bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary practices and influences on diet intake among women in a Woodland Cree community
Authors: Bruner B. G. , Chad K. E.
Published: May 2013

Background

Overweight and obesity are increasing concerns among Aboriginal women, and lifestyle behaviours (i.e. dietary patterns and physical activity) are considered to be contributing factors. The present study aimed to explore the social, cultural, behavioural and environmental factors influencing diet intake from a trans‐generational perspective and to characterise the dietary practices among Woodland Cree women.

Methods

A mixed methods design using a concurrent triangulation approach explored the factors influencing diet intake and healthy eating among First Nations women on a reserve community in northern Saskatchewan, Canada. Dietary practices were assessed using 24‐h recalls.

Results

Dietary analysis revealed low intake of fruits and vegetables and milk and alternatives in the sample, with high intake of ‘other’ foods. Limited amounts of traditional food (TF) were reported. Taste primarily influenced food choice, with a preference for TF highlighted among older participants. Healthy eating was considered to be a health‐promoting behaviour, yet a lack of availability, high costs and difficulties accessing various foods were the most noted barriers to healthy eating.

Conclusions

The dietary practices in this sample indicate the limited consumption and variety of TF and fruits and vegetables, and a high consumption of ‘other’ foods, which suggests inadequate intakes of various vitamins and nutrients. The findings from a trans‐generational perspective highlight various barriers across the age groups that can substantially impact food choices, and reinforces the need for community and age‐specific strategies to address issues of exposure, accessibility and affordability to nutritious foods that improve the diet and preserve cultural identity among residents living in reserve communities.
Deregulation of excitatory neurotransmission underlying synapse failure in Alzheimer's disease
Authors: Paula‐Lima Andrea C. , Brito‐Moreira Jordano , Ferreira Sergio T.
Published: May 2013

Alzheimer′s disease (AD) is the most common form of dementia in the elderly. Memory loss inADis increasingly attributed to soluble oligomers of the amyloid‐β peptide (AβOs), toxins that accumulate inADbrains and target particular synapses. Glutamate receptors appear to be centrally involved in synaptic targeting by AβOs. Once bound to neurons, AβOs dysregulate the activity and reduce the surface expression of bothN‐methyl‐d‐aspartate (NMDA) and 2‐amino‐3‐(3‐hydroxy‐5‐methyl‐isoxazol‐4‐yl)propanoic acid (AMPA) types of glutamate receptors, impairing signaling pathways involved in synaptic plasticity. In the extracellular milieu, AβOs promote accumulation of the excitatory amino acids, glutamate andd‐serine. This leads to overactivation of glutamate receptors, triggering abnormal calcium signals with noxious impacts on neurons. Here, we review key findings linking AβOs to deregulated glutamate neurotransmission and implicating this as a primary mechanism of synapse failure inAD. We also discuss strategies to counteract the impact of AβOs on excitatory neurotransmission. In particular, we review evidence showing that inducing neuronal hyperpolarization via activation of inhibitoryGABAAreceptors prevents AβO‐induced excitotoxicity, suggesting that this could comprise a possible therapeutic approach inAD.
Stronger Risk Controls, Lower Risk: Evidence from U.S. Bank Holding Companies
Authors: ELLUL ANDREW , YERRAMILLI VIJAY
Published: May 2013

We construct a risk management index (RMI) to measure the strength and independence of the risk management function at bank holding companies (BHCs). The U.S. BHCs with higher RMI before the onset of the financial crisis have lower tail risk, lower nonperforming loans, and better operating and stock return performance during the financial crisis years. Over the period 1995 to 2010, BHCs with a higher lagged RMI have lower tail risk and higher return on assets, all else equal. Overall, these results suggest that a strong and independent risk management function can curtail tail risk exposures at banks.
Corporate Innovations and Mergers and Acquisitions
Authors: BENA JAN , LI KAI
Published: May 2013

Using a large and unique patent‐merger data set over the period 1984 to 2006, we show that companies with large patent portfolios and low R&D expenses are acquirers, while companies with high R&D expenses and slow growth in patent output are targets. Further, technological overlap between firm pairs has a positive effect on transaction incidence, and this effect is reduced for firm pairs that overlap in product markets. We also show that acquirers with prior technological linkage to their target firms produce more patents afterwards. We conclude that synergies obtained from combining innovation capabilities are important drivers of acquisitions.
Market Expectations in the Cross‐Section of Present Values
Authors: KELLY BRYAN , PRUITT SETH
Published: May 2013

Returns and cash flow growth for the aggregate U.S. stock market are highly and robustly predictable. Using a single factor extracted from the cross‐section of book‐to‐market ratios, we find an out‐of‐sample return forecasting R2 of 13% at the annual frequency (0.9% monthly). We document similar out‐of‐sample predictability for returns on value, size, momentum, and industry portfolios. We present a model linking aggregate market expectations to disaggregated valuation ratios in a latent factor system. Spreads in value portfolios’ exposures to economic shocks are key to identifying predictability and are consistent with duration‐based theories of the value premium.
Risk Management and Firm Value: Evidence from Weather Derivatives
Authors: PÉREZ‐GONZÁLEZ FRANCISCO , YUN HAYONG
Published: May 2013

