bluuebunny/crossref_metadata_2025 huggingface dataset:
[1,2-Bis(dicyclohexylphosphanyl)-1,2-dicarba-closo-dodecaborane-2κ2P,P′]di-μ-chlorido-1:2κ4Cl:Cl-dichlorido-1κ2Cl-dimercury(II)
Authors: Yang Liguo
Published: March 2014

The title compound, [Hg2Cl4(C26H54B10P2)], was synthesized by the reaction of 1,2-bis(dicyclohexylphosphanyl)-1,2-dicarba-closo-dodecaborane with HgCl2. Both HgIIatoms show a distorted tetrahedral coordination geometry, provided by the two bridging chloride anions and the P atoms of the diphosphanyl ligand for one metal atom, and by two bridging and two terminal chloride anions for the other. The five-membered HgP2C2chelate ring assumes an envelope conformation, with the HgIIatom displaced by 0.1650 (5) Å from the mean plane of the other four atoms (r.m.s. deviation = 0.002 Å). In the crystal, B—H...Cl interactions link the molecules, forming a supramolecular chain along thea-axis direction.
Non‐random patterns of functional redundancy revealed in ground beetle communities facing an extreme flood event
Authors: Gerisch Michael
Published: March 2014

Theory predicts that species performing similar roles for ecological processes or functions can compensate for the loss of others and that this functional redundancy may promote resilience. However, there is no clear evidence for this mechanism, because functional redundancy has been observed to be low in many ecosystems. Using a severe flood event, this study tests whether functional redundancy exists in floodplain ground beetle communities, how it is controlled and how it connects to post‐flood resilience.

Ground beetles were sampled in floodplain grassland of the Elbe River, Germany. Functional redundancy was estimated as the proportion of species in a community having neutral effects on functional diversity. Null models were used to determine whether functional redundancy is higher or lower than expected and mixed effects modelling was applied to estimate the relationships between functional redundancy, flood disturbance and sampling season.

It was found that highly redundant ground beetle communities experienced fewer losses in functional diversity caused by an extreme flood than less redundant communities. Functional redundancy was lowest immediately after the flood, but quickly increased with time since flooding. It was significantly higher in spring than in autumn seasons and significantly higher in habitats exposed to frequent flooding. Null models confirmed that these patterns were to a high degree non‐random.

The results indicate that functional redundancy plays an important role for stabilizing ground beetles under regular, predictable flooding. However, given sizeable differences in functional diversity before and after the extreme flood, this effect may be lower than expected during extreme events. Other regulating forces, such as stochastic colonization processes and habitat templets, play more important roles directly after extreme disturbances. I therefore assume that a temporal hierarchy of mechanisms, including FR, controls the functional diversity of ground beetles in riparian habitats.
Evaluation of a curriculum initiative designed to enhance the research training of dietetics graduates
Authors: Desbrow Ben , Leveritt Michael , Palmer Michelle , Hughes Roger
Published: March 2014

Aim

To qualitatively evaluate a learning and teaching intervention for developing research and evaluation competencies, structured around the experience of having to conduct a significant research project.

Methods

A qualitative study utilising semi‐structured interviews among a sample of 25 recent graduates from Griffith University's Master of Nutrition and Dietetics Program. Interviews explored student motivations for doing the research major, the student's experience of the full‐time semester long research project, and the actual and perceived outcomes of this experience. Interviews were audiotaped, transcribed verbatim, and thematically analysed via open coding and triangular analysis by three of the authors.

Results

All of the graduates interviewed had conducted research projects across a range of practice settings. Motivations for electing to do the research major varied from disinterest in other options to an opportunity to ‘taste‐test’ research, to develop research competencies and secure pathways to later research studies. The student learning experience was described as intense, stressful but rewarding and a steep learning curve. Graduates reported that they learned much more than research competencies during this process and many converted this research activity into a research output (journal article or conference abstract). Students reflected on the strong sense of achievement associated with research outputs and the competitive advantage it had provided on seeking graduate employment.

Conclusions

It is possible to develop graduate dietitians' research and evaluation competencies using curriculum initiatives that exploit experiential learning. Exposing students to the research practice cycle culminating in peer‐reviewed publication builds research self‐efficacy and positions students for good employment outcomes.
Day‐to‐day activities of clinical dietitians working in the inpatient and outpatient settings in a group of New South Wales public hospitals: The results of a direct observational study
Authors: Milosavljevic Marianna , Noble Gary , Zaremba Carly
Published: March 2014

Aim

To describe the daily tasks undertaken by dietitians working within the inpatient and outpatient sectors within the NSW public hospital system.

Methods

This study used an ethnographic methodology that employed a direct, non‐participatory, discontinuous, observational technique to observe hospital dietitians, in both outpatient and inpatient settings, during a typical work shift. Trained volunteer observers collected the data over a three‐year period (2008, 2009 and 2010). The data were combined and then sorted into five categories including: direct patient care, indirect patient care, communication, administration and education of self or others.

