bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Affecting Prestocking Coded Wire Tag Loss in Lake Trout Tagged by an Automated System
Authors: Kornis Matthew S. , Pankow Kevin W. , Lane Allen A. , Webster James L. , Bronte Charles R.
Published: June 2016

Tag loss is an important consideration in tagging studies. We used two approaches to describe prestocking coded wire tag (CWT) loss in Lake Trout Salvelinus namaycush tagged by an automated tagging system and released in the Laurentian Great Lakes. First, four strains of Lake Trout tagged by an automated system through the Great Lakes Mass Marking Program were observed for up to 254 d to describe how tag loss and adipose fin clip success relates to time posttagging. Second, we also evaluated final tag loss and fin clip success from 197 tag lots from 2011 to 2013 that were tagged with an automated system to explore the factors affecting tag loss and fin clip success, and to compare tag loss and fin clip success rates with those from 1,080 tag lots from 1985 to 2003 that were manually tagged. Coded wire tag losses from experimental lots of four strains of Lake Trout were low and ranged from 2.8% to 5.7%. Coded wire tag losses stabilized 150 d posttagging, when fish had a mean length of 131 mm, which is far longer than that reported for other salmonines (30 d). We developed a descriptive model to correct for time effects on tag loss; tag loss could be estimated with high confidence after 100 d posttagging. Coded wire tag losses varied by genetic strain, possibly due to differences in body size and shape. Fish that lost a CWT were significantly smaller than fish retaining a CWT. In our comparison of the automated system with manual tagging, CWT loss across 197 automated tag lots was highly variable (0.0–14.0%), but it was <5.5% in 86% of samples and less than the loss rates from manually tagged fish (<5.5% in 72% of samples). Our results provide important details for CWT studies on Lake Trout and other species.

Received July 28, 2015; accepted February 7, 2016 Published online June 1, 2016
Enzymatic synthesis of novel oligosaccharides from N-acetylsucrosamine and melibiose using Aspergillus niger α-galactosidase, and properties of the products
Authors: Sakaki Yohei , Tashiro Mitsuru , Katou Moe , Sakuma Chiseko , Hirano Takako , Hakamata Wataru , Nishio Toshiyuki
Published: June 2016

Two kinds of oligosaccharides, N-acetylraffinosamine (RafNAc) and N-acetylplanteosamine (PlaNAc), were synthesized from N-acetylsucrosamine and melibiose using the transgalactosylation activity of Aspergillus niger α-galactosidase. RafNAc and PlaNAc are novel trisaccharides in which d-glucopyranose residues in raffinose (Raf) and planteose are replaced with N-acetyl-d-glucosamine. These trisaccharides were more stable in acidic solution than Raf. RafNAc was hydrolyzed more rapidly than Raf by α-galactosidase of green coffee bean. In contrast, RafNAc was not hydrolyzed by Saccharomyces cerevisiae invertase, although Raf was hydrolyzed well by this enzyme. These results indicate that the physicochemical properties and steric structure of RafNAc differ considerably from those of Raf.
Adaption of microbial community during the start-up stage of a thermophilic anaerobic digester treating food waste
Authors: Wu Bo , Wang Xing , Deng Ya-Yue , He Xiao-Lan , Li Zheng-Wei , Li Qiang , Qin Han , Chen Jing-Tao , He Ming-Xiong , Zhang Min , Hu Guo-Quan , Yin Xiao-Bo
Published: June 2016

A successful start-up enables acceleration of anaerobic digestion (AD) into steady state. The microbial community influences the AD performance during the start-up. To investigate how microbial communities changed during the start-up, microbial dynamics was analyzed via high-throughput sequencing in this study. The results confirmed that the AD was started up within 25 d. Thermophilic methanogens and bacterial members functioning in hydrolysis, acidogenesis, and syntrophic oxidation became predominant during the start-up stage, reflecting a quick adaption of microorganisms to operating conditions. Such predominance also indicated the great contribution of these members to the fast start-up of AD. Redundancy analysis confirmed that the bacterial abundance significantly correlated with AD conditions. The stable ratio of hydrogenotrophic methanogens to aceticlastic methanogens is also important to maintain the stability of the AD process. This work will be helpful to understand the contribution of microbial community to the start-up of AD.
Shared Structuring Resources across Domains: Double Task Effects from Linguistic Processing on the Structural Integration of Pitch Sequences
Authors: Van de Cavey Joris , Severens Els , Hartsuiker Robert J.
Published: June 2016

