bluuebunny/crossref_metadata_2025 huggingface dataset:
Mini‐Mental State Examination score trajectories and incident disabling dementia among community‐dwelling older Japanese adults
Authors: Taniguchi Yu , Kitamura Akihiko , Murayama Hiroshi , Amano Hidenori , Shinozaki Tomohiro , Yokota Isao , Seino Satoshi , Nofuji Yu , Nishi Mariko , Yokoyama Yuri , Matsuyama Yutaka , Fujiwara Yoshinori , Shinkai Shoji
Published: March 2017

Aim

The present prospective study used repeated measures analysis to identify potential Mini‐Mental State Examination (MMSE) score trajectories and determine whether MMSE trajectory was associated with incident disabling dementia among community‐dwelling older Japanese adults.

Methods

A total of 1724 non‐demented adults (mean age 71.4 years [SD 5.7]; 56.7% women) aged 65–90 years participated in annual geriatric health assessments during the period from June 2002 through July 2014. The total number of observations was 6755, and the average number of follow‐up assessments was 3.9. A review of municipal databases in the Japanese public long‐term care insurance system showed that 205 (11.9%) participants developed disabling dementia through December 2014.

Results

We identified three distinct MMSE score trajectory patterns (high, middle and low) in adults aged 65–90 years. After adjusting for important confounders, participants with middle (42.8%) and low (5.1%) MMSE trajectories had hazard ratios of 2.46 (95% confidence interval 1.64–3.68) and 10.73 (95% confidence interval 4.91–23.45), respectively, for incident disabling dementia, as compared with those in the high (52.1%) trajectory group.

Conclusions

Approximately half of the participants were classified as having a high MMSE trajectory, whereas 43% and 5% had middle and low MMSE trajectories, respectively, in this population. Individuals with middle and low MMSE trajectories had a higher risk for incident disabling dementia, which suggests that a high‐risk approach to dementia prevention should target people with mild and more rapid cognitive decline. Geriatr Gerontol Int 2017; 17: 1928–1935.
The association between physical activity and cognition in men with and without HIV infection
Authors: Monroe AK , Zhang L , Jacobson LP , Plankey MW , Brown TT , Miller EN , Martin E , Becker JT , Levine AJ , Ragin A , Sacktor NC
Published: March 2017

Objectives

HIV‐associated neurocognitive disorders are highly prevalent, and physical activity (PA) is a modifiable behaviour that may affect neurocognitive function. Our objective was to determine the association between PA and neurocognitive function and the effect of HIV on this association.

Methods

PA was assessed in the Multicenter AIDS Cohort Study with the International Physical Activity Questionnaire. A neuropsychological test battery assessed global impairment and domain‐specific impairment (executive function, speed of processing, working memory, learning, memory, and motor function) every 2 years. Semiannually, the Symbol Digit Modalities Test and Trail Making Test Parts A and B were performed. Adjusted logistic regression models were used to assess the PA–neurocognitive function association. Using longitudinal data, we also assessed the PA category–decline of neurocognitive function association with multivariate simple regression.

Results

Of 601 men, 44% were HIV‐infected. Low, moderate, and high PA was reported in 27%, 25%, and 48% of the HIV‐infected men vs. 19%, 32% and 49% of the HIV‐uninfected men, respectively. High PA was associated with lower odds of impairment of learning, memory, and motor function [odds ratio (OR) ranging from 0.52 to 0.57; P < 0.05 for all]. The high PA–global impairment association OR was 0.63 [95% confidence interval (CI) 0.39, 1.02]. Among HIV‐infected men only, across multiple domains, the high PA–impairment association was even more pronounced (OR from 0.27 to 0.49). Baseline high/moderate PA was not associated with decline of any domain score over time. HIV infection was marginally associated with a higher speed of decline in motor function.

Conclusions

A protective effect of high PA on impairment in neurocognitive domains was observed cross‐sectionally. Longitudinal PA measurements are needed to elucidate the PA–neurocognitive function relationship over time.
Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection
Authors: Brown J , McGowan JA , Chouial H , Capocci S , Smith C , Ivens D , Johnson M , Sathia L , Shah R , Lampe FC , Rodger A , Lipman M
Published: March 2017

Objectives

We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV‐negative individuals.

Methods

We recruited 197 HIV‐positive and 93 HIV‐negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation.

Results

PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6–25] in HIV‐positive subjects vs. 6 (IQR 2–14) in HIV‐negative subjects (P < 0.001); breathlessness was common in the HIV‐positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV‐positive and seven (9%) HIV‐negative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold‐change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14–2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15–5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV‐positive participants with a viral load < 40 HIV‐1 RNA copies/mL.

