bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and facilitators to self‐management of asthma in adolescents: An interview study to inform development of a novel intervention
Authors: Holley S. , Walker D. , Knibb R. , Latter S. , Liossi C. , Mitchell F. , Radley R. , Roberts G.
Published: March 2018

Background and Objective

Despite literature that spans twenty years describing the barriers to asthma self‐management in adolescents, successful, clinically based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self‐management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals.

Methods

Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12‐18 years, 14 healthcare professionals and 12 parents. Focus groups and interviews were audio‐recorded, and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis.

Results

Adolescents', parents' and healthcare professionals' views were summarized into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self‐management and our results provide further validation for previous studies.

Conclusion and Clinical Relevance

Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents' ability to effectively self‐manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two‐way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilize to empower adolescents to improve their asthma self‐management.
Correlation of natural autoantibodies and cardiovascular disease-related anti-bacterial antibodies in pericardial fluid of cardiac surgery patients
Authors: Simon D , Gilicze O , Farkas N , Najbauer J , Németh P , Lénárd L , Berki T
Published: March 2018

Our previous studies showed that anti-citrate synthase (anti-CS) immunoglobulin (Ig)M natural autoantibodies are present in healthy individuals without previous antigen stimulation, but no studies have investigated their presence in the pericardial fluid (PF). Therefore, we detected the natural anti-CS IgG/M autoantibody levels in plasma and PF of cardiac surgery patients and investigated their relationship with cardiovascular disease-associated bacterial pathogens. PF and blood samples of 22 coronary artery bypass graft (CABG) and 10 aortic valve replacement (AVR) patients were tested for total Ig levels, natural autoantibodies and infection-related antibodies using enzyme-linked immunosorbent assay (ELISA) and Luminex methods. The B cell subsets were measured by flow cytometry. The total Ig subclass levels were four to eight times lower in PF than in plasma, but the natural anti-CS IgM autoantibodies showed a relative increase in PF. The frequency of CD19+ B lymphocytes was significantly lower in PF than in blood (P = 0·01), with a significant relative increase of B1 cells (P = 0·005). Mycoplasma pneumoniae antibody-positive patients had significantly higher anti-CS IgM levels. In CABG patients we found a correlation between anti-CS IgG levels and M. pneumoniae, Chlamydia pneumoniae and Borrelia burgdorferi antibody titres. Our results provide the first evidence that natural autoantibodies are present in the PF, and they show a significant correlation with certain anti-bacterial antibody titres in a disease-specific manner.
Sorafenib paradoxically activates the RAS/RAF/ERK pathway in polyclonal human NK cells during expansion and thereby enhances effector functions in a dose- and time-dependent manner
Authors: Lohmeyer J , Nerreter T , Dotterweich J , Einsele H , Seggewiss-Bernhardt R
Published: March 2018

Natural killer (NK) cells play a major role in host immunity against leukaemia and lymphoma. However, clinical trials applying NK cells have not been as efficient as hoped for. Patients treated with rapidly accelerated fibrosarcoma (RAF) inhibitors exhibit increased tumour infiltration by immune cells, suggesting that a combination of RAF inhibitors with immunotherapy might be beneficial. As mitogen-activated protein kinases (MAPKs) such as raf-1 proto-oncogene, serine/threonine kinase (CRAF) regulate NK cell functions, we performed an in-vitro investigation on the potential of clinically relevant short-acting tyrosine kinase inhibitors (TKIs) as potential adjuvants for NK cell therapy: NK cells from healthy human blood donors were thus treated with sorafenib, sunitinib or the pan-RAF inhibitor ZM336372 during ex-vivo expansion. Functional outcomes assessed after washout of the drugs included cytokine production, degranulation, cytotoxicity, apoptosis induction and signal transduction with/without target cell contact. Paradoxically, sorafenib enhanced NK cell effector functions in a time- and dose-dependent manner by raising the steady-state activation level. Of note, this did not lead to NK cell exhaustion, but enhanced activity against target cells such as K562 or Daudis mediated via the RAS/RAF/extracellular-regulated kinase (ERK) pathway, but not via protein kinase B (AKT). Our data will pave the path to develop a rationale for the considered use of RAF inhibitors such as sorafenib for pre-activation in NK cell-based adoptive immune therapy.
The effects of the Union for International Cancer Control/American Joint Committee on Cancer Tumour, Node, Metastasis system version 8 on staging of differentiated thyroid cancer: a comparison to version 7
Authors: Verburg Frederik A. , Mäder Uwe , Luster Markus , Reiners Christoph
Published: March 2018

Objective

To assess the changes resulting from the changes from UICC/AJCC TNM version 7 to version 8 and to subsequently determine whether TNM version 8 is an improvement compared to previous iterations of the TNM system and other staging systems for differentiated thyroid cancer (DTC) with regard to prognostic power.

