bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravenous 0.9% sodium chloride therapy does not reduce length of stay of alcohol‐intoxicated patients in the emergency department: A randomised controlled trial
Authors: Perez Siegfried RS , Keijzers Gerben , Steele Michael , Byrnes Joshua , Scuffham Paul A
Published: November 2013

Background

I.v. 0.9% sodium chloride (normal saline) is frequently used to treat ED patients with acute alcohol intoxication despite the lack of evidence for its efficacy.

Objective

The study aims to compare treatment with i.v. normal saline and observation with observation alone in ED patients with acute alcohol intoxication.

Methods

A single‐blind, randomised, controlled trial was conducted to compare a single bolus of 20 mL/kg i.v. normal saline plus observation with observation alone. One hundred and forty‐four ED patients with uncomplicated acute alcohol intoxication were included. The study was conducted in one tertiary and one urban ED in Queensland, Australia. Primary outcome was ED length of stay (EDLOS). Secondary outcomes were treatment time, breath alcohol levels, intoxication symptom score, level of intoxication and associated healthcare costs.

Results

Both groups were comparable at baseline: blood alcohol content (BAC) was similar between treatment and control groups (0.20 % BAC vs 0.19 % BAC, P = 0.44) as were initial intoxication symptom scores (22.0 vs 22.3, P = 0.90). Both groups had a similar EDLOS (287 min vs 274 min, P = 0.89; difference 13 min [95% CI −37–63]) and treatment time (244 min vs 232 min, P = 0.94; difference 12 min [95% CI −31–55]). Change of breath alcohol levels, intoxication score and level of intoxication were not significantly different between the two groups. Patients in the treatment group had an additional healthcare cost of A$31.92 compared with control.

Conclusions

I.v. normal saline therapy added to observation alone does not decrease ED length of stay compared with observation alone. Intoxication symptom scores and general state of intoxication were similar in both groups. The present study suggests that either approach is reasonable, but observation alone might be preferred as it is less resource intensive.
Insulin therapy improves islet functions by restoring pancreatic vasculature in high‐fat diet‐fed streptozotocin‐diabetic rats (胰岛素治疗通过恢复胰腺血管提高高脂饮食联合链脲佐菌素诱导的糖尿病大鼠的胰岛功能)
Authors: Gu Huimin , Xia Xuan , Chen Zonglan , Liang Hua , Yan Jinhua , Xu Fen , Weng Jianping
Published: November 2013

Background

In a previous study, we showed early insulin therapy could improve β‐cell function in type 2 diabetic patients. However, the molecular mechanism was not clear. In the present study, we addressed this question by analyzing the pancreatic microvasculature in diabetic rats after insulin treatment.

Methods

Diabetes was induced in rats by a combination of low dose streptozotocin (STZ; 40 mg/kg) and feeding of a high‐fat diet. After the induction of diabetes, rats were treated with neutral protamine Hagedorn insulin (NPH; 6–8 U/day, s.c.) for 3 weeks. Three days after the end of treatment, rats were subjected to an intraperitoneal glucose tolerance test (IPGTT). The pancreatic microvasculature and the amount and size of the islets were evaluated by immunohistochemistry. Western blot analysis was used to determine levels of vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGF‐R2) protein.

Results

Treatment with NPH improved insulin secretion from β‐cells during the IPGTT and increased pancreatic islet size. The density of the microvasculature in the pancreas was determined by quantification of CD31, a marker of endothelial cells. Insulin treatment increased CD31 protein levels, as well as the expression of VEGF and VEGFR2.

Conclusions

The results suggest that insulin treatment improves islet recovery by increasing angiogenesis in the pancreas. The mechanism is related to the induction of VEGF and VEGFR2 expression in diabetic rats.
NKX2‐5, SIL/TAL and TLX3/HOX11L2 expression in Egyptian pediatric T‐cell acute lymphoblastic leukemia
Authors: Moussa Heba , Sidhom Iman
Published: November 2013

Aim

Cohorts of T‐cell acute lymphoblastic leukemia (T‐ALL) patients show regional geographic differences in incidence, biological features and clinical outcome, implying that in different populations, cases may harbor different genetic lesions than those reported elsewhere. In this study, we prospectively evaluated the frequency and the clinical relevance of NKX2‐5, TLX3/HOX11L2 and SIL/TAL expression in Egyptian childhood T‐ALL.

Methods

NKX2‐5, TLX3/HOX11L2 and SIL/TAL expression were tested in peripheral blood and/or bone marrow of 83 newly diagnosed Egyptian childhood T‐ALL patients.

Results

NKX2‐5 expression was detected in 11/83 cases (13%), TLX3/HOX11L2 (5/83, 6%) and SIL/TAL (4/83, 5%). Initial central nervous system involvement was significantly higher in the NKX2‐5 positive versus negative patients (P = 0.009). The follow‐up period was a median of 65.5 months. The 5‐year leukemia‐free and event‐free survival rates of the whole T‐ALL population were 70 ± 6% and 58 ± 6%, respectively. The 5‐year leukemia‐free and event‐free survival rates of NKX2‐5 were 86 ± 13% and 60 ± 16%, respectively. There were no statistically significant differences in clinical presentation, biological features, initial response to chemotherapy, or subsequent treatments between the subgroups and the total population.