Many studies have reported evidence suggesting that resources involved in linguistic structural processing might be domain-general by demonstrating interference from simultaneously presented non-linguistic stimuli on the processing of sentences (Slevc, Rosenberg, & Patel, 2009). However, the complexity of the analysed linguistic processes often precludes the interpretation of such interference as being based on structural—rather than more general—processing resources (Perruchet & Poulin-Charronnat, 2013). We therefore used linguistic structure as a source of interference for another structural processing task, by asking participants to read sentences while processing experimentally manipulated pitch sequences. Half of the sentences contained a segment with either an “out-of-context” sentential violation or a “garden path” unexpectancy. Furthermore, the pitch sequences contained a cluster shift, which did or did not align with the sentential unexpectancies. A two-tone recognition task followed each pitch sequence, providing an index of the strength with which this structural boundary was processed. When a “garden path” unexpectancy (requiring structural reintegration) accompanied the cluster shift, the structural boundary induced by this shift was processed more shallowly. No such effect occurred with non-reintegratable “out-of-context” sentential violations. Furthermore, the discussed interference effect can be isolated from general pitch recognition performance, supporting the interpretation of such interference as being based on overlapping structural processing resources (Kljajevic, 2010; Patel, 2003).
Boccaccio and the Early Modern Reception of Tragedy
Authors: Kriesel James C.
Published: June 2016

Fourteenth-century Italian humanists discussed the properties of tragedy while considering the value of Latin versus vernacular literature. Boccaccio was interested in these discussions because humanists were promoting classicizing tragic and epic literatures at the expense of vernacular writing. This article explores Boccaccio’s role in these debates by examining the tragic stories of the Decameron. It suggests that Boccaccio highlighted the virtues of his erotic tales by contrasting them to the tragic stories of day 4, a strategy inspired by Ovid’s elegiac poems. Boccaccio thus underscored the dignity of his low, Ovidian-inspired Decameron, and counterbalanced humanist fascination with high tragic-epic literatures.
The Emerging Role of Epigenetics in Pulmonary Arterial Hypertension: An Important Avenue for Clinical Trials (2015 Grover Conference Series)
Authors: Huston Jessica H. , Ryan John J.
Published: June 2016

Epigenetics is an emerging field of research and clinical trials in cancer therapy that also has applications for pulmonary arterial hypertension (PAH), as there is evidence that epigenetic control of gene expression plays a significant role in PAH. The three types of epigenetic modification include DNA methylation, histone modification, and RNA interference. All three have been shown to be involved in the development of PAH. Currently, the enzymes that perform these modifications are the primary targets of neoplastic therapy. These targets are starting to be explored for therapies in PAH, mostly in animal models. In this review we summarize the basics of each type of epigenetic modification and the known sites and molecules involved in PAH, as well as current targets and prospects for clinical trials.
Sphingosine‐1‐Phosphate is Involved in the Occlusive Arteriopathy of Pulmonary Arterial Hypertension
Authors: Gairhe Salina , Joshi Sachindra R. , Bastola Mrigendra M. , McLendon Jared M. , Oka Masahiko , Fagan Karen A. , McMurtry Ivan F.
Published: June 2016

Despite several advances in the pathobiology of pulmonary arterial hypertension (PAH), its pathogenesis is not completely understood. Current therapy improves symptoms but has disappointing effects on survival. Sphingosine‐1‐phosphate (S1P) is a lysophospholipid synthesized by sphingosine kinase 1 (SphK1) and SphK2. Considering the regulatory roles of S1P in several tissues leading to vasoconstriction, inflammation, proliferation, and fibrosis, we investigated whether S1P plays a role in the pathogenesis of PAH. To test this hypothesis, we used plasma samples and lung tissue from patients with idiopathic PAH (IPAH) and the Sugen5416/hypoxia/normoxia rat model of occlusive PAH. Our study revealed an increase in the plasma concentration of S1P in patients with IPAH and in early and late stages of PAH in rats. We observed increased expression of both SphK1 and SphK2 in the remodeled pulmonary arteries of patients with IPAH and PAH rats. Exogenous S1P stimulated the proliferation of cultured rat pulmonary arterial endothelial and smooth‐muscle cells. We also found that 3 weeks of treatment of late‐stage PAH rats with an SphK1 inhibitor reduced the increased plasma levels of S1P and the occlusive pulmonary arteriopathy. Although inhibition of SphK1 improved cardiac index and the total pulmonary artery resistance index, it did not reduce right ventricular systolic pressure or right ventricular hypertrophy. Our study supports that S1P is involved in the pathogenesis of occlusive arteriopathy in PAH and provides further evidence that S1P signaling may be a novel therapeutic target.
Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension
Authors: Sivak Joseph A. , Raina Amresh , Forfia Paul R.
Published: June 2016

Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH‐specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSERA) and that occurring before RA contraction (TAPSERV). RA fractional area change (RA‐FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one‐third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA‐FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSERA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects.
TetrahymenaPoc1 ensures proper intertriplet microtubule linkages to maintain basal body integrity
Authors: Meehl Janet B. , Bayless Brian A. , Giddings Thomas H. , Pearson Chad G. , Winey Mark
Published: June 2016

