and treating the genetic basis of human diseases.



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Acknowledgements to referees



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Stroke survivor activity during subacute inpatient rehabilitation: how active are patients?

Being active following stroke is recommended, but inactivity is common. The current study aimed to observe stroke survivors physical, social and cognitive activities in a large regional inpatient rehabilitation centre. Patients were observed over 8 separate days at 10-min intervals between 8 a.m. and 8 p.m. Patients were engaged in any form of activity 59.9% of the time and in therapy 4.6% of the time. Patients were inactive and alone 34.3% of the time. Activity levels were weakly associated with patients' functional abilities (Spearman's ρ≤0.39). Independent walkers spent a higher proportion of the day physically active (37.5%) compared with nonindependent walkers (30.6%) (P=0.019). Days since stroke was not correlated with patient activity levels. Initiatives to increase activity during inpatient rehabilitation appear to be warranted. Correspondence to Natasha A. Selenitsch, B. Physio, Department of Physiotherapy, McKellar Centre, Barwon Health, Ballarat Road, North Geelong, VIC 3215, Australia Tel: +61 342 155 511; fax: +61 342 156 385; e-mail: natashas@barwonhealth.org.au Received May 31, 2018 Accepted October 11, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Modeling age‐specific facial development in Williams–Beuren‐, Noonan‐, and 22q11.2 deletion syndromes in cohorts of Czech patients aged 3–18 years: A cross‐sectional three‐dimensional geometric morphometry analysis of their facial gestalt

American Journal of Medical Genetics Part A, EarlyView.


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Acanthosis nigricans in achondroplasia

American Journal of Medical Genetics Part A, EarlyView.


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Two patients with FOXF1 mutations with alveolar capillary dysplasia with misalignment of pulmonary veins and other malformations: Two different presentations and outcomes

American Journal of Medical Genetics Part A, EarlyView.


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Identification and expression analysis of type II and type III Pi transporters in the opossum kidney cell line

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Artesunate attenuates airway resistance in vivo and relaxes airway smooth muscle cells in vitro via bitter taste receptor dependent calcium signaling

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Is Activity Tracker–Measured Ambulation an Accurate and Reliable Determinant of Postoperative Quality of Recovery? A Prospective Cohort Validation Study

BACKGROUND: Quality of recovery (QOR) instruments measure patients' ability to return to baseline health status after surgery. Whether, and the extent to which, postoperative ambulation contributes to QOR is unclear, in part due to the lack of valid tools to measure ambulation in clinical settings. This cohort study of the cesarean delivery surgical model examines the accuracy and reliability of activity trackers in quantifying early postoperative ambulation and investigates the correlation between ambulation and QOR. METHODS: A prospective cohort of 200 parturients undergoing cesarean delivery between July 2015 and June 2017 was fitted with wrist-worn activity trackers immediately postpartum. The trackers were collected 24 hours later, along with QOR assessments (QoR-15 scale). The relationship between QOR and various covariates, including ambulation, was explored using multivariable linear regression and Spearman correlation (ρ). Forty-eight parturients fitted with 2 trackers also completed a walk exercise accompanied by a step-counting assessor, to evaluate accuracy, inter-, and intradevice reliability using interclass correlation (ICC). RESULTS: Compared to step counting, activity trackers had high accuracy (ICC = 0.93) and excellent inter- and intradevice reliability (ICC = 0.98 and 0.96, respectively). Correlation analysis suggested that early ambulation is moderately correlated with postcesarean QoR-15 scores, with a ρ (95% confidence interval) equivalent to 0.56 (0.328–0.728). Regression analysis suggested that ambulation is a determinant of postcesarean QoR-15 scores, with an effect estimate (95% confidence interval) equivalent to 0.002 (0.001–0.003). Ambulation was also associated with all QoR-15 domains, except psychological support. The patient's acceptable symptom state (subjective threshold for good ambulation) in the first 24 hours was 287 steps. CONCLUSIONS: This study demonstrated the accuracy and reliability of activity trackers in measuring ambulation in clinical settings and suggested that postoperative ambulation is a determinant of postoperative QOR. A hypothetical implication of our findings is that interventions that improve ambulation may also help to enhance QOR, but further research is needed to establish a causal relationship. Accepted for publication October 5, 2018. Funding: This work was supported by departmental funding. J.G.L., D.N.W., and F.W.A. were supported by the Merit Award Program, Department of Anesthesia, University of Toronto. F.W.A. also receives research time support from the Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa. D.N.W. is also supported by a New Investigator Award from the Canadian Institutes of Health Research. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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National Partnership for Maternal Safety Recommended Maternal Early Warning Criteria Are Associated With Maternal Morbidity

