bluuebunny/crossref_metadata_2025 huggingface dataset:
Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study
Authors: Walker G. J. , Moore L. , Heerasing N. , Hendy P. , Perry M. H. , McDonald T. J. , Debenham T. , Bethune R. , Bewshea C. , Hyde C. , Heap G. A. , Singh A. , Calvert C. , Kennedy N. A. , Goodhand J. R. , Ahmad T.
Published: March 2018

Background

Primary care faecal calprotectin testing distinguishes inflammatory bowel disease (IBD) from functional gut disorder in young patients presenting with abdominal symptoms; however, previous evaluations have excluded patients with alarm symptoms.

Aims

We sought to evaluate the diagnostic accuracy of calprotectin to distinguish IBD from functional gut disorder in young adults in whom general practitioners (GPs) suspected IBD; including patients reporting gastrointestinal alarm symptoms. We hypothesised that calprotectin would reduce secondary care referrals and healthcare costs.

Methods

We undertook a prospective cohort study of 789 young adults (18‐46 years old) presenting with gastrointestinal symptoms to 49 local general practices that had undergone calprotectin testing (1053 tests: between Jan 2014 and May 2016) because of suspected IBD. We considered calprotectin levels of ≥100 μg/g positive. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard.

Results

Overall, 39% (308/789) patients reported gastrointestinal alarm symptoms and 6% (50/789) tested patients were diagnosed with IBD. The positive and negative predictive values of calprotectin testing for distinguishing IBD from functional gut disorder in patients with gastrointestinal alarm symptoms were 50% (95% CI 36%‐64%) and 98% (96%‐100%): and in patients without gastrointestinal alarm symptoms were 27% (16%‐41%) and 99% (98%‐100%), respectively. We estimate savings of 279 referrals and £160 per patient.

Conclusions

Calprotectin testing of young adults with suspected IBD in primary care accurately distinguishes IBD from functional gut disorder, even in patients with gastrointestinal alarm symptoms and reduces secondary care referrals and diagnostic healthcare costs.
How an ordeal becomes the norm: A qualitative exploration of experiences of self‐cannulation in male home haemodialysis patients
Authors: Moore Currie , Majeed‐Ariss Rabiya , Jayanti Anuradha , Mitra Sandip , Skevington Suzanne , Wearden Alison
Published: March 2018

Objectives

Despite home haemodialysis (HHD) being associated with significant health and psychosocial benefits, it remains an under‐utilized dialysis modality for people with chronic kidney disease. Self‐cannulation, where patients insert their own needles for dialysis, is a key component of HHD. Recent research suggests that the prospect of self‐cannulation is a barrier for patients, but there is little research which examines why this is the case. The aim of this study was to explore male HHD patients’ experiences and attitudes towards self‐cannulation.

Design

Qualitative methods were adopted to gather in‐depth views from experienced HHD patients from a UK renal centre.

Methods

Semi‐structured interviews were conducted with eight male HHD patients (HHD duration: 12–55 months). During the interview, the researcher elicited participants’ lived experience of self‐cannulation. Topics included the decision to self‐cannulate and the impact of self‐cannulation on the patient. The data collected were analysed using interpretative phenomenological analysis.

Results

The findings from this study elucidate the process of how self‐cannulation changed from an ordeal to the norm in these participants’ lives. The central theme from these interviews is that ‘becoming a person who self‐cannulates is a process’. Three super‐ordinate themes were discussed that relate to this central theme: ‘gaining control’, ‘building confidence’, and ‘becoming the norm’.

Conclusions

The findings from this study suggest that some patients’ initial fears of self‐cannulation can be overcome. These findings offer health care professionals and patients alike a greater understanding of how patients who self‐cannulate conceptualize it and its role in their mental and physical health.

Statement of contribution

What is already known on this subject?

Home haemodialysis is a cost‐effective form of renal replacement therapy which is under‐utilized in the United Kingdom.

Home haemodialysis is associated with positive health outcomes.

Self‐cannulation is noted as a barrier to home haemodialysis.

What does this study add?

Describes the process by which male dialysis patients became proficient in self‐cannulation.

Highlights psychological mechanisms which may facilitate and maintain self‐cannulation.

Suggests practical techniques which can be incorporated into renal clinics and care plans.
Assessment of the psychometric properties of the Graded Care Profile version 2 (GCP2) tool for measuring child neglect
Authors: Johnson Robyn , Fisher Helen L.
Published: March 2018