Results

A total of 609 hours and 21 minutes were observed across a three‐year time period 2008–2010. On average, the dietitians in both inpatient and outpatient settings spent 18.3–32.2% of their time in direct patient care activities. The majority of time was spent in indirect patient care activities such as: information collection, documentation and discussion with other health‐care professionals. A comparison between the two work settings showed that those dietitians working in the inpatient setting spent less time in direct patient care (18.3% vs 33.1%, P < 0.05), and more time in indirect care activities (41.7% vs 23.3%, P < 0.05) and in communication about patient care (22.7% vs 14.4%, P < 0.05).

Conclusions

The findings show that dietitians spend most of their time doing activities that support patient care, but these activities occur away from the patient.
The role of scintigraphy and ultrasound in the imaging of neonatal hypothyroidism: 5‐year retrospective review of single‐centre experience
Authors: De Silva Ami , Jong Ian , McLean Glenda , Bergman Philip , Rodda Christina , Brown Justin , Nandurkar Dee
Published: March 2014

Introduction

Congenital hypothyroidism (CH), as indicated by an elevation of capillary thyroid‐stimulating hormone (TSH) at newborn screening, is a preventable cause of mental retardation with varying aetiology; it can be transient or permanent. Radionuclide assessment is currently the gold standard for imaging CH. This study aimed to (i) review the different scintigraphic patterns and correlate them with TSH levels/patient outcomes, (ii) assess the role of sonography in neonates with apparent agenesis as indicated by scintigraphy and (iii) develop a diagnostic investigative algorithm.

Methods

The technetium thyroid scans of 83 consecutive patients (49 females, average age 32 days) with CH scanned between 2005 and 2009 were retrospectively reviewed. Two nuclear medicine physicians blinded to the clinical details interpreted the scans in consensus. Scintigram appearances were categorised into five groups. Patients scintigraphically diagnosed with thyroid agenesis were evaluated with ultrasound. TSH values and scintigraphic and sonographic findings were correlated with patients' final diagnosis.

Results

Based on scintigraphy, 14, 13 and 19 patients out of 83 were assessed as having normal thyroid sites with normal, increased and decreased uptake, respectively. Twenty‐two of 83 patients had no uptake, and 15 of 83 patients had ectopic uptake. Higher median TSH levels were seen in no‐uptake and ectopic uptake subgroups. Eighteen of 22 patients with no uptake were evaluated with ultrasound. Three of the 18 patients had a normal thyroid gland, and three of 18 patients had a hypoplastic thyroid.

Conclusion

Scintigram findings in patients with congenital hypothyroidism fall into five major categories, which have therapeutic implications (lifelong thyroxine in agenesis versus trial of stopping thyroxine in other subgroups). Sonographic demonstration of thyroid tissue in patients scintigraphically diagnosed with thyroid agenesis has major management implications.
Exploring the Role of Central Astrocytic Glutamate Uptake in Ethanol Reward in Mice
Authors: Smith Karen L. , John Catherine S. , Sypek Elizabeth I. , Öngür Dost , Cohen Bruce M. , Barry Sarah M. , Bechtholt Anita J.
Published: March 2014

Background

Alcoholism is associated with specific brain abnormalities revealed through postmortem studies, including a reduction in glial cell number and dysregulated glutamatergic neurotransmission. Whether these abnormalities contribute to the etiology of alcoholism, are consequences of alcohol use, or both is still unknown.

Methods

We investigated the role of astrocytic glutamate uptake in ethanol (EtOH) binge drinking in mice, using the “drinking in the dark” (DID) paradigm by blocking the astrocytic glutamate transporter (GLT‐1) with intracerebroventricular (ICV) administration of dihydrokainic acid (DHK). To determine whether astrocytic glutamate uptake regulates the conditioned rewarding effects of EtOH, we examined the effects of ICV DHK on the acquisition and expression of EtOH‐induced conditioned place preference.

Results

Blocking central astrocytic glutamate uptake selectively attenuated EtOH binge drinking behavior in mice. DHK did not alter the acquisition or expression of preference for EtOH‐associated cues, indicating that reduced astrocytic glutamate trafficking may decrease binge‐like drinking without altering the conditioned rewarding effects of EtOH.

Conclusions

Several alternative conclusions are plausible, however, interpreting these data in the context of the human literature, these findings suggest that the reduction of glia in the alcoholic brain may not be a predisposing factor to developing alcoholism and could be a consequence of EtOH toxicity that decreases excessive EtOH intake.
Increased Cut‐Point of the TACER‐3 Screen Reduces False Positives Without Losing Sensitivity in Predicting Risk Alcohol Drinking in Pregnancy
Authors: Chiodo Lisa M. , Delaney‐Black Virginia , Sokol Robert J. , Janisse James , Pardo Yobany , Hannigan John H.
Published: March 2014

Background

Detection of in‐pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T‐ACE screen was developed for that purpose. We recently reported that increasing the total T‐ACE score cut‐point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4‐year‐old children with neurobehavioral effects associated with prenatal alcohol exposure.

Methods

In this study, the TACER‐3 was further validated in another prospectively identified high‐risk urban cohort. Women were categorized as follows: (i) Not At‐Risk Group (negative on T‐ACE and TACER‐3); (ii) At‐Risk Group (positive on T‐ACE and TACER‐3); and (iii) Change Risk Group (positive on T‐ACE but negative on TACER‐3).

