bluuebunny/crossref_metadata_2025 huggingface dataset:
Reference Values and Factors Associated With Renal Resistive Index in a Family-Based Population Study
Authors: Ponte Belén , Pruijm Menno , Ackermann Daniel , Vuistiner Philippe , Eisenberger Ute , Guessous Idris , Rousson Valentin , Mohaupt Markus G. , Alwan Heba , Ehret Georg , Pechere-Bertschi Antoinette , Paccaud Fred , Staessen Jan A. , Vogt Bruno , Burnier Michel , Martin Pierre-Yves , Bochud Murielle
Published: October 2013

Increased renal resistive index (RRI) has been recently associated with target organ damage and cardiovascular or renal outcomes in patients with hypertension and diabetes mellitus. However, reference values in the general population and information on familial aggregation are largely lacking. We determined the distribution of RRI, associated factors, and heritability in a population-based study. Families of European ancestry were randomly selected in 3 Swiss cities. Anthropometric parameters and cardiovascular risk factors were assessed. A renal Doppler ultrasound was performed, and RRI was measured in 3 segmental arteries of both kidneys. We used multilevel linear regression analysis to explore the factors associated with RRI, adjusting for center and family relationships. Sex-specific reference values for RRI were generated according to age. Heritability was estimated by variance components using the ASSOC program (SAGE software). Four hundred women (mean age±SD, 44.9±16.7 years) and 326 men (42.1±16.8 years) with normal renal ultrasound had mean RRI of 0.64±0.05 and 0.62±0.05, respectively (
P
<0.001). In multivariable analyses, RRI was positively associated with female sex, age, systolic blood pressure, and body mass index. We observed an inverse correlation with diastolic blood pressure and heart rate. Age had a nonlinear association with RRI. We found no independent association of RRI with diabetes mellitus, hypertension treatment, smoking, cholesterol levels, or estimated glomerular filtration rate. The adjusted heritability estimate was 42±8% (
P
<0.001). In a population-based sample with normal renal ultrasound, RRI normal values depend on sex, age, blood pressure, heart rate, and body mass index. The significant heritability of RRI suggests that genes influence this phenotype.
Ensuring the Global Availability of High-quality Dental Restorative Materials
Authors: Ferracane J. , Fisher J. , Eiselé J.L. , Fox C.H.
Published: October 2013

The Minamata Convention, a global legally binding instrument (treaty) on mercury, has been the catalyst for the emerging agenda on global dental materials research. If the current and future challenges of oral health maintenance and healing on a global scale are to be met, a logical and effective research agenda for the discovery and introduction of new, environmentally sustainable, dental materials must be developed through a coordinated effort involving materials scientists, dental clinicians, representatives of industry, members of regional and national regulatory bodies, and advocacy from research organizations. For universal impact, this agenda should be created with awareness of several important ongoing initiatives, such as the WHO non-communicable diseases action plan, the UN sustainable development agenda, and the IADR Global Oral Health In Inequalities Research Agenda (GOHIRA). A significant contributor to this cause is the FDI and its membership, who, through their Vision 2020 initiative, acknowledge their role and responsibility in globally preventing and managing dental disease and providing leadership to the profession in terms of information dissemination and affecting change. Dental researchers also have an obligation to advocate for appropriate funding to match the identified research needs, thus enhancing the possibility that key decision-makers will provide the needed support to achieve the research agenda agreed upon by this diverse group of stakeholders.
Incorporating New Materials and Techniques into Clinical Practice
Authors: Pitts N.B. , Drummond J. , Guggenberger R. , Ferrillo P. , Johnston S.
Published: October 2013

This article outlines the subjects presented and discussed at the December 2012 IADR Dental Materials Innovation Workshop held at King’s College London. Incorporating new materials and techniques into clinical practice was considered from 4 perspectives: (1) Accelerating the “research to regulatory approval” process was presented with current developments in the United States, with the National Institutes of Health/Food and Drug Administration process as a working example; (2) intellectual property and regulatory requirements were discussed across the well-established US and EU frameworks, as well as the more recently developed procedures across Brazil, Russia, India, and China; (3) the challenges and opportunities of incorporating innovations into dental education were considered with reference to the future needs of both students and faculty; and (4) the key but difficult and unpredictable step of translating such innovations into routine dental practice was then explored. Constructive and far-ranging discussion among the broadly based Workshop participants (from dental research, education, practice, and industry, as well as environmental organizations and the World Health Organization) mapped out key issues for the future. The focus was on facilitating the more timely adoption of improvements in both materials and techniques to improve patient health and health systems, while minimizing environmental impact.
Priorities for Future Innovation, Research, and Advocacy in Dental Restorative Materials
Authors: Watson T. , Fox C.H. , Rekow E.D.
Published: October 2013

