bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing undergraduate human anatomy and physiology laboratories: perspectives from a large-enrollment course
Authors: Griff Edwin R.
Published: August 2016

In the present article, a veteran lecturer of human anatomy and physiology taught several sections of the laboratory component for the first time and shares his observations and analysis from this unique perspective. The article discusses a large-enrollment, content-heavy anatomy and physiology course in relationship to published studies on learning and student self-efficacy. Changes in the laboratory component that could increase student learning are proposed. The author also points out the need for research to assess whether selective curricular changes could increase the depth of understanding and retention of learned material.
Engaging medical undergraduates in question making: a novel way to reinforcing learning in physiology
Authors: Mehta Bharati , Bhandari Bharti
Published: August 2016

The monotony of conventional didactic lectures makes students less attentive toward learning, and they tend to memorize isolated facts without understanding, just for the sake of passing exams. Therefore, to promote a habit of gaining indepth knowledge of basic sciences in medical undergraduates along with honing of their communication and analytical skills, we introduced this more interactive way of learning. The present study was performed on 99 first-semester medical students. After conventional didactic lectures, students were asked to prepare small conceptual questions on the topic. They were divided into two teams, which were made to ask questions to each other. If a team failed to answer, the student who questioned was supposed to answer to the satisfaction of the other team's student. Data were then obtained by getting feedback from the students on a 10-item questionnaire, and statistical evaluation was done using MS Excel and SPSS. To draft questions, students went through the whole system comprehensively and made questions from every possible aspect of the topic. Some of the questions (30%) were of recall type, but most judged higher cognitive domains. Student feedback revealed that they were satisfied, motivated to read more, and were confident of applying this learning and communication skills in future clinical practice. Students also expressed their desire to implement this activity as a regular feature of the curriculum. The activity resulted in an increase in student perceptions of their knowledge on the topic as well as communicative and analytical skills. This may eventually lead to better learning.
Polydopamine-Assisted Surface Modification for Bone Biosubstitutes
Authors: Huang Shishu , Liang Nuanyi , Hu Yang , Zhou Xin , Abidi Noureddine
Published: August 2016

Polydopamine (PDA) prepared in the form of a layer of polymerized dopamine (DA) in a weak alkaline solution has been used as a versatile biomimetic surface modifier as well as a broadly used immobilizing macromolecule. This review mainly discusses the progress of biomaterial surface modification inspired by the participation of PDA in bone tissue engineering. A comparison between PDA-assisted coating techniques and traditional surface modification applied to bone tissue engineering is first presented. Secondly, the chemical composition and the underlying formation mechanism of PDA coating layer as a unique surface modifier are interpreted and discussed. Furthermore, several typical examples are provided to evidence the importance of PDA-assisted coating techniques in the construction of bone biosubstitutes and the improvement of material biocompatibility. Nowadays, the application of PDA as a superior surface modifier in multifunctional biomaterials is drawing tremendous interests in bone tissue scaffolds to promote the osteointegration for bone regeneration.
A Computational Method for Optimizing Experimental Environments forPhellinus igniariusvia Genetic Algorithm and BP Neural Network
Authors: Li Zhongwei , Sun Beibei , Xin Yuezhen , Wang Xun , Zhu Hu
Published: August 2016

Flavones, the secondary metabolites ofPhellinus igniariusfungus, have the properties of antioxidation and anticancer. Because of the great medicinal value, there are large demands on flavones for medical use and research. Flavones abstracted from naturalPhellinuscan not meet the medical and research need, sincePhellinusin the natural environment is very rare and is hard to be cultivated artificially. The production of flavones is mainly related to the fermentation culture ofPhellinus, which made the optimization of culture conditions an important problem. Some researches were made to optimize the fermentation culture conditions, such as the method of response surface methodology, which claimed the optimal flavones production was 1532.83 μg/mL. In order to further optimize the fermentation culture conditions for flavones, in this work a hybrid intelligent algorithm with genetic algorithm and BP neural network is proposed. Our method has the intelligent learning ability and can overcome the limitation of large-scale biotic experiments. Through simulations, the optimal culture conditions are obtained and the flavones production is increased to 2200 μg/mL.
Formulation and Pharmacokinetic Evaluation of Microcapsules Containing Pravastatin Sodium Using Rats
Authors: Puttegowda Venkatesh Dinnekere , Karki Roopa , Goli Divakar , Jha Sajal kumar , Mudagal Manjunatha Panduranga
Published: August 2016

Pravastatin Sodium has a cholesterol lowering agent. It has shorter half-life and undergoes first-pass metabolism. Frequent dose is required in case of conventional dosage form. The purpose of the study is to formulate and evaluate microcapsules containing Pravastatin Sodium by complex with cholestyramine resins coated with Eudragit RLPO and Eudragit RSPO polymers for achieving control release. Complexation of drug on resin was carried out by batch method. Microencapsulation was carried out by nonaqueous solvent evaporation method. Pharmacokinetic studies were done by using rats. The intermediate stability studies were carried out on the most satisfactory formulations. FTIR, X-ray diffraction, and DSC spectra of drug, drug-resinates, and polymers revealed no chemical interaction. The % DEE and % yield were observed for formulations of f1 to f7 that were varied from 97.1 ± 0.8 to 98.9 ± 0.5% and 95.0 ± 3.25 to 98.8 ± 7.1%, respectively. Most satisfactory formulation, f6, showed drug release up to 72.6%. No changes in % DEE and % CDR were observed after stability studies. Microcapsules of f6 formulation achieved best performance regardingin vitrodrug release and from pharmacokinetic evaluation mean residence time was found to be 6.3 h, thus indicated, Pravastatin Sodium microcapsules were released and absorbed slowly over a prolonged period of time.
A Critical Analysis of a Hand Orthosis Reverse Engineering and 3D Printing Process
Authors: Baronio Gabriele , Harran Sami , Signoroni Alberto
Published: August 2016

