bluuebunny/crossref_metadata_2025 huggingface dataset:
Body composition, pre‐diabetes and cardiovascular disease risk in early schizophrenia
Authors: Strassnig Martin , Clarke Jennifer , Mann Steve , Remington Gary , Ganguli Rohan
Published: March 2015

Aim

This preliminary study examines the relationship between body composition, insulin resistance and NCEP‐III‐defined cardiovascular disease risk factors in persons early in the course of schizophrenia exposed to commonly prescribed atypical antipsychotic medications.

Methods

Subjects underwent modified oral glucose tolerance tests (OGTTs) and DEXA (dual X‐ray absorptiometry) scans corrected for relevant sociodemographic data, including activity levels. We used linear multiple regression models to evaluate relationships between body composition and metabolic variables.

Results

Thirty‐six individuals diagnosed with schizophrenia, receiving atypical antipsychotic monotherapy, and within 5 years of illness onset, participated. Average age was 25.1 ± 3.6 years (range, 19–34) and duration of illness was 2.5 years (30 ± 18 months). Mean body mass index (BMI) was 28.3 ± 4.9, with a mean total body fat mass of 28.6 ± 8.4%, suggesting an increase in fat relative to BMI. Ten participants (28%) had pre‐diabetes (fasting glucose 100–126 mg dL−1 or 2‐h OGTT 140–200 mg dL−1), but no participant had diabetes. Insulin resistance (HOMA‐IR) was predicted by total body mass (BMI) more so than by body fat mass, with an incremental contribution derived from antipsychotics. Insulin secretion in response to glucose challenge was predicted by BMI, body fat mass and antipsychotic medication.

Conclusions

Fat mass relative to BMI was increased in early schizophrenia patients receiving atypical antipsychotics. Body composition accounted for most of the variance in risk for abnormalities in glucose metabolism. Incremental contributions were derived from atypical antipsychotics, in line with their known adipogenicity. If direct fat mass measures are unavailable, frequent BMI measures may be practical proxy markers for metabolic risk.
The Precarious Role of Education in Identity and Value Formation Processes: the shift from state to market forces
Authors: Desjardins Richard
Published: March 2015

This article briefly reviews the evolving role of major institutions thought to form, reproduce and transform individual as well as collective identities and values, with an emphasis on the impact of state vs market forces via educational systems. This is accompanied by a discussion of various pressures against the state to exert social control on identity and value formation processes. The growing influence of market forces on education and in turn on identity and value formation processes is outlined with reference to specific policy prescriptions that are aligned with the neoliberal agenda, for example the No Child Left Behind Act in the US. The analysis suggests that these prescriptions have contributed to a narrower role for education which may have positive as well as negative implications on identity and value formation processes.
Right atrial and right ventricular ultrasound‐guided biopsy technique in standing horses
Authors: Decloedt A. , de Clercq D. , Ven S. , van der Vekens N. , Chiers K. , van Loon G.
Published: March 2015

Reasons for performing study

Endomyocardial biopsies could be a valuable tool in equine cardiology for diagnosing myocardial disease, which is probably underdiagnosed in horses because of lack of specific diagnostic measures and limitations of currently available diagnostic methods.

Objectives

To describe a technique for serial right atrial and right ventricular endomyocardial biopsy in standing horses using a percutaneous approach through the jugular vein.

Study design

Prospective study.

Methods

Biopsy was performed in 10 healthy standing horses sedated with detomidine, under continuous electrocardiography monitoring. A 10 cm (n = 6), 45 cm (n = 1) or 98 cm (n = 3) introducer sheath was inserted into the right jugular vein. Under echocardiographic guidance, a biopsy forceps was introduced through the sheath into the right ventricle and right atrium and endomyocardial biopsies were acquired.

Results

In all horses, 3 right ventricular biopsies were obtained from the right ventricular apex and 3 right atrial biopsies were obtained from the dorsal right atrial wall near thetuberculum intervenosum. The presence of myocardial tissue was confirmed by histology. All horses showed atrial and ventricular premature depolarisations associated with acquisition of the biopsies. In 9 horses, the arrhythmia disappeared after retraction of the forceps and introducer sheath. In one horse, ventricular premature depolarisations disappeared only after 8 h. No other complications were observed.

Conclusions

Endomyocardial biopsy of the right atrium and right ventricle could be performed in standing horses using a percutaneous approach through the jugular vein and was not associated with complications other than temporary arrhythmias. This technique may be useful for research purposes or as a diagnostic tool, although further research is needed to establish the safety of the technique in clinical patients with myocardial disease.
Heritability of racing durability traits in the Australian and Hong Kong Thoroughbred racing populations
Authors: Velie B. D. , Hamilton N. A. , Wade C. M.
Published: March 2015

Reasons for performing study

Many attempts have been made to improve the well‐being of racing Thoroughbreds through improvements in management and veterinary care. However, these attempts are often limited by the industry's ability to regulate a large number of environmental variables and as a result have arguably had limited success in providing long‐lasting change for the breed.