Innovations in materials science, both within and outside of dentistry, open opportunities for the development of exciting direct restorative materials. From rich dialog among experts from dental and non-dental academic institutions and industry, as well as those from policy, research funding, and professional organizations, we learned that capitalizing on these opportunities is multifactorial and far from straightforward. Beginning from the point when a restoration is needed, what materials, delivery systems, and skills are needed to best serve the most people throughout the world’s widely varied economic and infrastructure systems? New research is a critical element in progress. Effective advocacy can influence funding and drives change in practice and policy. Here we articulate both research and advocacy priorities, with the intention of focusing the energy and expertise of our best scientists on making a difference, bringing new innovations to improve oral health.
Mineral Association Changes the Secondary Structure and Dynamics of Murine Amelogenin
Authors: Lu J.X. , Xu Y.S. , Buchko G.W. , Shaw W.J.
Published: October 2013

Amelogenin is one of the key protein constituents responsible for the exquisite organization of the calcium phosphate crystals in enamel. Amelogenin forms into nanospheres in solution, while its association with hydroxyapatite is also essential to enamel development. Structural information of full-length amelogenin in either of these physiologically important forms has the potential to provide mechanistic information; however, these data are limited because of the difficulty of determining the structure of large protein complexes and proteins bound to surfaces. To obtain structural insights into amelogenin during these early stages of enamel development, we used a lysine-specific 13C-, 15N-labeled sample of murine amelogenin to provide insight into the structure of the hydroxyapatite (HAP)-binding domains of the protein. A combination of one-and two-dimensional solid-state NMR experiments was used to obtain molecular-level insights into the secondary structure and dynamics of full-length amelogenin within a nanosphere-gel and on the surface of HAP. Regions of amelogenin that appear to be primarily random coil in the nanosphere-gel adopt a β-strand structure and are less mobile with HAP binding, indicative of a structural switch upon binding that may be important in the role of amelogenin in enamel development.
The Challenge for Innovation in Direct Restorative Materials
Authors: Bayne S. , Petersen P.E. , Piper D. , Schmalz G. , Meyer D.
Published: October 2013

During the past 50 years, a series of key UN conferences have established a framework to minimize human health risks from environmental exposures to key chemicals. In January 2013, more than 140 countries agreed to the text of new treaty to minimize Hg effects on the environment (the Minamata Convention). Dental caries is omnipresent around the globe, affecting 60% to 90% of school children and most adults, and producing discomfort that affects quality of life. Dental amalgam is frequently used to treat carious lesions and its use releases mercury into the environment. The best way to avoid the use of dental amalgam is to emphasize caries prevention. Alternatives to amalgam are suitable in some applications, but no replacement for amalgam has been found for large posterior restorations. For any restorative material, safety and environmental impacts are part of clinical risk assessment. Safety is freedom from unacceptable risks. Risk is a combination of probability of exposure and severity of harm. Best management practices are crucial to manage dental amalgam, but these impose additional that are disproportionately more for developing countries. The Minamata Convention seeks a phase-out of all mercury-based products except dental amalgam, where a phase-down is the present goal. For dentistry, the most important focus is the promotion of caries prevention and research on new materials.
How University Students With Reading Difficulties Are Supported in Achieving Their Goals
Authors: Stack-Cutler Holly L. , Parrila Rauno K. , Jokisaari Markku , Nurmi Jari-Erik
Published: October 2013

We examine (a) what social ties university students with a history of reading difficulty (RD) report assisting them to achieve their goals, (b) outlets available for developing social ties, (c) resources mobilized within these relationships, and (d) the impact of social ties’ status on academic achievement. Participants were 107 university students with RD who were currently completing or had recently completed a university degree. Results showed that university students with RD named friends, parents, and significant others (e.g., boy/girlfriend, spouse) as social ties most often. Personal social ties were developed through social media networking sites and within close relationships, and institutional social ties through academic centers and university general services, among others. Resources mobilized among personal and institutional social ties included emotional and social support, advice and planning, writing and studying help, and goal setting. Institutional social ties also afforded job search assistance, accommodations, skill development, financial support, and mental health services. Finally, the status of employed, but not student, social ties explained academic achievement.
Better Medicine by Default
Authors: Ansher Cara , Ariely Dan , Nagler Alisa , Rudd Mariah , Schwartz Janet , Shah Ankoor
Published: October 2013

