bluuebunny/crossref_metadata_2025 huggingface dataset:
Mixtures of clovers with plantain and chicory improve lamb production performance compared to a ryegrass–white clover sward in the late spring and early summer period
Authors: Somasiri S. C. , Kenyon P. R. , Kemp P. D. , Morel P. C. H. , Morris S. T.
Published: April 2015

A research programme was undertaken over two consecutive years with the purpose of studying the effect of herb–clover swards on lamb production performance year‐round. The focus of this study was on two consecutive late spring and early summer periods (2011, 2012). In each year, three sward treatments were compared on grazed paddocks with 40 lambs ha−1: (i) grass–clover mixture (perennial ryegrass [Lolium perenneL.] and white clover [Trifolium repens]); (ii) plantain–clover mixture (plantain [Plantago lanceolata], white clover and red clover [Trifolium pratense]); and (iii) chicory–plantain–clover mixture (plantain, chicory [Cichorium intybusL.] and white and red clovers). Lambs were weighed at 2‐week intervals, and carcass weights and GR tissue depth measurements were obtained at slaughter. In both years, lambs on treatments (ii) and (iii) had greater (P < 0·05) final live weight, liveweight gain, carcass weight, dressing‐out percentage and GR tissue depth measurements, and lower feed conversion ratio compared to lambs on treatment (i). Lamb production was similar in treatments (ii) and (iii) (P > 0·05) in each year. Therefore, during the late spring and early summer period, herb–clover mixture swards were found to be a superior option to perennial ryegrass–white clover for finishing lambs.
Allergic reaction in a cohort of haemophilia A patients using plasma‐derived factor VIII (FVIII) concentrate is rare and not necessarily triggered by FVIII
Authors: Montalvão S. A. L. , Tucunduva A. C. , Siqueira L. H. , Sambo A. L. A. , Medina S. S. , Ozelo M. C.
Published: April 2015

In contrast to haemophilia B, allergic manifestations are rare complications in haemophilia A (HA) patients treated with factor VIII (FVIII) concentrates. Nevertheless, it can be serious and hamper replacement therapy in these cases. The aims of this study were to evaluate the frequency of allergic reaction in a cohort of HA patients treated only with plasma‐derived FVIII (pdFVIII) concentrates, and assess the possible immune mechanisms involved. History of allergic reaction was retrospectively assessed. Patients with allergic manifestations were followed, and had plasma samples collected in different timepoints in relation to the allergic episode. These samples were analysed for the presence of inhibitor and anti‐FVIII immunoglobulins subclasses. Three of 322 HA patients (0.9%) developed allergic reaction after exposure to pdFVIII products during the last 15 years in our centre. The first patient, with severe HA, without inhibitor, had anti‐pdFVIII IgE and IgG4, but no anti‐recombinant FVIII (rFVIII) IgE. The second patient, with severe HA, and high‐responding inhibitor, presented allergic manifestation with both, pdFVIII concentrate and activated prothrombin complex concentrate. Although anti‐pdFVIII and anti‐rFVIII IgG4 were detected, no anti‐FVIII IgE was present. The third patient, with moderate HA without inhibitor, atopic, had no anti‐FVIII immunoglobulin detected, and allergic symptoms disappeared after switching to rFVIII concentrate. This study corroborates the low incidence of allergic reactions in HA patients. In the three cases presented, the anti‐FVIII immunoglobulin profile demonstrated that the allergic manifestation was triggered by other proteins contained in pdFVIII products, and not directed to FVIII.
Lupus anticoagulant acquired hypoprothrombinemia syndrome in childhood: two distinct patterns and review of the literature
Authors: Sarker T. , Roy S. , Hollon W. , Rajpurkar M.
Published: April 2015

Introduction

Lupus anticoagulant associated with acquired prothrombin deficiency also known as ‘lupus anticoagulant hypoprothrombinemia syndrome’ (LAHS) is an entity that is well described in adults and is usually associated with autoimmune conditions (LAHS‐AI). However, in children, LAHS has unique features that are distinct from the adult type.

Aims

We report two paediatric cases of LAHS, describe their distinct patterns and review the paediatric literature on LAHS.

Methods

Case studies on two patients with LAHS were reviewed, details on their presentation, work up and management were extracted. A Medline search was conducted on LAHS in children between 1960 and 2014; Articles in languages other than English were excluded.

Results

The case studies highlight the differences in the two patterns of childhood LAHS. Additionally the review of the literature reveals that there are 15 case reports and 5 case series that report 25 children with LAHS‐AI, 9 case reports and 6 case series report 26 children of LAHS associated with viral infections (LAHS‐VI). At presentation, all patients with LAHS‐AI had positive laboratory tests for autoimmune diseases, most commonly for systemic lupus erythematosus while these tests were negative in LAHS‐VI. All patients with LAHS‐AI had a protracted course and needed prolonged treatment with immune‐suppressive therapy while patients with LAHS‐VI resolved spontaneously or needed short‐term immune‐modulating therapy.