Child neglect is highly prevalent, with extensive effects on children's development and often long‐lasting consequences. It is a complex issue, and the identification and assessment of neglect presents particular difficulties for professionals. The Graded Care Profile (GCP) is a tool that can help practitioners to assess neglect, but the updated version of this tool (GCP2) requires psychometric testing. We sought to test the GCP2 with qualified social work practitioners in the United Kingdom. Interrater reliability was assessed by comparing GCP2 scores between 3 pairs of practitioners following assessments of 30 children. Concurrent validity was assessed by comparing GCP2 scores to scores obtained using 2 other validated measures with 15 children. Professionals were surveyed concerning face validity. There was a substantial level of interrater agreement for 2 domains and a moderate level of agreement for the other 2 domains. There were strong correlations between the GCP2 and the other tools across all domains, and face validity results were positive. In conclusion, although this was a small sample, our findings provide preliminary evidence that the GCP2 has adequate psychometric properties pending further rigorous psychometric testing. It is thus likely to be a useful tool in aiding professionals in the assessment of child neglect.
EFNB2haploinsufficiency causes a syndromic neurodevelopmental disorder
Authors: Lévy J. , Haye D. , Marziliano N. , Casu G. , Guimiot F. , Dupont C. , Teissier N. , Benzacken B. , Gressens P. , Pipiras E. , Verloes A. , Tabet A.‐C.
Published: March 2018

Ephrin B2, one of the ligand of the EphB receptors, is involved in a complex signaling pathway regulating the development of the nervous system, neuronal migration, erythropoiesis and vasculogenesis. We report a patient with a de novo variant inEFNB2and a family in which segregates a 610‐kb deletion at chromosome 13q33 encompassing onlyARGLU1andEFNB2genes. The de novo variant was observed in a patient with anal stenosis, hypoplastic left ventricle and mild developmental delay. The deletion was identified in 2 sibs with congenital heart defect and mild developmental delay. One of the affected sibs further had myoclonic epilepsy and bilateral sensorineural hearing loss. The carrier mother was apparently asymptomatic. BecauseEFNB2is located in the subtelomeric region of 13q chromosome, we reviewed the previous reports of terminal 13q deletion. We suggest that haploinsufficiency of theEFNB2could be at the origin of several clinical features reported in 13qter deletions, including intellectual disability, seizures, congenital heart defects, anorectal malformation and hearing loss.
Trabecular bone microstructure and mineral density in human residual ridge at various intervals over a long period after tooth extraction
Authors: Tanaka Mikako , Yamashita‐Mikami Emi , Akazawa Kohei , Yoshizawa Michiko , Arai Yoshiaki , Ejiri Sadakazu
Published: March 2018

Background

Long‐term changes of trabecular microstructure in human tooth extraction socket have not been investigated.

Purpose

To examine the trabecular microstructure of human residual ridges at various intervals following tooth extraction, and to determine whether bone remodeling activity can attain points of relative stability and when such points are reached.

Materials and Methods

Forty‐four bone biopsy specimens were obtained from lower molar or premolar regions of residual ridges. Postextraction times ranged from 1.6 to 360 months. Samples were analyzed using micro‐computed tomography and three‐dimensional bone morphometry with histological analyses. Trabecular bone parameters were plotted against postextraction times, and a stepwise piecewise linear regression analysis was performed to determine at which points of time these parameters either increased or decreased.

Results

Using piecewise linear regression, “inflection points” were found in most trabecular bone parameters between 7 and 12 months postextraction. Among the residual ridge samples, woven trabecular structure became mature, consisting of thick lamellar trabeculae with sufficient bone density, under dynamic bone remodeling until the 7th to 12th month post‐tooth extraction. After this period, the mature network structure remained stable with low remodeling activity.

Conclusion

Bone remodeling of trabecular structure in human residual ridge after tooth extraction had a stabilization period.
It's a great big universe: Astrobiology and future trends for an astrotheology
Authors: Pryor Adam
Published: March 2018

Despite the awe and wonder that discoveries related to astrobiology inspire, the sheer volume and diversity of new discoveries related to space science can become overwhelming without meaningful frames of reference by which to organize our understanding of these phenomena. I suggest that a critical feature of the future of “astrotheology” relates to how it serves as an organizing correlate to astrobiology and space research. Considering that the prefix astro‐ has an amplicative and abductive effect on the fields of study to which it is applied, I contend that astrotheology implies a creative and constructive shift in how we conceptualize meaningful human being for theology that parallels how astrobiology effects a creative and constructive shift in how we conceptualize living systems.
Systematic theology at the crossroads: Explication of a symbolic universe or contextualization of a redemptive message?
Authors: Nürnberger Klaus
Published: March 2018

The article compares Ted Peters' and Klaus Nürnberger's approaches in their recently published systematic theologies. Peters retains the traditional symbolic universe, explicating it for “a new era”; Nürnberger treats the evolving tradition as a series of contextualizations that must be replaced with new contextualizations as situations change. The difference and its consequences are demonstrated in the cases of the concept of God, eschatology, and the content of the gospel. At stake is the validity of the tradition on the one hand and the plausibility of the Christian faith in a modern context on the other.
An insidious and deadly complication of mechanical chest compressions in a patient on anticoagulation and the subtle echocardiographic findings that enabled timely diagnosis
Authors: Koo Grace , Goyal Neha , DeCara Jeanne M. , Lang Roberto M. , Addetia Karima
Published: March 2018

