bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Laparoscopic Primary Repair in the Treatment of Colonic Perforation After Colonoscopy: A Review of 40,127 Patients
Authors: Zhong Wu , Qiu Chongrong , Liu Chuanyuan , Fang Chuanfa , Xia Laiyang , Liang Junlin , Zhang Seng , Chen Lisheng
Published: November 2016

Background:

In recent years, increasing colonoscopy use increases the incidence of colonic perforation. Colonic perforation during colonoscopy is a rare but extremely serious complication. Traditionally, the management of colonic perforation is explorative laparotomy with bowel resection. Treatment using laparoscopic approach is a novel approach, and has been reported in some recent literatures. Nowadays, the using of laparoscopic primary repair in treatment of colonoscopic perforations has not been confirmed. This study retrospectively reviewed our experiences in treating colonoscopic perforations by laparoscopic primary repair.

Objective:

The aim of this study was to evaluate the safety and efficacy of the laparoscopic primary repair in the treatment of colonic perforations during colonoscopy.

Methods:

Between January 2003 and December 2014, data were collected retrospectively on all patients who underwent colonoscopy and compared the recovery parameters and morbidity of patients who underwent laparoscopic primary repair versus those who had open surgery.

Results:

A total of 40,127 colonoscopies were performed during the study period. There were 24 patients who underwent primary repair [13 underwent laparoscopic surgery (LS) and 8 underwent open surgery (OS)]. There were no demographic differences between the LS and OS groups (P>0.05). Compared with OS group, patients who underwent laparoscopic repair had a significantly shorter incision length (LS: 3.15±0.35 mm vs. OS: 12.60±2.87 mm, P=0.000), fewer blood loss (LS: 28.54±10.82 mL vs. OS: 159.25±46.90 mL, P=0.000), shorter postoperative hospital stay (LS: 8.31±1.93 d vs. OS: 12.38±1.41 d, P=0.000), and shorter postoperative fasting time (LS: 3.38±0.7 d vs. OS: 5.25±0.71 d, P=0.000). The operative time of LS group was a little longer than OS group, but there were no significant differences (LS: 86.31±22.22 min vs. OS: 75.125 ±14.24 min, P=NS).

Conclusions:

Laparoscopic primary repair is safe and effective in resolving colonic perforation due to colonoscopy, and it might offer benefits over the open approach.
Increased Telomere Attrition After Renal Transplantation—Impact of Antimetabolite Therapy
Authors: Luttropp Karin , Nordfors Louise , McGuinness Dagmara , Wennberg Lars , Curley Hannah , Quasim Tara , Genberg Helena , Sandberg John , Sönnerborg Isabella , Schalling Martin , Qureshi Abdul Rashid , Bárány Peter , Shiels Paul G. , Stenvinkel Peter
Published: November 2016

Background

The uremic milieu exposes chronic kidney disease (CKD) patients to premature ageing processes. The impact of renal replacement therapy (dialysis and renal transplantation [RTx]) or immunosuppressive treatment regimens on ageing biomarkers has scarcely been studied.

Methods

In this study telomere length in whole blood cells was measured in 49 dialysis patients and 47 RTx patients close to therapy initiation and again after 12 months. Forty-three non-CKD patients were included as controls.

Results

Non-CKD patients had significantly (P ≤ 0.01) longer telomeres than CKD patients. Telomere attrition after 12 months was significantly greater in RTx patients compared to dialysis patients (P = 0.008). RTx patients receiving mycophenolate mofetil (MMF) had a greater (P = 0.007) degree of telomere attrition compared to those treated with azathioprine. After 12 months, folate was significantly higher in RTx patients than in dialysis patients (P < 0.0001), whereas the opposite was true for homocysteine (P < 0.0001). The azathioprine group had lower levels of folate after 12 months than the MMF group (P = 0.003).

Conclusions

The associations between immunosuppressive therapy, telomere attrition, and changes in folate indicate a link between methyl donor potential, immunosuppressive drugs, and biological ageing. The hypothesis that the increased telomere attrition, observed in the MMF group after RTx, is driven by the immunosuppressive treatment, deserves further attention.
Central Trochlear Palsy: Report of Two Patients With Ipsilesional Palsy and Review of the Literature
Authors: Jeong Seong-Hae , Kim Sung-Hee , Lee Seung-Han , Park Seong-Ho , Kim Hyo-Jung , Kim Ji-Soo
Published: November 2016

Background:

The trochlear (fourth) nerve is the only cranial nerve that decussates before emerging from the posterior aspect of the brainstem. Lesions involving the trochlear nucleus or fascicles mostly give rise to contralesional superior oblique palsy (SOP).

Methods:

We report 2 patients with SOP on the side of intraaxial lesions with a literature review on central trochlear palsy.

Results:

The lesions are more commonly located posterior to the cerebral aqueduct in patients with ipsilesional SOP than in those with contralesional SOP.