Conclusions

Despite effective ART, impaired respiratory health appears more common in HIV‐positive adults, and has a significant impact on health‐related quality of life.
“I think the middle class is disappearing”: Crisis perceptions and consumption patterns in Spain
Authors: Alonso Luis Enrique , Fernández Rodríguez Carlos J. , Ibáñez Rojo Rafael
Published: March 2017

The aim of this article is to explore social discourses in Spain on the economic crisis under the scenario of austerity policies and cutbacks. The goal is to explore whether social perceptions have changed throughout the crisis that evolved from the collapse of the housing market bubble to a public deficit and debt problem, leading to record rates of unemployment and a dramatic decline in living standards. The long crisis has left an imprint on Spanish society and it is worthwhile exploring how Spanish citizens reflect upon the crisis. To do so, 18 focus groups were organized in two rounds (2010 and 2014) and the results of those group conversations are discussed and compared here. The analysis shows that the participants elaborated not only on reflections about the crisis and on how it has lowered their consumption levels, but also on their further views about the social structure and change. The notorious pessimism of Spaniards about their future, regardless of their class position, is highlighted in the results. A more critical narrative about the crisis seemed to emerge in 2014, leaving behind the guilt‐laden “living beyond our means” discourses that dominated in 2010.
Cutaneous manifestations of subcutaneous and systemic fungal infections in tropical regions: a retrospective study from a referral center in southern Taiwan
Authors: Tsai Wen‐Chien , Lee Chih‐Hung , Wu Wei‐Min , Lin Shang‐Hung , Yang Yi‐Chien , Cheng Yu‐Wen , Ho Ji‐Chen , Liu Kwei‐Lan
Published: March 2017

Background

Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions.

Methods

We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes.

Results

The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long‐term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal.

Conclusions

Diabetes and long‐term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.
Two‐year‐old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy
Authors: Sugino Teruaki , Hamamoto Shuzo , Unno Rei , Moritoki Yoshinobu , Hamakawa Takashi , Naiki Taku , Ando Ryosuke , Okada Atsushi , Yasui Takahiro
Published: March 2017

Impacted stones frequently cause changes in the ureter, including edema of the ureteral wall, stone embedding in the ureteral mucosa or ureteral bending, which often preclude spontaneous passing of the stone and increase the risk of complications during surgery. When stone impaction is suspected preoperatively, management should be adapted accordingly. However, surgical treatment strategies remain controversial in pediatric patients because of the scarcity of cases reported. We describe the case of a 2‐year‐old girl with a right impacted ureteral stone who presented with gross hematuria and pyuria, but no metabolic risk factors or hematological abnormalities. Ureteroscopy was carried out in the presence of a percutaneous nephrostomy catheter. At the 7‐month follow up, hydronephrosis had improved from grade 3 to grade 1, and the ureter was free from residual or recurrent stones. No complications were noted. We believe that percutaneous nephrostomy before the lithotripsy facilitates treatment for impacted stones in pediatric patients.
Does digital rectal examination predict prostate volume greater than 30 mL?
Authors: Yamamoto Takanobu , Fukuta Fumimasa , Masumori Naoya
Published: March 2017

Objectives

To investigate the accuracy of digital rectal examination in estimating prostate volume in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.

Methods

A community‐based study was carried out in Japan to investigate the prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. A total of 457 men were screened and deemed eligible for the present analysis. Findings on digital rectal examination were compared with prostate volume measurement by transrectal ultrasound. Five groups were identified on digital rectal examination: flat, normal, slightly enlarged, moderately enlarged and markedly enlarged.

Results

The median age and prostate volume were 64 years and 19.7 mL, respectively. Prostate volumes for the flat, normal, slightly enlarged, moderately enlarged, and markedly enlarged groups were 16.4, 18.3, 27.0, 41.9 and 86.3 mL, respectively. There were significant differences in prostate volume between the groups. The positive predictive value was 94.1% if flat, and normal were assumed to have a prostate volume <30 mL. The value was 80.8% if moderately enlarged, and markedly enlarged were assumed to have a prostate volume ≥30 mL. Of the men in the slightly enlarged group, 61.0% had a prostate volume <30 mL.

Conclusions

It is possible to stratify prostate volume according to digital rectal examination. We could determine the prostates in the flat and normal groups to have a prostate volume <30 mL, and those in the moderately enlarged and markedly enlarged groups to have a prostate volume ≥30 mL by digital rectal examination with high accuracy. Transrectal ultrasound was required for those in the slightly enlarged group.
Nurses experiences of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature
Authors: Wyder Marianne , Ehrlich Carolyn , Crompton David , McArthur Leianne , Delaforce Caroline , Dziopa Fiona , Ramon Shulamit , Powell Elizabeth
Published: March 2017