Results

The TACER‐3 total score cut‐point of 3 yielded fewer “false positives” than the T‐ACE cut‐point of 2. Based on relative risk scores, women in the TACER‐3‐positive At‐Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At‐Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At‐Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at‐risk alcohol consumption in the At‐Risk Group was over >10 times that of the Change Risk Group.

Conclusions

Thus, the TACER‐3 was more effective at selectively identifying women drinking at fetal risk levels than the original T‐ACE. The TACER‐3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.
Cardiac Reactivity During the Ascending Phase of Acute Intravenous Alcohol Exposure and Association with Subjective Perceptions of Intoxication in Social Drinkers
Authors: Vatsalya Vatsalya , Momenan Reza , Hommer Daniel W. , Ramchandani Vijay A.
Published: March 2014

Background

The aim of this study was to characterize cardiac reactivity measures, heart rate (HR), and heart rate variability (HRV), following acute intravenous (IV) alcohol administration and their association with subjective responses in social drinkers.

Methods

Twenty‐four subjects (11 females) received IV alcohol infusions to attain and clamp the breath alcohol concentration (BrAC) at 50 mg% or placebo in separate sessions. Serial 5‐minute cardiac recordings at baseline and during the infusion were analyzed to obtain frequency and time domain cardiac measures. Self‐reported subjective perceptions were also obtained at the same time points.

Results

HR showed significant decreases from baseline, while the HRV measure pNN50 showed steady increases during the ascending phase of alcohol infusion. HR was inversely correlated with pNN50 across time and treatment. There was a significant association of HR with subjective feelings of high, intoxication, feeling drug effects, and liking drug effects across time during the ascending phase.

Conclusions

Acute IV alcohol resulted in decreases in HR and increases in HRV consistent with autonomic parasympathetic activation. The association of these changes with subjective responses suggests that cardiac reactivity may serve as a physiological marker of subjective alcohol effects. This study broadens the understanding of acute cardiovascular effects of alcohol and clinically significant cardiac conditions such as arrhythmia and cardiomyopathy associated with chronic alcohol drinking.
An In Vivo 1H Magnetic Resonance Spectroscopy Study of the Deep Cerebellar Nuclei in Children with Fetal Alcohol Spectrum Disorders
Authors: du Plessis Lindie , Jacobson Joseph L. , Jacobson Sandra W. , Hess Aaron T. , van der Kouwe Andre , Avison Malcolm J. , Molteno Christopher D. , Stanton Mark E. , Stanley Jeffrey A. , Peterson Bradley S. , Meintjes Ernesta M.
Published: March 2014

Background

Prenatal alcohol exposure has been linked to impairment in cerebellar structure and function, including eyeblink conditioning. The deep cerebellar nuclei, which play a critical role in cerebellar‐mediated learning, receive extensive inputs from brain stem and cerebellar cortex and provide the point of origin for most of the output fibers to other regions of the brain. We used in vivo 1H magnetic resonance spectroscopy (MRS) to examine effects of prenatal alcohol exposure on neurochemistry in this important cerebellar region.

Methods

MRS data from the deep cerebellar nuclei were acquired from 37 children with heavy prenatal alcohol exposure and 17 non‐ or minimally exposed controls from the Cape Coloured (mixed ancestry) community in Cape Town, South Africa.

Results

Increased maternal alcohol consumption around time of conception was associated with lower N‐Acetylaspartate (NAA) levels in the deep nuclei (r = −0.33, p < 0.05). Higher levels of alcohol consumption during pregnancy were related to lower levels of the choline‐containing metabolites (r = −0.37, p < 0.01), glycerophosphocholine plus phosphocholine (Cho). Alcohol consumption levels both at conception (r = 0.35, p < 0.01) and during pregnancy (r = 0.38, p < 0.01) were related to higher levels of glutamate plus glutamine (Glx). All these effects continued to be significant after controlling for potential confounders.

Conclusions

The lower NAA levels seen in relation to prenatal alcohol exposure may reflect impaired neuronal integrity in the deep cerebellar nuclei. Our finding of lower Cho points to disrupted Cho metabolism of membrane phospholipids, reflecting altered neuropil development with potentially reduced content of dendrites and synapses. The alcohol‐related alterations in Glx may suggest a disruption of the glutamate–glutamine cycling involved in glutamatergic excitatory neurotransmission.
Are older Western Australians exposed to potentially inappropriate medications according to the Beers Criteria? A 13‐year prevalence study
Authors: Price Sylvie D , Holman C D'Arcy J , Sanfilippo Frank M , Emery Jon D
Published: March 2014

Aim

To examine time trends and factors associated with exposure to potentially inappropriate medications (PIMs) by the Beers Criteria.

Methods

PIM consumption days accumulated from the pharmaceutical claims of 251 305 Western Australians aged ≥65 years (1993–2005) and person follow‐up times produced counts/rates. Logistic/Poisson regression generated odds/rate ratios.