Design

Database study of DTC patients treated in our centre between 1978 up to and including 1 July 2014. Results were compared to our previous comparison of prognostic systems using the same data set.

Patients

2257 DTC patients.

Measurements

Staging in accordance with TNM 7 and TNM 8. Thyroid cancer‐specific mortality; comparison was based on p‐values of univariate Cox regression analyses as well as analysis of the proportion of variance explained (PVE).

Results

There is a redistribution from stage 3 to lower stages affecting 206 (9.1%) patients. DTC‐related mortality according to Kaplan‐Meier for younger and older patients in TNM 7 had a slightly lower prognostic power than that in accordance with TNM 8 (P = 8.0 10−16 and P = 1.5 10−21, respectively). Overall staging is lower in 627/2257 (27.8%) patients. PVE (TNM 7: 0.29; TNM 8: 0.28) and the P‐value of Cox regressions (TNM 7: P = 7.1*10−52; TNM 8: P = 3.9*10−49) for TNM version 8 are marginally lower than that for TNM version 7, but still better than for any other DTC staging system.

Conclusion

TNM 8 results in a marked downstaging of patients compared to TNM 7. Although some changes, like the change in age boundary, appear to be associated with an improvement in prognostic power, the overall effect of the changes does not improve the predictive power compared to TNM 7.
Effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve implantation: a randomized control trial
Authors: Miraftabi Arezoo , Nilforushan Naveed , Darghahi Mina , Alemzadeh Sayyed Amirpooya , Parsamanesh Mohammad , Yadgari Maryam
Published: March 2018

Importance

The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation.

Background

Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation.

Design

Prospective and randomized clinical trial.

Participants

Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included.

Methods

In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization

Main Outcome Measures

The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12.

Results

Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88 ± 7.62 mmHg in group 1 and 27.52 ± 8.57 mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42 ± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP ≤ 21 mmHg with at least 20% reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP ≤ 18 mmHg The cumulative success according to criterion A and B was 77.8%, 72.2% in group 1 and 89.5% in group 2, respectively, at the end of follow‐up.

Conclusions and Relevance

Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow‐up.
Single, short in‐del, and copy number variations detection in monogenic dyslipidemia using a next‐generation sequencing strategy
Authors: Marmontel O. , Charrière S. , Simonet T. , Bonnet V. , Dumont S. , Mahl M. , Jacobs C. , Nony S. , Chabane K. , Bozon D. , Janin A. , Peretti N. , Lachaux A. , Bardel C. , Millat G. , Moulin P. , Marçais C. , Di Filippo M.
Published: March 2018

Optimal molecular diagnosis of primary dyslipidemia is challenging to confirm the diagnosis, test and identify at risk relatives. The aim of this study was to test the application of a single targeted next‐generation sequencing (NGS) panel for hypercholesterolemia, hypocholesterolemia, and hypertriglyceridemia molecular diagnosis. NGS workflow based on a custom AmpliSeq panel was designed for sequencing the most prevalent dyslipidemia‐causing genes (ANGPTL3, APOA5, APOC2, APOB, GPIHBP1, LDLR, LMF1, LPL, PCSK9) on the Ion PGM Sequencer. One hundred and forty patients without molecular diagnosis were studied. In silico analyses were performed using the NextGENe software and homemade tools for detection of copy number variations (CNV). All mutations were confirmed using appropriate tools. Eighty seven variations and 4 CNV were identified, allowing a molecular diagnosis for 40/116 hypercholesterolemic patients, 5/13 hypocholesterolemic patients, and 2/11, hypertriglyceridemic patients respectively. This workflow allowed the detection of CNV contrary to our previous strategy. Some variations were found in previously unexplored regions providing an added value for genotype‐phenotype correlation and familial screening. In conclusion, this new NGS process is an effective mutation detection method and allows better understanding of phenotype. Consequently this assay meets the medical need for individualized diagnosis of dyslipidemia.
A retrospective investigation of hexavalent chromium allergy in southern Sweden
Authors: Lejding Tina , Mowitz Martin , Isaksson Marléne , Bruze Magnus , Pontén Ann , Svedman Cecilia , Zimerson Erik , Engfeldt Malin
Published: March 2018

Background

Historically, allergic contact dermatitis caused by hexavalent chromium [Cr(VI)] in cement was the most common cause of invalidity attributable to skin disease in Sweden. Since the legislation to reduce Cr(VI) in cement was introduced in 1989, we rarely see allergic contact dermatitis caused by cement.

Objectives

To examine the frequency of contact allergy to Cr(VI) in southern Sweden in 2005–2014.