Objectives

To identify heritable durability traits for Thoroughbred horses racing in Australia and Hong Kong.

Study design

Heritability analysis of a longitudinal dataset.

Methods

Performance data on the Thoroughbred populations racing in Australia and Hong Kong between 2000 and 2011 (n = 168,993) were used to estimate the heritabilities and probability values of fixed effects and covariates for a range of racing durability traits. Heritabilities for all durability traits were estimated using a single trait animal model. Each model included, as a minimum, the effects of sex and trainer.

Results

Racing longevity (0.12 ± 0.01), racing persistence (0.10 ± 0.01), racing frequency (0.03 ± 0.01), spells (a time period between consecutive races, official trials and/or jump‐outs greater than 90 days in length) per year (0.05 ± 0.01), spells per 10 starts (0.03 ± 0.01) and variation of days between races (0.08 ± 0.03) were all significantly heritable for horses racing in Australia. Racing longevity (0.08 ± 0.02), racing persistence (0.04 ± 0.02), spells per year (0.06 ± 0.02) and spells per 10 starts (0.11 ± 0.04) were significantly heritable for horses racing in Hong Kong.

Conclusions

The heritabilities estimated for durability traits in this study provide support for the successful and practical application of genetic selection methodologies to improving the well‐being of racing Thoroughbreds.
Platelet function analyser (PFA‐100) results and von Willebrand factor deficiency: a 16‐year ‘real‐world’ experience
Authors: Ardillon L. , Ternisien C. , Fouassier M. , Sigaud M. , Lefrançois A. , Pacault M. , Ribeyrol O. , Fressinaud E. , Boisseau P. , Trossaërt M.
Published: March 2015

The platelet function analyser (PFA‐100) is a biological tool designed to explore primary haemostasis. This system has thus been widely demonstrated as reliable in detecting von Willebrand factor (VWF) deficiency. However, most studies were based on patients benefitting from regular medical care and accurate diagnosis, and it would seem probable that the results were somewhat optimistic, and do not reflect its performances in ‘real‐world’ situations. We have chosen to study the reliability of PFA‐100 for screening VWF ristocetin cofactor (VWF:RCo) deficiency. We retrospectively analysed the results (n = 6431) of 4027 patients referred to our centre between October 1997 and June 2013 and in whom PFA‐Epi, PFA‐ADP, and VWF:RCo activity had been evaluated. We studied the influence of blood group on the results and the performances of each method in a subgroup of 213 patients with genetically confirmed von Willebrand disease. We have shown that the PFA‐100 system, in our experience, constitutes an excellent screening test for detecting VWF:RCo deficiency, whatever the clinical situation, in ‘real‐world’ conditions. The negative predictive value (NPV), the positive predictive value, the sensitivity and the specificity were respectively: 0.98, 0.51, 0.98 and 0.40. When values adjusted for blood group are used, NPV and sensitivity are inferior to those using normal values which have not been adjusted for blood group. We have shown the PFA‐100 method to be more efficient in screening for VWF deficiency than the VWF:RCo technique.
Fatal reactivation of hepatitis B virus infection in a patient with adult T‐cell leukemia–lymphoma receiving the anti‐CC chemokine receptor 4 antibody mogamulizumab
Authors: Ifuku Hideki , Kusumoto Shigeru , Tanaka Yasuhito , Totani Haruhito , Ishida Takashi , Okada Masaya , Murakami Shuko , Mizokami Masashi , Ueda Ryuzo , Iida Shinsuke
Published: March 2015

We report an adult T‐cell leukemia–lymphoma (ATL) patient suffering from fatal reactivation of hepatitis B virus (HBV) infection after treatment with the anti‐CC chemokine receptor 4 (CCR4) monoclonal antibody, mogamulizumab. HBV reactivation occurred without liver damage in this hepatitis B surface antigen (HBsAg) negative patient, who was seropositive for antibodies against the viral core and surface antigens at baseline, after two cycles of CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisolone) followed by six cycles of THP‐COP regimen (cyclophosphamide, pirarubicin, vincristine and prednisolone). Unexpectedly, mogamulizumab monotherapy for relapsed CCR4 positive ATL induced sudden and fatal liver failure due to HBV reactivation, despite antiviral prophylaxis with entecavir. This clinical course may not only offer important suggestions to prevent critical HBV reactivation in HBsAg positive cancer patients who receive immune‐enhancing drugs such as anti‐CCR4 antibody, but also provide a clue to understanding the pathogenesis of HBV reactivation following systemic chemotherapy.
Nursing practice environment: A strategy for mental health nurse retention?
Authors: Redknap Robina , Twigg Di , Rock Daniel , Towell Amanda
Published: March 2015