Good‐quality chest compressions improve outcomes in cardiac arrest. While manual chest compressions are suboptimal in this regard, the LUCAS device has been shown to improve the effectiveness of chest compressions during cardiopulmonary resuscitation (CPR). The complication rate associated with mechanical CPR, however, has not been adequately studied. Limited evidence suggests no difference in internal injury between manual and mechanical CPR. We report the case of a patient on anticoagulation who developed a mediastinal hematoma post mechanical CPR and on whom subtle findings on initial echocardiography could have alerted the clinician to this complication early during the clinical course. This case further suggests that there may be special populations of patients in whom we may need to be more vigilant in the use of mechanical CPR.
Transesophageal echocardiography measures left atrial appendage volume and function and predicts recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation
Authors: He Yemei , Zhang Baixue , Zhu Fang , Hu Zheyu , Zhong Jia , Zhu Wenhui
Published: March 2018

Aims

Paroxysmal atrial fibrillation (PAF) commonly recurs after radiofrequency catheter ablation (RFCA). This study aimed to assess left atrial appendage (LAA) volume and function by transesophageal echocardiography (TEE) and to explore its value in predicting PAF recurrence after RFCA.

Methods

Eighty patients with PAF were recruited. The left atrial (LA) and LAA volume and function were measured by transthoracic echocardiography (TTE) and TEE before ablation. Patients were followed up for 12 months after RFCA, and recurrence was recorded. Odds ratios of candidate risk indicators were determined by logistic regression analysis. Prediction model was constructed using logistic regression with backward selection. Receiver operating characteristic (ROC) curve with area under curve (AUC) was performed to evaluate the prediction efficiency.

Results

Twenty‐four (30%) PAF patients had recurrence (R group), and 56 (70%) patients had no recurrence (NR group). Compared to NR group, LA dimension (LAD), LA volume index (LAVI), LAA maximum volume (LAAVmax), and LAA minimum volume (LAAVmin) were significantly higher in R group, while LAA peak emptying flow velocity (LAAeV), LAA peak filling flow velocity (LAAfV), and LAA ejection fraction (LAAEF) significantly declined in R group. According to multivariate analysis and backward selection, LAVI, LAAEF, and LAAeV were significant risk factors for PAF recurrence. The LAVI + LAAEF + LAAeV joint model could effectively predict PAF recurrence with AUC of 0.893 (95% confidence interval = 0.816, 0.970), sensitivity of 0.75, and specificity of 0.929.

Conclusions

This study demonstrated that LAVI, LAAEF, and LAAeV were significant predictors of PAF recurrence after RFCA.
Suitability of brachiaria grass as a trap crop for management ofChilo partellus
Authors: Cheruiyot Duncan , Midega Charles A.O. , Van den Berg Johnnie , Pickett John A. , Khan Zeyaur R.
Published: March 2018

The cereal stemborerChilo partellus(Swinhoe) (Lepidoptera:Crambidae) is a major insect pest of sorghum (Sorghum bicolorL.Moench) and maize (Zea maysL.) in Africa. Trap cropping systems have been shown to be a valuable tool in management of this pest. To optimize trap cropping strategies, an understanding of host‐plant preference for moth oviposition and host suitability for larval survival on potential trap plants is a prerequisite. Therefore, we assessed seven brachiaria accessions (Poaceae) for preference byC. partellusmoths and subsequent larval performance. In two‐choice tests with a local open‐pollinated maize variety (cv. Nyamula), significantly higher numbers of eggs were deposited on brachiaria accessions Marandu, Piata, and Xaraes than on maize, whereas fewer eggs were recorded on plants of Mulato II, Mulato I, and Cayman. There was a significant and negative correlation between the trichome density on plant leaves andC. partellusoviposition preference for brachiaria. In addition to poor larval performance on brachiaria, there was no clear ranking in the accessions regarding larval orientation, settling, arrest, and food ingestion and assimilation. First instars did not consume leaf tissues of brachiaria plants but consumed those of maize, which also suffered more stem damage than brachiaria plants. No larvae survived on brachiaria plant tissue for longer than 5 days, whereas 79.2% of the larvae survived on maize. This study highlights the preferential oviposition ofC. partelluson brachiaria plants over maize and the negative effects that these accessions have on subsequent larval survival and development. Our findings support the use of brachiaria as a trap crop for management ofC. partellusthrough a push‐pull technology.
The role of host patch characteristics and dispersal capability in distribution and abundance ofArhopalus rusticusin centralArgentina
Authors: Grilli Mariano P. , Fachinetti Romina
Published: March 2018

Host patch characteristics may influence the abundance of a species, but this will depend on the species’ dispersal ability and the distance between suitable patches. In central Argentina, an area of introduced pine forest was planted for wood production in the 1940s. In 2006, an invading longhorn beetle,Arhopalus rusticus(L.) (Coleoptera:Cerambycidae), was detected in the area. Since then, the species has expanded its range until it occupies the whole area. We analyze how the configuration of host patches and flight performance ofA. rusticusaffect its distribution. The study was performed in the center‐west of Córdoba Province, Argentina, with 24 000 ha of introduced pine forests the main pine production zone of the province. Land cover was estimated using Landsat 8 scenes. Landscape was quantified by estimating the focal patch's area, fractal dimension index (FRAC), and Euclidean nearest neighbor distance (ENN). Focal patch area showed a positive relationship withA. rusticusabundance, whereasENNandFRAChad a negative relationship. The dispersal ability ofA. rusticuswas determined by putting recently emerged individuals to fly in flight mills. The flight performance results indicated that the species was probably introduced in the area by human activity, then rapidly established and expanded to the whole area. This indicates the importance of preventing its arrival in other pine production areas of Argentina, as it has proved to be an extremely successful invader.
Life histories of an invasive and native ladybird under field experimental conditions in a temperate climate
Authors: Raak‐van den Berg C. Lidwien , de Jong Peter W. , Gort Gerrit , Manly Bryan F.J. , van Lenteren Joop C.
Published: March 2018

