bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical strategy for Apert syndrome: Retrospective study of developmental quotient and three‐dimensional computerized tomography
Authors: Tomita Shoichi , Miyawaki Takeshi , Nonaka Yuichirou , Sakai Shinsuke , Nishimura Reiji
Published: March 2017

There are many surgical techniques for craniosynostosis. However, the indications for and timing of surgery still remain unclarified. Most of the skull growth in craniosynostosis is completed in the first year, and the bone is strong enough to undergo distraction osteogenesis. However, previous reports showed that patients operated on before 1 year of age had better IQ than those operated later in life. This report aims to consider the best timing for cranial expansion and surgical strategy for Apert syndrome. From January 2002 to December 2011, 13 patients with Apert syndrome were operated on and were followed up for more than 5 years. Nine patients underwent operations before 1 year of age (early surgery group) and three patients underwent operations later in life (late surgery group). They underwent fronto‐orbital advancement for primary surgery. We evaluated postoperative developmental quotient every year and cephalic index (CI) measured by three‐dimensional computerized tomography (3D–CT) at the age over 5 years retrospectively. Eleven of 13 patients improved their developmental quotient scores, with no significant intergroup differences. The CI evaluation showed cases with remnant brachycephalic deformity in both groups. Two patients with remnant plagiocephalic deformities tend to have primary surgery early in life compared to the others. Thus the delay in primary surgery had little influence on psychological development. We conclude that the primary surgery can be delayed unless the intracranial pressure needs to be controlled. In addition, fronto‐orbital advancement could not sufficiently improve the brachycephalic appearance, other procedures like posterior vault distraction might be better alternatives.
“Planning Dissonance” and the Bases for Stably Diverse Neighborhoods: The Case of South Seattle
Authors: Lumley–Sapanski Audrey , Fowler Christopher S.
Published: March 2017

Recent scholarship has focused extensively on the rise of diverse neighborhoods in U.S. cities. Nevertheless, the theoretical frameworks we have for describing residential settlement patterns generally treat diversity as an unstable and transitory period that is the product of a unidirectional pressure towards segregation. In our analysis of six diverse neighborhoods in Southeast Seattle, we find evidence of processes at multiple scales that not only maintain diversity, but actually reinforce it. From individual decisions about property ownership to broader patterns of regional disinvestment, we find empirical evidence that indicates a need for a more complex theorization of the processes that create and sustain diverse neighborhoods. In our preliminary theorization of these conditions, we call for a conceptualization of residential settlement patterns that is explicitly multiscalar and recognizes a wider range of cultural, economic, and political relations as central to the production of observed patterns of neighborhood settlement.
Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico
Authors: Meacham Meredith C. , Roesch Scott C. , Strathdee Steffanie A. , Lindsay Suzanne , Gonzalez‐Zuniga Patricia , Gaines Tommi L.
Published: March 2017

Introduction and Aims

Patterns of polydrug use among people who inject drugs (PWID) may be differentially associated with overdose and unique human immunodeficiency virus (HIV) risk factors. Subgroups of PWID in Tijuana, Mexico, were identified based on substances used, route of administration, frequency of use and co‐injection indicators.

Design and Methods

Participants were PWID residing in Tijuana age ≥18 years sampled from 2011 to 2012 who reported injecting an illicit substance in the past month (n = 735). Latent class analysis identified discrete classes of polydrug use characterised by 11 indicators of past 6 months substance use. Multinomial logistic regression examined class membership association with HIV risk behaviours, overdose and other covariates using an automated three‐step procedure in mplus to account for classification error.

Results

Participants were classified into five subgroups. Two polydrug and polyroute classes were defined by use of multiple substances through several routes of administration and were primarily distinguished from each other by cocaine use (class 1: 5%) or no cocaine use (class 2: 29%). The other classes consisted primarily of injectors: cocaine, methamphetamine and heroin injection (class 3: 4%); methamphetamine and heroin injection (class 4: 10%); and heroin injection (class 5: 52%). Compared with the heroin‐only injection class, memberships in the two polydrug and polyroute use classes were independently associated with both HIV injection and sexual risk behaviours.

Discussion and Conclusions

Substance use patterns among PWID in Tijuana are highly heterogeneous, and polydrug and polyroute users are a high‐risk subgroup who may require more tailored prevention and treatment interventions. [Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez‐Zuniga P, Gaines TL. Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico. Drug Alcohol Rev 2018;37:128–136]
Revisiting the ‘paradigm shift’ in opioid use: Developments and implications 10 years later
Authors: Fischer Benedikt , Rehm Jürgen
Published: March 2017