The possibility to realize highly customized orthoses is receiving boost thanks to the widespread diffusion of low-cost 3D printing technologies. However, rapid prototyping (RP) with 3D printers is only the final stage of patient personalized orthotics processes. A reverse engineering (RE) process is in fact essential before RP, to digitize the 3D anatomy of interest and to process the obtained surface with suitable modeling software, in order to produce the virtual solid model of the orthosis to be printed. In this paper, we focus on the specific and demanding case of the customized production of hand orthosis. We design and test the essential steps of the entire production process with particular emphasis on the accurate acquisition of the forearm geometry and on the subsequent production of a printable model of the orthosis. The choice of the various hardware and software tools (3D scanner, modeling software, and FDM printer) is aimed at the mitigation of the design and production costs while guaranteeing suitable levels of data accuracy, process efficiency, and design versatility. Eventually, the proposed method is critically analyzed so that the residual issues and critical aspects are highlighted in order to discuss possible alternative approaches and to derive insightful observations that could guide future research activities.
AR-RBFS: Aware-Routing Protocol Based on Recursive Best-First Search Algorithm for Wireless Sensor Networks
Authors: Kiani Farzad
Published: August 2016

Energy issue is one of the most important problems in wireless sensor networks. They consist of low-power sensor nodes and a few base station nodes. They must be adaptive and efficient in data transmission to sink in various areas. This paper proposes an aware-routing protocol based on clustering and recursive search approaches. The paper focuses on the energy efficiency issue with various measures such as prolonging network lifetime along with reducing energy consumption in the sensor nodes and increasing the system reliability. Our proposed protocol consists of two phases. In the first phase (network development phase), the sensors are placed into virtual layers. The second phase (data transmission) is related to routes discovery and data transferring so it is based on virtual-based Classic-RBFS algorithm in the lake of energy problem environments but, in the nonchargeable environments, all nodes in each layer can be modeled as a random graph and then begin to be managed by the duty cycle method. Additionally, the protocol uses new topology control, data aggregation, and sleep/wake-up schemas for energy saving in the network. The simulation results show that the proposed protocol is optimal in the network lifetime and packet delivery parameters according to the present protocols.
Inhibiting Mitochondrial DNA Ligase IIIα Activates Caspase 1–Dependent Apoptosis in Cancer Cells
Authors: Sallmyr Annahita , Matsumoto Yoshihiro , Roginskaya Vera , Van Houten Bennett , Tomkinson Alan E.
Published: August 2016

Elevated levels of DNA ligase IIIα (LigIIIα) have been identified as a biomarker of an alteration in DNA repair in cancer cells that confers hypersensitivity to a LigIIIα inhibitor, L67, in combination with a poly (ADP-ribose) polymerase inhibitor. Because LigIIIα functions in the nucleus and mitochondria, we examined the effect of L67 on these organelles. Here, we show that, although the DNA ligase inhibitor selectively targets mitochondria, cancer and nonmalignant cells respond differently to disruption of mitochondrial DNA metabolism. Inhibition of mitochondrial LigIIIα in cancer cells resulted in abnormal mitochondrial morphology, reduced levels of mitochondrial DNA, and increased levels of mitochondrially generated reactive oxygen species that caused nuclear DNA damage. In contrast, these effects did not occur in nonmalignant cells. Furthermore, inhibition of mitochondrial LigIIIα activated a caspase 1–dependent apoptotic pathway, which is known to be part of inflammatory responses induced by pathogenic microorganisms in cancer, but not nonmalignant cells. These results demonstrate that the disruption of mitochondrial DNA metabolism elicits different responses in nonmalignant and cancer cells and suggests that the abnormal response in cancer cells may be exploited in the development of novel therapeutic strategies that selectively target cancer cells. Cancer Res; 76(18); 5431–41. ©2016 AACR.
Assessing Immune-Related Adverse Events of Efficacious Combination Immunotherapies in Preclinical Models of Cancer
Authors: Liu Jing , Blake Stephen J. , Harjunpää Heidi , Fairfax Kirsten A. , Yong Michelle C.R. , Allen Stacey , Kohrt Holbrook E. , Takeda Kazuyoshi , Smyth Mark J. , Teng Michele W.L.
Published: August 2016