Among characteristics that are thought to determine the success of invasive species, life‐history traits feature prominently. However, in most cases, these have been determined under laboratory conditions. Here, we use a field set‐up to determine immature development time and survival of invasive Harmonia axyridis (Pallas) and native Adalia bipunctata L. (both Coleoptera: Coccinellidae). On caged Tilia × europaea L. cv. Pallida trees (Malvaceae) with ample amounts of aphid food, we introduced freshly hatched larvae of a single or of both ladybird species and followed their development until emergence of adults. Under the condition of ample prey availability, both ladybird species apparently hardly interacted and intraguild predation did not cause significant mortality. Development time of both species is in line with data from laboratory tests under controlled conditions. Immature survival can reach high levels, but is considerably higher for H. axyridis (44–100%) than for A. bipunctata (11–77%), resulting in faster increase of H. axyridis populations, which is one of the factors that may explain its invasion success.
Current use of antihypertensive drugs in Japanese patients with hypertension: Analysis by age group
Authors: Ishida Takayuki , Oh Akinori , Hiroi Shinzo , Shimasaki Yukio , Tsuchihashi Takuya
Published: March 2018

Aim

To analyze the current use of antihypertensive drug classes in Japanese hypertensive patients stratified by age, highlighting differences between older and younger patients.

Methods

A nationwide medical database was used to evaluate antihypertensive use in patients (aged ≥20 years) who had received a prescription for one or more antihypertensive drug as an outpatient from April 2014 to March 2015. Patients (n = 59 867) were age‐stratified into three groups: <65 years (28.7%), 65–74 years (33.1%) and ≥75 years (38.2%).

Results

The mean number of antihypertensive drugs prescribed for patients in the overall population was 1.9 ± 1.0, with no appreciable differences between age groups. The most commonly prescribed drug classes for all ages were calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB). CCB were prescribed more often than ARB in the 65–74 years (66.9% vs 60.5%) and ≥75 years (70.4% vs 56.8%) years age groups, and ARB were prescribed more often than CCB in patients aged <65 years (63.1% vs 61.9%). There were minimal differences by age in prescription rates for β‐blockers, angiotensin‐converting enzyme inhibitors and thiazide diuretics. ARB prescription rates were lower in patients aged ≥75 years with diabetes mellitus or renal disease than in younger age groups. Prescription rates for loop diuretics were higher in patients aged ≥75 years than in younger age groups, especially among those with renal disease.

Conclusions

Antihypertensive drugs selected for patients aged ≥75 years differed from those selected for younger patients, in particular CCB and loop diuretics (prescribed more often), and ARB (prescribed less often). Geriatr Gerontol Int 2018; 18: 899–906.
On Using Lumped Parameter Models and Temperature Cycles in Heterogeneous Aquifers
Authors: Farlin Julien , Małoszewski Piotr
Published: March 2018

The use of the annual cycles of stable isotopes to estimate the parameters of transit time distribution (TTD) functions has been recently criticized by Kirchner who showed that if the catchment is heterogeneous the mean residence time calculated from the damping of the amplitude of the input signal is often underestimated by large factors. We modify Kirchner's initial analysis and show that the estimation bias is a function of the degree of heterogeneity. In low heterogeneity cases corresponding to permeable aquifers, the TTD of a simple exponential model developed assuming a homogeneous medium deviates only slightly from the true TTD, and thus estimated and true mean transit times are close. We also develop and test for a sandstone aquifer a model predicting the temperature amplitude of water at the outlet of a groundwater system from the annual air temperature cycle, and show that even though temperature is not a conservative tracer, it can be used to calibrate a lumped parameter model describing the TTD of the aquifer.
Unnatural history: is a paradigm shift of natural history in 21st century ornithology needed?
Authors: Callaghan Corey T. , Martin John M. , Kingsford Richard T. , Brooks Daniel M.
Published: March 2018

Natural history, across disciplines, is essential for the continuation of science, especially as we attempt to identify the myriad of threats that biodiversity faces in this rapidly changing world. Recording the natural history of birds is perhaps the most prominent, widespread and long‐standing pursuit of this activity. Yet, there is a distinct decrease in publishing of natural history in the ornithological sciences. Concomitantly, the natural history information being published is often in small and regional journals, less accessible by the global ornithological community. We argue that historical natural history needs a modern reinvigoration, and should focus on placing natural history observations in the context of an anthropogenically altered world – ‘unnatural history’. This includes, but is not limited to, behavioural adaptations, novel diet choices, hybridization and novel adaptations to urbanization. Here, we elaborate on natural history's place in modern ornithology, how this relates to citizen science and the potential cost of ignoring it. Ultimately, increased accessibility of natural history observations, encouragement of amateur ornithologists' participation in professional societies (and vice versa) and targeted citizen science projects are potential mechanisms by which to reinvigorate natural history in 21st century ornithology.
Electron microscopy examination of platelet whole mount preparations to quantitate platelet dense granule numbers: Implications for diagnosing suspected platelet function disorders due to dense granule deficiency
Authors: Brunet J. G. , Iyer J. K. , Badin M. S. , Graf L. , Moffat K. A. , Timleck M. , Spitzer E. , Hayward C. P. M.
Published: March 2018