Conclusions:

Intraaxial lesions may cause ipsilesional or contralesional SOP depending on the lesion location along the course of trochlear fascicle in the brainstem.
Faultless responsibility: on the nature and allocation of moral responsibility for distributed moral actions
Authors: Floridi Luciano
Published: November 2016

The concept of distributed moral responsibility (DMR) has a long history. When it is understood as being entirely reducible to the sum of (some) human, individual and already morally loaded actions, then the allocation of DMR, and hence of praise and reward or blame and punishment, may be pragmatically difficult, but not conceptually problematic. However, in distributed environments, it is increasingly possible that a network of agents, some human, some artificial (e.g. a program) and some hybrid (e.g. a group of people working as a team thanks to a software platform), may cause distributed
moral
actions (DMAs). These are morally good or evil (i.e. morally loaded) actions caused by local interactions that are in themselves neither good nor evil (morally neutral). In this article, I analyse DMRs that are due to DMAs, and argue in favour of the allocation, by default and overridably, of full moral responsibility (faultless responsibility) to all the nodes/agents in the network causally relevant for bringing about the DMA in question, independently of intentionality. The mechanism proposed is inspired by, and adapts, three concepts: back propagation from network theory, strict liability from jurisprudence and common knowledge from epistemic logic.

This article is part of the themed issue ‘The ethical impact of data science’.
Compelling truth: legal protection of the infosphere against big data spills
Authors: Schafer Burkhard
Published: November 2016

The paper explores whether legal and ethical concepts that have been used to protect the natural environment can also be leveraged to protect the ‘infosphere’, a neologism used by Luciano Floridi to characterize the totality of the informational environment. We focus, in particular, on the interaction between allocation of (intellectual) property rights and ‘communication duties’, in particular, data breach notification duties.

This article is part of the themed issue ‘The ethical impact of data science’.
The ethics of smart cities and urban science
Authors: Kitchin Rob
Published: November 2016

Software-enabled technologies and urban big data have become essential to the functioning of cities. Consequently, urban operational governance and city services are becoming highly responsive to a form of data-driven urbanism that is the key mode of production for smart cities. At the heart of data-driven urbanism is a computational understanding of city systems that reduces urban life to logic and calculative rules and procedures, which is underpinned by an instrumental rationality and realist epistemology. This rationality and epistemology are informed by and sustains urban science and urban informatics, which seek to make cities more knowable and controllable. This paper examines the forms, practices and ethics of smart cities and urban science, paying particular attention to: instrumental rationality and realist epistemology; privacy, datafication, dataveillance and geosurveillance; and data uses, such as social sorting and anticipatory governance. It argues that smart city initiatives and urban science need to be re-cast in three ways: a re-orientation in how cities are conceived; a reconfiguring of the underlying epistemology to openly recognize the contingent and relational nature of urban systems, processes and science; and the adoption of ethical principles designed to realize benefits of smart cities and urban science while reducing pernicious effects.

This article is part of the themed issue ‘The ethical impact of data science’.
Data science ethics in government
Authors: Drew Cat
Published: November 2016

Data science can offer huge opportunities for government. With the ability to process larger and more complex datasets than ever before, it can provide better insights for policymakers and make services more tailored and efficient. As with all new technologies, there is a risk that we do not take up its opportunities and miss out on its enormous potential. We want people to feel confident to innovate with data. So, over the past 18 months, the Government Data Science Partnership has taken an open, evidence-based and user-centred approach to creating an ethical framework. It is a practical document that brings all the legal guidance together in one place, and is written in the context of new data science capabilities. As part of its development, we ran a public dialogue on data science ethics, including deliberative workshops, an experimental conjoint survey and an online engagement tool. The research supported the principles set out in the framework as well as provided useful insight into how we need to communicate about data science. It found that people had a low awareness of the term ‘data science’, but that showing data science examples can increase broad support for government exploring innovative uses of data. But people's support is highly context driven. People consider acceptability on a case-by-case basis, first thinking about the overall policy goals and likely intended outcome, and then weighing up privacy and unintended consequences. The ethical framework is a crucial start, but it does not solve all the challenges it highlights, particularly as technology is creating new challenges and opportunities every day. Continued research is needed into data minimization and anonymization, robust data models, algorithmic accountability, and transparency and data security. It also has revealed the need to set out a renewed deal between the citizen and state on data, to maintain and solidify trust in how we use people's data for social good.

This article is part of the themed issue ‘The ethical impact of data science’.
The ethics of big data as a public good: which public? Whose good?
Authors: Taylor Linnet
Published: November 2016

International development and humanitarian organizations are increasingly calling for digital data to be treated as a public good because of its value in supplementing scarce national statistics and informing interventions, including in emergencies. In response to this claim, a ‘responsible data’ movement has evolved to discuss guidelines and frameworks that will establish ethical principles for data sharing. However, this movement is not gaining traction with those who hold the highest-value data, particularly mobile network operators who are proving reluctant to make data collected in low- and middle-income countries accessible through intermediaries. This paper evaluates how the argument for ‘data as a public good’ fits with the corporate reality of big data, exploring existing models for data sharing. I draw on the idea of corporate data as an ecosystem involving often conflicting rights, duties and claims, in comparison to the utilitarian claim that data's humanitarian value makes it imperative to share them. I assess the power dynamics implied by the idea of data as a public good, and how differing incentives lead actors to adopt particular ethical positions with regard to the use of data.