Conclusion

In childhood, two distinct patterns of LAHS are observed, either associated with infection or autoimmune disease. Initial diagnostic investigations are critical to differentiating these two patterns as the prognosis and outcome for each is distinct.
Haemophilia A carriers experience reduced health‐related quality of life
Authors: Gilbert L. , Paroskie A. , Gailani D. , Debaun M. R. , Sidonio R. F.
Published: April 2015

Introduction

Haemophilia A is an X‐linked recessive bleeding disorder that primarily affects males. Emerging data support evidence for increased bleeding in female haemophilia A carriers despite factor VIII activity within the normal range.

Aim

Data regarding the effect of increased bleeding on health‐related quality of life (HR‐QOL) in haemophilia A carriers is sparse. We tested the hypothesis that haemophilia A carriers have reduced HR‐QOL related to bleeding symptoms.

Methods

We conducted a cross‐sectional study at Vanderbilt University. Case subjects were obligate or genetically verified haemophilia A carriers age 18–60 years. Control subjects were mothers of children with cancer who receive care at the Vanderbilt paediatric haematology‐oncology clinic. Trained interviewers administered the Rand 36‐Item Health Survey 1.0, a validated questionnaire evaluating eight health concepts that may affect HR‐QOL, to each study participant. Mann–Whitney U‐tests were used to compare median scores for the eight health domains between the case and control groups.

Result

Forty‐two haemophilia A carriers and 36 control subjects were included in analyses. Haemophilia A carriers had significantly lower median scores for the domains of ‘Pain’ (73.75 vs. 90; P = 0.02) and ‘General health’ (75 vs. 85; P = 0.01) compared to control subjects.

Conclusion

Haemophilia A carriers in our study demonstrated significantly lower median scores on the Rand 36‐item Health Survey 1.0 in the domains of ‘Pain’ and ‘General Health’ compared to women in the control group. Our findings highlight the need for further investigation of the effect of bleeding on HR‐QOL in this population.
Outcome after total knee arthroplasty in haemophilic patients with stiff knees
Authors: Strauss A. C. , Schmolders J. , Friedrich M. J. , Pflugmacher R. , Müller M.C. , Goldmann G. , Oldenburg J. , Pennekamp P. H.
Published: April 2015

Introduction

Advanced haemophilic arthropathy of the knee is associated with progressive joint stiffness. Results after total knee arthroplasty (TKA) in stiff knees are considered to be inferior compared to those with less restricted preoperative range of motion (ROM). There is only very limited data on the results of primary TKA in haemophilic patients with stiff knees.

Aim

The purpose of this retrospective study was to evaluate the clinical outcome after TKA performed in haemophilic patients with preoperative ROM of 50° or less.

Methods

Twenty one patients (23 knees) undergoing TKA with stiff knees were retrospectively evaluated. Mean follow‐up was 8.3 years (range, 2–25). Clinical assessment included ROM, degree of flexion contracture and complication rate. Functional evaluation and pain status were assessed using the Knee Society's Scoring System (KSS).

Results

Range of motion improved from 26.7° preoperatively to 73.0° postoperatively. Flexion contracture decreased from 21.7° to 8.3°. KSS increased from 22.9 to 72.9 points. Evaluation of pain revealed a decrease from 8.4 points preoperatively to 2.1 points postoperatively. All these differences were statistically significant (P < 0.005). The complication rate was 8.7% including one late periprosthetic infection, and one aseptic implant loosening. Nine patients who required VY‐quadricepsplasty for knee exposure developed a mean postoperative extensor lag of 7°.

Conclusion

Total knee arthroplasty in haemophilic patients presenting with stiff knees results in significant improvement of function and reduction in pain. Although the clinical outcome is inferior compared to nonstiff knees reported in the literature, joint replacement surgery can be successfully performed in this particular group of patients.
Thalidomide for treatment of gastrointestinal bleedings due to angiodysplasia: a case report in acquired von Willebrand syndrome and review of the literature
Authors: Engelen E. T. , van Galen K. P. M. , Schutgens R. E. G.
Published: April 2015

Introduction

Acquired von Willebrand syndrome is a rare bleeding disorder and treatment of the associated gastrointestinal (GI) bleeding due to angiodysplasia is challenging.

Aim

The aim of this study was to present a new case on the successful use of thalidomide in a patient with acquired von Willebrand syndrome and recurrent angiodysplasia‐related GI bleedings, and to conduct a literature review on the use of thalidomide in patients with GI angiodysplasia.

Methods

A literature review was conducted, searching the electronic databases PubMed, Embase and Cochrane.

Results

We present a 75‐year‐old woman with IgG MGUS‐associated acquired von Willebrand syndrome (AVWS) who suffered from recurrent gastrointestinal (GI) bleedings and epistaxis. Treatment with immunoglobulins, desmopressin, Haemate‐P and blood transfusions failed to achieve long‐term haemostasis. Eventually, after these bleedings relapsed for almost a decade at 1‐ to 3‐month intervals, thalidomide was prescribed. Since then, only one single nose bleed and one single melaena episode had occurred. She currently remains in remission of GI bleeds after 3 years and 3 months follow‐up. The literature review revealed a beneficial effect of thalidomide in reducing GI bleeding due to angiodysplasia, including four case reports on inherited von Willebrand disease.