Background. American health care is transitioning to electronic physician ordering. These computerized systems are unique because they allow custom order interfaces. Although these systems provide great benefits, there are also potential pitfalls, as the behavioral sciences have shown that the very format of electronic interfaces can influence decision making. The current research specifically examines how defaults in electronic order templates affect physicians’ treatment decisions and medical errors. Methods. Forty-five medical residents completed order sets for 3 medical case studies. Participants were randomly assigned to receive order sets with either “opt-in” defaults (options visible but unselected) or “opt-out” defaults (options visible and preselected). Results compare error rates between conditions and examine the type and severity of errors most often made with opt-in versus opt-out defaults. Results. Opt-out defaults resulted in a greater number of items ordered and specifically increased commission errors (overordering) compared with opt-in defaults. However, while opt-in defaults resulted in fewer orders, they also increased omission errors. When the severity of the errors is taken into account, the default effects seem limited to less severe errors. Conclusion. The defaults used in electronic order sets influence medical treatment decisions when the consequences to a patient’s health are low. This pattern suggests that physicians cognitively override incorrect default choices but only to a point, and it implies tradeoffs that maximize accuracy and minimize cognitive effort. Results indicate that defaults for low-impact items on electronic templates warrant careful attention because physicians are unlikely to override them.
Validating a Vignette-Based Instrument to Study Physician Decision Making in Trauma Triage
Authors: Mohan Deepika , Fischhoff Baruch , Farris Coreen , Switzer Galen E. , Rosengart Matthew R. , Yealy Donald M. , Saul Melissa , Angus Derek C. , Barnato Amber E.
Published: October 2013

Background. The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown. Methods. We had previously developed a vignette-based instrument to study physician decision making in trauma triage. Here, we measured the retest reliability, internal consistency, known-groups performance, and criterion validity of the instrument. Thirty-two emergency physicians, recruited at a national academic meeting, participated in reliability testing. Twenty-eight trauma surgeons, recruited using personal contacts, participated in known-groups testing. Twenty-eight emergency physicians, recruited from physicians working at hospitals for which we had access to medical records, participated in criterion validity testing. We measured rates of undertriage (the proportion of severely injured patients not transferred to trauma centers) and overtriage (the proportion of patients transferred with minor injuries) on the instrument. For physicians participating in criterion validity testing, we compared rates of triage on the instrument with rates in practice, based on chart review. Results. Physicians made similar transfer decisions for cases (κ = 0.42, P < 0.01) on 2 administrations of the instrument. Responses were internally consistent (Kuder-Richardson, 0.71–0.91). Surgeons had lower rates of undertriage than emergency physicians (13% v. 70%, P < 0.01). No correlation existed between individual rates of under- or overtriage on the vignettes and in practice ( r = −0.17, P = 0.4; r = −0.03, P = 0.85). Conclusions. The instrument developed to assess trauma triage decision making performed reliably and detected known group differences. However, it did not predict individual physician performance.
Prevalence and clinical characteristics of headache in adolescents: A Croatian epidemiological study
Authors: Cvetković Vlasta Vuković , Plavec Davor , Lovrenčić-Huzjan Arijana , Strineka Maja , Ažman Dražen , Bene Raphael
Published: October 2013

Background

Headaches are often under-diagnosed in adolescents. The aim of this study was to examine the one-year prevalence of primary headaches among high school students in the city of Zagreb, the capital of Croatia.

Methods

This was a population-based, cross-sectional study. A total of 2350 questionnaires consisting of questions on demographic data, the presence and clinical characteristics of headaches were distributed among students in eight high schools; 2057 (87.5%) questionnaires were eligible for analysis.

Results

The mean age of the students was 17.2 ± 1.2 years; 50.2% were female. The prevalence of recurrent headache was 30.1% (620/2057), girls 35.1%, boys 25.2%. Among students with headache, 291 (46.9%) had migraine, and 329 (53.1%) had tension-type headaches (TTHs). The mean frequency of headaches was 5.66 per month in girls and 4.42 in boys; mean duration of a headache attack was 8.94 hours in girls and 8.37 hours in boys (NS). Unilateral headache was present in 31.6%, throbbing quality in 22.6%, dull in 34.4% of students; 22.4% had severe intensity and 70.3% moderate. Nausea was present in 4.0% always and in 14.7% frequently (girls 18.8%), photophobia in 41.3%, phonophobia in 63.2%, osmophobia in 23.9% (NS among genders). Almost 30% of students were disabled and stayed at home, more frequently boys. Girls (33.4%) were more likely to take drugs for every attack; number per month was 3.7. The results of this study showed that the prevalence of migraine among adolescents in Croatia was 16.5% for girls and 11.8% for boys; the prevalence of TTH was 18.4% for girls and 13.4% for boys.

Conclusions

The prevalence of self-reported headache among high school students in Zagreb is relatively high. Significant gender differences in frequency and clinical characteristics were observed. Primary headaches among adolescents are an important public health problem and should receive more attention from school and health authorities.
Stimulation of dural vessels excites the SI somatosensory cortex of the cat via a relay in the thalamus
Authors: Lambert Geoffrey A , Hoskin Karen L , Michalicek Jan , Panahi Seyed E , Truong Linda , Zagami Alessandro S
Published: October 2013

Aim

We carried out experiments in cats to determine the thalamo-cortical projection sites of trigeminovascular sensory neurons.