Methods

We investigated the occurrence of positive reactions to potassium dichromate 0.5% pet. in consecutively tested dermatitis patients, and compared the occurrence of atopic dermatitis, localization of dermatitis and simultaneous positive reactions to cobalt chloride and nickel sulfate in the Cr(VI)‐positive patients with those in a group of patients with a similar age and sex distribution.

Results

In total, 6482 patients were tested, and 233 Cr(VI)‐allergic individuals were found (3.6%). A significantly higher proportion of atopic dermatitis was found among Cr(VI)‐allergic patients, and a significantly higher share of foot dermatitis was found among Cr(VI)‐allergic women, than among controls. Cr(VI) allergy was less likely when both nickel allergy and cobalt allergy were present.

Conclusion

A relatively high frequency of contact allergy to Cr(VI) was found. The cause has shifted from cement exposure to other exposures, probably mainly leather.
A systematic review and meta‐analysis comparing adverse events and functional outcomes of different pouch designs after restorative proctocolectomy
Authors: Simillis C. , Afxentiou T. , Pellino G. , Kontovounisios C. , Rasheed S. , Faiz O. , Tekkis P. P.
Published: March 2018

Aim

There is no consensus as to which ileoanal pouch design provides better outcomes after restorative proctocolectomy. This study compares different pouch designs.

Method

A systematic review of the literature was performed. A random effects meta‐analytical model was used to compare adverse events and functional outcome.

Results

Thirty comparative studies comparing J, W, S and K pouch designs were included. No significant differences were identified between the different pouch designs with regard to anastomotic dehiscence, anastomotic stricture, pelvic sepsis, wound infection, pouch fistula, pouch ischaemia, perioperative haemorrhage, small bowel obstruction, pouchitis and sexual dysfunction. The W and K designs resulted in fewer cases of pouch failure compared with the J and S designs. J pouch construction resulted in a smaller maximum pouch volume compared with W and K pouches. Stool frequency per 24 h and during daytime was higher following a J pouch than W, S or K constructions. The J design resulted in increased faecal urgency and seepage during daytime compared with the K design. The use of protective pads during daytime and night‐time was greater with a J pouch compared to S or K. The use of antidiarrhoeal medication was greater after a J reservoir than a W reservoir. Difficulty in pouch evacuation requiring intubation was higher with an S pouch than with W or J pouches.

Conclusion

Despite its ease of construction and comparable complication rates, the J pouch is associated with higher pouch failure rates and worse function. Patient characteristics, technical factors and surgical expertise should be considered when choosing pouch design.
Community managed alcohol programs in Canada: Overview of key dimensions and implementation
Authors: Pauly Bernadette (Bernie) , Vallance Kate , Wettlaufer Ashley , Chow Clifton , Brown Randi , Evans Joshua , Gray Erin , Krysowaty Bonnie , Ivsins Andrew , Schiff Rebecca , Stockwell Tim
Published: March 2018

Introduction and Aims

People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues.

Design and Methods

Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs.

Results

Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections.

Discussion and Conclusions

MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re‐establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed.
Adolescents drink less: How, who and why? A review of the recent research literature
Authors: Pape Hilde , Rossow Ingeborg , Brunborg Geir Scott
Published: March 2018

Issues

Today’s teenagers have been described as a sober generation and we asked: ‘What is known about the recent decline in youth drinking?’

Approach

A literature review (2005–2017).

Key Findings

Research from wealthier parts of the world provides solid evidence of less alcohol use by youth since the millennium shift. Some studies show that this is reflected at all levels of consumption, but there are also indications that the heaviest drinkers have not reduced their drinking. The decrease is predominately seen in underage youth, and has been larger for boys than for girls in several countries. Teenagers across social strata drink less, but some disadvantaged subgroups have not followed the downward trend. Underage drinkers have apparently not become a more deviant group as the prevalence of drinking has dropped, indicating no hardening of the group. The major gap in the literature pertains to the issue of underlying driving forces. We found no evidence in support of the widespread assumption that the digital revolution has been of importance. A decline in parenting practices that are conductive to underage drinking has occurred in several countries, but studies examining whether these changes have contributed to less alcohol use by youth are almost non‐existent.

Implications

To inform alcohol policy and prevention, it is imperative to find out why teenage drinking has decreased in a fairly consistent way across numerous countries.