Introduction

Dense granule (DG) deficiency (DGD) is a feature of some platelet function disorders (PFD) with a prevalence similar to von Willebrand disease. Most laboratories assess for DGD using whole mount platelet preparations and electron microscopy (EM). We evaluated our experiences with this test and associations between DGD and bleeding.

Methods

Dense granule EM records for 2006‐2017 were examined for patients and simultaneously tested controls, and for an overlapping PFD study cohort to evaluate findings and their relationship to bleeding.

Results

More patient than control samples had reduced DG counts (6.5% vs 0.3%, P < .01). DG counts showed no relationship to age or mean platelet volume and had acceptable within‐subject variability that was higher for DGD than control participants (28% vs 12%). Repeat tests confirmed DGD in all persons with initial DG counts <4.0/platelet, but not in those with less severe reductions (4.0‐4.8 DG/platelet) or normal DG counts (≥4.9 DG/platelet). Aggregometry and adenosine triphosphate release tests, respectively, had only ~52% and 70% sensitivity for DGD. Confirmed DGD by EM was associated with higher bleeding scores and a bleeding disorder.

Conclusion

Whole mount EM is useful for the evaluation of suspected PFD due to DGD and detects abnormalities associated with bleeding.
Bacillus Calmette–Guérin strain differences as the basis for immunotherapies against bladder cancer
Authors: Miyazaki Jun , Onozawa Mizuki , Takaoka Eiichiro , Yano Ikuya
Published: March 2018

In the past 40 years, intravesical immunotherapy with Mycobacterium bovis bacillus Calmette–Guérin has been carried out as the most effective treatment for preventing local recurrences and tumor progression of non‐muscle‐invasive bladder cancer. Bacillus Calmette–Guérin is a family of vaccines derived in 1921 by the in vitro attenuation of Mycobacterium bovis. Subsequently, bacillus Calmette–Guérin seed lots were spread around the world, and both phenotypic and genotypic differences among the strains have been compiled. In recent genomic comparisons, the evolution of the different bacillus Calmette–Guérin substrains has begun to emerge. However, some of these genetic alterations in bacillus Calmette–Guérin strains have yet to be shown to affect the therapeutic effects and/or adverse effects. There are thus ongoing research efforts to assess the effects of these genetic alterations on the properties of bacillus Calmette–Guérin strains, with the ultimate goal of identifying an ideal bacillus Calmette–Guérin strain for treatment of non‐muscle‐invasive bladder cancer and providing clues for the improvement of bacillus Calmette–Guérin strains. The present review provides a history of bacillus Calmette–Guérin immunotherapy, and discusses the genetic differences among bacillus Calmette–Guérin strains, the different clinical outcomes afforded by bacillus Calmette–Guérin strains and possible future developments.
Les modes d'organisation de la protection sociale et du marché du travail peuvent‐ils expliquer les particularités du chômage des jeunes d'un pays à l'autre?
Authors: TAMESBERGER Dennis
Published: March 2018

Le chômage des jeunes ne se présente pas partout sous le même jour et dépend de différents facteurs agissant en synergie. Après une synthèse documentaire sur la question, l'auteur procède à une analyse en classification hiérarchique pour repérer les modes d'organisation de la protection sociale et du marché du travail pouvant influer en la matière dans l'UE27. Sur les cinq modèles mis en évidence, celui qui a l'effet le plus favorable sur le ratio de chômage des jeunes et le chômage de long terme dans la tranche d'âge associe prépondérance de l'apprentissage, politique sociale et familiale généreuse et politiques actives du marché du travail.
Medication recommendation by physiotherapists: A survey of Québec physiotherapists' opinions regarding a new interprofessional model of care with pharmacists
Authors: Matifat E. , Perreault K. , Gagné M. , Léveillé M. , Desmeules F.
Published: March 2018

Background

To improve the efficiency of the health care system, new interprofessional models of care are emerging. In 2015, two provincial professional colleges, regulating the practice of physiotherapists and that of pharmacists in the province of Québec, Canada, developed a new interprofessional model of care. This model is designed to guide non‐prescription medication recommendations by physiotherapists treating patients in primary care with neuromusculoskeletal disorders (NMSKD) with the collaboration of pharmacists.

Purpose

To assess Québec physiotherapists' interests to use this model and explore their opinions concerning their ability to recommend non‐prescription medications to patients in primary care with NMSKD.