Inpatient psychiatric care requires a balance between working with consumers' priorities and goals, managing expectations of the community, legal, professional and service responsibilities. In order to improve service delivery within acute mental health units, it is important to understand the constraints and facilitating factors for good care. We conducted a systematic narrative synthesis, where findings of qualitative studies are synthesised to generate new insights. 21 articles were identified. Our results show that personal qualities, professional skills as well as environmental factors all influence the ability to provide recovery focused care. Three overarching themes which either facilitated or hindered were identified. These included: (i) Complexity of the nursing role (clinical care; practical and emotional support: advocacy and education; enforcing aspects of the Mental Health Act. and, maintaining ward safety); (ii) Constraining factors (operational barriers; change in patient characteristic; and competing understandings of care); and (iii) Facilitating factors (ward factors; nursing tools; nurse characteristics; approach to people; approach to work and ability to self‐care). We suggest that the therapeutic use of self is central to the provision of recovery oriented care. However person‐centred practice can be fragile and fluid and a compassionate system of support is needed to enable an understanding of context and self. It is critical to have a work environment which fosters hope and optimism and is supportive of autonomy, ensures workload balance, and is safe.
Quantification of the impacts of climate warming and crop management on canola phenology in Punjab, Pakistan
Authors: Ahmad S. , Abbas G. , Fatima Z. , Khan R. J. , Anjum M. A. , Ahmed M. , Khan M. A. , Porter C. H. , Hoogenboom G.
Published: March 2017

Yield is influenced by the length of the growing season, which is affected by weather conditions and management practices of a crop, including sowing dates and shifting of cultivars. It is necessary to understand the effects of agronomic management practices and weather variables on phenological stages and crop phases in order to develop strategies for adaptation of agricultural systems to changes in climatic conditions. The goal of this study was to determine the impact of warming trends on phenology of canola from 1980 to 2014 for central and southern Punjab, Pakistan. Sowing, emergence, anthesis and physiological maturity dates were delayed by an average of 6.02, 3.14, 3.31 and 1.89 days per decade, respectively. The duration of sowing to anthesis, sowing to physiological maturity and anthesis to physiological maturity phases decreased an average 2.71, 4.13 and 1.42 days per decade, respectively, for all 10 locations that were analysed in this study. The sowing, emergence, anthesis and physiological maturity dates were positively correlated with an increase in temperature by an average 2.71, 1.41, 1.49 and 0.85 days per °C, respectively. However, the phenological phases such as sowing to anthesis, anthesis to maturity and sowing to maturity were negatively correlated with an increase in temperature by an average of 1.22, 0.64 and 1.86 days per °C, respectively, for all 10 locations. Applying a process‐based CSM‐CROPGRO‐Canola model using a standard cultivar (field tested) for all locations and years indicated that the simulated phenological stages occurred earlier due to the warming trend compared to the observed phenological stages. One‐quarter of the negative effects of this thermal trend was compensated by growing new cultivars that had higher thermal time requirements. Therefore, new canola genotypes with a higher number of growing degree day requirement and high temperature tolerance should be a priority for evolving new cultivars.
Comparison of osmotic adjustment, leaf proline concentration, canopy temperature and root depth for yield of juncea canola under terminal drought
Authors: Pandey B. R. , Burton W. A. , Salisbury P. A. , Nicolas M. E.
Published: March 2017

Two glasshouse and two field experiments were conducted in 2013 and 2014 to compare the relative importance of four physiological traits: osmotic adjustment (OA), leaf proline concentration, canopy temperature depression (CTD) and root depth on drought performance of canola quality B. juncea (juncea canola). Glasshouse experiments were conducted at The University of Melbourne, Parkville, and field experiments were conducted at Horsham, Victoria. The experiments used juncea canola hybrids and their parental lines and were laid out in a randomised complete block design with three replications. The glasshouse experiments consisted of two treatments, well watered and water deficit from first open flower to maturity, whereas the field experiments were sown at a site that received 266 mm annual rainfall in 2014. In the glasshouse, canopy temperature depression was the only trait to show a positive and consistent association with drought performance of juncea canola. Cooler canopy temperature was also associated with improved yield in field experiments. Root depth was positively correlated with CTD in 2014 in glasshouse, whereas no correlation of root depth with OA and leaf proline was observed. The results indicated that CTD was the only reliable trait among those tested to screen juncea canola for drought tolerance. Root depth of juncea canola hybrids was a constitutive trait and probably was a result of hybrid vigour.
A Pedagogy of the Concept: Rereading an Architectural Convention through the Philosophy of Deleuze and Guattari
Authors: Teal Randall , Loo Stephen
Published: March 2017

In this article, we seek to unpack and enrich the notion of the design concept. We do this through the use of Gilles Deleuze and Felix Guattari's ‘concept’ in its philosophical specificity to critique less‐effective uses of the design concept. In particular, we investigate the idea that a concept is actually an aggregation of many concepts that can be seen to have a virtual consistency as a way to reframing more limited, typical, design concepts – used as justification, explanation, clarification or excuse. Our interest here is to explore how concepts can become much more useful throughout the process of design by drawing linkages between the concept and the workings of the creative process itself. In other words, we see the concept, parsed philosophically, as fusing with design thinking; and by taking advantage of this coupling each strengthens the other. Ultimately, we claim that a richer view of language and a more perfomative processes of making (diagramming) drive this coupling; and when it is working, the design concept becomes a much more useful instrument for designing.
Estimation of genetic parameters for functional longevity in the South African Holstein cattle using a piecewise Weibull proportional hazards model
Authors: Imbayarwo‐Chikosi V.E. , Ducrocq V. , Banga C.B. , Halimani T.E. , van Wyk J.B. , Maiwashe A. , Dzama K.
Published: March 2017