Conclusion

Egyptian T‐ALL cases seemed to have a different genetic pattern compared to other populations, with a lower incidence of TLX3/HOX11L2 and SIL/TAL but a higher incidence of NKX2‐5 expression than recorded in Western countries.
The Semiconstrained Court: Public Opinion, the Separation of Powers, and the U.S. Supreme Court's Fear of Nonimplementation
Authors: Hall Matthew E.K.
Published: November 2013

Numerous studies have found that elite and popular preferences influence decision making on the U.S. Supreme Court; yet, uncertainty remains about when, how, and why the Court is constrained by external pressure. I argue the justices are constrained, at least in part, because they fear nonimplementation of their decisions. I test this theory by utilizing a recent study of judicial power, which finds the Court enjoys greater implementation power in “vertical” cases (those involving criminal and civil liability) than in “lateral” cases (all others; e.g., those involving schools or government agencies). I find that Court constraint is strongest in important lateral cases—those cases in which implementation depends on support from nonjudicial actors. My findings suggest that Supreme Court constraint is driven by the justices' fear of nonimplementation and is, therefore, dependent on institutional context.
Does Descriptive Representation Facilitate Women's Distinctive Voice? How Gender Composition and Decision Rules Affect Deliberation
Authors: Mendelberg Tali , Karpowitz Christopher F. , Goedert Nicholas
Published: November 2013

Does low descriptive representation inhibit substantive representation for women in deliberating groups? We address this question and go beyond to ask if the effects of descriptive representation also depend on decision rule. We conducted an experiment on distributive decisions, randomizing the group's gender composition and decision rule, including many groups, and linking individuals’ predeliberation attitudes to their speech and to postdeliberation decisions. Women's descriptive representation does produce substantive representation, but primarily under majority rule—when women are many, they are more likely to voice women's distinctive concerns about children, family, the poor, and the needy, and less likely to voice men's distinctive concerns. Men's references shift similarly with women's numerical status. These effects are associated with group decisions that are more generous to the poor. Unanimous rule protects women in the numerical minority, mitigating some of the negative effects of low descriptive representation. Descriptive representation matters, but in interaction with the decision rule.
Elections and Deceptions: An Experimental Study on the Behavioral Effects of Democracy
Authors: Corazzini Luca , Kube Sebastian , Maréchal Michel André , Nicolò Antonio
Published: November 2013

Traditionally, the virtue of democratic elections has been seen in their role as means of screening and sanctioning shirking public officials. This article proposes a novel rationale for elections and political campaigns considering that candidates incur psychological costs of lying, in particular from breaking campaign promises. These nonpecuniary costs imply that campaigns influence subsequent behavior, even in the absence of reputational or image concerns. Our lab experiments reveal that promises are more than cheap talk. They influence the behavior of both voters and their representatives. We observe that the electorate is better off when their leaders are elected democratically rather than being appointed exogenously—but only in the presence of electoral campaigns. In addition, we find that representatives are more likely to serve the public interest when their approval rates are high. Altogether, our results suggest that elections and campaigns confer important benefits beyond their screening and sanctioning functions.
Relation of Low Vitamin D to Nonvalvular Persistent Atrial Fibrillation in Chinese Patients
Authors: Chen Wei Ren , Liu Zhi Ying , Shi Yang , Yin Da Wei , Wang Hao , Sha Yuan , Chen Yun Dai
Published: November 2013

Background

Low vitamin D status has been associated with increased risk of cardiovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia. We evaluated the association between low vitamin D and AF.

Methods

We analyzed data from 162 Chinese patients with nonvalvular persistent AF and no other cardiovascular disease whose serum 25‐hydroxyvitamin D [25(OH)D] levels were measured in our hospital (AF group). Healthy subjects without AF who underwent health screening at our hospital served as controls (non‐AF group, n = 160). 25(OH)D was measured by chemiluminescence assay.

Results

The serum 25(OH)D level was significantly lower in the AF group than in the non‐AF group (18.5 ± 10.3 vs 21.4 ± 10.7 ng/mL, P < 0.05). The high‐sensitivity C‐reactive protein (hsCRP) level was significantly higher in the AF group than in the non‐AF group (0.35 ± 0.19 vs 0.2 ± 0.17 mg/dL, P < 0.01). The average left atrial diameter was significantly larger in the AF group than in the non‐AF group (P < 0.01). The serum 25(OH)D level showed a negative correlation with left atrial diameter, hsCRP level, and pulmonary artery systolic pressure. Logistic regression analysis identified that 25(OH)D was related to AF. Patients whose vitamin D levels were in the lowest 25(OH)D category (<20 ng/mL) were more often in the AF group, with their incidence about twofold higher than those in the highest 25(OH)D category (>30 ng/mL).