Methods

1) We stimulated the middle meningeal artery (MMA) with C-fibre intensity electrical shocks and made field potential recordings over the somatosensory cortical surface. 2) We then recorded neurons in the ventroposteromedial (VPM) nucleus of the thalamus in search of neurons which could be activated from the skin, MMA and superior sagittal sinus. 3) Finally, we attempted to antidromically activate the neurons found in stage 2 by stimulating the responsive cortical areas revealed in stage 1.

Results

VPM neurons received trigeminovascular input, input from the V1 facial skin and could also be activated by electrical stimulation of the somatosensory cortex. VPM neurons activated from the cortex responded with short and invariant latencies (6.7 ± 7.7 msec mean and SD). They could follow high rates of stimulation and sometimes showed collision with orthodromic action potentials.

Conclusions

We conclude that somatosensory (SI) cortical stimulation excites trigeminovascular VPM neurons antidromically. In consequence, these VPM neurons project to the somatosensory cortex. These findings may help to explain the ability of migraineurs with headache in the trigeminal distribution to localise their pain to a particular region in this distribution.
Equity Sensitivity and Gender Differences
Authors: Kim Dongho , Yang Choonhee , Lee Jongwon
Published: October 2013

The study was intended to examine whether gender differences exist with regard to equity sensitivity between Korean female and male workers. Employing equity sensitivity theory to represent gender and individual differences in a collectivistic country such as Korea may allow internationally located organisations and their managers to understand and accommodate different behaviours of individuals in a different culture. Understanding individual and gender differences in a particular culture can enable organisations and managers to design equitable reward systems. A total of 400 survey packets were mailed to two regional universities in Korea. A total of 380 survey packages were returned, and 374 surveys were useable for data analysis. The results of the study illustrated that gender differences in equity sensitivity exist in Korea. Korean workers felt more entitled than did workers from other countries in earlier studies. The significant finding was that Korean female students felt more entitled than did Korean male participants and their behaviours as ‘entitleds’ was consistent with the dimensions of equity sensitivity theory.
The Promotion of Masculinity and Femininity through Ayurveda in Modern India
Authors: Islam Md. Nazrul , Kuah-Pearce K.E.
Published: October 2013

This article argues that, although men’s sexual health has been presented in classical ayurvedic texts as associated with semen, physiology and reproduction, ayurvedic companies in modern India relate men’s sexual health to the ‘power of masculinity’ with an emphasis on sexual prowess, focusing on premature ejaculation, erectile dysfunction, etc. Women’s health is presented in the classical ayurvedic texts in terms of human reproduction, but ayurvedic companies today, problematically, redefine women’s health in terms of beauty. Emphasising the ‘natural’ content of ayurvedic medications, pharmaceutical companies target women as potential consumers by promoting products for the enhancement of beauty, associating women’s bodies with nature. This article concludes that a problematic gender distinction and hierarchy is reproduced through appeals to masculinity and femininity by manufacturers of ayurvedic products, so that women’s health is associated with nature while men’s health is associated with power.
Effects of Drought on Livelihoods and Gender Roles: A Case Study of Meghalaya
Authors: Singh Ram , Feroze S.M. , Ray Lala I.P.
Published: October 2013

Climate change has serious repercussions on food security, availability, accessibility and utilisation and food system stability. Women farmers currently account for 45–80 per cent of all food production in developing countries depending on the region. When climate change-related disasters strike, women are more vulnerable than men, and the workload of women and girls increases. In India, women are actively engaged in agricultural activities, including paddy cultivation and fishing, which are both affected by changing weather patterns. Loss of livelihood increases women’s vulnerability and marginalisation. The current study was conducted in 10 villages of Meghalaya, a north-eastern state in India. It concluded that extreme climate variability affects both the sexes but with different consequences as they are subjected to different roles and responsibilities. We suggest empowering women with requisite knowledge of their rights, relevant information and skills, and also by being helped with adequate resources to enable them to act and make their own decisions.
Behavior Change After Adventure Education Courses
Authors: Rhodes Heather M. , Martin Andrew J.
Published: October 2013

In this case study, a mixed-method approach is used to examine the extent and type of changes in workplace attitudes and behavior, as self-reported by soldiers who had participated in 6- to 10-day “Experiential Leadership Development Activities” (ELDAs) delivered by the New Zealand Army Leadership Centre. Observations made by workplace colleagues of ELDA participants corroborated the self-report data, both reports being made on an average of 4 months after a course. The findings indicated that almost all participants (97%) perceived improvements in their own attitude and/or behavior, the main changes being in the areas of “improvements in dealing with challenges” and “having a more positive attitude.” Most colleagues (87%) also noticed some improvement in behaviors, in similar areas. This mixed-method evaluation provides evidence of the benefits of adventure education courses, both prescribed and unpredicted outcomes, enhancing intra- and interpersonal skills in the workplace.
Prevalence of Vitamin D Deficiency in Patients With Foot and Ankle Injuries
Authors: Smith Jeremy T. , Halim Kareem , Palms David A. , Okike Kanu , Bluman Eric M. , Chiodo Christopher P.
Published: October 2013

Background:

Vitamin D deficiency has been identified as one of the most common causes of fragility fractures and poor fracture healing. Although rates of vitamin D deficiency have been delineated in various orthopaedic populations, little is known about the prevalence of vitamin D deficiency in patients with foot and ankle disorders. The goal of this study was to identify the prevalence of vitamin D deficiency in patients with a low energy fracture of the foot or ankle.