Conclusion

In conclusion, thalidomide can be a reasonable option for the treatment of recurrent GI bleeding due to angiodysplasia in AVWS and we report for the first time that refractory or relapsing GI bleeding in patients with AVWS can successfully be controlled with thalidomide.
The home hemodialysis hub: Physical infrastructure and integrated governance structure
Authors: Marshall Mark R. , Young Bessie A. , Fox Sally J. , Cleland Calli J. , Walker Robert J. , Masakane Ikuto , Herold Aaron M.
Published: April 2015

An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit‐for‐purpose facilities and implementation of a well‐considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient‐facing clinical activities and business processes.
Prescriptions for home hemodialysis
Authors: Lockridge Robert , Cornelis Tom , Van Eps Carolyn
Published: April 2015

Prescribing a regimen that provides “optimal dialysis” to patients who wish to dialyze at home is of major importance, yet there is substantial variation in how home hemodialysis (HD) is prescribed. Geographic location, patient health status and clinical goals, and patient lifestyle and preferences all influence the selection of a prescription for a particular patient—there is no single prescription that provides optimal therapy for all patients, and careful weighing of potential benefit and burden is required for long‐term success. This article describes how home HD prescribing patterns have changed over time and provides examples of commonly used home HD prescriptions. In addition, associated clinical outcomes and adequacy parameters as well as criteria for identifying which patients may benefit most from these diverse prescriptions are also presented.
HOUSEHOLD INTERACTION AND THE LABOR SUPPLY OF MARRIED WOMEN
Authors: Eckstein Zvi , Lifshitz Osnat
Published: April 2015

Are changing social norms affecting the employment rates of women? A model is built in which the employment of husbands and wives is the outcome of potentially exogenously determined three different types of household games: the Classical household, where the spouses play a Stackelberg leader game in which the wife's labor supply decision is based on her husband's employment outcome; the Modern household, which is characterized by a symmetric and simultaneous game solved as a Nash equilibrium, and the Cooperative household, where the couple jointly maximizes the weighted sum of their utilities. In all models, husbands’ employment is similar whereas wives work much less in Classical households.
INFLATION EXPECTATIONS AND BEHAVIOR: DO SURVEY RESPONDENTS ACT ON THEIR BELIEFS?
Authors: Armantier Olivier , Bruine de Bruin Wändi , Topa Giorgio , van der Klaauw Wilbert , Zafar Basit
Published: April 2015

We compare the inflation expectations reported by consumers in a survey with their behavior in a financially incentivized investment experiment. The survey is found to be informative in the sense that the beliefs reported by the respondents are correlated with their choices in the experiment. More importantly, we find evidence that most respondents act on their inflation expectations showing patterns consistent with economic theory. Respondents whose behavior cannot be rationalized tend to have lower education and lower numeracy and financial literacy. These findings help confirm the relevance of inflation expectations surveys and provide support to the microfoundations of modern macroeconomic models.
Different Worldviews Explain Perceived Effectiveness of Different Employment Tests
Authors: Highhouse Scott , Rada Thaddeus B.
Published: April 2015

A representative sample of (n = 439) adults in theUnitedStates responded to questions about the usefulness of tests of cognitive ability and conscientiousness, along with questions about their beliefs in free will and (scientific) determinism. As hypothesized, belief in scientific determinism predicted perceived usefulness of a cognitive ability test and belief in free will predicted the perceived usefulness of a test of conscientiousness. In a subsequent experiment (n = 337), people watchedTED‐style talks emphasizing either the importance of talent or the importance of hard work for success. People who watched the talk emphasizing talent scored higher on scientific determinism. Those who watched the talk emphasizing hard work scored both higher on free will and lower on scientific determinism.
Costs and Benefits of Newcomer Adjustment Tactics
Authors: Cooper‐Thomas Helena D. , Stadler Matthias J.
Published: April 2015

Research on information seeking, feedback seeking, and newcomer proactive behavior reveals that employees use various criteria in deciding how to act. This article investigates an integrative framework for such criteria proposed by Cooper‐Thomas and Wilson, comprising three domains (performance, ego, social) and two factors (cost, benefit). Three independent scenario‐based studies were used to test their model. The results supported some propositions of the model, such as the primacy of performance concerns, yet failed to support other propositions, with benefits consistently predominating over costs. Factors that might underlie the contradictory results were systematically controlled for, namely the sample, hypothetical scenario, and initial asset position. Theoretical and practical implications are discussed.
Effects of Organizationally Endorsed Coaching on Performance and Validity of Situational Judgment Tests
Authors: Stemig Melissa S. , Sackett Paul R. , Lievens Filip
Published: April 2015