Conclusions

Low vitamin D levels are associated with AF. It may be involved in its development.
Genotype‐Specific Risk Stratification and Management of Patients with Long QT Syndrome
Authors: Barsheshet Alon , Dotsenko Olena , Goldenberg Ilan
Published: November 2013

Long QT syndrome (LQTS) is an inherited disorder associated with life‐threatening ventricular arrhythmias. An understanding of the relationship between the genotype and phenotype characteristics of LQTS can lead to improved risk stratification and management of this hereditary arrhythmogenic disorder. Risk stratification in LQTS relies on combined assessment of clinical, electrocardiographic, and mutations‐specific factors. Studies have shown that there are genotype‐specific risk factors for arrhythmic events including age, gender, resting heart rate, QT corrected for heart rate, prior syncope, the postpartum period, menopause, mutation location, type of mutation, the biophysical function of the mutation, and response to beta‐blockers. Importantly, genotype‐specific therapeutic options have been suggested. Lifestyle changes are recommended according to the prevalent trigger for cardiac events. Beta‐blockers confer greater benefit among patients with LQT1 with the greatest benefit among those with cytoplasmic loops mutations; specific beta‐blocker agents may provide greater protection than other agents in specific LQTS genotypes. Potassium supplementation and sex hormone–based therapy may protect patients with LQT2. Sodium channel blockers such as mexiletine, flecainide, and ranolazine could be treatment options in LQT3.
Electrophysiological toxicity testing of VEGF Trap‐Eye in an isolated perfused vertebrate retina organ culture model
Authors: Januschowski Kai , Schnichels Sven , Hagemann Ulrike , Koch Vanessa , Hofmann Johanna , Spitzer Martin S. , Bartz‐Schmidt Karl‐Ulrich , Szurman Peter , Lüke Matthias , Aisenbrey Sabine
Published: November 2013

Purpose

Age‐related macular degeneration (AMD) is the leading cause of visual impairment in Western nations. Since the discovery of the importance of vascular endothelial growth factor (VEGF) in the pathogenesis of neovascular AMD, anti‐VEGF agents including pegaptanib, ranibizumab and bevacizumab provide a treatment option to improve vision in affected persons. VEGF Trap‐Eye (Aflibercept) is a new agent available for the treatment of exudative AMD. The molecule is a receptor decoy with a longer half‐life and a higher affinity to VEGF compared with ranibizumab or bevacizumab. The presented study has been designed to evaluate the short‐term toxic effects of VEGF Trap‐Eye on retinal function during and after direct exposure to the drug.

Methods

Isolated bovine retinas were perfused with an oxygen‐saturated nutrient solution, and the electroretinogram (ERG) was recorded using silver/silver chloride electrodes. A total of 0.5 mg or 2 mg VEGF Trap‐Eye was added to the nutrient solution and retinas were exposed for 45 min, followed by a washout period of 100 min. The percentage of a‐ and b‐wave reduction at the end of the washout was compared with the baseline values. Additionally, retinal whole mount cultures were exposed for 24 hr to VEGF Trap‐Eye, and the amount of apoptotic cells were determined using the terminal deoxynucleotidyl transferase‐mediated uridine 5'‐triphosphate‐biotin nick end labelling (TUNEL) assay.

Results

During simulation of intraocular application, no significant reduction in the a‐wave amplitude for 0.5 mg (2.70%, p = 0.37) and 2 mg (3.84%, p = 0.37) VEGF Trap‐Eye and b‐wave amplitude for 0.5 mg (19.68%, p = 0.17) and 2 mg (24.1%, p = 0.06) VEGF Trap‐Eye was observed at the end of the washout. However, there were significant changes in a‐wave and b‐wave amplitudes directly after exposure to 0.5 mg VEGF Trap‐Eye (18.4%, p = 0.004 and 43.1%, p = 0.006, respectively).

Conclusions

The presented data suggest that intraocular application of up to 2 mg VEGF Trap‐Eye does not induce irreversible toxic retinal damage. However, short‐term results showed a negative effect directly after the application for 0.5 mg and 2 mg VEGF Trap‐Eye.
Effect of body position on preterm newborns receiving continuous positive airway pressure
Authors: Brunherotti Marisa AA , Martinez Edson Z , Martinez Francisco E
Published: November 2013

Aim

To evaluate the effect of body position on the cardiorespiratory indicators of preterm newborns receiving nasal continuous positive airway pressure (CPAP).

Methods

Analytical, observational, prospective, cross‐sectional, randomised crossover study was carried out on sixteen newborns that received nasal CPAP. The infants had a mean gestational age of 29.7 ± 2 weeks and birthweight of 1353 ± 280 g. Cardiorespiratory indicators (respiratory rate, heart rate and oxygen saturation) were evaluated in each infant in the supine, prone and right and left lateral decubitus positions at intervals of 10 min over a period of 60 min.