Methods:

Over a 6-month period, a serum 25-OH vitamin D level was obtained from consecutive patients with a low energy ankle fracture, fifth metatarsal base fracture, or stress fracture of the foot or ankle. For comparative purposes, vitamin D levels in patients with an ankle sprain and no fracture were also examined.

Results:

The study cohort included 75 patients, of which 21 had an ankle fracture, 23 had a fifth metatarsal base fracture, and 31 had a stress fracture. The mean age was 52 (range, 16–80) years. Thirty-five of the fracture patients (47%) had an insufficient vitamin D level (below the recommended level of 30 ng/mL), and 10 of the patients (13%) had a level that was deficient (< 20 ng/mL). Vitamin D levels were significantly lower in those with a fracture than in those with an ankle sprain ( P = .02). In the fracture cohort, the factors significantly associated with vitamin D insufficiency in the multivariate analysis were smoking ( P = .03), obesity ( P = .003), and other medical risk factors for vitamin D deficiency ( P = .03).

Conclusion:

Hypovitaminosis D was common among patients with a foot or ankle injury seen at our institution. Patients with a low energy fracture of the foot or ankle were at particular risk for low vitamin D, especially if they smoked, were obese, or had other medical risk factors. Given that supplementation with vitamin D (± calcium) has been shown to reduce the risk of fragility fractures and improve fracture healing, monitoring of 25-OH vitamin D and supplementation should be considered in patients with fractures.

Level of Evidence:

Level III, prospective case control.
Most Business Editors Find Journalism Graduates Still Unprepared
Authors: Pardue Mary Jane
Published: October 2013

In 2002, a study was published in Newspaper Research Journal that explored the preparedness of graduating journalism students to cover business news. In 2012, a follow-up survey of business editors at the nation’s daily newspapers was done to see whether progress had been made in the training of journalism students for the business news beat. More than half of the editors in 2012 still rated journalism graduates unprepared, reflecting a call once again for academia to recognize that business journalism is a reporting area in high demand, requiring specialized skills that often are not taught at universities.
Formative Evaluation of an ABA Outreach Training Program for Parents of Children With Autism in Remote Areas
Authors: Heitzman-Powell Linda S. , Buzhardt Jay , Rusinko Lisa C. , Miller Todd M.
Published: October 2013

Families in rural or remote areas have limited access to evidence-based intervention for their children with autism. Using web-based training and telemedicine technology, the current study investigated the feasibility of training seven parents to implement Applied Behavior Analysis (ABA) strategies with their children with autism. In this exploratory formative evaluation, parents increased their knowledge of ABA strategies and concepts by an average of 39 percentage points, and improved their implementation of ABA strategies with their children by an average of 41 percentage points. A total of 9,052 driving miles were saved across the four families. Implications for families living in remote areas, improvements in the training program, and future research directions are discussed.
Counting and Accounting for Deaths in Australian Immigration Custody
Authors: Powell Rebecca , Weber Leanne , Pickering Sharon
Published: October 2013

Since 2000, more than 1,500 people have died trying to reach Australia by boat or in other ways that are connected with the enforcement of border controls. This article is concerned with a subset of those deaths that can be classified as deaths in immigration custody. In the Australian context, official deaths in custody reporting has only included deaths in the custodial settings of prison, juvenile detention, and police custody, and during the apprehension of criminal suspects or escapees by police or prison authorities. Deaths that occur in immigration detention centers or while authorities attempt to take suspected “unlawful non-citizens” into Migration Act custody are not considered to be deaths in custody for the purposes of investigation and national monitoring. At least 29 such deaths have occurred in Australia since 2000. As with deaths in criminal justice settings, all of these deaths raise questions concerning duty of care, prevention of future deaths, and the use of homicide-related categories in establishing state culpability. This article examines the prospects for achieving a level of accountability for non-citizens who die in immigration custody that mirrors the procedures, however flawed, that apply within criminal justice settings.
Three-item Direct Observation Screen (TIDOS) for autism spectrum disorder
Authors: Oner Pinar , Oner Ozgur , Munir Kerim
Published: October 2013

