bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of epithelial dysplasia adjacent to lip squamous cell carcinoma indicates that the degree of dysplasia is not associated with the occurrence of invasive carcinoma in this site
Authors: Nagata Gabriela , Santana Thalita , Queiroz Aline , Caramez Renata H. , Trierveiler Marília
Published: May 2018

Background

We analyzed the different grades of dysplasia in the epithelium adjacent to lip squamous cell carcinoma (LSCC), as a parallel to actinic cheilitis (AC) that suffered malignant transformation.

Methods

Forty samples of epithelium adjacent to LSCC were histologically graded according to the World Health Organization (WHO) and the binary systems. The expression of mutated p53 was evaluated through immunohistochemistry.

Results

According to WHO system, 37.5% of the cases were graded as mild, 45% as moderate and 17.5% as severe dysplasia (P = 0.09). Considering the binary system, 90% of the cases were classified as low‐risk and 10% as high‐risk lesions. Mutated p53 was present in 73.3% of mild, 88.8% of moderate and 71.4% of severe dysplasia cases. Considering the binary system, 80.5% of the low‐risk and 75% of high‐risk lesions were immunopositive; 62.5% expressed the protein in both tumor cells and adjacent epithelium; 17.5% in adjacent epithelium only, and 7.5% in LSCC islands only (P = 0.03).

Conclusions

We observed heterogeneous grades of epithelial dysplasia in the epithelium adjacent to LSCC, which indicates that the analysis of AC morphological features is insufficient to predict patient's prognosis and to determine a treatment decision. Positive expression of mutant p53 in mild dysplasia reinforces this idea.
The European Medicines Agency's approval of new medicines for type 2 diabetes
Authors: Blind Eberhard , Janssen Heidi , Dunder Kristina , de Graeff Pieter A.
Published: May 2018

Since 2005, more than 40 new medicines for the treatment of type 2 diabetes have been introduced on the market. These consist of 15 new active substances establishing three new classes of non‐insulin products, and several new or modified insulin products and combinations. The approval of these products in Europe is regulated via the centralized procedure at the European Medicines Agency. Demonstration of benefit with regard to improved glucose control remains the principal outcome required from confirmatory studies to demonstrate efficacy. For the majority of these new medicines approved since 2005, cardiovascular outcome trials have now been completed, and have invariably supported the cardiovascular safety of these products. In some of these trials additional important benefits have been observed, for instance, a reduction in major adverse cardiovascular events and improvement of renal outcome. The existing regulatory framework and the continuous adaption of regulatory requirements to emerging developments will continue to guide the approval of new products in the future.
Forced loans in the Spanish Empire: the first requisition of American treasures in 1523
Authors: Sardone Sergio
Published: May 2018

This article describes the policy of forced loans, employed in Spain by Charles V to solve the principal financial crises of the Royal Treasury and to fund the main military campaigns of the Habsburg Empire. Specifically, this study is focused on the first requisition of private American treasures—the earliest case of this in European history—which were expropriated in 1523 by the Casa de la Contratación (House of Trade) of Seville to finance the campaign of Fuenterrabía against the French army. The analysis of exceptional archival sources provides details of all the forced loans imposed on the holders of remittances (primarily gold) and the conditions for extinguishing the debts without causing harmful consequences to Atlantic traders. The article challenges the widespread view of the confiscations as an attack on property rights and overly simplistic ideas about the supposedly ‘highly absolutistic’ or predatory policies attributed to the Crown of Castile in some of the economic historiography.
The contribution of infrastructure investment to Britain's urban mortality decline, 1861–1900
Authors: Chapman Jonathan
Published: May 2018

It is well‐recognized that both improved nutrition and sanitation infrastructure are important contributors to mortality decline. However, the relative importance of the two factors is difficult to quantify since most studies are limited to testing the effects of specific sanitary improvements. This article uses new historical data regarding total investment in urban infrastructure, measured using the outstanding loan stock, to estimate the extent to which the mortality decline in England and Wales between 1861 and 1900 can be attributed to government expenditure. Fixed effects regressions indicate that infrastructure investment explains approximately 30 per cent of the decline in mortality between 1861 and 1900. Since these specifications may not fully account for the endogeneity between investment and mortality, additional specifications are estimated using lagged investment as an instrument for current investment. These estimates suggest that government investment was the major contributor to mortality decline, explaining up to 60 per cent of the reduction in total urban mortality between 1861 and 1900. Additional results indicate that investment in urban infrastructure led to declines in mortality from both waterborne and airborne diseases.
Recent violence and legal involvement among young adults with early psychosis enrolled in Coordinated Specialty Care
Authors: Rolin Stephanie A. , Marino Leslie A. , Pope Leah G. , Compton Michael T. , Lee Rufina J. , Rosenfeld Barry , Rotter Merrill , Nossel Ilana , Dixon Lisa
Published: May 2018

Aim

Individuals with serious mental illnesses have a small increased risk of engaging in violence or legal involvement compared to the general population. This seems to be particularly true for young adults experiencing early stages of psychosis. This study analysed the prevalence of and risk factors for reports of violence and legal involvement in a sample of young adults receiving Coordinated Specialty Care for early non‐affective psychosis.