Basal bodies comprise nine symmetric triplet microtubules that anchor forces produced by the asymmetric beat pattern of motile cilia. The ciliopathy protein Poc1 stabilizes basal bodies through an unknown mechanism. In poc1∆ cells, electron tomography reveals subtle defects in the organization of intertriplet linkers (A-C linkers) that connect adjacent triplet microtubules. Complete triplet microtubules are lost preferentially near the posterior face of the basal body. Basal bodies that are missing triplets likely remain competent to assemble new basal bodies with nine triplet microtubules, suggesting that the mother basal body microtubule structure does not template the daughter. Our data indicate that Poc1 stabilizes basal body triplet microtubules through linkers between neighboring triplets. Without this stabilization, specific triplet microtubules within the basal body are more susceptible to loss, probably due to force distribution within the basal body during ciliary beating. This work provides insights into how the ciliopathy protein Poc1 maintains basal body integrity.
How Women in Biomedical PhD Programs Manage Gender Consciousness as They Persist Toward Academic Research Careers
Authors: Remich Robin , Jones Remi , Wood Christine V. , Campbell Patricia B. , McGee Richard
Published: June 2016

Purpose

Women remain underrepresented as biomedical faculty and are more likely than white and Asian men to lose interest in faculty careers in graduate school. However, some women maintain interest in academic research careers during PhD training and are the most likely candidates for faculty positions. This study explored how these women described and interpreted gender issues at early stages in their training.

Method

Annual interviews from 2009 to 2014 with 22 female PhD students aspiring to research faculty careers were analyzed using an iterative, content analysis approach rooted in the interview data. Focusing on career intentions and experiences with gender, race, and ethnicity, authors arrived at 11 themes which describe a range of gendered experiences and strategies.

Results

Of the 22 women, 19 (86%) acknowl edged systemic gender inequities in science and/or reported instances of bias, while 15 of them also said they had not yet experienced unequal treatment. All 22 described using at least one “gender-explicit strategy,” where they based decisions on gender or in response to perceived biases. “Gender-agnostic strategies” emerged for 12 (55%) who doubted that gender will affect their career.

Conclusions

Findings show that women biomedical PhD students continue to face conditions that can lead to unequal treatment; gender biases continue to persist. Students displayed a range of perceptions and strategies in response to these conditions at this early training stage. Following these students over time will determine whether these or other strategies are required and sufficient to enable persistence toward academic careers.
Prediction of Postoperative Pain From Electrical Pain Thresholds After Laparoscopic Cholecystectomy
Authors: Persson Anna K.M. , Dyrehag Lars-Erik , Åkeson Jonas
Published: June 2016

Objective:

Early postoperative pain correlates to persisting pain, psychosocial distress, and delayed mobilization with thromboembolic and infectious complications. Electrical pain thresholds (EPT) have shown promising results in being able to predict postoperative pain, but the results are conflicting. The aim of this study was to test whether EPT levels can be used to predict the postoperative pain in patients of both sexes.

Materials and Methods:

One hundred eighty patients scheduled for laparoscopic cholecystectomy were included in this prospective clinical study. Individual levels of EPT were measured before surgery, and the pain intensity was evaluated in the early postoperative period.

Results:

There were significant correlations between EPT and the maximum postoperative pain intensity (r
s=−0.21, P=0.009), time to the first rescue opioid (r
s=0.26, P=0.006), and the total dose of rescue opioid (r
s=−0.22, P=0.001). The interaction test showed significant influence of the sex on the ability of EPT to predict the postoperative pain intensity. Female patients with low EPT (<15) had a 4.5 times higher risk of postoperative pain (P=0.003).

Discussion:

Levels of EPT are reproducible, and the technique is well tolerated. However, it can be used to predict postoperative pain only in women. A weak correlation with the postoperative pain intensity, found here as well as previously, and the high sex dependency of the EPT levels obtained considerably limit the predictive value of this technique for routine use in perioperative clinical practice.
Privacy Practices of Health Social Networking Sites
Authors: Charbonneau Deborah H.
Published: June 2016

While online communities for social support continue to grow, little is known about the state of privacy practices of health social networking sites. This article reports on a structured content analysis of privacy policies and disclosure practices for 25 online ovarian cancer communities. All of the health social networking sites in the study sample provided privacy statements to users, yet privacy practices varied considerably across the sites. The majority of sites informed users that personal information was collected about participants and shared with third parties (96%, n = 24). Furthermore, more than half of the sites (56%, n = 14) stated that cookies technology was used to track user behaviors. Despite these disclosures, only 36% (n = 9) offered opt-out choices for sharing data with third parties. In addition, very few of the sites (28%, n = 7) allowed individuals to delete their personal information. Discussions about specific security measures used to protect personal information were largely missing. Implications for privacy, confidentiality, consumer choice, and data safety in online environments are discussed. Overall, nurses and other health professionals can utilize these findings to encourage individuals seeking online support and participating in social networking sites to build awareness of privacy risks to better protect their personal health information in the digital age.
Relationships Between eHealth Literacy and Health Behaviors in Korean Adults
Authors: Kim Sun-Hee , Son Youn-Jung
Published: June 2016

