bluuebunny/crossref_metadata_2025 huggingface dataset:
Time to competitive exclusion
Authors: Kramer Andrew M. , Drake John M.
Published: May 2014

A predictive theory of population extinction for natural populations requires integrating the effects of stochasticity with the interactions engaged in with populations of other species. The theory of competitive exclusion predicts that inferior competitors for a limiting resource will be driven to extinction, but the effects of resource competition on time to extinction have not been examined. We studied a stochastic version of Tilman's resource competition model to examine two species competition‐driven extinction. Simulations showed that competitive imbalance, population size and demographic rates of the “inferior” competitor were the most important determinants of mean extinction time, while factors including resource supply and nutrient uptake had negligible influence. However, when competitors were more evenly matched and had small initial population sizes the “superior” competitor often went extinct. In these cases the distribution of extinction times shifted from the familiar exponential tail towards a heavy‐tailed distribution with characteristically longer extinction times that may be indicative of the transition between exclusion and coexistence. These results provide new insight into the quantitative effects of competition and demographic stochasticity on extinction risk. Further work is needed to understand how extinction of superior competitors affects coexistence and extinction in natural communities.
Comparison of Two Transcutaneous Bilirubinometers in Term and Near-Term Neonates
Authors: Sarici Serdar Umit , Köklü Esad , Babacan Oguzhan
Published: May 2014

Purpose: Determination of bilirubin levels is performed for many newborns in the first days of life, and several different transcutaneous bilirubinometers are available. We aimed to determine whether transcutaneous bilirubin measurement, as performed using Jaundice Detector JH20-1C, a new device, correlates with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103.

Design and Sample: The study was performed on term or near-term newborn infants who underwent transcutaneous bilirubin measurements as part of their normal care. The study group consisted of 585 newborn infants with gestational ages ranging from 35 to 42 weeks, coming from an uneventful pregnancy. In this prospective study, bilirubin concentrations were determined with two different transcutaneous bilirubinometers.

Main Outcome Variable: In 585 infants, the correlation coefficient for Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was .965 (p < .0001). The mean (± standard deviation) difference between the Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was 0.26 ± 0.95 mg/dL. Results showed the Jaundice Detector JH20-1C to have an acceptable level of intradevice imprecision (r = .978, p < .0001, mean differences .0158 ± .871 mg/dL).

Results: Jaundice Detector JH20-1C showed the good performances of intradevice and interdevice imprecision in comparison with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. Jaundice Detector JH20-1C may be suitable for screening term or near-term newborn infants for jaundice in the well-baby nursery or maternity ward.
Productive Failure in Stem Education
Authors: Trueman Rebecca J.
Published: May 2014

Science education is criticized because it often fails to support problem-solving skills in students. Instead, the instructional methods primarily emphasize didactic models that fail to engage students and reveal how the material can be applied to solve real problems. To overcome these limitations, this study asked participants in a general ecology course to operate an advanced environmental instrumentation (GC/MS), collect pollution samples, complete data analysis, develop an environmental assessment, and proffer a remediation plan for a local river during an ill-structured task. Students were then given a novel task to assess their transfer skills. The study specifically examined student attitudes, effectiveness, and outcomes toward the integration of laboratories into a science course. Results found that students rated their level of instrumentation confidence as low, but showed statistically significant differences on transfer task scores. Implications for research are discussed.
The Family Bereavement Program: Description of a Theory-based Prevention Program for Parentally-Bereaved Children and Adolescents
Authors: Ayers Tim S. , Wolchik Sharlene A. , Sandler Irwin N. , Twohey Joan L. , Weyer Janelle Lutzke , Padgett-Jones Sarah , Weiss Lillie , Cole Eloise , Kriege Gary
Published: May 2014

This article describes a preventive intervention to promote resilience of parentally bereaved youth. This intervention includes separate but concurrent programs for youth and caregivers that were developed to change empirically-supported risk and protective factors. We first discuss the risk that parental death confers to youth mental health and social adaptation outcomes. Next, we discuss the theoretical framework underlying this program. After describing the content and structure of the program, we describe the results of an experimental field trial and discuss directions for future work.
Exploiting Loss?: Ethical Considerations, Boundaries, and Opportunities for the Study of Death and Grief Online
Authors: Carmack Heather J. , Degroot Jocelyn M.
Published: May 2014

More people are turning to the Internet to communicate about dying, death, and grief experiences. This theoretical article explores the ethical dilemmas, challenges, and opportunities presented to researchers interested in exploring how death and grief are communicated online. Weaving together the literatures of computer-mediated communication and thanatology (dying and death), we discuss the ways in which many common ethical dilemmas uniquely manifest related to death and grief. We also explore the emotional impact studying death and grief online has on researchers and the importance of thinking about researcher emotions on scholars who study these issues. We end with recommendations of how to move forward in the dialogue about ethics and studying death and grief online.
Peer Supporters' Experiences of a Bereavement Follow-up Intervention for Grieving Parents
Authors: Aho Anna Liisa , Åstedt-Kurki Pāivi , Kaunonen Marja
Published: May 2014

