bluuebunny/crossref_metadata_2025 huggingface dataset:
Shrinkage of Tape Cast Products During Binder Burnout
Authors: Fu Zongwen , Roosen Andreas
Published: October 2014

During sintering of tape cast products, anisotropic shrinkage occurs, which can be attributed to an anisotropic green tape structure concerning particle and pore orientation. Little is known about the shrinkage during binder burnout (BBO) and its relation to the microstructure of green tapes including the binder–plasticizer phase. Therefore, the article determines the shrinkage behavior of green tapes derived from alumina powders with different particle shape during binder burnout and prefiring in all spatial directions. The shrinkage after prefiring relative to the green and the debindered states is also discussed. The interrelation between shrinkage behavior and microstructure is investigated in dependence on different process parameters and specifically on the thermal behavior of the binder–plasticizer phase in the green tapes. It is shown that the subtraction of the BBO shrinkage from the total shrinkage results in completely different data for the sintering shrinkage anisotropy in z direction.
The Sintering Trajectory and Electrical Properties of Niobium‐Doped Titania Sputtering Targets
Authors: Wu Ming‐Wei , Chen Yan‐Chi
Published: October 2014

Nb‐doped TiO2 (TNO) films, which are highly conductive and transparent, can be used as transparent conductive oxide (TCO) films. A predominant manufacturing method for TCO film is magnetron sputtering, and the material of the sputtering target affects the performance of the film. The objective of this study was to investigate the sintering densification, microstructure, and electrical properties of TNO and TiO2 sputtering targets. The results showed that the segregation of Nb at the grain boundary in TNO helps to facilitate densification and inhibit grain growth. After 1200°C sintering, the sintered density of TNO target achieves almost 100% of the theoretical density. Moreover, the Nb2O5 additive greatly improves the electrical properties, decreasing the resistivity of TiO2 from >108 Ωcm to 4.6 × 101 Ωcm. Correlations between TNO sputtering target investigated in this study and TNO sputtered film reported in the literature are also preliminarily established. The resistivity of TNO film with an anatase structure is obviously lower than that of TNO target with a rutile structure.
Photostimulated and Long Persistent Luminescence Properties from Different Crystallographic Sites of β‐Sr2SiO4: Eu2+, R3+ (R = Tm, Gd)
Authors: Zhang Buhao , Yu Xue , Wang Ting , Cheng Shuai , Qiu Jianbei , Xu Xuhui
Published: October 2014

Sintered ceramics of β‐Sr2SiO4: Eu2+, R3+(R=Tm, Gd) were prepared and their spectroscopic properties were evaluated. A large enhancement of green photostimulated luminescence (PSL) was observed from β‐Sr2SiO4:Eu2+ codoping with Tm3+ at a recognizable intensity level, and the most efficient PSL was obtained when the codoping concentration of Tm3+ was 0.002. It was proved that the introduction of Tm3+ created a large number of oxygen vacancies which serve as traps for electrons excited by UV irradiation. In addition, a distinguishable difference between the photoluminescence (PL) and PSL spectra of β‐Sr2SiO4: Eu2+, Tm3+ was observed, namely the PSL spectrum exhibits only a symmetric emission band peaked at about 540 nm while both 470 and 540 nm peaks were detected in the PL spectrum. It is safe to say that PSL only derives from one emission center of Eu2 in the crystallographic Sr2 sites, which could be ascribed to the different distribution of trap centers for two crystallographic Sr sites.
Dielectric Properties of Lithium Molybdate Ceramic Fabricated at Room Temperature
Authors: Kähäri Hanna , Teirikangas Merja , Juuti Jari , Jantunen Heli
Published: October 2014

Lithium molybdate disks were fabricated by moistening water‐soluble Li2MoO4 powder with deionized water and compressing it under a pressure of 130 MPa. Disks were postprocessed at room temperature, at 120°C, and at 540°C, which is a common sintering temperature for Li2MoO4. Regardless of the postprocessing temperature, densities as high as 87%–93% of the theoretical value were achieved. The X‐ray diffraction patterns of processed disks were all the same with no signs of hydrates or constitutional water. The samples also exhibited very similar microstructures and microwave dielectric properties with a relative permittivity of 4.6–5.2 and a Q × f value of 10 200–18 500 at 9.6 GHz, depending on the postprocessing temperature.
Sex differences in ADHD symptom severity
Authors: Arnett Anne B. , Pennington Bruce F. , Willcutt Erik G. , DeFries John C. , Olson Richard K.
Published: October 2014

Background

Males show higher rates of attention deficit hyperactivity disorder (ADHD) than do females. Potential explanations include genuine etiological differences or artifact.

Methods

2,332 twin and sibling youth participated in behavioral and cognitive testing. Partially competing models of symptom severity distribution differences, the mean difference, and variance difference models, were tested within a randomly selected subsample. The Delta method was used to test for mediation of sex differences in ADHD symptom severity by processing speed, inhibition and working memory.

Results

The combined mean difference and variance difference models fully explained the sex difference in ADHD symptom severity. Cognitive endophenotypes mediated 14% of the sex difference effect.