Methods

A total of 373 young adults (ages 16‐30) within 2 years of the onset of non‐affective psychosis were enrolled in 10 Coordinated Specialty Care sites in New York State from October 2013 to August 2016. Baseline violent ideation or behaviour and legal involvement was described and predictors identified.

Results

Approximately one‐quarter of individuals had either recent violent ideation or behaviour at baseline (n = 90, 24.6%); nearly one‐tenth of the sample reported recent legal involvement (n = 33, 9.0%). Individuals with violent ideation or behaviour had lower levels of education and were less likely to be working. Those with recent legal involvement were more likely to be male and more likely to have substance use (alcohol, cannabis and other drugs).

Conclusions

The overall rate of recent violent ideation or behaviour is similar to other studies; up to one‐third of individuals experiencing a first‐episode of psychosis (FEP) report violence. Recent legal involvement was strongly associated with substance use. This study presents insight into violence and legal involvement among individuals with FEP and indicates the need for further research.
Genetic generalized epilepsies
Authors: Mullen Saul A. , Berkovic Samuel F. ,   the ILAE Genetics Commission
Published: May 2018

The genetic generalized epilepsies (GGEs) are mainly genetically determined disorders. Although inheritance in most cases appears to be complex, involving multiple genes, variants of a number of genes are known to contribute. Pathogenic variants of SLC2A1 leading to autosomal‐dominant GLUT1 deficiency account for up to 1% of cases, increasing to 10% of those with absence seizures starting before age 4 years. Copy number variants are found in around 3% of cases, acting as risk alleles. Copy number variation is much more common in those with comorbid learning disability. Common variant associations are starting to emerge from genome‐wide association studies but do not yet explain a large proportion of GGEs. Although currently genetic testing is not likely to yield a diagnosis for most patients with GGEs, it can be of great importance in specific clinical situations. Providers should consider the individual patient's history in determining the utility of genetic testing.
Genetic literacy series: Primer part 2—Paradigm shifts in epilepsy genetics
Authors: Helbig Ingo , Heinzen Erin L. , Mefford Heather C. ,   the International League Against Epilepsy Genetics Commission
Published: May 2018

This is the second of a 2‐part primer on the genetics of the epilepsies within the Genetic Literacy Series of the Genetics Commission of the International League Against Epilepsy. In Part 1, we covered types of genetic variation, inheritance patterns, and their relationship to disease. In Part 2, we apply these basic principles to the case of a young boy with epileptic encephalopathy and ask 3 important questions: (1) Is the gene in question an established genetic etiology for epilepsy? (2) Is the variant in this particular gene pathogenic by established variant interpretation criteria? (3) Is the variant considered causative in the clinical context? These questions are considered and then answered for the clinical case in question.
Methodologies for data collection in congenital haemophilia with inhibitors (CHwI): critical assessment of the literature and lessons learned from recombinant factor VIIa
Authors: Kessler C. M. , Benchikh el Fegoun S. , Worster A.
Published: May 2018

Aims

To systematically review the effectiveness of on‐demand treatment with recombinant coagulation factor VIIa (rFVIIa) in congenital haemophilia with inhibitors and, if feasible, perform a meta‐analysis of the data.

Materials and methods

Publications from Embase®, MEDLINE®, MEDLINE® In‐Process and the Cochrane Central Register of Controlled Trials were searched. Selected publications were reviewed for inclusion by two independent expert reviewers. Discrepancies were reconciled by a third independent reviewer. Data from selected studies were extracted using a predefined grid to ensure uniform and comparable results were captured.

Results

A systematic search (cut‐off date of 2 May 2016) identified 20 studies (13 observational; seven randomized controlled trials). All studies were of sufficient quality to include in this analysis and comprised 1221 participants, with 5981 bleeds in 746 individuals treated with rFVIIa. Haemostatic overall effectiveness of the individual studies identified ranged from 68% to 100% at ≤12 hours, 86% to 96% at 13‐24 hours and 76% to 99% at 24‐48 hours with rFVIIa <100 μg/kg, with similar rates reported for the ≥250 μg/kg dose. However, heterogeneity between the studies precluded pooling of results.

Conclusions

Data from the individual studies confirmed that rFVIIa is an effective therapy for the on‐demand treatment of bleeds in congenital haemophilia with inhibitors. However, the high levels of heterogeneity between studies precluded pooling of results for a valid, reliable or precise summary measure. There remains a need to implement standardized clinical definitions and measurements for the effectiveness and safety of haemophilia therapies in future clinical trials.
PD‐1 and PD‐L1 expression in HNSCC primary cancer and related lymph node metastasis – impact on clinical outcome
Authors: Schneider Sven , Kadletz Lorenz , Wiebringhaus Robert , Kenner Lukas , Selzer Edgar , Füreder Thorsten , Rajky Orsolya , Berghoff Anna S , Preusser Matthias , Heiduschka Gregor
Published: May 2018

Aims

Expression profiles and clinical impact of programmed cell death ligand 1 (PD‐L1) and programmed cell death 1 (PD‐1) expressing tumour infiltrating lymphocytes (TILs) in head and neck squamous cell carcinoma (HNSCC) are not elucidated fully. This study evaluates expression patterns in primary HNSCC and related lymph node metastasis and the impact on patients’ clinical outcome.