Non‐genetic factors influencing functional longevity and the heritability of the trait were estimated in South African Holsteins using a piecewise Weibull proportional hazards model. Data consisted of records of 161,222 of daughters of 2,051 sires calving between 1995 and 2013. The reference model included fixed time‐independent age at first calving and time‐dependent interactions involving lactation number, region, season and age of calving, within‐herd class of milk production, fat and protein content, class of annual variation in herd size and the random herd–year effect. Random sire and maternal grandsire effects were added to the model to estimate genetic parameters. The within‐lactation Weibull baseline hazards were assumed to change at 0, 270, 380 days and at drying date. Within‐herd milk production class had the largest contribution to the relative risk of culling. Relative culling risk increased with lower protein and fat per cent production classes and late age at first calving. Cows in large shrinking herds also had high relative risk of culling. The estimate of the sire genetic variance was 0.0472 ± 0.0017 giving a theoretical heritability estimate of 0.11 in the complete absence of censoring. Genetic trends indicated an overall decrease in functional longevity of 0.014 standard deviation from 1995 to 2007. There are opportunities for including the trait in the breeding objective for South African Holstein cattle.
Difference in evening home blood pressure between before dinner and at bedtime in Japanese elderly hypertensive patients
Authors: Fujiwara Takeshi , Hoshide Satoshi , Nishizawa Masafumi , Matsuo Takefumi , Kario Kazuomi
Published: March 2017

The authors evaluated the differences between evening home blood pressure (HBP) readings taken before dinner and those taken at bedtime, which were documented in a European and a Japanese guideline, respectively. Forty‐eight patients (mean age, 76.4 years) measured their evening HBP twice each day (two measurements both before dinner and at bedtime) for 14 days. The authors defined the at‐bedtime (B) minus the before‐dinner (D) systolic HBP as the B‐D difference. The mean B‐D difference was −8.7 mm Hg (P<.001). The depressor effect of bathing was significantly prolonged for 120 minutes. The B‐D difference with alcohol consumption was significantly greater than that without alcohol. In the linear mixed model analysis, time after bathing ≤120 minutes and alcohol consumption were significantly associated with the B‐D difference after adjustment with covariates. There was a marked difference between evening HBP values. When patients' evening HBP is measured according to the guidelines, their daily activities should be considered.
Correlating the relationship between interarm systolic blood pressure and cardiovascular disease risk factors
Authors: Ma Wei , Zhang Baowei , Yang Ying , Qi Litong , Meng Lei , Zhang Yan , Huo Yong
Published: March 2017

Interarm systolic blood pressure difference (IASBPD) can predict cardiovascular disease. To investigate the relationship between IASBPD and cardiovascular disease risk factors, a total of 1426 individuals were studied. Blood pressure was assessed simultaneously and IASBPD was expressed as the absolute difference value (|R−L|). Cardiovascular disease risk factors were compared between the high IASBPD group (IASBPD ≥10 mm Hg) and the normal IASBPD group (IASBPD <10 mm Hg). An increased prevalence of hypertension, body mass index, and systolic and diastolic blood pressure were observed in the high IASBPD group (P<.05), associated with the enhanced mean values of intima–media thickness and maximum intima–media thickness (P<.05). Brachial‐ankle pulse wave velocity was increased, while ankle‐brachial index was lower in the high IASBPD group (P<.05). Multivariate logistic regression analysis revealed that IASBPD ≥10 mm Hg was positively associated with body mass index (odds ratio, 1.077; P=.002) and systolic blood pressure (odds ratio, 1.032; P<.001), and negatively associated with ankle‐brachial index (odds ratio, 0.038; P<.001).
Tyrphostin AG556 increases the activity of large conductance Ca2+‐activated K+ channels by inhibiting epidermal growth factor receptor tyrosine kinase
Authors: Wang Yan , Sun Hai‐Ying , Liu Ying‐Guang , Song Zheng , She Gang , Xiao Guo‐Sheng , Wang Yan , Li Gui‐Rong , Deng Xiu‐Ling
Published: March 2017