This paper shows that active risk management policies lead to an increase in firm value. To identify the effect of hedging and to overcome endogeneity concerns, we exploit the introduction of weather derivatives as an exogenous shock to firms’ ability to hedge weather risks. This innovation disproportionately benefits weather‐sensitive firms, irrespective of their future investment opportunities. Using this natural experiment and data from energy firms, we find that derivatives lead to higher valuations, investments, and leverage. Overall, our results demonstrate that risk management has real consequences on firm outcomes.
Do Hedge Funds Manipulate Stock Prices?
Authors: BEN‐DAVID ITZHAK , FRANZONI FRANCESCO , LANDIER AUGUSTIN , MOUSSAWI RABIH
Published: May 2013

We provide evidence suggesting that some hedge funds manipulate stock prices on critical reporting dates. Stocks in the top quartile of hedge fund holdings exhibit abnormal returns of 0.30% on the last day of the quarter and a reversal of 0.25% on the following day. A significant part of the return is earned during the last minutes of trading. Analysis of intraday volume and order imbalance provides further evidence consistent with manipulation. These patterns are stronger for funds that have higher incentives to improve their ranking relative to their peers.
A randomised trial of a simplified method for complete denture fabrication: patient perception and quality
Authors: Regis R. R. , Cunha T. R. , Della Vecchia M. P. , Ribeiro A. B. , Silva‐Lovato C. H. , de Souza R. F.
Published: May 2013

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health‐related quality of life (OHRQoL), patient satisfaction and denture quality. Forty‐two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.
Correlation of previous experience, patient expectation and the number of post‐delivery adjustments of complete dentures with patient satisfaction in a Brazilian population
Authors: Gaspar M. G. , Dos Santos M. B. F. , Dos Santos J. F. F. , Marchini L.
Published: May 2013

A number of variables may influence the outcome of complete denture therapy. The objective of this study was to verify possible correlations between previous experience with dentures, patient expectation and the number of post‐delivery adjustments with patient satisfaction after treatment. One hundred patients (mean age 61·9 ± 10·3) rated their previous experiences with complete dentures and their expectations before and satisfaction after treatment on a visual analogue scale (VAS) using scores from 0 (worst results) to 10 (best results). The number of post‐delivery adjustments and other patient‐related clinical variables was also noted. Patient expectation scores were higher than previous experience scores and satisfaction after treatment scores. Positive and weak correlations were found between previous chewing experiences with complete dentures, with regard to chewing expectations and comfort of use. Phonetics and comfort of use in previous experiences presented a positive correlation with expectations for chewing, aesthetics, phonetics and comfort of use. Groups of patients with different levels of education presented significant differences in expectation scores regarding comfort of use as well. A negative and weak correlation was found between phonetics satisfaction and the number of post‐delivery adjustments. Patients' expectations for the therapy were higher than their satisfaction after treatment. Previous experiences with complete dentures could slightly influence patients' expectations and satisfaction, whereas lower scores for previous experience with complete dentures caused lower scores for both expectation and satisfaction. Patients' educational levels and the number of post‐delivery adjustments influenced negatively the expectations about comfort of use and patient satisfaction, respectively.
Novel therapies for oral lichen planus
Authors: Thongprasom Kobkan , Prapinjumrune Chanwit , Carrozzo Marco
Published: May 2013

Oral lichen planus (OLP) is a chronic mucocutaneous disorder commonly found in middle‐aged women. Despite the progress in research and advance in knowledge on OLP, a successful management is still difficult to achieve. The main aim of OLP treatment is to control the symptoms of the affected patients. Steroids and other immunosuppressive drugs have been recommended and widely used in the treatment of OLP. Topical corticosteroids are the mainstay of OLP treatment, but strong evidence on their effectiveness is lacking. The effectiveness of alternative ways of managing OLP has been recently reported. Topical aloe vera, topical pimecrolimus and oral curcuminoids are the most promising of the new treatment modalities. Other interesting modalities are topically applied thalidomide and amlexanox. Nevertheless, the careful assessment between the risks and benefits of these drugs is crucial and larger and well‐conducted trials need to confirm the above encouraging results.
Bitterness evaluation of intact and crushed Vesicare orally disintegrating tablets using taste sensors
Authors: Haraguchi Tamami , Miyazaki Airi , Yoshida Miyako , Uchida Takahiro
Published: May 2013

Objective

Vesicare tablets, whose main component is solifenacin succinate, are known to be extremely bitter. The purpose of this study was to evaluate the effect of crushing on the bitterness of the Vesicare orally disintegrating tablets (ODTs).

Method

Vesicare ODTs and conventional Vesicare tablets (CTs) were crushed either heavily or lightly. The bitterness scores and release rates of sample solutions obtained 5, 10, 30, 60, 90 or 120 s after placing a crushed CT or ODT containing 5 mg solifenacin in 40 ml of water were predicted using two taste sensors (SA402B and a-ASTREE) and HPLC, respectively. The particle size and the surfaces of the crushed tablets were observed microscopically.