Historically, mental health services have faced challenges in their ability to attract and retain a competent nursing workforce in the context of an overall nursing shortage. The current economic downturn has provided some respite; however, this is likely to be a temporary reprieve, with significant nursing shortages predicted for the future. Mental health services need to develop strategies to become more competitive if they are to attract and retain skilled nurses and avoid future shortages. Research demonstrates that creating and maintaining a positive nursing practice environment is one such strategy and an important area to consider when addressing nurse retention. This paper examines the impact the nursing practice environment has on nurse retention within the general and mental health settings. Findings indicate, that while there is a wealth of evidence to support the importance of a positive practice environment on nurse retention in the broader health system, there is little evidence specific to mental health. Further research of the mental health practice environment is required.
Jordanian mothers' knowledge of infants' childrearing and developmental milestones
Authors: Safadi R.R. , Ahmad M. , Nassar O.S. , Alashhab S.A. , AbdelKader R. , Amre H.M.
Published: March 2015

Aim

This study explored Jordanian mothers' knowledge of infants' childrearing practices and developmental milestones, the socio‐demographic variables of relevance to knowledge, and sources of information that guide childrearing practices.

Background

Parents' knowledge is considered the frame of reference for parents' interpretations of their children's behaviors and provides the basis for having the appropriate expectation of the child's developmental stage. Parents' knowledge of childrearing is essential for children's physical, cognitive and emotional development.

Methods

A cross‐sectional design using a modified version of MacPhee's ‘Knowledge of Infant Development Inventory’ was used to assess 400 mothers' knowledge of infants' childrearing and developmental milestones, in Amman, Jordan.

Results

Mothers were found to be more knowledgeable in physical and safety skills and less in cognitive, emotional, and parent‐infant interaction skills. Parental age, education, parity and planned pregnancy had limited influence on developmental milestones knowledge. Formal and informal sources of information were used conforming to traditional societies.

Discussion and conclusion

Results were congruent with findings from other studies in the region and similar traditional societies. Results allude to conclusion that mothers resort to informal sources and traditional practices to replace formally structured programmes when absent.

Implications for nursing and health policy

Healthcare professionals, nursing schools and healthcare policy makers are encouraged to develop and institute a holistic approach encompassing physical, cognitive, emotional and parent‐infant interaction domains in childrearing educational programmes. Structured parenting programmes for mothers and culturally accepted sources of information for fathers are essential to enhance parenting skills among Jordanian couples.
A novel way to treat skin tears
Authors: Moradian Scott , Klapper Andrew M
Published: March 2015

Skin tears are one of the most commonly treated wounds in the elderly population. In their most basic form, they are essentially traumatic random pattern flaps. We postulate that the injured blood flow to these skin flaps should be ignored and the tissue should be treated as a skin graft. A case report is presented of an 86‐year‐old female with an 8 × 3·5 cm skin tear to her right upper extremity after a hip fracture. In addition to conventional wound closure strips re‐approximating the tissues, a disposable negative pressure wound therapy device was placed to act as bolster. Upon its removal on day 5, the opposed skin tear tissue was found to be 100% viable. We therefore propose that this update may be an improvement over classical skin tear treatments and should be followed up with a case series.
Feasibility of an electrostimulation system treatment for wound healing: a case series of patients with chronic ulcers in Barbados
Authors: Ojeh Nkemcho , Rose Angela , Jackman Selma , Applewhaite Morvillia , Webster Veronica
Published: March 2015

Major advances have been made in the development of new therapies for chronic wounds.Fenzian™, an electrostimulation system (ES), has been clinically used for a variety of conditions. TheESwas recently tested in the Barbadian population for tolerability and acceptability by asthma patients, with encouraging results. Barbados has an estimated 170 people with diabetes having some form of lower‐extremity amputation annually. Here, we describe a case series of 21 chronic ulcer patients with diabetes recruited as inpatients (n= 10) and outpatients (n= 11) in a pilot study to evaluate the feasibility and acceptability ofESin the Barbadian population. Results showed statistically significant improvement among those in the inpatient‐ versus outpatient‐recruited group for wound perimeter (P= 0·04), wound surface area (P= 0·03) and wound volume (P= 0·08). We also demonstrate that the improvement continued after cessation ofEStreatment. Participants reported increased levels of pain at the end of treatment, and there was no statistically significant change in the reported quality of life. Our results showed greater improvements in reduction of ulcer size for participants from the inpatient‐ versus outpatient‐recruited group.
Peer Influences on Sexual Activity among Adolescents in Ghana
Authors: Bingenheimer Jeffrey B. , Asante Elizabeth , Ahiadeke Clement
Published: March 2015

Little is known about the influences of peers on the sexual activity of adolescents in sub‐Saharan Africa. Better understanding of these issues could lead to more effective sexual and reproductive health interventions. Using two waves of survey data from 1,275 adolescents in two southeastern Ghanaian towns, we examine age, sex, and community differences in peer group characteristics. We also examine prospective associations between peer group characteristics and self‐reported sexual initiation and multiple partnerships during a 20‐month follow‐up period. Sex differences in peer‐context variables were small. Affiliation with antisocial peers and perceived peer norms favoring sex increased the odds of transition to first sex. Having more friends increased the odds among younger respondents of acquiring multiple new sexual partners. Among males, perceived peer norms favoring sex increased the odds of acquiring multiple partners. We discuss the implications of these findings for adolescent sexual and reproductive health intervention strategies in sub‐Saharan Africa, and conclude that peer‐based interventions may be best suited to the needs of at‐risk adolescent boys.
Aligning Goals, Intents, and Performance Indicators in Family Planning Service Delivery
Authors: RamaRao Saumya , Jain Anrudh K.
Published: March 2015