We compared ratings on the Three-Item Direct Observation Screen test for autism spectrum disorders completed by pediatric residents with the Social Communication Questionnaire parent reports as an augmentative tool for improving autism spectrum disorder screening performance. We examined three groups of children (18–60 months) comparable in age (18–24 month, 24–36 month, 36–60 preschool subgroups) and gender distribution: n = 86 with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) autism spectrum disorders; n = 76 with developmental delay without autism spectrum disorders; and n = 97 with typical development. The Three-Item Direct Observation Screen test included the following (a) Joint Attention, (b) Eye Contact, and (c) Responsiveness to Name. The parent Social Communication Questionnaire ratings had a sensitivity of .73 and specificity of .70 for diagnosis of autism spectrum disorders. The Three-Item Direct Observation Screen test item Joint Attention had a sensitivity of .82 and specificity of .90, Eye Contact had a sensitivity of .89 and specificity of .91, and Responsiveness to Name had a sensitivity of .67 and specificity of .87. In the Three-Item Direct Observation Screen test, having at least one of the three items positive had a sensitivity of .95 and specificity of .85. Age, diagnosis of autism spectrum disorder, and developmental level were important factors affecting sensitivity and specificity. The results indicate that augmentation of autism spectrum disorder screening by observational items completed by trained pediatric-oriented professionals can be a highly effective tool in improving screening performance. If supported by future population studies, the results suggest that primary care practitioners will be able to be trained to use this direct procedure to augment screening for autism spectrum disorders in the community.
The contribution of epigenetics to understanding genetic factors in autism
Authors: Hall Layla , Kelley Elizabeth
Published: October 2013

Autism spectrum disorder is a grouping of neurodevelopmental disorders characterized by deficits in social communication and language, as well as by repetitive and stereotyped behaviors. While the environment is believed to play a role in the development of autism spectrum disorder, there is now strong evidence for a genetic link to autism. Despite such evidence, studies investigating a potential single-gene cause for autism, although insightful, have been highly inconclusive. A consideration of an epigenetic approach proves to be very promising in clarifying genetic factors involved in autism. The present article is intended to provide a review of key findings pertaining to epigenetics in autism in such a way that a broader audience of individuals who do not have a strong background in genetics may better understand this highly specific and scientific content. Epigenetics refers to non-permanent heritable changes that alter expression of genes without altering the DNA sequence itself and considers the role of environment in this modulation of gene expression. This review provides a brief description of epigenetic processes, highlights evidence in the literature of epigenetic dysregulation in autism, and makes use of noteworthy findings to illustrate how a consideration of epigenetic factors can deepen our understanding of the development of autism. Furthermore, this discussion will present a promising new way for moving forward in the investigation of genetic factors within autism.
Sex differences in co-occurring conditions of children with autism spectrum disorders
Authors: Stacy Maria E , Zablotsky Benjamin , Yarger Heather A , Zimmerman Andrew , Makia Barraw , Lee Li-Ching
Published: October 2013

This study investigated differences in co-occurring diagnoses made in females compared to males with autism spectrum disorders in 913 children (746 males and 167 females) living in the United States with a current autism spectrum disorder diagnosis identified via caregiver-reported data from the National Survey of Children’s Health 2007. The results indicated that overall, females had significantly fewer reported autism spectrum disorder co-occurring conditions than males. Females, compared to males, with a current autism spectrum disorder diagnosis had lower rates of past learning disorder, current mild learning disorder, and past anxiety diagnoses. Females with a current autism spectrum disorder diagnosis were more likely than males to have been diagnosed with a speech problem in the past, while males with a current autism spectrum disorder diagnosis were more likely than females to have a current diagnosis of a mild learning disability and a past diagnosis of learning disability. In addition, males with a current autism spectrum disorder diagnosis were more likely than females to have two or more co-occurring diagnoses. These findings provide insight into trends in sex differences in autism spectrum disorder co-occurring conditions.
The cost-effectiveness of supported employment for adults with autism in the United Kingdom
Authors: Mavranezouli Ifigeneia , Megnin-Viggars Odette , Cheema Nadir , Howlin Patricia , Baron-Cohen Simon , Pilling Stephen
Published: October 2013

Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings.
Partial evacuation of the fracture haematoma does not potentiate the analgesic effect of infiltrated local anaesthetic in the manipulation of distal radius fractures
Authors: Khan Sameer K , Singh HP , Markillie C
Published: October 2013

Wrist haematoma blocks increase the volume of the fracture-soft tissue envelope and the resulting compartment pressures. We hypothesised that evacuating the haematoma before infiltrating with local anaesthetic would reduce the risk of undue swelling and produce a more effective block as measured by changes in a visual analogue score for pain. A total of 100 patients (100 fractures) were recruited; 77 had the haematoma partially evacuated (Group 1) and 23 did not (Group 2). The volumes of infiltrated anaesthetic, timing of manipulation, rates of re-manipulation and splitting of cast were not different between the two groups. The mean visual analogue score before manipulation in the two groups were 7.8 and 7.5, respectively, which declined to 3.2 and 2.5 at 5 min and to 2.8 and 2.4 at 10 min. The differences in change in visual analogue score were not significant at 5 and 10 min ( p = 0.42, p = 0.55). This suggests that evacuation of the haematoma does not influence the analgesic effect of the infiltrated agent.
Diabetes care for the most vulnerable in society – the views of professionals working in care homes and domiciliary care using focus group methodology
Authors: Fox CJ , Gillespie CR , Kilvert A , Sinclair AJ
Published: October 2013