A decade ago, we queried the unfolding of a ‘paradigm shift’ in illicit opioid use in North America, specifically involving a shift away from heroin to prescription opioid (PO) use. Today, this situation is more acute than ever, with prescription opioid misuse, morbidity and mortality amounting to one of the most severe substance use‐related public health crises ever, now even impacting life expectancy in key population segments. Despite medical system‐based PO dispensing and practices being recognised as core drivers of the PO crisis, effective policy measures have been long absent or limited—including those to reduce medical PO use to levels supported by best evidence for pain care. At the same time, heroin use has been increasing again, now commonly tied into interdependent opioid use trajectories, initiated with POs yet shifting to heroin as influenced by economic or availability factors. For policy, there are now two major and urgent—yet partly conflicting—tasks: one is to reduce the determinants of PO misuse and harms by reducing medical prescribing to levels supported by good evidence, while the other is to effectively protect those many active problematic PO users from acute harms (including overdose mortality) by providing effective treatment and survival aids (e.g. naloxone). Surprisingly, it appears that a major ‘homemade’ and medical system‐induced drug crisis has been at least as challenging for North American policy systems to address as other, more conventional illicit drug problems. Lessons for policy hence need to be urgently identified and applied for the future. [Fischer B, Rehm J. Revisiting the ‘paradigm shift’ in opioid use: Developments and implications 10 years later. Drug Alcohol Rev 2017;00:000‐000]
Dual CCR2/CCR5 antagonist treatment attenuates adipose inflammation, but not microvascular complications in ob/ob mice
Authors: O'Brien Phillipe D. , Hinder Lucy M. , Parlee Sebastian D. , Hayes John M. , Backus Carey , Zhang Hongyu , Ma Lijun , Sakowski Stacey A. , Brosius Frank C. , Feldman Eva L.
Published: March 2017

Diabetic peripheral neuropathy (DPN) and diabetic kidney disease (DKD) are common diabetic complications with limited treatment options. Experimental studies show that targeting inflammation using chemokine receptor (CCR) antagonists ameliorates DKD, presumably by reducing macrophage accumulation or activation. As inflammation is implicated in DPN development, we assessed whether CCR2 and CCR5 antagonism could also benefit DPN. Five‐week‐old ob/ob mice were fed a diet containing MK‐0812, a dual CCR2‐CCR5 receptor antagonist, for 8 weeks; DPN, DKD and metabolic phenotyping were then performed to determine the effect of CCR inhibition. Although MK‐0812 reduced macrophage accumulation in adipose tissue, the treatment had largely no effect on metabolic parameters, nerve function or kidney disease in ob/ob mice. These results conflict with published data that demonstrate a benefit of CCR antagonists for DKD and hyperglycaemia. We conclude that CCR signaling blockade is ineffective in ob/ob mice and suspect that this is explained by the severe hyperglycaemia found in this model. It remains to be determined whether MK‐0812 treatment, alone or in combination with improved glycaemic control, is useful in preventing diabetic complications in alternate animal models.
Effects of increased left ventricular wall thickness on the myocardium in severe aortic stenosis with normal left ventricular ejection fraction: Two‐ and three‐dimensional multilayer speckle tracking echocardiography
Authors: Cho Eun Jeong , Park Sung‐Ji , Kim Eun Kyoung , Lee Ga Yeon , Chang Sung‐A , Choi Jin‐Oh , Lee Sang‐Chol , Park Seung Woo
Published: March 2017

Background

The aim of this study was to determine the capability of real time three‐dimensional echocardiography (RT3DE) and two‐dimensional (2D) multilayer speckle tracking echocardiography (MSTE) for evaluation of early myocardial dysfunction triggered by increased left ventricular (LV) wall thickness in severe aortic stenosis (AS) with normal LV ejection fraction (EF≥55%).

Methods

Conventional, RT3D STE and 2D MSTE were performed in 45 patients (mean 68.9±9.0 years) with severe AS (aortic valve area <1 cm2, aortic velocity Vmax >4 m/s or mean PG >40 mm Hg) and normal left ventricular ejection fraction (LVEF) without overt coronary artery disease and in 18 age‐, sex‐matched healthy controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated using RT3DE and MSTE.

Results

The severe AS group had lower 3D GLS, GRS, GAS and 2D epicardium, and mid‐wall and endocardium GLS compared to healthy controls. In MSTE analysis, 2D LS and CS values decreased from the endocardial layer toward the epicardial layer. Severe AS patients with increased LV wall thickness had lower 3D GLS and 2D epicardium, and mid‐wall and endocardium GLS compared with severe AS patients without LV wall thickening. GLS on RT3D STE was correlated with GLS on 2D MSTE, left ventricular mass index, LVEF, left atrial volume index, and lnNT‐proBNP.

Conclusion

RT3DE and 2D MSTE can be used to identify subtle contractile dysfunction triggered by increased LV wall thickness in severe AS with normal LVEF. Therefore, RT3D STE and 2D MSTE may provide additional information that can facilitate decision‐making regarding severe AS patients with increased LV wall thickness and normal LV function.
An Unexpected Crisis? Looking at Pricing Effectiveness of Heterogeneous Banks
Authors: Vacca Valerio
Published: March 2017