Conclusions

The sex difference in ADHD symptom severity is valid and may be due to differing genetic and cognitive liabilities between the sexes.
Adalimumab retreatment successfully restores clinical response and health‐related quality of life in patients with moderate to severe psoriasis who undergo therapy interruption
Authors: Gordon K.B. , Gottlieb A.B. , Langely R.G. , van de Kerkhof P. , Belasco K.T. , Sundaram M. , Okun M. , Serra L.
Published: October 2014

Background

Published evaluations of skin disease signs and health‐related quality of life (HRQoL) upon therapy withdrawal and retreatment in psoriatic patients are limited to results of drug withdrawal after short‐term treatment. Analyses are lacking that evaluate patients' response to retreatment for patients treated successfully long‐term.

Objective

To study the efficacy and safety of adalimumab in patients with long‐term clinical responses to adalimumab who then discontinue therapy and are retreated with the same dosing regimen as the initial course. Skin disease signs and patients' HRQoL are evaluated.

Methods

This post hoc analysis of an open‐label study (NCT00195676) included patients who had responded favourably to adalimumab during initial treatment (≥75% improvement in Psoriasis Area and Severity Index [PASI 75 response]) and had maintained good clinical response for an extended period (up to 252 weeks); patients had Physician's Global Assessment (PGA) 0 or 1 before treatment interruption. Following drug withdrawal (up to 40 weeks), all patients were retreated with adalimumab 80 mg initial dose, followed by 40 mg every‐other‐week for 16 weeks. PASI response and HRQoL were evaluated.

Results

Of the 133 patients in this analysis, 24 (18%) relapsed during therapy withdrawal. After 16 weeks of retreatment, 75% who relapsed and 89.9% who did not relapse, had a PASI 75 response; 89.5% achieved European Consensus Programme treatment goals after 16 weeks of retreatment. During drug withdrawal, HRQoL disproportionally worsened compared to skin disease signs; HROoL also considerably worsened for patients who did not relapse. Patients regained HRQoL upon retreatment with adalimumab. No new safety signals were identified in this study.

Conclusion

Retreatment with adalimumab was successful in improving psoriasis skin signs and HRQoL in this subgroup with initial and extended responses to therapy followed by relapse after treatment withdrawal. Patient's HRQoL should be considered, as it may substantially worsen during therapy interruption.
Anaesthetic digital block with epinephrine vs. tourniquet in ingrown toenail surgery: a clinical trial on efficacy
Authors: Córdoba‐Fernández A. , Rodríguez‐Delgado F.J.
Published: October 2014

Background

Current evidence shows that anaesthetic digital block with epinephrine is safe in surgical selected patients. There are no controlled studies that have examined the efficacy of local anaesthesia with vasoconstrictor in chemical matricectomy without using tourniquet to control bleeding.

Objectives

A controlled, prospective and randomized study was conducted to examine primarily the rate of recurrence after segmental phenolization matricectomy with anaesthetic digital block with epinephrine vs. tourniquet. As secondary aims, duration of anaesthetic effect, post‐operative bleeding and pain were analysed in both groups.

Methods

Forty‐four healthy subjects with ingrown hallux nails (70 toes) were enrolled. A total of 34 toes were anaesthetized with a solution of 2% mepivacaine with (1 : 100 000) epinephrine and operated without tourniquet (experimental group) vs. 36 toes anesthetized with a solution of 2% mepivacaine without epinephrine and operated with tourniquet (control group).

Results

There was no statistically significant difference in recurrence rates (P = 0.478). Post‐operative bleeding was significantly higher in the group with anaesthetic digital block without vasoconstrictor and with tourniquet (P = 0.001). Anaesthetic effect was higher in the group with anaesthetic digital block with vasoconstrictor and without tourniquet (P = 0.001). No post‐operative complications occurred in any of the treatment groups.

Conclusions

The use of local anaesthetic with vasoconstrictor to perform chemical matricectomy likely to be an effective procedure to reduce the disadvantages of using digital tourniquet (post‐operative bleeding and lower anaesthetic effect) without increasing the risk of recurrence. The addition of epinephrine may reduce the need for a tourniquet and produce better and longer perioperative pain control.
Do Gerontology Nurse Specialists Make a Difference in Hospitalization of Long‐Term Care Residents? Results of a Randomized Comparison Trial
Authors: Boyd Michal , Armstrong Delwyn , Parker Janet , Pilcher Carole , Zhou Lifeng , McKenzie‐Green Barbara , Connolly Martin J.
Published: October 2014

Residents of long‐term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on‐site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61–0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56–0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68–1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health.
Teaching Geriatrics Using an Innovative, Individual‐Centered Educational Game: Students and Educators Win. A Proof‐of‐Concept Study
Authors: van de Pol Marjolein H. J. , Lagro Joep , Fluit Lia R. M. G. , Lagro‐Janssen Toine L. M. , Olde Rikkert Marcel G. M.
Published: October 2014