Methods and results

Immunohistochemical staining patterns of PD‐L1 and PD‐1 were evaluated in 129 specimens of primary HNSCC and 77 lymph node metastases. Results were correlated with patients’ clinical data. PD‐L1 expression was observed in 36% of primary carcinoma and 33% of lymph node metastasis, and correlates significantly with decreased overall survival (OS) (P = 0.01) and disease‐free survival (DFS) (P = 0.001) in oral cavity squamous cell carcinoma patients. PD‐L1 expression was associated with presence of lymph node metastasis (P = 0.0223). Infiltration of PD‐1‐expressing lymphocytes correlates significantly with favourable OS (P = 0.001) and DFS (P = 0.001) in oropharyngeal cancer and hypopharyngeal cancer patients OS (P = 0.007) and DFS (P = 0.001). Presence of PD‐1 TILs also correlates significantly with better OS (P = 0.005) and DFS (P = 0) in the human papilloma virus (HPV)‐negative cohort. Cox regression multivariate analysis revealed PD‐1 TIL expression as an independent prognostic marker for OS (P = 0.004) and DFS (P = 0.001) and T stage was validated as negative prognostic marker for OS (P = 0.011). PD‐1‐expressing lymphocytes (P = 0.0412) and PD‐L1 expression (P = 0.0022) patterns correlate significantly in primary cancers and matched lymph node metastases.

Conclusions

Our results characterise the expression profiles of PD‐1 axis proteins in HNSCC which might serve as possible clinical prognostic markers.
Uncertain tax benefits, international tax risk, and audit specialization: Evidence from US multinational firms
Authors: Taylor Grantley , Richardson Grant , Al‐Hadi Ahmed
Published: May 2018

The purpose of this study is twofold. First, it examines the association between income‐shifting arrangements consisting of transfer pricing aggressiveness, tax haven use and foreign tax rate differentials, and Financial Interpretation No. 48 (FIN48, now ASC740–10‐25) unrecognized tax benefits (UTBs). Second, it analyzes the impact of audit specialization on the association between income‐shifting arrangements and UTBs. Using a dataset of 286 US multinational firms over the 2007–2016 period (2,097 firm‐years), our regression results show that income‐shifting arrangements represented by transfer pricing aggressiveness, tax haven use and foreign tax rate differentials are significantly positively associated with UTBs. We also observe that audit specialization magnifies the positive association between transfer pricing aggressiveness and UTBs, and foreign tax rate differentials and UTBs. Finally, in additional analysis we provide some evidence that the positive association between income‐shifting arrangements and UTBs is magnified in the post‐2010 uncertain tax position reporting requirement period. Overall, our study extends prior research on the topic of audit characteristics (i.e., audit specialization) and tax aggressiveness.
Laboratory diagnosis of clinically relevant platelet function disorders
Authors: Gresele P. , Falcinelli E. , Bury L.
Published: May 2018

Inherited platelet function disorders (IPFDs) represent a significant fraction of congenital hemorrhagic disorders, and may be associated with bleeding of considerable severity. IPFDs may be difficult to diagnose and a preliminary accurate clinical examination and an objective evaluation of the severity of the bleeding history are mandatory. The laboratory investigation of IPFDs should follow a rational algorithm based on a streamlined panel of laboratory tests with subsequent steps of increasing levels of complexity. First screening tests include platelet count, peripheral blood smear, light transmission aggregometry, measurement of platelet granule content and release, and the expression of glycoproteins by flow cytometry. Several of these tests have been largely employed, and a few validated, for the diagnosis of IPFDs and some recent developments are discussed. Point‐of‐care tests may provide the advantage of rapidity and the possibility to study platelet function in whole blood, but further studies are required to clarify their potential diagnostic application. Genotyping is recommended for some conditions (genotype/phenotype correlations, forms associated with a high risk of developing hematologic malignancies) but, especially when carried out by next‐generation sequencing (NGS) techniques, needs to be critically evaluated taking into account clinical and laboratory phenotypes.
How I investigate for bleeding disorders
Authors: Hayward C. P. M.
Published: May 2018

Introduction

Laboratory investigations for bleeding disorders are warranted when an individual has a personal and/or family history of bleeding, and/or laboratory findings that suggest the possibility of an inherited or acquired bleeding disorder.

Methods

This review summarizes author's experience with ordering and reporting on diagnostic investigations for common and rare bleeding disorders, with consideration of recent articles on diagnosing bleeding disorders. An updated strategy is presented for investigating common and rare, congenital and acquired bleeding disorders.

Results

An investigation of a suspected bleeding disorder requires a practical strategy that considers the clinical problem to be investigated, the pretest probability of true‐positive and false‐positive findings, the investigations can be performed locally or in a reference laboratory and limit the number of blood samples required to establish a diagnosis. It is often advantageous to simultaneously test for von Willebrand disease and platelet function disorders, and for coagulation defects, including fibrinogen disorders. An investigation for rarer bleeding disorders, including those affecting factor XIII, α2 antiplasmin, and plasminogen activator inhibitor‐1, is appropriate when faced with a severe congenital or acquired bleeding problem that cannot be explained by the initial diagnostic investigations.