This article is part of the themed issue ‘The ethical impact of data science’.
The dynamics of big data and human rights: the case of scientific research
Authors: Vayena Effy , Tasioulas John
Published: November 2016

In this paper, we address the complex relationship between big data and human rights. Because this is a vast terrain, we restrict our focus in two main ways. First, we concentrate on big data applications in scientific research, mostly health-related research. And, second, we concentrate on two human rights: the familiar right to privacy and the less well-known right to science. Our contention is that human rights interact in potentially complex ways with big data, not only constraining it, but also enabling it in various ways; and that such rights are dynamic in character, rather than fixed once and for all, changing in their implications over time in line with changes in the context we inhabit, and also as they interact among themselves in jointly responding to the opportunities and risks thrown up by a changing world. Understanding this dynamic interaction of human rights is crucial for formulating an ethic tailored to the realities—the new capabilities and risks—of the rapidly evolving digital environment.

This article is part of the themed issue ‘The ethical impact of data science’.
Tunable Extracellular Self-Assembly of Multi-Protein Conjugates fromBacillus subtilis
Authors: Gilbert Charlie , Howarth Mark , Harwood Colin R. , Ellis Tom
Published: November 2016

The ability to stably and specifically conjugate recombinant proteins to one another is a powerful in vitro technique for engineering multifunctional enzymes, protein therapeutics and novel biological materials. However, for many applications spontaneous in vivo protein conjugation would be preferable to in vitro methods. Exploiting the recently described SpyTag-SpyCatcher system, we describe here how enzymes and structural proteins can be genetically-encoded to covalently conjugate in culture media following programmable secretion by Bacillus subtilis. Using this novel approach, we demonstrate how self-conjugation of a secreted industrial enzyme, XynA, dramatically increases its resilience to boiling and we show that cellular consortia can be engineered to self-assemble functional multi-protein complexes with tunable composition. This genetically-encoded modular system provides a new, flexible strategy for protein conjugation harnessing the substantial advantages of extracellular self-assembly.
Crystal structure ofN,N′-dibenzylpyromellitic diimide
Authors: Im Hansu , Moon Suk-Hee , Kim Tae Ho , Park Ki-Min
Published: November 2016

The title compound, C24H16N2O4[systematic name: 2,6-dibenzylpyrrolo[3,4-f]isoindole-1,3,5,7(2H,6H)-tetraone], consists of a central pyromellitic diimide moiety with terminal benzyl groups at the N-atom positions. The molecule is located about an inversion centre, so the asymmetric unit contains one half-molecule. In the molecule, both terminal phenyl groups, tilted by 72.97 (4)° with respect to the mean plane of the central pyromellitic diimide moiety (r.m.s. deviation = 0.0145 Å), are oriented away from each other, forming an elongated S-shaped conformation. In the crystal, molecules are connectedviaweak C—H...O hydrogen bonds and C—H...π interactions, resulting in the formation of supramolecular layers extending parallel to theabplane.
9-Butyl-3-nitro-9H-carbazole
Authors: Ping Zhang , Ting Zhang , Song Chang-Chun
Published: November 2016

The title compound, C16H16N2O2, is a carbazole derivative with the 3-position substituted by a nitro group and the 9-position substituted by ann-butyl group. The nitro group is inclined to the benzene ring to which it is attached by 4.4 (2)°. Then-butyl substituent has an extended conformation and lies almost normal to the plane of the carbozole ring. In the crystal, inversion-related molecules stack along theaaxis and are linkedviaoffset π–π interactions, forming columns [shortest intercentroid distance = 3.773 (1) Å].
Out‐of‐Network Emergency Department Use among Managed Medicaid Beneficiaries
Authors: Raven Maria C. , Guzman David , Chen Alice H. , Kornak John , Kushel Margot
Published: November 2016

Objective

Out‐of‐network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out‐of‐network ED use among Medicaid beneficiaries.

Data Sources and Study Setting

Enrollment, claims, and encounter data for adult Medi‐Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014.

Study Design

We analyzed the data to identify factors associated with out‐of‐network ED use classified by mode of arrival (ambulance vs. nonambulance).

Data Extraction Methods

We extracted encounter, ambulance, and ED census data and linked them together based on ED visit date.

Principal Findings

Of 11,143 ED visits, 6,808 (61.1 percent) were out‐of‐network. The number of hours the study ED was on ambulance diversion increased the odds of out‐of‐network visits for the 3,365 (30.2 percent) ED visits arriving by ambulance. For all visit types, assignment to a primary care clinic at the in‐network hospital and having had any primary care visit during the study period decreased the odds of out‐of‐network ED care. Individuals were more likely to go out‐of‐network for ED care if they lived in neighborhoods containing out‐of‐network EDs.