Given the increasingly aging population, nearly every doctor will encounter elderly adults who present with multiple complex comorbidities that can challenge even experienced physicians. This may explain why many medical students do not have a positive attitude toward elderly adults and find the complexity of their problems overwhelming. It was hypothesized that a recently developed medical school geriatrics course, based on the game GeriatriX and designed specifically to address the complexities associated with decision‐making in geriatrics, can have a positive effect on attitudes toward geriatrics and on perceived knowledge of geriatrics. The effects of this game‐based course were evaluated as a proof of concept. The assessment was based on the Aging Semantic Differential (ASD) and a validated self‐perceived knowledge scale of geriatric topics. The usability of (and satisfaction with) GeriatriX was also assessed using a 5‐point Likert scale. After completion of the course, the ASD changed significantly in the geriatrics course group (n = 29; P = .02) but not in a control group that took a neuroscience course (n = 24; P = .30). Moreover, the geriatrics course group had a significant increase in self‐perceived knowledge for 12 of the 18 topics (P = .002), whereas in the control group self‐perceived knowledge increased significantly for one topic only (sensory impairment) (P = .04). Finally, the geriatrics students reported enjoying GeriatriX. This proof‐of‐concept study clearly supports the hypothesis that a 4‐week course using a modern educational approach such as GeriatriX can improve students' self‐perceived knowledge of geriatrics and their attitudes toward elderly adults.
Comparison of In‐Person and Telephone Administration of the Mini‐Mental State Examination in the University of Alabama at Birmingham Study of Aging
Authors: Kennedy Richard E. , Williams Courtney P. , Sawyer Patricia , Allman Richard M. , Crowe Michael
Published: October 2014

Objectives

To validate the Mini‐Mental State Examination (MMSE) Telephone (MMSET) against the MMSE.

Design

Cross‐sectional.

Setting

Homes of community‐dwelling older adults.

Participants

African‐American and non‐Hispanic white adults aged 75 and older participating in the University of Alabama at Birmingham Study of Aging II, a longitudinal epidemiological study across the state of Alabama (N = 419).

Measurements

Cognition, measured using the MMSE, MMSET, and Six‐Item Screener (SIS), and function, based on self‐reported difficulty performing instrumental activities of daily living (IADLs). Correlation and agreement coefficients were used to examine concordance of the MMSE and MMSET; linear and logistic regressions were used to test associations with clinical outcomes of IADL difficulty and verified diagnoses of dementia.

Results

The MMSET showed good internal consistency (Cronbach α = 0.845), similar to the full MMSE, and strong correlation with the latter (Spearman ρ = 0.694, P < .001). The MMSET explained a similar proportion of IADL difficulty as the full MMSE (coefficient of variation = 0.201 and 0.189, respectively). The MMSET was also associated with verified dementia diagnoses (area under the receiver operating characteristic curve = 0.73), which was similar to the full MMSE.

Conclusion

The MMSET is a brief, valid measure of cognition in older adults with psychometric properties similar to that of the full MMSE. Because it can be administered over the telephone, further use in epidemiological studies is promising.
Multiple Anticholinergic Medication Use and Risk of Hospital Admission for Confusion or Dementia
Authors: Kalisch Ellett Lisa M. , Pratt Nicole L. , Ramsay Emmae N. , Barratt John D. , Roughead Elizabeth E.
Published: October 2014

Objectives

To identify the association between use of multiple anticholinergic medications and risk of hospitalization for confusion or dementia.

Design

Retrospective cohort study conducted over 2 years between July 2010 and June 2012, using administrative claims data from the Australian Department of Veterans' Affairs.

Setting

Australia.

Participants

Australian veterans dispensed at least one moderately or highly anticholinergic medication in the year before study start.

Measurements

Cumulative anticholinergic use on each day of the study period was determined. The association between hospitalization for confusion or dementia and number of anticholinergic medications used at the time of admission was compared against times during which participants were not taking anticholinergic medications. Sensitivity analyses were undertaken limiting the outcome to admissions for acute confusion and excluding individuals taking antipsychotics.

Results

Adjusted results showed a significantly greater risk of hospitalization for confusion or dementia when individuals were taking two or more anticholinergic medications. The adjusted incident rate ratios (IRRs) were 2.58 (95% confidence interval (CI) = 1.91–3.48) for those taking two anticholinergics and 3.87 (95% CI = 1.83–8.21) for those taking three or more. Sensitivity analyses in which participants taking antipsychotic medications were excluded and the outcome was limited to acute confusion also found similar risks for those taking two (IRR 1.82, 95% CI = 1.18–2.80) and three or more (IRR = 3.98 95% CI = 1.50–10.58) anticholinergic medications.

Conclusion

Taking more anticholinergic medications is associated with greater risk of hospitalization for confusion or dementia. Strategies to reduce anticholinergic medication burden are likely to translate into significant health benefits.
Impact of the 2008 U.S. Preventative Services Task Force Recommendation on Frequency of Prostate‐Specific Antigen Screening in Older Men
Authors: Lee Shin Yin , Friderici Jennifer , Stefan Mihaela S. , Rothberg Michael B.
Published: October 2014

Objectives

To evaluate the effect of the 2008 U.S. Preventative Services Task Force recommendation against prostate‐specific antigen (PSA) screening in men aged 75 and older on frequency of PSA screening in elderly men.

