bluuebunny/crossref_metadata_2025 huggingface dataset:
Too Smart to Fail
Authors: Henfield Malik S. , Woo Hongryun , Lin Yi-Chun , Rausch Meredith A.
Published: February 2014

There is a considerable history of misunderstandings associated with Asian American in education. Although many educators and scholars have begun to pay more attention to unique issues associated with this population, studies exploring these students’ experiences as honors students in collegiate contexts are scant in the educational literature. The purpose of this study is to explore high-achieving Asian American students’ perceptions of their experiences in a collegiate honors program. Using an ecological framework, the authors explored four Asian American students’ unique experiences as members of a collegiate honors program at a large university in the Midwest. Using consensual qualitative research as a methodological framework, six domains were found: (a) experiences in the honors program, (b) resources, (c) perceptions of ethnic identity, (d) career aspirations, (e) suggestions for gifted students, and (f) needs and hopes.
Interactive education in public administration (2)
Authors: Brock Jonathan , Alford John
Published: February 2014

The previous article (‘Interactive education in public administration (1): The role of teaching “objects”’) described the benefits of ‘moving from behind the lectern’ to engage in interactive teaching in public policy and administration, and the central role of ‘objects’ in that process. But teaching ‘objects’ can only produce effective results if they are used in a way that achieves learning objectives. Interaction for interaction’s sake is not enough; it must also lead to understanding of new concepts and analytical approaches. Moreover, interactive teaching can be challenging for teachers who mainly use didactic traditional lecturing, since it entails sharing control of the discussion with students. This article explains and justifies a purposeful, structured framework both for stimulating engagement in public administration courses, and for turning that engagement into learning, in a way that provides for the intellectual safety of the teacher and student – which is crucial for enabling participants to take risks in classroom discussions. In the process, the article further addresses the rationale for using interactive and object-based approaches specifically in public administration and related disciplines.
The Conceptual and the Empirical in Science and Technology Studies
Authors: Gad Christopher , Ribes David
Published: February 2014

It is the purpose of this special issue to acknowledge the shifting definitions and uses of the conceptual and empirical in the field of Science and Technology Studies (STS), and to explore the constructive potential of this condition. In this introductory essay we point to four formulations in STS for the relation between the conceptual and the empirical which do not figure them as binaries or opposites: (1) the empirical as a path to the conceptual, (2) the conceptual as practical and empirical, (3) the empirical as an instantiation of the conceptual (and the dangers of that view), and (4) a conceptual minimalism. We then point to some inspirations in contemporary thought for engaging creatively with the conceptual and empirical, and conclude by summarizing the contributions to this issue.
Vocal Cord Paralysis and Dysphagia after Aortic Arch Reconstruction and Norwood Procedure
Authors: Pham Vinh , Connelly Diana , Wei Julie L. , Sykes Kevin J. , O'Brien Jim
Published: February 2014

Objectives

To determine the incidence of vocal cord (VC) paralysis and dysphagia after aortic arch reconstruction, including the Norwood procedure.

Setting

Tertiary children's hospital.

Study Design

Retrospective cohort.

Methods

Database/chart review of neonates requiring Norwood or arch surgery between January 2005 and December 2012. Demographics, postoperative VC function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long‐term follow‐up were reviewed.

Results

One hundred fifty‐one consecutive subjects (96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days (interquartile range [IQR], 7‐13) for Norwood and 24 days (IQR, 12‐49) for arch reconstruction (P <. 001). Documentation of VC motion abnormality was found in 60 of 104 (57.6%) subjects and unavailable in 47 (16 without documentation and 31 who died prior to extubation). There were no significant differences in proportions of documented VC motion (P =. 337), dysphagia (P =. 987), and VC paralysis (P =. 706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without unilateral VC paralysis (UVCP), dysphagia was present (56% Norwood, 61% arch). Overall, 120 of 151 (79.5%) required feeding evaluation and a modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55 of 151 (36.4%) patients. Of those with VC paralysis, only 23 (22%) had any otolaryngology follow‐up after discharge from surgery. More than 75% with VC paralysis with follow‐up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis.

Conclusion

There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.
No Evidence for Distinguishing Bacterial from Viral Acute Rhinosinusitis Using Symptom Duration and Purulent Rhinorrhea: A Systematic Review of the Evidence Base
Authors: van den Broek Medard F. M. , Gudden Corien , Kluijfhout Wouter P. , Stam‐Slob Manon C. , Aarts Mark C. J. , Kaper Nina M. , van der Heijden Geert J. M. G.
Published: February 2014

Objective

To evaluate the diagnostic value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis.

Data Sources

PubMed, EMBASE, and the Cochrane Library.

Review Methods

We performed a comprehensive systematic search on March 28, 2013. We included studies on the diagnostic value of duration of symptoms and purulent rhinorrhea in patients suspected of having acute bacterial rhinosinusitis. We assessed study design of included articles for directness of evidence and risk of bias. We extracted prevalence and positive and negative predictive values.