A flurry of policy initiatives in the fields of both population and development and reproductive health, many addressing the provision of family planning services, are currently underway: FP2020, the ICPD Beyond 2014, and the post‐2015 development agenda, among others. This is an opportune time, therefore, to reflect upon and take into consideration what five decades of family planning programs can teach us about ensuring that policies and programs integrate their underlying intents, concrete goals, and performance indicators. The family planning field has encountered instances in its history when inconsistencies between goals, intents, and indicators arose and adversely affected the delivery of services. This commentary presents our observations concerning potential misalignments that may arise within the many promising initiatives underway. We examine the relationship between the intent, goal, and indicators of FP2020 as a case study highlighting the need for ensuring a tight alignment. We offer suggestions for ensuring that this and other initiatives use carefully calibrated indicators to guide the achievement of explicit program goals without undermining their underlying intent—namely, promoting well‐being and reproductive rights.
Phylogenetic diversity and endemism of Australian daisies (Asteraceae)
Authors: Schmidt‐Lebuhn Alexander N. , Knerr Nunzio J. , Miller Joseph T. , Mishler Brent D.
Published: March 2015

Aim

To explore the performance of phylogenetic diversity metrics and of the novel categorical analysis of neo‐ and palaeo‐endemism (CANAPE) using a dataset of Australian native Asteraceae and in particular to compare the results at two taxonomic ranks: genus and species.

Location

Australia.

Methods

We used specimen data from Australia's Virtual Herbarium to produce species and genus distribution models withMaxent, and reconstructed a genus‐level phylogeny. Spatial analyses were conducted at a 100 km × 100 km scale. Randomization tests were employed to identify cells with significantly high or low values of phylogenetic diversity (PD), andCANAPEwas used to identify significant hotspots of neo‐ and palaeo‐endemism.

Results

Significantly highPDvalues were found scattered along the northern and north‐eastern coast, whereas significantly lowPDvalues characterized the arid interior.CANAPEsignalled hotspots of neo‐endemism in the mountainous south‐east of Australia and hotspots of palaeo‐endemism in the tropical north. Patterns were similar between genus‐ and species‐level analyses, although the latter inferred more cells with significant values.

Main conclusions

PDandCANAPEgenerally provided results for Australian Asteraceae consistent with expectations based on previous studies. This is further evidence for their utility in formulating and testing hypotheses about phylogenetic and biogeographical processes. The strength of the results is, however, partly dependent on the taxonomic scale of the analysis, a fact that has to be taken into account in the design and interpretation of future studies.
Climate‐related spatial and temporal variation in bill morphology over the past century in Australian parrots
Authors: Campbell‐Tennant Daniel J. E. , Gardner Janet L. , Kearney Michael R. , Symonds Matthew R. E.
Published: March 2015

Aim

Allen's rule posits that the appendages of endothermic organisms will be larger in warmer climates to allow for dumping of heat loads. Given a link between appendage size and climate, we tested the prediction that climate change has driven the evolution of larger bills in birds, resulting in measurable changes over the recent past.

Location

Australia.

Methods

We explored geographical and temporal variation in bill surface area of five Australian parrot species to determine whether individuals from warmer climates have larger bills, and whether there have been increases in bill surface area over time, consistent with climatic warming. Measurements were obtained from museum specimens dating from 1871 to 2008. These data were then related to geographical location, collection date and locality‐specific climate data, in order to construct and compare models of spatio‐temporal and climate‐related variation in bill morphology.

Results

There have been increases in bill surface area in mulga parrots (Psephotus varius), gang‐gang cockatoos (Callocephalon fimbriatum), red‐rumped parrots (Psephotus haematonotus) and male crimson rosellas (Platycercus elegans), equating to a c. 4–10% increase in bill surface area since 1871. Average maximum summer temperature in the 5 years prior to specimen collection also positively predicted bill surface area in mulga parrots, red‐rumped parrots and crimson rosellas, consistent with Allen's rule. With the exception of red‐rumped parrots, however, models with geographical location and year of collection were still better predictors of bill surface area than local climate at the date of collection.