Conclusions

There are a number of factors related to out‐of‐network ED use, including the proximity and density of out‐of‐network EDs, race and ethnicity, a prior history of out‐of‐network ED use, and individuals’ connection to primary care. EDs that serve Medicaid beneficiaries may need to explore alternative sites and modalities of care as alternatives to the ED, and consider their ability to absorb large numbers of out‐of‐network visits given already limited capacity.
Stratifying Patients with Diabetes into Clinically Relevant Groups by Combination of Chronic Conditions to Identify Gaps in Quality of Care
Authors: Magnan Elizabeth M. , Bolt Daniel M. , Greenlee Robert T. , Fink Jennifer , Smith Maureen A.
Published: November 2016

Objective

To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics.

Data Sources/Study Setting

Twenty‐nine thousand five hundred and sixty‐two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010–2011.

Study Design

We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions (“classes”) based on condition co‐occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization.

Data Collection

We extracted electronic health record data using a standardized algorithm.

Principal Findings

We found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7–2.2), 1.6 (1.4–1.9), 1.3 (1.2–1.5), and 1.3 (1.2–1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics.

Conclusions

Patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.
Testing a Novel 3D Printed Radiographic Imaging Device for Use in Forensic Odontology
Authors: Newcomb Tara L. , Bruhn Ann M. , Giles Bridget , Garcia Hector M. , Diawara Norou
Published: November 2016

There are specific challenges related to forensic dental radiology and difficulties in aligning X‐ray equipment to teeth of interest. Researchers used 3D printing to create a new device, the combined holding and aiming device (CHAD), to address the positioning limitations of current dental X‐ray devices. Participants (N = 24) used the CHAD, soft dental wax, and a modified external aiming device (MEAD) to determine device preference, radiographer's efficiency, and technique errors. Each participant exposed six X‐rays per device for a total of 432 X‐rays scored. A significant difference was found at the 0.05 level between the three devices (p = 0.0015), with the MEAD having the least amount of total errors and soft dental wax taking the least amount of time. Total errors were highest when participants used soft dental wax—both the MEAD and the CHAD performed best overall. Further research in forensic dental radiology and use of holding devices is needed.
Double Hanging with Single Ligature: An Unusual Method in Suicide Pact
Authors: Behera Chittaranjan , Rautji Ravi , Kumar Rajesh , Pooniya Shashank , Sharma Piyush , Gupta Sudhir Kumar
Published: November 2016

A married casual labor couple was found hanging in their makeshift bedroom with each end of a single chunni (a cloth worn around the neck by Indian women) spread across an iron bar below the roof. They left their two children, daughter, and son of 4 and 3 yrs age, respectively, with their grandmother living separately nearby, and went to attend cremation of one of their relatives. They returned late in the evening and found hanging in their bedroom next morning by neighbors.
Community structure of partial nitritation‐anammox biofilms at decreasing substrate concentrations and low temperature
Authors: Persson Frank , Suarez Carolina , Hermansson Malte , Plaza Elzbieta , Sultana Razia , Wilén Britt‐Marie
Published: November 2016

Partial nitritation‐anammox (PNA) permits energy effective nitrogen removal. Today PNA is used for treatment of concentrated and warm side streams at wastewater treatment plants, but not the more diluted and colder main stream. To implement PNA in the main stream, better knowledge about microbial communities at the typical environmental conditions is necessary. In order to investigate the response of PNA microbial communities to decreasing substrate availability, we have operated a moving bed biofilm reactor (MBBR) at decreasing reactor concentrations (311–27 mg‐N l−1 of ammonium) and low temperature (13°C) for 302 days and investigated the biofilm community using high throughput amplicon sequencing; quantitative PCR; and fluorescence in situ hybridization. The anammox bacteria (Ca. Brocadia) constituted a large fraction of the biomass with fewer aerobic ammonia oxidizing bacteria (AOB) and even less nitrite oxidizing bacteria (NOB; Nitrotoga, Nitrospira and Nitrobacter). Still, NOB had considerable impact on the process performance. The anammox bacteria, AOB and NOB all harboured more than one population, indicating some diversity, and the heterotrophic bacterial community was diverse (seven phyla). Despite the downshifts in substrate availability, changes in the relative abundance and composition of anammox bacteria, AOB and NOB were small and also the heterotrophic community showed little changes in composition. This indicates stability of PNA MBBR communities towards decreasing substrate availability and suggests that even heterotrophic bacteria are integral components of these communities.
The role of CA3‐LS‐VTA loop in the formation of conditioned place preference induced by context‐associated reward memory for morphine
Authors: Jiang Jin‐Xiang , Liu Huan , Huang Zhen‐Zhen , Cui Yue , Zhang Xue‐Qin , Zhang Xiao‐Long , Cui Yu , Xin Wen‐Jun
Published: November 2016