Results

The cardiorespiratory indicators were similar and within the normal range in the four decubitus positions. There was no difference in respiratory or heart rate between body positions. Although they showed desirable values, oxygen saturation was significantly lower in left lateral decubitus (96.6 ± 1.7%) when compared to the supine (97.1 ± 1.3%) and prone positions (97.4 ± 1.1%) (p = 0.00) and was also significantly lower in right lateral decubitus (96.9 ± 1.4%) when compared to the prone position (p = 0.00).

Conclusion

We found no preferential decubitus position for preterm newborns receiving nasal CPAP, the supine position may be a choice, but the left and right lateral positions were less advantageous in terms of oxygen saturation.
Endothelin‐1 signalling controls early embryonic heart rate in vitro and in vivo
Authors: Karppinen S. , Rapila R. , Mäkikallio K. , Hänninen S. L. , Rysä J. , Vuolteenaho O. , Tavi P.
Published: November 2013

Aim

Spontaneous activity of embryonic cardiomyocytes originates from sarcoplasmic reticulum (SR) Ca2+ release during early cardiogenesis. However, the regulation of heart rate during embryonic development is still not clear. The aim of this study was to determine how endothelin‐1 (ET‐1) affects the heart rate of embryonic mice, as well as the pathway through which it exerts its effects.

Methods

The effects of ET‐1 and ET‐1 receptor inhibition on cardiac contraction were studied using confocal Ca2+ imaging of isolated mouse embryonic ventricular cardiomyocytes and ultrasonographic examination of embryonic cardiac contractions in utero. In addition, the amount of ET‐1 peptide and ET receptor a (ETa) and b (ETb) mRNA levels were measured during different stages of development of the cardiac muscle.

Results

High ET‐1 concentration and expression of both ETa and ETb receptors was observed in early cardiac tissue. ET‐1 was found to increase the frequency of spontaneous Ca2+ oscillations in E10.5 embryonic cardiomyocytes in vitro. Non‐specific inhibition of ET receptors with tezosentan caused arrhythmia and bradycardia in isolated embryonic cardiomyocytes and in whole embryonic hearts both in vitro (E10.5) and in utero (E12.5). ET‐1‐mediated stimulation of early heart rate was found to occur via ETb receptors and subsequent inositol trisphosphate receptor activation and increased SR Ca2+ leak.

Conclusion

Endothelin‐1 is required to maintain a sufficient heart rate, as well as to prevent arrhythmia during early development of the mouse heart. This is achieved through ETb receptor, which stimulates Ca2+ leak through IP3 receptors.
Improving Amphetamine Therapeutic Selectivity: N,N‐dimethyl‐MTA has Dopaminergic Effects and does not Produce Aortic Contraction
Authors: Sotomayor‐Zárate Ramón , Jara Pablo , Araos Patricio , Vinet Raúl , Quiroz Gabriel , Renard Georgina M. , Espinosa Pedro , Hurtado‐Guzmán Claudio , Moya Pablo R. , Iturriaga‐Vásquez Patricio , Gysling Katia , Reyes‐Parada Miguel
Published: November 2013

Amphetamine derivatives have therapeutic potential in diseases such as attention deficit hyperactivity disorder, narcolepsy and obesity. However, their prolonged use has been associated with cardiovascular toxicity and addiction. In recent years, we have studied the pharmacological effects of amphetamine derivatives such as methylthioamphetamine (MTA) and N,N‐dimethyl‐thioamphetamine, with the aim of improving their therapeutic selectivity. In this work, we show that similarly to MTA, N,N‐dimethyl‐thioamphetamine has effects on the dopamine system, producing a significant increase in extracellular levels of dopamine (as measured by in vivo brain microdialysis) and locomotor activity, which is a behavioural measure of dopaminergic activation. However, unlike MTA, N,N‐dimethyl‐ thioamphetamine does not produce aortic contraction in vitro. Our results show that N,N‐dimethyl‐thioamphetamine is a drug that retains the dopaminergic effects of amphetamine derivatives but exhibits a lower potential for producing cardiovascular side effects.
Moral Distress and Moral Conflict in Clinical Ethics
Authors: Fourie Carina
Published: November 2013

Much research is currently being conducted on health care practitioners' experiences of moral distress, especially the experience of nurses. What moral distress is, however, is not always clearly delineated and there is some debate as to how it should be defined. This article aims to help to clarify moral distress. My methodology consists primarily of a conceptual analysis, with especial focus on Andrew Jameton's influential description of moral distress.

I will identify and aim to resolve two sources of confusion about moral distress: (1) the compound nature of a narrow definition of distress which stipulates a particular cause, i.e. moral constraint, and (2) the distinction drawn between moral dilemma (or, more accurately, moral conflict) and moral distress, which implies that the two are mutually exclusive.