The Internet is a useful and accessible source for health-related information for modern healthcare consumers. Individuals with adequate eHealth literacy have an incentive to use the Internet to access health-related information, and they consider themselves capable of using Web-based knowledge for health. This cross-sectional study aimed to describe the relationship between eHealth literacy and health behaviors. A total of 230 adults aged 18 to 39 years and residing in South Korea participated in the study. The mean (SD) score for eHealth literacy was 25.52 (4.35) of a total possible score of 40. The main source of health information was the Internet. Using hierarchical linear regression, the results showed that eHealth literacy was the strongest predictor of health behaviors after adjusting for general characteristics. These findings indicate that eHealth literacy can be an important factor in promoting individual health behaviors. Further research on eHealth literacy and actual health behaviors including intention and self-reported health behaviors are required to explain the impact of eHealth literacy on overall health status.
Pediatric Liver Transplantation
Authors: Bilhartz Jacob L. , Shieck Victoria L.
Published: June 2016

Liver transplantation originated in children more than 50 years ago, and these youngest patients, while comprising the minority of liver transplant recipients nationwide, can have some of the best and most rewarding outcomes. The indications for liver transplantation in children are generally more diverse than those seen in adult patients. This diversity in underlying cause of disease brings with it increased complexity for all who care for these patients. Children, still being completely dependent on others for survival, also require a care team that is able and ready to work with parents and family in addition to the patient at the center of the process. In this review, we aim to discuss diagnoses of particular uniqueness or importance to pediatric liver transplantation. We also discuss the evaluation of a pediatric patient for liver transplant, the system for allocating them a new liver, and also touch on postoperative concerns that are unique to the pediatric population.
Endometrial ‘scratching’: what the data show
Authors: Santamaria Xavier , Katzorke Nora , Simón Carlos
Published: June 2016

Purpose of review

Since its first description in 2003, the endometrial scratching procedure has been the topic of over 1000 studies. This procedure, used to improve endometrial receptivity for assisted reproduction, is accessible – any gynecologist can easily perform it – and has been adapted into clinical routine by some reproductive units. However, the available data are controversial, and no biological plausibility exists to support the use of this intervention. This study aims to critically review the existing data, focusing on the last 2 years, regarding the efficiency of endometrial scratching.

Recent findings

A total of five randomized controlled studies, one meta-analysis, and a systematic review related to endometrial scratching/injury were published in 2014 and 2015. Considerable heterogeneity exists among these studies regarding the selected population, type of treatment, and even timing and devices used to perform the endometrial injury. Importantly, none of these studies reported improved reproductive outcomes in terms of live birth rates following endometrial scratching.

Overall, data from properly designed and powered randomized controlled studies demonstrate no beneficial effect of this intervention that is based on unknown biological effects. Endometrial scratching produces pain, costs money, and the side-effects of systematic scratching in the production of Asherman syndrome remain to be seen. Think before scratching.
Management considerations for patients with uterine fibroids and concurrent venous thromboembolism
Authors: Moulder Janelle K. , Siedhoff Matthew T. , Till Sara R. , Moll Stephan
Published: June 2016

Purpose of review

The purpose is to provide an update on management strategies for uterine fibroids in the setting of venous thromboembolism (VTE).

Recent findings

Uterine fibroids and VTE are independently associated with morbidity and increasing healthcare costs. Women with large uterine fibroids have a higher likelihood of VTE. Current strategies for stratifying patients with VTE take into account the nature of the VTE (i.e., truly provoked or unprovoked) and many patients may only require short-term anticoagulation. In those patients with risk factors for recurrent VTE, longer term anticoagulation may be required.

In women with large uterine fibroids, the likelihood of concurrent VTE increases. Peri and postoperative management should be determined based on patient-specific risk stratification, with the majority of patients requiring short-term anticoagulation. Further risk stratification may be required for patients with essentially an unprovoked VTE, and consultation with a thrombosis specialist is recommended.
Hysteroscopy safety
Authors: Cholkeri-Singh Aarathi , Sasaki Kirsten Jill
Published: June 2016

Purpose of review

Hysteroscopy is a very common tool providing the gynecologist the ability to diagnose and treat a variety of intrauterine disorders. This outpatient therapy has provided quick and effective relief for women worldwide. Although simple in concept, hysteroscopy is associated with minor and major complications. Awareness of these difficulties and methods of prevention and management is key to good surgical outcomes. This article reviews well tolerated practices for hysteroscopy complications.

Recent findings

Although complications with both diagnostic and operative hysteroscopy are rare, they can often be prevented with thorough preoperative evaluation and appropriate intraoperative decision making. Understanding the patient, disorder, and surgical process can assist the surgeon in providing the best outcome for the patient.

