Evaluation of suspected child abuse at the ED; implementation of American Academy of Pediatrics guidelines in the Netherlands.

Emergency departments (EDs) are important to detect child physical abuse. A structured approach will contribute to an adequate detection of abused children at the ED. The American Academy of Pediatrics (AAP) provided guidance in the clinical approach to the evaluation of suspected physical abuse in children.

A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction.

Background: Erythema Nodosum Leprosum (ENL) is a humoral immunological response in leprosy that leads to inflammatory skin nodules which may result in nerve and organ damage, and may occur years after antibiotic treatment. Multiple episodes are frequent and suppression requires high doses of immunosuppressive drugs. Global occurrence is unknown.

Advancing plant phenology and reduced herbivore production in a terrestrial system associated with sea ice decline.

The contribution of declining Arctic sea ice to warming in the region through Arctic amplification suggests that sea ice decline has the potential to influence ecological dynamics in terrestrial Arctic systems. Empirical evidence for such effects is limited, however, particularly at the local population and community levels. Here we identify an Arctic sea ice signal in the annual timing of vegetation emergence at an inland tundra system in West Greenland.

Record of a Zoophthora sp. (Entomophthoromycota: Entomophthorales) pathogen of the irruptive noctuid moth Eurois occulta (Lepidoptera) in West Greenland.

Eurois occulta undergoes extreme population fluctuations in Greenland, with long periods of low density punctuated by brief population explosions. During the summers of high E. occulta density in 2010 and 2011, large numbers of deceased late-instar larvae were observed in the summit disease position characteristic of entomophthoralean infection.

Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT).

Objectives: Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. We hypothesized that the Life Goals Collaborative Care (LGCC) intervention, compared to enhanced usual care, would reduce CVD risk factors and improve physical and mental health outcomes in US Department of Veterans Affairs patients with bipolar disorder.

Method: Patients with an ICD-9 diagnosis of bipolar disorder and ≥ 1 CVD risk factor (N = 118) enrolled in the Self-Management Addressing Heart Risk Trial, conducted April 2008-May 2010, were randomized to LGCC (n = 58) or enhanced usual care (n = 60).

Ecological consequences of sea-ice decline.

After a decade with nine of the lowest arctic sea-ice minima on record, including the historically low minimum in 2012, we synthesize recent developments in the study of ecological responses to sea-ice decline. Sea-ice loss emerges as an important driver of marine and terrestrial ecological dynamics, influencing productivity, species interactions, population mixing, gene flow, and pathogen and disease transmission. Major challenges in the near future include assigning clearer attribution to sea ice as a primary driver of such dynamics, especially in terrestrial systems, and addressing pressures arising from human use of arctic coastal and near-shore areas as sea ice diminishes.

Capital and income breeding traits differentiate trophic match-mismatch dynamics in large herbivores.

For some species, climate change has altered environmental conditions away from those in which life-history strategies evolved. In such cases, if adaptation does not keep pace with these changes, existing life-history strategies may become maladaptive and lead to population declines. We use life-history theory, with a specific emphasis on breeding strategies, in the context of the trophic match-mismatch framework to form generalizable hypotheses about population-level consumer responses to climate-driven perturbations in resource availability.

Advancing the long view of ecological change in tundra systems. Introduction.

Despite uncertainties related to sustained funding, ideological rivalries and the turnover of research personnel, long-term studies and studies espousing a long-term perspective in ecology have a history of contributing landmark insights into fundamental topics, such as population- and community dynamics, species interactions and ecosystem function. They also have the potential to reveal surprises related to unforeseen events and non-stationary dynamics that unfold over the course of ongoing observation and experimentation. The unprecedented rate and magnitude of current and expected abiotic changes in tundra environments calls for a synthetic overview of the scope of ecological responses these changes have elicited.

Rapid comprehensive characterization of crude oils by thermogravimetry coupled to fast modulated gas chromatography-single photon ionization time-of-flight mass spectrometry.

Comprehensive multi-dimensional hyphenation of a thermogravimetry device (i.e. a thermobalance) to gas chromatography and single photon ionization-time-of-flight mass spectrometry (TG-GC×SPI-MS) has been used to investigate two crude oil samples of different geographical origin.

Enhanced effectivity of an ALK5-inhibitor after cell-specific delivery to hepatic stellate cells in mice with liver injury.

Transforming growth factor-β (TGF-β) is a major pro-fibrotic cytokine, causing the overproduction of extracellular matrix molecules in many fibrotic diseases. Inhibition of its type-I receptor (ALK5) has been shown to effectively inhibit fibrosis in animal models. However, apart from its pro-fibrotic effects, TGF-β also has a regulatory role in the immune system and influences tumorigenesis, which limits the use of inhibitors.

Erosion of community diversity and stability by herbivore removal under warming.

Climate change has the potential to influence the persistence of ecological communities by altering their stability properties. One of the major drivers of community stability is species diversity, which is itself expected to be altered by climate change in many systems. The extent to which climatic effects on community stability may be buffered by the influence of species interactions on diversity is, however, poorly understood because of a paucity of studies incorporating interactions between abiotic and biotic factors.

Two randomized controlled clinical trials to study the effectiveness of prednisolone treatment in preventing and restoring clinical nerve function loss in leprosy: the TENLEP study protocols.