Conclusion

Future research into the issue of falling prevalence rates of youth drinking should focus on possible explanatory factors at the population level rather than at the individual level.
Women Workers and the Politics of Claims Making: The Local and the Global
Authors: Kabeer Naila
Published: March 2018

This article analyses the evolving politics of claims making in relation to women workers in the global South. It asks what claims are being made and by whom, who these claims are addressed to and what strategies are being employed to press these claims. It distinguishes between women working for global markets and those working for domestic markets in order to identify possible differences in constraints, priorities and opportunities underlying these strategies. It also distinguishes between the different kinds of organizations involved in making claims: organizations of women workers, organizations working with women workers and organizations working on behalf of women workers. The article is one of several papers forming a cluster on feminist mobilizations.
Feminist Mobilization, Claims Making and Policy Change: An Introduction
Authors: Rao Nitya , Cagna Paola
Published: March 2018

More than two decades after the Fourth World Conference on Women was held in Beijing, gender equality policies have not delivered in the ways envisaged. This special cluster of articles seeks to understand why. Women's mobilization and feminist activism was central to the Beijing process and the advocacy that followed, yet their influence on policy processes seems constrained in the current context of global political and economic changes. The articles in this cluster explore the negotiations between different actors, institutions and discourses — and the tensions and contradictions therein — as explanations for why certain domains of women's rights remain at the margins of political agendas and others receive more attention. Specifically, why have women's labour rights and the demands of the unpaid care economy failed to gain policy traction? The articles point to the importance of political practice, which includes the ‘framing’ of policy demands as compelling narratives, engagement with state entities and the forming and managing of alliances. There are trade‐offs inherent in each of these elements, for example, between transformative gender equality objectives and the pragmatic impulse to frame claims in less politically and socially threatening ways. Further, in a context of increasing globalization, mobilization is required at multiple levels — from the local to the transnational. The articles thus seek to deepen our understanding of how policy change for women's rights occurs.
South–South Cooperation and Neoliberal Hegemony in a Post‐aid World
Authors: Morvaridi Behrooz , Hughes Caroline
Published: March 2018

The current iteration of South–South Cooperation (SSC) differs fundamentally from the first manifestation in the early 1970s, largely because of differences in assumptions about who is cooperating with whom and to what end, in the context of SSC. These differences are significant for the material practice of SSC and the ideological function of SSC rhetoric. In this article, the authors argue that contemporary ideas about SSC do not retrieve the radical potential of the original formulation, but rather expand the hegemonic neoliberal world order into a new phase through a reframed idea of the relationships between North and South and between states and markets. This promotes a new common‐sense understanding of the contemporary international political economy while further depoliticizing the idea of development. It hijacks the critical force of dependency theory, harnessing the terminology of the 1970s and a nostalgia for state‐led development to an ideological fix that in fact shores up the neoliberal world order in the context of a potentially destabilizing shift in the functioning of global capital.
Readmission and complications within 30 days after intrathecal baclofen pump placement
Authors: Lam Sandi K , Mayer Rory R , Vedantam Aditya , A Staggers Kristen , Harris Dominic A , Pan I‐Wen
Published: March 2018

Aim

To describe 30‐day outcomes after intrathecal baclofen (ITB) pump placement in children and identify risk factors for readmission, reoperation, and perioperative complication using the National Surgical Quality Improvement Program‐Pediatric (NSQIP‐P) database.

Method

Patients aged 0 to 18 years who underwent ITB pump placement (2012–2014) comprised the study cohort defined in the database. Multivariate regression analysis was performed using preoperative and perioperative data from the American College of Surgeons’ NSQIP‐P database. Outcomes of interest within 30 days of surgery were (1) unplanned reoperation; (2) unplanned readmission; and (3) composite postoperative event, including complication, reoperation, and/or readmission.

Results

We identified 423 surgeries; 246 (58.2%) patients were male, 177 (41.8%) patients were female. Median age was 12 years and 11 months. Median operative time was 70 minutes (interquartile range 56–97min). Mean length of stay was 3.8 days. The patient population had a high number of medical comorbidities. The overall readmission rate was 7.3%; mean postoperative admission date was 14.1 days after surgery. Of readmitted patients, 64.5% underwent reoperation. The most common indication for reoperation was surgical site infection. Female sex was associated with decreased risk of readmission (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.09–0.65; p=0.01); American Society of Anesthesiologists Classification of greater than or equal to 3 was associated with decreased risk of unplanned return to surgery (OR 0.26, 95% CI 0.11–0.66; p=0.04); length of stay greater than or equal to 3 days at index surgery was associated with increased risk of composite 30‐day perioperative event (OR 2.33, 95% CI 1.29–4.20; p=0.01).

Interpretation

Our data provide national perspectives on 30‐day perioperative outcomes for ITB pump placement in children. Results illustrate NSQIP‐P database collection methodology and highlight opportunities for quality improvement in clinical practice.

What this paper adds

Seven percent of patients who underwent intrathecal baclofen pump placement required readmission within 30 days.