Conclusion

An organized strategy for investigating bleeding disorders that consider important issues, confirms abnormal findings, encourages proper interpretation of the results, and provides a helpful framework for assessing both common and rare causes of bleeding.
Genetic basis of congenital erythrocytosis
Authors: Bento C.
Published: May 2018

Introduction

Congenital Erythrocytosis (CE) represents a rare and heterogeneous clinical entity. It is caused by deregulated erythropoiesis where red blood cell overproduction results in elevated hemoglobin and hematocrit levels. CE may either be primary or secondary to elevated erythropoietin concentrations. The only known form of primary CE is caused by mutations in the EPOR gene. Secondary CE can be a consequence of tissue hypoxia, being caused by congenital defects such as hemoglobin variants with increased oxygen affinity, due to mutations in the α‐ or β‐globin genes (HBB, HBA2, HBA1), or due to mutations in the BPGM gene. Secondary CE can also result from defects in the components of the oxygen‐sensing pathway (PHD2, HIF2α and VHL).

Methodology

The family history and the quantification of serum EPO are mandatory to define the best diagnostic strategy regarding molecular studies. Based upon the serum EPO level, P50 and familial data, it is possible to establish a diagnostic algorithm.

Results

Despite recent important discoveries in the molecular pathogenesis of CE, in about 70% of the patients the genetic causes remain to be identified. Clinical data on patients suffering from CE are sparse. This fact is conditional upon the effective way to predict the disease evolution, the establishment of the best management and the genetic counselling.

Conclusion

The number and phenotypic variability of patients that remain without an identified etiology suggest that other genes have to be implicated. Studies by next generation sequencing methodologies are already being performed and it is expected the identification of other genes involved in the pathophysiology of the CE.
Vitamin B12 deficiency and clinical laboratory: Lessons revisited and clarified in seven questions
Authors: Salinas M. , Flores E. , López‐Garrigós M. , Leiva‐Salinas C.
Published: May 2018

The objective of this review article is to address the most frequently asked questions that pathologists and primary care physicians might face when dealing with a patient with suspicion of vitamin B12 deficiency. More specifically, the article mainly discusses the importance and prevalence of the deficit, how to recognize it, and the important role of a prompt diagnosis confirmation based on laboratory biomarkers for efficient replacement therapy.
Epidemiology of prostate cancer in Asian countries
Authors: Kimura Takahiro , Egawa Shin
Published: May 2018

The incidence of prostate cancer has been increasing worldwide in recent years. The GLOBOCAN project showed that prostate cancer was the second most frequently diagnosed cancer and the fifth leading cause of cancer mortality among men worldwide in 2012. This trend has been growing even in Asian countries, where the incidence had previously been low. However, the accuracy of data about incidence and mortality as a result of prostate cancer in some Asian countries is limited. The cause of this increasing trend is multifactorial. One possible explanation is changes in lifestyles due to more Westernized diets. The incidence is also statistically biased by the wide implementation of early detection systems and the accuracy of national cancer registration systems, which are still immature in most Asian countries. Mortality rate decreases in Australia, New Zealand and Japan since the 1990s are possibly due to the improvements in treatment and/or early detection efforts employed. However, this rate is increasing in the majority of other Asian countries. Studies of latent and incidental prostate cancer provide less biased information. The prevalence of latent and incidental prostate cancer in contemporary Japan and Korea is similar to those in Western countries, suggesting the influence of lifestyle changes on carcinogenesis. Many studies reported evidence of both congenital and acquired risk factors for carcinogenesis of prostate cancer. Recent changes in the acquired risk factors might be associated with the increasing occurrence of prostate cancer in Asian countries. This trend could continue, especially in developing Asian countries.
Clinical risk factors for acute ischaemic and haemorrhagic stroke in patients with infective endocarditis
Authors: Valenzuela Ives , Hunter Madeleine D. , Sundheim Kathryn , Klein Bradley , Dunn Lauren , Sorabella Robert , Han Sang M. , Willey Joshua , George Isaac , Gutierrez Jose
Published: May 2018

Background

Stroke as a complication of infective endocarditis portends a poor prognosis, yet risk factors for stroke subtypes have not been well defined.

Aim

To identify risk factors associated with ischaemic and haemorrhagic strokes.

Methods

A retrospective patient chart review was performed at a single US academic centre to identify risk factors and imaging for patients who were 18 years or older with infectious endocarditis (IE) and stroke diagnoses. Differences in patient characteristics by stroke status were assessed using univariate analysis, χ2 or student’s t‐test as well as logistic regression models for multivariable analyses and correlation matrices to identify possible collinearity between variables and to obtain odds ratios (OR) and their 95% confidence intervals.

Results

A final sample of 1157 participants was used for this analysis. The total number of non‐surgical strokes was 178, with a prevalence of 15.4% (78% ischaemic, 10% parenchymal haemorrhages, 8% subarachnoid haemorrhages and 4% mixed ischaemic/haemorrhagic). Multivariate risk factors for ischaemic stroke included prior stroke (OR 2.0, 1.3–3.1), Staphylococcus infection (OR 2.0, 1.3–3.0), mitral vegetations (OR 2.2, 1.4–3.3) and valvular abscess (OR 2.7, 1.7–4.3). Risk factors for haemorrhagic stroke included fungal infection (OR 6.4, 1.2–34.0), male gender (OR 3.5, 1.4–8.3) and rheumatic heart disease (OR 3.3, 1.1–10.4).

