bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Patterns after Prostate Cancer Diagnosis in Relation to Disease-Specific and Total Mortality
Authors: Yang Meng , Kenfield Stacey A. , Van Blarigan Erin L. , Batista Julie L. , Sesso Howard D. , Ma Jing , Stampfer Meir J. , Chavarro Jorge E.
Published: June 2015

Men diagnosed with nonmetastatic prostate cancer have a long life expectancy, and many die of unrelated causes. It is therefore important to know to what extent post-diagnostic diet may affect disease-specific and overall mortality. A total of 926 men participating in the Physicians' Health Study diagnosed with nonmetastatic prostate cancer completed diet questionnaires for a median of 5.1 years after diagnosis, and were followed thereafter to assess mortality for a median of 9.9 years since questionnaire completion. Two post-diagnostic dietary patterns were identified: a Prudent pattern, characterized by higher intake of vegetables, fruits, fish, legumes, and whole grains; and a Western pattern, characterized by higher intake of processed and red meats, high-fat dairy and refined grains. Cox regression was used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI). During 8,093 person-years of follow-up, 333 men died, 56 (17%) of prostate cancer. The Western pattern was significantly related to a higher risk of prostate cancer–specific and all-cause mortality. Comparing men in the highest versus the lowest quartile of the Western pattern, the HRs were 2.53 (95% CI, 1.00–6.42; Ptrend = 0.02) for prostate cancer–specific mortality and 1.67 (95% CI, 1.16–2.42; Ptrend = 0.01) for all-cause mortality. The Prudent pattern was associated with a significantly lower all-cause mortality (HRQuartile 4 vs. Quartile 1: 0.64; 95% CI, 0.44–0.93; Ptrend = 0.02); the relationship with prostate cancer–specific mortality was inverse but not statistically significant. A post-diagnostic Western dietary pattern was associated with higher prostate cancer–specific and all-cause mortality, whereas a Prudent dietary pattern was related to lower all-cause mortality after prostate cancer diagnosis. Cancer Prev Res; 8(6); 545–51. ©2015 AACR.
Her Support, His Support: Money, Masculinity, and Marital Infidelity
Authors: Munsch Christin L.
Published: June 2015

Recent years have seen great interest in the relationship between relative earnings and marital outcomes. Using data from the 1997 National Longitudinal Survey of Youth, I examine the effect of relative earnings on infidelity, a marital outcome that has received little attention. Theories of social exchange predict that the greater one’s relative income, the more likely one will be to engage in infidelity. Yet, emerging literature raises questions about the utility of gender-neutral exchange approaches, particularly when men are economically dependent and women are breadwinners. I find that, for men, breadwinning increases infidelity. For women, breadwinning decreases infidelity. I argue that by remaining faithful, breadwinning women neutralize their gender deviance and keep potentially strained relationships intact. I also find that, for both men and women, economic dependency is associated with a higher likelihood of engaging in infidelity; but, the influence of dependency on men’s infidelity is greater than the influence of dependency on women’s infidelity. For economically dependent persons, infidelity may be an attempt to restore relationship equity; however, for men, dependence may be particularly threatening. Infidelity may allow economically dependent men to engage in compensatory behavior while simultaneously distancing themselves from breadwinning spouses.
Prayers That Form Us: Rhetoric and Psalms Interpretation
Authors: Cook Ryan
Published: June 2015

Rhetorical criticism of the Psalms has been practiced in a variety of ways. Applying traditional rhetorical theory to the interpretation of the Psalms is a growing, but underdeveloped area of study. This article argues that a traditional approach to rhetorical criticism helps provide new perspectives on the interpretation of an individual psalm as a unit. Building on the work of George Kennedy, this article proposes a way of applying rhetorical criticism to the Psalms. Through applying this approach to Psalm 46, the psalm is analyzed as a type of epideictic rhetoric.
Isaiah's Critique of Shebna's Trespass: A Reconsideration of Isaiah 22.15–25
Authors: Ganzel Tova
Published: June 2015

Scholarly treatments of Isa. 22.15–25 address the action by Shebna that led to his harsh punishment, the scope of the oracle, and the related question of the nature of the affinity between vv. 15–19 and 20–25. The reconsideration in this article suggests a different understanding of this passage. Based on terminological examination of the passage, comparison to Ezek. 43.6–9, and consideration of the realia of keys and their holders, this study suggests that Shebna's transgression can be identified as encroachment on Davidic and divine authority by undertaking to hew his tomb in close proximity to the Temple. It examines Shebna's position as second to the king, his transgression and punishment, the portrayal of the transfer of authority from Shebna to Eliakim, and the role of the image of the bolt-pin in this oracle.
For Whom the Plowshares and Pruning Hooks Toil: A Tradition-Historical Reading of Joel 4.10
Authors: Bang Seung Ho
Published: June 2015