BACKGROUND: Many cases of maternal mortality and morbidity are preventable. A delayed response to clinical warning signs contributes to preventability. Therefore, the National Partnership for Maternal Safety devised maternal early warning criteria (MEWC), composed of abnormal vital signs that trigger bedside evaluation by a provider with the capacity to escalate care. The relationship of the MEWC to maternal morbidity has not been studied. We evaluated the correlation between the MEWC and maternal morbidity. METHODS: We retrospectively reviewed the first 400 deliveries at the University of Chicago in 2016. We analyzed the electronic medical record to determine whether vital signs triggered the MEWC during the admission to labor and delivery and whether patients experienced morbidity during their delivery hospitalization. The association between MEWC and morbidity was tested using χ2 analysis. We calculated the sensitivity, specificity, and positive and negative predictive values of the MEWC. RESULTS: Two hundred eighty-one (70%) of 400 patients triggered the MEWC at least once, and 198 (50%) of 400 patients had multiple or recurrent triggers. Ninety-nine (25%) of 400 patients experienced morbidity. The most common causes of morbidity were hemorrhage, suspected infection, and preeclampsia with severe features. The relative risk of maternal morbidity with at least a single trigger was 13.55 (95% confidence interval [CI], 4.38–41.91) and with recurrent or multiple triggers was 5.29 (95% CI, 3.22–8.71). The sensitivity of the MEWC in predicting morbidity was 0.97 (95% CI, 0.92–0.99) and the specificity was 0.39 (95% CI, 0.33–0.44) when patients with at least a single trigger were included. When including only patients with multiple or recurrent triggers, the sensitivity was 0.84 (95% CI, 0.75–0.90) and the specificity was 0.62 (95% CI, 0.56–0.67). The positive predictive value of the MEWC in our population was 0.34 (95% CI, 0.29–0.40), and the negative predictive value was 0.97 (95% CI, 0.93–0.99). When considering only patients with multiple or recurrent triggers, the positive predictive value was 0.42 (95% CI, 0.38–0.46) and the negative predictive value was 0.92 (95% CI, 0.88–0.95). CONCLUSIONS: The MEWC are associated with maternal morbidity. As a screening tool, they appropriately prioritize sensitivity and have an excellent negative predictive value. The criteria demonstrate low specificity, which is slightly improved by considering only patients with recurrent or multiple triggers. Additional efforts to improve the specificity of MEWC, with a focus on identifying sustained or recurrent patterns of abnormal vital signs, may be necessary before their widespread implementation. Accepted for publication September 26, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Barbara M. Scavone, MD, Departments of Anesthesia and Critical Care and Obstetrics and Gynecology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637. Address e-mail to bscavone@dacc.uchicago.edu. © 2018 International Anesthesia Research Society

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Psychometrics: Trust, but Verify

There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals—both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results—in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test–retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings. Accepted for publication September 10, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2018 International Anesthesia Research Society

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Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa

BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries. METHODS: Accordingly, with input from East African health care professionals, we created a context-relevant obstetric anesthesia checklist for cesarean delivery. Second, clinical observations were performed to assess in a real-world setting. Third, a pilot testing of the cognitive aid was undertaken. RESULTS: Clinical observation data highlighted significant deficiencies in the management of obstetric emergencies. The use of the cesarean delivery checklist during simulations of peripartum hemorrhage and preeclampsia showed significant improvement in the percentage of completed actions (pretraining 23% ± 6% for preeclampsia and 22% ± 13% for peripartum hemorrhage, posttraining 75% ± 9% for preeclampsia, and 69% ± 9% for peripartum hemorrhage [P

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Monitoring Mechanical Ventilation Using Ventilator Waveforms

No abstract available

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Limitation of the Internationalized Normalized Ratio in Guiding Perioperative Plasma Transfusion

No abstract available

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Preoperative Echocardiography for Patients With Hip Fractures Undergoing Surgery: A Retrospective Cohort Study Using a Nationwide Database