Methods

An email invitation to complete an electronic survey was sent in February 2016 to all the Ordre professionnel de la physiothérapie du Québec's registered physiotherapists. The survey included a questionnaire with 31 questions divided into 5 sections. Descriptive analyses and Chi‐square tests (χ2) were performed to compare proportions (%) across demographic and clinical characteristics.

Results

Two hundred twenty‐five physiotherapists completed the full survey. Of these, 70% of respondents knew of the model of care, but only 15% had previously used it. Perceived workload increase was one major reason reported for this lack of use (51%). Most of the respondents had a positive perception of this model and interactions with pharmacists and were confident regarding their ability to safely recommend medication (63%). However, 63% believed that further training was necessary to enable physiotherapists to provide efficient and safe non‐prescription medication recommendations to patients with NMSKD.

Conclusions

Overall, physiotherapists have a positive perception of this model, but there remain opportunities for increased integration into practice. Most respondents believe that additional training is required regarding non‐prescription medication recommendations.
Impact of educational outreach intervention on enhancing health care providers' knowledge about statin therapy prescribing in Malaysian patients with type 2 diabetes mellitus
Authors: Elnaem Mohamed Hassan , Nik Mohamed Mohamad Haniki , Zaman Huri Hasniza , Azarisman Shah M
Published: March 2018

Rationale

Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process.

Aims and Objectives

This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge.

Methods

This was a cross‐sectional study based on educational outreach intervention targeting physicians and pharmacists in 1 major tertiary hospital in the state of Pahang, Malaysia. Participants responded to a 12‐item, validated questionnaire both prior to and after the outreach educational program. Two sessions were conducted separately for 2 cohorts of pharmacists and physicians. The knowledge scores prior to and after the educational intervention were calculated and compared using a paired‐samples t‐test.

Results

The response rate to both pre‐and post‐educational outreach questionnaires was 91% (40/44). Prior to the intervention, around 84% (n37) of the participants decided to initiate statin therapy for both pre‐assessment clinical case scenarios; however, only 27% (n12) could state the clinical benefits of statin therapy. Forty‐five percent (n20) could state the drug to drug interactions, and 52.3% (n23) could identify the statin therapy that can be given at any time day/evening. The educational outreach program increased participants' knowledge scores of 1.450 (95% CI, 0.918 to 1.982) point, P < .0005, which is statistically significant. Forty respondents (91%) were of the opinion that statin side effects are the most common cause of treatment discontinuation.

Conclusion

This work demonstrated the impact of an educational outreach intervention on improving health care providers' knowledge and beliefs about statin therapy. This type of intervention is considered effective for short‐term knowledge enhancement. Further research is needed to test the long‐term efficacy of such intervention.
Cardiovascular self‐management support program for preventing cardiovascular complication behaviors and clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus in Indonesia: A pilot study
Authors: Hisni Dayan , Rukmaini Rukmaini , Saryono Saryono , Chinnawong Tippamas , Thaniwattananon Ploenpit
Published: March 2018

Aim

The aim of the study was to determine the feasibility, and to evaluate the effect of, a cardiovascular self‐management support program by applying the 5A's self‐management support program on preventing cardiovascular complication behaviors and to assess the clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus (DM).

Methods

This pilot study used a quasi‐experimental study design. Twelve elderly persons with poorly controlled type 2 DM were assigned into either a control or experimental group, with six participants in each group. The Preventing Cardiovascular Complication Behaviors (PCCB) was measured by the Preventing Cardiovascular Complication Behaviors Questionnaire, while the clinical outcomes were measured by clinical devices that were provided. These measurements were conducted and compared at baseline and 6 weeks after the completion of the program. The self‐management support program was a 6 week program with several implementation methods, based on the 5A's self‐management support program.

Results

The participants who received the cardiovascular self‐management support program reported a significant improvement in their PCCB and clinical outcomes, compared to those receiving the usual care.

Conclusion

This study revealed that a cardiovascular self‐management support program that applies the 5A's self‐management support program is feasible for implementation.
Three‐Dimensional Digital Evaluation of the Fit of Endocrowns Fabricated from Different CAD/CAM Materials
Authors: Zimmermann Moritz , Valcanaia Andre , Neiva Gisele , Mehl Albert , Fasbinder Dennis
Published: March 2018

Purpose

A wide variety of CAD/CAM materials are available for single‐tooth restorations. CAD/CAM material characteristics are different and may influence CAM fabrication accuracy. There is no study investigating the influence of different CAD/CAM materials on the final fit of the restoration. The aim of this study was to evaluate the fit of endocrowns fabricated from different CAD/CAM materials using a new 3D evaluation method with an intraoral scanning system. The null hypothesis was that there are no significant differences for the fitting accuracy of different CAD/CAM materials.