Key findings

The predicted bitterness scores and the drug release rates of CTs were high, irrespective of the degree of crushing. The lightly crushed ODT was predicted to be less bitter than the heavily crushed ODT. In lightly crushed ODTs, spherical particles were observed, about 200 mm in diameter.

Conclusions

The degree of crushing was a critical factor in determining the expression of bitterness by crushed ODTs. When intact tablets of Vesicare must be crushed to adjust the dosage, it is strongly recommended that ODTs be crushed gently.
Differentiation of human dental stem cells reveals a role for microRNA‐218
Authors: Gay I. , Cavender A. , Peto D. , Sun Z. , Speer A. , Cao H. , Amendt B. A.
Published: May 2013

Background

Regeneration of lost periodontium is the ultimate goal of periodontal therapy. Advances in tissue engineering have demonstrated the multilineage potential and plasticity of adult stem cells located in periodontal apparatus. However, it remains unclear how epigenetic mechanisms controlling signals determine tissue specification and cell lineage decisions. To date, no data are available on micro‐RNA (miRNA) activity behind human‐derived dental stem cells (DSCs).

Material and Methods

In this study, we isolated periodontal ligament stem cells, dental pulp stem cells and gingival stem cells from extracted third molars; human bone marrow stem cells were used as a positive control. The expression of OCT4A and NANOG was confirmed in these undifferentiated cells. All cells were cultured under osteogenic inductive conditions and RUNX2 expression was analyzed as a marker of mineralized tissue differentiation. The miRNA expression profile was obtained at baseline and after osteogenic induction in all cell types.

Results

The expression of RUNX2 demonstrated successful osteogenic induction of all cell types, which was confirmed by alizarin red stain. The analysis of 765 miRNAs demonstrated a shift in miRNA expression that occurred in all four stem cell types, including a decrease in hsa‐mir‐218 across all differentiated cell populations. Hsa‐mir‐218 targets RUNX2 and decreases RUNX2 expression in undifferentiated human DSCs. DSC mineralized tissue type differentiation is associated with a decrease in hsa‐mir‐218 expression.

Conclusion

These data reveal a miRNA‐regulated pathway for the differentiation of human DSCs and a select network of human miRNAs that control DSC osteogenic differentiation.
Endothelium-Independent Relaxant Effect of Rubus Coreanus Extracts in Corpus Cavernosum Smooth Muscle
Authors: Lee Jun Ho , Chae Mee Ree , Sung Hyun Hwan , Ko Mikyeong , Kang Su Jeong , Lee Sung Won
Published: May 2013

Introduction

Rubus coreanus is a perennial shrub native to the southern part of the Korean peninsula. Although it is known that R. coreanus has a dose-dependent relaxation effect on rabbit corpus cavernosum (CC), the exact mechanism of action by which R. coreanus work is not fully known.

Aims

To elucidate the direct effects of unripe R. coreanus extract (RCE) on CC smooth muscle cells.

Methods

Dried unripe R. coreanus fruits were pulverized and extracted with 95% ethanol. Isolated rabbit CC strips were mounted in an organ-bath system, and the effects of RCE were evaluated. To estimate [Ca2+]i, we used a Fura-2 fluorescent technique.

Main Outcome Measures

The effects of unripe RCE on ion channels and the intracellular Ca2+ concentration ([Ca2+]i) of CC.

Results

RCE effectively relaxed phenylephrine (PE)-induced tone in rabbit CC, and removal of the endothelium did not completely abolish the relaxation effect of RCE. Tetraethylammonium (1 mM) did not inhibit RCE-induced relaxation in strips precontracted by PE in the organ bath. However, CaCl2-induced constriction of CC strips, bathed in Ca2+-free buffer and primed with PE, was abolished by RCE. In addition, RCE decreased basal [Ca2+]i in corporal smooth muscle cells. The increases of [Ca2+]i evoked by 60 mM K+-containing solution in A7r5 cells were suppressed by RCE, and RCE relaxed KCl-induced tone in endothelium-free CC, which indicated that RCE blocked the voltage-dependent Ca2+ channels (VDCCs). RCE decreased basal [Ca2+]i and the [Arg8]-vasopressin-induced [Ca2+]i increases in A7r5 cells, and RCE inhibited the contraction of endothelium-free CC induced by PE in Ca2+-free solution, which suggested that RCE might act as a modulator of corporal smooth muscle cell tone by inhibiting Ca2+ release from sarcoplasmic reticulum.

Conclusion

RCE acts through endothelium-independent and endothelium-dependent pathways to relax CC. RCE may inhibit VDCCs and Ca2+ release from sarcoplasmic reticulum.
The Global Online Sexuality Survey (GOSS): The United States of America in 2011 Chapter III—Premature Ejaculation Among English-Speaking Male Internet Users
Authors: Shaeer Osama
Published: May 2013

Introduction

The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders. In 2010, the first report of GOSS came from the Middle East.

Aim

This report studies the prevalence rate of premature ejaculation (PE) in the U.S. as of 2011–2012 and evaluates risk factors for PE.

Methods

GOSS was randomly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook®, comprising 146 questions.

Main Outcome Measures

Prevalence of PE as per the International Society of Sexual Medicine's (ISSM) definition.