The aim of this study was to describe the experiences of peer supporters of a bereavement intervention for grieving parents and how the program should be developed further. The intervention included: a support package for grieving parents, peer supporters' contact, and healthcare personnel's contact with parents. The sample included 16 peer supporters. Data were collected via open-format questionnaires and telephone interviews and analyzed by content analysis. Peer supporters perceived the intervention and its viability as mostly good. Parents' willingness to receive support and peer supporters' good resources were important for the follow-up contact. However, the peer sup-porters' resources were insufficient to meet parents' unexpected needs. Continuous training and systematic supervision of peer supporters is needed. Study results suggest that support interventions aimed at grieving families need a greater number of male supporters, as fathers hope to receive more support from their male counterparts. Inter-organizational cooperation in supporting parents is important and must be further developed.
Occupational medicine - then and now: Where we could go from here
Authors: Belkic Karen , Nedic Olesja
Published: May 2014

Occupational medicine has a long-standing history in the region of the former
Yugoslavia with seminal contributions to the theory and practice of this
discipline. This tradition should be expanded to incorporate psychosocial
stressors. We review the sociological work stress models and empirical
evidence gleaned thereby, and then the occupational stressor index, an
additive burden model developed from a cognitive ergonomics perspective. In
numerous studies, the occupational stressor index is significantly associated
with risk behaviors: smoking, obesity and sedentariness and clinical
outcomes: hypertension, ischemic heart disease, dyslipidemia and type 2
diabetes. The occupational stressor index characterizes the work conditions
of physicians including surgeons and anesthesiologists; professional drivers
and other groups at elevated risk for stress-related disorders. Much of these
empirical data are from this region. Work-stress related health disorders are
a major public health problem, with enormous human and economic costs. A more
proactive role for physicians is needed vis-?-vis our working environment and
that of patients. We physicians face a heavy job stressor burden strongly
implicated with adverse health outcomes. The challenge is to identify
effective strategies to lower the risk of work-stressor related illness. The
critical gap is the lack of evidence-based guidelines. Intervention studies
are needed in which job stressors are ameliorated as a therapeutic/preventive
modality; the logical starting point is within our own profession. We also
suggest how the relevant clinical competence could be enhanced. Alongside
clinical enhancement should be the full restoration of physician empowerment
to implement work-related recommendations. A participatory action research
perspective by physicians for physicians and for our patients is needed.
What kind of milk can prevent infant’s sideropenic anemia: Comparative study
Authors: Milankov Olgica , Bjelica Milena , Savic Radojica
Published: May 2014

Introduction. The most common cause of sideropenic anemia in infants, during
the period of their fast growth and development, is inadequate nutrition or
insufficient intake of food rich in iron. The aim of this paper is to provide
the insight into the problem of anemia and to emphasize nutrition as an
important etiologic factor in the onset and prevention of anemia in infants.
Material and Methods. Two retrospective studies were conducted at the
Institute for Child and Youth Healthcare of Vojvodina, Department for Infant
and Small Children?s Pathology. The first study covered the period of eight
years (1988-1995), and it included a total of 507 children, aged 1-24 months.
The second study covered the period of two years (2010-2011) and a total of
290 children aged 1-12 months were included. The diagnosis of anemia was made
according to clinical examination or after taking routine laboratory tests.
According to the criteria of the World Health Organization, all children were
divided into those with severe, moderate or mild anemia. Results. Out of 507
children examined in the first study, 333 (65.68%) were breastfed, while 174
(34.32%) had never been breastfed. In the second study, 206 (71.03%) out of
290 children were breastfed, while 56 (19.31%) had never been breastfed. In
both studies the highest percentage of children breastfed for the longest
period was among children with mild form of anemia, while the children who
were breastfed for the shortest period had severe anemia. In addition, the
highest percentage of anemic children was supplementary fed with cow?s milk
in both studies. Conclusion. Short natural diet, early introduction of
supplementation and choice of milk could be determining factors in the
development and manifestation of anemia.
Effects of phthalic acid esters on fetal health
Authors: Bajkin Ivana , Bjelica Artur , Icin Tijana , Dobric Vesna , Kovacev-Zavisic Branka , Medic-Stojanoska Milica
Published: May 2014