New combination immunotherapies are displaying both efficacy and immune-related adverse events (irAE) in humans. However, grade 3/4 irAEs occur in a high proportion, which can lead to discontinuation of treatment and can result in fatalities if not promptly treated. Prolonged T regulatory cell (Treg) depletion in tumor-bearing Foxp3-DTR mice using diphtheria toxin (DT) mirrored the spectrum of antitumor responses and severity of irAEs that can occur in ipilimumab/nivolumab-treated patients. In contrast, transient Treg depletion or anti-CTLA-4/PD-1 therapy had equivalent effects in mice, lowering the immune tolerance threshold and allowing irAEs to be more easily induced following treatment with additional immunomodulatory antibodies. Transient Treg depletion of DT in combination with anti-PD-1 or anti-TIM-3 monoclonal antibodies had a high therapeutic window compared with DT plus anti-CD137. In contrast, DT plus anti-CD137–treated mice developed severe irAEs similar to grade 3/4 clinical symptoms. These irAEs appeared because of an infiltration of activated proliferating effector T cells in the tissues producing IFNγ and TNF; however, TNF blockade decreased irAEs severity without impacting on tumor growth. Cancer Res; 76(18); 5288–301. ©2016 AACR.
Tissue Stiffness and Hypoxia Modulate the Integrin-Linked Kinase ILK to Control Breast Cancer Stem-like Cells
Authors: Pang Mei-Fong , Siedlik Michael J. , Han Siyang , Stallings-Mann Melody , Radisky Derek C. , Nelson Celeste M.
Published: August 2016

Breast tumors are stiffer and more hypoxic than nonmalignant breast tissue. Here we report that stiff and hypoxic microenvironments promote the development of breast cancer stem-like cells (CSC) through modulation of the integrin-linked kinase ILK. Depleting ILK blocked stiffness and hypoxia-dependent acquisition of CSC marker expression and behavior, whereas ectopic expression of ILK stimulated CSC development under softer or normoxic conditions. Stiff microenvironments also promoted tumor formation and metastasis in ovo, where depleting ILK significantly abrogated the tumorigenic and metastatic potential of invasive breast cancer cells. We further found that the ILK-mediated phenotypes induced by stiff and hypoxic microenvironments are regulated by PI3K/Akt. Analysis of human breast cancer specimens revealed an association between substratum stiffness, ILK, and CSC markers, insofar as ILK and CD44 were expressed in cancer cells located in tumor regions predicted to be stiff. Our results define ILK as a key mechanotransducer in modulating breast CSC development in response to tissue mechanics and oxygen tension. Cancer Res; 76(18); 5277–87. ©2016 AACR.
Risk Factors for Stroke in People with End-Stage Kidney Disease: A Cohort Study
Authors: Masson Philip , Kotwal Sradha , Kelly Patrick J. , Craig Jonathan C. , Lindley Richard I. , Gallagher Martin , Cass Alan , Webster Angela C.
Published: August 2016

Background: It is unclear how traditional cardiovascular risk factors and different treatment modalities for end-stage kidney disease (ESKD) affect stroke risk in people with ESKD. We aimed to identify the risk factors for stroke (ischemic and hemorrhagic) in people with ESKD. Methods: We conducted a retrospective cohort study using data linkage between the Australian and New Zealand Dialysis and Transplant Registry, clinical and administrative datasets. Using Cox proportional hazards models, we estimated the magnitudes of risk of hospitalization with different subtypes of strokes associated with traditional cardiovascular risk factors and ESKD treatment modalities (hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation). Results were expressed as hazard ratios (HRs) with 95% CIs. Results: A total of 10,745 people received treatment for ESKD in New South Wales, Australia, between 2000 and 2010. We observed 640 hospitalizations for stroke in 49,497 person-years of follow-up (129.4 per 10,000 person years). Some risk factors were consistent with those found in the general population, including smoking and a history of previous stroke. Other risk factors were novel for people with ESKD. Women were 85% more likely to have an intracerebral hemorrhage (HR 1.85, 95% CI 1.22-2.79) and 30% more likely to have an ischemic stroke (HR 1.30, 95% CI 1.01-1.66) than men. Compared to people on HD, people with kidney transplants had a 65% lower risk of intracerebral hemorrhage (HR 0.35, 95% CI 0.18-0.69) but a similar risk of ischemic stroke (HR 0.97, 95% CI 0.64-1.49). People on PD had a 36% higher risk of ischemic stroke (HR 1.36, 95% CI 1.05-1.76) but a similar risk of intracerebral hemorrhage compared to people on HD (HR 0.69, 95% CI 0.43-1.11). Conclusions: These findings could be used to establish reliable estimates of the risk of stroke in people with ESKD and identify those who are most likely to benefit from preventive treatments.
Standardized Grading of Shock Wave Lithotripsy Complications with Modified Clavien System
Authors: Mittal Varun , Srivastava Anesh , Kappor Rakesh , Ansari M.S. , Patidar Nitesh , Arora Sohrab , Kumar Manoj , Kudchadkar Sharmad , Raj Anubhav
Published: August 2016