There is growing interest in organizationally provided or organizationally endorsed coaching. However, little is known about the effects of such coaching on test scores in operational settings. This study reports on an examination of such a program in the context of the use of a situational judgment test (SJT) for medical school admissions. We examine the effects of multiple types of coaching methods on SJT scores and on their construct‐related and predictive validities. Results suggest that (1) commercial coaching techniques may not be as effective as previously thought, whereas organizationally provided methods may be more effective, and that (2) the criterion‐related validity of the SJT scores is not degraded by the availability of coaching. Generally, this study illustrates that concerns about potential unfairness of coaching can be countered by making effective coaching available to all examinees, in the form of organizationally endorsed coaching.
Supply chain coordination with an option contract under vendor‐managed inventory
Authors: Cai Jianhu , Hu Xiaoqing , Han Yi , Cheng Haifang , Huang Weilai
Published: April 2015

In this paper, we propose an option contract for a two‐echelon supply chain operating under vendor‐managed inventory (VMI). We find that the supply chain coordination and Pareto improvement can be achieved synchronously. As a comparison, a subsidy contract is introduced to coordinate the supply chain. The paper further considers the influence of a replenishment tactic on the performance of the supply chain. After introducing a replenishment tactic, the supply chain can replenish the products to satisfy unmet demand during the selling season. We further use an option contract to coordinate the supply chain, and a Pareto improvement can be gained. All our findings are numerically illustrated.
Multistage portfolio optimization with stocks and options
Authors: Davari‐Ardakani Hamed , Aminnayeri Majid , Seifi Abbas
Published: April 2015

We develop a multistage portfolio optimization model that utilizes options for mitigating market risk in a dynamic setting. Due to the key role of scenarios in the quality of investment decisions, a new scenario generation method is proposed that characterizes the dynamic behavior of asset returns. This methodology takes the dependence structure of different asset returns into account, and also considers serial correlations of each of the asset returns. Moreover, it preserves marginal distributions of asset returns. Also, it precludes arbitrage opportunities. To investigate the role of options, we implement the scenario generation method on a set of stocks selected from the New York Stock Exchange. Results show the high performance of the proposed scenario generation method. Afterwards, the generated set of scenarios is used as the uncertainty set for the multistage portfolio optimization model. Static and dynamic assessments are used for measuring the performance of options in mitigating market risks and generating additional returns. Finally, backtesting simulations are used for assessing different trading strategies of options.
Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care
Authors: Nordmeyer Matthias , Pauser Johannes , Biber Roland , Jantsch Jonathan , Lehrl Siegfried , Kopschina Carsten , Rapke Christian , Bail Hermann J , Forst Raimund , Brem Matthias H
Published: April 2015

To evaluate the clinical use and economic aspects of negative pressure wound therapy (NPWT) after dorsal stabilisation of spinal fractures. This study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after surgical stabilisation of spinal fractures by internal fixation. Patients were randomised to either standard wound dressing treatment (group A) or NPWT (group B). The wound area was examined by ultrasound to measure seroma volumes in both groups on the 5th and 10th day after surgery. Furthermore, data on economic aspects such as nursing time for wound care and material used for wound dressing were evaluated. A total of 20 patients (10 in each group) were enrolled. Throughout the whole study, mean seroma volume was significantly higher in group A than that in group B (day 5: 1·9 ml versus 0 ml; P = 0·0007; day 10: 1·6 ml versus 0·5 ml; P <0·024). Furthermore, patients of group A required more wound care time (group A: 31 ± 10 minutes; group B 13·8 ± 6 minutes; P = 0·0005) and more number of compresses (total number; group A 35 ± 15; group B 11 ± 3; P = 0·0376). NPWT reduced the development of postoperative seroma, reduced nursing time and reduced material required for wound care.
PLEBOTHROMBOSIS AND THROMBOPHLEBITIS IN THE AGED
Authors: HODGSON FRANK H.
Published: April 2015

This article is a partial summary of current literature on venous thrombosis with the author's version of correct present‐day management of this problem, applied particularly to the person past 50 years of age. Any general statement that may depict the hazards or the need for care in preventing and treating thromboses, becomes decidedly apropos when applied to the older age group.
Gastrointestinal Consequences of Treatment with Drugs in Elderly Patients
Authors: Johnson Philip C.
Published: April 2015

The aging process affects many organs of the gastrointestinal tract. The most common effect is decreased motility, which may result in patient discomfort and various alterations in absorption. Concurrent pathologic conditions, common in the elderly, can lead in turn to the use of many pharmaceuticals, either alone or in combination. Untoward reactions to these drugs, when they occur, are often manifest in the gastrointestinal tract. Agents that may cause gastrointestinal bleeding include aspirin, corticosteroids, anticoagulants, antimetabolites, and agents used in cancer chemotherapy. Ethanol or aspirin or other drugs can cause erosive gastritis.
The Use of Non‐prescription Analgesics in an Older Population
Authors: Cupit Gary C.
Published: April 2015