Addiction‐related behaviors, such as conditioned place preference (CPP), require animals to remember an association between environmental cue and drug treatment, and exposure to environmental cue is one of the key contributing factors to relapse. However, how central neural circuit participates in the formation of CPP induced by stimulus of morphine‐paired environment remains unknown. In the present study, we found that reexposure to morphine‐paired environment significantly increased the activity of hippocampal CA3 neurons, increased the excitability of GABAergic neurons and expression of glutamic acid decarboxylase 65/67 in the caudal lateral septum (LSc) and decreased the activity of GABAergic neurons and GAD65/67 expression in ventral tegmental area (VTA), leading to activation (disinhibition) of dopaminergic neurons. Inactivation of CA3 neurons attenuated GABAergic neurons activity and decreased the upregulation of GAD65/67 in LSc, prevented the dopaminergic neurons activation,and GAD65/67 downregulation in VTA and ameliorated the CPP behavior following exposure to morphine‐paired context. Blockade of NMDA receptor in LSc also prevented the upregulation of GAD65/67 in LSc and formation of CPP induced by stimulus of morphine‐paired environment. Suppression of GAD activity in LSc also remarkably attenuated the dopaminergic neurons activation and the GAD65/67 downregulation in VTA and prevented the formation of CPP induced by reexposure to morphine‐associated context. Collectively, these results, for the first time, illustrated the involvement of neural circuitry of CA3‐LSc‐VTA, through integration of the contexts and reward information, participated in the reinstatement of CPP induced by exposure to morphine‐associated context, which advanced our understanding on neurobiological basis for the context‐associated memory and rewarding behavior.
2‐arachidonoylglycerol levels are increased in leukocytospermia and correlate with seminal macrophages
Authors: Barbonetti A. , Bisogno T. , Battista N. , Piscitelli F. , Micillo A. , Francavilla S. , Maccarrone M. , Francavilla F.
Published: November 2016

Evidence has been produced that macrophages can actively generate endocannabinoids (eCBs) in response to inflammatory stimuli. As eCBs are involved in the control of several physiological processes, including reproduction, here, we explored whether seminal levels of the eCBs, N‐arachidonoylethanolamine (AEA), and 2‐arachidonoylglycerol (2‐AG), were higher in the presence of leukocytospermia, and were correlated with semen concentration of macrophages. The content of AEA and 2‐AG was measured by high‐performance liquid chromatography/mass spectrometry in seminal plasma of ejaculates from 18 leukocytospermic patients (>1 × 106 leukocytes/mL) and 21 normozoospermic controls. In the same ejaculates, round cells were phenotyped by flow‐cytometry as leukocytes (CD45+), macrophages (CD14+), and activated macrophages (CD14+, HLA‐DR+). The levels of 2‐AG, but not of AEA, were significantly higher in ejaculates from leukocytospermic patients than in controls and exhibited a significant correlation with semen concentration of macrophages and activated macrophages. Significant associations of 2‐AG with macrophages and activated macrophages persisted after adjustment for semen volume and sperm concentration. In conclusion, here we provide evidence that seminal plasma levels of 2‐AG are higher in the presence of leukocytospermia, as a marker of macrophages activation. Further studies are warranted to elucidate possible clinical implications.
High androgen levels protect against hypothyroidism
Authors: Schmidt Johanna , Dahlgren Eva , Bryman Inger , Berntorp Kerstin , Trimpou Penelope , Wilhelmsen Lars , Landin‐Wilhelmsen Kerstin
Published: November 2016

Introduction

Hypothyroidism is a common disorder, appearing mainly in women although less frequently found in women with polycystic ovary syndrome (PCOS). The objective was to test the hypothesis that hyperandrogenism might protect against hypothyroidism.

Material and methods

The data from three prospective follow‐up studies (up to 21 years) and one register study were compared: women with PCOS (Rotterdam criteria), n = 25, women with Turner syndrome, n = 217, a random population sample of women, n = 315, and men, n = 95 (the WHO MONICA study). Findings were to be verified or rejected in all females, n = 553 716, from the same region. The proportion of hypothyroidism was calculated and thyroid peroxidase antibodies (TPO) in serum were measured.

Results

Hypothyroidism at >50 years of age was found in 8% of women with PCOS, 4% in men (PCOS vs. men; ns), 43% of women with Turner syndrome, irrespective of karyotype (p < 0.001 vs. PCOS), and in 17% of postmenopausal women in the population (p < 0.01 vs. PCOS). Elevated TPO were similar in PCOS and women and men in the population but higher in Turner syndrome. Hypothyroidism increased with age in all groups except PCOS women and men. In the register study, hypothyroidism was less common in women with PCOS >25 years (5.5%) than in women without PCOS (6.8%) from the same region (p < 0.01).