Results

A total of 187 616 participants (74.7%) took ≥1 PIM (1993–2005), the cohort consuming 109 415 PIM daily doses/1000 person‐years. Annual exposure decreased from 45–47% to 40%, and annual consumption rate declined from 117 836 to 90 364 daily doses/1000 person‐years. Temazepam had the highest exposures (>17 000 daily doses/1000 person‐years). Number of medications taken (OR 35.03; 95% CI 34.37–35.71 for ≥10 vs. 0–2 drugs), annual drug intake (2.08; 2.04–2.12 for highest vs. lowest quartile), and high‐level residential aged care (1.96; 1.91–2.01) were most predictive of PIM exposure.

Conclusions

PIM exposure remains high in older Western Australians. Our findings identify patients most at risk and medications to consider on Australia‐specific PIM lists.
Leadership Lessons: Minority Governments, Independents and Relationships
Authors: Arklay Tracey M.
Published: March 2014

The 2010 Australian election returned the first “hung” House of Representatives since the Second World War. This paper tracks the political lessons of history to the only other time when a prime minister had to work in a hung parliament. Circumstances and political parties differ, but on closer examination some common themes emerge. The prime ministership is both a gift and a burden, where control is, for the most part illusory. R.G. Menzies lacked the personal qualities his parliamentary colleagues found in Arthur Fadden. In 1941 he lost the prime ministership because he lost the support of his party room. Just as she had defeated Kevin Rudd in 2010, Julia Gillard was eventually defeated in a caucus ballot in June 2013. However, at least initially, Gillard displayed personal traits which Rudd lacked and which enabled her to retain the trust of both the ALP caucus and key independent members. History contains some valid lessons which, given recent events, need restating: relationships in politics matter.
Peripheral hypertrophic subepithelial corneal degeneration – clinical and histopathological features
Authors: Järventausta Petri J. , Tervo Timo M. T. , Kivelä Tero , Holopainen Juha M.
Published: March 2014

Purpose

To refine the diagnostic criteria for peripheral hypertrophic subepithelial corneal degeneration (PHSD) and characterize its clinical phenotype, histopathology and immunohistochemical features.

Methods

Diagnostic criteria were refined on the basis of literature data. Fourteen patients (13 women and one man; median age 52 years, range 33–66) were identified based on these criteria. Keratectomy specimens were evaluated via routine and immunohistochemical stainings. The main outcome measures were symptoms, clinical phenotype, immunological status and histopathologic results.

Results

We defined the diagnostic criteria of typical PHSD as elevated circumferential and perilimbal subepithelial fibrosis with focal superficial corneal neovascularization, which were supported by female sex (93%), bilaterality (86%), the centre being in the upper quadrants (81%) and irregular astigmatism of two dioptres or more. The typical symptoms were reduced vision (86%) and the symptoms of ocular surface disease (64%). Light microscopy showed fibrosis with abundant collagen deposition but no inflammation in all patients. An immunohistochemical analysis of nine patients showed uniform staining for vimentin in three distinct types of fibroblasts in variable proportions: keratocyte‐like cells that were positive for CD34, myofibroblasts that were positive for smooth muscle actin (SMA) and fibroblasts that were negative for CD34 and SMA. Small numbers of CD68‐positive macrophages were also found.

Conclusions

Peripheral hypertrophic subepithelial degeneration is characteristic of middle‐aged women, in whom it is typically a bilateral idiopathic degeneration of the cornea associated with ocular surface disease and reduced vision. The fibrotic lesions probably undergo remodelling, inducing changes in corneal contour. A smouldering low‐grade inflammation favouring low TGF‐β1 concentrations is postulated as the primary pathological process leading to PHSD.
Plasma Levels of 25‐Hydroxyvitamin D3 and In Vivo Markers of Cytochrome P450 3A Activity in Swedes and Koreans: Effects of a Genetic Polymorphism and Oral Contraceptives
Authors: Nylén Hanna , Björkhem‐Bergman Linda , Ekström Lena , Roh Hyung‐Keun , Bertilsson Leif , Eliasson Erik , Lindh Jonatan D. , Diczfalusy Ulf
Published: March 2014

In vitro studies have shown that vitamin D may induce several cytochrome P450 (CYP) enzymes in general and CYP3A4 in particular. The primary aim of this study was to investigate the relationship between plasma levels of 25‐hydroxyvitamin D3 and suggested in vivo markers of CYP3A activity in healthy volunteers from Sweden and Korea. Plasma concentrations of 25‐hydroxyvitamin D3 were analysed in samples from three previously performed studies, and the correlation between these levels and suggested in vivo markers of CYP3A activity was investigated by means of nonparametric correlation. In addition, we studied the modulating effects of three vitamin D receptor promoter polymorphisms on the association between 25‐hydroxyvitamin D3 and CYP3A enzyme activity in Swedish subjects. The plasma levels of 25‐hydroxyvitamin D3 were not significantly associated with CYP3A phenotypes in any of the three studies, but after accounting for the vitamin D receptor polymorphism rs4516035, there was a significant positive association between 25‐hydroxyvitamin D3 and CYP3A activity (p = 0.004). Swedes (n = 65) had significantly higher 25‐hydroxyvitamin D3 levels than Koreans (n = 67), 75 nM compared with 31 nM (p < 0.001). Swedish women taking oral contraceptives (OC) (n = 19) had somewhat higher plasma levels of 25‐hydroxyvitamin D3 compared with Swedish women not taking oral contraceptives (n = 21), 89 and 72 nM, respectively (p = 0.02). In conclusion, our results suggest that the overall influence on the CYP3A activity by 25‐hydroxyvitamin D3 is of marginal importance.
Fistula and Other Adverse Reproductive Health Outcomes among Women Victims of Conflict‐Related Sexual Violence: A Population‐Based Cross‐Sectional Study
Authors: Dossa Nissou Ines , Zunzunegui Maria Victoria , Hatem Marie , Fraser William
Published: March 2014