Results

With a mean age of 52.38 years ± 14.5, 1,133 participants reported on sexual function. As per the ISSM definition of PE, the prevalence rate of PE in the USA as of 2011 was 6.3%. This is in contrast to 49.6% as per the Premature Ejaculation Diagnostic Tool (PEDT), 77.6% as per unfiltered subjective reports, and 14.4% as per subjective reporting on more consistent basis. 56.3% of the latter reported lifelong PE. 63.2% could be classified as having natural variable PE. Erectile dysfunction is a possible predisposing factor for acquired PE, while genital size concerns may predispose to lifelong PE. Age, irregular coitus, circumcision, and the practice of masturbation did not pose a risk for PE, among other risk factors. Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics, particularly in those with lifelong PE.

Conclusion

Applying the ISSM definition, prevalence of PE is far less than diagnosed by other methods, 6.3% among Internet users in USA as of the year 2011. PEDT measures both lifelong and acquired PE, in addition to 35% men with premature-like ejaculatory dysfunction, making it inaccurate for isolating lifelong and acquired PE cases.
The Sexual Functioning Profile of a Nonforensic Sample of Individuals Reporting Sexual Aggression Against Women
Authors: Carvalho Joana , Quinta-Gomes Ana , Nobre Pedro J.
Published: May 2013

Introduction

Sexual offenders are believed to present marked sexual difficulties. However, most of the studies characterizing sex offenders' sexual functioning were conducted with samples of documented/incarcerated sexual aggressors. At the present state of the knowledge there is limited information on the sexual functioning profile of individuals reporting some form of sexual violence but who were not documented/apprehended by the judicial system.

Aim

The aim of this preliminary study was to characterize a sample of community sexual aggressors (college students) according to their sexual functioning. Results were expected to add information about the relationship between sexual functioning and sexual violence, and to impact strategies aimed at preventing sexual aggression on college campus.

Methods

One hundred sixty-one male college students participated in a cross-sectional study. Students were recruited at a Portuguese university using nonrandom methods. Among these students, 35 reported sexual aggression against women. The measures were completed individually and anonymously.

Main Outcome Measures

Participants completed a modified version of the International Index of Erectile Function, the Sexual Inhibition and Sexual Excitation Scales, the Sexual Self-Consciousness Scale, the Questionnaire of Cognitive Schema Activation in Sexual Context, and the Sexual-Esteem Scale.

Results

Results indicated that students reporting sexual aggression against women presented significantly more erectile and orgasmic difficulties, and more sexual inhibition due to the threat of performance failure than the control peers. Additionally, students reporting sexual aggression presented more sexual embarrassment, and more schemas of undesirability and incompetence.

Conclusions

Results pointed toward a possible relationship between sexual violence as reported by college students and sexual performance anxiety. These findings are expected to impact conceptual models on sexual aggression perpetrated by nonforensic individuals.
Epidemiological characteristics of hepatocellular carcinoma in Egypt: a retrospective analysis of 1313 cases
Authors: Shaker Mohamed K. , Abdella Heba M. , Khalifa Mohamed O. , Dorry Ahmed K. El
Published: May 2013

Background & Aims

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours worldwide. Egypt has the highest prevalence of HCV in the world and the prevalence of HCC is increasing in the last years. The aim was to study epidemiological characteristics of HCC in Egypt.

Methods

Retrospective chart review of 1456 Egyptian patients with HCC was done. Records of 1313 patients (1035 males, 278 females; median age 56 years) fulfilling diagnostic criteria for HCC were analysed for clinical, aetiological, radiological and tumour characteristics.

Results

The majority of cases (75%) were from rural areas. The most frequent age category affected by HCC was between 51 and 60 years (45.7%); 50% of the patients reported accidental discovery of their hepatic focal lesions. The major presenting symptom was newly developed right hypochondrial pain (66.3%). HCV Ab was detected in 91.32% of the studied patients while HVB infection was reported in 2.51%. 59.3% of patients had AFP levels below 200 ng/ml (the diagnostic level). On studying tumour characteristics, the right lobe of the liver was more frequently occupied by the focal lesions (75.4%) than the left lobe (15.7%) and 12.5% of patients had bilobar affection. Five hundred and six patients (38.6%) had more than one hepatic focal lesion and 228 patients (17.4%) had tumours occupying >50% of the liver.

Conclusion

HCC is a major health problem in Egypt and its incidence is increasing. The high prevalence of HCV infection makes screening programmes and surveillance of those patients a very important tool to early detect cases of small HCCs.
Role of proton pump inhibitors in the occurrence and the prognosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites
Authors: de Vos Marie , De Vroey Bénédicte , Garcia Béatrice Garcia , Roy Clothilde , Kidd François , Henrion Jean , Deltenre Pierre
Published: May 2013

Background

Proton pump inhibitors (PPIs) facilitate intestinal bacterial translocation. No robust data exist demonstrating that PPIs increase the risk of spontaneous bacterial peritonitis (SBP) and that PPIs worsen the prognosis of SBP patients. PPI use might be unsuitable for cirrhotic patients.