Results

Of 4173 unique publications, we included 1 study with high directness of evidence and moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval [CI], 0.24‐0.35); we could not extract posterior probabilities. Odds ratios (95% CI) from univariate analysis were 1.03 (0.78‐1.36) for duration of symptoms and 2.69 (1.39‐5.18) for colored discharge on the floor of the nasal cavity.

Conclusion and Recommendation

We included 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis. Recommendations to distinguish between a viral and a bacterial source based on purulent rhinorrhea are not supported by evidence, and the decision to prescribe antibiotic treatment should not depend on its presence. Based on judgment driven by theory and subsidiary evidence of a greater likelihood of bacterial rhinosinusitis after 10 days, antibiotic therapy may seem a reasonable empirical option.
Bacterial Biofilms and Increased Bacterial Counts Are Associated with Airway Stenosis
Authors: Mazhar Kashif , Gunawardana Manjula , Webster Paul , Hochstim Christian , Koempel Jeffery , Kokot Niels , Sinha Uttam , Rice Dale , Baum Marc
Published: February 2014

Objectives

Most airway stenoses are acquired secondary to the use of prolonged endotracheal intubation. Antibiotics have been shown to decrease local inflammation and granulation tissue formation in the trachea. However, antibiotic therapy is not 100% effective in preventing or treating granulation tissue formation. Development of bacterial biofilms may explain this finding. This study evaluates the difference between tracheal stenotic segments and normal trachea in terms of (1) presence of bacterial biofilms, (2) quantitative bacterial counts, and (3) inflammatory markers.

Study Design

Cross‐sectional study.

Setting

Tertiary care academic medical center.

Subjects

A total of 12 patients were included in the study. Tissue from stenotic segments from 6 patients with airway stenosis undergoing open airway procedures were compared with tracheal tissue from 6 patients without airway stenosis undergoing tracheostomy.

Methods

Scanning electron microscopy for biofilm detection, quantitative polymerase chain reaction for quantitative analysis of bacterial count, and immunohistochemistry were performed for inflammatory markers transforming growth factor β1 (TGF‐β1) and SMAD3.

Results

Compared with the patients without airway stenosis, patients in the airway stenosis group showed presence of bacterial biofilms, a significantly higher expression of 16S rRNA gene copies per microgram of tissue (187.5 vs 7.33, P =. 01), and higher expression of TGF‐β1 (91% vs 8%, P <. 001) and SMAD3 (83.5% vs 17.8%, P <. 001).

Conclusion

Bacterial biofilms, increased bacterial counts, and higher expression of TGF‐β1 and SMAD3 are associated with airway stenosis.
Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endoscopy
Authors: Wu Wei , Chen Qiang , Zhang Liang-cheng , Chen Wen-hua
Published: February 2014

Objectives

To investigate the efficacy and safety of sedation with dexmedetomidine in upper gastrointestinal endoscopy.

Methods

Patients with ASA physical status I–II undergoing elective upper gastrointestinal endoscopy were randomly allocated to receive dexmedetomidine or midazolam for conscious sedation. Continuous peripheral oxygen saturation (SpO2), heart rate, mean arterial pressure (MAP), Ramsay Sedation Scale (RSS) and numeric rating scale pain scores were recorded before, during and after the procedure. Patients completed a post-procedure satisfaction questionnaire.

Results

Patients in the midazolam group ( n = 30) experienced a significant decrease in MAP during sedation compared with pre-sedation values. Patients in the dexmedetomidine group ( n = 30) had significantly higher SpO2 and RSS scores during sedation than those in the midazolam group. Overall satisfaction was higher in the dexmedetomidine group than the midazolam group. There were no clinically significant complications in either group.

Conclusion

Dexmedetomidine has a good safety profile and is an effective sedative for use in upper gastrointestinal endoscopy.
Comparative Pathology of Neurovirulent Lineage 1 (NY99/385) and Lineage 2 (SPU93/01) West Nile Virus Infections in BALBc Mice
Authors: Williams J. H. , Mentoor J. D. L. , Van Wilpe E. , Venter M.
Published: February 2014

The pathology in mice infected with neurovirulent South African lineage 2 West Nile virus (WNV) strains has not previously been described. Three- to 4-month-old male BALBc mice were infected with South African neurovirulent lineage 2 (SPU93/01) or lineage 1 (NY385/99) WNV strains and the gross and microscopic central nervous system (CNS) and extra-CNS pathology of both investigated and compared. Mice infected with both lineages showed similar illness, paralysis, and death from days 7 to 11 postinfection (PI). Two survivors of each lineage were euthanized on day 21 PI. WNV infection was confirmed by nested real-time reverse transcription polymerase chain reaction of tissues, mostly brain, in the majority of mice euthanized sick or that died and in 1 healthy lineage 2 survivor. Gross lesions caused by both lineages were identical and included marked gastric and proximal small intestinal fluid distension as described in a previous mouse study, but intestinal microscopic lesions differed. CNS lesions were subtle. Immunohistochemical (IHC)–positive labeling for WNV E protein was found in neurons multifocally in the brain of 3 lineage 1–infected and 3 lineage 2–infected mice from days 9 to 11 PI, 4 of these including brainstem neurons, and of cecal myenteric ganglion neurons in 1 lineage 2–infected day 8 PI mouse. Findings supported hypotheses in hamsters that gastrointestinal lesions are likely of brainstem origin. Ultrastructurally, virus-associated cytoplasmic vesicular or crystalline structures, or amorphous structures, were found to label IHC positive in control-positive avian cardiomyocytes and mouse thalamic neurons, respectively, and WNV-like 50-nm particles, which were scarce, did not label.
Biogas production from Pongamia biomass wastes and a model to estimate biodegradability from their composition
Authors: Gunaseelan Victor Nallathambi
Published: February 2014