Credit quality of loans to Italian firms dramatically worsened during the cyclical downturn of 2008–09, compared with the previous period of growth (2006–07). This paper shows that, if credit quality transition matrices (i.e. the change in the actual firms’ riskiness, gauged ex post) are mapped to interest rates (i.e. the conditions applied ex ante to the credit), banks appear to have been able at calibrating required risk premiums to actual firms’ idiosyncratic risk, both during expansion and recession. However, the uncertainty generated by the crisis emphasized the unexpected component of credit worsening, thus making evident flaws in pricing effectiveness. Moreover, banks’ organizational features did matter in driving the pricing effectiveness: the main finding is that larger banking groups were more affected than smaller ones by the sudden deterioration of credit quality, which was poorly reflected in their risk pricing on the eve of the crisis. The bank‐size effect can be tackled through an efficient use of hard or soft information: both the banks using quantitative credit rating models and highly decentralized banks showed an above‐average ability in calibrating rates to upcoming risk, suggesting that a clear‐cut adoption of a consistent lending technique outperforms more ambiguous strategies; banks with a strong relationship with borrowers smoothed the risk–price curve in normal times.
Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study
Authors: Pauli Carla , Schwarzbold Marcelo Liborio , Diaz Alexandre Paim , de Oliveira Thais Maria Emilia Rodrigues , Kondageski Charles , Linhares Marcelo Neves , Guarnieri Ricardo , de Lemos Zingano Bianca , Ben Juliana , Nunes Jean Costa , Markowitsch Hans Joachim , Wolf Peter , Wiebe Samuel , Lin Katia , Walz Roger
Published: March 2017

Objectives

To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug‐resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE‐HS) in Brazilian patients.

Methods

Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy‐31 Inventory (QOLIE‐31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE‐HS.

Results

The overall QOLIE‐31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1–16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2–14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity.

Significance

These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.
Impact of iatrogenic iron overload on the course of hepatitis C in the dialysis population: A plea for caution
Authors: Rostoker Guy , Vaziri Nosratola D.
Published: March 2017

About 2.5% of the world population, corresponding to about 177 million individuals, are infected by hepatitis C virus (HCV), a small, single‐stranded RNA virus. The prevalence of HCV infection among dialysis patients in Japan, Europe, and North America during the 2012 to 2015 period was found to be 8.7% in the DOPPS study. Nosocomial HCV spread in hemodialysis facilities still occurs. Increased hepatic tissue iron has been shown to play a deleterious role in the course of hepatitis C, favor development of fibrosis and cirrhosis and possibly increase the risk of liver cancer in the general population. Regular loss of blood in the hemodialysis circuit, in routine blood sampling for laboratory tests (for uremia monitoring), and in gut due to uremic enteropathy, invariably results in iron deficiency for which patients are commonly treated with intravenous (IV) iron preparations. Data on the effects of IV iron in hemodialysis patients with hepatitis C are limited (2 studies) and strongly suggest that parenteral iron may contribute to hepatocellular injury.

Iatrogenic iron overload is extremely prevalent among hemodialysis population worldwide. Iron overload and toxicity has emerged as one of the most controversial topic in the management of anemia in dialysis patients. Given the known impact of iron in promoting growth and virulence of HCV and the associated liver disease, it is necessary to use iron therapy cautiously and closely monitor plasma markers of iron metabolism and liver iron stores non‐invasively by means of MRI to avoid iron overload in this vulnerable population.
Elbasvir/grazoprevir does not worsen renal function in patients with hepatitis C virus infection and pre‐existing renal disease
Authors: Reddy K. Rajender , Roth David , Bruchfeld Annette , Hwang Peggy , Haber Barbara , Robertson Michael N. , Barr Eliav , Greaves Wayne
Published: March 2017

Aim

Treatment options have been limited for patients with hepatitis C virus (HCV) infection and chronic kidney disease stage 4/5 (CKD 4/5). The aim of this analysis was to evaluate the impact of elbasvir/grazoprevir (EBR/GZR) on estimated glomerular filtration rate (eGFR) in patients with CKD stage 3 enrolled in phase II/III clinical trials.

Methods

We undertook a retrospective integrated analysis of patients with CKD 3 enrolled in the EBR/GZR phase II/III clinical trials. All patients were required to have chronic HCV infection and have received EBR 50 mg/GZR 100 mg, with or without ribavirin, for 8–18 weeks. Patients with CKD 3 (eGFR <60 to ≥30 mL/min/1.73 m2) at baseline plus ≥1 eGFR assessment postbaseline were included. In all studies, the primary endpoint was sustained virologic response 12 weeks after completion of therapy.

Results

Thirty‐two patients with CKD 3 were identified from a pooled dataset of 1689 patients enrolled in the EBR/GZR clinical trial program. Thirty‐one (97%) patients achieved SVR12 and one patient relapsed. In these 32 patients, there was no decline in median eGFR at the end of treatment or at follow‐up week 12 compared with baseline. Median eGFR values were 56 mL/min/1.73 m2 (range, 45–59) at baseline, 58 mL/min/1.73 m2 (range, 41–78) at the end of treatment and 59 mL/min/1.73 m2 (range, 38–78) 12 weeks after completing treatment.

Discussion

Elbasvir/grazoprevir is a safe and effective treatment option for patients with compromised renal function, irrespective of baseline eGFR.
Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes
Authors: Jamieson L , Evans D , Brennan AT , Moyo F , Spencer D , Mahomed K , Maskew M , Long L , Rosen S , Fox MP
Published: March 2017

Objectives

Antiretroviral therapy (ART) has been associated with unfavourable lipid profile changes and increased risk of cardiovascular disease (CVD). With a growing population on ART in South Africa, there has been concern about the increase in noncommunicable diseases such as CVD. We determined risk factors associated with increased total cholesterol (TC) in a large cohort on ART and describe the clinical management thereof.