In light of these concerns, I argue that the definition of moral distress should be revised so that moral constraint should not be a necessary condition of moral distress, and that moral conflict should be included as a potential cause of distress. Ultimately, I claim that moral distress should be understood as a specific psychological response to morally challenging situations such as those of moral constraint or moral conflict, or both.
Fleshing Out Vulnerability
Authors: Tavaglione Nicolas , Martin Angela K. , Mezger Nathalie , Durieux‐Paillard Sophie , François Anne , Jackson Yves , Hurst Samia A.
Published: November 2013

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged – that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care – thus fleshing out a claim‐based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self‐respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice.
Specific Language Impairment Across Languages
Authors: Leonard Laurence B.
Published: November 2013

Children with specific language impairment (SLI) have a significant and longstanding deficit in spoken language ability that adversely affects their social and academic well‐being. Studies of children with SLI in a wide variety of languages reveal diverse symptoms, most of which seem to reflect weaknesses in grammatical computation and phonological short‐term memory. The symptoms of the disorder are sensitive to the type of language being acquired, with extraordinary weaknesses seen in those areas of language that are relatively challenging for younger typically developing children. Although these children's deficits warrant clinical and educational attention, their weaknesses might reflect the extreme end of a language aptitude continuum rather than a distinct, separable condition.
Visual scoring of non cavitated caries lesions and clinical trial efficiency, testing xylitol in caries‐active adults
Authors: Brown John P. , Amaechi Bennett T. , Bader James D. , Gilbert Gregg H. , Makhija Sonia K. , Lozano‐Pineda Juanita , Leo Michael C. , Chen Chuhe , Vollmer William M.
Published: November 2013

Objectives

To better understand the effectiveness of xylitol in caries prevention in adults and to attempt improved clinical trial efficiency.

Methods

As part of the Xylitol for Adult Caries Trial (X‐ACT), non cavitated and cavitated caries lesions were assessed in subjects who were experiencing the disease. The trial was a test of the effectiveness of 5 g/day of xylitol, consumed by dissolving in the mouth five 1 g lozenges spaced across each day, compared with a sucralose placebo. For this analysis, seeking trial efficiency, 538 subjects aged 21–80, with complete data for four dental examinations, were selected from the 691 randomized into the 3‐year trial, conducted at three sites. Acceptable inter‐ and intra‐examiner reliability before and during the trial was quantified using the kappa statistic.

Results

The mean annualized noncavitated plus cavitated lesion transition scores in coronal and root surfaces, from sound to carious favoured xylitol over placebo, during the three cumulative periods of 12, 24, and 33 months, but these clinically and statistically nonsignificant differences declined in magnitude over time. Restricting the present assessment to those subjects with a higher baseline lifetime caries experience showed possible but inconsistent benefit.

Conclusions

There was no clear and clinically relevant preventive effect of xylitol on caries in adults with adequate fluoride exposure when non cavitated plus cavitated lesions were assessed. This conformed to the X‐ACT trial result assessing cavitated lesions. Including non cavitated lesion assessment in this full‐scale, placebo‐controlled, multisite, randomized, double‐blinded clinical trial in adults experiencing dental caries did not achieve added trial efficiency or demonstrate practical benefit of xylitol. Trial Registration: ClinicalTrials.Gov NCT00393055.
Molecular analyses of novel ASAH1 mutations causing Farber lipogranulomatosis: analyses of exonic splicing enhancer inactivating mutation
Authors: Bashyam M.D. , Chaudhary A.K. , Kiran M. , Reddy V. , Nagarajaram H.A. , Dalal A. , Bashyam L. , Suri D. , Gupta A. , Gupta N. , Kabra M. , Puri R.D. , RamaDevi R. , Kapoor S. , Danda S.
Published: November 2013

Farber lipogranulomatosis is a rare autosomal recessive lysosomal storage disorder caused by mutations in the ASAH1 gene. In the largest ever study, we identified and characterized ASAH1 mutations from 11 independent Farber disease (FD) families. A total of 13 different mutations were identified including 1 splice, 1 polypyrimidine tract (PPT) deletion and 11 missense mutations. Eleven mutations were exclusive to the Indian population. The IVS6+4A>G splice and IVS5‐16delTTTTC PPT deletion mutations resulted in skipping of exon 6 precluding thereby the region responsible for cleavage of enzyme precursor. A missense mutation (p.V198A) resulted in skipping of exon 8 due to inactivation of an exonic splicing enhancer (ESE) element. This is the first report of mutations affecting PPT and ESE in the ASAH1 gene resulting in FD.
Communication and technology in genetic counseling for familial cancer
Authors: Lynch H.T. , Snyder C. , Stacey M. , Olson B. , Peterson S.K. , Buxbaum S. , Shaw T. , Lynch P.M.
Published: November 2013

When a cancer predisposing germline mutation is detected in an index case, the presence of the underlying syndrome is confirmed and the potential for predictive testing of at‐risk relatives is established. However, the reporting of a positive family history does not routinely lead to communication of information about risk to close, much less distant relatives. This review summarizes information technology utilized to address penetration or ‘reach’ of knowledge of risk within extended families, including the use of telephone and video counseling to reach distant patients, and anticipate novel internet‐based processes for communication between investigators and relatives.
Chinese herbal medicine for idiopathic sudden sensorineural hearing loss: a systematic review of randomised clinical trials
Authors: Su C.‐X. , Yan L.‐J. , Lewith G. , Liu J.‐P.
Published: November 2013

Background

Idiopathic sudden sensorineural hearing loss has great impact on quality of life. Many clinical trials using Chinese herbal medicine for idiopathic sudden sensorineural hearing loss have been conducted and reported beneficial results. However, there is no critical appraised evidence on efficacy and safety of Chinese herbal medicine for idiopathic sudden sensorineural hearing loss to inform clinical use.