Despite the dense allusions in the book of Joel, the creative characteristics of Joel have not been clearly understood. In particular, the intertextual connection of the famous reversal of the phrase of Mic. 4.3bα/Isa. 2.4bα in Joel 4.10 have remained largely overlooked. This article draws an analogy with the modern, digital art form known as Photomosaic, arguing that recognizing smaller images within a larger whole is a helpful tool that augments tradition-historical readings. Such an approach enables us to gain a multi-dimensional appreciation of Joel 4.10 with its adjacent verses, on both macro and microscopic levels. This approach reveals that Joel as a Schriftprophet, like a Photomosaic artist, created his own big picture, the Day of Yhwh (an eschatological day of holy war against nations), out of the images of intertextually linked traditions. The traditions used as bits of images are the Holy War, the victory of Jehoshaphat in the valley, ancient defensive warfare, and agriculture in the Judean hill country. The conclusion offered here is that Joel probably used these traditions to intensify the meaning of participating in the alluded eschatological Day of Yhwh by wielding of weapons with agricultural implements to the Iron Age farmers.
Chinese returnees' conceptions of positive career outcomes after graduating from Australian universities – quantitative findings
Authors: Lin-Stephens Serene , Uesi John , Doherty Julie
Published: June 2015

This paper reports the quantitative findings of a study on conceptions of positive career outcomes held by Chinese students who returned home to work after gaining higher education qualifications in Australia. The study explores what positive career outcomes mean to Chinese returnees, the actual positive career outcomes Chinese returnees have experienced and contributing factors to the positive career outcomes achieved. Both quantitative and qualitative research methods are used and here the analysis of the quantitative findings is presented. The survey data show that Chinese returnees assign greater importance to ‘soft outcomes’ relating to personal and life fulfilment than ‘hard outcomes’ such as employment results. Also, the discrepancy between the returnees’ ideal and actual outcomes is greater in the soft outcomes than the hard outcomes. Statistical analysis indicates three emergent, distinct groups of conceptions of positive career outcomes. The qualitative findings will be presented separately.
An exploratory study of career, psychosocial, and clinical mentoring of podiatrists
Authors: Coppin Rosalie , Fisher Greg
Published: June 2015

The benefits of mentoring in the health sector have received a great deal of attention from health management researchers. Much of this research has concentrated on doctors and nurses at pre-qualification or early career stages in their professional lives working in large organizations. Little attention has been paid to the needs of podiatrists who are often employed in multiple part time or casual roles in public sector clinics or private practices. Many podiatrists rely on a professional association to provide a mentor and continuing professional development. This study uses semi-structured interviews with mentors and mentees and template analysis, to explore three dimensions of mentoring; career, psychosocial and clinical, of podiatrists who are members of a professional association. The implications for practice, theory and further research on podiatrists and other allied health professions are discussed.
Youth with refugee backgrounds in Australia: Contextual and practical considerations for career counsellors
Authors: Abkhezr Peyman , McMahon Mary , Rossouw Pieter
Published: June 2015

Youth with refugee backgrounds face challenges in their journey towards successful integration in Australia. Some challenges relate to macro-level changes occurring in the world of work and some to their transition from an agrarian or industrial society to a post-industrial Western country. Addressing the future career development of youth with refugee backgrounds may lead to improved integration outcomes. As career counselling has its roots in social justice, assisting those from refugee backgrounds to integrate into Australian society is an important task for career counsellors. However, career counsellors need to respond with caution and sensitivity as many models and theories have been criticised for not responding to multicultural and contextual issues concerning diverse populations. This article outlines some of the challenges faced by youth with refugee backgrounds in Australia, considers possible relevant approaches for career counselling and proposes suggestions for career counsellors.
Gender differences found in a qualitative study of a disordered eating prevention programme: What do boys have to say?
Authors: González Marcela L , Mora Marisol , Penelo Eva , Goddard Elizabeth , Treasure Janet , Raich Rosa M
Published: June 2015