With appropriate training and education, gynecologists can safely incorporate hysteroscopy into their surgical practice.
Thoracic Outlet Syndrome: Past and Present—88 Surgeries in 30 Years at Chang Gung
Authors: Chwei-Chin Chuang David , Fang Frank , Nai-Jen Chang Tommy , Chuieng-Yi Lu Johnny
Published: June 2016

Background:

Thoracic outlet syndrome (TOS) is a highly controversial clinical entity. There is much debate on its terminology, existence, diagnosis, and treatment. The purpose of this study was to describe our opinions about these controversial topics of TOS and the treatment of TOS over the past 30 years.

Methods:

From 1985 to 2014, a total of 80 patients underwent decompressive surgery for TOS. Eight patients requested a second surgery on the contralateral limb. They all had at least 1-year follow-up. Preoperative evaluation included provocative tests, plain X-ray, magnetic resonance angiography/computed tomography angiography, and electromyography. Surgical intervention for each patient involved a supraclavicular approach and near-total resection of the anterior scalene muscle and the first rib and of any cervical rib if it was present. Rib resection was performed with the use of Kerrison bone punch forceps. The operative time was typically 2 hours.

Results:

Major postoperative complications were rare. Nearly all patients (98%) experienced significant symptom relief, with improvement in soreness and tightness of the shoulder, neck, and arm immediately on the first postoperative day or within a few weeks thereafter. There were no cases with symptoms recurring.

Conclusions:

It is evident that decompressive surgery through a supraclavicular approach for TOS not only is an effective and safe procedure but also provides a diagnosis of the cause of TOS. For a patient who meets the criteria for surgical indication, decompressive surgery usually results in resolution of symptoms and no recurrence.
Rhinofacial Entomophthoromycosis Presenting as a Oronasal Tumor
Authors: Mohammed Abdul Wadood , Mohammed Babitha Alingal
Published: June 2016

Entomophoromycosis is a rare mycotic infection affecting the subcutaneous tissue and nasal mucosa. Entomophthorales are seen in immunocompetent individuals. We present the case of a 22-year-old man who presented with nasal obstruction, unilateral watering from eye, and oral mass. On examination, the patient had an oronasal mass completely filling the left nasal cavity and extending into the left oropharynx. He also had left nasolacrimal duct obstruction. The mass was excised by a combined endoscopic and transoral microscopic approach along with endoscopic dacryocystorhinostomy. Postoperative biopsy was entomophthoromycosis. The patient was put on itraconazole and is on follow-up. This case is unique because of its atypical presentation. We also discuss the nuances regarding its optimal management as per the available literature and how we successfully managed the case.
Early Childhood Intervention and Inclusion in Austria
Authors: Pretis Manfred
Published: June 2016

This article assesses the situation of preschool children in Austria facing the need to implement the UN Convention on the Rights of Persons with Disability. Eligibility criteria for preventive preschool services and the necessary labeling of children as “disabled” or “at risk” are assessed as inhibiting factors within educational systems that ostensibly facilitate “education” for all. On the operative level, existing support systems across Austria differ in their level of inclusiveness. The kindergarten system can be seen to offer a more inclusive service for children aged 0–3 years. Nurseries and child minder services particularly lack inclusive strategies or resources. Because of economic restrictions and the persistence of ambivalent attitudes among mainstream teachers, the school system faces major obstacles, including initiatives of parents to opt for special schools to ensure social integration and specific (therapeutic) resources. This article emphasizes the need for concrete methods, exchange, and resources for people working with children with special needs and reflects on the partial paradox of current parallel developments.
Early Childhood Inclusion in Turkey
Authors: Diken Ibrahim H. , Rakap Salih , Diken Ozlem , Tomris Gozde , Celik Secil
Published: June 2016

Inclusion of young children with disabilities into regular preschool classrooms is a common practice that has been implemented for several decades in industrialized nations around the world, and many developing countries including Turkey have been developing and implementing laws, regulation, and services to support inclusion and teaching in natural environments. The current definition of inclusion provided in special education laws developed in Turkey aligns with the definition of inclusion provided in the contemporary literature. However, implementation of inclusive practices in early years is still in its early stages and baby steps are taken to develop more comprehensive system of special education and inclusive practices. The purpose of this article is 4-fold: (a) to describe Turkish special education laws and regulations that support inclusive education and teaching in natural environment; (b) to summarize current inclusive practices in early childhood in Turkey; (c) to summarize and synthesize the available research on early childhood inclusion in Turkey; and (d) to discuss challenges and suggestions for future directions to enhance early childhood inclusion in Turkey.
Early Childhood Inclusion in Croatia
Authors: Ljubešić Marta , Šimleša Sanja
Published: June 2016

This article explains early childhood inclusion in Croatia from its beginnings up to challenges in current policy and practice. The first preschool education for children with disabilities dates back to the 1980s and was provided in special institutions. In the last 10 years, mainstream kindergartens have been enrolling children with disabilities but unevenly in different Croatian regions and also with a different quality of support. The lower economic potential of the rural and smaller local communities adversely influence the possibility of organizing support for children with disabilities in general, especially in an inclusive setting. The great challenge in analyzing the quality of early childhood inclusion in educational settings is the lack of reliable sources of data and evaluation research. Main challenges in early childhood inclusion and future directions are discussed.
Early Childhood Inclusion in Aotearoa New Zealand
Authors: Foster-Cohen Susan H. , van Bysterveldt Anne K.
Published: June 2016