Objective of review

To assess the beneficial effect and safety of Chinese herbal medicine for idiopathic sudden sensorineural hearing loss.

Type of review

Systematic review of randomised clinical trials.

Search strategy

Seven electronic databases and two trial registries were searched for all eligible trials from inception to January 2013.

Evaluation method

Two authors independently selected trials and extracted data. The Cochrane risk of bias tool was utilised to assess the methodological quality of the included trials. revman 5.2 software was applied for data analysis with effect estimate presented as risk ratio and mean difference with its 95% confidence interval.

Results

Forty‐one randomised clinical trials involving 3560 participants were identified. Five kinds of Chinese herbal medicine were trialed. All trials compared conventional therapies of steroids, vasodilaltors, anticoagulants, nutritional supplements or hyperbaric oxygen with or without herbal medicine. No trial was identified that compared herbal medicine alone with placebo. No trial was identified that blinded the participants or the observers to their herbal medication. Only one trial adequately reported its method of randomisation. No trial reported the sample size calculated to show an effect. All trials had material other defects giving a high likelihood of bias. Because of the overall poor quality of all 41 trials, it was concluded that there was no level‐one evidence to support the use of Chinese herbal medicine, alone or in addition to conventional therapies, to improve the hearing in adults with idiopathic sudden sensorineural hearing loss. Two trials reported adverse effects, and no severe adverse effects were found in the Chinese herbal medicine groups.

Conclusions

The existing evidence for the beneficial effect and safety of Chinese herbal medicine for idiopathic sudden sensorineural hearing loss comes from methodologically poor studies and therefore cannot be reliably used to support their clinical use. We identify a justification to further investigate the effect and safety of Chinese herbal medicine for people with idiopathic sudden sensorineural hearing loss in rigorously designed randomised trials.
Identifying Barriers to Healthcare to Reduce Health Disparity in Zuni Indians Using Focus Group Conducted by Community Health Workers
Authors: Shah Vallabh O. , Ghahate Donica M , Bobelu Jeanette , Sandy Phillip , Newman Sara , Helitzer Deborah L. , Faber Thomas , Zager Philip
Published: November 2013

The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo.

Community health representatives (CHRs) led 14 one‐hour focus group sessions at which a total of 112 people participated posed unique questions that took into account the Zuni culture to elicit information on perceived barriers to healthcare. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program.

We identified nine themes emerged regarding the barriers experienced in receiving healthcare and adhering to medical advice. These included distance; transportation; embarrassment; relating to healthcare professionals; navigating the medical system; awareness of available resources; waiting times; adhering to medication; and incentives in health promotion.

In conclusion the implementation of culturally appropriate community‐based health promotion programs and preventive screening techniques will improve access to healthcare and diminish health disparities.
Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology
Authors: Osawa Hiroyuki , Yamamoto Hironori
Published: November 2013

The usefulness of flexible spectral imaging color enhancement (FICE) has been reported for evaluating the esophagus, stomach, and small and large intestine. Higher contrast is shown between cancer and the surrounding mucosa in the esophagus and stomach and may facilitate the detection of gastric cancers missed by white light imaging alone. The surface patterns of gastric mucosa are clearly visualized in non‐malignant areas but are irregular and blurred in malignant areas, leading to clear demarcation. Capsule endoscopy with FICE detects angiodysplasia and erosions of the small intestine. The surface and vascular pattern with FICE is useful for the differential diagnosis of colorectal polyps. However, FICE remains somewhat poor at visualizing mucosal microvasculature on a tumor surface. Narrow‐band imaging (NBI) is dark in observing whole gastric mucosa and poor at visualizing mucosal microstructure. Blue laser imaging (BLI) has the potential to resolve these limitations. Narrow‐band laserlight combined with white light shows irregular microvessels on both differentiated and undifferentiated gastric cancer similar to those using NBI. In addition, irregular surface patterns including minute white zones are clearly seen on the uneven surface of differentiated lesions, resulting in exclusion of undifferentiated lesions. Using both distant and close‐up views, a high contrast between green intestinal metaplasia and brown gastric cancer may lead to early detection of gastric cancers and determination of a demarcation line. BLI produces high‐contrast images in esophageal cancer with clear vision of intrapapillary capillary loops and also predicts the histopathological diagnosis and depth of invasion in colorectal neoplasms.
The Social Value of Knowledge and International Clinical Research
Authors: Wenner Danielle M.
Published: November 2013