Introduction: Definitive consensus on grading of complications of shock wave lithotripsy (SWL) does not exist. The objective of this study was to grade complications of SWL in relation to different stone and shock wave parameters, according to the modified Clavien system. Materials and Methods: Complications observed in 2,648 patients who underwent SWL between January 2003 and May 2014 were evaluated statistically and stratified into 5 grades by the modified Clavien system focusing on stone and shock wave parameters. Results: Statistically significant association (p ≤ 0.05) was found between SWL outcome, Clavien grade of complications and stone and shock wave parameters. According to the modified Clavien system, grades I, II, IIIa, IIIb, IV and V complications were observed in 1,811 (68.39%), 619 (23.37%), 183 (6.91%), 34 (1.28%), nil (0.00%) and 1 (0.03%) patients, respectively. The overall success rate at 3 months was 87.72%. Conclusions: The modified Clavien system provides a standardized grading of SWL complications and can be used to standardize procedural errors and maintain quality, thereby preventing associated complications and improving the overall management and hence outcome of SWL.
Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically Ill Patients: A Post-Hoc Analysis
Authors: Egal Mohamud , de Geus Hilde R.H. , Groeneveld A.B. Johan
Published: August 2016

Background: Oliguria occurs frequently in critically ill patients, challenging clinicians to distinguish functional adaptation from serum-creatinine-defined acute kidney injury (AKIsCr). We investigated neutrophil gelatinase-associated lipocalin (NGAL)'s ability to differentiate between these 2 conditions. Methods: This is a post-hoc analysis of a prospective cohort of adult critically ill patients. Patients without oliguria within the first 6 h of admission were excluded. Plasma and urinary NGAL were measured at 4 h after admission. AKIsCr was defined using the AKI network criteria with pre-admission serum creatinine or lowest serum creatinine value during the admission as the baseline value. Hazard ratios for AKIsCr occurrence within 72 h were calculated using Cox regression and adjusted for risk factors such as sepsis, pre-admission serum creatinine, and urinary output. Positive predictive values (PPV) and negative predictive values (NPV) were calculated for the optimal cutoffs for NGAL. Results: Oliguria occurred in 176 patients, and 61 (35%) patients developed AKIsCr. NGAL was a predictor for AKIsCr in univariate and multivariate analysis. When NGAL was added to a multivariate model including sepsis, pre-admission serum creatinine and lowest hourly urine output, it outperformed the latter model (plasma p = 0.001; urinary p = 0.048). Cutoff values for AKIsCr were 280 ng/ml for plasma (PPV 80%; NPV 79%), and 250 ng/ml for urinary NGAL (PPV 58%; NPV 78%). Conclusions: NGAL can be used to distinguish oliguria due to the functional adaptation from AKIsCr, directing resources to patients more likely to develop AKIsCr.
Chromosomal Spreading of Microsatellites and (TTAGGG)n Sequences in the Characidium zebra and C. gomesi Genomes (Characiformes: Crenuchidae)
Authors: Pucci Marcela B. , Barbosa Patricia , Nogaroto Viviane , Almeida Mara C. , Artoni Roberto F. , Scacchetti Priscila C. , Pansonato-Alves José C. , Foresti Fausto , Moreira-Filho Orlando , Vicari Marcelo R.
Published: August 2016

Sex chromosome evolution involves the accumulation of repeat sequences such as multigenic families, noncoding repetitive DNA (satellite, minisatellite, and microsatellite), and mobile elements such as transposons and retrotransposons. Most species of Characidium exhibit heteromorphic ZZ/ZW sex chromosomes; the W is characterized by an intense accumulation of repetitive DNA including dispersed satellite DNA sequences and transposable elements. The aim of this study was to analyze the distribution pattern of 18 different tandem repeats, including (GATA)n and (TTAGGG)n, in the genomes of C. zebra and C. gomesi, especially in the C. gomesi W chromosome. In the C. gomesi W chromosome, weak signals were seen for (CAA)10, (CAC)10, (CAT)10, (CGG)10, (GAC)10, and (CA)15 probes. (GA)15 and (TA)15 hybridized to the autosomes but not to the W chromosome. The (GATA)n probe hybridized to the short arms of the W chromosome as well as the (CG)15 probe. The (GATA)n repeat is known to be a protein-binding motif. GATA-binding proteins are necessary for the decondensation of heterochromatic regions that hold coding genes, especially in some heteromorphic sex chromosomes that may keep genes related to oocyte development. The (TAA)10 repeat is accumulated in the entire W chromosome, and this microsatellite accumulation is probably involved in the sex chromosome differentiation process and crossover suppression in C. gomesi. These additional data on the W chromosome DNA composition help to explain the evolution of sex chromosomes in Characidium.
Nonfocal Symptoms in Patients with Transient Ischemic Attack or Ischemic Stroke: Occurrence, Clinical Determinants, and Association with Cardiac History
Authors: Plas Gerben J.J. , Booij Heleen A. , Brouwers Paul J.A.M. , Brusse-Keizer Marjolein , Koudstaal Peter J. , Dippel Diederik W.J. , den Hertog Heleen M.
Published: August 2016