Design

Retrospective, cross‐sectional analysis.

Setting

Fifteen community primary care practices in western Massachusetts.

Participants

Men aged 65 and older with one or more annual physicals between January 1, 2006, and December 31, 2010.

Measurements

PSA testing was determined from the electronic health record. Mixed‐effects logistic regression was used to model the rate of PSA testing over time for two age groups: 65 to 74, and 75 and older.

Results

Of the 7,833 men in this study, 60% were younger than 75. PSA screening rates were consistently lower in men aged 75 and older. Annual rates, adjusted for number of clinic visits, ranged from 12% to 28% in men aged 75 and older, and 37% to 49% in men aged 65 to 74. In the 2 years before the guideline was released, there was already a slow decline in screening rate in men aged 75 and older, whereas the screening rate in men aged 65 to 74 was rising. Compared to 2008, there was a 36% relative reduction in screening rate in 2009 and a 51% relative reduction in 2010 for men aged 75 and older, and a 12% relative reduction in screening rate in 2009 and a 24% relative reduction in 2010 for men aged 65 to 74.

Conclusion

The 2008 recommendation appeared to reduce PSA screening rates in older men in 2009 and 2010; there was a substantial reduction in men aged 75 and older and a more modest reduction in men aged 65 to 74.
Association Between Frailty and Carotid Central Structure Changes: The Three‐City Study
Authors: Avila‐Funes José Alberto , Meillon Céline , González‐Colaço Harmand Magali , Tzourio Christophe , Dartigues Jean‐François , Amieva Hélène
Published: October 2014

Objectives

To demonstrate the association between carotid central structure changes and frailty.

Design

Cross‐sectional study.

Setting

The Three‐City Study, a French prospective cohort designed to evaluate the risk of cognitive decline attributable to vascular risk factors.

Participants

Community‐dwelling individuals aged 65 to 95 (N = 4,257).

Measurements

Frailty was defined as proposed by Fried and colleagues. Carotid intima‐media thickness (IMT), diameter of the common carotid arteries, and the presence of plaques in both carotid arteries were determined using carotid Doppler ultrasonography. Multinomial logistic regression models, including adjustment for traditional cardiovascular and dementia risk factors, were used to evaluate the independent association between the central arterial structure and frailty.

Results

6.8% of participants were classified as frail. Multivariate regression models showed an independent association between carotid IMT and frailty and between carotid diameter and frailty after adjusting for sociodemographic factors, cardiovascular risk factors, disability, and apolipoprotein E ε4 genotype. A 1–standard deviation (SD) increase in IMT (odds ratio (OR) = 1.15; P = .04) and a 1‐SD increase in carotid diameter (OR = 1.23; P = .006) were associated with greater probability of being frail.

Conclusion

The association between carotid structure changes and frailty suggests that frail elderly adults have vascular damage, which may explain, at least partly, why several adverse health‐related outcomes are frequently observed in frail elderly adults.
A Postal Screener for Pain and Need for Treatment in Older Persons in Primary Care
Authors: de Waal Margot W. M. , den Elzen Wendy P. J. , Achterberg Wilco P. , Gussekloo Jacobijn , Blom Jeanet W.
Published: October 2014

Objectives

To test the Pain intensity, Enjoyment in life, General activity questionnaire (PEG) as a postal screener for pain in older persons.

Design

Population‐based survey. Postal screening questionnaires followed by an interview of a sample of participants.

Setting

Family practices.

Participants

Persons aged 75 and older (N = 243; 95 interviewed).

Measurements

Screening included the PEG, a three‐item abbreviated version of the Brief Pain Inventory (BPI), plus an additional question on treatment need. Pain severity and related interference was assessed (BPI) during the interview, as was the current (need for) pain treatment.

Results

The median PEG score of the 243 persons participating in the screening (response 76%) was 2.0 (interquartile range 0–4.7). Seventy‐nine (35%) had moderate to severe pain (PEG score ≥4), of whom 56% reported current pain treatment and 15% stated that they might ask for help. For a PEG score cutoff of 4 or greater, sensitivity was 0.81 and specificity was 0.78 to find scores of 4 or greater on one or both BPI subscales during the interview. For the question on need for treatment, replies on the screener and the interview were not always consistent. Of the 43 interviewed participants with a PEG score of 4 or greater, 60% received treatment. Of the 17 without current pain treatment, 10 still reported pain, three of whom said that they might ask for help.

Conclusion

The PEG can be used as a postal screener to detect the presence of pain in older persons, but treatment needs cannot be established using the PEG alone or in combination with a simple additional question.
Quality of Life in Elderly Kidney Transplant Recipients
Authors: Weber Marc , Faravardeh Arman , Jackson Scott , Berglund Danielle , Spong Richard , Matas Arthur J. , Gross Cynthia R. , Ibrahim Hassan N.
Published: October 2014

Objectives

To evaluate quality of life (QOL) in kidney transplant recipients aged 65 and older, identify predictors of impaired physical and mental QOL cross‐sectionally and compare QOL over time with that of younger transplant recipients and general population controls.