Early childhood education is encouraged for all 3- to 5-year-old children in New Zealand (known in the Māori language as Aotearoa) and is supported by a well-constructed bicultural curriculum (Te Whāriki) and reasonably generous government funding. However, a number of factors mitigate against inclusion of children with developmental delays and disabilities. These include a lack of training for early childhood teachers; no requirement for Early Childhood Centers to have policies of inclusion; funding and support arrangements based on age rather than developmental stage; a lack of sufficient specialist and paraprofessional support; and a strong sociocultural approach to early childhood education that is often at odds with the need for active support of child development. These barriers to inclusion are surprising, given the quality of the curriculum, the government-supported levels of oversight and quality assessment, and the strong rights-driven research tradition across the nation's universities. The most pressing need is for significant changes to the preservice and in-service teacher education programs to ensure that the responsibility for inclusion is shouldered by the whole profession and the potential of Te Whāriki can be realized.
Assessment of the Abuse Potential of the Orexin Receptor Antagonist, Suvorexant, Compared With Zolpidem in a Randomized Crossover Study
Authors: Schoedel Kerri A. , Sun Hong , Sellers Edward M. , Faulknor Janice , Levy-Cooperman Naama , Li Xiaodong , Kennedy William P. , Cha Jang-Ho , Lewis Nicole M. , Liu Wen , Bondiskey Phung , McCrea Jacqueline B. , Panebianco Deborah L. , Troyer Matthew D. , Wagner John A.
Published: June 2016

Suvorexant is a dual orexin receptor antagonist approved in the United States and Japan for the treatment of insomnia at a maximum dose of 20 mg. This randomized double-blind crossover study evaluated the abuse potential of suvorexant in 36 healthy recreational polydrug users with a history of sedative and psychedelic drug use. Single doses of suvorexant (40, 80, and 150 mg: 2–7.5 × maximum dose), zolpidem (15 and 30 mg: 1.5–3 × maximum dose), and placebo were administered, with a 10-day washout between treatments. Subjective and objective measures, including visual analog scales (VASs), Addiction Research Center Inventory, and cognitive/psychomotor tests, were evaluated for 24-hour postdose. Suvorexant had significantly greater peak effects on “drug liking” VAS (primary endpoint) than placebo. Although effects of suvorexant on abuse potential measures were generally similar to zolpidem, they remained constant across doses, whereas zolpidem often had greater effects at higher doses. Suvorexant (all doses) had significantly fewer effects than zolpidem 30 mg on secondary measures, such as “high” VAS, Bowdle VAS, and Addiction Research Center Inventory morphine-benzedrine group. The overall incidence of abuse-related adverse events, such as euphoric mood and hallucination, was numerically lower with suvorexant than zolpidem. In agreement with its classification as a schedule IV drug, suvorexant demonstrated abuse potential, compared with placebo. The abuse potential was similar to zolpidem using certain measures, but with a reduced incidence of abuse-related adverse events. Although this suggests that the overall abuse liability of suvorexant may be lower than zolpidem, the actual abuse rates will be assessed with the postmarketing experience.
Postoperative complications in cardiac patients undergoing noncardiac surgery
Authors: De Hert Stefan , Moerman Annelies , De Baerdemaeker Luc
Published: June 2016

Purpose of review

In this article we review the current knowledge on the underlying mechanisms of perioperative myocardial injury, the preoperative methods of predicting these complications, the diagnostic tools for detecting perioperative myocardial injuries, and the available protective strategies to prevent or attenuate the extent of myocardial injury.

Recent findings

The last years’ new insights have provided a better understanding of the problem of perioperative myocardial injury and infarction. Specifically, the importance of early diagnosis and prompt treatment are increasingly getting attention. Concomitantly, the results of recent large multicenter studies have challenged classical therapeutic approaches in the perioperative treatment of cardiac patients undergoing noncardiac surgery.

These new insights will help to better tailor individual strategies to prevent or minimize perioperative cardiac complications. Especially, early diagnosis and intensification of treatment will get specific interest in the coming years.
Postoperative hemodynamic instability and monitoring
Authors: Minokadeh Anushirvan , Pinsky Michael R.
Published: June 2016

Purpose of review

The purpose of the review is to identify the recently validated minimally invasive or noninvasive monitoring devices used to both monitor and guide resuscitation in the critically ill patients.

Recent findings

Recent advances in noninvasive measures of blood pressure, blood flow, and vascular tone have been validated and complement existing minimally invasive and invasive monitoring techniques. These monitoring approaches should be used within the context of a focused physical examination and static vital sign analysis. When available, measurement of urinary output is often included. All studies show that minimally invasive and noninvasive measure of arterial pressure and cardiac output are possible and often remain as accurate as invasive measures. The noninvasive techniques degrade in severe circulatory failure and the use of vasopressor therapy. Importantly, these output parameters form the treatment goals for many goal-directed therapies protocols.