Background: Transient ischemic attacks (TIAs) accompanied by nonfocal symptoms are associated with a higher risk of cardiovascular events, in particular cardiac events. Reported frequencies of TIAs accompanied by nonfocal symptoms range from 18 to 53%. We assessed the occurrence of nonfocal symptoms in patients with TIA or minor ischemic stroke in a neurological outpatient clinic in terms of clinical determinants, cardiac history, and atrial fibrillation (AF). Methods: We included 1,265 consecutive patients with TIA or minor stroke who visited the outpatient clinic. During these visits, we systematically asked for nonfocal symptoms. Nonfocal symptoms included decreased consciousness, amnesia, positive visual phenomena, non-rotatory dizziness, and paresthesias. Relative risks for the presence of nonfocal symptoms in relation to clinical determinants, AF, and cardiac history were calculated. Results: In 243 (19%) of 1,265 patients, TIA or minor ischemic stroke was accompanied by one or more nonfocal symptoms. Non-rotatory dizziness, paresthesia, and amnesia were the most common nonfocal symptoms. In patients with an event of the posterior circulation or obesity, the qualifying TIA or minor stroke was more frequently accompanied by nonfocal symptoms, and in patients with significant carotid stenosis, nonfocal symptoms occurred less frequently. AF was related only with amnesia. Conclusion: Nonfocal symptoms are present in one out of 5 patients with TIA or ischemic stroke, in particular when located in the posterior circulation. A cardiac history or AF was not directly related to nonfocal symptoms. A heterogeneous etiology is suggested.
Multitargeted Kinase Inhibition in Metastatic Differentiated Radioiodine-Refractory Thyroid Cancer: A Look at New Therapeutic Options for a Rare Disease
Authors: Mischler Katharina , Kneifel Stefan , Cathomas Richard
Published: August 2016

Background: Metastatic differentiated thyroid cancer (DTC) is a rare disease that is in the first line treated with iodine-131 radioisotope therapy. Until recently, options were very limited in the case of progressive radioactive-iodine (RAI)-refractory disease. Based on new study results, tyrosine kinase inhibitors (TKIs) have attracted attention. The TKI sorafenib demonstrated significantly improved progression-free survival (PFS) in a phase III trial. Recent data from another phase III trial showed that the TKI lenvatinib achieved high response rates and a large improvement in PFS in metastatic RAI-refractory DTC patients in the first-line setting and after 1 prior line of TKI. However, little is known about the response to lenvatinib in patients pretreated with multiple lines of TKIs. Case Report: We present the case of a 45-year-old man with metastatic RAI-refractory DTC progressing after multiple prior treatments with TKIs and chemotherapy. A very good and long-lasting response to lenvatinib was observed. Careful and prospective monitoring as well as management of side effects including dose adaptation were necessary to ensure success of treatment. Conclusion: Here, we review different novel treatment options for patients with metastatic RAI-refractory DTC.
Misuse of Substitution Drugs in the Substitution-Based Therapy
Authors: Bleckwenn Markus , Heister Lara , Weckbecker Moritz , Weckbecker Klaus , Mücke Martin
Published: August 2016

Background: The reasons for, and the extent of, misuse of prescribed substitution medication as well as parallel consumption of other drugs during substitution-based therapy have still not been adequately researched in Germany. Methods: This study examines the use of substitution medication in German substitution clinics utilizing a nationwide survey with anonymised questionnaires. Results: The analysis of the 605 questionnaires showed a 30-day consumption prevalence of 8.8% with regard to misuse of substitution substances. The lack of available heroin (38%) and the lack of open spots in treatment programs (21%) were quoted as being the main reasons for the misuse of substitution medication. Conclusion: Although the misuse of substitution medications is considered an important problem, our study showed that the current misuse was prevalent only among a minority of the patients. German regulations focused on the avoidance of misuse might be partially contributing to the problem.
Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure
Authors: Maeder Micha T. , Zurek Marzena , Rickli Hans , Tobler Daniel , Kiencke Stephanie , Suter Thomas , Yoon Se‐Il , Julius Barbara , Pfisterer Matthias E. , Brunner‐La Rocca Hans‐Peter ,   for the TIME‐CHF Investigators
Published: August 2016

Background

The prognostic value of the change in heart rate from the supine to upright position (∆
HR
) in patients with chronic heart failure (
HF
) is unknown.

Methods and Results

∆
HR
was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (
TIME
‐
CHF
) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆
HR
on 18‐month outcome (
HF
hospitalization‐free survival) was assessed. In addition, the prognostic effect of changes in ∆
HR
between baseline and month 6 on outcomes in the following 12 months was determined. A lower ∆
HR
was associated with a higher risk of death or
HF
hospitalization (hazard ratio 1.79 [95% confidence interval {95%
CI
} 1.19‐2.75] if ∆
HR
≤3 beats/min [bpm],
P
=0.004). In the multivariate analysis, lower ∆
HR
remained an independent predictor of death or
HF
hospitalization (hazard ratio 1.75 [95%
CI
, 1.18‐2.61] if ∆
HR
≤3 bpm,
P
=0.004) along with ischemic
HF
etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline β‐blocker use. In patients without event during the first 6 months, the change in ∆
HR
from baseline to month 6 predicted death or
HF
hospitalization during the following 12 months (hazard ratio=2.13 [95%
CI
1.12–5.00] if rise in ∆
HR
<2 bpm;
P
=0.027).

Conclusions

∆
HR
as a simple bedside test is an independent prognostic predictor in patients with chronic
HF
. ∆
HR
is modifiable, and changes in ∆
HR
also provide prognostic information, which raises the possibility that ∆
HR
may help to guide treatment.