Older patients are frequent users of aspirin and acetaminophen, either recommended by physicians or self‐prescribed, for the aches and pains that accompany aging. These mild analgesics provide effective pain relief when used appropriately. Aspirin and acetaminophen are equianalgesic on a milligram‐for‐milligram basis for most indications. Both are safe for most patients. Aspirin use may be associated with salicylate intoxication or salicylate interactions with other agents. There have been reports of an association of hepatotoxicity with acute massive overdosages of acetaminophen.
Antacids and Laxatives for Symptomatic Relief in the Elderly
Authors: Gerbino Philip P. , Gans John A.
Published: April 2015

Guidelines for the safe, effective use of antacids and laxatives are presented, with emphasis on the special problems and considerations of their use in the elderly. Discussed are properties affecting drug selection, dosage, measures to ensure compliance, adverse reactions, and drug interactions. Physician–patient dialogs are recommended, as is patient education about the dangers of inappropriate or excessive use of these products, and the need to obtain medical care for unremitting symptoms.
Complications of Alcohol Use Combined with Drug Therapy in the Elderly
Authors: Gerbino Philip P.
Published: April 2015

Chronic ingestion of ethanol in alcoholic beverages can impair drug therapy, lead to sometimes hazardous interactions, or compromise adherence to a well‐planned drug treatment program. Various drugs consistently interact with alcohol: CNS depressants, such as benzodiazepines, barbiturates, muscle relaxants, antihistamines, and psychotropic agents; analgesics, including aspirin and narcotics; anticoagulants and other cardiovascular drugs, namely digitalis glycosides, diuretics, antihypertensives, and antiarrhythmics; and antidiabetic agents. Abstinence from alcohol by elderly patients receiving these drugs is recommended.
Effects of Diet and Nutrition on Drug Therapy
Authors: Lamy Peter P.
Published: April 2015

Foods containing biochemically active substances have been used therapeutically throughout the ages and continue to function as important adjuncts to drug therapy. But naturally‐occurring substances can also have adverse effects, as can the food additives of today. Food‐drug interactions can alter the effects of therapeutic agents or cause adverse reactions where none had existed. These problems are often aggravated in elderly patients, who may suffer from malnutrition (e.g., protein insufficiency) or altered food metabolism. Malnutrition in the elderly can be caused by disease, socioeconomic factors, or simply by the deterioration of eating habits. Although nutritional requirements decrease with age, the elderly still need nutrients for the repair of normal structures and for energy. The nutritional needs of the elderly remain poorly defined. Drugs can alter food metabolism, which, in turn, can affect drug action. Many food–drug interactions are well documented; drug absorption and drug elimination are often affected by an altered food metabolism. Particular problems include salicylate‐induced iron deficiency, poor monitoring of vitamin metabolism and the effects of vitamin underuse and overuse, and lack of knowledge about the effects of long‐term drug use on vitamin metabolism. An additional problem is the presence of potentially harmful materials in non‐prescription products.
Targeting Strategies: An Overview of Criteria and Outcomes
Authors: Winograd Carol Hutner
Published: April 2015

Researchers generally agree that Geriatric Evaluation and Management (GEM) Units are effective only when they are targeted at a specific group of frail, elderly patients who are most likely to benefit. Such patients are those who are neither too sick (eg, severely demented or moribund) nor too well. Various strategies for identifying such patients have been employed by investigators with little consensus on the most efficient targeting criteria. Criteria most often used for inclusion in GEM programs are various combinations of patient age, degree of functional impairment, presence of geriatric conditions (eg falls, incontinence, confusion), particular diagnostic conditions (eg, multiple disorders), and psychosocial conditions (eg, living alone, recent bereavement, low income). Commonly used exclusion factors are severe dementia, inevitable nursing home placement, and terminal illness. Outcome studies suggest that beneficial effects of GEM care are most apparent when patients are selected using specific clinical criteria. Future research on targeting should address the potential need for differing criteria in different settings (eg, inpatient vs outpatient GEM units), simplifications of criteria for greatest ease of application, and prospective evaluation of which criteria best predict functional improvement, longer survival, and reduced health care expenditures in response to GEM care.
Working Group Recommendations: Measuring Outcomes of Care in Geriatric Evaluation and Management Units
Authors: Hedrick Susan C. , Barrand Nancy , Deyo Richard , Haber Paul , James Kenneth , Metier Jeffrey , Mor Vincent , Scanlon William , Weissert William , Williams Mark
Published: April 2015

Issues related to measuring outcomes of care in geriatric evaluation and management (GEM) units were identified by the outcomes working group of the GEM evaluation conference. GEM units have as a major goal the improvement or maintenance of both physical and psychosocial function. Suggested outcome measures for physical health included survival, restricted activity days, general health perceptions, comprehensive physical function, and miscellaneous specific types of functioning. In the area of psycho‐social function, the working group suggested measuring cognitive function, affect/life satisfaction, social function, and satisfaction with care. The patient's caregiver (eg, spouse or child) is often an important target of GEM care, and the group suggested measuring caregiver burden, life satisfaction, and assessment of patient behavior problems.