Materials and Methods

Preparation for an endocrown was performed on a maxillary right first molar on a typodont, and restorations were fabricated with a chairside CAD/CAM system (CEREC Omnicam, MCXL). Three groups using three different CAD/CAM materials were established (each n = 10): zirconia‐reinforced lithium silicate ceramic (Celtra Duo; CD), leucite‐reinforced silicate ceramic (Empress CAD; EM), resin nanoceramic (Lava Ultimate; LU). A 3D digital measurement technique (OraCheck, Cyfex AG) using an intraoral scanner (CEREC Omnicam) was used to measure the difference in fit between the three materials for a master endocrown preparation. The preparation scan and the endocrown fit scan were matched with special difference analysis software OraCheck. Three areas were selected for fitting accuracy measurements: margin (MA), axial (AX), occlusal (OC). Statistical analysis was performed using 80% percentile, one‐way ANOVA, and post‐hoc Scheffé test. Significance level was set to p = 0.05.

Results

Results varied from best 88.9 ± 7.7 μm for marginal fit of resin nanoceramic restorations (LU_MA) to worst 182.3 ± 24.0 μm for occlusal fit of zirconia‐reinforced lithium silicate restorations (CD_OC). Statistically significant differences were found both within and among the test groups. Group CD performed statistically significantly different from group LU for marginal fit (MA) and axial fit (AX) (p < 0.05). For occlusal fit (OC), no statistically significant differences were found within all three test groups (p > 0.05). Deviation pattern for differences was visually analyzed with a color‐coded scheme for each restoration.

Conclusions

Statistically significant differences were found for different CAD/CAM materials if the CAM procedure was identical. Within the limitations of this study, the choice of CAD/CAM material may influence the fitting accuracy of CAD/CAM‐fabricated restorations.
Risk of Dental Implant Failure Associated With Medication Use
Authors: Carr Alan B. , Revuru Venkata S. , Lohse Christine M.
Published: March 2018

Purpose

The probability of achieving important clinical outcomes is an increasingly important factor for patients considering various treatment options for tooth loss. For oral reconstruction involving dental implants, the patient‐specific risks of implant failure may be influenced by the patient's medication profile. The purpose of this study was to identify associations between dental implant failure and medication use in a consecutive series of patients seen from October 1983 through December 2014 at the Department of Dental Specialties, Mayo Clinic (Rochester, Minnesota).

Materials and Methods

In this patient‐level analysis, demographic, implant‐specific, and medical profile data were abstracted from a prospective clinical database and individual medical records and used to determine the time to first implant failure. Implant failure‐free survival at the patient level was estimated using the Kaplan‐Meier method. Associations of demographic characteristics and medication use with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals.

Results

In the 31‐year study period, 6358 patients received their first dental implant (median age, 53 years). The median follow‐up duration of the 5645 patients whose implants did not fail was 5.8 years, and 713 patients had implant failure (median, 0.6 years). All associations were adjusted for age, sex, and era of implantation because these features strongly influence medication use and implant failure. After adjustment, no medication increased the risk of implant failure in the cohort; specifically, medication use at the time of implant placement or starting a medication after implant placement did not increase the risk of implant failure. Among the medications used at the time of implant placement, corticosteroids were associated with a reduced risk of implant failure (hazard ratio, 0.82; 95% CI, 0.67‐0.99; p = 0.04). This association was not seen when corticosteroids were started after implant placement.

Conclusion

In the population studied, medication use was not associated with an increased risk of dental implant failure.
In Vitro Fracture Resistance of Adhesively Restored Molar Teeth with Different MOD Cavity Dimensions
Authors: Forster András , Braunitzer Gábor , Tóth Máté , Szabó Balázs P. , Fráter Márk
Published: March 2018

Purpose

Molar MOD (mesial‐occlusal‐distal) cavity preparation weakens relative cuspal stiffness by up to 63%, often resulting in cuspal fracture. This investigation inspects fracture resistance of MOD cavities restored using direct composite restoration.

Materials and Methods

120 extracted, intact mandibular molars were selected. MOD cavities with different depth/wall thickness were prepared in 9 groups (n = 12): A: 3 mm/3.5 mm, B: 3 mm/2.5 mm, C: 3 mm/1.5 mm, D: 5 mm/3.5 mm, E: 5 mm/2.5 mm, F: 5 mm/1.5 mm, G: 7 mm/3.5 mm, H: 7 mm/2.5 mm, I: 7 mm/1.5 mm. Specimens with 7 mm deep cavities received root canal treatment. The teeth were restored with dental composite. Maximal fracture strength test was conducted. Intact natural teeth were used as control. For statistical analysis Kruskal‐Wallis ANOVA with post‐hoc pairwise comparisons was used (α = 0.05).

Results

Significant difference was indicated between the control and groups D, E, F, G, H, and I. No significant differences were found between the A, B, C groups and the control. Comparing the 5 and 7 mm cavity depth groups, there was no statistical difference between any of them.