Clinical Trial Registration Information

URL
:
www.isrctn.org
. Unique identifier:
ISRCTN
43596477.
Should the United States Reject MAD? Damage Limitation and U.S. Nuclear Strategy toward China
Authors: Glaser Charles L. , Fetter Steve
Published: August 2016

As China invests in its nuclear forces and U.S.-China relations become increasingly strained, questions of U.S. nuclear doctrine require greater attention. The key strategic nuclear question facing the United States is whether to attempt to maintain and enhance its damage-limitation capability against China. The answer is less straightforward than it was during the Cold War, because China's nuclear force is orders of magnitude smaller than the Soviet force was. Part of the answer depends on the military-technical feasibility of the United States achieving a significant damage-limitation capability: What would be the outcome of military competition over the survivability of China's intercontinental ballistic missiles, submarine-launched ballistic missiles, and command and control, and over the effectiveness of U.S. ballistic missile defenses? The answer also depends on the benefits that a damage-limitation capability would provide; these could include contributions to homeland deterrence, extended deterrence, and reassurance of U.S. regional allies. The final piece of the analysis concerns the potential costs of a damage-limitation capability, which could include increased escalatory pressures during crises and growing political tension between the United States and China. A thorough analysis demonstrates that the United States should forgo such a capability because the prospects for preserving a significant damage-limitation capability are poor; the deterrent benefits would be small; and the escalatory and political costs would be relatively large.
Future Warfare in the Western Pacific: Chinese Antiaccess/Area Denial, U.S. AirSea Battle, and Command of the Commons in East Asia
Authors: Biddle Stephen , Oelrich Ivan
Published: August 2016

Many analysts worry that improvements in Chinese missile, sensor, guidance, and other technologies will enable China to deny the U.S. military access to parts of the Western Pacific that the United States has long controlled. Although these “antiaccess, area denial” (A2/AD) capabilities are real, they are a geographically limited long-term threat. As both the United States and China deploy A2/AD capabilities, a new era will emerge in which the U.S. military no longer enjoys today's command of the global commons, but is still able to deny China military hegemony in the Western Pacific. In this new era, the United States will possess a sphere of influence around allied landmasses; China will maintain a sphere of influence over its own mainland; and a contested battlespace will cover much of the South and East China Seas wherein neither power enjoys wartime freedom of surface or air movement. This in turn suggests that the Chinese A2/AD threat to U.S. allies is real but more limited than often supposed. With astute U.S. choices, most U.S. allies in this new system will be imperfectly, but substantially, secure.
Understanding Difference amid Superdiversity: Space, ‘Race’ and Granular Essentialisms at an Inner-City Football Club
Authors: Rosbrook-Thompson James
Published: August 2016

Using the findings of ethnographic fieldwork conducted at an inner-city football club, the article examines the relationship between superdiversity and understandings of human variation. It is argued that club personnel relied on what I have termed ‘granular essentialisms’ to make sense of their superdiverse surroundings. These were assertions about ethnicity and ‘race’ that resulted from sustained engagement across various categories of difference and saw these categories intersected in various ways, with notions of space and place being invoked in the process. This granular approach is compared with the attitudes to migration-related diversity encountered outside the inner city. I conclude that proponents of superdiversity should take greater account of the inequalities, tensions and prejudices evident in and around superdiverse areas if they are to construct a more comprehensive picture of the lived realities of contemporary cities and the understandings of ethno-racial difference which take hold there.
Inspection of appearance defects for polarizing films by image processing and neural networks
Authors: Huang Chang-Chiun , Kuo Chung-Feng Jeffrey , Chen Chien-Tarn , Liao Chien-Chun , Tang Tsann-Tay , Su Te-Li
Published: August 2016

Polarizing films are critical components for a wide range of products and their inspection is helpful to enhance product quality. Inspection and classification of the normal and five types of defects for polarizing films are presented using image processing and neural network approaches. The defects are cloud chromatism, strip chromatism, spot chromatism, scratch and poor pasting. Three features, the area, average intensity and compactness, are selected according to the shapes and brightness of the defects regions. The number of training samples are 20, 30 and 40, and the number of testing samples is 40. The results show the recognition rate is 100% when the number of training samples is greater than or equal to 30, proving that the back-propagation neutral network can achieve a high recognition rate with enough training samples, and it can be successfully applied to the inspection of polarizing film defects.
Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study
Authors: Sajeev Mona , Cohen Jennifer , Wakefield Claire E. , Fardell Joanna E. , Cohn Richard J.
Published: August 2016

Background: Despite the importance of nutrition support in preventing malnutrition in pediatric oncology, the decision to initiate and choose which nutrition support method is most appropriate can be difficult for parents and healthcare professionals. Decision aids are decision‐focused patient information materials. They can improve knowledge, reduce decisional conflict, improve patients’ risk perception, and increase patient participation in the decision‐making process. They have never been evaluated for pediatric oncology nutrition decisions. We aimed to develop and pilot test a decision aid to assist parents making these decisions in collaboration with their healthcare team. Materials and Methods: The decision aid was developed in accordance with the International Patient Decision Aid Standards guidelines and evaluated in a single‐center pilot study. The parents and healthcare professionals of pediatric oncology patients were eligible. Participants read the decision aid and completed a questionnaire assessing acceptability, usability, and improvement in understanding. Results: Thirty‐one parents and 15 healthcare professionals participated. Parents found the decision aid balanced, relevant, and satisfactory overall. Some parents reported the decision aid was too long (26%). Healthcare professionals positively rated the development process, usefulness to parents, and content and format of the decision aid. Forty‐three percent reported that using the decision aid would save them time. There were no significant associations between health literacy, decisional satisfaction, decisional regret, acceptability, and improvement in understanding. Conclusion: The decision aid appears acceptable and usable for our target population. Decision aid feedback provided critical data to make modifications before evaluating the decision aid in a randomized controlled trial.
Immunonutrition Is Associated With a Decreased Incidence of Graft‐Versus‐Host Disease in Bone Marrow Transplant Recipients: A Meta‐Analysis
Authors: Kota Harshitha , Chamberlain Ronald S.
Published: August 2016