Background

Sexual violence (SV) is being used widely as a weapon of war. However, few studies have investigated its health effects. The objective of the present study is to investigate the relationship between sexual violence and several serious reproductive health conditions including fistula.

Methods

We conducted a cross‐sectional study among 320 women living in Goma, the Democratic Republic of Congo. We assessed the association of four outcomes: fistula, chronic pelvic pain, desire for sex, and desire for children, with SV in two contexts: conflict‐related and nonconflict‐related. Two groups of women: those who experienced conflict‐related sexual violence (CRSV) and those who experienced nonconflict‐related sexual violence (NCRSV), were compared with women who had not experienced SV. Data were collected by trained interviewers using a standard questionnaire.

Results

Compared with women who did not experience SV, after adjustment for potential confounders, women who experienced CRSV were significantly more likely to have fistula (OR = 11.1, 95% CI [3.1–39.3]), chronic pelvic pain (OR = 5.1, 95% CI [2.4–10.9]), and absence of desire for sex (OR = 3.5, 95% CI [1.7–6.9]) and children (OR = 3.5, 95% CI [1.6–7.8]). Women who experienced NCRSV were more likely to report absence of desire for children (OR = 2.7, 95% CI [1.1–6.5]), and seemed more likely to report chronic pelvic pain (OR = 2.3, 95% CI [0.95–5.8]), although the difference was not statistically significant. Women who experienced NCRSV did not have higher odds for fistula and absence of sexual desire.

Conclusion

Conflict‐related sexual violence can contribute to women's adverse reproductive health outcomes. Its impact is more devastating than that of NCRSV.
Trends in Family Physicians Performing Deliveries, 2003–2010
Authors: Rayburn William F. , Petterson Stephen M. , Phillips Robert L.
Published: March 2014

Objective

This observational study examined the proportion of family physicians continuing to perform deliveries from 2003–2010.

Methods

Data were collected annually from the same census questionnaire completed by family physicians who passed their recertification examination. Aggregated responses began in 2003 when data first became available electronically and ended in 2009 before recertification changes. Using cross‐sectional design and logistic regression analysis, we examined associations between physician demographic or geographic factors and performance of deliveries.

Results

The sample consisted of 49,267 family physicians between 2003 and 2009, including 7,456 in 2009. The proportion performing any deliveries declined by 40.6 percent, from 17.0 percent in 2003 to 10.1 percent in 2009. Most recently, 5.5 percent of all family physicians delivered 1–25 babies per year, whereas 2.8 percent delivered 26–50, and 1.9 percent delivered ≥ 51. Those who performed deliveries were most likely to be junior members of a partnership or group practice, and provided prenatal and newborn care. Deliveries were more common in nonmetropolitan areas, where other obstetric practitioners were unavailable.

Conclusions

The proportion of family physicians performing deliveries continues to decline with most delivering 25 or fewer babies per year. This change will require more effort by obstetrician‐gynecologists and midwives in being primary birth attendants.
Interrelations Between Four Antepartum Obstetric Interventions and Cesarean Delivery in Women at Low Risk: A Systematic Review and Modeling of the Cascade of Interventions
Authors: Rossignol Michel , Chaillet Nils , Boughrassa Faiza , Moutquin Jean‐Marie
Published: March 2014

Objectives

To critically appraise the literature on the relations between four intrapartum obstetric interventions—electronic fetal monitoring (EFM), epidural analgesia, labor induction, and labor acceleration; and two types of delivery—instrumental (forceps and vacuum) and cesarean section.

Methods

This review included meta‐analyses published between January 2000 and April 2012 including at least one randomized clinical trial published after 1995 and presenting results on low‐risk pregnancies between 37 and 42 weeks of gestation, searched in the databases Medline, Cochrane Library, and EMBASE with no language restriction.

Results

Of 306 documents identified, 8 fulfilled the inclusion criteria and presented results on women at low risk. EFM at admission (vs intermittent auscultation) was associated with cesarean delivery (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.00–1.44) and epidural analgesia (OR = 1.25, 95% CI 1.09–1.43). Epidural on request was associated with cesarean delivery (OR = 1.60, 95% CI 1.18–2.18), instrumental delivery (OR = 1.21, 95% CI 1.03–1.44), and oxytocin use (OR = 1.20, 95% CI 1.01–1.43) when compared with epidural on request plus nonpharmacological labor pain control methods such as one‐to‐one support, breathing techniques, and relaxation. Induction and acceleration of labor showed heterogeneous patterns of associations with cesarean delivery and instrumental delivery.