Conclusion

Among patients with IE, there exist characteristics that relate differentially to ischaemic and haemorrhagic stroke risk.
Long‐term renal outcomes in multi‐ethnic Southeast Asians with lupus nephritis: a retrospective cohort study
Authors: Lim Cynthia C. , Tan Hui Z. , Hao Ying , Chin Yok M. , Woo Keng T. , Chan Choong M. , Choo Jason C. J.
Published: May 2018

Background

Renal involvement is common among Asians with systemic lupus erythematosus and long‐term renal outcomes have been described in homogeneous Caucasian and East Asian populations with lupus nephritis, but data are scarce for other ethnicities.

Aim

To evaluate the incidence and risk factors for progressive chronic kidney disease (CKD) in multi‐ethnic Southeast Asians with lupus nephritis.

Methods

This is a single‐centre retrospective cohort study of adults with biopsy‐proven lupus nephritis diagnosed between May 2001 and May 2009. Demographic and clinical data were retrieved from electronic medical records. Patients were excluded if baseline comorbid, renal function or pharmacotherapy data were incomplete or if they default follow‐up within 3 months from time of diagnosis. Primary outcome was progressive CKD, defined by end‐stage renal disease or persistent doubling of serum creatinine or reduction in eGFR ≥50% for ≥3 months from baseline.

Results

We studied 113 patients with newly diagnosed biopsy‐proven lupus nephritis. Median age was 42 (interquartile range 29–52) years; the majority were Chinese (76%; Malay 13% and others 11%) and female (81%). Two‐thirds had International Society of Nephrology and Renal Pathology Society Class III or IV nephritis; serum creatinine was 86 (67–125) μmol/L with heavy proteinuria (6.3 (2.5–12.2) g/g creatinine). Median follow‐up was 110 (83–142) months. Remission (partial and complete) occurred in 96% at 3.1 (1.6–5.2) months after diagnosis. Among patients who achieved remission, 56% had disease relapse at 19.0 (6.0–40.2) months after remission. Patients with progressive CKD (n = 13, 11%) had lower baseline CKD Epidemiology Collaboration estimated glomerular filtration rate (37.3 (16.5–82.0) vs 79.4 (57.5–101.0) mL/min/1.73 m2, P = 0.03) and higher chronicity index (5 (3–6) vs 3 (2–3), P = 0.04) than those who did not. Remission, early remission within 6 months, complete remission and non‐relapse were less frequently associated with progressive CKD (P < 0.01).

Conclusion

Multi‐ethnic Southeast Asians with biopsy‐proven lupus nephritis had high remission rates and low incidence of progressive CKD. Progressive CKD was associated with poorer baseline renal function, higher histological chronicity index, failure to achieve remission and occurrence of relapse.
New‐onset diabetes mellitus among patients with glomerular diseases
Authors: Lim Cynthia C. , Wong Maggie W. Y. , Koh Hui L. , Chin Yok M. , Mok Irene Y. J. , Choo Jason C. J.
Published: May 2018

Background

Glomerulonephritis commonly causes kidney failure. Immunosuppressant treatment may be diabetogenic, but data on hyperglycaemia in glomerulonephritis treated with usual clinical care are scant.

Aim

To assess the epidemiology, risk factors and outcomes for new‐onset diabetes among patients with glomerular disease (NODAG).

Methods

A single‐centre retrospective cohort of nondiabetic adults diagnosed with glomerulonephritis between January 2011 and July 2015. Clinical, laboratory and pharmacotherapy data were retrieved from electronic medical records. Using modified American Diabetes Association criteria, the primary outcome of NODAG was present if fasting venous glucose was ≥7 mmol/L for at least two readings, HbA1c was ≥6.5% or if patient required antidiabetic medications. Secondary outcomes were end‐stage renal disease, cardiovascular disease and death.

Results

NODAG occurred in 48 patients (10.7%); 22 required antidiabetic medication at median 6.2 (interquartile range 1.7, 20.0) months after glomerulonephritis diagnosis. Patients with NODAG had higher prebiopsy fasting glucose, greater proteinuria and lower fasting high‐density lipoprotein cholesterol levels. Methylprednisolone and cyclophosphamide were more commonly used among patients with NODAG. In multivariate logistic regression, greater proteinuria (odds ratio 1.08 (95% confidence interval 1.01, 1.16), P = 0.02) and methylprednisolone use (odds ratio 4.02 (95% confidence interval 1.76, 9.18), P = 0.001) were significantly associated with NODAG, independent of the triglyceride/high‐density lipoprotein cholesterol ratio as a surrogate measure of insulin resistance. Median follow up was 39.6 (26.9, 57.2) months. Secondary outcomes were not significantly different in patients with and without NODAG.