Main conclusions

Our analysis provides evidence that four species of parrot have exhibited adaptive change in bills over the past century potentially mitigating the thermal stress caused by climatic warming. Although consistent with the predicted effects of climate change, the temporal patterns we observe may have additional causes, however, such as changes in primary productivity, habitat or food availability.
Does Systolic Blood Pressure Response to Lifestyle Intervention Indicate Metabolic Risk and Health‐Related Quality‐of‐Life Improvement Over 1 Year?
Authors: Stuckey Melanie I. , Gill Dawn P. , Petrella Robert J.
Published: March 2015

The purpose of this study was to determine whether responders (minimum 4‐mm Hg reduction of systolic blood pressure [BP]) at 24 weeks) to a 52‐week lifestyle intervention had greater changes in metabolic risk factors and health‐related quality of life than nonresponders. Participants (N=126; age, 57.4 [9.1] years) had waist circumference (WC), resting BP, glycated hemoglobin, lipids, and fitness assessed at baseline and at 12, 24, and 52 months. The 36‐item short‐form survey was administered to assess HRQOL. At baseline, responders had higher mental health scores (P=.04) and systolic and diastolic BPs (P<.001) than nonresponders. Across 52 weeks, responders also had greater improvements in diastolic BP (P<.001), WC (P=.01), and maximal oxygen uptake (P=.04) compared with nonresponders. Participants with clinically important changes in systolic BP at 24 weeks had greater metabolic improvements across 52 weeks, compared with those without clinically important systolic BP changes.
Risk factors for unplanned hospital re‐admissions: a secondary data analysis of hospital discharge summaries
Authors: Braet Anja , Weltens Caroline , Sermeus Walter , Vleugels Arthur
Published: March 2015

Rationale, aims and objectives

To identify patient groups at risk for unplanned hospital re‐admissions and risk factors for re‐admission.

Method

We analysed the Belgian Hospital Discharge Dataset including data from 1 130 491 patients discharged in 2008. Patient and hospital factors contributing to re‐admission rate were analysed using a multivariable model for logistic regression.

Results

The overall unplanned re‐admission rate was 5.2%. Cardiovascular and pulmonary diagnoses were the most common reasons for re‐admission. We found that 10.4% of all re‐admissions were due to complications. A high number of previous emergency department (ED) visits proved to be a predictor for re‐admission [odds ratio (OR) for patients with at least four ED visits in the past 6 months 4.65; 95% confidence interval (CI) 4.25–5.08]. Patients discharged on Friday (OR 1.05; 95% CI 1.01–1.08) and patients with a long length of stay (OR 1.19; 95% CI 1.15–1.23) also had a higher risk for re‐admission. Patients with short lengths of stay were not at risk for re‐admission (OR 0.99; 95% CI 0.95–1.02).

Conclusions

Actions to reduce re‐admissions can be targeted to patient groups at risk, and should be aimed at the caring for chronic cardiovascular or pulmonary diseases, preventing complications and multiple ED visits, and ensuring continuity of care after discharge, especially for patients discharged on Friday.
A Vision System for Surface Homogeneity Analysis of Dough Based on the Grey Level Co‐occurrence Matrix (GLCM) for Optimum Kneading Time Prediction
Authors: Perez Alvarado Fernando A. , Hussein Mohamed A. , Becker Thomas
Published: March 2015

This paper presents an investigation of a methodology for predicting the optimum time to decide dough readiness by using two‐dimensional imaging and statistical texture analysis. Based on the master baker experience and the torque curve generated by the dough mixer, the system will be correlated to stop the kneading process with the minimum error on the optimum time or point of maximum dough development (peak consistency). This development takes advantage of the gray level co‐occurrence matrix (GLCM) texture analysis for the development of an algorithm to emulate the visual inspection performed by the master bakers, where the homogeneity feature of dough is analyzed during the kneading time. An automatic graphical user interface software for offline and inline analysis was developed for the homogeneity analysis. The programmed algorithm was implemented in many experiments (online and offline) for testing, producing an average error of 33.9 s with respect to average optimal mixing time.

Practical Applications

The development of a dough analyzing method, on the basis of an optical surface evaluation, represents an entirely new way to look at the dough properties. The possibility of applying an online dough judgment method without any losses will be given. Simple upgrading of existing production lines can help to prevent erroneous processing and to increase the quality of the end product. Instantaneous state of the art for determining the optimum dough development or dough readiness is the visual and tactile evaluation of the technical staff and laboratory investigations. The expansion of the indirect method by a digital interface‐based analytic approach provides a significant improvement in industrial bakery production and a potential direct method for dough analysis.
Taste Characterization for the Quality Assessment of Dried Lycium Fruits
Authors: Tian Xiaojing , Wang Jun , Cui Shaoqing , Wei Zhenbo
Published: March 2015

A taste‐sensing system was used to study dried Lycium fruits of different producing year and grades. Physical indexes were measured to classify the grade of Lycium fruits and to find correlation between grade indexes and taste characterization. The least significant difference, principal component analysis and linear regression were applied in the data processing. Significant differences were found for sourness, bitterness, astringency and aftertaste‐B. Classifications according to producing years and grades were found by principle component analysis. Strong correlations between producing year, grades and taste characterization were found.