Methods

We conducted an observational cohort study of ART‐naïve adults initiating standard first‐line ART in a large urban clinic in Johannesburg, South Africa. TC was measured annually for most patients. A proportional hazards regression model was used to determine risk factors associated with incident high TC (≥ 6 mmol/L).

Results

Significant risk factors included initial regimen non‐tenofovir vs. tenofovir [hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.14–2.08], age ≥40 vs. <30 years (HR 3.22; 95% CI 2.07–4.99), body mass index (BMI) ≥ 30 kg/m2 (HR 1.65; 95% CI 1.18–2.31) and BMI 25–29.9 kg/m2 (HR 1.70; 95% CI 1.30–2.23) vs. 18–24.9 kg/m2, and baseline CD4 count < 50 cells/μL (HR 1.55; 95% CI 1.10–2.20) and 50–99 cells/μL (HR 1.40; 95% CI 1.00–1.97) vs. > 200 cells/μL. Two‐thirds of patients with high TC were given cholesterol‐lowering drugs, after repeat TC measurements about 12 months apart, while 31.8% were likely to have received dietary counselling only.

Conclusions

Older age, higher BMI, lower CD4 count and a non‐tenofovir regimen were risk factors for incident elevated TC. Current guidelines do not indicate regular cholesterol testing at ART clinic visits, which are the main exposure to regular clinical monitoring for most HIV‐positive individuals. If regular cholesterol monitoring is conducted, improvements can be made to identify and treat patients sooner.
The endangered São Tomé Grosbeak Neospiza concolor is the world's largest canary
Authors: Melo Martim , Stervander Martin , Hansson Bengt , Jones Peter J.
Published: March 2017

The São Tomé Grosbeak Neospiza concolor, endemic to the island of São Tomé (Gulf of Guinea), is one of the least known birds in the world. Formerly considered to be an aberrant weaver (Ploceidae), it is currently placed in a monotypic genus within the true finches (Fringillidae). Phylogenetic inference based on mitochondrial and nuclear sequences confidently identifies N. concolor as an Old World finch (Fringillidae: Carduelinae) within the Crithagra seedeater/canary clade. The São Tomé Grosbeak is therefore the world's largest canary, 50% heavier than the next largest species, and it co‐occurs with a population of its sister species, the Príncipe Seedeater Crithagra rufobrunnea.
Influence of nickel‐titanium rotary systems with varying tapers on the biomechanical behaviour of maxillary first premolars under occlusal forces: a finite element analysis study
Authors: Askerbeyli Örs S. , Serper A.
Published: March 2017

Aim

To evaluate the effect of three nickel‐titanium (Ni‐Ti) rotary systems with varying tapers on stress distribution and to analyse potential fracture patterns as well as the volume of fracture‐susceptible regions in two‐rooted maxillary premolars.

Methodology

The root canals of three single‐rooted premolars were prepared with either HeroShaper (Micro‐Mega, Besançon, France) to (size 30, .04 taper), Revo‐S (Micro‐Mega) to AS30 (size 30, .06 taper) or ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) to F3 (size 30, .09 taper) Ni‐Ti files. The three root canals were scanned using micro‐computed tomography (μCT) (Skyscan 1174, Skyscan, Kontich, Belgium) and modelled according to the μCT data. An intact tooth model with a root length of 16 mm was also constructed based on μCT images of an extracted maxillary premolar with two roots. New models were constructed by replacing both of the original canals of the intact two‐rooted premolar model with the modelled canals prepared with the HeroShaper, Revo‐S or ProTaper Universal system. Occlusal forces of 200 N were applied in oblique and vertical directions. Finite element analysis was performed using Abaqus FEA software (Abaqus 6.14, ABAQUS Inc., Providence, RI, USA).

Results

Upon the application of oblique occlusal forces, the palatal external cervical root surface and the bifurcation (palatal side of the buccal root) in tooth models experienced the highest maximum principal (Pmax) stresses. The application of vertical forces resulted in minor Pmax stress values. Models prepared using the ProTaper system exhibited the highest Pmax stress values. The intact models exhibited the lowest Pmax stress values followed by the models prepared with the HeroShaper system.

Conclusion

The differences in Pmax stress values amongst the different groups of models were mathematically minimal under normal occlusal forces. Rotary systems with varying tapers might predispose the root fracture on the palatal side of the buccal root and cervical palatal root surface in two‐rooted premolars.
Lower risk for cardiovascular mortality for patients with root filled teeth in a Finnish population
Authors: Meurman J. H. , Janket S.‐J. , Surakka M. , Jackson E. A. , Ackerson L. K. , Fakhri H. R. , Chogle S. , Walls A.
Published: March 2017

Aim

To investigate the relationship of radiographic evidence of root filled teeth to cardiovascular outcomes.