Introduction. Phthalates are synthetic industrial compounds capable of
disrupting endocrine system. Effects of phthalates depend on dosage, duration
of action and stage of development of the individual, thus making the fetus,
newborn, and children at puberty the most vulnerable groups. Metabolism of
Phthalates: Metabolism of these compounds consists of at least two steps:
hydrolysis and conjugation. They are mainly excreted in urine, with a low
percent being excreted through feces. Exposure to Phthalates. Exposure to the
effects of phthalates begins at the intrauterine stage since the phthalates
pass through the placental barrier. Phthalates may be found in plastic
products, toys, medical equipment, industrial materials, food, and clothes.
Determination of Phthalate Levels in Humans. Urine is the best sample for
evaluating phthalate levels in humans because of rapid phthalate metabolism
and high concentrations of metabolites in the urine. Fetal Testicular
Dysgenesis Syndrome: Fetal testicular dysgenesis syndrome involves disorders
of male genital tract such as shortened anogenital distance, hypospadia,
cryptorchidism, malformations of seminal vesicles, prostate, epididymis and
it results from the harmful effects of phthalates. Other Effects of
Phthalates on Health. Negative effects of phthalates on female health are
mostly reflected in anovulation, premature puberty, changes in duration of
pregnancy. There is a possible effect on neurocognitive development,
occurrence of allergies, asthma, testicular carcinoma, hepatic and renal
damages, insulin resistance and obesity, thyroid dysfunction. Conclusion.
Further studies are needed to establish the safe phthalate concentration in
certain products and to determine more negative consequences of exposure to
phthalate.
Application of fibrin rich blocks with concentrated growth factors in pre-implant augmentation procedures
Authors: Tadic Ana , Puskar Tatjana , Petronijevic Branislava
Published: May 2014

Introduction. Growth factors are mediators regulating the key processes of
tissue regeneration, including cell proliferation and differentiation,
extracellular matrix synthesis, chemotaxis and angiogenesis. In addition to
the role they play in haemostasis and inflammatory processes, thrombocytes
are of major importance in the reparation of mineralized and soft tissues.
Application of fibrin rich blocks with concentrated growth factors is one of
the latest approaches to guided bone regeneration and augmentation of lost
bony structures of the alveolar ridge. Case report. This paper presents a
case of a female patient who underwent reconstruction of the defect of
residual alveolar ridge of the upper jaw by applying fibrin rich blocks with
concentrated growth factors and subsequent placement of two titanium
endosteal implants five months after wound healing. Conclusion. The loss of a
single tooth or several teeth sometimes entails the augmentation of lost bony
structures in order to provide optimal conditions for dental implant
placement and subsequent prosthetic rehabilitation. A range of contemporary
surgical procedures and a variety of dental materials for reconstruction of
bony defects of the upper and lower jaws are available nowadays. The method
described in this paper, i.e. the application of concentrated growth factors
is one of the latest approaches which poses no risk of transmissible and
allergic diseases and is at the same time cost effective.
The efficacy of hydrothermally obtained carbonated hydroxyapatite in healing alveolar bone defects in rats with or without corticosteroid treatment
Authors: Markovic Dejan , Jokanovic Vukoman , Petrovic Bojan , Peric Tamara , Vukomanovic Biserka
Published: May 2014

Background/Aim. Autogenous bone grafting has been the gold standard in
clinical cases when bone grafts are required for bone defects in dentistry.
The study was undertaken to evaluate multilevel designed carbonated
hydroxyapatite (CHA) obtained by hydrothermal method, as a bone substitute in
healing bone defects with or without corticosteroid treatment in rats as
assessed by histopathologic methods. Methods. Bone defects were created in
the alveolar bone by teeth extraction in 12 rats. The animals were initially
divided into two groups. The experimental group was pretreated with
corticosteroids: methylprednisolone and dexamethasone, intramuscularly, while
the control group was without therapy. Posterior teeth extraction had been
performed after the corticosteroid therapy. The extraction defects were
fulfilled with hydroxyapatite with bimodal particle sizes in the range of
50-250 ?m and the sample from postextocactional defect of the alveolar bone
was analyzed pathohystologically. Results. The histopatological
investigations confirmed the biologic properties of the applied material. The
evident growth of new bone in the alveolar ridge was clearly noticed in both
groups of rats. Carbonated HA obtained by hydrothermal method promoted bone
formation in the preformed defects, confirming its efficacy for usage in bone
defects. Complete resorption of the material?s particles took place after 25
weeks. Conclusion. Hydroxyapatite completely meets the clinical requirements
for a bone substitute material. Due to its microstructure, complete
resorption took place during the observation period of the study.
Corticosteroid treatment did not significantly affect new bone formation in
the region of postextractional defects.
The prevalence of substance use among adolescents and its correlation with social and demographic factors
Authors: Rakic Dusica , Rakic Branislava , Milosevic Zoran , Nedeljkovic Ivan
Published: May 2014