While the primary goal of GEM units is to improve health status, their effects on the utilization and cost of health care are important to decisions about wide‐spread implementation and funding. The group therefore suggested a comprehensive assessment of these outcomes. Among the large array of recommended outcomes, the most important were thought to be mortality, function, and cost.
Research Strategies for Geriatric Evaluation and Management: Conference Summary and Recommendations
Authors: Kramer Andrew , Deyo Richard , Applegate William , Meehan Shirley
Published: April 2015

In this paper, we present the consensus statement from a national conference on research priorities and methodologies for studying geriatric evaluation and management (GEM) programs. These conclusions, discussion points, and recommendations resulted from discussions of plenary papers, working group deliberations, and a final session in which findings were synthesized by the conference co‐chairmen and presented to conference participants for final review.

Major conclusions included: (1) The importance of linking geriatric evaluation with care management in future studies; (2) The need for multi‐center trials of inpatient units to establish efficacy; (3) The importance of studying criteria for targeting GEM care on patients who are most likely to benefit; (4) The need for further developmental studies of outpatient GEM clinics; (5) The importance of assessing a range of outcomes including mortality, patient function, satisfaction, caregiver burden, and cost; and (6) The need to define more carefully the nature of the intervention that is being studied to aid in comparing and extrapolating findings.

The following research priorities for GEMS were formulated based on the conference: (1) Within the VA health care system, a multi‐site randomized trial of inpatient GEM units should be initiated; (2) Multi‐site studies of inpatient GEM units and consultation teams linked to outpatient care should be initiated in non‐VA settings; (3) Studies should identify the components of GEM that are most critical to outcome; (4) Studies should explore efficacy of GEM in settings that have not been well studied to date such as nursing homes; and (5) Studies are needed to test screening methods and targeting criteria for GEM in all settings.
Bubble Nucleation During Oxidation of SiC
Authors: Raj Rishi , Terauds Kalvis
Published: April 2015

Oxidation of SiC at 1400°C–1700°C produces carbon monoxide (CO), which can form bubbles at the interface between the substrate and the silica (SiO2) overgrowth. The bubbles add complexity to the mechanistic understanding of the oxidation process. We analyze the kinetics of bubble formation, where the driving force for their nucleation depends on the partial pressure of CO while their growth is determined by the viscosity of silica. The mechanism bears analogy to oxygen migrating from the atmosphere into superalloys, and reacting with carbide precipitates at the grain boundaries to nucleate bubbles of carbon monoxide, or hydrogen migrating into carbon‐steel to form methane. The unique feature of the present case is the ability of silica to release the gas pressure within the bubbles by viscous flow, and then, to heal the crater that is left behind. As the bubbles grow out from the interface and escape into the atmosphere, they can expose bare surface to the atmosphere rendering silicon carbide vulnerable to active oxidation. The relative significance of the mechanisms of oxidation of SiC is presented in the form of an oxidation map, where atmosphericand oxidation temperature are the experimental variables. We discover that experiments often lie in the regime of bubble formation.
The Relationship Between Problem‐Solving Ability and Self‐Harm Amongst People with Mild Intellectual Disabilities
Authors: Rees Joanna , Langdon Peter E.
Published: April 2015

Background

The purpose of this study was to investigate the relationship between depression, hopelessness, problem‐solving ability and self‐harming behaviours amongst people with mild intellectual disabilities (IDs).

Methods

Thirty‐six people with mild IDs (77.9% women, Mage = 31.77, SD = 10.73, MIQ = 62.65, SD = 5.74) who had a history of self‐harm were recruited. Participants were asked to complete measures of depression, hopelessness and problem‐solving ability.

Results

Cutting was most frequently observed, and depression was prevalent amongst the sample. There was a significant positive relationship between depression and hopelessness, while there was no significant relationship between self‐harm and depression or hopelessness. Problem‐solving ability explained 15% of the variance in self‐harm scores.

Conclusions

Problem‐solving ability appears to be associated with self‐harming behaviours in people with mild IDs.
The clinical response and systemic effects of non‐surgical periodontal therapy in end‐stage renal disease patients: a 6‐month randomized controlled clinical trial
Authors: Fang Fuchun , Wu Buling , Qu Qian , Gao Jie , Yan Wenjuan , Huang Xin , Ma Dandan , Yue Jin , Chen Ting , Liu Fei , Liu Ying
Published: April 2015

Aims

Scientific evidence on the effects of chronic periodontitis on end‐stage renal disease (ESRD) remains inadequate and inconclusive. This intervention study was designed to evaluate the effects of non‐surgical periodontal therapy on the clinical response and systemic status of ESRD patients.