Conclusion

Proteinuria and methylprednisolone were associated with incident diabetes among patients with glomerular disease treated with usual care. At‐risk patients should be appropriately counselled and monitored for hyperglycaemia.
‘Walking the tightrope’: The role of peer support workers in facilitating consumers’ participation in decision‐making
Authors: Cleary Michelle , Raeburn Toby , Escott Phil , West Sancia , Lopez Violeta
Published: May 2018

In adult mental health services, the participation of consumers is essential. The aim of this study was to explore the challenges faced by peer support workers when involving mental health consumers in decision‐making about their care and the strategies they employed to overcome these challenges so as to improve mental health consumers’ participation in decision‐making and recovery. Semi‐structured individual interviews were conducted with six peer support workers currently employed in psychiatric hospitals and/or community mental health systems. Thematic analysis identified challenges related to role definition, power imbalance, doctor‐centric medical approaches to care, and lack of resources. Strategies to overcome these challenges that were reported, included the following: facilitating meaningful involvement for service users, appropriate use of the lived experience, building relationships and communication, promoting rights and advocacy, and promoting professionalism of peer support workers (PSWs). Nursing staff need ongoing support and education to understand and value the varied roles of PSWs and thereby empower PSWs to engage in enhancing consumer decision‐making. The roles of the PSWs should be viewed as complementary, and greater appreciation and understanding of roles would better support recovery‐oriented care.
The rocky road to universal health coverage in Egypt: A political economy of health insurance reform from 2005–15
Authors: Ismail Sharif A.
Published: May 2018

Processes of public policy formation and implementation in the Middle East and North Africa are underexplored. This article presents a case study in public policy reform, focusing on efforts to expand health insurance coverage in Egypt. The account draws on a thematic analysis of peer and non‐peer reviewed literature and print media between 2005 and 2015, with a particular focus on the period to 2011. This analysis shows that reform initiatives failed for much of this period because of fundamental disagreements between key actors over the goals, proposals and the political process for change. The success of planned reforms in Egypt may well depend on the extent to which account is taken of the varied agendas and evolving power relations of these actors, especially given the profound political, social and economic challenges the Egyptian health system now faces.
Spatial and environmental factors predict skull variation and genetic structure in the cosmopolitan bat Tadarida brasiliensis
Authors: Morales Ariadna E. , De‐la‐Mora Marisol , Piñero Daniel
Published: May 2018

Aim

To assess if geographical and/or environmental factors are driving skull morphology and genetic structure in the cosmopolitan bat species, Tadarida brasiliensis.

Location

North, Central and South America, Greater and Lesser Antilles.

Methods

We analysed morphometric, genetic and environmental data from the entire distribution of T. brasiliensis. Individuals were genotyped at nine nuclear loci, and clustering analyses were used to detect genetic groups and test correlations between genetic, geographical, and environmental distances. Museum specimens were photographed and 111 two‐dimensional landmarks were digitized per individual. Multivariate analyses were applied to explore whether factors such as sex, genetic group, subspecies, biogeographical regions, latitude, longitude and/or environment contribute to the morphometric variation of this species. We also applied a novel approach based on trend surface analyses and model selection to compare models of spatial and environmental dependence and to predict size, shape, and allometry‐free variation across the Americas.

Results

Genetic and morphometric differences among populations coincide with major biogeographical and climatic breaks in Nearctic, Neotropical and Antillean regions. Trend surface analyses showed that skull size variation can be explained by spatial factors (latitude and longitude), whereas skull shape can be explained by the interaction of spatial and environmental factors. However, allometry‐free shape variation might respond to complex interactions not captured by our models.

Main conclusion

Our explicit testing of spatial and environmental dependence using geostatistical model selection approaches allowed us to identify extrinsic factors that shape genetic and phenotypic responses in a cosmopolitan bat species. Our findings suggest that skull size is primarily driven by geographical factors (genetic drift), whereas shape variation is driven by adaptive responses to environmental conditions.
Seeking reproducibility: Assessing a multimodal study of the testing effect
Authors: Beardsley M. , Hernández‐Leo D. , Ramirez‐Melendez R.
Published: May 2018

Low‐cost devices have widened the use of multimodal data in experiments providing a more complete picture of behavioural effects. However, the accurate collection and combination of multimodal and behavioural data in a manner that enables reproducibility is challenging and often requires researchers to refine their approaches. This paper presents a direct replication of a multimodal wordlist experiment. Specifically, we use a low‐cost Emotiv EPOC® to acquire electrophysiological measures of brain activity to investigate whether retrieval during learning facilitates the encoding of subsequent learning as measured by performance on recall tests and reflected by changes in alpha wave oscillations. Behavioural results of the wordlist experiment were replicated, but physiological results were not. We conclude the paper by highlighting the challenges faced in terms of replicating the previous work and in attempting to facilitate the reproducibility of our own experiment.
The moderating effects of intrinsic load on the relationship between self‐regulated effort and germane load
Authors: Lange C. , Costley J.
Published: May 2018