The present study was designed to investigate whether large conductance Ca2+‐activated K+ (BK) channels were regulated by epidermal growth factor (EGF) receptor (EGFR) tyrosine kinase. BK current and channel tyrosine phosphorylation level were measured in BK‐HEK 293 cells expressing both functional α‐subunits and the auxiliary β1‐subunits using electrophysiology, immunoprecipitation and Western blotting approaches, respectively, and the function of rat cerebral basilar arteries was determined with a wire myography system. We found that BK current in BK‐HEK 293 cells was increased by the broad spectrum protein tyrosine kinase (PTK) inhibitor genistein and the selective EGFR tyrosine kinase inhibitor AG556, one of the known tyrphostin. The effect of genistein or AG556 was antagonized by the protein tyrosine phosphatase (PTP) inhibitor orthovanadate. On the other hand, orthovanadate or EGF decreased BK current, and the effect was counteracted by AG556. The tyrosine phosphorylation level of BK channels (α‐ and β1‐subunits) was increased by EGF and orthovanadate, while decreased by genistein and AG556, and the reduced tyrosine phosphorylation of BK channels by genistein or AG556 was reversed by orthovanadate. Interestingly, AG556 induced a remarkable enhancement of BK current in rat cerebral artery smooth muscle cells and relaxation of pre‐contracted rat cerebral basilar arteries with denuded endothelium, and these effects were antagonized by the BK channel blocker paxilline or orthovanadate. These results demonstrate that tyrosine phosphorylation of BK channels by EGFR kinase decreases the channel activity, and inhibition of EGFR kinase by AG556 enhances the channel activity and dilates rat cerebral basilar arteries.
Diabetic polyneuropathy is a risk factor for decline of lower extremity strength in patients with type 2 diabetes
Authors: Nomura Takuo , Ishiguro Tomoyasu , Ohira Masayoshi , Ikeda Yukio
Published: March 2017

Aims/Introduction

The present study elucidated the effect of diabetic polyneuropathy (DPN) on lower extremity strength in a wide age range of type 2 diabetes patients.

Materials and Methods

Participants (n = 1,442) were divided into three age groups (30–49 years, 50–69 years and 70–87 years), and comparisons were made separately for each sex. Lower extremity strength was measured in terms of knee extension force (KEF) with a hand‐held dynamometer. KEF was compared according to the presence or absence of DPN. Furthermore, the effect of DPN on KEF with other diabetic complications (diabetic retinopathy and diabetic nephropathy), diabetes status (diabetes duration and glycated hemoglobin) and habitual behavior (regular exercise, smoking and drinking behaviors) as explanatory variables was analyzed using multiple regression analysis in several models.

Results

The frequency of DPN differed among age groups, ranging from 14.3 to 49.6%, and increasing with age. There was no significant difference in KEF between patients aged 30–49 years with and without DPN. However, among both men and women aged 50–69 years and 70–87 years, patients with DPN showed significantly diminished KEF (11.0–12.9% and 11.9–16.6%, respectively) compared with those without DPN (P < 0.01–0.001). In women aged 50–69 years and 70–87 years, and in men aged 50–69 years, DPN was a significant explanatory variable for KEF in all multiple regression analysis models.

Conclusion

DPN might reinforce a KEF decline in middle‐aged and elderly type 2 diabetes patients.
Dipeptidyl peptidase‐4 inhibitors as preferable oral hypoglycemic agents in terms of treatment satisfaction: Results from a multicenter, 12‐week, open label, randomized controlled study in Japan (PREFERENCE 4 study)
Authors: Ishii Hitoshi , Hayashino Yasuaki , Akai Yasuhiro , Yabuta Matahiro , Tsujii Satoru
Published: March 2017

Aims/Introduction

To compare the treatment satisfaction of four classes of oral hypoglycemic agents (OHAs): dipeptidyl peptidase‐4 (DPP‐4) inhibitors, α‐glucosidase inhibitors (αGI), biguanides (BG) and sulfonylureas (SU), which are common initial treatments for type 2 diabetes mellitus patients in Japan, and to identify the best oral hypoglycemic agent in terms of treatment satisfaction.

Materials and Methods

In this 12‐week, randomized, controlled, open‐label study, Japanese outpatients with type 2 diabetes mellitus who were naïve to pharmacological treatment were randomly assigned a DPP‐4 inhibitor, a BG., an αGI or a SU. The primary end‐point was the Oral Hypoglycemic Agent Questionnaire (OHA‐Q) total and subscale scores (treatment convenience, somatic symptoms and satisfaction) at week 4. Adherence, glycated hemoglobin (HbA1c) level and safety were also evaluated.

Results

The DPP‐4 inhibitor group scored highest in the OHA‐Q total and all subscale scores at week 4. The total score was significantly higher in the DPP‐4 inhibitor group than in the BG or αGI groups (P = 0.0084 and 0.0147, respectively). The mean total score at week 12 was also highest in the DPP‐4 inhibitor group, with a significant difference compared with the αGI group (P = 0.0293). The mean HbA1c decreased from baseline to week 12 in all groups. The DPP‐4 inhibitor group had the highest adherence at weeks 4 and 12. A total of 11 patients reported adverse events, including one hypoglycemic event in the SU group.

Conclusions

The DPP‐4 inhibitor was the most preferable option in terms of treatment satisfaction.
Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs
Authors: Nichols Linda O. , Martindale‐Adams Jennifer , Zhu Carolyn W. , Kaplan Erin K. , Zuber Jeffrey K. , Waters Teresa M.
Published: March 2017

Objective

Examine caregiver and care recipient healthcare costs associated with caregivers’ participation in Resources for Enhancing Alzheimer's Caregivers Health (REACH II or REACH VA) behavioral interventions to improve coping skills and care recipient management.