The most common indication for reoperation was surgical site infection.
The risk, burden, and management of non‐communicable diseases in cerebral palsy: a scoping review
Authors: Ryan Jennifer M , Allen Elizabeth , Gormley John , Hurvitz Edward A , Peterson Mark D
Published: March 2018

Aim

To examine the risk, burden, and management of non‐communicable diseases (NCDs) among people with cerebral palsy (CP).

Method

Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted.

Results

Thirty‐six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females.

Interpretation

The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP.

What this paper adds

Adults with cerebral palsy (CP) have an increased risk of non‐communicable diseases (NCDs) and increased risk of death because of NCDs.

Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs.

Evidence is consistent that people with CP participate in reduced physical activity.

Only one study reported on management of NCD among people with CP.

Available evidence suggests people with CP are less likely to receive preventive medicine.
Perioperative neonatal brain injury is associated with worse school‐age neurodevelopment in children with critical congenital heart disease
Authors: Claessens Nathalie H P , Algra Selma O , Ouwehand Tom L , Jansen Nicolaas J G , Schappin Renske , Haas Felix , Eijsermans Maria J C , de Vries Linda S , Benders Manon J N L ,   CHD Lifespan Study Group Utrecht
Published: March 2018

Aim

To assess the impact of perioperative neonatal brain injury and brain volumes on neurodevelopment throughout school‐age children with critical congenital heart disease (CHD).

Method

Thirty‐four survivors of neonatal cardiac surgery (seven females, 27 males) were included. Neonatal preoperative and postoperative cerebral magnetic resonance imaging was performed and neurodevelopment was assessed at 24 months (SD 0.7, n=32, using Bayley Score of Infant and Toddler Development, Child Behavior Checklist) and 6 years (mean age 5y 11mo; SD 0.3, n=30, using Movement Assessment Battery for Children, Wechsler Preschool and Primary Scale of Intelligence, Child Behavior Checklist, Teacher Report Form). Brain injury, brain volumes, and cortical measures were related to outcome with adjustment for maternal educational level.

Results

Two‐year cognitive score and 6‐year Full‐scale IQ were poorer in children with neonatal white matter injury (n=21, all p<0.05), with higher teacher‐reported attention problems (p=0.03). Five of six children with involvement of the posterior limb of the internal capsule showed motor problems (p=0.03). Children with a below‐average Fulll‐scale IQ (<85, n=9) showed smaller volumes of basal ganglia thalami (−8%, p=0.03) and brain stem (−7%, p=0.03).

Interpretation

Our findings provide evidence of unfavourable outcome in school‐age children with critical CHD who acquire perioperative neonatal brain injury.

What this paper adds

This paper extends knowledge about neonatal brain injury and long‐term outcome in congenital heart disease.

Children with white matter injury show lower IQ and more attention problems at school age.

Injury of the posterior limb of the internal capsule increases the risk of motor problems.

This study provides evidence for worse outcomes in neonates acquiring brain injury around cardiac surgery.
Rosiglitazone lowers resting and blood pressure response to exercise in men with type 2 diabetes: A 1‐year randomized study
Authors: Piché Marie‐Eve , Laberge Anne‐Sophie , Brassard Patrice , Arsenault Benoit J. , Bertrand Olivier F. , Després Jean‐Pierre , Costerousse Olivier , Poirier Paul
Published: March 2018

Aims

We aimed to determine the effect of 1‐year treatment with the insulin sensitizer peroxisome proliferator‐activated receptor (PPAR)‐γ agonist rosiglitazone on exercise capacity and blood pressure (BP) response to exercise in men with coronary artery disease (CAD) and type 2 diabetes (T2D).

Materials and Methods

A total of 116 men (age, 64 ± 7 years; body mass index, 30.0 ± 4.4 kg/m2) with CAD and T2D were randomized to receive rosiglitazone or placebo for 1 year. Exercise capacity (VO2peak) and BP response to exercise were assessed with a maximal treadmill test, prior to the intervention and at 1‐year follow‐up. Exercise‐induced hypertension (EIH) was defined as maximal systolic BP ≥ 220 mm Hg and/or diastolic BP ≥ 100 mm Hg.

Results

PPAR‐γ agonist‐treated patients showed improvements in fasting glucose, HbA1c and insulin sensitivity (Homeostasis model assessment of insulin resistance [HOMA‐IR]) (all P < .05). Resting BPs, maximal exercise diastolic BP and resting rate‐pressure product (RPP) were all reduced in the PPAR‐γ agonist group (P < .05). Maximal exercise duration was unchanged. T2D patients who displayed the greatest improvement in insulin sensitivity (HOMA‐IR) under PPAR‐γ agonist treatment experienced a greater reduction in exercise BP and RPP (P < .05). The proportion of men with EIH decreased in the PPAR‐γ agonist group during follow‐up (39.00% ± 0.06% vs 21.00% ± 0.05%). In the subgroup with EIH that was treated with a PPAR‐γ agonist, resting and exercise diastolic BP, as well as resting RPP, were all reduced at 1‐year follow‐up (P < .05).