Aims

To analyse: (i) the role of PPIs in the occurrence of SBP in cirrhotic patients; (ii) their impact on the prognosis of SBP patients; and (iii) the suitability of their use.

Methods

In this retrospective case‐control study, PPI use was first assessed in cirrhotic patients consecutively admitted with SBP (group I) and in a control group that included the same number of uninfected cirrhotic patients with ascites (group II). Afterwards, the impact of PPIs on SBP was assessed in group I by comparing survival of patients with and without PPIs.

Results

A total of 102 patients were included, 51 in each group. (i) SBP patients were more frequently treated by PPIs than controls (49 vs. 25%, P = 0.014). (ii) In group I, patients with (n = 25) and without (n = 26) PPIs had similar survival rates at 1 month (64.0 ± 9.6% vs. 59.4 ± 10.0%), 3 months (41.2 ± 10.2% vs. 44.6 ± 10.6%), and 1 year (26.6 ± 9.6% vs. 28.9 ± 10.1%), and similar median age at death (53 vs. 57 years). (iii) The reason for PPI use was inappropriate or undocumented in 34% of group I and II.

Conclusions

Proton pump inhibitors were more frequently used in SBP patients than in controls, but did not influence the prognosis in SBP. Overuse of PPIs was encountered in one‐third of cirrhotic patients and should be avoided.
The only girl in the room: how paradigmatic trajectories deter female students from surgical careers
Authors: Hill Elspeth , Vaughan Suzanne
Published: May 2013

Objectives

Over 60% of UK medical students are female, yet only 33% of applicants to surgical training are women. Role modelling, differing educational experiences and disidentification in female medical students have been implicated in this disparity. We are yet to fully understand the mechanisms that link students’ experiences with national trends in career choices. We employ a hitherto unused concept from the theory of communities of practice: paradigmatic trajectories. These are visible career paths provided by a community and are cited by Wenger as potentially the most influential factors shaping the learning of newcomers. We pioneer the use of this theoretical tool in answering the research question: How do paradigmatic trajectories shape female medical students’ experiences of surgery and subsequent career intentions?

Methods

This qualitative study comprised a secondary analysis of data sourced from 19 clinical medical students. During individual, in‐depth, semi‐structured interviews, we explored these students’ experiences at medical school. We carried out thematic analysis using sensitising concepts from communities of practice theory, notably that of ‘paradigmatic trajectories’.

Results

Female students’ experiences of surgery were strongly gendered; they were positioned as ‘other’ in the surgical domain. Four key processes – seeing, hearing, doing and imagining – facilitated the formation of paradigmatic trajectories, on which students could draw when making career decisions. Female students were unable to see or identify with other women in surgery. They heard about challenges to being a female surgeon, lacked experiences of participation, and struggled to imagine a future in which they would be successful surgeons. Thus, based on paradigmatic trajectories constructed from exposure to surgery, they self‐selected out of surgical careers. By contrast, male students had experiences of ‘hands‐in’ participation and were not marginalised by paradigmatic trajectories.

Conclusions

The concept of the paradigmatic trajectory is a useful theoretical tool with which to understand how students’ experiences shape career decisions. Paradigmatic trajectories within surgery deter female students from embarking on careers in surgery.
Advancing the objective structured clinical examination: sequential testing in theory and practice
Authors: Pell Godfrey , Fuller Richard , Homer Matthew , Roberts Trudie
Published: May 2013

Context

Models of short‐term remediation for failing students are typically associated with improvements in candidate performance at retest. However, the process is costly to deliver, particularly for performance retests with objective structured clinical examinations (OSCEs), and there is increasing evidence that these traditional models are associated with the longitudinal underperformance of candidates.

Methods

Rather than a traditional OSCE model, sequential testing involves a shorter ‘screening’ format, with an additional ‘sequential’ test for candidates who fail to meet the screening standard. For those tested twice, overall pass/fail decisions are then based on results on the full sequence of tests. In this study, the impacts of sequential assessment on student performance, cost of assessment delivery and overall reliability were modelled using data sourced from a final graduating OSCE in an undergraduate medical degree programme.

Results

Initial modelling using pre‐existing OSCE data predicted significant improvements in reliability in the critical area, reflected in pilot results: 13.5% of students (n = 228) were required to sit the sequential OSCE. One student (0.4%) was identified as representing a false positive result (i.e. under the previous system this student would have passed the OSCE but failed on extended testing). Nine students (3.9%) who would have required OSCE retests under the prior system passed the full sequence and were therefore able to graduate at the normal time without loss of earnings. Overall reliability was estimated as 0.79 for the full test sequence. Significant cost savings were realised.

Conclusions

Sequential testing in OSCEs increases reliability for borderline students because the increased number of observations implies that ‘observed’ student marks are closer to ‘true’ marks. However, the station‐level quality of the assessment needs to be sufficiently high for the full benefits in terms of reliability to be achieved. The introduction of such a system has financial benefits, good validity inferences and has proved acceptable to students and other stakeholders.
Admission criteria and diversity in medical school
Authors: O'Neill Lotte , Vonsild Maria C , Wallstedt Birgitta , Dornan Tim
Published: May 2013

Context

The under‐representation in medical education of students from lower socio‐economic backgrounds is an important social issue. There is currently little evidence about whether changes in admission strategies might increase the diversity of the medical student population. Denmark introduced an ‘attribute‐based’ admission track to make it easier for students who may not be eligible for admission on the ‘grade‐based’ track to be admitted on the basis of attributes other than academic performance. The aim of this research was to examine whether there were significant differences in the social composition of student cohorts admitted via each of the two tracks during the years 2002–2007.