Using focus group methods, we report that the main concerns of health care professionals working in care homes and in the domiciliary sector are as follows: Poor communication with all other health care agencies, including hospital, primary care and mental services The need for training, specifically in diabetes and dementia Currently available e-learning was not found to be useful Poor support from the specialist diabetes team
Application of methods for central statistical monitoring in clinical trials
Authors: Kirkwood Amy A , Cox Trevor , Hackshaw Allan
Published: October 2013

Background

On-site source data verification is a common and expensive activity, with little evidence that it is worthwhile. Central statistical monitoring (CSM) is a cheaper alternative, where data checks are performed by the coordinating centre, avoiding the need to visit all sites. Several publications have suggested methods for CSM; however, few have described their use in real trials.

Methods

R-programs were created to check data at either the subject level (7 tests within 3 programs) or site level (9 tests within 8 programs) using previously described methods or new ones we developed. These aimed to find possible data errors such as outliers, incorrect dates, or anomalous data patterns; digit preference, values too close or too far from the means, unusual correlation structures, extreme variances which may indicate fraud or procedural errors and under-reporting of adverse events. The methods were applied to three trials, one of which had closed and has been published, one in follow-up, and a third to which fabricated data were added. We examined how well the methods work, discussing their strengths and limitations.

Results

The R-programs produced simple tables or easy-to-read figures. Few data errors were found in the first two trials, and those added to the third were easily detected. The programs were able to identify patients with outliers based on single or multiple variables. They also detected (1) fabricated patients, generated to have values too close to the multivariate mean, or with too low variances in repeated measurements, and (2) sites which had unusual correlation structures or too few adverse events. Some methods were unreliable if applied to centres with few patients or if data were fabricated in a way which did not fit the assumptions used to create the programs. Outputs from the R-programs are interpreted using examples.

Limitations

Detecting data errors is relatively straightforward; however, there are several limitations in the detection of fraud: some programs cannot be applied to small trials or to centres with few patients (<10) and data falsified in a manner which does not fit the program’s assumptions may not be detected. In addition, many tests require a visual assessment of the output (showing flagged participants or sites), before data queries are made or on-site visits performed.

Conclusions

CSM is a worthwhile alternative to on-site data checking and may be used to limit the number of site visits by targeting only sites which are picked up by the programs. We summarise the methods, show how they are implemented and that they can be easy to interpret. The methods can identify incorrect or unusual data for a trial subject, or centres where the data considered together are too different to other centres and therefore should be reviewed, possibly through an on-site visit.
Inference from blinded data in randomized clinical trials
Authors: Zhou Kefei , Ganju Jitendra
Published: October 2013

Background

With blinded data, several authors have concluded that there is a negligible chance of inferring a non-null treatment effect. The recent Food and Drug Administration (FDA) draft guidance document on adaptive trials, by encouraging blinded sample size reestimation, implies the same.

Purpose

We derive methods to investigate whether the probability of inferring a treatment effect is much larger than previously thought, and whether that is of concern.

Methods

A statistic is developed that contributes to improving signal detection. Additionally, trials that are overpowered, for reasons external to powering the primary objective, further strengthen the chance of finding a signal.

Results

An example of data from a clinical trial shows how revealing a blinded analysis can be. The ability to infer a non-null effect while a blinded trial is ongoing is a serious matter.

Limitations

The methods apply to superiority trials and are of limited use for non-inferiority or equivalence trials.

Conclusion

It is important, therefore, that guidance documents include clear language to limit or prevent inference from blinded data to maintain trial integrity. Simple steps are proposed to make inference difficult.
Contact areas of the scaphoid and lunate with the distal radius in neutral and extension: correlation of falling strategies and distal radial anatomy
Authors: Chen Y. R. , Wu Y. F. , Tang J. B. , Giddins G.
Published: October 2013