Practical Applications

Lycium barbarum L. has been used as traditional medicine in Asian and many countries. This study evaluates the taste characterization and its application in determination of producing years and grades of Lycium fruits. With multivariate analysis, it is possible to detect producing years and grades of dried Lycium fruits with taste characterization, providing evidence for fast adulteration detection of Lycium fruits.
Investigation on Physicochemical and Sensory Evaluation of Cookies Substituted with Papaya Pulp Flour
Authors: Varastegani Boshra , Zzaman Wahidu , Yang Tajul A.
Published: March 2015

In this present study, papaya pulp flour (PPuF) was used as a substitute for normal wheat flour used in cookies (15, 30 and 50%) and then the nutritional properties of the prepared cookies were investigated. Improvement of the nutritional value of cookies indicated that PPuF contained 17.16% dietary fiber, 8.55 mg/g polyphenol, 1.05% resistant starch and 15.48% 2,2‐diphenyl‐1‐picrylhydrazyl (DPPH) oxidation which is higher than wheat flour. The total dietary fiber content increased from control cookie to 50% cookie substituted with PPuF (3.46 to 6.56%, respectively). The content of polyphenols increased from 0.01 to 1.37 mg/g. The antioxidant properties of cookies with the 50% incorporation of PPuF increased from 0.31 to 9.12%. The cookies incorporated with PPuF showed improved antioxidant properties, dietary fiber, resistant starch and acceptable organoleptic attribute. The sensory evaluation showed higher overall acceptability in cookies made from 50% substituted papaya flour among all cookies.

Practical Applications

These dried papaya also have bioactive compounds that are useful to human health. Industrial application and relevancy of papaya powder could be exported to other countries as capsulation added to pharmaceutical factories in terms of flavoring and antioxidant activities. Papaya dried powder can be added to wheat flour as composite flour to be used in bakery products in term of flavoring, soluble dietary fiber, antioxidant activities, resistant starch, water‐holding capacity and oil binding capacity.
In vivo classification of colorectal neoplasia using high‐resolution microendoscopy: Improvement with experience
Authors: Parikh Neil D , Perl Daniel , Lee Michelle H , Chang Shannon S , Polydorides Alexandros D , Moshier Erin , Godbold James , Zhou Elinor , Mitcham Josephine , Richards‐Kortum Rebecca , Anandasabapathy Sharmila
Published: March 2015

Background and Aims

High‐resolution microendoscopy (HRME) is a novel, low‐cost “optical biopsy” technology that allows for subcellular imaging. The study aim was to evaluate the learning curve of HRME for the differentiation of neoplastic from non‐neoplastic colorectal polyps.

Methods

In a prospective cohort fashion, a total of 162 polyps from 97 patients at a single tertiary care center were imaged by HRME and classified in real time as neoplastic (adenomatous, cancer) or non‐neoplastic (normal, hyperplastic, inflammatory). Histopathology was the gold standard for comparison. Diagnostic accuracy was examined at three intervals over time throughout the study; the initial interval included the first 40 polyps, the middle interval included the next 40 polyps examined, and the final interval included the last 82 polyps examined.

Results

Sensitivity increased significantly from the initial interval (50%) to the middle interval (94%, P = 0.02) and the last interval (97%, P = 0.01). Similarly, specificity was 69% for the initial interval but increased to 92% (P = 0.07) in the middle interval and 96% (P = 0.02) in the last interval. Overall accuracy was 63% for the initial interval and then improved to 93% (P = 0.003) in the middle interval and 96% (P = 0.0007) in the last interval.

Conclusions

In conclusion, this in vivo study demonstrates that an endoscopist without prior colon HRME experience can achieve greater than 90% accuracy for identifying neoplastic colorectal polyps after 40 polyps imaged. HRME is a promising modality to complement white light endoscopy in differentiating neoplastic from non‐neoplastic colorectal polyps.
Living kidney donors' experiences while undergoing evaluation for donation: a qualitative study
Authors: Agerskov Hanne , Ludvigsen Mette Spliid , Bistrup Claus , Pedersen Birthe D
Published: March 2015

Aim and objective

To explore living kidney donors' experiences during the donor evaluation process.

Background

Due to a shortage of organs for kidney transplantation from deceased donors, the living kidney donation rate has increased. The time period until transplantation is often shorter when using living donors compared to deceased donors. Although technological developments in immunology have made it possible to perform successful kidney transplants between donors and recipients, a large disparity still exists between the number of patients needing a kidney transplant and the supply of kidneys from living donors. This need has promoted donation from living kidney donors. The evaluation phase prior to donation is a crucial period in the recruitment of living kidney donors, as it ensures that donors are physically and mentally suitable for donation.

Design

A qualitative study taking a phenomenological‐hermeneutic approach.

Methods

Data were generated using participant observation during the evaluation period and semi‐structured interviews after conclusion of the evaluation. In total, 18 potential donors were included. Data were interpreted and discussed in accordance with Ricoeur's theory of interpretation: naïve reading, structural analysis, critical interpretation and discussion.

Results

Feelings of hope concerning acceptance as a donor and concerns for the recipient's illness and everyday life were evident during evaluation. Donors' experiences largely depended on the quality of their communication and interaction with the healthcare professionals. In some cases, donors were supported and cared for, while in other cases, frustrations and vulnerability were evident and emotional support and attention to donors' needs were not present.