Design

Comparison of serial Medical Outcomes Study 36‐item Short‐Form Survey (SF‐36) QOL scores in transplant recipients aged 65 and older with those of transplant recipients younger than 65 and with those of general population controls from the National Health Measurement Study (NHMS).

Setting

University of Minnesota.

Participants

Individuals aged 65 and older (n = 150) and younger than 65 (n = 1,544) who received a primary kidney transplant between 1963 and 2009.

Measurements

Two‐sample t‐tests and logistic regression were used to assess the risk of significant impairment in physical and mental QOL, defined as 1 standard deviation below the general population norms (<40 points) for the SF‐36 Physical (PCS) and Mental Component Subscale (MCS) scores.

Results

PCS scores were 39.3 for transplant recipients aged 65 and older, 43.5 for recipients younger than 65, and 49.2 for NHMS controls (P < .005 for each pairwise comparison). MCS scores were 54.6 for transplant recipients aged 65 and older, 51.0 for recipients younger than 65, and 53.8 for NHMS controls (P < .005 for ≥65 vs <65 and NHMS vs <65). These scores did not change significantly from the first (3.6 years after transplant) to the last (6.2 years after transplant) survey. Longer time since transplantation in elderly participants was associated with having significantly impaired physical QOL, but no predictors were associated with significantly impaired mental QOL. In younger recipients, rejection, diabetes mellitus, delayed graft function, coronary artery disease, and longer time on dialysis were associated with impaired physical QOL. Rejection, smoking, diabetes mellitus, and longer time on dialysis were predictors of impaired mental QOL.

Conclusion

Physical QOL is lower in elderly recipients but mental QOL is maintained and is higher than in younger recipients.
Gastroprotective Agent Underuse in High‐Risk Older Daily Nonsteroidal Anti‐Inflammatory Drug Users over Time
Authors: Marcum Zachary A. , Hanlon Joseph T. , Strotmeyer Elsa S. , Newman Anne B. , Shorr Ronald I. , Simonsick Eleanor M. , Bauer Douglas C. , Boudreau Robert , Donohue Julie M. , Perera Subashan ,   the Health, Aging and Body Composition Study
Published: October 2014

Objectives

To examine whether older adults taking nonsteroidal anti‐inflammatory drugs (NSAIDs) decreased the underuse of gastroprotective agents over time.

Design

Before‐and‐after study.

Setting

Health, Aging and Body Composition Study.

Participants

Daily users of a NSAID (prescription and over the counter (OTC)) at visits in 2002–03 (preperiod; n = 404) and 2006–07 (postperiod; n = 172). The sample had a mean ± standard deviation age of 78.2 ± 2.7 at the preperiod visit and 81.9 ± 2.7 at the postperiod visit. The majority were white and female and had 12 or more years of education.

Measurements

Underusers were defined as persons taking nonselective NSAIDs who were at risk of peptic ulcer disease (PUD; because of current warfarin or glucocorticoid use or history of PUD) and not using a proton pump inhibitor (PPI) or persons taking cyclooxygenase 2 (COX‐2) selective NSAIDs and aspirin who were at risk of PUD (having at least one risk factor) and not using a PPI.

Results

Daily NSAID use decreased from 17.6% to 11.3% (P < .001), and gastroprotective agent underuse decreased from 23.5% to 15.1% (P = .008). Controlling for important covariates, having prescription insurance was somewhat protective against underuse in the preperiod (adjusted odds ratio (AOR) = 0.78, 95% confidence interval (CI) = 0.46–1.34; P = .37), but more so and significantly in the postperiod (AOR = 0.41, 95% CI = 0.18–0.93; P = .03). Having prescription insurance was more protective in the post‐ than in the preperiod (less gastroprotective agent underuse; adjusted ratio of OR = 0.53, 95% CI = 0.22–1.29; P = .16), but this increased protection was not statistically significant.

Conclusion

In older daily NSAID users at high risk of PUD, having prescription insurance and adequate gastroprotective use was more common in the post‐ than in the preperiod.
Cumulative Associations Between Midlife Health Behaviors and Physical Functioning in Early Old Age: A 17‐Year Prospective Cohort Study
Authors: Sabia Séverine , Elbaz Alexis , Rouveau Nicolas , Brunner Eric J. , Kivimaki Mika , Singh‐Manoux Archana
Published: October 2014

Objectives

To examine cumulative associations between midlife health behaviors and walking speed and upper‐limb strength in early old age.

Design

Prospective cohort study.

Setting

Whitehall II Study.

Participants

Individuals (mean age 49.1 ± 5.9 in 1991–93) with health behavior data for at least two of the three assessments (1991–93, 1997–99, 2002–04) and physical functioning measures in 2007–09 (mean age 65.9 ± 5.9) (N = 5,671).

Measurements

A trained nurse assessed walking speed and upper‐limb strength. Unhealthy behaviors were defined as current or recent smoking, nonmoderate alcohol consumption (abstinence or heavy drinking), fruit and vegetable consumption less than twice per day, and physical inactivity (<1 h/wk of moderate and <1 h/wk of vigorous physical activity). For each unhealthy behavior, a cumulative score was calculated as the number of times a person reported the behavior over the three assessments divided by 3. The score ranged between 0 (never) and 1 (all three times).