Backround/Aim. Adolescence is the period of greatest risk of starting to use
substances: cigarette smoking, alcohol and illicit drugs. In the first decade
of this millennium substance use among adolescents has increased. The aim of
this study was to explore the prevalence of substances use among adolescents
and its correlation with social and demographic factors. Methods. The study
was conducted among adolescents in Novi Sad during 2010-2011 and included 594
conveniently selected adolescents (275 male and 319 female), aged 15-19
years. A special questionnaire was used and statistical analysis performed in
SPSS17. The correlation between parameters was evaluated by the Pearson
correlation method and frequency differences were analysed using ?2 test and
starting level was p < 0.05. Results. The prevalence of substance use was
statistically higher in males. Cigarettes were smoked daily by 21.45% males
and 15.67% females (p < 0.01), alcohol was consumed by 81.6% males and 69.11%
females (p < 0.001) and illicit drugs were used by 13.65% males and 8.30%
females (p < 0.05). There was a positive correlation between smoking
cigarettes and alcohol consumption, but negative between smoking cigarettes
and the use of illicit drugs (p < 0.01). The prevalence of substance use was
statistically higher among adolescents with poor achievement in school (p <
0.01), who lived in a broken home (illicit drugs p < 0.01) and who had more
pocket money (cigarette smoking p < 0.01, and alcohol consumption p < 0.5).
Conclusion. Stable family, lower amount of pocket money weekly and good
school performance are protective factors in prevention of substances use
among adolescents.
Sarcoidosis of the pleura: A case report
Authors: Jovanovic Dragana , Vucinic Violeta , Stevic Ruza , Roksandic-Milenkovic Marina , Samardzic Natalija , Velinovic Marta , Stjepanovic Mihailo
Published: May 2014

Introduction. Pleural involvement is an uncommon manifestation of
sarcoidosis. It may manifest as pleural effusion, pneumothorax, pleural
thickening and nodules, hydropneumothorax, trapped lung, hemothorax, or
chylothorax. The incidence of pleural effusion with sarcoidosis ranges from
0% to 5% but has been reported to be as high as 7.5%. Pleural effusions
complicate sarcoidosis in < 3% of patients. Case report. We reported a
64-year-old male patient with chronic multiorgan sarcoidosis. This patient
developed pleural sarcoidosis with massive pleural effusion several years
after the diagnosis of sarcoidosis. A definitive diagnosis of a sarcoid
pleural effusion was based on a biopsy demonstrating noncaseating granuloma.
The patient responded well to the treatment (methotrexate and
methylprednisolone) with a complete withdrawal of pleural effusion following
five weeks of the treatment beginning. Conclusion. The presented patient is a
rare case of pleural involvement of sarcoidosis with massive effusion, who
responded well to the treatment.
Glycoprotein 130 Receptor Signaling Mediates α-Cell Dysfunction in a Rodent Model of Type 2 Diabetes
Authors: Chow Samuel Z. , Speck Madeleine , Yoganathan Piriya , Nackiewicz Dominika , Hansen Ann Maria , Ladefoged Mette , Rabe Björn , Rose-John Stefan , Voshol Peter J. , Lynn Francis C. , Herrera Pedro L. , Müller Werner , Ellingsgaard Helga , Ehses Jan A.
Published: May 2014

Dysregulated glucagon secretion accompanies islet inflammation in type 2 diabetes. We recently discovered that interleukin (IL)-6 stimulates glucagon secretion from human and rodent islets. IL-6 family cytokines require the glycoprotein 130 (gp130) receptor to signal. In this study, we elucidated the effects of α-cell gp130 receptor signaling on glycemic control in type 2 diabetes. IL-6 family cytokines were elevated in islets in rodent models of this disease. gp130 receptor activation increased STAT3 phosphorylation in primary α-cells and stimulated glucagon secretion. Pancreatic α-cell gp130 knockout (αgp130KO) mice showed no differences in glycemic control, α-cell function, or α-cell mass. However, when subjected to streptozotocin plus high-fat diet to induce islet inflammation and pathophysiology modeling type 2 diabetes, αgp130KO mice had reduced fasting glycemia, improved glucose tolerance, reduced fasting insulin, and improved α-cell function. Hyperinsulinemic-euglycemic clamps revealed no differences in insulin sensitivity. We conclude that in a setting of islet inflammation and pathophysiology modeling type 2 diabetes, activation of α-cell gp130 receptor signaling has deleterious effects on α-cell function, promoting hyperglycemia. Antagonism of α-cell gp130 receptor signaling may be useful for the treatment of type 2 diabetes.
Blockade of Na+ Channels in Pancreatic α-Cells Has Antidiabetic Effects
Authors: Dhalla Arvinder K. , Yang Ming , Ning Yun , Kahlig Kristopher M. , Krause Michael , Rajamani Sridharan , Belardinelli Luiz
Published: May 2014