In this study, I investigated the chemical characteristics, biochemical methane potential, conversion kinetics and biodegradability of untreated and NaOH-treated Pongamia plant parts, and pod husk and press cake from the biodiesel industry to evaluate their suitability as an alternative feedstock for biogas production. The untreated Pongamia seeds exhibited the maximum CH4 yield of 473 ml g −1 volatile solid (VS) added. Yellow, withered leaves gave a yield as low as 122 ml CH4 g −1 VS added. There were significant variations in the CH4 production rate constants, which ranged from 0.02 to 0.15 d −1, and biodegradability, which ranged from 0.25 to 0.98. NaOH treatment of leaf and pod husk, which were highly rich in fibers, increased the yields by 15–22% and CH4 production rate constants by 20–75%. Utilization of Pongamia wastes in biogas digesters not only influences the economics of biodiesel production but also yields CH4 fuel and protects the environment. The experimental data from this study were used to develop a multiple regression model, which could estimate biodegradability based on biochemical characteristics. The model predicted the biodegradability of previously published biomass wastes (r2 = 0.88) from their biochemical composition. The theoretical CH4 yields estimated as 350 ml g−1 chemical oxygen demand destroyed are much higher than the experimental yields as 100% biodegradability is assumed for each substrate. Upon correcting the theoretical CH4 yields with biodegradability data obtained from chemical analyses of substrates, their ultimate CH4 yields could be predicted rapidly.
What factors influence choice of waste management practice? Evidence from rice straw management in the Philippines
Authors: Launio Cheryll C , Asis Constancio A , Manalili Rowena G , Javier Evelyn F , Belizario Annabelle F
Published: February 2014

This study applied a multinomial logit model to understand why farmers choose to burn, incorporate or remove rice straw in the field. Four hundred randomly selected farmers were interviewed in four major rice-producing provinces covering the 2009 wet and 2010 dry seasons. Results of the model with burning as the baseline category indicate farm type, location dummies, number of household members with older than 13 years, cow ownership and distance from farm to house as significant variables influencing farmers’ choice of straw incorporation or removal over burning. Significant perception variables are the negative impacts of open-field burning, awareness of environmental regulations and attitude towards incentives. Other factors significantly influencing the decision to incorporate over-burn are training attendance and perceptions of effects of straw incorporation. Income from non-rice farming, total area cultivated, tenure status, presence of burning and solid waste management provincial ordinances are significant factors affecting choice to remove over burn. Continually providing farmers’ training in rice production, increasing demand for rice straw for other uses, and increasing awareness of environmental laws and regulations are policy directions recommended.
Suction characteristics of compacted zeolite-bentonite and sand–bentonite mixtures
Authors: Durukan Seda , Pulat Hasan Firat , Yukselen-Aksoy Yeliz
Published: February 2014

Soil suction is one of the most important parameters describing soil moisture conditions for unsaturated soils used in landfill liners. However, few studies have been conducted on the suction characteristics of compacted zeolite–bentonite mixtures (ZBMs) and sand–bentonite mixtures (SBMs), which are proposed for use as liner materials. Nevertheless, zeolite is known for its microporous skeleton containing cages and tunnels and it has a great physical affiliation to water uptake. Zeolite and bentonite, in a mixture, are thought to be in competition for water uptake and this may alter the distribution of water content for each soil in the mixture. The present study investigated the suction properties of compacted ZBMs and SBMs for varying mixing ratios and compaction water contents. The soil suction measurement technique chosen was the filter-paper method. The suction characteristics of powdered, granular, and block zeolites, as well as 0, 10, and 20% bentonite in ZBMs and SBMs were measured and compared with each other. Contaminated compacted ZBMs are compared with those of uncontaminated compacted ones at the optimum water content for the 10% and 20% mixtures. The results show that suction capacity of zeolite increases with grain size. As bentonite content increases, both matric and total suction increase for both mixtures. ZBMs have higher matric suction values than SBMs, but not total suction values. Contaminated total suction values are found to be higher than those of uncontaminated samples due to an increase in dissolved ion concentration.
Dental solid waste characterization and management in Iran: A case study of Sistan and Baluchestan Province
Authors: Bazrafshan Edris , Mohammadi Leili , Mostafapour Ferdos Kord , Moghaddam Alireza Ansari
Published: February 2014