Qualitative studies examining gender differences of eating disorder prevention programmes are scarce. We aimed to evaluate gender differences in adolescents who participated in a larger study on effectiveness of a disordered eating prevention programme. Perceptions of eating, female and male aesthetic models, media influences, prevention programmes and emerging topics from 12 school-going boys who received a media-literacy programme ( n = 4), media-literacy plus nutrition-awareness programme ( n = 4) or neither ( n = 4) were explored using Interpretative Phenomenological Analysis and compared with previous results in girls. Findings suggest that the prevention programme is effective for both genders. Gender differences and consumer-culture influences may be considered in future interventions.
Sleep and food intake: A multisystem review of mechanisms in children and adults
Authors: Lundahl Alyssa , Nelson Timothy D
Published: June 2015

The foods we eat have substantial impact on our health, and excessive food intake is associated with numerous long-term health conditions. It is therefore essential to understand the factors influencing this crucial health behavior. Research has identified sleep problems as one such factor; however, little research has examined how sleep problems impact food intake. Using a multisystemic perspective, this article proposes a variety of ways in which sleep problems likely increase food intake and illustrates the need for research to empirically examine these underlying mechanisms. Such research would have important treatment implications for health conditions often treated with dietary interventions.
Distraction, not hunger, is associated with lower mood and lower perceived work performance on fast compared to non-fast days during intermittent fasting
Authors: Appleton Katherine M , Baker Stephanie
Published: June 2015

Using a repeated measures design, 16 females recorded hunger, distraction, mood and perceived work performance on two consecutive fast days, on two earlier and on two subsequent consecutive non-fast days, during intermittent fasting. Using regression analyses, low positive mood was associated with higher distraction ( β = −0.38, p < 0.01), and lower perceived work performance was associated with higher distraction ( β = −0.50, p < 0.01) and lower positive mood ( β = 0.59, p = 0.01). No associations were found with hunger (largest β = −0.11, p = 0.15). Associations between mood, perceived work performance and distraction but not hunger mirror those found in traditional dieting and suggest no benefit for attention from intermittent fasting-type regimes.
Understanding same-sex male and female partners’ restrained eating in the context of their relationships
Authors: Bailey Lindzee , Markey Charlotte N , Markey Patrick M , August Kristin J , Nave Christopher S
Published: June 2015

This study examined weight status and dietary restraint among same-sex couples using Actor–Partner Interdependence Models. Body mass indices and restrained eating behaviors (i.e., cognitive dietary restraint, uncontrolled eating, and emotional eating) were assessed for members of 144 same-sex couples (72 lesbian and 72 gay couples; mean age = 33.74 years, standard deviation = 11.27 years). Results indicated that both men and women who were relatively heavy and who had relatively thin partners were at particular risk of engaging in restrained eating. These findings extend our understanding of partner comparison processes within the context of same-sex relationships in determining men and women’s eating behaviors.
Type D personality and dietary intake: The mediating effects of coping style
Authors: Booth Lorna , Williams Lynn
Published: June 2015

This study aimed to investigate the relationship between Type D and dietary intake and to determine whether this relationship is mediated by coping. In a cross-sectional study, 187 healthy participants completed a self-report questionnaire measuring Type D personality, dietary intake and coping. Results showed that Type D was associated with maladaptive coping and significantly less healthy food intake, including more consumption of fat and sugar, and significantly less consumption of fruit and vegetables. Regression analyses showed that this relationship was partially mediated by coping. The results suggest that Type D personality may represent a risk factor for unhealthy eating.
Exploring the motives and mental health correlates of intentional food restriction prior to alcohol use in university students
Authors: Roosen Kaley M , Mills Jennifer S
Published: June 2015

This study explored the prevalence of and motivations behind ‘drunkorexia’ – restricting food intake prior to drinking alcohol. For both male and female university students ( N = 3409), intentionally changing eating behaviour prior to drinking alcohol was common practice (46%). Analyses performed on a targeted sample of women ( n = 226) revealed that food restriction prior to alcohol use was associated with greater symptomology than eating more food. Those who restrict eating prior to drinking to avoid weight gain scored higher on measures of disordered eating, whereas those who restrict to get intoxicated faster scored higher on measures of alcohol abuse.
Body image and college women’s quality of life: The importance of being self-compassionate
Authors: Duarte Cristiana , Ferreira Cláudia , Trindade Inês A , Pinto-Gouveia José
Published: June 2015

This study explored self-compassion as a mediator between body dissatisfaction, social comparison based on body image and quality of life in 662 female college students. Path analysis revealed that while controlling for body mass index, self-compassion mediated the impact of body dissatisfaction and unfavourable social comparisons on psychological quality of life. The path model accounted for 33 per cent of psychological quality of life variance. Findings highlight the importance of self-compassion as a mechanism that may operate on the association between negative body image evaluations and young women’s quality of life.
Like mother, like daughter? An examination of the emotive responses to food
Authors: Lewis Sarah , Katsikitis Mary , Mulgrew Kate
Published: June 2015

The modelling of sub-clinical eating disorders and emotive responses to food between mothers and their early adolescent daughters was investigated. Twenty dyads viewed images of food and rated their levels of happiness, fear and disgust. Results suggest similarities between mothers’ and daughters’ emotive responses, but the exact nature of this relationship differed across food type and response type. Disordered eating was only related to responses to the low-calorie foods. Furthermore, mother’s eating disorders symptoms were related to concerns about shape and weight in the daughters (all ps  < .05). These results suggest a transmission of emotive responses to food within the dyad which may inform family-based intervention efforts in the prevention of eating disorders in young women.
The impact of a school-based gardening intervention on intentions and behaviour related to fruit and vegetable consumption in children
Authors: Duncan Michael J , Eyre Emma , Bryant Elizabeth , Clarke Neil , Birch Samantha , Staples Victoria , Sheffield David
Published: June 2015

A total of 77 children (34 boys, 43 girls, mean age ± standard deviation = 9 ± 1 years) participated in this study; 46 children (intervention) undertook a 12-week school gardening programme and 31 children acted as controls. Measures of the Theory of Planned Behaviour and fruit and vegetable consumption were taken pre- and post-intervention. Repeated measures analysis of variance and hierarchical regression analysis indicated that the intervention group increased daily consumption of fruits and vegetables and increased intentions, attitudes, norms, and perceived behavioural control related to fruit and vegetable consumption. Attitudes, norms and perceived behavioural control significantly predicted changes in fruit and vegetable consumption.
Nutrient-centrism and perceived risk of chronic disease
Authors: Schuldt Jonathon P , Pearson Adam R
Published: June 2015

This experiment explored consequences of two common lay theories about the diet–disease link: nutrient-centrism, the belief that nutrients (e.g. potassium) are crucial to staving off disease, and whole-food centrism, the belief that whole foods (e.g. bananas), containing these nutrients in their natural context, are most beneficial. Depicting an individual’s diet in terms of nutrients rather than whole foods containing these nutrients reduced the perceived likelihood that the individual would experience leading diet-related diseases (e.g. heart disease, diabetes). Although nutrition experts increasingly emphasize the health benefits of natural whole foods, people nevertheless appear to privilege nutrients when estimating disease risks.
Promoting health behaviour in Portuguese children via Short Message Service: The efficacy of a text-messaging programme
Authors: Silva Cátia , Fassnacht Daniel B , Ali Kathina , Gonçalves Sónia , Conceição Eva , Vaz Ana , Crosby Ross D , Machado Paulo PP
Published: June 2015

A Short Message Service programme was adapted to monitor three health behaviours and provide supportive feedback. The study aimed to evaluate the effectiveness of the programme to increase fruit/vegetable consumption and physical activity and to decrease screen time. A total of 139 Portuguese children, aged 8–10 years, grouped by classroom, were randomly assigned to an intervention (8 weeks of monitoring/feedback) or a control condition. Participants had their key behaviours assessed at baseline, post-intervention and follow-up. A three-level hierarchical linear model was developed. Results showed that the monitoring and feedback programme significantly increased fruit and vegetable consumption over time.
The relation of anxiety, depression, and stress to binge eating behavior
Authors: Rosenbaum Diane L , White Kamila S
Published: June 2015

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.
Understanding self-reported staging of dietary behavior in low-income women
Authors: DiClemente Carlo C , Delahanty Janine C , Havas Stephen W , Van Orden Onna R
Published: June 2015

This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and psychosocial variables were obtained from 2057 low-income women enrolled in the Maryland Food for Life Program. Results indicated that staging of specific dietary consumption behaviors was significantly related to staging for the global goal of eating a low-fat diet. Women evaluate their motivation about eating low-fat diets based on perceived efforts and specific activities related to dietary consumption with important implications for dietary behavior change measurement and interventions.
Trans fatty acid intake and emotion regulation
Authors: Holt Megan E , Lee Jerry W , Morton Kelly R , Tonstad Serena
Published: June 2015

We examined whether there is a relationship between trans fatty acid intakes and emotion regulation, mediated by positive or negative affect. Archival data on 1699 men and 3293 women were used to measure trans fatty acid intake at baseline, positive, and negative affects and emotion regulation at follow-up. Higher trans fatty acid intake related to subsequent difficulties with emotional awareness ( p = 0.045), clarity ( p = 0.012), and regulation strategies ( p = 0.009). Affect mediated these relationships. Lower trans fatty acid intake associated with increased positive and decreased negative affects which, in turn, associated with improved emotion regulation. Trans fatty acid intakes may be associated with subsequent ability to regulate emotions.
Can the Learnability Criterion Ensure Determinacy in New Keynesian Models?
Authors: Minford Patrick , Srinivasan Naveen
Published: June 2015

Forward-looking rational expectation (RE) models such as the popular New Keynesian (NK) model do not provide a unique prediction about how the model economy behaves. We need some mechanism that ensures determinacy. McCallum (2012) says it is not needed because models are learnable only with the determinate solution and so the NK model, once learnt in this way, will be determinate. We agree the only learnable solution that has agents converge on the true NK model is the bubble-free one. But once they have converged, they must then understand the model and its full solution therefore including the bubble. Hence, the learnability criterion still fails to pick a unique RE solution in NK models.

JEL Classifications: C62, D84
The Role of Political Regimes in the Macroeconomic Effectiveness of Foreign Aid in Pakistan
Authors: Luqman Muhammad , Haq Mirajul , Khan Karim
Published: June 2015

This study is an attempt to analyze the role of political regimes in the effectiveness of foreign aid. In particular, we focus on the role of foreign aid in economic growth under democratic regimes. The empirical exercise is based on time-series data of the Pakistan economy over the period 1972–2011. To meet the objective of the study, an interactive term of democratic regime and foreign aid is used as a regressor in the growth equation. Our findings show that democratic regimes are harmful in the effectiveness of foreign aid as far as the economic growth of Pakistan is concerned. Moreover, the study suggests diminishing returns to scale of foreign aid as the assumption of a linear relationship between foreign aid and economic growth is relaxed. The other control variables such as physical capital and human capital enter the model in a significant way and with their expected signs in both the short and the long run.

JEL Classification: F34, O4, O11, O43
Monetary Policy, Income Growth and Price Stability in Malaysia
Authors: Maitra Biswajit
Published: June 2015

Malaysia is a rapidly progressing high middle-income economy. As a highly open economy with an increasingly liberalized financial sector, the implementation of a comprehensive macroeconomic policy is a challenging task. This article enquires into the efficacy of money in raising income and stabilizing price level, and it also attempts to identify the effective component of money in this direction over the period 1971–2012. The autoregressive distributed lag (ARDL) approach to co-integration confirms the existence of a long-run relationship among money, income and price level. Error correction mechanism (ECM–ARDL) models with a battery of econometric techniques such as vector autoregression (VAR) model, the Wald test and innovation accounting confirm that only M1 money supply causes a raise in income. Price level, on the other hand, negatively contributes to income. Three components of money supply namely M1, M2 and M3 lead to a raise in price or inflation where M2 money is found to be the most potent component provoking inflation. The role of income is insignificant. Competent management of monetary instruments, therefore, may promote higher income maintaining stability in price level.

JEL Classification: E52, E31
Gender Discrimination and Work Engagement: Moderating Role of Future Time Perspective
Authors: Sia Surendra Kumar , Sahoo Bharat Chandra , Duari Pravakar
Published: June 2015

This article examines the contribution of perceived gender discrimination to work engagement; the contribution of future time perspective (FTP) to work engagement and more importantly, the moderating role of FTP on the relationship between perceived gender discrimination and work engagement. Based on a social cognitive frame work, it was hypothesized that FTP is positively related to work engagement. Further, it was also expected that FTP would work as a compensatory motivational resource and weaken the negative relationship between gender discrimination and work engagement. These questions were examined using a sample of female employees working in textile and apparel companies in the Chennai and Puducherry regions of India ( N = 234). Results indicate that FTP has a positive relationship with physical, cognitive as well as emotional engagement of the respondents. It also moderates significantly the relationship between perceived gender discrimination and cognitive as well as emotional dimensions of work engagement. However, no significant moderating effect appears for the relationship between gender discrimination and physical engagement of these employees.
Gender (In)Equality in South Asia: Problems, Prospects and Pathways
Authors: Strachan Glenda , Adikaram Arosha , Kailasapathy Pavithra
Published: June 2015

This paper is the guest editorial for this Special Issue on Gender (In)equality in South Asia of the South Asian Journal of Human Resources Management. This paper offers a perspective on the gender (in)equality issues as well as prospects in South Asia. The paper examines equalities and inequalities in national and regional labour markets, national legislative frameworks and within companies and organisations and recognises that women themselves are a heterogeneous group. Further, we introduce the papers included in this special issue representing India, Sri Lanka and Pakistan.
Reconstructing Jane Austen’s Silk Pelisse, 1812–1814
Authors: Davidson Hilary
Published: June 2015

This article explores the physical qualities and historical contexts of the silk pelisse coat dated c. 1812–1814 associated with Jane Austen (1775–1817) through family provenance and now held by Hampshire County Museum Services and Archives. The author took an exact pattern of the pelisse (included), then made replica garments. The association with Jane Austen is considered using evidence from Austen’s letters about her tastes in colours, length of fabrics needed for clothing, and ownership of a silk pelisse. The silk’s oak-leaf pattern is interpreted as a British patriotic motif, especially during the period of Napoleonic conflicts. Questions and insights arising from the process of reproduction are discussed, and the pelisse is compared to other surviving garments, and to contemporary fashionable images. As evidence suggests the pelisse probably did belong to Austen, her physical characteristics that can be gleaned from the garment are compared with information about Austen’s appearance.
The Thing about Replicas—Why Historic Replicas Matter
Authors: Foster Sally M. , Curtis Neil G.W.
Published: June 2015

Reproduction of archaeological material was a significant and serious enterprise for antiquarians and museums in the long nineteenth century. Replicas embed many stories and embody considerable past human energy. Behind their creation, circulation, use, and after-life lies a series of specific social networks and relationships that determined why, when, and in what circumstances they were valued, or not. Summarising the context of their production, circulation, and changing fortunes, this article introduces the ways in which replicas are important, and considers the specific benefits and aspects of a biographical approach to their study. Beyond the evidential, the study of existing replicas provides a historical and contemporary laboratory in which to explore the concepts of value and authenticity, and their application in cultural heritage and collections management, offering us a richer insight into the history of ourselves as archaeologists and curators.
Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension
Authors: Jenkins David
Published: June 2015

Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH) and alleviate right ventricular dysfunction. In the majority of patients there is symptomatic and prognostic benefit. However, not all patients with CTEPH are suitable for treatment with PEA. Operability assessment is not always easy, being largely subjective and based on experience. It is therefore important that all patients are referred to an experienced CTEPH centre for careful evaluation of suitability for surgery. The most common reason for inoperability is distal vasculopathy accounting for a high proportion of the vascular resistance. Surgery requires cardiopulmonary bypass and periods of deep hypothermic circulatory arrest. Complications include reperfusion lung injury and persistent PH. However, with careful patient selection, surgical technique and post-operative management, PEA is a highly effective treatment with mortality rates <5% at experienced centres. Patients who are unsuitable for surgery may be candidates for medical therapy.
Diagnostic advances and opportunities in chronic thromboembolic pulmonary hypertension
Authors: D'Armini Andrea M.
Published: June 2015

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by the presence of thromboembolic material in the pulmonary circulation, and patients have a poor prognosis without treatment. Patients present with nonspecific symptoms, such as breathlessness and syncope, which means that other more common conditions are sometimes suspected before CTEPH, leading to delayed diagnosis and treatment. This is problematic because CTEPH is potentially curable with surgical pulmonary endarterectomy (PEA); indeed, CTEPH should always be considered in any patient with unexplained pulmonary hypertension (PH).

Several key evaluations are necessary and complementary to confirm a diagnosis of CTEPH and assess operability. Echocardiography is initially used to confirm a general diagnosis of PH. Ventilation/perfusion scanning is then essential in the first stage of CTEPH diagnosis, with a wedge-shaped perfusion deficit indicative of CTEPH. This should be followed by right heart catheterisation (RHC) which is mandatory in confirming the diagnosis and providing haemodynamic parameters that are key predictors of the risk associated with PEA and subsequent prognosis. RHC is ideally coupled with conventional pulmonary angiography, the gold-standard technique for confirming the location and extent of disease, and thus whether the obstruction is surgically accessible. Computed tomographic pulmonary angiography is also now routinely used as a complementary technique to aid diagnosis and operability assessment.

Recent improvements in the resolution of other noninvasive techniques, such as cardiac magnetic resonance imaging, allow for detailed reconstructions of the vascular tree and imaging of vessel defects, and interest in their use is increasing.
Pharmacological therapy for patients with chronic thromboembolic pulmonary hypertension
Authors: Hoeper Marius M.
Published: June 2015

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but life-threatening disease resulting from unresolved thromboembolic obstructions. Pulmonary endarterectomy (PEA) surgery is the gold-standard treatment as it is potentially curative; however, not all patients are deemed operable and up to one-third have persistent or recurrent CTEPH after the procedure. Pulmonary arterial hypertension (PAH) and CTEPH have similar clinical presentations and histopathological features, so agents shown to be effective in PAH have often been prescribed to patients with CTEPH in the absence of proven therapies. However, clinical evidence for this strategy is not compelling. A number of small uncontrolled trials have investigated endothelin receptor antagonists, prostacyclin analogues and phosphodiesterase type 5 inhibitors in CTEPH with mixed results, and a phase III study of the endothelin receptor antagonist bosentan met only one of its two co-primary end-points. Recently, however, the soluble guanylate cyclase stimulator, riociguat, was approved in the USA and Europe for the treatment of inoperable or persistent/recurrent CTEPH following positive results from the phase III CHEST study (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase–Stimulator Trial). This article reviews the current evidence for the use of pharmacological therapies in CTEPH.
Chronic thromboembolic pulmonary hypertension: a distinct disease entity
Authors: Lang Irene
Published: June 2015

Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct subtype of pulmonary hypertension (PH). One disease hypothesis is that CTEPH results from the non-resolution of venous thromboembolism. CTEPH is characterised by the presence of obstructive fibrotic thromboembolic material in the major pulmonary vessels, with concomitant microvascular arteriopathy, resulting in progressive PH. The clinical presentation of CTEPH is similar to pulmonary arterial hypertension with nonspecific symptoms, but it is distinguished from pulmonary arterial hypertension by the presence of mismatched segmental defects on the ventilation/perfusion scan. The exact prevalence and incidence of CTEPH are unknown, but are thought to have been underestimated in the past. CTEPH is unique among the subgroups of PH in that it is potentially curable with pulmonary endarterectomy, a surgical intervention intended to remove the occlusive material from the pulmonary vasculature. However, in some patients the obstructions are technically inaccessible or the risk/benefit ratios are unfavourable, making the condition inoperable. It is thought that the involvement of the smaller, more distal vessels is a target for medical treatment. Untreated, CTEPH may result in right heart failure and death. The pathophysiological mechanisms which cause CTEPH are complex and have not yet been fully elucidated.
Monitoring asthma in childhood
Authors: Lødrup Carlsen Karin C. , Pijnenburg Mariëlle W.
Published: June 2015

The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein.

We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems.
Monitoring asthma in childhood: management-related issues
Authors: Rottier Bart L. , Eber Ernst , Hedlin Gunilla , Turner Steve , Wooler Edwina , Mantzourani Eva , Kulkarni Neeta
Published: June 2015

Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood.

The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established.

In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention.
Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation
Authors: Moeller Alexander , Carlsen Kai-Hakon , Sly Peter D. , Baraldi Eugenio , Piacentini Giorgio , Pavord Ian , Lex Christiane , Saglani Sejal
Published: June 2015

This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children.

Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.
Adverse childhood experience and asthma onset: a systematic review
Authors: Exley Daniel , Norman Alyson , Hyland Michael
Published: June 2015

Adverse childhood experiences such as abuse and neglect are associated with subsequent immune dysregulation. Some studies show an association between adverse childhood experiences and asthma onset, although significant disparity in results exists in the published literature.

We aimed to review available studies employing a prospective design that investigates associations between adverse childhood experience and asthma. A search protocol was developed and studies were drawn from four electronic journal databases. Studies were selected in accordance with pre-set inclusion criteria and relevant data were extracted.

12 studies, assessing data from a total of 31 524 individuals, were identified that investigate the impact of a range of adverse childhood experiences on the likelihood of developing asthma. Evidence suggests that chronic stress exposure and maternal distress in pregnancy operate synergistically with known triggers such as traffic-related air pollution to increase asthma risk.