Conclusions

The insulin sensitizer rosiglitazone has a beneficial effect on resting and BP response to exercise in men with CAD and T2D, especially in those with an exaggerated BP response to exercise.
SGLT2 inhibitors and risk of stroke in patients with type 2 diabetes: A systematic review and meta‐analysis
Authors: Guo Man , Ding Jingya , Li Jingsong , Wang Jiying , Zhang Ting , Liu Cuiping , Huang Wei , Long Yang , Gao Chenlin , Xu Yong
Published: March 2018

The effects of sodium‐glucose cotransporter 2 (SGLT2) inhibitors on risk of stroke have not been conclusively established. Therefore, we conducted a meta‐analysis to evaluate the effects of SGLT2 inhibitors on stroke risk in patients with type 2 diabetes mellitus (T2DM) by searching available randomized trials in PubMed, Embase, CENTRAL, Web of Science, Scopus and ClinicalTrials.gov databases. We identified 32 eligible trials involving 75 540 participants. The incidence of stroke in groups receiving SGLT2 inhibitor monotherapy or combination therapy did not differ significantly from that in control groups, with a relative risk (RR) of 1.01 and 1.0, respectively. Three SGLT2 inhibitors were tested, with similar RR values (canagliflozin [RR, 0.91], dapagliflozin [RR, 0.99] and empagliflozin [RR, 1.03]). Subgroup analyses showed that RR values were not affected by gender, age, diabetes duration, BMI or HbA1C levels, but Black patients had a lower incidence of stroke than White or Asian patients. This meta‐analysis indicated that SGLT2 inhibitor therapy did not increase stroke incidence, and no significant differences in stroke risk were observed among 3 SGLT2 inhibitors (class effect). However, the small racial disparity requires further study and confirmation.
Effects of exenatide once weekly plus dapagliflozin, exenatide once weekly alone, or dapagliflozin alone added to metformin monotherapy in subgroups of patients with type 2 diabetes in the DURATION‐8 randomized controlled trial
Authors: Frías Juan P. , Hardy Elise , Ahmed Azazuddin , Öhman Peter , Jabbour Serge , Wang Hui , Guja Cristian
Published: March 2018

This analysis assessed whether responses with exenatide once weekly plus dapagliflozin (n = 231), exenatide once weekly alone (n = 230), or dapagliflozin alone (n = 233) differed in key patient subpopulations of the DURATION‐8 trial. Potential treatment‐by‐subgroup interactions for changes in glycated haemoglobin (HbA1c) and body weight after 28 weeks were evaluated among subgroups determined by baseline HbA1c, age, sex, body mass index, type 2 diabetes duration, race, ethnicity and estimated glomerular filtration rate (eGFR). Exenatide once weekly plus dapagliflozin reduced HbA1c and body weight across all subgroups: least‐squares mean reductions ranged from −8.4 to −26.1 mmol/mol (−0.77% to −2.39%) for HbA1c and from −2.07 to −4.55 kg for body weight. Potential treatment‐by‐subgroup interactions (P < .10) were found for HbA1c change by age (P = .016) and eGFR (P = .097). Age subgroup analysis findings were not consistent with expected mechanistic effects, with the small number of patients aged ≥65 years (n = 74 vs n = 499 for patients aged <65 years) limiting the interpretability of the interaction term. In the exenatide once weekly plus dapagliflozin and dapagliflozin groups, but not the exenatide once weekly group, HbA1c reductions were greater among patients with eGFR ≥90 vs ≥60 to <90 mL/min/1.73 m2 (least‐squares mean reductions of −23.6 vs −19.0 mmol/mol [−2.16% vs −1.74%], −17.3 vs −12.0 mmol/mol [−1.58% vs −1.10%], and −17.7 vs −16.9 mmol/mol [−1.62% vs −1.55%] for the respective treatments); this was consistent with the mechanism of action of dapagliflozin. A potential treatment‐by‐subgroup interaction was observed for change in body weight by sex (P = .099), with greater weight loss for women vs men across all treatments (range −2.56 to −3.98 kg vs −0.56 to −2.99 kg). In conclusion, treatment with exenatide once weekly plus dapagliflozin reduced HbA1c and body weight across all patient subgroups and was more effective than exenatide once weekly or dapagliflozin alone in all adequately sized subgroups.
Metformin's impact on statin‐associated muscle symptoms: An analysis of ACCORD study data and research materials from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center
Authors: Carris Nicholas W. , Tsalatsanis Athanasios , Tipparaju Srinivas M. , Cheng Feng , Magness Ronald R. , Kumar Ambuj
Published: March 2018