Results

In linear regression models adjusted for age, sex, education, marital status, and height, all unhealthy behaviors in 1991–93 were associated with slower walking speed in 2007–09, with differences ranging from 0.10 (nonmoderate alcohol consumption) to 0.25 (physical inactivity) of a standard deviation between participants with and without the unhealthy behavior (Pt‐test<.001). For walking speed, the accumulation‐of‐risk model provided the best fit for unhealthy diet (β for a 1‐point increment in the low fruit and vegetable consumption score = −0.29, 95% confidence interval (CI) = −0.36 to −0.22) and physical inactivity (β = −0.37, 95% CI = −0.45 to −0.29). For smoking and nonmoderate alcohol consumption, a cumulative effect was also observed, but partial F‐tests did not suggest that it provided a better fit than models with behaviors in 1991–93, 1997–99, or 2002–04. All behavioral scores except smoking were associated with grip strength, but F‐tests supported the accumulation‐of‐risk hypothesis only for physical inactivity.

Conclusion

These findings highlight the importance of duration of unhealthy behaviors, particularly for diet and physical activity, when examining associations with physical functioning.
High Prevalence of Falls, Fear of Falling, and Impaired Balance in Older Adults with Pain in the United States: Findings from the 2011 National Health and Aging Trends Study
Authors: Patel Kushang V. , Phelan Elizabeth A. , Leveille Suzanne G. , Lamb Sarah E. , Missikpode Celestin , Wallace Robert B. , Guralnik Jack M. , Turk Dennis C.
Published: October 2014

Objectives

To determine the prevalence of clinically relevant falls‐related outcomes according to pain status in older adults in the United States.

Design

Cross‐sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%).

Setting

In‐person assessments were conducted in the home or residential care facility of the sampled study participant.

Participants

Individuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries).

Measurements

Participants were asked whether they had been “bothered by pain” and the location of pain, as well as questions about balance and coordination, fear of falling, and falls.

Results

Fifty‐three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥2 falls) was 19.5% in participants with pain and 7.4% in those without (age‐ and sex‐adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28–3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24–4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance.

Conclusion

Falls‐related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.
Vitamin D Levels and Cognition in Elderly Adults in China
Authors: Chei Choy‐Lye , Raman Prassanna , Yin Zhao‐Xue , Shi Xiao‐Ming , Zeng Yi , Matchar David B.
Published: October 2014

Objectives

To evaluate the association between vitamin D level and cognitive impairment in individuals aged 60 and older.

Design

Cross‐sectional cohort study.

Setting

Chinese Longitudinal Healthy Longevity Survey, a community‐based cohort study in areas in China where the density of centenarians is exceptionally high.

Participants

Individuals with mean age of 84.9 ± 12.7 (N = 2,004).

Measurements

Participants’ cognitive state was evaluated using the Mini‐Mental State Examination (MMSE). Vitamin D was measured in plasma using an enzyme‐linked immunoassay.

Results

The cross‐sectional association between quartiles of plasma vitamin D level and cognitive impairment (MMSE score <18) was modeled using logistic regressions. Plasma vitamin D levels were lower in individuals with cognitive impairment (31.9 ± 15.3 nmol/L) than in those without (45.6 ± 19.6 nmol/L). There was a reverse association between plasma vitamin D and cognitive impairment. After adjusting for age, sex, chronic conditions, smoking and drinking habits, outdoor activities, depression, and activity of daily living limitations, the association remained significant. The multivariable‐adjusted odds ratio for lowest versus highest vitamin D levels was 2.15 (95% confidence interval (CI) = 1.05–4.41) for cognitive impairment, and the multivariable odds ratio associated with a 1‐standard deviation decrement in plasma vitamin D was 1.32 (95% CI = 1.00–1.74) for cognitive impairment.

Conclusion

Low plasma vitamin D levels were associated with greater odds of cognitive impairment. Further prospective studies in Asian populations are needed to examine the causal direction of this association.
Earlier depression and later‐life self‐reported chewing difficulties: results from the Whitehall II study
Authors: AlJameel A. H. , Watt R. G. , Brunner E. J. , Tsakos G.
Published: October 2014

This study aimed to assess, whether depression in adulthood was associated with self‐reported chewing difficulties at older age, and examine whether the strength of the association differed according to the number of depression episodes in earlier adult life. We used Whitehall II study data from 277 participants who completed a questionnaire in 2011. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES‐D) in 2003 and 2008. The association between CES‐D depression and self‐reported chewing ability was assessed using regression models adjusted for some socio‐demographic factors. Participants with depression at some point in their earlier adulthood had an odds ratio (95% CI) of 2·01 (1·06, 3·82) for reporting chewing difficulties in older adulthood, compared to those without depression. The respective odds ratios were 1·42 (0·66, 3·04) for individuals with depression in only one phase, but 3·53 (1·51, 8·24) for those with depression in two phases. In conclusion, while further research is required, there was an association between depression and chewing difficulty that was independent of demographic and socio‐economic characteristics. Furthermore, this increased odds for chewing difficulties was primarily among adults that experienced two episodes or a prolonged period of depression.
NETWORK CAPACITY‐BUILDING IN HIGH‐TECH SECTORS: OPENING THE BLACK BOX OF CLUSTER FACILITATION POLICY
Authors: GIEST SARAH
Published: October 2014