Pancreatic α-cells express voltage-gated Na+ channels (NaChs), which support the generation of electrical activity leading to an increase in intracellular calcium, and cause exocytosis of glucagon. Ranolazine, a NaCh blocker, is approved for treatment of angina. In addition to its antianginal effects, ranolazine has been shown to reduce HbA1c levels in patients with type 2 diabetes mellitus and coronary artery disease; however, the mechanism behind its antidiabetic effect has been unclear. We tested the hypothesis that ranolazine exerts its antidiabetic effects by inhibiting glucagon release via blockade of NaChs in the pancreatic α-cells. Our data show that ranolazine, via blockade of NaChs in pancreatic α-cells, inhibits their electrical activity and reduces glucagon release. We found that glucagon release in human pancreatic islets is mediated by the Nav1.3 isoform. In animal models of diabetes, ranolazine and a more selective NaCh blocker (GS-458967) lowered postprandial and basal glucagon levels, which were associated with a reduction in hyperglycemia, confirming that glucose-lowering effects of ranolazine are due to the blockade of NaChs. This mechanism of action is unique in that no other approved antidiabetic drugs act via this mechanism, and raises the prospect that selective Nav1.3 blockers may constitute a novel approach for the treatment of diabetes.
IKKε Is Key to Induction of Insulin Resistance in the Hypothalamus, and Its Inhibition Reverses Obesity
Authors: Weissmann Laís , Quaresma Paula G.F. , Santos Andressa C. , de Matos Alexandre H.B. , Pascoal Vínicius D’Ávila Bittencourt , Zanotto Tamires M. , Castro Gisele , Guadagnini Dioze , da Silva Joelcimar Martins , Velloso Licio A. , Bittencourt Jackson C. , Lopes-Cendes Iscia , Saad Mario J.A. , Prada Patricia O.
Published: May 2014

IKK epsilon (IKKε) is induced by the activation of nuclear factor-κB (NF-κB). Whole-body IKKε knockout mice on a high-fat diet (HFD) were protected from insulin resistance and showed altered energy balance. We demonstrate that IKKε is expressed in neurons and is upregulated in the hypothalamus of obese mice, contributing to insulin and leptin resistance. Blocking IKKε in the hypothalamus of obese mice with CAYMAN10576 or small interfering RNA decreased NF-κB activation in this tissue, relieving the inflammatory environment. Inhibition of IKKε activity, but not TBK1, reduced IRS-1Ser307 phosphorylation and insulin and leptin resistance by an improvement of the IR/IRS-1/Akt and JAK2/STAT3 pathways in the hypothalamus. These improvements were independent of body weight and food intake. Increased insulin and leptin action/signaling in the hypothalamus may contribute to a decrease in adiposity and hypophagia and an enhancement of energy expenditure accompanied by lower NPY and increased POMC mRNA levels. Improvement of hypothalamic insulin action decreases fasting glycemia, glycemia after pyruvate injection, and PEPCK protein expression in the liver of HFD-fed and db/db mice, suggesting a reduction in hepatic glucose production. We suggest that IKKε may be a key inflammatory mediator in the hypothalamus of obese mice, and its hypothalamic inhibition improves energy and glucose metabolism.
Sleep Fragmentation During Late Gestation Induces Metabolic Perturbations and Epigenetic Changes in Adiponectin Gene Expression in Male Adult Offspring Mice
Authors: Khalyfa Abdelnaby , Mutskov Vesco , Carreras Alba , Khalyfa Ahamed A. , Hakim Fahed , Gozal David
Published: May 2014

Sleep fragmentation (SF) is a common condition among pregnant women, particularly during late gestation. Gestational perturbations promote the emergence of adiposity and metabolic disease risk in offspring, most likely through epigenetic modifications. Adiponectin (AdipoQ) expression inversely correlates with obesity and insulin resistance. The effects of SF during late gestation on metabolic function and AdipoQ expression in visceral white adipose tissue (VWAT) of offspring mice are unknown. Male offspring mice were assessed at 24 weeks after dams were exposed to SF or control sleep during late gestation. Increased food intake, body weight, VWAT mass, and insulin resistance, with reductions in AdipoQ expression in VWAT, emerged in SF offspring. Increased DNMT3a and -b and global DNA methylation and reduced histone acetyltransferase activity and TET1, -2, and -3 expression were detected in VWAT of SF offspring. Reductions in 5-hydroxymethylcytosine and H3K4m3 and an increase in DNA 5-methylcytosine and H3K9m2 in the promoter and enhancer regions of AdipoQ emerged in adipocytes from VWAT and correlated with AdipoQ expression. SF during late gestation induces epigenetic modifications in AdipoQ in male offspring mouse VWAT adipocytes along with a metabolic syndrome–like phenotype. Thus, altered gestational environments elicited by SF impose the emergence of adverse, long-lasting metabolic consequences in the next generation.
Comparison of Insulin Degludec/Insulin Aspart and Biphasic Insulin Aspart 30 in Uncontrolled, Insulin-Treated Type 2 Diabetes: A Phase 3a, Randomized, Treat-to-Target Trial
Authors: Fulcher Gregory R. , Christiansen Jens Sandahl , Bantwal Ganapathi , Polaszewska-Muszynska Miroslawa , Mersebach Henriette , Andersen Thomas H. , Niskanen Leo K.
Published: May 2014

OBJECTIVE

Insulin degludec/insulin aspart (IDegAsp) is the first combination of a basal insulin with an ultralong duration of action, and a rapid-acting insulin in a single injection. This trial compared IDegAsp with biphasic insulin aspart 30 (BIAsp 30) in adults with type 2 diabetes inadequately controlled with once- or twice-daily (OD or BID) pre- or self-mixed insulin with or without oral antidiabetic drugs.