Conclusions

Hypothyroidism was less frequently seen in women with PCOS and in men compared with women in the general population and among women with Turner syndrome. This was not explained by altered autoimmunity or the Y‐chromosome. Androgens seem to protect against hypothyroidism.
Two years' experience of using the Bravo wireless oesophageal pH monitoring system at a single UK tertiary centre
Authors: Rao Nagendra M. , Campbell David I. , Rao Prithviraj
Published: November 2016

Aim

The Bravo wireless pH monitoring system enables oesophageal pH to be monitored in children intolerant to nasal catheters and records measurements over 48 hours. This study aimed to document the minimum child weight that enabled successful capsule placement and any associated complications. We also compared the diagnostic sensitivity of 48 hours versus 24 hours.

Methods

We included 203 consecutive patients (122 male children) with clinically documented or suspected reflux symptoms. The age range was two years to 19 years, and the minimum weight was 9.29 kg. The pH capsule was deployed endoscopically under general anaesthetic. Recordings taken over 24 and 48 hours were compared to determine the frequency of differences and correlations in the reflux index and DeMeester scores.

Results

Testing using the detached probe was successful in 190 children (93.6%) with weight as low as 9.29 kg, with no side effects, with failed deployment being the most frequent problem. Clinically different results in the reflux index were found in 16% of the children's day 1 or day 2 readings (p < 0.0001), suggesting the benefit of 48‐hour measurements.

Conclusion

Measuring oesophageal pH with the Bravo wireless pH monitoring system was successful in 93.6% of cases. A 48‐hour test improved the detection rate of gastro‐oesophageal reflux disease by 16%.
In vitro and physiologically‐based pharmacokinetic based assessment of drug–drug interaction potential of canagliflozin
Authors: Mamidi Rao N. V. S. , Dallas Shannon , Sensenhauser Carlo , Lim Heng Keang , Scheers Ellen , Verboven Peter , Cuyckens Filip , Leclercq Laurent , Evans David C. , Kelley Michael F. , Johnson Mark D. , Snoeys Jan
Published: November 2016

Aims

Canagliflozin is a recently approved drug for use in the treatment of type 2 diabetes. The potential for canagliflozin to cause clinical drug–drug interactions (DDIs) was assessed.

Methods

DDI potential of canagliflozin was investigated using in vitro test systems containing drug metabolizing enzymes or transporters. Basic predictive approaches were applied to determine potential interactions in vivo. A physiologically‐based pharmacokinetic (PBPK) model was developed and clinical DDI simulations were performed to determine the likelihood of cytochrome P450 (CYP) inhibition by canagliflozin.

Results

Canagliflozin was primarily metabolized by uridine 5′‐diphospho‐glucuronosyltransferase 1A9 and 2B4 enzymes. Canagliflozin was a substrate of efflux transporters (P‐glycoprotein, breast cancer resistance protein and multidrug resistance‐associated protein‐2) but was not a substrate of uptake transporters (organic anion transporter polypeptide isoforms OATP1B1, OATP1B3, organic anion transporters OAT1 and OAT3, and organic cationic transporters OCT1, and OCT2). In inhibition assays, canagliflozin was shown to be a weak in vitro inhibitor (IC50) of CYP3A4 (27 μmol l –1, standard error [SE] 4.9), CYP2C9 (80 μmol l –1, SE 8.1), CYP2B6 (16 μmol l–1, SE 2.1), CYP2C8 (75 μmol l –1, SE 6.4), P‐glycoprotein (19.3 μmol l –1, SE 7.2), and multidrug resistance‐associated protein‐2 (21.5 μmol l –1, SE 3.1). Basic models recommended in DDI guidelines (US Food & Drug Administration and European Medicines Agency) predicted moderate to low likelihood of interaction for these CYPs and efflux transporters. PBPK DDI simulations of canagliflozin with CYP probe substrates (simvastatin, S‐warfarin, bupropion, repaglinide) did not show relevant interaction in humans since mean areas under the concentration‐time curve and maximum plasma concentration ratios for probe substrates with and without canagliflozin and its 95% CIs were within 0.80–1.25.

Conclusions

In vitro DDI followed by a predictive or PBPK approach was applied to determine DDI potential of canagliflozin. Overall, canagliflozin is neither a perpetrator nor a victim of clinically important interactions.
Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
Authors: Edqvist Malin , Hildingsson Ingegerd , Mollberg Margareta , Lundgren Ingela , Lindgren Helena
Published: November 2016

Introduction

Most women who give birth for the first time experience some form of perineal trauma. Second‐degree tears contribute to long‐term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second‐degree tears among primiparous women.

Methods

An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro‐iliac joints, and 3) a two‐step head‐to‐body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables.

Results

A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second‐degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33–0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention.