Countries increasingly bring in facilitators for managing high‐tech networks. Facilitators are broadly defined as experts who take on a central position in the network with the goal of connecting various stakeholder groups. They also receive public funding and pose as a communication link between stakeholders and government. However, the use of facilitators challenges government to identify their benefits. Based on three case studies and interviews in biotechnology networks, the article opens up the black box of facilitation. It addresses the evaluation challenges by establishing a conceptual framework based on collaborative and absorptive capacity‐building theory to identify the elements relevant to facilitation. The analysis of Chicago (USA), Medicon Valley (Denmark/Sweden), and Singapore shows that facilitators not only create capacity‐enhancing elements within networks, they also occur in varying forms, including a government‐ and stakeholder‐funded model in European countries, an independent model in North America, and a government‐financed model in Asia.
THE DOUBLE LIFE OF TARGETS IN PUBLIC POLICY: DISCIPLINING AND SIGNALLING IN UK ASYLUM POLICY
Authors: BOSWELL CHRISTINA
Published: October 2014

Performance targets tend to be depicted as management tools, designed to improve public policy outcomes. Yet targets also have a symbolic function, signalling commitment to and underscoring achievement of political goals. This article explores the tension between these ‘disciplining’ and ‘signalling’ functions, looking at UK targets on asylum, 2000–10. Attempts to combine the two functions led to three types of problem: (1) technical targets designed to steer organizational performance lacked political resonance, prompting politicians to resort to top‐down, political targets; (2) the imposition of unfeasible political targets created distortions in the organization, encouraging forms of gaming; and (3) the political risks of adopting stretch targets were not offset by the dividends of positive attention when targets were met: the government was unable to establish targets as the predominant mode of assessing its performance. The failed attempt to marry these functions suggests the need to decouple political and management targets in public administration.
Enhanced formation of aromatic amino acids increases fragrance without affecting flower longevity or pigmentation in Petunia × hybrida
Authors: Oliva Moran , Ovadia Rinat , Perl Avichai , Bar Einat , Lewinsohn Efraim , Galili Gad , Oren‐Shamir Michal
Published: October 2014

Purple Petunia × hybrida V26 plants accumulate fragrant benzenoid‐phenylpropanoid molecules and anthocyanin pigments in their petals. These specialized metabolites are synthesized mainly from the aromatic amino acids phenylalanine. Here, we studied the profile of secondary metabolites of petunia plants, expressing a feedback‐insensitive bacterial form of 3‐deoxy‐di‐arabino‐heptulosonate 7‐phosphate synthase enzyme (AroG*) of the shikimate pathway, as a tool to stimulate the conversion of primary to secondary metabolism via the aromatic amino acids. We focused on specialized metabolites contributing to flower showy traits. The presence of AroG* protein led to increased aromatic amino acid levels in the leaves and high phenylalanine levels in the petals. In addition, the AroG* petals accumulated significantly higher levels of fragrant benzenoid‐phenylpropanoid volatiles, without affecting the flowers' lifetime. In contrast, AroG* abundance had no effect on flavonoids and anthocyanins levels. The metabolic profile of all five AroG* lines was comparable, even though two lines produced the transgene in the leaves, but not in the petals. This implies that phenylalanine produced in leaves can be transported through the stem to the flowers and serve as a precursor for formation of fragrant metabolites. Dipping cut petunia stems in labelled phenylalanine solution resulted in production of labelled fragrant volatiles in the flowers. This study emphasizes further the potential of this metabolic engineering approach to stimulate the production of specialized metabolites and enhance the quality of various plant organs. Furthermore, transformation of vegetative tissues with AroG* is sufficient for induced production of specialized metabolites in organs such as the flowers.
Site‐specific proteolytic degradation of IgG monoclonal antibodies expressed in tobacco plants
Authors: Hehle Verena K. , Lombardi Raffaele , van Dolleweerd Craig J. , Paul Mathew J. , Di Micco Patrizio , Morea Veronica , Benvenuto Eugenio , Donini Marcello , Ma Julian K‐C.
Published: October 2014

Plants are promising hosts for the production of monoclonal antibodies (mAbs). However, proteolytic degradation of antibodies produced both in stable transgenic plants and using transient expression systems is still a major issue for efficient high‐yield recombinant protein accumulation. In this work, we have performed a detailed study of the degradation profiles of two human IgG1 mAbs produced in plants: an anti‐HIV mAb 2G12 and a tumour‐targeting mAb H10. Even though they use different light chains (κ and λ, respectively), the fragmentation pattern of both antibodies was similar. The majority of Ig fragments result from proteolytic degradation, but there are only a limited number of plant proteolytic cleavage events in the immunoglobulin light and heavy chains. All of the cleavage sites identified were in the proximity of interdomain regions and occurred at each interdomain site, with the exception of the VL/CL interface in mAb H10 λ light chain. Cleavage site sequences were analysed, and residue patterns characteristic of proteolytic enzymes substrates were identified. The results of this work help to define common degradation events in plant‐produced mAbs and raise the possibility of predicting antibody degradation patterns ‘a priori’ and designing novel stabilization strategies by site‐specific mutagenesis.
The cell size distribution of tomato fruit can be changed by overexpression of CDKA1
Authors: Czerednik Anna , Busscher Marco , Angenent Gerco C. , de Maagd Ruud A.
Published: October 2014