The management of dental solid waste continues to be a major challenge, particularly in most healthcare facilities of the developing world. In Iran, few studies on management of dental solid waste and its composition are available. An effort has been made through this study to evaluate the hazardous and infectious status of dental solid waste, keeping in mind its possible role in cross-infection chain. For this study, 123 private dental centres and 36 public dental centres were selected and the composition and generation rate of dental solid waste produced were measured. Dental solid waste was classified to four main categories: (i) domestic-type; (ii) potentially infectious; (iii) chemical and pharmaceutical; and (iv) toxic, which constituted 11.7, 80.3, 6.3, and 1.7%, respectively, of the total. Also, the results indicated that the dental solid waste per patient per day generation rate for total, domestic-type, potentially infectious, chemical and pharmaceutical, and toxic wastes were 169.9, 8.6, 153.3, 11.2, and 3.3 g/patient/d, respectively. Furthermore, the per day generation rates for total, domestic-type, potentially infectious, chemical and pharmaceutical, and toxic wastes were 194.5, 22.6, 156.1, 12.3, and 3.4 kg/d, respectively. According to findings of this study, for best management of dental waste it is suggested that source reduction, separation, reuse, and recycling programmes be implemented and each section of dental waste be collected and disposed of separately and in accordance with related criteria.
A strategic theory of effective monitoring arrangements for international institutions
Authors: Sanchez Thania , Urpelainen Johannes
Published: February 2014

States often delegate compliance monitoring to international monitors. It is commomly assumed that these monitors will report accurately on the information they gather. However, the effectiveness of compliance monitors varies widely. Monitors may fail to collect information about non-compliance or even collude with non-compliant states and deliberately fail to report the information they gather. To explain this variation, we present a formal theory of how structural conditions and institutional designs lead to different levels of monitoring efficacy. We show that international institutions can improve monitoring by avoiding ruthless sanctions, and that intrinsically motivated monitors generally achieve better outcomes than neutral bureaucrats. Our theory contributes to the broad literature on international institutional design and treaty effectiveness.
Fuel prereforming and combustion characteristics study of chemically recuperated gas turbine
Authors: Liu Xiao , Zheng Hongtao , Yang Ren , Li Zhiming
Published: February 2014

The chemically recuperated gas turbine cycle testing platform was designed and built based on theoretical research and experimental study, which included the dual-stage flash evaporation, the diesel steam reformer, and the dual-fuel combustion system. In this paper, an experimental study on the oil (C7H16) prereforming performance is analyzed and the relative increment of the equivalent calorific value is 46.2%. Combustion characteristics are calculated with oil and reformed gas and the results show that main combustion zone temperature drops from 2280 to 1910 K, which leads the ultra-low NO emissions of 1.8 ppm. The flame is stable using reformed gas and the wall temperature is low, but the nonuniformity of outlet is relatively high. Thermal efficiency of combustion is more than 99% even at low load condition.
A frequency-domain solution for efficient stability prediction of variable helix cutters milling
Authors: Jin Gang , Zhang Qichang , Qi Houjun , Yan Bing
Published: February 2014

The utilization of variable pitch or helix cutters is an effective means to prevent chatter vibration during milling. In this paper, a frequency-domain solution to efficiently predict the stability for variable helix cutters milling is presented. This method is based on the principles of variable pitch model developed by Altintas and only considers the zero-order approximation of time-varying directional cutting constants. After discretizing the axial depth of cut into finite elements and modeling each element as a variable pitch cutter, time-varying regenerative delays in the case of variable helix cutters are transformed into multiple constant regenerative times. The chatter free axial depth of cut is solved from a stability expression in which the regenerative delay terms are approximated by the Taylor series expansion, whereas the spindle speed is identified from regenerative phase delays. Compared with time-averaged semidiscretization method, the accuracy and efficiency of the proposed technique has been verified. The results show that the proposed method has high computational efficiency. It is suited to calculate optimal geometries of milling tools and beneficial for application.
Nominal stresses and Modified Wöhler Curve Method to perform the fatigue assessment of uniaxially loaded inclined welds
Authors: Susmel Luca
Published: February 2014

The present paper summarises an attempt of proposing a simple formula suitable for estimating the fatigue strength of welded connections whose weld beads are inclined with respect to the direction along which the fatigue loading is applied. By explicitly considering the degree of multiaxiality of the nominal stress state damaging the weld toe, such a formula is directly derived from the so-called Modified Wöhler Curve Method (MWCM). The MWCM is a bi-parametrical critical plane approach which postulates that, independently from the complexity of the assessed load history, fatigue strength can accurately be estimated by using the stress components relative to that material plane experiencing the maximum shear stress range. The accuracy and reliability of the proposed design technique were checked against a number of experimental results taken from the literature and generated by testing steel plates with inclined fillet-welded attachments. This validation exercise allowed us to prove that the devised formula can successfully be used in situations of practical interest to design against fatigue welded joints whose welds are inclined with respect to the direction along which the cyclic force is applied.
The International and Domestic Sources of Bipartisanship in U.S. Foreign Policy
Authors: Flynn Michael E.
Published: February 2014