Methods

This prospective cohort study included 1074 medical students admitted during 2002–2007 to the University of Southern Denmark medical school. Of these, 454 were admitted by grade‐based selection and 620 were selected on attributes other than grades. To explore the social mix of candidates admitted on each of the two tracks, respectively, we obtained information on social indices associated with educational attainment in Denmark (ethnic origin, father's education, mother's education, parenthood, parents living together, parent in receipt of social benefits).

Results

Selection strategy (grade‐based or attribute‐based) had no statistically significant effect on the social diversity of the medical student population.

Conclusions

The choice of admission criteria may not be very important to widening access and increasing social diversity in medical schools. Attracting a sufficiently diverse applicant pool may represent a better strategy for increasing diversity in the student population.
Curricular transformations in medical school: an exploration of the promotion of change in Brazil
Authors: Alves Claudia L , Belisário Soraya A , Abreu Daisy M X , Lemos José M C , D'Ávila Luciana S , Goulart Lúcia M H F
Published: May 2013

Context

Curricular transformation is complex and involves many interrelated and influential factors. The idiosyncratic nature of the time‐frame in which curricular change takes place makes it difficult to study these factors systematically. In 2002, the Brazilian government established the Programme of Incentives for Curricular Changes in Medical Schools (PROMED). Nineteen schools participated in the programme and were given resources to finance curricular reforms in an effort to align their course structures with the tenets of the government proposal. This study analyses reforms in coursework among the schools in this cohort in an effort to better understand the impact of such incentive programmes and factors that might influence the degree of impact across institutions.

Methods

We compared data on the schools before and after their participation in PROMED. To facilitate comparison, we used a scheme of axes and vectors to classify the schools according to the profundity of the curricular changes, ranging from the most conservative to the most innovative. The data used for the classification were obtained through document analysis, interviews and focus group discussions.

Results

Different trends were observed for each axis. Important changes were noticed in the pedagogic approach axis, particularly in terms of pedagogic changes, which called for the adoption of active teaching and learning methods. The practice scenarios axis also underwent considerable changes, specifically in terms of primary health care. The vector related to production of knowledge pertaining to health system needs showed fewer changes; none of the schools reached stage 3 (effective fulfilment of an educational innovation).

Conclusions

The PROMED initiative provided considerable support for implementing and consolidating curricular reforms that placed greater emphasis on the needs of society and the health care system. The different trends observed revealed the complexity behind curricular transformation and highlighted the need for the collective construction of curricula with the participation of all groups involved.
Functional dissection and evidence for intercellular transfer of the heterocyst‐differentiation PatS morphogen
Authors: Corrales‐Guerrero Laura , Mariscal Vicente , Flores Enrique , Herrero Antonia
Published: May 2013

The formation of a diazotrophic cyanobacterial filament represents a simple example of biological development. In Anabaena, a non‐random pattern of one nitrogen‐fixing heterocyst separated by about 10 photosynthetic vegetative cells results from lateral inhibition elicited by the cells differentiating into heterocysts. Key to this process is the patS gene, which has been shown to produce an inhibitor of heterocyst differentiation that involves the C‐terminal RGSGR pentapeptide. Complementation of a ΔpatS Anabaena mutant with different versions of PatS, including point mutations or tag fusions, showed that patS is translated into a 17‐amino acid polypeptide. Alterations in the N‐terminal part of PatS produced inhibition of heterocyst differentiation, thus this part of the peptide appears necessary for proper processing and self‐immunity in the producing cells. Alterations in the C‐terminal part of PatS led to over‐differentiation, thus supporting its role in inhibition of heterocyst differentiation. A polypeptide, produced in proheterocysts, consisting of a methionine followed by the eight, but not the five, terminal amino acids of PatS recreated the full activity of the native peptide. Immunofluorescence detection showed that an RGSGR‐containing peptide accumulated in the cells adjacent to the producing proheterocysts, illustrating intercellular transfer of a morphogen in the cyanobacterial filaments.
Taken for granted: normalizing nurses' work in hospitals
Authors: Urban Ann‐Marie
Published: May 2013