Methodology

Baseline data for 506 subjects including 256 angiographically verified heart disease patients and 250 matched cardiologically healthy controls participating in the Kuopio Oral Health and Heart study were collected in 1995–1996. Cardiovascular disease (CVD) mortalities were accrued until 31 May 2015 and appended to the baseline data. Mortality status data were obtained from the Finnish National Death Register where all mortality cases and the causes of death are compiled for all Finnish citizens. Of the 506 participants, 473 subjects who had no missing values in the predictor, outcome or confounding factors were included in the analyses to assess the relationship of radiographic evidence of root filled teeth with prevalent coronary artery disease (CAD) cross sectionally and also with CVD mortality longitudinally. Multivariable logistic regression was used for the cross‐sectional part and proportional hazard regression analyses for the longitudinal part of the study were used adjusting for age, sex, smoking, edentulism, diabetes, hypertension, total/HDL cholesterol ratio and income. Additionally, whether this association was independent of periodontitis, and a systemic marker of inflammation, serum C‐reactive protein (CRP) was examined.

Results

Having ≥1 root filled teeth was associated with 84% lower odds of prevalent CAD with Odds Ratio (OR) = 0.16, 95% confidence interval (CI) 0.09–0.28, P < 0.0001. The OR for edentulism was 1.32 (CI: 0.73–2.38), P = 0.36, suggesting a nonsignificant increase in risk. Prospectively, having at least one root filled teeth was associated with a 49% lower risk of CVD mortality (hazard ratio [HR] = 0.51, CI = 0.27–0.97, P = 0.04) whilst edentulism was associated with nonsignificantly increased risk for CVD mortality: HR = 1.25 (CI: 0.65–2.42), P = 0.36. Adjustment for periodontitis or serum CRP levels changed the OR or HR slightly but the associations remained significant.

Conclusions

Having ≥1 root filled teeth was associated with significantly lower odds for prevalent CAD cross sectionally and lower risk of cardiovascular mortality prospectively. These reduced associations with CVD were independent of periodontitis or serum CRP levels.
Breastmilk with a high omega‐6 to omega‐3 fatty acid ratio induced cellular events similar to insulin resistance and obesity in 3T3‐L1 adipocytes
Authors: Vaidya H. , Cheema S. K.
Published: March 2017

Background

An imbalance of omega (n)‐3 and n‐6 polyunsaturated fatty acids (PUFA) during critical periods of development may have adverse effects on the health of the newborn in later life.

Objectives

We hypothesized that breastmilk with higher n‐6 to n‐3 PUFA ratio will have higher inflammatory cytokines and initiate cellular events similar to insulin resistance and obesity.

Methods

Breastmilk was collected from healthy women who gave natural birth at full term. Breastmilk fatty acids were measured using gas chromatography; samples were pooled based on the n‐6 to n‐3 PUFA ratio (high, medium and low), and soluble cytokines were measured. Pooled samples were used to treat 3T3‐L1 cells; mRNA expression of diacylglycerol acyltransferase2, stearoyl‐CoA desaturase‐1, leptin and RPLPO was measured.

Results

Breastmilk with a higher ratio of n‐6 to n‐3 PUFA showed higher pro‐inflammatory cytokines; there was a direct correlation between n‐6 PUFA and pro‐inflammatory cytokines. Breastmilk with a higher ratio of n‐6 to n‐3 PUFA increased the expression of genes involved in lipogenesis.

Conclusions

Pro‐inflammatory cytokines in breastmilk are associated with higher levels of n‐6 PUFA in breastmilk and has the capacity to alter adipose tissue metabolism to likely predispose the newborn to a higher risk of obesity in later life.
Weight management in adults with intellectual and developmental disabilities: A randomized controlled trial of two dietary approaches
Authors: Ptomey Lauren T , Saunders Richard R , Saunders Muriel , Washburn Richard A , Mayo Matthew S , Sullivan Debra K , Gibson Cheryl A , Goetz Jeannine R , Honas Jeff J , Willis Erik A , Danon Jessica C , Krebill Ron , Donnelly Joseph E
Published: March 2017

Background

The prevalence of obesity among individuals with intellectual and developmental disabilities (IDD) is equal to or greater than the general population.

Methods

Overweight/obese adults (BMI ≥25 kg/m2) with mild‐to‐moderate intellectual and developmental disabilities were randomized to an enhanced stop light diet (eSLD = SLD + portion‐controlled meals, n = 78) or a conventional diet (CD, n = 72) for an 18 months trial (6 months weight loss, 12 months maintenance). Participants were asked to increase physical activity (150 min/week), self‐monitor diet and physical activity and attend counselling/educational sessions during monthly home visits.

Results

Weight loss (6 months) was significantly greater in the eSLD (−7.0% ± 5.0%) compared with the CD group (−3.8% ± 5.1%, p < .001). However, at 18 months, weight loss between groups did not differ significantly (eSLD = −6.7% ± 8.3%; CD = 6.4% ± 8.6%; p = .82).

Conclusion

The eSLD and CD provided clinically meaningful weight loss over 18 months in adults with intellectual and developmental disabilities.
Interpersonal relationships of older adults with an intellectual disability in Ireland
Authors: McCausland Darren , McCallion Philip , Brennan Damien , McCarron Mary
Published: March 2017

Background

People with intellectual disability tend to have smaller social networks than other groups, with even those living in community‐based residences comparatively worse off.