Foreign policy scholars have long emphasized bipartisanship in foreign policymaking, particularly in the context of presidential appointments to the foreign policy bureaucracy, emphasizing the role of international crises and national security in affecting bipartisanship. In spite of their enduring nature, few systematic analyses of these claims exist. This study addresses these gaps using new data on appointees to the foreign policy bureaucracy. The results challenge the conventional wisdoms emerging from the foreign policy literature regarding the importance of factors like war, instead pointing to the importance of domestic political factors in affecting bipartisanship in appointments to the foreign policy bureaucracy.
Electrical Integration of Human Embryonic Stem Cell-Derived Cardiomyocytes in a Guinea Pig Chronic Infarct Model
Authors: Shiba Yuji , Filice Dominic , Fernandes Sarah , Minami Elina , Dupras Sarah K. , Biber Benjamin Van , Trinh Peter , Hirota Yusuke , Gold Joseph D. , Viswanathan Mohan , Laflamme Michael A.
Published: February 2014

Background:

Human embryonic stem cell-derived cardiomyocytes (hESC-CMs) were recently shown to be capable of electromechanical integration following direct injection into intact or recently injured guinea pig hearts, and hESC-CM transplantation in recently injured hearts correlated with improvements in contractile function and a reduction in the incidence of arrhythmias. The present study was aimed at determining the ability of hESC-CMs to integrate and modulate electrical stability following transplantation in a chronic model of cardiac injury.

Methods and Results:

At 28 days following cardiac cryoinjury, guinea pigs underwent intracardiac injection of hESC-CMs, noncardiac hESC derivatives (non-CMs), or vehicle. Histology confirmed partial remuscularization of the infarct zone in hESC-CM recipients while non-CM recipients showed heterogeneous xenografts. The 3 experimental groups showed no significant difference in the left ventricular dimensions or fractional shortening by echocardiography or in the incidence of spontaneous arrhythmias by telemetric monitoring. Although recipients of hESC-CMs and vehicle showed a similar incidence of arrhythmias induced by programmed electrical stimulation at 4 weeks posttransplantation, non-CM recipients proved to be highly inducible, with a ∼3-fold greater incidence of induced arrhythmias. In parallel studies, we investigated the ability of hESC-CMs to couple with host myocardium in chronically injured hearts by the intravital imaging of hESC-CM grafts that stably expressed a fluorescent reporter of graft activation, the genetically encoded calcium sensor GCaMP3. In this work, we found that only ∼38% (5 of 13) of recipients of GCaMP3+ hESC-CMs showed fluorescent transients that were coupled to the host electrocardiogram.

Conclusions:

Human embryonic stem cell-derived cardiomyocytes engraft in chronically injured hearts without increasing the incidence of arrhythmias, but their electromechanical integration is more limited than previously reported following their transplantation in a subacute injury model. Moreover, non-CM grafts may promote arrhythmias under certain conditions, a finding that underscores the need for input preparations of high cardiac purity.
The Relationship Between Life Satisfaction and ADHD Symptoms in Middle School Students
Authors: Ogg Julia A. , Bateman Lisa , Dedrick Robert F. , Suldo Shannon M.
Published: February 2014

Objective: ADHD is associated with increased academic and social difficulties and comorbid psychopathology which may lead to decreased life satisfaction (LS). Methods: The current study utilized a bifactor model of ADHD consisting of a general factor and two specific factors (inattention and hyperactivity-impulsivity) to determine if ADHD symptoms place middle school students ( n = 183) at risk for diminished LS and if this relationship differed depending on whether teachers versus students reported ADHD symptoms. Results: Confirmatory factor analyses indicated that the bifactor model provided very good fit to the ADHD symptoms reported by students (comparative fit index [CFI] = .995; root mean square error of approximation [RMSEA] = .028) and teachers (CFI = .997; RMSEA = .043). Results also demonstrated that when students rated ADHD symptoms, the general ADHD factor and inattention were negatively related to LS; however, when teachers rated ADHD symptoms, only inattention was negatively related to LS. Conclusions: Implications and future directions related to these results are discussed.
Thyroid autoimmunity and dysfunction in multiple sclerosis patients during long-term treatment with interferon beta or glatiramer acetate: an Italian multicenter study
Authors: Frisullo Giovanni , Calabrese Massimiliano , Tortorella Carla , Paolicelli Damiano , Ragonese Paolo , Annovazzi Pietro , Radaelli Marta , Malucchi Simona , Gallo Antonio , Tomassini Valentina , Nociti Viviana , D’Onghia Mariangela , Lo Re Vincenzina , Rodegher Mariemma , Solaro Claudio , Gasperini Claudio
Published: February 2014