Conclusions

Within the limitations of this investigation, the following conclusions can be drawn regarding molar teeth with a MOD cavity: 3 mm or shallower cavities can be restored to the physiological fracture strength with direct composite restorations; 5 mm or deeper cavities cannot be restored to the physiological fracture strength with direct composite restorations. Cusp thickness does not significantly influence fracture strength in molar MOD cavities with a direct composite restoration.
Associations between quantitative sleep EEG and subsequent cognitive decline in older women
Authors: Djonlagic Ina , Aeschbach Daniel , Harrison Stephanie Litwack , Dean Dennis , Yaffe Kristine , Ancoli‐Israel Sonia , Stone Katie , Redline Susan
Published: March 2018

The pathophysiological processes of Alzheimer's dementia predate its clinical manifestation. Sleep disturbances can accelerate the aging process and are common features of dementia. This study examined whether quantitative sleep electroencephalogram changes predate the clinical development of mild cognitive impairment and/or incident dementia. We collected data from a nested case‐control sample of women (mean age 83 years) from the Sleep and Cognition Study, an ancillary study to the longitudinal Study of Osteoporotic Fractures, who were characterized as cognitively normal at the time of a baseline polysomnography study (Study of Osteoporotic Fractures visit 8) based on a Mini‐Mental Status Exam (MMSE) score >24. Cases (n = 85) were women who developed new mild cognitive impairment or dementia by objective cognitive testing 5 years after polysomnography. Controls were women with no mild cognitive impairment/dementia (n = 85) at baseline or at follow‐up. Differences in electroencephalogram absolute and relative power density were observed between the two groups. Specifically, higher electroencephalogram power values were found in the dementia/mild cognitive impairment group, for the alpha (p = .01) and theta bands (p = .04) in non‐rapid eye movement sleep, as well as alpha (p = .04) and sigma (p = .04) bands in rapid eye movement sleep. In contrast, there were no group differences in traditional polysomnography measures of sleep architecture and sleep stage distribution, as well as sleep apnea and periodic limb movement indices. Our results provide evidence for quantitative electroencephalogram changes, which precede the clinical onset of cognitive decline and the diagnosis of dementia in elderly women, and support the application of quantitative sleep electroencephalogram analysis as a promising biomarker for imminent cognitive decline.
Fire‐disturbed landscapes induce phenotypic plasticity in lizard locomotor performance
Authors: Wild K. H. , Gienger C. M.
Published: March 2018

Phenotypic plasticity can occur in response to environmental fluctuation and can bring about pronounced changes in behavioral, physiological, or morphological traits. Anthropogenic habitat modifications, such as prescribed fire, can provide insight on the phenotypic response of ectotherms to structural habitat change. Our objective was to quantify the effect of fire‐altered landscapes on the locomotor performance of the eastern fence lizard (Sceloporus undulatus). Lizard sprint performance was compared among three habitats with different fire histories: a control habitat, which had not experienced fire in more than 60 years, a recovering habitat that had not experienced fire in 4 years, and a recent burn habitat that burned less than 6 months prior to the study. There were significant differences in locomotor performance among lizards from the different habitats (indicative of phenotypic plasticity), and lizards in the recent burn habitat had significantly higher maximum sprint speeds than lizards in recovering and control habitats. To measure the consistency of locomotor performance within individuals, lizards were captured and raced during the field seasons of 2014 and again in 2015. Locomotor performance was significantly repeatable across years, suggesting lizard populations contain considerable individual variation, despite this trait being closely tied to fitness. To the best of our knowledge, this is the first study to observe individual between‐year repeatability in performance of free‐ranging S. undulatus. Lizards had similar body condition among habitats suggesting that nutritional status did not play a role in performance plasticity. Habitats differed both structurally and thermally, and less restrictive thermal regimes in recently burned habitats appear to be the underlying mechanism permitting increased lizard locomotor performance.
Unanticipated increases in hepatic steatosis among human immunodeficiency virus patients receiving mineralocorticoid receptor antagonist eplerenone for non‐alcoholic fatty liver disease
Authors: Chaudhury Chloe S. , Purdy Julia B. , Liu Chia‐Ying , Morse Caryn G. , Stanley Takara L. , Kleiner David , Hadigan Colleen
Published: March 2018

Background & Aims

Non‐alcoholic fatty liver disease is common in human immunodeficiency virus, but there are no approved therapies. The aim of this open‐label proof‐of‐concept study was to determine the effect of the mineralocorticoid receptor antagonist eplerenone on hepatic fat in human immunodeficiency virus‐infected patients with hepatic fat ≥5% by magnetic resonance spectroscopy.

Methods

Five subjects received eplerenone (25 mg daily × 1 week followed by 50 mg daily × 23 weeks). Laboratory tests were done at each visit, and the primary endpoint, change in hepatic fat content, was determined by MRI spectroscopy at baseline and week 24.

Results

The study was stopped early after observing unexpected significant increases in hepatic fat at week 24 (mean increase 13.0 ± 7.3%, P = .02). The increases in steatosis were accompanied by a tendency for transaminase values to decrease (alanine aminotransferase mean change −14 ± 16 IU/L, P = .14). There were no consistent changes in other metabolic parameters or blood pressure. Repeat assessment of hepatic steatosis 1‐2 months after stopping study medication revealed improvements in steatosis towards baseline values.

Conclusions

The unexpected observation of increased hepatic steatosis with the administration of eplerenone led to early termination of the investigation. While limited because of the small number of participants and the open‐label design, this study provides data to suggest that mineralocorticoid receptor antagonism with eplerenone may not be an effective approach to treat hepatic steatosis in human immunodeficiency virus or the general population. Additional research is needed to determine the pathophysiological mechanism behind these unanticipated observations.