RESEARCH DESIGN AND METHODS

In this 26-week, randomized, open-label, multinational, treat-to-target trial, participants (mean age 58.7 years, duration of diabetes 13 years, BMI 29.3 kg/m2, and HbA1c 8.4% [68 mmol/mol]) were exposed (1:1) to BID injections of IDegAsp (n = 224) or BIAsp 30 (n = 222), administered with breakfast and the main evening meal and dose titrated to a self-measured premeal plasma glucose (PG) target of 4.0–5.0 mmol/L.

RESULTS

After 26 weeks, mean HbA1c was 7.1% (54 mmol/mol) for both groups, with IDegAsp achieving the prespecified noninferiority margin for mean change in HbA1c (estimated treatment difference [ETD] –0.03% points [95% CI –0.18 to 0.13]). Treatment with IDegAsp was superior in lowering fasting PG (ETD –1.14 mmol/L [95% CI –1.53 to –0.76], P < 0.001) and had a significantly lower final mean daily insulin dose (estimated rate ratio 0.89 [95% CI 0.83–0.96], P = 0.002). Fewer confirmed, nocturnal confirmed, and severe hypoglycemia episodes were reported for IDegAsp compared with BIAsp 30.

CONCLUSIONS

IDegAsp BID effectively improves HbA1c and fasting PG levels with fewer hypoglycemia episodes versus BIAsp 30 in patients with uncontrolled type 2 diabetes previously treated with once- or twice-daily pre- or self-mixed insulin.
Flight Results of Vision-Based Navigation for Autonomous Spacecraft Inspection of Unknown Objects
Authors: Fourie Dehann , Tweddle Brent E. , Ulrich Steve , Saenz-Otero Alvar
Published: May 2014

This paper describes a vision-based relative navigation and control strategy for inspecting an unknown, noncooperative, and possibly spinning object in space using a visual–inertial system that is designed to minimize the computational requirements while maintaining a safe relative distance. The proposed spacecraft inspection system relies solely on a calibrated stereo camera and a three-axis gyroscope to maintain a safe inspection distance while following a circular trajectory around the object. The navigation system is based on image processing algorithms, which extract the relative position and velocity between the inspector and the object, and a simple control approach is used to ensure that the desired range and bearing are maintained throughout the inspection maneuver. The hardware implementation details of the system are provided. Computer simulation results and experiments conducted aboard the International Space Station during Expedition 34 are reported to demonstrate the performance and applicability of the proposed hardware, and related navigation and control systems to inspect an unknown spacecraft.
The Physical Function Intensive Care Test: Implementation in Survivors of Critical Illness
Authors: Nordon-Craft Amy , Schenkman Margaret , Edbrooke Lara , Malone Daniel J. , Moss Marc , Denehy Linda
Published: May 2014

Background

Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population.

Objective

The purpose of this study was to determine the responsiveness and predictive capabilities of the PFIT-s in patients in the United States admitted to the ICU who required mechanical ventilation (MV) for 4 days or longer.

Methods

This nested study within a randomized trial administered the PFIT-s, Medical Research Council (MRC) sum score, and grip strength test at ICU recruitment and then weekly until hospital discharge, including at ICU discharge. Spearman rho was used to determine validity. The effect size index was used to calculate measurement responsiveness for the PFIT-s. The receiver operating characteristic curve was used in predicting participants' ability to perform functional components of the PFIT-s.

Results

From August 2009 to July 2012, 51 patients were recruited from 4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s scores were highly correlated to MRC sum scores (rho=.923) and grip strength (rho=.763) (P<.0005). Using baseline test with ICU discharge (26 pairs), test responsiveness was large (1.14). At ICU discharge, an MRC sum score cut-point of 41.5 predicted participants' ability to perform the standing components of the PFIT-s.

Limitations

The small sample size was a limitation. However, the findings are consistent with those in a larger sample from Australia.

Conclusions

The PFIT-s is a feasible and valid measure of function for individuals who require MV for 4 days or longer and who are alert, able to follow commands, and have sufficient strength to participate.
Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition
Authors: Fernandez-Miranda Juan C. , Gardner Paul A. , Rastelli Milton M. , Peris-Celda Maria , Koutourousiou Maria , Peace David , Snyderman Carl H. , Rhoton Albert L.
Published: May 2014

Object

The object of this paper was to describe the surgical anatomy and technical nuances of the endonasal transcavernous posterior clinoidectomy approach with interdural pituitary transposition and to report the clinical outcome of this technical modification.