BACKGROUND: The effect of preoperative transthoracic echocardiography on the clinical outcomes of patients with hip fractures undergoing surgical treatment remains controversial. We hypothesized that preoperative echocardiography is associated with reduced postoperative morbidity and improved patient survival after surgical repair of hip fractures. METHODS: Drawing from a nationwide administrative database, patients undergoing hip fracture surgeries between April 1, 2008 and December 31, 2016 were included. We examined the association of preoperative echocardiography with the incidence of in-hospital mortality using propensity score matching. Secondary outcomes included postoperative complications, the incidence of postoperative intensive care unit admissions, and length of hospital stay. For sensitivity analyses, we restricted the overall cohort to include only hip fracture surgeries performed within 2 days from admission. RESULTS: Overall, 34,679 (52.1%) of 66,620 surgical patients underwent preoperative echocardiography screening. The screened patients (mean [SD] age, 84.3 years [7.7 years]; 79.0% female) were propensity score matched to 31,941 nonscreened patients (mean [SD] age, 82.1 years [8.7 years]; 78.2% female). The overall in-hospital mortality, before propensity matching, was 1.8% (1227 patients). Propensity score matching created a matched cohort of 25,205 pairs of patients. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 417 [1.65%] vs 439 [1.74%]; odds ratio, 0.95; 95% confidence interval, 0.83–1.09; P = .45). Preoperative echocardiography was not associated with reduced postoperative complications and intensive care unit admissions. In sensitivity analysis, we identified 25,637 patients from the overall cohort (38.5%) with hip fracture surgeries performed within 2 days of admission. There were no in-hospital mortality differences between the 2 groups (screened versus nonscreened: 1.67% vs 1.80%; odds ratio, 0.93; 95% confidence interval, 0.72–1.18; P = .53). Findings were also consistent with other sensitivity analyses and subgroup analyses. CONCLUSIONS: This large, retrospective, nationwide cohort study demonstrated that preoperative echocardiography was not associated with reduced in-hospital mortality or postoperative complications. Accepted for publication September 25, 2018. Funding: Institutional/departmental. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). The authors have no conflicts of interest directly relevant to the content of this article within 36 months before submission. Reprints will not be available from the authors. Address correspondence to Koji Kawakami, MD, PhD, Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto 6068501, Japan. Address e-mail to kawakami.koji.4e@kyoto-u.ac.jp. © 2018 International Anesthesia Research Society

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Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult?

No abstract available

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Fundamentals of Pain Medicine, 1st ed

No abstract available

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Do We Need Specific Certification to Use Anesthesia Information Management Systems?

No abstract available

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Liver Anesthesiology and Critical Care Medicine, 2nd ed

No abstract available

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In Response

No abstract available

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Evaluation of the quality of acute pain management in a pediatric surgical setting: Validation of a parent proxy modified version of the revised American Pain Society Patient Outcome Questionnaire

Pediatric Anesthesia, EarlyView.


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Cover Image

Pediatric Anesthesia, Volume 28, Issue 11, Page i-i, November 2018.


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Parental satisfaction of child's perioperative care

Pediatric Anesthesia, Volume 28, Issue 11, Page 955-962, November 2018.


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In this issue November 2018

Pediatric Anesthesia, Volume 28, Issue 11, Page 939-939, November 2018.


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Issue Information

Pediatric Anesthesia, Volume 28, Issue 11, Page ii-iv, 937, November 2018.


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Ultrasound‐guided bougie insertion during anticipated difficult intubation

Pediatric Anesthesia, Volume 28, Issue 11, Page 1061-1061, November 2018.


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The effect of orthodontic separator and short‐term fixed orthodontic appliance on inflammatory mediators and somatosensory function

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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SIRT1 overexpression attenuates offspring metabolic and liver disorders as a result of maternal high‐fat feeding

The Journal of Physiology, EarlyView.


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Anticipation of food intake induces phosphorylation switch to regulate basolateral amino acid transporter LAT4 (SLC43A2) function

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Early Functional Outcomes for Pediatric Patients Diagnosed with Anti-NMDA Receptor Encephalitis during Inpatient Rehabilitation

Objective The aims of the current study were to characterize the demographic and clinical presentation of pediatric patients diagnosed with anti-NMDA receptor encephalitis who require inpatient rehabilitation, to examine early functional outcomes, and to investigate predictors of early recovery. Design A retrospective chart review was conducted for 27 pediatric patients diagnosed with anti-NMDA receptor encephalitis who received intensive inpatient neurorehabilitation. Results On average, patients were 10.6 years of age (range 2-18) at the time of symptom onset. Average time to treatment from symptom onset was 27.2 days (range 5-91). Patients displayed significant improvements between admission and discharge WeeFIM DFQ scores across patients (p<.01 mean weefim total dfq score at admission was and discharge younger age onset seizures number of treatments received associated with worse functional outcomes discharge. time to initiate treatment not found be early outcomes. conclusion pediatric patients diagnosed anti-nmda receptor encephalitis displayed significant gains during inpatient rehabilitation despite persistent deficits suggesting the need for ongoing monitoring intervention. correspondence: robyn a. howarth phd children healthcare atlanta department neuropsychology meridian mark road suite ga phone: fax: email: robyn.howarth author disclosures: none funding: no funding copyright wolters kluwer health inc. all rights reserved.>

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