The functional neutral of wrist movement is about 10° extension yet the distal radius has a volar tilt. This has not previously been explained. Assuming that the contact area between the carpus and the distal radius increased in wrist extension this would also help stabilize the carpus on the distal radius in positions where typically there is greater loading. To test this hypothesis we reconstructed three-dimensional structures of the carpal bones and distal radius using computed tomography scans of 13 normal wrists. The contact areas of the scaphoid with the distal radius were measured and were found progressively increased from flexion 20°, neutral, extension 20°, to extension 40°. The maximal increases in the contact area of the scaphoid and the distal radius was at full wrist extension. No significant changes in the contact areas of the lunate with the distal radius were found between the different positions. The contact characteristics provide greater stability to the carpus on the distal radius, and to help spread forces from impact to the wrist reducing the transmitted peak forces and thus the risk of distal radius and carpal injuries.
A prospective case-control study to compare the sensitivity and specificity of the grind and traction-shift (subluxation-relocation) clinical tests in osteoarthritis of the thumb carpometacarpal joint
Authors: Choa R. M. , Parvizi N. , Giele H. P.
Published: October 2013

The diagnosis of osteoarthritis of the thumb carpometacarpal joint is made predominantly by correlating examination findings with patients’ symptoms and radiographs. The importance of clinical examination is enhanced due to the poor correlation between radiological severity of osteoarthritis of this joint and symptoms. Despite the importance of clinical examination findings, no previous studies have analyzed the traction-shift test nor compared clinical tests for this diagnosis. In this prospective case-control study the relative performance of the commonly used grind and traction-shift (subluxation-relocation) tests were compared in 30 patients and 30 unaffected controls. The traction-shift test had greater sensitivity (66.7%) and specificity (100%) than the grind test (30% and 96.7%, respectively), whilst also demonstrating superior positive (100%) and negative (75%) predictive value than the grind test (90% and 58%, respectively). Therefore, we believe this to be the superior clinical test for osteoarthritis of the carpometacarpal joint of the thumb.
Endoscopic submucosal dissection for early gastric cancer in cases preoperatively contraindicated for endoscopic treatment
Authors: Kakushima Naomi , Hagiwara Tomoko , Tanaka Masaki , Sawai Hiroaki , Kawata Noboru , Takizawa Kohei , Imai Kenichiro , Takao Toshitatsu , Hotta Kinichi , Yamaguchi Yuichiro , Matsubayashi Hiroyuki , Ono Hiroyuki
Published: October 2013

Background and study aims

Endoscopic submucosal dissection (ESD) is an optimal treatment for early gastric cancer (EGC) with negligible risk of lymph node metastasis; however, ESD is sometimes performed to treat lesions preoperatively contraindicated for the procedure due to various reasons. Here we aim to evaluate the treatment outcomes of ESD for lesions that were preoperatively contraindicated for ESD.

Patients and methods

Clinicopathological data of 104 EGC lesions in 104 patients were reviewed retrospectively. The demographic characteristics of patients, reasons for ESD, treatment results, complications, and outcomes were assessed.

Results

The major reasons for undergoing ESD included advanced age, desire to undergo ESD, and the existence of comorbidities. En‐bloc and complete resection rates were 97 and 71%, respectively. Perforation and postoperative bleeding rates were 13 and 9%, respectively. Resection was beyond the expanded Japanese criteria for endoscopic treatment of EGC in 87 patients (84%), 41 (47%) of whom underwent additional therapy, including subsequent gastrectomy (29 patients) and photodynamic therapy (12 patients). The median follow‐up period was 47 months, during which seven patients died from recurrent disease. The 5‐year overall and disease‐specific survival rates were 70 and 91.5%, respectively.

Conclusions

ESD is a technically demanding procedure for lesions preoperatively contraindicated for endoscopic resection. The curative resection rate was low, but the 5‐year disease‐specific survival rate of 91.5% was favourable. In experienced hands, ESD may be a treatment option for patients not suitable for radical surgery, and the relevant risk of complications must be considered before treatment.
Molecular analysis of subtilase cytotoxin genes of food-borne Shiga toxin-producing Escherichia coli reveals a new allelic subAB variant
Authors: Funk Joschua , Stoeber Helen , Hauser Elisabeth , Schmidt Herbert
Published: October 2013

Background

The open reading frames ofsubABgenes and their flanking regions of 18 food-borne Shiga toxin-producingE. coli(STEC) strains were analyzed.

Results

All but onesubABopen reading frames (ORF) were complete in all STEC strains. ThesubAB1genes of nine STEC strains were located on large plasmids. ThesubAB2allele (here designatedsubAB2-1), which was recently described by others to be present in the Subtilase-Encoding PAI (SE-PAI) was found in 6 STEC strains. A new chromosomalsubAB2variant, designatedsubAB2-2was detected in 6 strains and was linked to a chromosomal gene hypothetically encoding an outer membrane efflux protein (OEP). Three STEC strains contained bothsubAB2variants. DNA analysis indicated sequence conservation in the plasmid-located alleles and sequence heterogeneity among the chromosomalsubAB2genes.

Conclusions

The results of this study have shown that 18subAB-PCR positive STEC strains contain completesubABopen reading frames. Furthermore, the new allelic variantsubAB2-2was described, which can occur in addition tosubAB2-1on a new chromosomal locus.