The aim of this article is to add to the research surrounding nurses' work in hospitals. Throughout history, nurses have faced adverse working conditions, an aspect of their work that remains remarkably unchanged today. Prevailing historical ideologies and sociopolitical conditions influences the context of nurses' work in contemporary hospitals. This research revealed how ruling patriarchal power and nurses' altruistic ways normalize the conditions in hospitals as nurses' work. Moving discourses further add to the work of nurses in hospitals. For example, cost containment strategies, overcapacity and short staffing have resulted in practices to accommodate these problems. While contemporary hospitals may look different, clearly, inside, little has changed since the early days; hospital issues have clearly become an ordinary part of nurses' work. This article discusses how the conditions in hospitals have become an ordinary part of nurses' work. The research in this article emphasizes how prevailing ideologies and institutional discourses make invisible and taken‐for‐granted, how this normalizing of nurses' work contributes to sustaining the hospital's power.
Bifidobacterium longum NCC3001 inhibits AH neuron excitability
Authors: Khoshdel A. , Verdu E. F. , Kunze W. , McLean P. , Bergonzelli G. , Huizinga J. D.
Published: May 2013

Background

Bifidobacterium longum (B. longum) NCC3001 can affect behavior and brain biochemistry, but identification of the cellular targets needs further investigation. Our hypothesis was that the communication with the brain might start with action on enteric sensory neurons.

Methods

Ileal segments from adult mice were used to create a longitudinal muscle‐myenteric‐plexus preparation to expose sensory after‐hyperpolarizing (AH) neurons in the myenteric plexus to allow access with microelectrodes. The intrinsic excitability of AH neurons was tested in response to the perfusion of conditioned media (B. longum culture supernatant) or unconditioned media (growth medium, MRS).

Key Results

B. longum conditioned medium significantly reduced the excitability of AH neurons compared to perfusion with the unconditioned medium. Specifically, a reduction was seen in the number of action potentials fired per depolarizing test pulse, the instantaneous and time‐dependent input resistances and the magnitude of the hyperpolarization‐activated cationic current (Ih).

Conclusions & Inferences

The probiotic B. longum reduces excitability of AH sensory neurons likely via opening of potassium channels and closing of hyperpolarization‐activated cation channels.
Glucose‐induced incretin hormone release and insulin sensitivity are impaired in patients with idiopathic gastroparesis: results from a pilot descriptive study
Authors: Prévost G. , Ducrotté P. , Cailleux A. , Khalfi K. , Basuyau J. P. , Lefebvre H. , Kuhn J. M.
Published: May 2013

Background

Incretin hormones [glucagon‐like peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic peptide (GIP)] released by the gut modulate gastrointestinal motility and influence gastric emptying (GE). Abnormal secretion or sensitivity to these hormones could contribute to the pathogenesis of gastroparesis. The aim of this study was to investigate incretin hormone secretion during a prolonged oral glucose load in non‐diabetic patients with documented idiopathic gastroparesis.

Methods

Fifteen patients referred for digestive postprandial discomfort with delayed GE demonstrated by a 13C‐labeled octanoate breath test were included and compared with 10 healthy controls. A 75 g oral glucose load was performed, with blood samplings every 30 min for 5 h, to determine glucose, insulin, GIP, and GLP‐1 blood levels.

Key Results

Fasting GIP concentration was significantly higher in the patient group (56.1 ± 5.8 pg mL−1 vs 29.9 ± 7.7 pg mL−1, P =0.012). Postglucose load GIP concentrations were also significantly elevated in patients with gastroparesis, whereas GLP‐1 concentrations during fasting and postglucose load conditions were not different to those of healthy controls. Moreover, glucose tolerance during glucose load was abnormal in patients, combining hyperglycemic insulin resistance and hyperinsulinism patterns, while fasting values for glycemia, insulin sensitivity, and insulin concentrations were normal.

Conclusions & Inferences

Patients with idiopathic gastroparesis exhibit abnormal GIP levels associated with impaired insulin sensitivity during oral glucose load. Further studies are needed to establish the involvement of these defects in the pathophysiology of gastroparesis.
Impact of intestinal electrical stimulation on nutrient‐induced GLP‐1 secretion in vivo
Authors: Sandoval D. , Dunki‐Jacobs A. , Sorrell J. , Seeley R. J. , D'Alessio D. D.
Published: May 2013

Background

Increases in L‐cell release of GLP‐1 are proposed to serve as a negative feedback signal for postprandial changes in gastric emptying and/or motility. Previous ex vivo data suggests that direct electrical stimulation (E‐stim) of ileal segments stimulates secretion of GLP‐1. This suggests potential feed‐forward increases in GLP‐1 driven by intestinal neuronal and/or motor activity.

Methods

To determine if E‐stim could increase GLP‐1 levels in an in vivo setting, we administered E‐stim and nutrients to male Long‐ Evans rats (300–350 g) under general anesthesia.

Key Results

Nutrient infusion into the duodenum or ileum significantly increased plasma GLP‐1 levels, but E‐stim applied to these locations did not (P < 0.05). However, the combination of E‐stim and nutrient infusion, in either the ileum or duodenum, significantly increased plasma GLP‐1 when compared to nutrient infusion alone (P < 0.05), and this effect was not blocked by either norepinephrine or atropine. To test the impact of intestinal motor activity, the effect of extra‐luminal mechanical stimulation (M‐stim) on GLP‐1 levels was assessed. In the duodenum, but not the ileum, M‐stim plus nutrient infusion significantly increased GLP‐1 over nutrient infusion or M‐stim alone (P < 0.05).