Few long-term follow-up data are available on thyroid dysfunction (TD) in multiple sclerosis (MS) patients treated with glatiramer acetate (GA) or with interferon-beta (IFNb). In a cohort of 787 relapsing–remitting MS (RRMS) patients whom were followed up for 8 years, we observed an increased prevalence of TD and thyroid autoimmunity (TA) within the first year of IFNb treatment, regardless of the dose or frequency of administration, while no change was observed with GA treatment. The increased prevalence of TD and TA within the first year of IFNb treatment suggested the need for close monitoring of thyroid function and autoimmunity, though only during the first year of IFNb treatment.
Trends in overweight and obesity in Danish children and adolescents: 2000-2008 – exploring changes according to parental education
Authors: Matthiessen Jeppe , Stockmarr Anders , Biltoft-Jensen Anja , Fagt Sisse , Zhang Hao , Groth Margit Velsing
Published: February 2014

Aims: To examine the hypotheses that an overall levelling off in the prevalence of overweight and obesity during the period 2000–2008 has occurred, and that increasing social inequality in overweight and obesity exists in a nationally representative sample of Danish children and adolescents. Methods: The population comprised a random sample of 1849 children aged 4–14 years who participated in the Danish National Survey of Diet and Physical Activity in 2000–2002, 2003–2004 and 2005–2008. Parental education was chosen as an indicator of children’s socioeconomic status. Body mass index (BMI) was calculated from parent-reported weight and height. Subjects were classified as overweight and obese according to the International Obesity Task Force age- and gender-specific BMI cut-off values. Crude prevalence estimates and logistic regression models were used to analyse trends in overweight and obesity as the main outcome measures. Results: An increase was found in the crude prevalence of overweight (including obesity) in boys (12.8–21.7%, p = 0.0006), but not in girls (17.6–15.9%, p = 0.56), between 2000–2002 and 2005–2008. The prevalence of overweight increased significantly in boys of parents with low educational level only. A strong inverse social gradient in overweight and obesity was documented for boys and girls during the whole survey period. Conclusions: The present study showed an increase in the prevalence of overweight in Danish boys, but not in girls. This increase was due to increasing social inequality in overweight among boys. Public health initiatives aimed at preventing and reducing overweight and obesity should consider gender difference and especially target boys with parents of low educational level.
Risk Patterns Among College Youth
Authors: Luo Juhua , Agley Jon , Hendryx Michael , Gassman Ruth , Lohrmann David
Published: February 2014

Purpose. This study identified underlying subgroups among college students in terms of lifestyle characteristics and health risk behaviors and then investigated how demographic factors were associated with the underlying risk patterns to bolster health promotion efforts and interventions. Method. College students ( N = 996) enrolled at Indiana University during 2009-2010 participated in a multidimensional online survey. Latent class analysis was used to identify underlying risk patterns based on seven lifestyle and health behaviors, including frequent alcohol use, binge drinking, smoking, low physical activity, low vegetable intake, low fruit intake, and poor sleep. Results. Four distinct risk behavior patterns were identified for both males and females including a “healthy” class, “low substance use but poor other health behaviors” class, “high substance use” (males)/“high alcohol use” (females) class, and a risk class characterized by elevated probability of all seven indicators. The highest risk class included 34% of the males and 22% of the females; they tended to be older or in more advanced undergraduate classes. Among males, compared with the “healthy” class, the “high substance use” class was more likely to contain non-Hispanic White students and students in advanced classes. Among females, the “low substance use but poor other health behaviors” class was associated with racial/ethnic minority status and lower levels of parental education. Conclusions. Our data suggest that risky health behaviors may tend to cluster in some students and that health promotion techniques might effectively be targeted to identifiable student subgroups.
Do Patients With Multiple Sclerosis Show Different Daily Physical Activity Patterns From Healthy Individuals?
Authors: Rietberg Marc B. , van Wegen Erwin E. H. , Kollen Boudewijn J. , Kwakkel Gert
Published: February 2014

Background. Reduced physical activity is an important consequence of multiple sclerosis (MS). However, little is known about the real quantity and type of daily activities that people with MS perform in their own home environment. Objective. To gain insight into differences in the amount and patterns of physical activities performed over a 24-hour period in the own community environment of patients with MS and healthy individuals. Methods. A total of 43 ambulatory patients with MS and 26 age- and gender-matched healthy individuals participated. Physical activity recorded with an ambulatory activity monitor was classified into postures and motions. Multilevel analyses were conducted to investigate whether the pattern of physical activities across daily periods (morning, afternoon, and evening) was dependent on the group (MS vs healthy individuals). Results. Results showed a significant overall lower amount of dynamic activity as compared with a group of healthy controls ( P < .001). Patients with MS started with lower physical activity levels already in the morning ( P < .001), and this difference persisted in the afternoon ( P = .002) and evening ( P = .032). Conclusion. Activity monitoring gives insight into real-world daily physical behavior. Our findings suggest that patients with MS may adopt a deliberate anticipatory strategy of lower activity in the morning, which persists throughout the day. Future trials evaluating daily changes in physical activity behavior should simultaneously sample self-report measures of energy levels and fatigue to elucidate the complex interaction between symptoms and physical activity.
Characteristic interviews, different strategies
Authors: Sigstad Hanne Marie Høybråten
Published: February 2014