In light of the growth in the conduct of international clinical research in developing populations, this paper seeks to explore what is owed to developing world communities who host international clinical research. Although existing paradigms for assigning and assessing benefits to host communities offer valuable insight, I criticize their failure to distinguish between those benefits which can justify the conduct of research in a developing world setting and those which cannot. I argue that the justification for human subjects research is fundamentally grounded in the social value of knowledge, and that this value is context‐dependent in a manner which should inform our ethical evaluation of the conduct of research in specific settings. I propose a new framework for the assessment of research benefits assigned to developing world host communities, a natural implication of which is to limit the types of research projects which may permissibly be conducted in developing world settings.
Mind the gap: An empirical study of post‐trial access in HIV biomedical prevention trials
Authors: Haire Bridget , Jordens Christopher
Published: November 2013

The principle of providing post‐trial access for research participants to successful products of that research is widely accepted and has been enshrined in various declarations and guidelines. While recent ethical guidelines recognise that the responsibility to provide post‐trial access extends to sponsors, regulators and government bodies as well as to researchers, it is the researchers who have the direct duty of care to participants. Researchers may thus need to act as advocates for trial participants, especially where government bodies, sponsors, and regulatory bodies have complex interests vested in decisions about whether or not new interventions are made available, how, and to whom. This paper provides an empirical account of post‐trial access in the context of HIV prevention research. It describes both access to the successful products of research and the provision antiretroviral drugs for trial participants who acquire HIV. First, we provide evidence that, in the current system, there is considerable variation in the duration and timeliness of access. We then argue that by analysing the difficulties faced by researchers to this point, and their efforts to meet this obligation, much can be learned about how to secure post‐trial access in HIV biomedical preventions trials. While researchers alone have a limited obligation, their advocacy on behalf of trial participants may be necessary to call the other parties to account.
Overcoming Entrenched Disagreements: the Case of Misoprostol for Post‐Partum Haemorrhage
Authors: Ghinea Narcyz , Lipworth Wendy , Little Miles , Kerridge Ian , Day Richard
Published: November 2013

The debate about whether misoprostol should be distributed to low resource communities to prevent post‐partum haemorrhage (PPH), recognised as a major cause of maternal mortality, is deeply polarised. This is in spite of stakeholders having access to the same evidence about the risks and benefits of misoprostol. To understand the disagreement, we conducted a qualitative analysis of the values underpinning debates surrounding community distribution of misoprostol. We found that different moral priorities, epistemic values, and attitudes towards uncertainty were the main factors sustaining the debate. With this understanding, we present a model for ethical discourse that might overcome the current impasse.
Normative values for the Timed ‘Up and Go’ test in children and adolescents and validation for individuals with Down syndrome
Authors: Nicolini‐Panisson Renata D'Agostini , Donadio Márcio V F
Published: November 2013

Aim

To determine normative values for the Timed Up and Go (TUG) test in typically developing children and adolescents and to validate its use in individuals with Down syndrome.

Method

Participants in this cross‐sectional study were South Brazilian schoolchildren aged 3 to 18 years. In phase 1, 459 typically developing individuals (227 males, 232 females; mean age 10y 8mo (SD 4y 4mo) were included; and in phase 2, 40 individuals with Down syndrome (16 males, 24 females; mean age 10y 6mo (SD 4y 4mo). Anthropometric measurements, real leg length, TUG test scores, and Gross Motor Function Measure (GMFM) scores were evaluated. The association between the TUG test and possible predictive variables was analyzed.

Results

In phase 1, the mean time to perform the TUG test was 5.61 seconds (SD 1.06). Values were stratified in age groups that served as normative data for both sexes. A multiple linear regression analysis was conducted and the best variables to predict TUG scores were age and weight. The best model obtained presented an R2 of 0.25 and a standard error of the estimate of 0.92. Excellent intrasession reliability in the three tests performed (intraclass correlation coefficient [ICC] of 0.93, 0.94, and 0.95) and between the sessions (both with an ICC of 0.95) was demonstrated. In phase 2, the test also showed excellent reproducibility (ICC=0.82 between the two tests performed). The performance time was significantly longer (p<0.001) in individuals with Down syndrome compared with sex‐ age‐, and weight‐matched typically developing children with a mean difference of −3.53 (95% confidence interval −4.05 to −3.00). Dimension E of the GMFM (Walking, Running and Jumping) showed the highest correlation (r=−0.55, p<0.001) with the test.

Interpretation

This study provides normative values for the TUG test and shows that TUG scores can be predicted as a function of age and weight in typically developing individuals. The test can also be used for assessment of functional mobility in individuals with Down syndrome.
Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review
Authors: Hartling L. , Dryden D. M. , Guthrie A. , Muise M. , Vandermeer B. , Donovan L.
Published: November 2013

Aims

To assess different diagnostic thresholds for gestational diabetes on outcomes for mothers and their offspring in the absence of treatment for gestational diabetes. This information was used to inform a National Institutes of Health consensus conference on diagnosing gestational diabetes.

Methods

We searched 15 electronic databases from 1995 to May 2012. Study selection was conducted independently by two reviewers. Randomized controlled trials or cohort studies were eligible if they involved women without known pre‐existing diabetes mellitus and who did not undergo treatment for gestational diabetes. One reviewer extracted, and a second reviewer verified, data for accuracy. Two reviewers independently assessed methodological quality.