Design

RCT (REACH II); propensity‐score matched, retrospective cohort study (REACH VA).

Setting

Five community sites (REACH II); 24 VA facilities (REACH VA).

Participants

Care recipients with Alzheimer's disease and related dementias (ADRD) and their caregivers who participated in REACH II study (analysis sample of 110 caregivers and 197 care recipients); care recipients whose caregivers participated in REACH VA and a propensity matched control group (analysis sample of 491).

Measurements

Previously collected data plus Medicare expenditures (REACH II) and VA costs plus Medicare expenditures (REACH VA).

Results

There was no increase in VA or Medicare expenditures for care recipients or their caregivers who participated in either REACH intervention. For VA care recipients, REACH was associated with significantly lower total VA costs of care (33.6%). VA caregiver cost data was not available.

Conclusion

In previous research, both REACH II and REACH VA have been shown to provide benefit for dementia caregivers at a cost of less than $5/day; however, concerns about additional healthcare costs may have hindered REACH's widespread adoption. Neither REACH intervention was associated with additional healthcare costs for caregivers or patients; in fact, for VA patients, there were significantly lower healthcare costs. The VA costs savings may be related to the addition of a structured format for addressing the caregiver's role in managing complex ADRD care to an existing, integrated care system. These findings suggest that behavioral interventions are a viable mechanism to support burdened dementia caregivers without additional healthcare costs.
Coordinating Monetary and Macroprudential Policies
Authors: PAOLI BIANCA DE , PAUSTIAN MATTHIAS
Published: March 2017

This paper studies noncooperative games between a monetary authority and a macroprudential regulator whose objectives are a subset of those in the social loss function. The analysis is based on a New Keynesian model with a financial sector and a financial friction à la Gertler and Karadi (2011). When the friction affects the financing of all factors of production equally, macroprudential policy is shown to be a powerful additional tool, fully eliminating inefficiencies, regardless of the source of the shock and no matter whether the central bank and the regulator cooperate. But when trade‐offs are present and policy is discretionary, the institutional arrangements become crucial. While coordination leads to higher welfare than a setting in which each authority takes the decision rule of the other as given (namely, the Nash equilibrium), our analysis shows that a noncooperative setting in which the macroprudential authority acts as a leader within the period can be superior to cooperation. Finally, our conclusions are unaffected by whether the macroprudential instrument affects funding costs or acts as a liquidity requirement.
When Preferences for a Stable Interest Rate Become Self‐Defeating
Authors: ALSTADHEIM RAGNA , RØISLAND ØISTEIN
Published: March 2017

Monetary policymakers often seem to have preferences for a stable interest rate, in addition to stable inflation and output. In this paper, we investigate the implications of having an interest rate level term in the loss function when the policymaker lacks commitment technology. We show that such preferences may become self‐defeating, in the sense that they generate a less stable interest rate than in the case without preferences for interest rate stability.
Regime Shifts in Price‐Dividend Ratios and Expected Stock Returns: A Present‐Value Approach
Authors: CHOI KWANG HUN , KIM CHANG‐JIN , PARK CHEOLBEOM
Published: March 2017

We incorporate regime shifts in the mean of price‐dividend ratios into the present value model of van Binsbergen and Koijen (2010) who propose a latent variable approach to modeling expected returns and dividend growth rates. We find that accounting for regime shifts results in much lower persistence of expected returns and higher volatility of expected returns, and thus higher in‐sample predictability, when compared to the results from the van Binsbergen and Koijen (2010) model. We also show that the main source of the increase in the mean of price‐dividend ratios in the mid‐1990s is a decrease in the mean of expected returns.
Financial Markets' Views about the Euro–Swiss Franc Floor
Authors: JERMANN URBAN J.
Published: March 2017

Exchange rates and option prices incorporate market participants' views about the credibility and the effects of exchange rate targets. I present a model to determine exchange rates under policy targets that can be used to price options. The model is estimated with Euro–Swiss Franc exchange rate and options price data. In the first few months of the minimum exchange rate policy, the implied survival probability of the policy for a 3‐month horizon was typically less than 75%. Over time, the credibility increased and this probability reached 95% in August 2014.
Relational Family Therapy as an Aid Toward Resolving the Trauma of Sexual Abuse in Childhood in the Process of Separation in the Couple Relationship
Authors: Repič Slavič Tanja , Gostečnik Christian
Published: March 2017

Relational family therapy (RFT) is a psycho‐organic therapeutic approach that combines intrapsychic dynamics with interpersonal mechanisms and a systemic perspective. This integrative model is based on the assumption that the repetitive patterns of relationships in early childhood repeat in adulthood. It often happens that a sexually abused individual will later unconsciously be attracted to someone with whom they will relive the abusive atmosphere and dynamics from childhood. The purpose of this contribution is to present the RFT approach for dealing with sexual abuse. We will present a case study with individual segments from therapy with a woman, who previously had been sexually abused and was separated from her partner.
The P–T–t evolution of the exhumed Himalayan metamorphic core in the Likhu Khola region, East Central Nepal
Authors: Shrestha S. , Larson K. P. , Guilmette C. , Smit M. A.
Published: March 2017