Tomato is one of the most cultivated vegetables in the world and an important ingredient of the human diet. Tomato breeders and growers face a continuous challenge of combining high quantity (production volume) with high quality (appearance, taste and perception for the consumers, processing quality for the processing industry). To improve the quality of tomato, it is important to understand the regulation of fruit development and of fruit cellular structure, which is in part determined by the sizes and numbers of cells within a tissue. The role of the cell cycle therein is poorly understood. Plant cyclin‐dependent kinases (CDKs) are homologues of yeast cdc2, an important cell cycle regulator conserved throughout all eukaryotes. CDKA1 is constitutively expressed during the cell cycle and has dual functions in S‐ and M‐phase progression. We have produced transgenic tomato plants with increased expression of CDKA1 under the control of the fruit‐specific TPRP promoter, which despite a reduced number of seeds and diminished amount of jelly, developed fruits with weight and shape comparable to that of wild‐type fruits. However, the phenotypic changes with regard to the pericarp thickness and placenta area were remarkable. Fruits of tomato plants with the highest expression of CDKA1 had larger septa and columella (placenta), compared with wild‐type fruits. Our data demonstrate the possibility of manipulating the ratio between cell division and expansion by changing the expression of a key cell cycle regulator and probably its activity with substantial effects on structural traits of the harvested fruit.
Overexpression of a NF‐YC transcription factor from bermudagrass confers tolerance to drought and salinity in transgenic rice
Authors: Chen Miao , Zhao Yujuan , Zhuo Chunliu , Lu Shaoyun , Guo Zhenfei
Published: October 2014

Nuclear factor Y (NF‐Y) is a ubiquitous transcription factor formed by three distinct subunits, namely NF‐YA, NF‐YB and NF‐YC. A stress‐responsive cDNA of NF‐YC (Cdt‐NF‐YC1) was isolated from triploid bermudagrass (Cynodon dactylon × Cynodon transvaalensis), and its role in abiotic stress tolerance was investigated in this study. Cdt‐NF‐YC1 transcript was detected in all vegetative tissues with higher levels being observed in roots. Transcription of Cdt‐NF‐YC1 in leaves was induced by dehydration, salinity, and treatments with abscisic acid (ABA), hydrogen peroxide (H2O2) or nitric oxide (NO), but not altered by cold. The dehydration‐ or salt‐induced transcription of Cdt‐NF‐YC1 was blocked by inhibitor of ABA synthesis and scavenger of H2O2 or NO, indicating that ABA, H2O2 and NO were involved in the dehydration‐ and salt‐induced transcription of Cdt‐NF‐YC1. Overexpression of Cdt‐NF‐YC1 resulted in elevated tolerance to drought and salt stress and increased sensitivity to ABA in transgenic rice. Transcript levels of stress/ABA responsive genes (OsLEA3, OsRAB16A, OsLIP9 and OsP5CS1), ABA synthesis and signalling genes (OsNCED3 and OsABI2), and ABA‐independent genes (OsDREB1A, OsDREB1B and OsDREB2A) were substantially higher in transgenic rice than in wild‐type plants. The results suggested that that Cdt‐NF‐YC1 is a good candidate gene to increase drought and salinity tolerance in transgenic rice through modulating gene regulation in both ABA‐dependent and ABA‐independent pathways.
Interleukin‐2 receptor antagonists for pediatric liver transplant recipients: A systematic review and meta‐analysis of controlled studies
Authors: Crins Nicola D. , Röver Christian , Goralczyk Armin D. , Friede Tim
Published: October 2014

IL‐2RA are frequently used as induction therapy in liver transplant recipients to decrease the risk of AR while allowing the reduction of concomitant immunosuppression. The exact association with the use of IL‐2RA, however, is uncertain. We performed a systematic literature search for relevant studies. Random effects models were used to assess the incidence of AR, steroid‐resistant rejection, graft loss, patient death, and adverse drug reaction, with or without IL‐2RA. Six studies (two randomized and four non‐randomized) met the eligibility criteria. Acute rejection at six months or later favored the use of IL‐2RA significantly (RR 0.38; 95% CI 0.22–0.66, p = 0.0005). Although not statistically significant, IL‐2RA showed a substantial reduction of the risk of steroid‐resistant rejection (RR 0.32; CI 0.19–1.03, p = 0.0594). Graft loss and patient death showed a reductive tendency through the use of IL‐2RA. The use of IL‐2RA is safe and is associated with a statistically significantly lower incidence of AR after transplantation and substantial reduction of steroid‐resistant rejection, graft loss, and patient death.