Conclusion

It is possible to reduce second‐degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low‐ and high‐risk pregnancies.
The moral dimension of politicized identity: Exploring identity content during the 2012 Presidential Elections in the USA
Authors: Turner‐Zwinkels Felicity M. , van Zomeren Martijn , Postmes Tom
Published: November 2016

It is well known that politicized identities are especially good predictors of collective action, but very little is known about what these identities are. We propose that moral identity content plays a central role in politicized identities. We examined this among (un)politicized Americans in the 2012 US Presidential Elections. In a longitudinal community sample of US citizens (N = 760), we tracked personal (i.e., unique) and politicized (i.e., party activist) identity content: before, during, and after the election. We compared identity content of individuals who self‐labelled as politicized (i.e., active party promoters) or unpoliticized (i.e., passive party supporters): (1) Democrats (n = 69) longitudinally and (2) Republicans (n = 69) cross‐sectionally to examine three hypotheses: Moral identity content (e.g., trustworthy) would be more prominent in politicized (vs. unpoliticized) identities (H1); moral identity content overlapping politicized and personal identities predict seeing the self as politicized (H2) and engaging in party activism (H3). Results largely supported H1 and H2, but only weakly supported H3. We conclude that politicized identities are moralized identities that have a self‐evaluative, but not strongly action‐motivation, function. We discuss the implications of our findings and method for politicization research.
Utility of patient‐specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot‐assisted laparoscopic partial nephrectomy
Authors: von Rundstedt Friedrich‐Carl , Scovell Jason M. , Agrawal Smriti , Zaneveld Jacques , Link Richard E.
Published: November 2016

Objective

To describe our experience using patient‐specific tissue‐like kidney models created with advanced three‐dimensional (3D)‐printing technology for preoperative planning and surgical rehearsal prior to robot‐assisted laparoscopic partial nephrectomy (RALPN).

Patients and Methods

A feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D‐print kidney models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction, we generated pre‐surgical models using a silicone‐based material. All surgical rehearsals were performed using the da Vinci® robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) before the actual procedure. To determine construct validity, we compared resection times between the model and actual tumour in a patient‐specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumour volume resected for each model and patient tumour.

Results

We generated patient‐specific models for 10 patients with complex tumour anatomy. R.E.N.A.L. nephrometry scores were between 7 and 11, with a mean maximal tumour diameter of 40.6 mm. The mean resection times between model and patient (6:58 vs 8:22 min, P = 0.162) and tumour volumes between the computer model, excised model, and excised tumour (38.88 vs 38.50 vs 41.79 mm3, P = 0.98) were not significantly different.

Conclusions

We have developed a patient‐specific pre‐surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision‐making, provide preoperative rehearsals, and improve surgical training.
Viewpoint: Estimating the causal effects of policies and programs
Authors: Smith Jeffrey , Sweetman Arthur
Published: November 2016

Estimation, inference and interpretation of the causal effects of programs and policies have all advanced dramatically over the past 25 years. We highlight three particularly important intellectual trends: an improved appreciation of the substantive importance of heterogeneous responses and of their methodological implications, a stronger focus on internal validity brought about by the “credibility revolution,” and the scientific value that follows from grounding estimation and interpretation in economic theory. We discuss a menu of commonly employed partial equilibrium approaches to the identification of causal effects, emphasizing that the researcher's central intellectual contribution always consists of making an explicit case for a specific causal interpretation given the relevant economic theory, the data, the institutional context and the economic question of interest. We also touch on the importance of general equilibrium effects and full cost–benefit analyses.
An amplification mechanism in a model of energy
Authors: Kormilitsina Anna
Published: November 2016

This paper investigates a propagation mechanism of the energy price shock in a model where capital utilization is associated with costly energy consumption. Endogenous depreciation is an important element of the model, as it has been shown to produce a significant negative effect of energy prices on output. I show that the amplifying effect of endogenous depreciation is determined by the choice of the functional form and calibration strategy for the energy cost function. My estimates of the energy cost function allow to conclude that the energy price shock has only a moderate effect on output in this model, while endogenous depreciation mitigates rather than amplifies the effect of the energy price shock.
Poverty‐aware social work practice: service users' perspectives
Authors: Saar‐Heiman Yuval , Lavie‐Ajayi Maya , Krumer‐Nevo Michal
Published: November 2016

In recent years, there has been an increase in scholarly writing on the theory and practice of critical social work with people living in poverty. Yet there is a lack of research on the experiences and perspectives of service users regarding this kind of practice. This paper presents a qualitative study that explored the practice of a special poverty‐aware social work programme in Israel, through the experiences of women who took part in it. Using an interpretative interactionist approach, in‐depth interviews with nine women were held three times over a 2‐year period. Findings reveal a high degree of satisfaction with the programme on the part of the women. The satisfaction was derived from four main experiences: the experience of visibility, the experience of the active partnership in the fight against poverty, the experience of close, hierarchy‐challenging relationships, and the experience of responsiveness to material and emotional needs. The findings are discussed in terms of three principles of practice: intervention in a real‐life context, relationship‐based intervention and the focus on both the material and emotional needs and their fulfilment.
Ultrathin versus pediatric instruments for colonoscopy in older female patients: A randomized trial
Authors: Nemoto Daiki , Utano Kenichi , Endo Shungo , Isohata Noriyuki , Hewett David G. , Togashi Kazutomo
Published: November 2016

Background and Aim

Small‐caliber endoscopes such as gastroscopes or pediatric colonoscopes are occasionally required to negotiate fixed or angulated colons. However, the use of a new ultrathin instrument (diameter 7.0 mm) narrower than other conventional colonoscopes has not been evaluated. The aim of the present study was to compare the use compare the use of an ultrathin colonoscope (UTC) with a pediatric colonoscope (PDC) for colonoscopy in older female patients.