The recent identification of multiple strike‐parallel discontinuities within the exhumed Himalayan metamorphic core has helped revise the understanding of convergence accommodation processes within the former mid‐crust exposed in the Himalaya. Whilst the significance of these discontinuities to the overall development of the mountain belt is still being investigated, their identification and characterization has become important for potential correlations across regions, and for constraining the kinematic framework of the mid‐crust. The result of new phase equilibria modelling, trace element analysis and high‐precision Lu–Hf garnet dating of the metapelites from the Likhu Khola region in east central Nepal, combined with the previously published monazite petrochronology data confirms the presence of one of such cryptic thrust‐sense tectonometamorphic discontinuities within the lower portion of the exhumed metamorphic core and provides new constraints on the P–T estimates for that region. The location of the discontinuity is marked by an abrupt change in the nature of P–T–t paths of the rocks across it. The rocks in the footwall are characterized by a prograde burial P–T path with peak metamorphic conditions of ~660°C and ~9.5 kbar likely in the mid‐to‐late Miocene, which are overlain by the hanging wall rocks, that preserve retrograde P–T paths with P–T conditions of >700°C and ~7 kbar in the early Miocene. The occurrence of this thrust‐sense structure that separates rock units with unique metamorphic histories is compatible with orogenic models that identify a spatial and temporal transition from early midcrustal deformation and metamorphism in the deeper hinterland to later deformation and metamorphism towards the shallower foreland of the orogen. Moreover, these observations are comparable with those made across other discontinuities at similar structural levels along the Himalaya, confirming their importance as important orogen‐scale structures.
Adenosine production by brain cells
Authors: Jackson Edwin K. , Kotermanski Shawn E. , Menshikova Elizabeth V. , Dubey Raghvendra K. , Jackson Travis C. , Kochanek Patrick M.
Published: March 2017

The early release of adenosine following traumatic brain injury (TBI) suppresses seizures and brain inflammation; thus, it is important to elucidate the cellular sources of adenosine following injurious stimuli triggered by TBI so that therapeutics for enhancing the early adenosine‐release response can be optimized. Using mass spectrometry with 13C‐labeled standards, we investigated in cultured rat neurons, astrocytes, and microglia the effects of oxygen‐glucose deprivation (OGD; models energy failure), H2O2 (produces oxidative stress), and glutamate (induces excitotoxicity) on intracellular and extracellular levels of 5′‐AMP (adenosine precursor), adenosine, and inosine and hypoxanthine (adenosine metabolites). In neurons, OGD triggered increases in intracellular 5′‐AMP (2.8‐fold), adenosine (2.6‐fold), inosine (2.2‐fold), and hypoxanthine (5.3‐fold) and extracellular 5′‐AMP (2.2‐fold), adenosine (2.4‐fold), and hypoxanthine (2.5‐fold). In neurons, H2O2 did not affect intracellular or extracellular purines; yet, glutamate increased intracellular adenosine, inosine, and hypoxanthine (1.7‐fold, 1.7‐fold, and 1.6‐fold, respectively) and extracellular adenosine, inosine, and hypoxanthine (2.9‐fold, 2.1‐fold, and 1.6‐fold, respectively). In astrocytes, neither H2O2 nor glutamate affected intracellular or extracellular purines, and OGD only slightly increased intracellular and extracellular hypoxanthine. Microglia were unresponsive to OGD and glutamate, but were remarkably responsive to H2O2, which increased intracellular 5′‐AMP (1.6‐fold), adenosine (1.6‐fold), inosine (2.1‐fold), and hypoxanthine (1.6‐fold) and extracellular 5′‐AMP (5.9‐fold), adenosine (4.0‐fold), inosine (4.3‐fold), and hypoxanthine (1.9‐fold). Conclusion: Under these particular experimental conditions, cultured neurons are the main contributors to adenosine production/release in response to OGD and glutamate, whereas cultured microglia are the main contributors upon oxidative stress. Developing therapeutics that recruit astrocytes to produce/release adenosine could have beneficial effects in TBI.

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Copper increases the ability of 6‐hydroxydopamine to generate oxidative stress and the ability of ascorbate and glutathione to potentiate this effect: potential implications in Parkinson's disease
Authors: Cruces‐Sande Antón , Méndez‐Álvarez Estefanía , Soto‐Otero Ramón
Published: March 2017