Conducting qualitative research interviews among individuals with intellectual disabilities, including cognitive limitations and difficulties in communication, presents particular research challenges. One question is whether the difficulties that informants encounter affect interviews to such an extent that the validity of the results is weakened. This article focuses on voluntary informed consent and the specific challenges with the greatest effects on such interviews. The discussion shows that complementary and meaningful descriptions from informants imply the need to employ alternative strategies and methods that may, in other contexts, challenge the traditional understanding of what is acceptable in research.
Multiple Source Biosimilar Insulin, What’s a Provider to Do?
Authors: Carter Alan
Published: February 2014

In the United States the FDA designates generic products that are bioequivalent as AB substitutable (FDA rating signifying the approved application contains adequate scientific evidence establishing through in vivo and/or in vitro studies the bioequivalence of the product to a selected reference product) and are expected to produce the same therapeutic results as the innovator product. In the case of biological proteins that are similar to already approved innovator biologicals, such as recombinant human insulin, the insulin molecule and accompanying secondary and tertiary structures will differ between manufacturing sources. Even subtle differences between innovator (branded) and alternative “biosimilar” products may produce different therapeutic endpoints. Substitution of a branded insulin with a biosimilar insulin product may result in more, less, or equal therapeutic response making in difficult for the practitioner to assess glycemic control between patient follow-up visits. Significant therapeutic difference is possible, which could result in mild to severe hypoglycemia reaction or hyperglycemia induced tissue damage. Slight molecular changes along with different accompanying proteins, protein fragments, and other naturally occurring contaminants theoretically increase odds of insulin resistance or allergic reaction. Current review of medication product and device quality relies on manufacturer self-oversight and individual reporting of product adverse events after use. While this is usually sufficient for oral medications and many medical devices, critical use products such as sterile products, biosimilar insulin, insulin delivery devices, self-monitoring blood glucose monitoring systems, and test strips require much more vigorous oversight to prevent individual and/or large scale catastrophe. Health care providers should advocate for their patient to have access to affordable, consistent, quality-assured products to effectively and safely manage their medical issues. A potential commonsense solution would be to utilize existing nonprofit organizations with access to pharmacy/laboratory services that have vested interest in ensuring product quality throughout the supply pipeline. The old adage “an ounce of prevention is worth a pound of cure” holds even more true in today’s medical environment.
The UVA/PADOVA Type 1 Diabetes Simulator
Authors: Man Chiara Dalla , Micheletto Francesco , Lv Dayu , Breton Marc , Kovatchev Boris , Cobelli Claudio
Published: February 2014

Objective:

Recent studies have provided new insights into nonlinearities of insulin action in the hypoglycemic range and into glucagon kinetics as it relates to response to hypoglycemia. Based on these data, we developed a new version of the UVA/PADOVA Type 1 Diabetes Simulator, which was submitted to FDA in 2013 (S2013).

Methods:

The model of glucose kinetics in hypoglycemia has been improved, implementing the notion that insulin-dependent utilization increases nonlinearly when glucose decreases below a certain threshold. In addition, glucagon kinetics and secretion and action models have been incorporated into the simulator: glucagon kinetics is a single compartment; glucagon secretion is controlled by plasma insulin, plasma glucose below a certain threshold, and glucose rate of change; and plasma glucagon stimulates with some delay endogenous glucose production. A refined statistical strategy for virtual patient generation has been adopted as well. Finally, new rules for determining insulin to carbs ratio (CR) and correction factor (CF) of the virtual patients have been implemented to better comply with clinical definitions.

Results:

S2013 shows a better performance in describing hypoglycemic events. In addition, the new virtual subjects span well the real type 1 diabetes mellitus population as demonstrated by good agreement between real and simulated distribution of patient-specific parameters, such as CR and CF.

Conclusions:

S2013 provides a more reliable framework for in silico trials, for testing glucose sensors and insulin augmented pump prediction methods, and for closed-loop single/dual hormone controller design, testing, and validation.
Patient Perspectives on Biosimilar Insulin
Authors: Wilkins Alasdair R. , Venkat Manu V. , Brown Adam S. , Dong Jessica P. , Ran Nina A. , Hirsch James S. , Close Kelly L.
Published: February 2014