Conclusion

The evaluation period for living kidney donation involves hope, vulnerability and concern. Interaction, communication and support from healthcare professionals to help donors manage this crucial phase are essential. Accordingly, the identification of donors' specific care and support needs, including physical, mental and ethical factors, is key to a positive experience.

Relevance to clinical practice

The attention, commitment and engagement of healthcare professionals are essential elements in the identification of donors' individual needs.
Assessment of psychosocial problems in children with type 1 diabetes and their families: the added value of using standardised questionnaires in addition to clinical estimations of nurses and paediatricians
Authors: Boogerd Emiel A , Damhuis Anouk MA , van Alfen‐van der Velden Janiëlle (A)AEM , Steeghs Marley CCH , Noordam Cees , Verhaak Chris M , Vermaes Ignace PR
Published: March 2015

Aims and objectives

To investigate the assessment of psychosocial problems in children with type 1 diabetes by means of clinical estimations made by nurses and paediatricians and by using standardised questionnaires.

Background

Although children with type 1 diabetes and their parents show increased risk for psychosocial problems, standardised assessment of these problems lacks in diabetes care.

Design

By comparing these different modes of assessment, using a cross‐sectional design, information about the additional value of using standardised questionnaires is provided.

Methods

Participants were 110 children with type 1 diabetes (aged 4–16), their parents, and healthcare professionals. Children filled out the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Inventory, Diabetes Module. Parents filled out the Strengths and Difficulties Questionnaire parent‐report and the Parenting Stress Index. Independently, nurses and paediatricians filled out a short questionnaire, which assessed their clinical estimations of the children's psychosocial problems and quality of life, and parents' levels of parenting stress. Reports of children and parents were compared to clinical estimations.

Results

Children in our sample showed more psychosocial problems and lower health‐related quality of life than their healthy peers. In approximately half of the children, dichotomous estimations by healthcare professionals and dichotomised reports by patients and parents were in agreement. In 10% of the children, no psychosocial problems were present according to professionals' estimations, although patients and parents‐reported psychosocial problems. In 40%, psychosocial problems were present according to professionals' estimations, although parents and patients did not report psychosocial problems.

Conclusion

Children with type 1 diabetes show more psychosocial problems than healthy children. Professionals seem to tend towards overestimating psychosocial problems.

Relevance to clinical practice

Extending the assessment of psychosocial problems with routine screening on patient‐reported outcomes, using validated questionnaires, could be of additional value in tailoring care to the needs of the individual child and parents.
Potential utilization of expanded function dental auxiliaries to place restoratives
Authors: Darling Brian G. , Kanellis Michael J. , McKernan Susan C. , Damiano Peter C.
Published: March 2015

Objectives

The Affordable Care Act is predicted to increase dental benefits coverage for millions of Americans. Utilization of expanded function dental auxiliaries (EFDAs) can contribute to increased workforce capacity. Iowa currently allows EFDAs to perform certain nonrestorative procedures. This study investigated dentists' willingness to use auxiliaries for restorative procedures in order inform recent discussions about expanding scope of practice for EFDAs to include such procedures.

Methods

This study examined responses from 677 primary care dentists who responded to the 2013 Survey of Iowa Dentists (response rate = 59 percent). The authors performed univariate and bivariate analyses (χ2 and t‐tests) to examine characteristics of dentists who indicated willingness to utilize an auxiliary for newly proposed restorative functions.

Results

Thirty‐seven percent of respondents indicated they would delegate at least one of the newly proposed restorative functions to an auxiliary. Pediatric dentists were significantly more likely to be willing to delegate (P = 0.042). Placing stainless steel crowns was most acceptable (31.9 percent of respondents), followed by amalgam restorations (22.3 percent), and composites (18.6 percent).

Conclusions

Many dentists are willing to delegate reversible restorative procedures. Increasing scope of practice for auxiliaries may increase capacity of the existing dental workforce and improve access for newly insured populations. Expanding scope of practice for dental auxiliaries offers a viable mechanism to rapidly increase states' dental capacity in response to rising demands for dental care, including newly insured Medicaid populations.
Dyspareunia and Sexual Dysfunction after Vaginal Delivery in Thai Primiparous Women with Episiotomy
Authors: Chayachinda Chenchit , Titapant Vitaya , Ungkanungdecha Anuree
Published: March 2015

Introduction

Episiotomy remains commonly practiced in Thailand. There are limited data on its impacts on sexuality among Asian women during the first postdelivery year.

Aims

The aim was to study dyspareunia and sexual function at 3–12 months after vaginal delivery in Thai primiparous women with episiotomy.

Methods

A total of 190 participants were approached on Day 2 postpartum. Of these, 93 sexually active women were evaluated for dyspareunia and sexual function at 3 months by using 10-cm visual analog scale and the validated Thai version of Female Sexual Function Index (TFSFI). TFSFI < 26.5 was defined as having potential sexual dysfunction. At 6 and 12 months, sexual function was evaluated by telephone interview.