Methods

The surgical anatomy of the proposed approach was studied in 10 colored silicon-injected anatomical specimens. The medical records of 12 patients that underwent removal of the posterior clinoid(s) with this technique were reviewed.

Results

The natural anatomical corridor provided by the cavernous sinus is used to get access to the posterior clinoid by mobilizing the pituitary gland in an interdural fashion. The medial wall of the cavernous sinus is preserved intact and attached to the gland during its medial and superior mobilization. This provides protection to the gland, allowing for preservation of its venous drainage pathways. The inferior hypophyseal artery is transected to facilitate the manipulation of the medial wall of the cavernous sinus and pituitary gland. This approach was successfully performed in all patients, including 6 with chordomas, 5 with petroclival meningiomas, and 1 with an epidermoid tumor. No patient in this series had neurovascular injury related to the posterior clinoidectomy. There were no instances of permanent hypopituitarism or diabetes insipidus.

Conclusions

The authors introduce a surgical variant of the endoscopic endonasal posterior clinoidectomy approach that does not require intradural pituitary transposition and is more effective than the purely extradural approach. The endoscopic endonasal transcavernous approach facilitates the removal of prominent posterior clinoids increasing the working space at the lateral recess of the interpeduncular cistern, while preserving the pituitary function.
Management of intended durotomy in minimally invasive intradural spine surgery
Authors: Tan Lee A. , Takagi Ippei , Straus David , O'Toole John E.
Published: May 2014

Object

Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature.

Methods

A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively.

Results

Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery.

Conclusions

Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.
The effect of stem cells in bridging peripheral nerve defects: a meta-analysis
Authors: Hundepool Caroline A. , Nijhuis Tim H. J. , Mohseny Behnam , Selles Ruud W. , Hovius Steven E. R.
Published: May 2014

Object

For decades the gold standard for reconstructing a large peripheral nerve defect has been, and remains, the nerve autograft. Alternatives to the nerve autograft include biological conduits and vessels. Adding stem cells in the lumen of a nerve conduit has been the subject of multiple studies. The purpose of the present meta-analysis was to summarize animal experimental studies on the effect of stem cells as a luminal additive when reconstructing a peripheral nerve defect with a nerve graft.

Methods

A literature search of the MEDLINE and Embase databases was performed from inception to April 2012, searching for animal experiments on peripheral nerve reconstruction models in which a nerve conduit was used with and without the support of 3 different types of stem cells. Stem cells were analyzed according to their origin: bone marrow, adipose tissue, and other origins. Included studies had consistent outcome measurements: walking track analysis, muscle mass ratio, and electrophysiology.

Results

Forty-four studies were included in the final analysis. Forest plots of the 3 outcome measurements (walking track analysis, muscle mass ratio, and electrophysiology) showed positive effects of stem cells on the regeneration of peripheral nerves at different time points. Almost all comparisons showed significant differences for all 3 stem cells groups compared with a control group in which stem cells were not used.

Conclusions

The present report systematically analyzed the different studies that used stem cells as a luminal additive when bridging a large peripheral nerve defect. All 3 different stem cell groups showed a beneficial effect when used in the reconstruction compared with control groups in which stem cells were not used.
Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient
Authors: Kronenburg Annick , van Doormaal Tristan , van Eijsden Pieter , van der Zwan Albert , Leijten Frans , Han Kuo Sen
Published: May 2014

Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2–3 (proximal) and 2–4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.
Progress towards an optically powered cryobot
Authors: Stone W.C. , Hogan B. , Siegel V. , Lelievre S. , Flesher C.
Published: May 2014

VALKYRIE (Very-deep Autonomous Laser-powered Kilowatt-class Yo-yoing Robotic Ice Explorer) is a NASA-funded project to develop key technologies for an autonomous ice penetrator, or cryobot, capable of delivering science payloads through outer planet ice caps and terrestrial glaciers. This 4 year effort will produce a cylindrical cryobot prototype 280 cm in length and 25 cm in diameter. One novel element of VALKYRIE’s design is the use of a high-energy laser as the primary power source. 1070 nm laser light is transmitted at 5 kW from a surface-based laser and injected into a custom-designed optical waveguide that is spooled out from the descending cryobot. Light exits the downstream end of the fiber, travels through diverging optics, and strikes an anodized aluminum beam dump, which channels thermal power to hot-water jets that melt the descent hole. Some beam energy is converted to electricity via photovoltaic cells, for running on-board electronics and jet pumps. Since the vehicle can be sterilized prior to deployment, and forward contamination is minimized as the melt path refreezes behind the cryobot, expansions on VALKYRIE concepts may enable cleaner access to deep subglacial lakes. This paper focuses on laser delivery and beam dump thermal design.
Assessment of Some Aspects of Cardiovascular Function Status in Male Patients with Stable COPD
Authors: Pervin Magfura , Begum Noorzahan , Ali Taskina
Published: May 2014