Conclu‐sions & Inferences

Thus, both E‐ and M‐stim of the duodenum, but only E‐stim of the ileum augmented nutrient‐stimulated GLP‐1 release. These data demonstrate that factors beyond enteral nutrients could contribute to the regulation of GLP‐1 secretion.
A randomised clinical trial to assess the effect of a dual treatment on myopia progression: The Cambridge Anti‐Myopia Study
Authors: Allen Peter M , Radhakrishnan Hema , Price Holly , Rae Sheila , Theagarayan Baskar , Calver Richard I , Sailoganathan Ananth , Latham Keziah , O'Leary Daniel J
Published: May 2013

Purpose

To evaluate the effect of a dual treatment modality for myopia, by improving accommodative functions, on myopia progression.

Methods

A double blind randomised control trial was conducted on 96 subjects. The treatment modality for the trial employed custom designed contact lenses which control spherical aberration in an attempt to optimise static accommodation responses during near‐work, and a vision‐training programme to improve accommodation dynamics. Myopia progression was assessed over a 2 year period using cycloplegic autorefraction and biometry.

Results

The mean progression was found to be −0.33 Dioptres (D) over the 2 years of the study. There was no interaction between contact lens treatment and vision training treatment at 24 months (p = 0.72). There was no significant treatment effect of either Vision Training or Contact Lens Spherical Aberration control on myopia progression.

Conclusions

This study is unable to demonstrate that the progression of myopia can be reduced over a 2 year period by either of the two treatments aimed at improving accommodative function. Neither treatment group (contact lens or vision training) progressed at a slower rate over the 2 years of the study than did the appropriate control group.
Nearwork‐induced transient myopia (NITM) in anisometropia
Authors: Lin Zhong , Vasudevan Balamurali , Liang Yuan Bo , Zhang Yi Cao , Zhao Shi Qiang , Yang Xiao Dong , Wang Ning Li , Gilmartin Bernard , Ciuffreda Kenneth J
Published: May 2013

Objective

To assess the magnitude of nearwork‐induced transient myopia (NITM) under binocular viewing conditions separately in each eye of individuals with mild to moderate anisometropia to determine the relationship between NITM and their interocular refractive error.

Methods

Forty‐three children and young adults with anisometropia [cycloplegic spherical equivalent (SE) difference >1.00 D] were tested (ages 9–28 years). NITM was measured with binocular viewing separately in each eye after binocularly performing a sustained near task (5 D) for 5 min incorporating a cognitive demand using an open‐field, infrared autorefractor (Grand‐Seiko, WAM‐5500). Data were averaged over 10 s bins for 3 min in each eye. Initial NITM, its decay time (DT), and its decay area (DA) were determined. A‐scan ultrasound ocular biometry was also performed to determine the axial length of each eye.

Results

The more myopic eye exhibited increased initial NITM, DT, and DA as compared to the less myopic eye (0.21 ± 0.16 D vs 0.15 ± 0.13 D, p = 0.026; 108.4 ± 64.3 secs vs 87.0 ± 65.2 secs, p = 0.04; and 17.6 ± 18.7 D*secs vs 12.3 ± 15.7 D*secs, p = 0.064), respectively. The difference in DA and the difference in SE between the more versus less myopic eye were significantly correlated (r = 0.31, p = 0.044). Furthermore, 63% (27/43), 56% (24/43), and 70% (30/43) of the more myopic eyes exhibited increased initial NITM, longer DT, and larger DA, respectively, than found in the less myopic eye.

Conclusions

In approximately two‐thirds of the anisometropic individuals, the initial NITM and its decay area were significantly increased in the more myopic eye as compared to the less myopic eye. NITM may play an important role in the development of interocular differences in myopia, although a causal relationship is yet to be established. Furthermore, the findings have potentially important implications regarding accommodative control and interocular accommodative responsitivity in anisometropia, in particular for anisomyopia.
Does sunlight (bright lights) explain the protective effects of outdoor activity against myopia?
Authors: Ngo Cheryl , Saw Seang‐Mei , Dharani Ramamurthy , Flitcroft Ian
Published: May 2013

In the following point‐counterpoint article, internationally‐acclaimed myopia researchers were challenged to defend the two opposing sides of the topic defined by the title; their contributions, which appear in the order, Point followed by Counterpoint, were peer‐reviewed by both the editorial team and an external reviewer. Independently of the invited authors, the named member of the editorial team provided an Introduction and Summary, both of which were reviewed by the other members of the editorial team. By their nature, views expressed in each section of the Point‐Counterpoint article are those of the author concerned and may not reflect the views of all of the authors.
How does atropine exert its anti‐myopia effects?
Authors: McBrien Neville A. , Stell William K. , Carr Brittany
Published: May 2013

In the following point‐counterpoint article, internationally‐acclaimed myopia researchers were challenged to defend the two opposing sides of the topic defined by the title; their contributions, which appear in the order, Point followed by Counterpoint, were peer‐reviewed by both the editorial team and an external reviewer. Independently of the invited authors, the named member of the editorial team provided an Introduction and Summary, both of which were reviewed by the other members of the editorial team. By their nature, views expressed in each section of the Point‐Counterpoint article are those of the author concerned and may not reflect the views of all of the authors.