Conclusions

Complex patterns of associations between obstetric interventions and modes of delivery were illustrated in an empirical model. Intermittent auscultation and nonpharmacological labor pain control interventions, such as one‐to‐one support during labor, have the potential for substantially reducing cesarean deliveries.
The Role of Labor Pain and Overall Birth Experience in the Development of Posttraumatic Stress Symptoms: A Longitudinal Cohort Study
Authors: Garthus‐Niegel Susan , Knoph Cecilie , von Soest Tilmann , Nielsen Christopher S. , Eberhard‐Gran Malin
Published: March 2014

Background

The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework.

Methods

The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested.

Results

Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience.

Conclusions

Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care.
Shortcomings of Maternity Care in Serbia
Authors: Arsenijevic Jelena , Pavlova Milena , Groot Wim
Published: March 2014

Background

Maternity care in Serbia is an integrated part of the centralized health care system inherited from the former Yugoslavia. Childbirth is often perceived as a medical event instead of a physiological process. This paper examines quality and access indicators, and patient payments for maternity care in Serbia.

Methods

We apply a method of triangulation using data collected through three sources: online questionnaires filled in by mothers who delivered in one of the maternity wards in Serbia in the period 2000–2008, research publications, and official guidelines. To compare the qualitative data from all three sources, we apply framework analysis.

Results

The results show a good network of maternity wards in Serbia. On the other hand, many women who gave birth in maternity wards in Serbia indicate problems with the treatment they received. The existence of informal patient payments and so‐called “special connections” make the position of Serbian women in maternity wards vulnerable, especially when they have neither connections nor the ability to pay. Poor communication and bedside manner of medical staff (obstetricians, other physicians, midwives, and nurses) during the birth process are also frequently reported.

Discussion

Actions should be taken to improve bedside manners of medical staff. In addition, the government should consider the involvement of private practitioners paid by the national insurance fund to create competition and decrease the need for informal payments and “connections.”
Symmetry‐Aware Template Deformation and Fitting
Authors: Kurz C. , Wu X. , Wand M. , Thormählen T. , Kohli P. , Seidel H.‐P.
Published: March 2014

In this paper, we propose a new method for reconstructing 3D models from a noisy and incomplete 3D scan and a coarse template model. The main idea is to maintain characteristic high‐level features of the template that remain unchanged for different variants of the same type of object. As invariants, we chose the partial symmetry structure of the template model under Euclidian transformations, i.e. we maintain the algebraic structure of all reflections, rotations and translations that map the object partially to itself. We propose an optimization scheme that maintains continuous and discrete symmetry properties of this kind while registering a template against scan data using a deformable iterative closest points (ICP) framework with thin‐plate‐spline regularization. We apply our new deformation approach to a large number of example data sets and demonstrate that symmetry‐guided template matching often yields much more plausible reconstructions than previous variants of ICP.
Validation of the European Group for Blood and Marrow Transplantation (EBMT) risk score in patients receiving allogeneic hematopoietic stem cell transplantation at a single center in Japan
Authors: Numata Ayumi , Tanaka Masatsugu , Matsumoto Kenji , Takasaki Hirotaka , Tachibana Takayoshi , Fujimaki Katsumichi , Sakai Rika , Fujisawa Shin , Tomita Naoto , Fujita Hiroyuki , Maruta Atsuo , Ishigatsubo Yoshiaki , Kanamori Heiwa
Published: March 2014

We validated the European Group for Blood and Marrow Transplantation (EBMT) risk score in 273 consecutive adult patients receiving allogeneic hematopoietic stem cell transplantation between 2000 and 2010 at our center. The patients were divided into four groups according to the EBMT risk score: low risk (LR, score 0–2), intermediate risk‐1 (IR‐1, score 3), intermediate risk‐2 (IR‐2, score 4), and high risk (HR, score 5–7). The five‐yr overall survival of the LR (n = 65), IR‐1 (n = 67), IR‐2 (n = 70), and HR (n = 71) groups was 72%, 57%, 41%, and 25%, respectively (p < 0.001). The five‐yr transplant‐related mortality rates were 16%, 30%, 25%, and 36%, respectively (p = 0.07). The five‐yr cumulative incidence of relapse was 20%, 18%, 37%, and 41%, respectively (p < 0.001). In the subgroup analysis, the prognostic value of the EBMT risk score was confirmed in patients undergoing myeloablative conditioning (MAC), but not in those undergoing reduced‐intensity conditioning (RIC). The results suggest that the EBMT risk score is a useful tool to predict transplant outcome for patients undergoing MAC, but not for those undergoing RIC and may be beneficial for stratifying patients in clinical studies.
Utility of immune monitoring in heart transplant recipients on everolimus‐based immune suppression
Authors: Ben Gal Tuvia , Israeli Moshe , Yaari Victoria , Hasdai David , Matz Israel , Yussim Alexander , Battler Alexander , Klein Tirza , Medalion Benjamin
Published: March 2014

Background

Everolimus provides effective immune suppression (IS) after heart transplant (HTx). Its pharmacologic properties differentiate everolimus from other IS drugs. A non‐invasive immune monitoring (IM) assay test appears to predict the immune state in HTx recipients on standard calcineurin‐inhibitor‐based IS. The utility of IM in HTx recipients on everolimus‐based IS was evaluated.