Given that a new wave of biosimilar insulins will likely enter the market in coming years, it is important to understand patient perspectives on these biosimilars. A survey (N = 3214) conducted by the market research company dQ&A, which maintains a 10 000-patient panel of people with type 1 or type 2 diabetes in roughly equal measure, investigated these perspectives. The survey asked whether patients would switch to a hypothetical less expensive biosimilar insulin that was approved by their provider. Approximately 66% of respondents reported that they would “definitely” or “likely” use a biosimilar insulin, while 17% reported that they were “unlikely” to use or would “definitely not use” such a product. Type 2 diabetes patients demonstrated slightly more willingness to use biosimilars than type 1 diabetes patients. Common patient concerns included whether biosimilars would be as effective as reference products (~650 respondents), whether side effect profiles would deviate from those of reference products (~220 respondents), and the design of the delivery device (~50 respondents). While cost savings associated with biosimilar insulins could increase patient uptake, especially among patients without health insurance (some recent estimates suggest that biosimilars will come at a substantial discount), patients may still need assurance that a cheaper price tag is not necessarily associated with substandard quality. Overall, the dQ&A survey indicates that the majority of patients are willing to consider biosimilar insulins, but manufacturers will need to work proactively to address and assuage patient concerns regarding efficacy, safety, drug administration, and other factors.
Impact of Biosimilar Insulins on Clinical Practice
Authors: Dolinar Richard O. , Edelman Steve , Heinemann Lutz , Home Philip , Goyal Shefali , Polonsky William H. , Schellekens Huub
Published: February 2014

The availability of biosimilar insulins can potentially lead to lower insulin costs and increased access for patients with diabetes, worldwide. However, clinicians and regulatory agencies have raised several concerns regarding the safety and efficacy of these new medications. The European regulatory agencies have established guidelines for market approval of biosimilar insulins; however, many issues remain unresolved. Moreover, although the FDA has developed preliminary pathways for biosimilar protein development and is prepared to review each application on a case-by-case basis, insulins do not fall under this pathway at this time. The development of effective postmarketing surveillance protocols, determination of product interchangeability, and product identification/labeling remain key concerns. Numerous issues surround the development and commercialization of biosimilar insulins; thus, it is important that all stakeholders fully understand the complexity of these issues and how they can potentially affect patient care. Bridging the educational gap among clinicians and regulatory agencies will be challenging but necessary for ensuring patient safety.
An Eye for Odin? Divine Role-Playing in the Age of Sutton Hoo
Authors: Price Neil , Mortimer Paul
Published: February 2014

This paper presents some new observations concerning the construction of the Sutton Hoo helmet, as a point of entry to a wider discussion of pre-Christian religious and ideological links across Scandinavia. It will be argued that in certain circumstances and locations, such as the firelit interior of the hall, the wearer of the helmet was seen as both war leader and war god, a literal personification of Odin. This interpretation is supported and extended with a variety of Scandinavian finds from the sixth to tenth centuries, and arguably represents an unusually physical manifestation of the ritual border-crossing between human and divine elites. In the socio-political context of early medieval kingdoms, the dramatic imagery of the helmets and related military equipment had a critical role to play in the communication of power, the origin of military prowess, and the religious allegiance of a warlord.
Alumina coating of polyvinylidene fluoride (PVDF) surface in liquid phase
Authors: Liiv J. , Panov D. , Tenno T. , Järv J.
Published: February 2014

A two-step procedure is developed for preparing alumina coated polyvinylidene fluoride particles (diameter, ∼100 μm) whose chemically inert and non-adhesive surface is initially grafted with polystyrene. The first coating step involves deposition of alumina precipitation centres into the polystyrene layer using the reaction of trimethylaluminium with a small residual amount of water retained within the porous brushy polystyrene structure after incomplete drying of the particles. The second coating step is performed through gentle precipitation of aluminium hydroxide from an aqueous aluminium chloride solution, with the alumina deposition being directed by the precipitation centres implanted during the first step. As a result of this process, the particles are covered uniformly with inorganic material. The quality and thickness of the final coating layer are controlled by the precipitation rate and stirring conditions.
Influence of substrate carboxylation on morphology of Ni(OH)2 thin film
Authors: Jiao W. L. , Zhang L. , Li A. X.
Published: February 2014

Cellular structure nickel hydroxide thin film was obtained by hydrothermal method. The influence of substrate pretreatment and hydrothermal temperature on the morphology and microstructure of Ni(OH)2 thin film was investigated by means of X-ray diffraction, Fourier transform infrared spectroscopy and scanning electron microscopy. The results indicated that the Ni(OH)2 thin film was of multilayer cellular structure, in which plate-like β-Ni(OH)2 crystals stood on the carboxylated substrate vertically and connected with each other. The carboxylation pretreatment of glass substrate could enable carbochains to play an important template role in the Ni(OH)2 thin film growth process, which was the key to the cellular structure of Ni(OH)2 thin film. Higher hydrothermal temperature could improve the degree of crystallinity of Ni(OH)2 crystal, but the temperature exceeding 200°C would damage the cellular structure.
Entire solutions of certain type of difference equations
Authors: Liu Nana , Lü Weiran , Shen Tiantian , Yang Chungchun
Published: February 2014

In this paper, we shall study the conditions regarding the existence of transcendental entire solutions of certain type of difference equations. Our results are either supplements to some results obtained recently, or are relating to the conjecture raised in Yang and Laine (Proc. Jpn. Acad., Ser. A, Math. Sci. 86:10-14, 2010). Finally, two relevant conjectures are posed for further studies.

MSC:39B32, 34M05, 30D35.