Introduction: Graft‐versus‐host disease (GVHD) is a serious complication of bone marrow transplantation (BMT), requiring higher doses of glucocorticoids or immunosuppressive therapies and further straining transplant recipients. Immunonutrition, such as vitamins and amino acid supplements, increase immunity and decrease inflammation and oxidative stress. This meta‐analysis examines the impact of immunonutrition on the incidence of GVHD and postoperative infections among BMT recipients. Methods: A comprehensive literature search for all published randomized controlled trials was conducted with PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966–2016). Keywords in the search included variations of terms related to immunonutrition, such as “vitamin,” “glutamine,” and “transplant.” Outcomes included incidence of GVHD and infection. Results: Ten randomized controlled trials involving 681 BMT recipients were analyzed: 332 receiving immunonutrition and 349 receiving standard nutrition. Immunonutrition is correlated with a decreased incidence of GVHD by 19% (relative risk [RR] = 0.810, 95% CI: 0.695–0.945, P = .007). There was no significant difference in the incidence of infections with immunonutrition (RR = 1.016, 95% CI: 0.819–1.261, P = .885). Subgroup analysis of glutamine compared with N‐acetylcysteine, selenium, and eicosapentaenoic acid showed no significant difference in the incidence of GVHD or infections (RR = 0.913, 95% CI: 0.732–1.139, P = .419; RR = 0.951, 95% CI: 0.732–1.235; P = .708, respectively). Conclusion: The use of immunonutrition is associated with a reduced risk of GVHD in BMT recipients, potentially as a result of improved immune support and free radical scavenging. Providing immunonutrient supplements is a valuable adjunct in the routine care of BMT recipients, helping to alleviate a common and deadly complication.
Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners
Authors: Malisoux Laurent , Chambon Nicolas , Urhausen Axel , Theisen Daniel
Published: August 2016

Background:

Modern running shoes are available in a wide range of heel-to-toe drops (ie, the height difference between the forward and rear parts of the inside of the shoe). While shoe drop has been shown to influence strike pattern, its effect on injury risk has never been investigated. Therefore, the reasons for such variety in this parameter are unclear.

Purpose:

The first aim of this study was to determine whether the drop of standard cushioned running shoes influences running injury risk. The secondary aim was to investigate whether recent running regularity modifies the relationship between shoe drop and injury risk.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Leisure-time runners (N = 553) were observed for 6 months after having received a pair of shoes with a heel-to-toe drop of 10 mm (D10), 6 mm (D6), or 0 mm (D0). All participants reported their running activities and injuries (time-loss definition, at least 1 day) in an electronic system. Cox regression analyses were used to compare injury risk between the 3 groups based on hazard rate ratios (HRs) and their 95% CIs. A stratified analysis was conducted to evaluate the effect of shoe drop in occasional runners (<6 months of weekly practice over the previous 12 months) versus regular runners (≥6 months).

Results:

The overall injury risk was not different among the participants who had received the D6 (HR, 1.30; 95% CI, 0.86-1.98) or D0 (HR, 1.17; 95% CI, 0.76-1.80) versions compared with the D10 shoes. After stratification according to running regularity, low-drop shoes (D6 and D0) were found to be associated with a lower injury risk in occasional runners (HR, 0.48; 95% CI, 0.23-0.98), whereas these shoes were associated with a higher injury risk in regular runners (HR, 1.67; 95% CI, 1.07-2.62).

Conclusion:

Overall, injury risk was not modified by the drop of standard cushioned running shoes. However, low-drop shoes could be more hazardous for regular runners, while these shoes seem to be preferable for occasional runners to limit injury risk.
Assessing Mathematics Classroom Goal Structures in a Sample of Italian Students During Sixth Grade
Authors: Poliandri Donatella , Sette Stefania , Vinci Emanuela , Romiti Sara
Published: August 2016

The present study analyzed the factor validity of the Patterns of Adaptive Learning Scale (PALS) to assess students’ perceptions of mathematics classroom goal structures. Participants were N = 7,773 Italian students aged from 11 to 15 years ( M = 11.97, SD = 0.50). The confirmatory factor analysis replicated a three-factor structure (i.e., mastery, performance-avoidance, and performance-approach goals) of the scale. Multigroup confirmatory factor analyses supported configural, metric, and scalar measurement invariance of the scale across gender. Moreover, the students’ mathematics achievement was positively related to mastery goals and negatively associated with performance-avoidance goals. The use of the scale may help teachers to understand the relations between classroom goal structures and mathematics achievement during middle school.
Theorizing children’s subjectivity: Ethnographic investigations in rural Rwanda
Authors: Williams Timothy P
Published: August 2016