Methods

Between June 2005 and June 2011, 34 adult HTx recipients followed up at our center received everolimus and had 381 IM assays that were performed at six months to 16‐yr post‐transplant. Results of the IM assay were correlated with infection and rejection episodes that occurred during the IM testing.

Results

In the everolimus‐based IS group, there were 18 infectious episodes and four rejection episodes. The average IM score was significantly lower during infection than at steady state (188 ± 122 vs. 338 ± 137 ng/mL ATP, p < 0.001) and not significantly different during rejection when compared with steady state (430 ± 132 vs. 338 ± 137 ng/mL ATP, p = 0.5).

Conclusions

The non‐invasive IM assay predicts infectious risk in HTx recipients on everolimus‐based IS. Its inconclusive association with rejection was probably due to the small number of rejections. Serial longitudinal IM may allow proper adjustment of everolimus doses.
Sharing of Grant Funds between Academic Institutions and ­Community Partners in Community‐Based Participatory Research
Authors: Cain Katrice D. , Theurer Jacqueline R. , Sehgal Ashwini R.
Published: March 2014

Objectives

To determine how grant funds are shared between academic institutions and community partners in community‐based participatory research (CBPR).

Methods

Review of all 62 investigator‐initiated R01 CBPR grants funded by the National Institutes of Health from January 2005 to August 2012. Using prespecified criteria, two reviewers independently categorized each budget item as being for an academic institution or a community partner. A third reviewer helped resolve any discrepancies.

Results

Among 49 evaluable grants, 68% of all grant funds were for academic institutions and 30% were for community partners. For 2% of funds, it was unclear whether they were for academic institutions or for community partners. Community partners’ share of funds was highest in the categories of other direct costs (62%) and other personnel (48%) and lowest in the categories of equipment (1%) and indirect costs (7%).

Conclusions

A majority of CBPR grant funds are allocated to academic institutions. In order to enhance the share that community partners receive, funders may wish to specify a minimum proportion of grant funds that should be allocated to community partners in CBPR projects.
Assessing diabetic foot osteomyelitis remission with white blood cell SPECT/CT imaging
Authors: Vouillarmet J. , Morelec I. , Thivolet C.
Published: March 2014

Aims

Diabetic foot osteomyelitis is an important risk factor of lower limb amputation. Antibiotic therapy is often effective in preventing surgery. However, the duration of antibiotic therapy is difficult to define in the absence of a marker to diagnose osteomyelitis remission at the end of the treatment. In this study, we assessed the diagnostic performance of white blood cell SPECT/CT imaging for evaluating osteomyelitis remission.

Patients and methods

Twenty‐nine out of 42 episodes of diabetic foot osteomyelitis seen between December 2009 and April 2012 had radiographs, a three‐phase bone scintigraphy and a white blood cell SPECT/CT at the end of antibiotic therapy. They were treated with antibiotics alone and considered in clinical remission. White blood cell SPECT/CT results were considered positive when abnormal uptake in the osteomyelitis location was identified. Osteomyelitis remission was defined by the absence of an osteomyelitis relapse after 12 months’ follow‐up.

Results

A negative white blood cell SPECT/CT was seen for 22 episodes of osteomyelitis. All of them were in remission. A positive white blood cell SPECT/CT was observed for seven episodes. A relapse occurred in five episodes (71.5%) after a median duration of 4 months (2–7 months). Sensitivity, specificity, positive predictive value and predictive negative value in predicting osteomyelitis relapse after the discontinuation of antibiotic treatment were, respectively, for radiographs 80%, 33%, 20% and 89%; for three‐phase bone scintigraphy 100%, 12.5%, 15.5% and 100%; and for the white blood cell SPECT/CT 100%, 91.5%, 71.5% and 100%.

Conclusion

Negative uptake on white blood cell SPECT/CT is a good marker for diagnosis of diabetic foot osteomyelitis remission and might be very useful in guiding antibiotic therapy.
Differences in the HbA1c‐lowering efficacy of glucagon‐like peptide‐1 analogues between Asians and non‐Asians: a systematic review and meta‐analysis
Authors: Kim Y. G. , Hahn S. , Oh T. J. , Park K. S. , Cho Y. M.
Published: March 2014

Aims

To compare the HbA1c‐lowering efficacy of glucagon‐like peptide‐1 (GLP‐1) analogues between Asians and non‐Asians with type 2 diabetes.