Methods

A prospective, randomized, controlled trial was conducted in a single academic endoscopy unit. A total of 77 female patients aged ≥70 years undergoing unsedated colonoscopy were randomized to colonoscopy with a UTC (n = 39) or PDC (n = 38). Primary outcome measurement was the degree of pain using a numerical rating scale, and secondary outcomes were cecal intubation rate, ileal intubation rate, time to cecum and adenoma detection rate.

Results

There was a significant difference in reported pain using the numerical rating scale (median, UTC 1 vs PDC 4, P < 0.0001). Cecal intubation rates were 97.4% in UTC and 92.1% in PDC (P = 0.36), and ileal intubation rates were 82.0% and 89.4% (P = 0.76), respectively. However, median times to cecum were significantly longer using UTC compared with PDC (15.2 min vs 11.1 min, P = 0.022). Adenoma detection rates were 30.7% in UTC and 26.3% in PDC (P = 0.80).

Conclusions

Colonoscopy using UTC was almost equivalent to that of PDC in older female patients, with significantly less pain compared with PDC. UTC may be an alternative to PDC for the difficult colon.
The development of locomotor kinetics in the foal and the effect of osteochondrosis
Authors: Gorissen B. M. C. , Wolschrijn C. F. , Serra Bragança F. M. , Geerts A. A. J. , Leenders W. O. J. L. , Back W. , van Weeren P. R.
Published: November 2016

Reason for performing study

Foals stand and walk immediately after birth, but insight into the subsequent longitudinal development of their gait kinetics in the early juvenile phase and the possible influence of osteochondrosis thereon is lacking.

Objectives

To quantify gait kinetics in foals during the first half year of life, taking into account their osteochondrosis status.

Study design

Prospective, cohort study performed at a single stud farm.

Methods

Pressure plate measurements at walk and trot from 11 Dutch Warmblood foals during the first 24 weeks of life were used to determine body mass normalised peak vertical force, normalised vertical impulse and stance duration. Coefficients of variation of peak vertical force and stance duration were used as measures for gait maturity. Radiographs of tarsocrural and femoropatellar joints were taken at age 4–6 weeks and after 6 months to check for osteochondrosis. A linear mixed model was used to determine the effects of age, limb, presence of osteochondrosis and speed on gait parameters.

Results

Mean walking and trotting velocity increased over time as did stance duration and normalised vertical impulse, normalised peak vertical force values however remained relatively constant. During the first weeks of their life only the coefficient of variation of stance duration decreased significantly, while the coefficient of variation of peak vertical force did not. None of the foals was visibly lame, but the presence of osteochondrosis resulted in a temporarily but significantly reduced normalised peak vertical force.

Main limitations

This study is a relatively small sample size of one breed from a single stud farm. A stand‐alone pressure plate was used and body mass was estimated rather than measured.

Conclusions

Despite being precocious, foals need time to mature their gait. During growth, velocity at walk and trot increases, but normalised peak vertical force remains relatively constant. Although not visibly lame, a temporary reduction in normalised peak vertical force was detected in osteochondrosis positive foals using a pressure plate.
Local Groundwater Withdrawal Permitting Laws in the South‐Western U.S.: California in Comparative Context
Authors: Nelson Rebecca Louise , Perrone Debra
Published: November 2016

The Sustainable Groundwater Management Act (SGMA) aims to control, for the first time in California's history, the state's significant use and depletion of groundwater. SGMA gives local agencies a high degree of discretion in relation to a new permitting power, but the discretion is a double‐edged sword: agencies gain maximum flexibility to tailor their regime to local conditions, yet the statute provides no direction on appropriate components of a groundwater permitting regime. We introduce SGMA and the broader legislative context to its permitting power, and we explain the continuing common law context in which the legislation operates. This information is used as the foundation for a comparative legal analysis of fundamental elements of permitting regimes. We compare a selection of six other south‐western permitting regimes established in legislation for areas recognized as requiring intensive management through permitting: “special permitting areas” (SPAs). We find that permitting regimes in south‐western SPAs share a structure containing several almost universal elements, although the policy settings that apply to those elements vary widely. The established permitting regimes in the other south‐western states' SPAs may inform Californian agencies seeking to use their new permitting power for the first time, as well as water agencies further afield, as to important components of a permitting regime, and the different policy settings that could apply to those components. Californian local agencies, and its Department of Water Resources, which is charged with providing local agencies technical advice, should have regard to these permitting possibilities.