Materials and methods

Analysis of data from the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS‐TILDA) (n = 701) examined measures of interpersonal relationships and interactions. Predictors of family contact and having non‐resident friends were also explored.

Results

Social networks of older people with intellectual disability differ considerably from the general older population, with a reliance on support staff and co‐resident friends in place of their own immediate family structures and wider friendships. Proximity to family most strongly predicted family contact. Residence in independent or family residences was most strongly linked to having non‐resident friends.

Conclusions

While family proximity and community living are associated with improved social networks and contacts, older people with intellectual disability remain worse off than the general older population.
Intelligent tutorial system based on personalized system of instruction to teach or remind mathematical concepts
Authors: Paiva R.C. , Ferreira M.S. , Frade M.M.
Published: March 2017

The growth of the higher education population and different school paths to access an academic degree has increased the heterogeneity of students inside the classroom. Consequently, the effectiveness of traditional teaching methods has reduced. This paper describes the design, development, implementation and evaluation of a tutoring system (TS) to improve student's engagement in higher mathematics. The TS design was based on the Personalized System of Instruction of the Mastery Learning pedagogical approach and can be implemented in any higher education course with mathematics needs. The TS consists on small self‐paced modularized units of educational contents, including tutorial videos, notes and formative e‐assessment with personalized feedback. The TS ensures that the student is only allowed to proceed to the next unit after he or she achieves the required mastery criterion of the current unit. The TS was implemented in the Quantitative Methods course of an undergraduate degree and received good acceptance from students. It was also recognized that TS contributed to learning and engagement with the discipline. Through an experimental research experience, it has been shown that the imposition of restrictions on the advance to the next level by a mastery criterion leads to a significant improvement in student's engagement and performance.
Use of nanofractional radiofrequency for the treatment of acne scars in Indian skin
Authors: Goel Apratim , Gatne Vallari
Published: March 2017

Background

Pitted acne scars of all types remain notoriously challenging to treat with no satisfactory treatment modality, particularly true for darker Fitzpatrick skin types such as Indian skin.

Aim

Nanofractional radiofrequency has been shown to be an effective treatment modality for the cosmetic improvement of acne scars.

Methods

Twenty healthy male and female Indian patients aged 16–60 years with Fitzpatrick skin types IV‐V and moderate‐to‐severe acne scar lesions received 1–3 treatments with a nanofractional radiofrequency device (Venus Viva) at baseline and at 3‐ to 6 week intervals and were evaluated with photographs at each treatment visit and up to 6 months after the final treatment session. Patients reported on their satisfaction with the treatment. The safety of treatments was evaluated by the frequency, severity, and type of adverse events.

Results

The majority of study patients achieved improvement in the appearance of their acne scar lesions. There was less improvement on ice pick scar compared to box and rolling type scars, with less impact on ice pick scar type. Overall patient satisfaction from treatment at the 6‐month follow‐up visit was very high. Adverse events were mild but transient in nature.

Conclusion

The data and results presented here support the efficacy of nanofractional radiofrequency used for the cosmetic improvement of acne scar lesions in facial skin. Moreover, the favorable adverse event profile witnessed in this trial underscores the safety of this technology for cosmetic facial treatments such as facial acne scar lesion therapy in darker Fitzpatrick skin types.
A psychometric evaluation of the Chinese version of the nursing home survey on patient safety culture
Authors: Lin Shu‐Yuan , Tseng Wei Ting , Hsu Miao‐Ju , Chiang Hui‐Ying , Tseng Hui‐Chen
Published: March 2017

Aims and objectives

To test the psychometric properties of the Chinese version of the Nursing Home Survey on Patient Safety Culture scale among staff in long‐term care facilities.

Background

The Nursing Home Survey on Patient Safety Culture scale is a standard tool for safety culture assessment in nursing homes. Extending its application to different types of long‐term care facilities and varied ethnic populations is worth pursuing.

Design

A national random survey.

Methods

A total of 306 managers and staff completed the Chinese version of the Nursing Home Survey on Patient Safety Culture scale among 30 long‐term care facilities in Taiwan. Content validity and construct validity were tested by content validity index (CVI) and principal axis factor analysis (PAF) with Promax rotation. Concurrent validity was tested through correlations between the scale and two overall rating items. Reliability was computed by intraclass correlation coefficient and Cronbach's α coefficients. Statistical analyses such as descriptive, Pearson's and Spearman's rho correlations andPAFwere completed.

Results

Scale‐level and item‐levelCVIs (0.91–0.98) of the Chinese version of the Nursing Home Survey on Patient Safety Culture scale were satisfactory. Four‐factor construct and merged item composition differed from the Nursing Home Survey on Patient Safety Culture scale, and it accounted for 53% of variance. Concurrent validity was evident by existing positive correlations between the scale and two overall ratings of resident safety. Cronbach's α coefficients of the subscales and the Chinese version of the Nursing Home Survey on Patient Safety Culture scale ranged from .76–.94.

Conclusions

The Chinese version of the Nursing Home Survey on Patient Safety Culture scale identified essential dimensions to reflect the important features of a patient safety culture in long‐term care facilities. The researchers introduced the Chinese version of the Nursing Home Survey on Patient Safety Culture for safety culture assessment in long‐term care facilities, but further testing of the reliability of the scale in a large Chinese sample and in different long‐term care facilities was recommended.