Methods

We searched randomized controlled trials from MEDLINE, EMBASE, LILACS, CENTRAL and ClinicalTrials.gov. Studies described in English were included if the treatment duration was 12 weeks or more, information about ethnicity and baseline HbA1c values were available and a GLP‐1 analogue was compared with a placebo. For the ethnic comparison, we divided the studies into Asian‐dominant studies (≥50% Asian participants) and non‐Asian‐dominant studies (<50% Asian participants).

Results

Among the 837 searched studies, 15 trials were included for the meta‐analysis. The weighted mean difference of HbA1c with GLP‐1 analogues was −1.16% [95% confidence interval (CI) −1.48, −0.85] in the Asian‐dominant studies and −0.83% (95% CI −0.97, −0.70) in the non‐Asian‐dominant studies. The between‐group difference was −0.32% (95% CI −0.64, −0.01; p = 0.04). The relative risk (RR) with 95% CIs for achieving the target HbA1c ≤7.0% tended to be greater in the Asian‐dominant studies [RR 5.7 (3.8, 8.7)] than in the non‐Asian‐dominant studies [RR 2.8 (2.4, 3.3)]. Body weight changes were similar between the two groups. Hypoglycaemia tended to be more common in Asian‐dominant studies (RR 2.8 [2.3, 3.5]) than in non‐Asian‐dominant studies (RR 1.5 [1.2, 1.8]), but severe hypoglycaemia was very rare in both groups.

Conclusion

GLP‐1 analogues lower HbA1c more in Asian‐dominant studies than in non‐Asian‐dominant studies. Further studies are warranted to explore the potential mechanisms of the ethnic difference.
Implications of the Bologna Process for Throughput in the Higher Education Sector: an empirical illustration based on a Finnish‐British comparison
Authors: Lindberg Matti
Published: March 2014

This study illustrates the differences between Finnish and British graduates in the higher education‐to‐work transition and related market mechanisms in the year 2000. Specifically, the differences between the Finnish and British students' academic careers and ability to find employment after graduation were evaluated in relation to the Finnish HE policy that hastens the entry of new graduates into the labour market. The Finnish HE system is representative of a system that operates in an occupation‐specific and relatively strictly‐regulated labour market context, whereas the labour market context for the British HE system is essentially the most liberal in Europe. The results of the study suggest that it is not the length of the first degree programmes per se that determines the throughput of the HE sector, but the relative emphasis placed on the opportunity structures pertaining to HE participation and on career mobility in the labour market.
Chronic metformin treatment improves post‐stroke angiogenesis and recovery after experimental stroke
Authors: Venna Venugopal R. , Li Jun , Hammond Matthew D. , Mancini Nickolas S. , McCullough Louise D.
Published: March 2014

Metformin is currently the first‐line treatment drug for type 2 diabetes. Metformin is a well‐known activator of AMP‐activated protein kinase (AMPK). In experimental studies, metformin has been shown to exert direct vascular effects by increasing vascular endothelial growth factor expression and improving microvascular density. As stroke is the leading cause of long‐term disability and angiogenesis is implicated as an important mechanism in functional recovery, we hypothesized that chronic metformin treatment would improve post‐stroke functional recovery by enhancing functional microvascular density. For this study, C57BL/6N male mice were subjected to a 60‐min middle cerebral artery occlusion, and were given 50 mg/kg/day metformin beginning 24 h post‐stroke for 3 weeks. Behavioral recovery was assessed using adhesive‐tape removal and the apomorphine‐induced turning test. The role of angiogenesis was assessed by counting vessel branch points from fluorescein‐conjugated lectin‐perfused brain sections. Importantly even if metformin treatment was initiated 24 h after injury it enhanced recovery and significantly improved stroke‐induced behavioral deficits. This recovery occurred in parallel with enhanced angiogenesis and with restoration of endogenous cerebral dopaminergic tone and revascularization of ischemic tissue. We assessed if the effects on recovery and angiogenesis were mediated by AMPK. When tested in AMPK α‐2 knockout mice, we found that metformin treatment did not have the same beneficial effects on recovery and angiogenesis, suggesting that metformin‐induced angiogenic effects are mediated by AMPK. The results from this study suggest that metformin mediates post‐stroke recovery by enhancing angiogenesis, and these effects are mediated by AMPK signaling.
Case‐based reasoning for predicting the success of therapy
Authors: Janssen Rosanne , Spronck Pieter , Arntz Arnoud
Published: March 2014

For patients with mental health problems, various treatments exist. Before a treatment is assigned to a patient, a team of clinicians must decide which of the available treatments has the best chance of succeeding. This is a difficult decision to make, as the effectiveness of a treatment might depend on various factors, such as the patient's diagnosis, background and social environment. Which factors are the predictors for successful treatment is mostly unknown. In this article, we present a case‐based reasoning approach for predicting the effect of treatments for patients with anxiety disorders. We investigated which techniques are suitable for implementing such a system to achieve a high level of accuracy. For our evaluation, we used data from a professional mental healthcare centre. Our application correctly predicted the success factor of 65% of the cases, which is significantly higher than the prediction of the baseline of 55%. Under the condition that the prediction was based on only cases with a similarity of at least 0.62, the success rate of 80% of the cases was predicted correctly. These results warrant further development of the system.