Highly interactive and complex content within e‐learning induces high levels of intrinsic load. Self‐regulated effort represents one strategy that may help learners overcome such issues within e‐learning. Using intrinsic load items representative of content complexity, germane load items representative of learning, and self‐regulated effort items representative of effort, this study analysed survey responses from a group of university students (n = 1,471) who participated in e‐learning courses in South Korea. The results showed that intrinsic load had a negative relationship with germane load, self‐regulated effort had a positive relationship with germane load, and intrinsic load positively moderated the relationship between self‐regulated effort and germane load. These results add to what current research states about the ability to overcome the processing of complicated content through higher levels of student effort.
Profiling sympathetic arousal in a physics course: How active are students?
Authors: Pijeira-Díaz H.J. , Drachsler H. , Kirschner P.A. , Järvelä S.
Published: May 2018

Low arousal states (especially boredom) have been shown to be more deleterious to learning than high arousal states, though the latter have received much more attention (e.g., test anxiety, confusion, and frustration). Aiming at profiling arousal in the classroom (how active students are) and examining how activation levels relate to achievement, we studied sympathetic arousal during two runs of an elective advanced physics course in a real classroom setting, including the course exam. Participants were high school students (N = 24) who were randomly selected from the course population. Arousal was indexed from electrodermal activity, measured unobtrusively via the Empatica E4 wristband. Low arousal was the level with the highest incidence (60% of the lesson on average) and longest persistence, lasting on average three times longer than medium arousal and two times longer than high arousal level occurrences. During the course exam, arousal was positively and highly correlated (r = .66) with achievement as measured by the students' grades. Implications for a need to focus more on addressing low arousal states in learning are discussed, together with potential applications for biofeedback, teacher intervention, and instructional design.
Glycaemic status affects the subgingival microbiome of diabetic patients
Authors: Longo Priscila L. , Dabdoub Shareef , Kumar Purnima , Artese Hilana P. C. , Dib Sergio A. , Romito Giuseppe A. , Mayer Marcia Pinto Alves
Published: May 2018

Aim

Periodontitis is correlated with type 2 diabetes mellitus (T2DM), but little is known about glycaemic status effect on subgingival microbiota associated with periodontitis. This study evaluated if periodontal microbiome of T2DM patients is affected by glycaemic status.

Materials and methods

Twenty‐one T2DM non‐smoking patients with chronic periodontitis and body mass index ≤40 kg/m2 were allocated into two groups according to systemic glycaemic status: inadequate (DMI‐ HbA1c ≥ 8%) and adequate (DMA‐ HbA1c <7.8%). Subgingival biofilm was collected from sites with moderate (PD = 4–6 mm) and severe disease (PD ≥ 7 mm) in two quadrants. The V5–V6 hypervariable region of the 16SrRNA was sequenced using the GS‐FLX‐454 Titanium platform. Sequences were compared with HOMD database using QIIME and PhyloToAST pipelines. Statistical comparisons were made using two‐sample t‐tests.

Results

DMA microbiome presented higher diversity than DMI. Inadequate glycaemic control favoured fermenting species, especially those associated with propionate/succinate production, whereas those forming butyrate/pyruvate was decreased in DMI. Higher abundances of anginosus group and Streptococcus agalactiae in DMI may indicate that subgingival sites can be reservoir of potentially invasive pathogens. Altered subgingival microbiome in DMI may represent an additional challenge in the periodontal treatment of these patients and in the prevention of more invasive infections.

Conclusion

Glycaemic status in T2DM patients seems to modulate subgingival biofilm composition.
Cumulative childhood risk is associated with a new measure of chronic inflammation in adulthood
Authors: Rasmussen Line Jee Hartmann , Moffitt Terrie E. , Eugen‐Olsen Jesper , Belsky Daniel W. , Danese Andrea , Harrington HonaLee , Houts Renate M. , Poulton Richie , Sugden Karen , Williams Benjamin , Caspi Avshalom
Published: May 2018

Background

Childhood risk factors are associated with elevated inflammatory biomarkers in adulthood, but it is unknown whether these risk factors are associated with increased adult levels of the chronic inflammation marker soluble urokinase plasminogen activator receptor (suPAR). We aimed to test the hypothesis that childhood exposure to risk factors for adult disease is associated with elevated suPAR in adulthood and to compare suPAR with the oft‐reported inflammatory biomarker C‐reactive protein (CRP).

Methods

Prospective study of a population‐representative 1972–1973 birth cohort; the Dunedin Multidisciplinary Health and Development Study observed participants to age 38 years. Main childhood predictors were poor health, socioeconomic disadvantage, adverse childhood experiences (ACEs), low IQ, and poor self‐control. Main adult outcomes were adulthood inflammation measured as suPAR and high‐sensitivity CRP (hsCRP).

Results

Participants with available plasma samples at age 38 were included (N = 837, 50.5% male). suPAR (mean 2.40 ng/ml; SD 0.91) was positively correlated with hsCRP (r 0.15, p < .001). After controlling for sex, body mass index (BMI), and smoking, children who experienced more ACEs, lower IQ, or had poorer self‐control showed elevated adult suPAR. When the five childhood risks were aggregated into a Cumulative Childhood Risk index, and controlling for sex, BMI, and smoking, Cumulative Childhood Risk was associated with higher suPAR (b 0.10; SE 0.03; p = .002). Cumulative Childhood Risk predicted elevated suPAR, after controlling for hsCRP (b 0.18; SE 0.03; p < .001).