Relevance to clinical practice

The Chinese version of the Nursing Home Survey on Patient Safety Culture scale was developed to increase the users’ intention towards safety culture assessment. It can identify areas for improvement, understand safety culture changes over time and evaluate the effectiveness of interventions.
The influence of role models in undergraduate nurse education
Authors: Jack Kirsten , Hamshire Claire , Chambers Alison
Published: March 2017

Aims and Objectives

To explore the concept of role modelling in undergraduate nurse education and its effect on the personal and professional development of student nurses.

Background

Effective educative strategies are important for student nurses, who have to cope with learning in both clinical and university settings. Given the contemporary issues facing nurse education and practice in the United Kingdom (UK), it is timely and important to undertake pedagogical research into the concept of role modelling as an effective educative method.

Design

A descriptive narrative approach.

Methods

Unstructured interviews were conducted with 14 current/recently discontinued students from Adult and Mental Health branches of nursing degree programmes in the north‐west region of England, United Kingdom (UK). Data were thematically analysed.

Results

Students valued exposure to positive role models in clinical and university settings and viewed them as beneficial to their learning. Exposure to negative role models occurred, and this provided students with opportunities to consider the type of nurse they aspired to become. In some cases, students’ exposure to perceived poor practice had an adverse effect on their learning and led to negative feelings about nursing work. Clinical staff might be perceived as more relevant role models than those in the university setting although there were still opportunities for academic staff to model professional behaviours.

Conclusion

The study found that role modelling is an effective way to support learning and led to student satisfaction across both clinical and university settings. The findings support the use of role models in nurse education, and further research about conscious positive modelling of practice is required.

Relevance to practice

Exploring the use of role models is important when examining ways in which the quality of nurse education might be developed.
When Elites Forget Their Duties: The Double‐Edged Sword of Prestigious Directors on Boards
Authors: Oehmichen Jana , Braun Daniel , Wolff Michael , Yoshikawa Toru
Published: March 2017

Previous research indicates that the performance effect of prestigious directors is ambiguous. Our study addresses this issue by integrating the theoretical lens of board capital and the institutional perspective. We argue that prestigious directors can bring benefits as well as costs. We claim that the emergence of these costs depends on the institutional context, specifically the institutional characteristics of the country's corporate elite circle which is characterized by the elite cohesion and the elite exclusiveness. Our empirical results with a 15‐country sample covering the period of 2005 to 2014 provide evidence for the overall existence of a positive performance effect of prestigious boards. However, our results also indicate that these beneficial effects of prestigious boards are mitigated in countries with high elite exclusiveness. Hence, under these certain institutional conditions, the elite‐favouring behaviour of prestigious directors also brings costs.
Survey of neurodevelopmental allied health teams in Australian and New Zealand neonatal nurseries: Staff profile and standardised neurobehavioural/neurological assessment
Authors: Allinson Leesa G , Doyle Lex W , Denehy Linda , Spittle Alicia J
Published: March 2017

Aims

The primary aim of this study was to establish how many neonatal nurseries in Australia and New Zealand had a neurodevelopmental allied health team, to ascertain the disciplines involved, their qualifications and experience. The secondary aim was to evaluate which standardised neurobehavioural/neurological assessments were currently being implemented, and the existing practice in relation to their use.

Methods

A descriptive cross‐sectional survey, sampling 179 eligible public and private hospital neonatal intensive care units (NICUs) and special care nurseries (SCNs) throughout Australia and New Zealand, was purpose‐developed and administered electronically from the 5th April to 23rd July 2013.

Results

A total of 117 units (65%) overall, and 26 of 26 (100%) NICUs responded to the survey. NICUs had more neurodevelopmental allied health staff than SCNs, with physiotherapists and speech pathologists the most common disciplines. Physiotherapists were more likely to administer standardised neurobehavioural/neurological assessments in NICUs, while medical staff were more likely to do so in SCNs. A wide variety of standardised neurobehavioural/neurological assessment tools were used, with Prechtl's General Movements Assessment the most common in the NICUs (50%) and the Hammersmith Neonatal Neurological Examination the most common in the special care units (25%). Standardised neurobehavioural assessments were not administered in 22% of SCNs.

Conclusions

Although neurodevelopmental allied health teams and standardised neurobehavioural/neurological assessments are valued by many, there was little consistency across Australian and New Zealand neonatal nurseries.
An anti‐system president in France?
Authors: Bickerton Chris
Published: March 2017

With mainstream politics seemingly in disarray, Chris Bickerton asks whether a victory for either Macron or Le Pen would represent the collapse of the traditional left–right party politics in France.
Impatiens rugosipetala sp. nov. (Balsaminaceae) from Arunachal Pradesh, northeast India
Authors: Gogoi Rajib , Borah Souravjyoti
Published: March 2017