Results

Thirty‐eight studies were included. Three large, methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of Caesarean section and macrosomia. When data were examined categorically (i.e. women meeting or not meeting specific diagnostic thresholds), women with gestational diabetes across all glucose criteria had significantly more Caesarean sections, shoulder dystocia, macrosomia (except for International Association of Diabetes in Pregnancy Study Groups’ criteria) and large for gestational age. Higher glucose thresholds did not consistently demonstrate greater risk for all outcomes.

Conclusions

Higher glucose thresholds did not consistently demonstrate greater risk, possibly because studies did not compare mutually exclusive groups of women. A pragmatic approach for diagnosis of gestational diabetes using Hyperglycemia and Adverse Pregnancy Outcome Study odds ratio 2.0 thresholds warrants further consideration until additional analysis of the data comparing mutually exclusive groups of women is provided and large randomized controlled trials investigating different diagnostic and treatment thresholds are completed.
Are bedtime nutritional strategies effective in preventing nocturnal hypoglycaemia in patients with type 1 diabetes?
Authors: Desjardins K. , Brazeau A.‐S. , Strychar I. , Rabasa‐Lhoret R.
Published: November 2013

Hypoglycaemia remains the major limiting factor for adequate diabetes control for patients with type 1 diabetes (T1D), especially during the night‐time. Although nutritional strategies for nocturnal hypoglycaemia (NH) prevention are regularly suggested in clinical practice, there is no evidence‐based recommendation for the usefulness and optimal composition of a bedtime snack. The aim of this narrative review was to analyse the current state of knowledge on nutritional strategies to prevent NH in individuals with T1D. A literature search was conducted, using PubMed and Medline (1946 to 2013); 16 studies were retrieved. Overall, the level of evidence was low. Results indicated that a calibrated bedtime snack based on bedtime blood glucose (BG) level could be effective to reduce NH occurrence for patients treated with human or animal insulin (short‐acting combined with lente, ultralente and/or intermediate‐acting insulin), but there is no evidence for patients treated with insulin analogues as part of multiple daily injections or insulin pump regimen. Some evidence suggests that including uncooked cornstarch or alanine in the bedtime snack composition could provide some benefits for the prevention of NH. Individualized recommendations of a bedtime snack intake for patients or situations at high risk for NH (long standing diabetes, hypoglycaemia unawareness, prior physical activity, alcohol consumption, bedtime BG close to hypoglycaemia threshold) appear as a prudent recommendation. On the basis of the available evidence, a bedtime snack cannot be recommended systematically but it might be useful if prescribed in an individualized fashion; further research is needed to evaluate these strategies.
Optimal control of population recovery – the role of economic restoration threshold
Authors: Lampert Adam , Hastings Alan
Published: November 2013

A variety of ecological systems around the world have been damaged in recent years, either by natural factors such as invasive species, storms and global change or by direct human activities such as overfishing and water pollution. Restoration of these systems to provide ecosystem services entails significant economic benefits. Thus, choosing how and when to restore in an optimal fashion is important, but has not been well studied. Here we examine a general model where population growth can be induced or accelerated by investing in active restoration. We show that the most cost‐effective method to restore an ecosystem dictates investment until the population approaches an ‘economic restoration threshold’, a density above which the ecosystem should be left to recover naturally. Therefore, determining this threshold is a key general approach for guiding efficient restoration management, and we demonstrate how to calculate this threshold for both deterministic and stochastic ecosystems.
Interpopulation Variations in Behavioral Syndromes of a Jumping Spider from Insecticide‐Treated and Insecticide‐Free Orchards
Authors: Royauté Raphaël , Buddle Christopher M. , Vincent Charles
Published: November 2013

Variations in environmental conditions can influence behavioral syndromes (correlated tendencies in behaviors), and understanding the factors that shape trait covariation is particularly relevant when species are challenged by environmental changes. We investigated how behavioral syndromes varied at extremes of a gradient of anthropogenic disturbance, using apple orchards with different histories of insecticidal applications as a model system. Eris militaris (Araneae: Salticidae) jumping spiders were sampled from an insecticide‐free orchard and an insecticide‐treated orchard from Southern Québec. Spiders were tested for activity, aggression, boldness, and voracity under standardized conditions. Behavioral syndrome structure was compared between the two populations using Bayesian multiresponse models and structural equation modeling. Syndrome structure differed significantly between the two populations. The insecticide‐free population showed evidence of a syndrome involving all measured traits, while only aggression, boldness and voracity were correlated in the insecticide‐treated population. The insecticide‐free population showed negative correlations between active and voracious behavioral types vs. aggressive and bold types while the insecticide‐treated population showed a negative correlation between aggression‐boldness and voracity. This research is a first step in investigating the impact of anthropogenic disturbances on behavioral syndromes and demonstrates that behavioral syndromes may vary with respect to insecticidal applications.