Conclusions

Exposure to more childhood risk factors was associated with higher suPAR levels, independent of CRP. suPAR is a useful addition to studies connecting childhood risk to adult inflammatory burden.
Advance Care Planning for Older Homeless‐Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study
Authors: Sudore Rebecca L. , Cuervo Isabel Arellano , Tieu Lina , Guzman David , Kaplan Lauren M. , Kushel Margot
Published: May 2018

Older homeless‐experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross‐sectional analysis of a cohort of 350 homeless‐experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision‐makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). We used multivariable logistic regression to examine factors associated with ACP discussions and documentation. The median age of the cohort was 59 (range 52–82), 75.2% were male, and 82.1% were black. Sixty‐one percent reported a potential surrogate, 21.5% had discussed ACP, and 19.0% reported ACP documentation. In multivariable models, having 1 to 5 confidants versus none (adjusted odds ratio (aOR)=5.8, 95% confidence interval (CI)=1.7–20.0), 3 or more chronic conditions versus none (aOR=2.3, 95% CI=0.9–5.6), and a recent primary care visit (aOR=2.1, 95% CI=1.0–4.4) were associated with higher odds of ACP discussions and each additional 5 years of homelessness (aOR=0.7, 95% CI=0.5—0.9) with lower odds. Having 1 to 5 confidants (aOR=5.0, 95% CI=1.4–17.5), being black (aOR=5.5, 95% CI=1.5–19.5), and having adequate versus limited literacy (aOR=7.0, 95% CI=1.5–32.4) were associated with higher odds of ACP documentation and illicit drug use (aOR=0.3, 95% CI=0.1–0.9) with lower odds. Although the majority of older homeless‐experienced adults have a potential surrogate, few have discussed or documented their ACP wishes; the odds of both were greater with larger social networks. Future interventions must be customized for individuals with limited social networks and address the instability of homelessness, health literacy, and the constraints of safety‐net healthcare settings.
The Effects of Airline Mergers on Consumers' Perceptions of Services and Behavioral Responses
Authors: Andersen Peter , Weisstein Fei L.
Published: May 2018

Prior literature focuses on customer satisfaction in the airline industry, while research on consumers' perceptions and behavioral responses to airline mergers is limited and understudied. This paper conducts a field survey on the merger between United and Continental Airlines to examine the effects of an airline merger on passenger satisfaction, service value, and behavioral intentions through perceived service quality. Data were collected from airline passengers arriving at three US airports in two phases: before and after the merger across a period of four years. The results show a noticeable increase in customer satisfaction and positive behavioral responses with the postmerger United Airlines due to the perceived improvement in service quality. This study provides insights into the role of airline mergers in improving customer satisfaction, implications for airline managers, and directions for future research.
Mindfulness, Money Attitudes, and Credit
Authors: Pereira Maria C. , Coelho Filipe
Published: May 2018

Consumer credit is a central feature of modern living, having been an important topic of research for some time. In contrast, mindfulness has only recently gained research prominence. Our study develops a model that links individuals' mindfulness with their credit intentions/use, and that further proposes money attitudes as a mediator variable. Broad support for the model is provided by a sample of students from a Portuguese University and a second sample composed of adult US residents. The results suggest that mindfulness might play a significant role in shaping consumers' money attitudes and credit intentions/use. Additionally, the study suggests that the relationships of mindfulness and money attitudes with credit are only significant when credit is directed toward the purchase of nonbasic products. These results yield a number of considerations for future research and for institutions promoting financial education, which could lead to improved debt management and greater financial well‐being.
Effect of oak (Quercus persica) acorn level on apparent digestibility, ruminal fermentation, nitrogen balance and urinary purine derivatives in pregnant goats
Authors: Jafari H. , Fatahnia F. , Khatibjoo A. , Taasoli G. , Fazaeli H. , Varmaghany S.
Published: May 2018

The aim of this experiment was to investigate the effect of dietary oak (Quercus persica) acorn (OA) level on dry matter intake (DMI), apparent nutrient digestibility, nitrogen (N) utilization, ruminal fermentation, protozoa population and urinary purine derivatives (PD) during the last 60 days of goat pregnancy. Twenty‐four multiparous pregnant goats (41.7 ± 2.3 kg BW) were assigned to one of three experimental diets consisted of control diet (C, without OA) and diets containing 20 (OA20) or 40 g/100 g of OA (OA40) on a DM basis in a completely randomized block design. Goats fed OA40 had lower DMI (p < .01), DM (p < .01), OM (p < .01) and NDF (p < .05) digestibility, ruminal NH3‐N concentration (p < .01), N intake (p < .01) and N retention (p < .01). Crude protein digestibility and ruminal acetate and total volatile fatty acid (VFA) concentration were lower in animals fed OA‐contained diets (p < .01), whereas ruminal propionate concentration was higher in goats fed the C diet (p < .01). Animals fed OA40 had higher faecal N excretion and lower urinary N excretion (p < .01). Urinary PD was lower in goats fed diets containing OA in relation to those fed the C diet (p < .01). Total protozoa population decreased linearly with increasing OA level in the diet (p < .05). These results suggest that feeding OA, especially high level, has negative impacts on DMI, nutrient digestibility, VFA concentration, N retention and urinary PD excretion that may have adverse effects on metabolism and performance of pregnant goats.