Materials and Methods

Patients in the intervention group (n = 48) received non‐surgical periodontal therapy and then a supragingival prophylaxis at the 3‐month follow up, and those in the control group (n = 49) received no intervention throughout the study. At 6 weeks, 3 months, and 6 months after therapy, clinical periodontal examinations were conducted and blood samples were taken to evaluate inflammatory, nutritional and lipid profiles.

Results

The results showed a significant improvement in clinical periodontal parameters (p < 0.05) in the intervention group. Compared to the control group, the intervention group had significantly lower high‐sensitivity C‐reactive protein at 3 months and 6 months. Significant improvements were found (p < 0.05) in interleukin‐6, ferritin, albumin, creatinine, blood urea nitrogen, and transferrin after therapy.

Conclusions

Non‐surgical periodontal therapy can effectively improve periodontal, circulating inflammatory and nutritional status in ESRD patients. Non‐surgical periodontal therapy, as a relatively simple intervention, has beneficial systemic effects in ESRD patients.
Disclosures About Disclosures: Can Conflict of Interest Warnings be Made More Effective?
Authors: Taha Ahmed E. , Petrocelli John V.
Published: April 2015

People regularly rely on advisors who have conflicts of interest. The law often requires advisors to disclose these conflicts. Despite these disclosures, people generally insufficiently discount conflicted advice. This might be partly due to people interpreting the very fact that the advisor is disclosing a conflict of interest as a sign that the advisor is trustworthy, undermining the purpose and effectiveness of the disclosure. This article presents the results of an experiment indicating that requiring advisors to also disclose that they are legally required to disclose their conflict of interest makes people discount their advice more. This occurs, at least in part, because such advisors are viewed as less trustworthy than advisors who merely disclose their conflict of interest without also stating that the disclosure is legally required.
Participation and factors associated with late or non‐response to an online survey in primary care
Authors: Aerny‐Perreten Nicole , Domínguez‐Berjón Ma. Felicitas , Esteban‐Vasallo María D. , García‐Riolobos Carmen
Published: April 2015

Rationale, aims and objectives

Online surveys have several advantages, but a low response rate is common and it is uncertain how results are affected. Response inducement techniques can be used to overcome this problem. The objectives of this study were to describe the percentage of change in the response rate after reminders and to analyse the characteristics associated with non‐response and late response based on the survey results, as well as by applying archival and extrapolation techniques.

Method

In the Autonomous Community of Madrid, an online questionnaire about cancer prevention was sent to a random sample of primary care health professionals (3586 physicians and nurses). Two reminders were sent later. The percentage of change in response rates after reminders, global and by demographic and health care characteristics of participants; and factors associated with non‐response and late response were analysed using response rates and odds ratios (ORs).

Results

After the reminders, the response rate increased from 22.6% to 32.9% and to 39.4%. Non‐response was associated with age [OR: 3.14; confidence interval (CI) 95%: 2.23–4.42 for aged >60 years], gender and functional area. Further, a higher response rate after reminders was observed in professionals with heavier workloads (OR: 1.46; CI 95%: 1.08–1.97) and in those who stated a lower relevance of cancer prevention in primary care.

Conclusions

After electronic reminders, the response rate increased, especially among professionals with the highest workloads and a minor interest in the survey topic. However, possible bias associated with non‐response remains and the factors behind this should be examined in future research.
Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care
Authors: Loughlin Michael , Bluhm Robyn , Fuller Jonathan , Buetow Stephen , Borgerson Kirstin , Lewis Benjamin R. , Kious Brent M.
Published: April 2015

Last year saw the 20th anniversary edition ofJECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.
A survey on the awareness and attitude of pharmacists and doctors towards the application of pharmacogenomics and its challenges in Qatar
Authors: Elewa Hazem , Alkhiyami Dania , Alsahan Dima , Abdel‐Aziz Ahmed
Published: April 2015

Rationale, aims and objectives

Pharmacists are expected to play an important role in applying pharmacogenomics discoveries to patient care. Despite the increased attention to genetic research in Qatar, clinicians' attitudes towards the application of pharmacogenomics are not yet explored. The aim of this study was to assess the awareness and attitude of pharmacists compared with doctors towards pharmacogenomics and its implications by submitting an electronic‐based survey to all pharmacists and doctors currently working in a large medical corporation in Qatar.

Methods

A cross‐sectional survey instrument was developed based on literature review. Eligible participants were pharmacists and doctors currently practicing in Hamad Medical Corporation hospitals in Qatar. The survey comprised questions on demographic and professional characteristics. It also evaluated the awareness, attitudes and challenges towards pharmacogenomics and its application.

Results

We collected 202 surveys, 108 (53.2%) of which were pharmacists and the remaining 94 (46.5%) were doctors. The overall participants' mean total awareness score percentage was low (39% ± 22) and there were no difference between the mean score achieved by pharmacists and doctors. Pharmacists had significantly more positive attitudes than doctors towards: (i) taking the responsibility of applying pharmacogenomics to drug therapy selection, dosing and monitoring; (ii) perceiving a positive role of pharmacogenomics testing on the control of drug expenditure; and (iii) their willingness to participate in pharmacogenomics‐related training sessions. Both pharmacists and doctors perceived lack of knowledge and guidelines as major challenges towards the application of pharmacogenomics in Qatar.