Impatiens rugosipetala sp. nov. is described and illustrated from Arunachal Pradesh, northeast India. The species is characterised by brick‐red flowers, narrowly elliptic to lanceolate coriaceous leaves, lower sepal mouth with a thick awn or beak, hooked spur and rugose petals.
The selective metabotropic glutamate receptor 5 antagonist mavoglurant (AFQ056) reduces the incidence of reflux episodes in dogs and patients with moderate to severe gastroesophageal reflux disease
Authors: Rouzade‐Dominguez M.‐L. , Pezous N. , David O. J. , Tutuian R. , Bruley des Varannes S. , Tack J. , Malfertheiner P. , Allescher H.‐D. , Ufer M. , Rühl A.
Published: March 2017

Background

Transient lower esophageal sphincter relaxations (TLESRs) induced by gastric distension are modulated by the metabotropic glutamate receptor 5 (mGluR5) that influences the vagal reflex loop. We therefore aimed to examine the effects of the selective mGluR5 antagonist mavoglurant (AFQ056) on the number of TLESRs in dogs and reflux episodes in patients with gastroesophageal reflux disease (GERD).

Methods

In a dog model, the number of meal‐induced TLESRs was determined after intravenous (0.03, 0.1, 0.3, and 1 mg kg−1) and oral (1, 3, and 10 mg kg−1) doses of mavoglurant with reference to vehicle.

In a multicenter, randomized, double‐blind, placebo‐controlled, three‐period crossover study, the incidence of meal‐induced reflux episodes was assessed by esophageal impedance monitoring after single, oral doses of mavoglurant (50 and 400 mg) or baclofen (40 mg) in 30 patients with moderate to severe GERD.

Key Results

In dogs, mavoglurant reduced the number of TLESRs after intravenous and oral administration. In patients with GERD, the incidence of postprandial reflux episodes was significantly lower at a dose of 400 mg mavoglurant (−37.5% ; 90% confidence interval [CI]: −57.8, −17.2), whereas there was no significant difference at 50 mg of mavoglurant compared to placebo. A significantly lower incidence of reflux episodes was also noted with the active comparator baclofen (−50.3%; 90% CI: −66.2, −34.3), thereby validating this study.

Conclusions and Inferences

These data suggest a potential clinical benefit of mGluR5 antagonists such as mavoglurant in patients with GERD, particularly in those with persisting symptoms despite treatment with proton pump inhibitors.
Jasmonic acid‐dependent regulation of seed dormancy following maternal herbivory in Arabidopsis
Authors: Singh Prashant , Dave Anuja , Vaistij Fabian E. , Worrall Dawn , Holroyd Geoff H. , Wells Jonathan G. , Kaminski Filip , Graham Ian A. , Roberts Michael R.
Published: March 2017

Maternal experience of abiotic environmental factors such as temperature and light are well known to control seed dormancy in many plant species. Maternal biotic stress alters offspring defence phenotypes, but whether it also affects seed dormancy remains unexplored.

We exposed Arabidopsis thaliana plants to herbivory and investigated plasticity in germination and defence phenotypes in their offspring, along with the roles of phytohormone signalling in regulating maternal effects.

Maternal herbivory resulted in the accumulation of jasmonic acid‐isoleucine and loss of dormancy in seeds of stressed plants. Dormancy was also reduced by engineering seed‐specific accumulation of jasmonic acid in transgenic plants. Loss of dormancy was dependent on an intact jasmonate signalling pathway and was associated with increased gibberellin content and reduced abscisic acid sensitivity during germination. Altered dormancy was only observed in the first generation following herbivory, whereas defence priming was maintained for at least two generations.

Herbivory generates a jasmonic acid‐dependent reduction in seed dormancy, mediated by alteration of gibberellin and abscisic acid signalling. This is a direct maternal effect, operating independently from transgenerational herbivore resistance priming.
Free movement, the welfare state, and the European Union's over‐constitutionalization: Administrating contradictions
Authors: Blauberger Michael , Schmidt Susanne K.
Published: March 2017

The European Union (EU) has to reconcile free movement rights with national welfare states. Case law of the European Court of Justice (ECJ) has broadened rights to welfare of economically inactive or marginally active EU citizens. Applying the Court's jurisprudence, which is vague and specific at the same time, poses serious challenges for national administrations. Vague criteria for individual assessments have to be translated into mass procedures. And legislative corrections of the case law are often foreclosed given the EU‘s skewed separation of powers and the over‐constitutionalization of European law, where crucial policy choices are taken by the Court's Treaty interpretation. We compare the British and the German approaches and show that ECJ case law impacts through different channels, but triggers similar challenges for national administrations.
Fifty years of the American Academy of Pediatrics Section on Anesthesiology: a history of our specialty
Authors: Agarwal Rita , Riefe Jennifer , Houck Constance S.
Published: March 2017

The American Academy of Pediatrics Section on Anesthesiology and Pain Medicine celebrated its 50th Anniversary in 2015. The Section was one of the first and only subspecialty organizations in anesthesiology at the time. This special article will focus on the contributions of the Section to the practice of pediatric anesthesiology in the areas of advocacy, education and member contributions. In 1986, the Section created the Robert M. Smith Award to honor those members who had made significant advances in the practice of pediatric anesthesiology. It is named after one of the Section founders, an influential educator, inventor, and researcher in our field. We will focus the latter part of the article on the Robert M. Smith award winners to illustrate the contributions of the Section and its members to the development of the field of pediatric anesthesiology.