When coupled with a focused physical examination and functional hemodynamic monitoring analyses, these measures become even more specific at defining volume responsiveness and vasomotor tone and can be used to drive resuscitation strategies.
Fracture risk calculation tool enhances dual-energy X-ray absorptiometry scan referral pathway in cirrhosis patients
Authors: Nicoll Ruairidh , Black Alison , Bailey Lorna , Dundas Pauline , McLeman Lindsay , Vijayan Balasubramaniam , Fraser Andrew , Mukhopadhya Ashis
Published: June 2016

Objectives

Liver cirrhosis is associated with osteoporosis leading to an increased risk of fractures. We aimed to establish whether a risk stratification strategy using a fracture risk calculation tool (FRAX) to determine which patients should receive a dual-energy X-ray absorptiometry (DXA) scan is effective in reducing scan rates without compromising sensitivity for detecting osteoporosis.

Methods

A retrospective analysis of 252 patients with liver cirrhosis attending hepatoma surveillance clinics. Receiver operating characteristic analysis was performed to assess sensitivity and specificity at 10-year fracture risk thresholds of 5, 10 and 15%.

Results

DXA scans were performed among 252 patients. Mean age was 61.6±10.2 years, of which 53.2% were male. Cirrhosis aetiology was largely a result of alcohol excess (n=33.3%), chronic hepatitis C virus infection (n=20.2%) and nonalcoholic fatty liver disease (n=15.9%). The majority of patients were in good prognostic groups (87.4% Child–Pugh A, 11.3% Child–Pugh B, 1.3% Child–Pugh C). Osteoporosis was present in 19.0% of those who underwent DXA scanning. The optimum 10-year fracture risk threshold was found to be 10% using the FRAX tool. This retained a high sensitivity of 95.8%, specificity 64.7%, and negative predictive value 98.5%. Introduction of a 10% FRAX threshold would result in a reduction of the DXA scanning rate to 46.8% of the current rate.

Conclusion

A risk stratification strategy for DXA scanning using a fracture risk assessment tool (FRAX) and a 10-year fracture risk threshold of 10% leads to a significant reduction in scan rates without compromising osteoporosis detection rates.
Disposition of emergency department patients diagnosed with acute heart failure: an international emergency medicine perspective
Authors: Miró Òscar , Levy Philip D. , Möckel Martin , Pang Peter S. , Lambrinou Ekaterini , Bueno Héctor , Hollander Judd E. , Harjola Veli-Pekka , Diercks Deborah B. , Gray Alasdair J. , DiSomma Salvatore , Papa Ann M. , Collins Sean P.
Published: June 2016

Many patients with acute heart failure are initially managed in emergency departments (EDs) worldwide. Although some require hospitalization for further management, it is likely that a sizeable proportion could be safely discharged either directly from the ED or after a more extended period of management in an observation-type unit. Identification of low-risk patients who are safe for such an approach to management continues to be a global unmet need. This is driven in part by a lack of clarity on postdischarge outcomes for lower risk patients and a nonexistent consensus on what may be acceptable event rates. The current paper reviews previous studies carried out on patients directly discharged from the ED, suggests a general disposition algorithm and focuses on discharge metrics, which are based on both evidence and expert opinion. In addition, we propose that the following variables be considered for future determination of acceptable event rates: (a) baseline characteristics and risk status of the patient; (b) access to follow-up; (c) ED capability to provide an extended period of observation before discharge; (d) the temporal relationship between the event and ED discharge decision; and (e) the type of event experienced.
Endoscopic Treatment of Walled‐off Necrosis in Children
Authors: Bang Ji Young , Varadarajulu Shyam
Published: June 2016

Objectives:

Data on the endoscopic treatment outcomes for walled‐off necrosis (WON) in children are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic approach for the treatment of WON in children.

Methods:

A retrospective study was conducted of all children with symptomatic WON treated endoscopically over 6 years. Treatment consisted of endoscopic ultrasound‐guided transmural drainage using either a lumen‐apposing metal stent or multiple 7Fr double pigtail plastic stents with or without percutaneous drainage. Main outcome measures were technical success, treatment success, recurrence, reinterventions, and adverse events.

Results:

Six children (5 girls, median age 12 years) underwent endoscopic ultrasound‐guided WON drainage by creation of a single transmural tract in 5 patients and multiple transmural tracts in 1. Stents placed were plastic in 5 patients and lumen‐apposing metal stent in 1. One patient underwent concomitant percutaneous drainage. Treatment success was achieved in all of the 6 patients (100%) following a single intervention in 4 patients and 2 interventions in 2. No procedure‐related adverse events were encountered. At 8‐week follow‐up, the transmural stents were retrieved in all but 1 patient who had a disconnected pancreatic duct. At a median follow‐up of 781 days (interquartile range 336–869 days), no WON or symptom recurrence was encountered in any patient.