Statins are widely prescribed, yet statin muscle pain limits their use, leading to increased cardiovascular risk. No validated therapy for statin muscle pain exists. The goal of the study was to assess whether metformin was associated with reduced muscle pain. A secondary analysis of data from the ACCORD trial was performed. An ACCORD sub‐study assessed patients for muscle cramps and leg/calve pain while walking, typical non‐severe statin muscle pain symptoms. We compared muscle pain between patients using a statin (n = 445) or both a statin and metformin (n = 869) at baseline. Overall patient characteristics were balanced between groups. Unadjusted analysis showed fewer reports of muscle cramps (35%) and leg/calve pain while walking (40%) with statins and metformin compared to statin only (muscle cramps, 42%; leg/calve pain while walking, 47%). Multivariable regression demonstrated a 22% odds reduction for muscle cramps (P = 0.049) and a 29% odds reduction for leg/calve pain while walking (P = 0.01). Metformin appears to reduce the risk of non‐severe statin muscle pain and additional research is needed to confirm the findings and assess metformin's impact on statin adherence and related cardiovascular outcomes.
Assessing international organizations’ support to social enterprise
Authors: Hoyos Angela , Angel‐Urdinola Diego F.
Published: March 2018

This article takes stock of a sample of interventions and programmes across different countries and regions supported by international organizations to foster the development of social enterprise. The primary objective of the article is to generate a compilation of such interventions and draw some lessons about their potential contribution to the growth and sustainability of the sector. The results indicate that international organizations’ support to social enterprise has focused primarily on the provision of financial resources, notably loans and grants. While programmes remain largely unassessed, the few available rigorous evaluations show that social enterprise has the potential to be a cost‐effective mechanism to deliver basic social services to the poor. The article proposes a set of policy recommendations directed primarily to international organizations and the public administration to improve and enhance their support to the sector.
Site fidelity and movements of an amphidromous goby revealed by otolith multi‐elemental signatures along a tropical watershed
Authors: Teichert Nils , Tabouret Helene , Lagarde Raphaël , Grondin Henri , Ponton Dominique , Pécheyran Christophe , Bareille Gilles
Published: March 2018

Otolith microchemistry can provide crucial information to address gaps of knowledge in spatio‐temporal ecology of fish species. However, understanding the seasonal variability of water chemistry and its effect on otolith signatures is needed to interpret fish movements. Otolith multi‐elemental signatures were used to examine the diadromous migration and small‐scale movements of a tropical goby (Sicyopterus lagocephalus) within a watershed in La Réunion Island, Indian Ocean. The elemental ratios Sr:Ca, Ba:Ca and Sr:Ba recorded monthly in the water of nine sampling sites varied between localities and were correlated with otolith signatures, whereas the Mg:Ca signature was not. The incorporation of some trace elements in otoliths was influenced by the size of fish and site where they were caught, reflecting an effect of endogenous and exogenous factors. Despite these sources of variation, the elemental signatures did not overlap for three river sections distributed along the 26‐km‐long watershed. The diadromous migration and fish lifetime movements between these river sections were reconstructed using an original process based on random forest analysis. This approach revealed distinct migratory behaviours after fish entered in the river, with some individuals progressing slowly in the watershed whereas other rapidly reached the upper localities. As adults, S. lagocephalus showed a restricted exploratory behaviour and a strong site fidelity to a particular part of the watershed. The detection of adult movement was typically only between adjacent locations and is possibly explained by shifts in local intraspecific hierarchies and/or displacement during extreme discharge caused by cyclones.
Red operculum spots, body size, maturation and evidence for a satellite male phenotype in non‐native European populations of pumpkinseed Lepomis gibbosus
Authors: Zięba Grzegorz , Smith Carl , Fox Michael G. , Yavno Stan , Záhorská Eva , Przybylski Mirosław , Masson Gérard , Cucherousset Julien , Verreycken Hugo , van Kleef Hein H. , Copp Gordon H.
Published: March 2018

Carotenoid‐based pigmentation is a striking feature of many taxa, yet the function, if any, of colour traits is often unclear. Pumpkinseed Lepomis gibbosus, a widely introduced freshwater sunfish that exhibits alternative male mating strategies, express a striking, red operculum spot. To investigate the potential function of this red spot as a signal in this species' mating system, we determined the presence and measured the size of red operculum spots in fish collected from 12 populations in five European countries in which pumpkinseed is an established non‐native species. We subsequently related the presence and size of the red spot to body size and mating strategy, based on an analysis of relative gonad size (gonado‐somatic index, GSI), using a mixed modelling approach. The study demonstrated that the presence of a red operculum spot in pumpkinseed is associated with sexual maturation, with GSI frequency distributions suggesting that cuckolders in some non‐native populations comprised both sneaker and satellite males, the latter not having previously been reported for this species. Further, the size of red spot correlated strongly with body size in parental and cuckolder males, although there was no difference in the presence or size of the red operculum spot between male mating strategies. The function of a red operculum spot in females is not clear but may be partly mediated by pleiotropic genetic mechanisms. Red operculum spots appear to function as signals of male maturation and body size in pumpkinseed, irrespective of mating strategy.
A rapid review of serious games: From healthcare education to dental education
Authors: Sipiyaruk K. , Gallagher J. E. , Hatzipanagos S. , Reynolds P. A.
Published: March 2018

Introduction

Games involving technology have the potential to enhance hand‐eye coordination and decision‐making skills. As a result, game characteristics have been applied to education and training, where they are known as serious games. There is an increase in the volume of literature on serious games in healthcare education; however, evidence on their impact is still ambiguous.

Aims

The aims of this study were (i) to identify high‐quality evidence (systematic reviews or meta‐analyses) regarding impacts of serious games on healthcare education; and (ii) to explore evidence regarding impacts of serious games in dental education.

Methods

A rapid review of the literature was undertaken to synthesise available evidence and examine serious games in healthcare education (Stage 1) and dental education (Stage 2).

Results

Nine systematic reviews were included in Stage 1, four of which were of high, three of moderate and two of low quality. For Stage 2, two randomised control trials with moderate quality were included. The findings demonstrated that serious games are potentially effective learning tools in terms of knowledge and skills improvement, although outcomes of serious games over traditional learning approaches were not consistent. In addition, serious games appeared to be more engaging and satisfying for students, which could be considered as the most important positive impact.

Conclusion

Serious games provide an option for healthcare and dental education but remain underutilised and researched. At best, they offer a similar experience to other methods in relation to educational outcome; however, they can provide a supplementary strategy to engage students and improve learner satisfaction.
Reasoning, rational requirements, and occurrent attitudes
Authors: Lee Wooram
Published: March 2018

This paper explores the sense in which rational requirements govern our attitudes like belief and intention. I argue that there is a tension between the idea that rational requirements govern attitudes understood as standing states and the attractive idea that we can directly satisfy the requirements by performing reasoning. I identify the tension by (a) illustrating how a dispositional conception of belief can cause trouble for the idea that we can directly revise our attitudes through reasoning by considering John Broome's view, and (b) advancing a general argument that a standing state cannot be directly affected by reasoning. I then propose a solution: by recognizing the proper targets of rational requirements as occurrent, rather than dispositional attitudes, we can preserve the idea that we can directly satisfy rational requirements through reasoning.
You meta believe it
Authors: Levy Neil
Published: March 2018

Because of the privileged place of beliefs in explaining behaviour, mismatch cases—in which agents sincerely claim to believe that p, but act in a way that is inconsistent with that belief—have attracted a great deal of attention. In this paper, I argue that some of these cases, at least, are at least partially explained by agents believing that they believe that p, while failing to believe that p. Agents in these cases do not believe that ~p; rather, they have an indistinct first‐order, beliefy, representation that p. The indistinctness of this first‐order representation provides the leeway for the inconsistency seen in their behaviour.
Climate and soil moisture content during development of the first palaeosol in the southern Loess Plateau
Authors: Zhao J.‐B. , Luo X.‐Q. , Ma Y.‐D. , Zhou Q. , Chen B.‐Q. , Yue Y.‐L.
Published: March 2018

The scientific problems concerning Quaternary soil water content and the water cycle have not been researched. This study examined the soil water content and depth of distribution of gravitational water in the south Loess Plateau during development of the first palaeosol layer (S1) by methods such as field investigation, electron microscopy, energy spectrum analysis, chemical analysis, and so on. The purpose was to reveal the climate, water balance and vegetation type at the time when S1 developed. The depth of migration of CaCO3 and Sr were 4.2 m below the upper boundary of the S1 palaeosol, and the depth of weathered loess beneath the argillic horizon was 4.0 m. Ferri‐argillans developed well in the argillic horizon and their depth of migration was 1 m below the argillic horizon. These findings suggest that the climate during the last interglacial was subtropical and humid, and the soil‐water balance was positive. Gravitational water was present to a depth of least 4.2 m from the top of S1, and the water content was adequate for tree growth. The chemical weathering index showed that this palaeosol has been moderately weathered.

Highlights

We studied the palaeo-water content index during development of the first palaeosol.

Soil water balance during development of S1 palaeosol in the south Loess plateau was positive.

Available water content was 14% during development of S1 palaeosol.

We suggest that a subtropical climate and forest vegetation prevailed.