Main Outcome Measures

The prevalence of dyspareunia at 3 months and the changes of TFSFI scores during the first postdelivery year were the main outcome measures.

Results

The average age of the participants, over 90% of whom were high school finishers, was 24. Their partners were around 3 years older, and the median partnership duration was 3 years. At 3 months, 30.1% of participants reported dyspareunia. There was no association between dyspareunia and the following characteristics: pre-pregnancy dyspareunia, newborn's head circumference and birthweight and breast-feeding (P > 0.05 for all). Sexual dysfunction was demonstrated in 66.7% at 3 months, 31.0% at 6 months, and 14.9% at 12 months. From 3 to 12 months, the median TFSFI scores in all domains increased significantly. There was no difference of the scores in all domains at 3 and 12 months between women with and without dyspareunia at 3 months. However, at 6 months, those without dyspareunia had better scores in pain, orgasm, satisfaction, and total scores (P < 0.05 for all).

Conclusion

Dyspareunia at 3 months is common in Thai primiparous women with episiotomy. Those with dyspareunia have a slower resumption of normal sexual function.
An expert panel‐based study on recognition of gastro‐esophageal reflux in difficult esophageal pH‐impedance tracings
Authors: Smits M. J. , Loots C. M. , van Wijk M. P. , Bredenoord A. J. , Benninga M. A. , Smout A. J. P. M.
Published: March 2015

Background

Despite existing criteria for scoring gastro‐esophageal reflux (GER) in esophageal multichannel pH‐impedance measurement (pH‐I) tracings, inter‐ and intra‐rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH‐I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard.

Methods

Twenty‐one experts from 10 countries were asked to mark GER presence for adult and pediatric pH‐I patterns in an online pre‐assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER.

Key Results

Majority consensus was reached for 35/79 episodes in the online pre‐assessment (interrater κ = 0.332). Mean agreement between pre‐assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH‐I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard.

Conclusions & Inferences

Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter ‘retrograde propagation pattern’ is an indicator of GER in difficult pH‐I patterns.
Untangling the origin of viruses and their impact on cellular evolution
Authors: Nasir Arshan , Sun Feng‐Jie , Kim Kyung Mo , Caetano‐Anollés Gustavo
Published: March 2015

The origin and evolution of viruses remain mysterious. Here, we focus on the distribution of viral replicons in host organisms, their morphological features, and the evolution of highly conserved protein and nucleic acid structures. The apparent inability of RNA viral replicons to infect contemporary akaryotic species suggests an early origin of RNA viruses and their subsequent loss in akaryotes. A census of virion morphotypes reveals that advanced forms were unique to viruses infecting a specific supergroup, while simpler forms were observed in viruses infecting organisms in all forms of cellular life. Results hint toward an ancient origin of viruses from an ancestral virus harboring either filamentous or spherical virions. Finally, phylogenetic trees built from protein domain and tRNA structures in thousands of genomes suggest that viruses evolved via reductive evolution from ancient cells. The analysis presents a complete account of the evolutionary history of cells and viruses and identifies viruses as crucial agents influencing cellular evolution.
MUC1/SEC and MUC1/Y overexpression is associated with inflammation in Sjögren's syndrome
Authors: Sung HH , Castro I , González S , Aguilera S , Smorodinsky NI , Quest AFG , Bahamondes V , Alliende C , Cortés J , Molina C , Urzúa U , Barrera M‐J , Hermoso M , Herrera L , Leyton C , González M‐J
Published: March 2015

Objectives

To evaluate the expression and localization of MUC1/SEC and MUC1/Y isoforms in labial salivary glands (LSG) from Sjögren's syndrome patients (SS patients), as well as their in vitro expression induced by cytokines.

Subjects and methods

Labial salivary gland from 27 primary SS patients and 22 non‐SS sicca subjects were studied. Relative MUC1/SEC and MUC1/Y mRNA levels were determined by qPCR and protein levels by Western blotting. Induction of mucin mRNAs was assayed in vitro. Immunohistochemistry was used for localization.

Results

Relative MUC1/SEC and MUC1/Y mRNA and protein levels were significantly higher in LSG from SS patients. These mRNAs were induced by cytokines. MUC1/SEC and MUC1/Y were detected in acini apical region of control LSGs, and significant cytoplasmic accumulation was observed in acini of SS patients. MUC1/Y localized in acinar nuclei and cytoplasm of inflammatory cells of LSG from SS patients. A strong positive correlation was observed between cellular MUC1/SEC levels and glandular function determined by scintigraphy.

Conclusions

We show for the first time that MUC1/SEC and MUC1/Y are expressed in LSG of both SS patients and non‐SS sicca subjects. The observed overexpression and aberrant localization of MUC1/SEC and MUC1/Y and their induction by pro‐inflammatory cytokines may favor the perpetuation of the inflammatory environment that disrupts the salivary glandular homeostasis in SS patients.