Conclusion

Despite doctors' and pharmacists' low level of awareness towards pharmacogenomics, they both have positive attitudes towards the clinical implications of pharmacogenomics. Pharmacists are more motivated to learn about pharmacogenomics and are more willing to take initiatives in its clinical application and patient education.
Voluntary emergence and water detection in a newly recognized amphibious fish
Authors: Magellan K.
Published: April 2015

Galaxias ‘nebula’, a small fish which has adaptations for air‐breathing but is not known to be amphibious, voluntarily emerged from water and, in an unfamiliar environment, moved preferentially towards an alternative water source. Nebula may thus be considered one of the few truly amphibious fishes, and their ability to detect water provides a selective advantage which aids their survival in unpredictable natural environments.
Study on Flammulina Velutipes Ready‐to‐Eat Snacks Prepared by Microwave Vacuum Osmotic Dehydration Combined with Hot‐Air Drying
Authors: Liu Su‐Wen , Chang Xue‐Dong , Song Zi‐Zi
Published: April 2015

Flammulina velutipes ready‐to‐eat snacks are not commonly known. Response surface methodology was employed to optimize the process parameters in making ready‐to‐eat snacks. The optimum dehydration condition was found at a sucrose concentration of 30%, a vacuum pressure of −40 ± 1.5 kPa, an osmotic time of 165 s and a microwave intensity of 65 W/g. These parameters resulted in water loss, solid gain and sensory evaluation values of 39.15%, 6.96% and 7.87, respectively. The water diffusion rate and solid gain diffusion rate were 1.55 × 10−9 and 1.29 × 10−9 m2/s, respectively, when employing the optimum microwave vacuum osmotic dehydration (MVOD) parameters. When F. velutipes mushrooms were dried for 180 min by hot‐air drying, the water content of the ready‐to‐eat snack was 9.8 ± 0.5% and the water diffusion rate was 1.14 × 10−11 m2/s. Both the MVOD and the hot‐air drying stages were consistent with the Page model.

Practical Applications

Osmotic dehydration technology combined with other drying technologies, such as hot air, can improve the use value and economic benefits of fruits and vegetables. The two correlations developed by modifying second‐order polynomial equations were adequate to predict the responses for the Flammulina velutipes samples. The water and solid effective diffusion rates were calculated at different microwave vacuum osmotic dehydration times and different hot‐air drying times for F. velutipes mushrooms. The Page model could be used to illustrate the water loss and solid gain for these two drying stages. The F. velutipes mushroom snacks made using these conditions had good color, high gloss and a moderately soft texture, with a sweet and sour flavor. The developed mathematical models can be considered precise for the prediction and optimization of process parameters in experimental and industrial applications.
Attempting Civil Service Reform: A Theory‐based Comparison of Policy Processes in Mexico and Guatemala
Authors: Romero Antonio
Published: April 2015

This article examines two attempts at changing civil service policy in Mexico and Guatemala. The purpose of this study is to understand the factors that determine policy change and stability in the public management policy domain, drawing from an analytical framework based on Kingdon, and Baumgartner and Jones, to account for policy change and stability. The article presents narrative accounts of two initiatives that aimed to enact a civil service law in Mexico and another in Guatemala and reveals the institutional configurations that structured the policy processes in both episodes. Policy venues, policy communities, and political parties play key roles in fostering policy change. The study also reveals the roles and interactions of groups and individuals in pursuit of their policy objectives. The activities of policy entrepreneurs as they take advantage of policy windows are particularly relevant. Based on this analysis, explanations for the outcomes are presented, pointing to the determinants of policy change and stability. Beyond the case findings, this article provides an assessment of the ability of two well‐established policy theories to explain policymaking in the Latin American context.
Turkish German
Authors: Kern Friederike
Published: April 2015

Today, long‐term effects of migration into Germany are shown most notably in the emergence of linguistic practices of young people, many of them second or third generation migrants, in urban areas. Turkish German describes a way of speaking that first emerged in young people's speech in multi‐ethnic urban areas and was first associated with Turkish adolescents. Later, it became widely known through its appearance in films, comedies and rap songs. In contrast to earlier studies on immigrants' language in Germany (see section ), Turkish German is not associated with imperfect acquisition but with the manner in which speakers actively construct and perform ethnic identities and other social meanings via language. Turkish German is conceptualised either as an ethnolect, or an ethnic style, implying different research traditions with focus on different aspects of linguistic descriptions. Other studies choose the term ‘Kiezdeutsch’ over Turkish German to emphasise the ways of speaking multiethnolectal dimension.

It is the aim of this article to present different linguistic approaches to Turkish German, with a critical discussion of some of the key concepts, and to give an overview over its linguistic features and functions on the basis of relevant empirical studies on the linguistic practices among Turkish–German bilinguals.