Chronic stress in early life is associated with an increased risk of asthma onset. There is evidence that adverse childhood experience increases the impact of traffic-related air pollution and inconsistent evidence that adverse childhood experience has an independent effect on asthma onset.
Development of a simple binary response questionnaire to identify airflow obstruction in a smoking population in Argentina
Authors: Bergna Miguel A. , García Gabriel R. , Alchapar Ramon , Altieri Hector , Casas Juan C. Figueroa , Larrateguy Luis , Nannini Luis J. , Pascansky Daniel , Grabre Pedro , Zabert Gustavo , Miravitlles Marc
Published: June 2015

The CODE questionnaire (COPD detection questionnaire), a simple, binary response scale (yes/no), screening questionnaire, was developed for the identification of patients with chronic obstructive pulmonary disease (COPD). We conducted a survey of 468 subjects with a smoking history in 10 public hospitals in Argentina. Patients with a previous diagnosis of COPD, asthma and other respiratory illness were excluded. Items that measured conceptual domains in terms of characteristics of symptoms, smoking history and demographics data were considered. 96 (20.5%) subjects had a diagnosis of COPD according to the 2010 Global Initiative for Chronic Obstructive Lung Disease strategy document. The variables selected for the final questionnaire were based on univariate and multivariate analyses and clinical criteria. Finally, we selected the presence or absence of six variables (age ≥50 years, smoking history ≥30 pack-years, male sex, chronic cough, chronic phlegm and dyspnoea). Of patients without any of these six variables (0 points), none had COPD. The ability of the CODE questionnaire to discriminate between subjects with and without COPD was good (the area under the receiver operating characteristic curve was 0.75). Higher scores were associated with a greater probability of COPD. The CODE questionnaire is a brief, accurate questionnaire that can identify smoking individuals likely to have COPD.
Occupational exposure to pesticides and respiratory health
Authors: Mamane Ali , Baldi Isabelle , Tessier Jean-François , Raherison Chantal , Bouvier Ghislaine
Published: June 2015

This article aims to review the available literature regarding the link between occupational exposure to pesticides and respiratory symptoms or diseases. Identification of epidemiological studies was performed using PubMed. 41 articles were included, 36 regarding agricultural workers and five regarding industry workers.

Among the 15 cross-sectional studies focusing on respiratory symptoms and agricultural pesticide exposure, 12 found significant associations with chronic cough, wheeze, dyspnoea, breathlessness or chest tightness. All four studies on asthma found a relationship with occupational exposure, as did all three studies on chronic bronchitis. The four studies that performed spirometry reported impaired respiratory function linked to pesticide exposure, suggestive of either obstructive or restrictive syndrome according to the chemical class of pesticide.

12 papers reported results from cohort studies. Three out of nine found a significant relationship with increased risk of wheeze, five out of nine with asthma and three out of three with chronic bronchitis. In workers employed in pesticide production, elevated risks of chronic obstructive pulmonary disease (two studies out of three) and impaired respiratory function suggestive of an obstructive syndrome (two studies out of two) were reported.

In conclusion, this article suggests that occupational exposure to pesticides is associated with an increased risk of respiratory symptoms, asthma and chronic bronchitis, but the causal relationship is still under debate.
Scale-dependent effects of habitat fragmentation on reproduction in the annual Circaeaster agristis, a narrow endemic and threatened species
Authors: Zhao Jie-Cai , Luo Jun , Yang Chun-Ping , Cao Guo-Xing
Published: June 2015

Background

Habitat fragmentation and the resulting decline in population size and density commonly reduce the reproduction of rare and threatened species. We investigated the impacts of population size and density on reproduction in more than 30 populations of Circaeaster agristis, a narrow endemic and threatened species, in 2010 and 2011. We also examined the effects of NND (nearest neighbor distance) and LNS (local neighbor size), within radii of 0.1 m, 0.2 m and 0.3 m, on reproduction in two of the populations in 2011.

Results

Population size did not affect fruit (seed) number and fruit set in either year studied. Population density had an indirect negative effect on fruit number and fruit set as a consequence of a negative effect on plant size in 2010, but had no effect on fruit number and fruit set in 2011. Within populations, individual fruit number did not change, and individual fruit set increased independent of plant size, in response to increasing NND. Both individual fruit number and individual fruit set increased, independent of plant size, with increases in LNS within a 0.1 m radius, but did not change with increases in LNS within radii of between 0.1 m and 0.2 m radii or between 0.2 m and 0.3 m.

Conclusions

The effect of habitat fragmentation on reproduction of C. agristis is scale-dependent. In contrast to the generally accepted idea that fragmentation reduces plant reproduction, reproductive success may increase in sparse populations or increase in response to decreases in LNS in C. agristis.