Background: Nerve damage in leprosy often causes disabilities and deformities. Prednisolone is used to treat nerve function impairment (NFI). However, optimal dose and duration of prednisolone treatment has not been established yet.

Determinants of readiness for primary care-mental health integration (PC-MHI) in the VA Health Care System.

Background: Depression management can be challenging for primary care (PC) settings. While several evidence-based models exist for depression care, little is known about the relationships between PC practice characteristics, model characteristics, and the practice's choices regarding model adoption.

Objective: We examined three Veterans Affairs (VA)-endorsed depression care models and tested the relationships between theoretically-anchored measures of organizational readiness and implementation of the models in VA PC clinics.

Cost-effectiveness analysis of three leprosy case detection methods in Northern Nigeria.

Background: Despite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy.

Interactions among shrub cover and the soil microclimate may determine future Arctic carbon budgets.

Arctic and Boreal terrestrial ecosystems are important components of the climate system because they contain vast amounts of soil carbon (C). Evidence suggests that deciduous shrubs are increasing in abundance, but the implications for ecosystem C budgets remain uncertain. Using midsummer CO(2) flux data from 21 sites spanning 16° of latitude in the Arctic and Boreal biomes, we show that air temperature explains c.

The antitumor activity of hydrophobin SC3, a fungal protein.

The use of mushroom extracts has been common practice in traditional medicine for centuries, including the treatment of cancer. Proteins called hydrophobins are very abundant in mushrooms. Here, it was examined whether they have antitumor activity.

Variation in estimated ozone-related health impacts of climate change due to modeling choices and assumptions.

Background: Future climate change may cause air quality degradation via climate-induced changes in meteorology, atmospheric chemistry, and emissions into the air. Few studies have explicitly modeled the potential relationships between climate change, air quality, and human health, and fewer still have investigated the sensitivity of estimates to the underlying modeling choices.

Objectives: Our goal was to assess the sensitivity of estimated ozone-related human health impacts of climate change to key modeling choices.

Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with bipolar disorder.

Background: Persons with bipolar disorder (BD) experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), contributing to decreased function and premature mortality. We describe the design, rationale, and baseline findings for the Self-Management Addressing Heart Risk Trial (SMAHRT), a randomized controlled effectiveness trial of an intervention (Life Goals Collaborative Care; LGCC) designed to reduce CVD risk factors and improve physical and mental health outcomes in patients with BD.

Methods: Patients with BD and at least one CVD risk factor were recruited from a VA healthcare system and randomized to either LGCC or usual care (UC).

Mood disorder symptoms and elevated cardiovascular disease risk in patients with bipolar disorder.

Objectives: We examined the association between mood symptoms and 10-year CVD risk estimated by Framingham risk score in a cohort of patients with bipolar disorder.

Methods: Veterans with bipolar disorder and CVD risk factors (N=118) were recruited from outpatient VA clinics. CVD risk factor data were collected from electronic medical records and patient surveys, and used to calculate patient Framingham Scores.

Climate change and the ecology and evolution of Arctic vertebrates.

Climate change is taking place more rapidly and severely in the Arctic than anywhere on the globe, exposing Arctic vertebrates to a host of impacts. Changes in the cryosphere dominate the physical changes that already affect these animals, but increasing air temperatures, changes in precipitation, and ocean acidification will also affect Arctic ecosystems in the future. Adaptation via natural selection is problematic in such a rapidly changing environment.

Global assessment of experimental climate warming on tundra vegetation: heterogeneity over space and time.

Understanding the sensitivity of tundra vegetation to climate warming is critical to forecasting future biodiversity and vegetation feedbacks to climate. In situ warming experiments accelerate climate change on a small scale to forecast responses of local plant communities. Limitations of this approach include the apparent site-specificity of results and uncertainty about the power of short-term studies to anticipate longer term change.

The role of mental and behavioral health in the application of the patient-centered medical home in the Department of Veterans Affairs.

The patient-centered medical home, which is termed the Patient Aligned Care Team (PACT) in the Department of Veterans Affairs (VA), is a transformational initiative with mental and behavioral health as integral components. Funding has been provided to VA medical facilities to assist with the transformation and process redesign of primary care into interdisciplinary teams focused on increased access, Veteran-centered care, and active incorporation of collaborative expertise from specialists within primary care. Primary care clinics are not simple machines that change by merely replacing parts or colocating additional resources.

Climate change intensification of herbivore impacts on tree recruitment.

Altered species interactions are difficult to predict and yet may drive the response of ecological communities to climate change. We show that declining snowpack strengthens the impacts of a generalist herbivore, elk (Cervus elaphus), on a common tree species. Thick snowpack substantially reduces elk visitation to sites; aspen (Populus tremuloides) shoots in these areas experience lower browsing rates, higher survival and enhanced recruitment.

Climate change and tropical biodiversity: a new focus.

Considerable efforts are focused on the consequences of climate change for tropical rainforests. However, potentially the greatest threats to tropical biodiversity (synergistic interactions between climatic changes and human land use) remain understudied. Key concerns are that aridification could increase the accessibility of previously non-arable or remote lands, elevate fire impacts and exacerbate ecological effects of habitat disturbance.