The importance of approaching the study of young people through their own experiences has been well established in the sociological and anthropological records. But less attention has been paid to how the impersonal forces of history and political economy are constituted throughout the social domain to inform those experiences. Drawing from 15 months of ethnographic fieldwork in Rwanda, this article elaborates upon the concept and application of “subjectivity” in the study of children’s lives.
Rapid generation of landing footprint based on geometry-predicted trajectory
Authors: Zhang Yuan-Long , Chen Ke-Jun , Liu Lu-Hua , Tang Guo-Jian , Bao Wei-Min
Published: August 2016

Landing footprint is critical to generate a feasible trajectory onboard for entry vehicles. In this paper, a new landing footprint calculation based on geometry-predicted trajectory is proposed. First, the lateral motion states, turning radius and angle, are analytically solved based on a planned drag acceleration vs. energy (D–E) profile. Through some simple coordinate and geometrical triangle transformation, all the trajectory states are extracted. Second, by calculating the maximum longitudinal range point, the furthest reachable boundary for planned D–E profile is obtained with proposed geometry-predicted trajectory. Finally, the landing footprint can be generated by repeatedly computing the reachable boundaries for all D–E profiles in the entry corridor. Simulation results with Common Aero Vehicle (CAV) model validate the accuracy of the geometry-predicted trajectory. Furthermore, detailed comparison of footprint generation results between the traditional and the proposed are presented at last.
Resilience, rapid transitions and regime shifts: Fingerprinting the responses of Lake Żabińskie (NE Poland) to climate variability and human disturbance since AD 1000
Authors: Hernández-Almeida Iván , Grosjean Martin , Gómez-Navarro Juan José , Larocque-Tobler Isabelle , Bonk Alicja , Enters Dirk , Ustrzycka Alicja , Piotrowska Natalia , Przybylak Rajmund , Wacnik Agnieszka , Witak Małgorzata , Tylmann Wojciech
Published: August 2016

Rapid ecosystem transitions and adverse effects on ecosystem services as responses to combined climate and human impacts are of major concern. Yet few long-term (i.e. >60 years) quantitative observational time series exist, particularly for ecosystems that have a long history of human intervention. Here, we combine three major environmental pressures (land use, nutrients and erosion) with quantitative summer and winter climate reconstructions and climate model simulations to explore the system dynamics, resilience and the role of disturbance regimes in varved eutrophic Lake Żabińskie (NE Poland) since AD 1000. The comparison between these independent sources of information allows us to establish the coherence and points of disagreements between such data sets. We find that climate reconstructions capture noticeably natural forced climate variability, while internal variability is the dominant source of variability during most parts of the last millennium at the regional scale, precisely at which climate models seem to underestimate forced variability. Using different multivariate analyses and change point detection techniques, we identify ecosystem changes through time and shifts between rather stable states and highly variable ones. Prior to AD 1600, the lake ecosystem was characterised by high stability and resilience against observed natural climate variability. During this period, the anthropogenic fingerprint was small; the lake ecosystem was buffered against the combined human and natural disturbance. In contrast, lake–ecosystem conditions started to fluctuate across a broad range of states after AD 1600. The period AD 1745–1886 represents the phase with the strongest human disturbance of the catchment–lake ecosystem. During that time, the range of natural climate variability did not increase. Analyses of the frequency of change points in the multi-proxy data set suggest that the last 400 years were highly variable and increased vulnerability of the ecosystem to the anthropogenic disturbances. This led to significant rapid ecosystem transformations.
The advance of cultivation at its northern European limit: Process or event?
Authors: Lahtinen Maria , Oinonen Markku , Tallavaara Miikka , Walker James WP , Rowley-Conwy Peter
Published: August 2016

Dates for early cultivation in Finland obtained from pollen analysis and remains from archaeological sites are compared with the changes in population size derived from the summed calendar-year probability distributions. The results from these two independent proxies correlate strongly with one another indicating that population size and the advance of farming were closely linked to each other. Moreover, the results show that the adaptation and development of farming in this area was a complex process comprising several stages and with major differences between regions The most intensive expansion having occurred in and after the Iron Age. It is therefore more accurate to describe the introduction of farming into the area as a long-lasting process, rather than an event.
Solving the “Personhood Jigsaw Puzzle” in Residential Care Homes for the Elderly in the Hong Kong Chinese Context
Authors: Kong Sui-Ting , Fang Christine Meng-Sang , Lou Vivian W. Q.
Published: August 2016

End-of-life care studies on the nature of personhood are bourgeoning; however, the practices utilized for achieving personhood in end-of-life care, particularly in a cultural context in which interdependent being and collectivism prevail, remain underexplored. This study seeks to examine and conceptualize good practices for achieving the personhood of the dying elderly in residential care homes in a Chinese context. Twelve interviews were conducted with both medical and social care practitioners in four care homes to collect narratives of practitioners’ practices. Those narratives were utilized to develop an “end-of-life case graph.” Constant comparative analysis led to an understanding of the practice processes, giving rise to a process model of “solving the personhood jigsaw puzzle” that includes “understanding the person-in-relationship and person-in-time,” “identifying the personhood-inhibiting experiences,” and “enabling personalized care for enhanced psychosocial outcomes.” Findings show how the “relational personhood” of the elderly can be maintained when physical deterioration and even death are inevitable.