Copper is an essential metal for the function of many proteins related to important cellular reactions and also involved in the synaptic transmission. Although there are several mechanisms involved in copper homeostasis, a dysregulation in this process can result in serious neurological consequences, including degeneration of dopaminergic neurons. 6‐Hydroxydopamine is a dopaminergic neurotoxin mainly used in experimental models of Parkinson's disease, whose neurotoxicity has been related to its ability to generate free radicals. In this study, we examined the effects induced by copper on 6‐OHDA autoxidation. Our data show that both Cu+ and Cu2+ caused an increase in •OH production by 6‐OHDA autoxidation, which was accompanied by an increase in the rate of both p‐quinone formation and H2O2 accumulation. The presence of ascorbate greatly enhanced this process by establishing a redox cycle which regenerates 6‐OHDA from its p‐quinone. However, the presence of glutathione did not change significantly the copper‐induced effects. We observed that copper is able to potentiate the ability of 6‐OHDA to cause both lipid peroxidation and protein oxidation, with the latter including a reduction in free‐thiol content and an increase in carbonyl content. Ascorbate also increases the lipid peroxidation induced by the action of copper and 6‐OHDA. Glutathione protects against the copper‐induced lipid peroxidation, but does not reduce its potential to oxidize free thiols. These results clearly demonstrate the potential of copper to increase the capacity of 6‐OHDA to generate oxidative stress and the ability of ascorbate to enhance this potential, which may contribute to the destruction of dopaminergic neurons.

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The experiences of heart transplant recipients' spouses during the pretransplant waiting period: integrative review
Authors: Cater Rachel , Taylor Julie
Published: March 2017

Aims and objectives

To explore the experiences of spouses of heart transplant recipients and to consider how an understanding of these experiences may inform nursing practice.

Background

There is a lack of knowledge about the experiences of spouses of heart transplant recipients during the pretransplant wait. Evidence suggests that spousal support improves post‐transplant outcomes of heart transplant recipients; therefore, it is important to understand how nurses can improve spouses' psychological well‐being during the pretransplant wait.

Design

Integrative review.

Method

A search of six electronic databases between November 2015–December 2015 and a hand search yielded 510 citations; nine studies met the review eligibility criteria. Inclusion criteria were applied to selected studies for review. Methodological quality of selected studies was evaluated, and data were extracted and compiled.

Results

Six themes were identified: uncertainty, thoughts about death, changes to lifestyle and priorities, loss of sense of self, quality of life and learning to cope. Spouses experience high levels of stress caused by uncertainty about the patient's survival, increased responsibilities and changes to their lifestyle.

Conclusion

The results reveal that the pretransplant period is all‐consuming for spouses of heart transplant recipients. The impact of the pretransplant wait on spouses' well‐being should be recognised by nurses, and improvements must be made in support and education available to spouses during the pre‐transplant period.

Relevance for clinical practice

There is a need for improved education about the transplant process, and reinforcement of positive coping strategies.
Mixed‐methods research in nursing – a critical review
Authors: Bressan Valentina , Bagnasco Annamaria , Aleo Giuseppe , Timmins Fiona , Barisone Michela , Bianchi Monica , Pellegrini Ramona , Sasso Loredana
Published: March 2017

Aims and objectives

To review the use of mixed‐methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research.

Background

Mixed‐methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed‐methods research is underdeveloped.

Methods

This study identified mixed‐methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two‐stage search using CINAHL to find papers with titles that included the key term ‘mixed method’.

Conclusion

An analysis of studies that used mixed‐methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity.

Relevance to clinical practice

This study highlights current gaps in knowledge, understanding and reporting of mixed‐methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed‐methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed‐methods research so that findings may be critically implemented in practice.
Malignant transformation of oral submucous fibrosis in Taiwan: A nationwide population‐based retrospective cohort study
Authors: Yang Po‐Yu , Chen Yi‐Tzu , Wang Yu‐Hsun , Su Ni‐Yu , Yu Hui‐Chieh , Chang Yu‐Chao
Published: March 2017

Background

Oral submucous fibrosis (OSF) is one of the well‐recognized oral potentially malignant disorders. In this study, we investigated the malignant transformation of OSF in a Taiwanese population.

Methods

A retrospective cohort study was analyzed from Taiwan's National Health Insurance Research Database. A comparison cohort was randomly frequency‐matched with the OSF cohort according to age, sex, and index year. Oral leukoplakia (OL) was further stratified to evaluate for the possible synergistic effects of OSF‐associated malignant transformation.

Results

In this cohort, 71 (9.13%) of 778 cases of OSF were observed to transform into oral cancer. The malignant transformation rate was 29.26‐fold in the OSF cohort than in the comparison cohort after adjustment (95% confidence intervals 20.55‐41.67). To further stratify with OL, OSF with OL (52.46%; 95% confidence intervals 34.88‐78.91) had higher risk of malignant transformation rate than OSF alone (29.84%; 95% confidence intervals 20.99‐42.42). The Kaplan‐Meier plot revealed the rate free of malignant transformation was significant over the 13‐year follow‐up period (log‐rank test, P<.001). The mean duration of malignant transformation was 5.1, 2.7, and 2.2 years for non‐OSF, OSF alone, and OSF with OL, respectively.

Conclusion

Oral submucous fibrosis patients exhibited a significantly higher risk of malignant transformation than those without OSF. OL could enhance malignant transformation in patients with OSF.