Background: COPD is a preventable and treatable disease with some important extra pulmonary effects, which may contribute to the severity of this disease. Among these extra pulmonary ailments cardiovascular disorders are noteworthy. Although its silent involvement is known, but little attention paid to this major comorbidity while treating COPD patients. Objective: to assess rate, systolic blood pressure (SBP) and peak systolic velocity (PSV) of blood flow to observe the cardiovascular function status in stable COPD patients Methods: This cross-sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during 2010. For this purpose 60 (sixty) male, smoker (5 to 10 pack years) patients of stable COPD (FEV1/FVC% <0.70; FEV1 e 80%; without any exacerbation for last 4 weeks) were randomly selected from the Out Patient Department of the Department of Cardiology, BSMMU and also from a private clinic in Dhaka city. On the basis of spirometric findings, 30 mild (group B1) and 30 moderate stage (group B2) of COPD patients with age 35-45 years were included in the study. In addition, 30 age and BMI matched apparently healthy male persons were studied as control (group A). For assessment of cardiovascular function, pulse rate, SBP and PSV were measured. PSV of blood flow in distal part of the right brachial artery in arm was measured by Color Doppler ultrasonography. For statistical analysis, Independent sample t-test and Pearsons Correlation Coefficient test were used. Results: Significantly (p<0.001) higher mean pulse rate and SBP were observed in moderate stage of COPD patients than those of control and mild stage. PSV was significantly (p<0.001) higher in both stages than those of the control as well as in moderate stage to that of the mild COPD. In addition, SBP and PSV were negatively correlated with FEV1 in moderate stage which was statistically significant (p<0.01). Conclusion: This study suggests that, cardiovascular status may be altered in stable COPD and this alteration is inversely related to the severity of the disease. DOI: http://dx.doi.org/10.3329/jbsp.v8i2.18654 Bangladesh Soc Physiol. 2013, December; 8(2): 51-57
Autonomic Neuropathy in Healthy Elderly Person
Authors: Islam Taslima , Begum Noorzahan , Ferdousi Sultana
Published: May 2014

Background: Cardiac autonomic nerve function can be affected in older age. Objective: To find out the degree of autonomic neuropathy by autonomic nerve function scoring system in apparently healthy elderly subjects. Methods: This cross sectional study was conducted in the Department of Physiology, BSMMU, Dhaka between July 2005 and June 2006.For study group, 30 elderly subjects age ranged from 51-60 years were enrolled in one group whereas another 30 elderly subjects age between 61-70 years were enrolled in another group. For comparison sex and BMI matched thirty apparently healthy adults with age from 21-30 years were studied as control. Autonomic nerve function status of all the subjects were examined by five simple non-invasive cardiovascular reflex tests Valsalva maneuver deep breathing test, orthostatic test handgrip test, and sudden standing. Autonomic nerve function (ANF) scoring was done to find out the degree of autonomic neuropathy. Results: 23.34% of subjects of 61-70 years group showed autonomic nerve dysfunctions and 20% had early involvement and 3.34% of them had definite involvement of Autonomic neuropathy. But this percentage was relatively less (10%) in 51-60 years who had early involvement and none had found definite involvement whereas autonomic nerve function was normal in 21-30 years age group.. Conclusion: From this study, it can be concluded that aging process substantially impaired cardiovascular autonomic nerve function. DOI: http://dx.doi.org/10.3329/jbsp.v8i2.18658 Bangladesh Soc Physiol. 2013, December; 8(2): 77-83
Imperfect physician assistant and physical therapist admissions processes in the United States
Authors: Jones Phillip Eugene , Simpkins Susan , Hocking Jennie Alicea
Published: May 2014

We compared and contrasted physician assistant and physical therapy profession admissions processes based on the similar number of accredited programs in the United States and the co-existence of many programs in the same school of health professions, because both professions conduct similar centralized application procedures administered by the same organization. Many studies are critical of the fallibility and inadequate scientific rigor of the high-stakes nature of health professions admissions decisions, yet typical admission processes remain very similar. Cognitive variables, most notably undergraduate grade point averages, have been shown to be the best predictors of academic achievement in the health professions. The variability of non-cognitive attributes assessed and the methods used to measure them have come under increasing scrutiny in the literature. The variance in health professions students’ performance in the classroom and on certifying examinations remains unexplained, and cognitive considerations vary considerably between and among programs that describe them. One uncertainty resulting from this review is whether or not desired candidate attributes highly sought after by individual programs are more student-centered or graduate-centered. Based on the findings from the literature, we suggest that student success in the classroom versus the clinic is based on a different set of variables. Given the range of positions and general lack of reliability and validity in studies of non-cognitive admissions attributes, we think that health professions admissions processes remain imperfect works in progress.