Conclusions:

Endoscopic treatment is effective, safe, and when available should be the first‐line modality for the management of WON in children.
Normalization Time of Celiac Serology in Children on a Gluten‐free Diet
Authors: Gidrewicz Dominica , Trevenen Cynthia L. , Lyon Martha , Butzner J. Decker
Published: June 2016

Objectives:

Response to a gluten‐free diet (GFD) in children with celiac disease is determined by symptom resolution and normalization of serology. We evaluated the rate of normalization of the transglutaminase (TTG) and antiendomysial (EMA) for children on a GFD after diagnosis.

Methods:

Celiac serologies were obtained over 3.5 years after starting a GFD in 228 newly diagnosed children with biopsy‐proven celiac disease. Patients were classified into categories based on serology (group A, TTG ≥10 × upper limit of normal [ULN] and EMA ≥ 1:80; group B, TTG ≥10 × ULN and EMA ⩽ 1:40; and group C, TTG <10 × ULN) and by severity of histologic injury at diagnosis.

Results:

In children with the highest serology at diagnosis (group A), 79.7% had an abnormal TTG at 12 months after diagnosis (mean TTG 12 months, 68.8 ± 7.3, normal <20 kU/L). At 2 years, an abnormal TTG persisted in 41.7%. In contrast, only 35% of children with the lowest serology at diagnosis (group C) displayed an abnormal TTG at 12 months (mean TTG 14.3 ± 1.9 kU/L). In those with the most severe mucosal injury, Marsh 3C, 74.2% and 33.2% had an abnormal TTG at 1 and 2 years.

Conclusions:

Normalization of celiac serology took >1 year in approximately 75% of GFD‐compliant children with the highest celiac serology or most severe mucosal injury at diagnosis. Clinicians must consider serology and histology at diagnosis to properly evaluate response to GFD.
Presentation and Treatment of Histoplasmosis in Pediatric Oncology Patients: Case Series and Review of the Literature
Authors: Hess Jennifer , Fondell Andrew , Fustino Nicholas , Malik Jeff , Rokes Christopher
Published: June 2016

Histoplasmosis is an endemic fungus in several regions of the United States. The diagnosis and treatment of this infection can be challenging in pediatric oncology patients. We present 5 patients diagnosed with histoplasmosis while receiving treatment at a midsize pediatric oncology center in Iowa. Two cases occurred in patients with acute lymphoblastic leukemia and 3 cases in patients with solid tumors. All patients were treated with antifungal therapy and demonstrated excellent clinical response. Histoplasmosis should be considered as a potential cause of nonspecific febrile illness, pulmonary masses, and bone marrow suppression in immunocompromised patients in endemic regions. Prompt and accurate diagnosis can facilitate timely antifungal therapy and avoidance of prolonged hospital stays, invasive testing, unnecessary antibiotics, and unwarranted anticancer therapies.
A Previously Healthy Premature Infant Treated With Thrombolytic Therapy for Life-threatening Pulmonary Artery Thrombosis
Authors: Ulubas Isik Dilek , Celik Istemi H. , Yilmaz Osman , Bas Ahmet Y. , Demirel Nihal
Published: June 2016

Pulmonary artery thrombosis is rarely reported in preterm neonates. Although treatment of neonatal thrombosis remains controversial, thrombolytic agents must be considered when the thrombosis is life threatening. We herein present a case of a preterm newborn with pulmonary artery thrombosis accompanied by acute-onset respiratory failure and cyanotic congenital heart disease. The thrombosis was successfully treated using tissue plasminogen activator. In conclusion, the thrombolytic therapy should be considered in treatment of patients in whom the thrombosis completely occludes the pulmonary arteries.
Applications and modifications of aptamers: potential tool for medical microbiology
Authors: Fooladi Abbas Ali Imani , Ch Mojtaba Hedayati , Amin Mohsen , Amani Jafar
Published: June 2016

Aptamers are ligands made of single-stranded DNA, oligonucleotide RNA or short peptides which bind specifically to their target molecules with high affinity. They resemble different types of monoclonal, polyclonal and recombinant antibodies in their mode of attachment. Aptamers optimally bind their targets in a range of μmol to ρmol. Targets vary from small molecules to macromolecules to whole cells. Systematic evolution of ligands by exponential enrichment is an affinity-based screening method for aptamers. Examples of aptamer applications include structural analysis of molecules, affinity/specificity testing, epitope mapping, making aptamer libraries by systematic evolution of ligands by exponential enrichment, pathogenic targeting, specific molecular targeting, live cell targeting, analytical applications, therapeutic potentials and drug delivery. Staphylococcal enterotoxin B is one of the most important bacterial toxins in different disorders. Aptamers offer a fast, feasible, reliable and affordable method for detecting this toxin.
Nurses and Psychologists Advancing the Patient-Centered Medical Home Model
Authors: Corso Kent A. , Gage Donna
Published: June 2016

As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide “integrated” care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals.