bluuebunny/crossref_metadata_2025 huggingface dataset:
Incipient signs of genetic differentiation among African elephant populations in fragmenting miombo ecosystems in south‐western Tanzania
Authors: Lobora Alex L. , Nahonyo Cuthbert L. , Munishi Linus K. , Caro Tim , Foley Charles , Prunier Jérôme G. , Beale Colin M. , Eggert Lori S.
Published: July 2018

Habitat fragmentation can play a major role in the reduction of genetic diversity among wildlife populations. The Ruaha‐Rungwa and Katavi‐Rukwa ecosystems in south‐western Tanzania comprise one of the world's largest remaining African savannah elephant metapopulations but are increasingly threatened by loss of connectivity and poaching for ivory. To investigate the genetic structure of populations, we compared the genotypes for nine microsatellite loci in the western, central and eastern populations. We found evidence of genetic differentiation among the three populations, but the levels were low and mostly concerned the younger cohort, suggesting recent divergence probably resulting from habitat loss between the two ecosystems. We identified weak isolation by distance, suggesting higher gene flow among individuals located less than 50 km apart. In a long‐lived species with overlapping generations, it takes a long time to develop genetic substructure even when there are substantial obstacles to migration. Thus, in these recently fragmented populations, inbreeding (and the loss of heterozygosity) may be less of an immediate concern than the loss of adults due to illegal hunting.
Isolating cues to social judgements from faces: The possible effects of hairstyles
Authors: Matsumoto David , Hwang Hyisung C.
Published: July 2018

A previous study provided evidence for the existence of “nonverbal accents” by demonstrating differences in judgements by American observers of the nationality of Japanese national and Japanese American emotional and neutral expressions. The stimuli used in that study, however, confounded differences in potential contextual cues such as hairstyles with nationality. To test whether any contextual cues may have contributed to differences in judgements of nationality, we replicated that study and tested whether one type of contextual cue—hairstyles—affected nationality judgements. Hairstyle differences contributed to differences in judging nationality, especially in judgements of Japanese nationals. These findings suggested that participants may have been able to distinguish the nationality of the expressors not because of a variation in facial expressions of emotion but because of other factors such as hairstyles. The findings raise questions about the basis of nonverbal accents in facial expressions.
Asymmetries and opportunities: Power and inequality in Fairtrade wine global production networks
Authors: Herman Agatha
Published: July 2018

Fairtrade is changing. The hegemonic certified system, governed by Fairtrade International, has seen some high‐profile withdrawals by major processors and retailers in recent months, which is leading to both proponents and critics questioning who, and what, the system is for. While the certified system has seen increasing conventionalisation, there remains at its core a mission to make trade fair, empower those marginalised in global trade and foster sustainable livelihoods. Taking a global production network (GPN) framework supports a critical exploration of the market, social and political asymmetries of this international system of production and distribution. Drawing on empirical evidence from the wine industry, this paper uses a production‐space perspective to critically reflect on some of the key relations within Fairtrade GPNs. While there are many positive impacts, particularly in social development, producers have experienced a conventionalisation of supply chains, a lack of contextual responsiveness and limited engagement with the global system. These indicate a continuation of power asymmetries that are intersecting, multiscalar and evolving. Although these are from wine industry case studies, anecdotal evidence suggests that they are not uncommon experiences and even a hint of unfair, disempowering and unsustainable trading practices negatively impacts both these producers’ livelihoods and the reputation of the Fairtrade system as a whole. Nonetheless, there remains significant producer buy‐in indicating that the ideals of Fairtrade retain currency. This therefore presents a critical opportunity for Fairtrade to actively address the market, social and political inequalities that persist in its GPNs and re‐establish itself as a leader in the ethical marketplace.
Multiple Robust Estimation of Marginal Structural Mean Models for Unconstrained Outcomes
Authors: Babino Lucia , Rotnitzky Andrea , Robins James
Published: July 2018

We consider estimation, from longitudinal observational data, of the parameters of marginal structural mean models for unconstrained outcomes. Current proposals include inverse probability of treatment weighted and double robust (DR) estimators. A difficulty with DR estimation is that it requires postulating a sequence of models, one for the each mean of the counterfactual outcome given covariate and treatment history up to each exposure time point. Most natural models for such means are often incompatible. Robins et al., (2000b) proposed a parameterization of the likelihood which implies compatible parametric models for such means. Their parameterization has not been exploited to construct DR estimators and one goal of this article is to fill this gap. More importantly, exploiting this parameterization we propose a multiple robust (MR) estimator that confers even more protection against model misspecification than DR estimators. Our methods are easy to implement as they are based on the iterative fit of a sequence of weighted regressions.
A Useful Design Utilizing the Information Fraction in a Group Sequential Clinical Trial With Censored Survival Data
Authors: Hsu Chih-Yuan , Chen Chen-Hsin , Hsu Ken-Ning , Lu Ya-Hung
Published: July 2018

Lan and DeMets (1983) proposed the alpha spending function for group sequential trials to permit the use of unspecified frequencies and timings of interim analyses in the trial design. Regarding a trial with censored time to endpoint, Lan and DeMets (1989) later defined information time at an interim analysis in a maximum duration trial. To compare two survival curves utilizing such a design, information times for group sequential logrank and Wilcoxon-type statistics have been developed by assuming that the survival time follows an exponential distribution or a Weibull distribution without considering the censoring distribution. To better address the practical concerns inherent in clinical trials with survival endpoints, we present a new approach to adequately design a group sequential trial using the Harrington–Fleming (1982) test based on our proposed information fractions by assuming the censoring distribution depends on the patient's accrual time according to various entry distributions and by extending the underlying survival distribution to the generalized gamma distribution. We also determine associated sample sizes, expected number of events and expected stopping time. Two phase III trials of non-small-cell lung cancer originally designed using fixed-sample tests are utilized to illustrate the potential advantages of using a group sequential design with the proposed approach. This enhanced method facilitates the design and analysis of group sequential clinical trials studying survival endpoints by increasing implemental flexibility.
Does urinary cytology have a role in haematuria investigations?
Authors: Tan Wei Shen , Sarpong Rachael , Khetrapal Pramit , Rodney Simon , Mostafid Hugh , Cresswell Joanne , Watson Dawn , Rane Abhay , Hicks James , Hellawell Giles , Davies Melissa , Srirangam Shalom J. , Dawson Louise , Payne David , Williams Norman , Brew‐Graves Chris , Feber Andrew , Kelly John D. ,   DETECT I trial collaborators
Published: July 2018

Objectives

To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria.

Patient and methods

The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub‐analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells.

Results

Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3–33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High‐risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high‐risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow‐up.

Conclusions

Urine cytology will miss a significant number of muscle‐invasive bladder cancer and high‐risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.
Three‐ to Four‐Year‐Old Children Rapidly Adapt Their Predictions and Use Them to Learn Novel Word Meanings
Authors: Havron Naomi , de Carvalho Alex , Fiévet Anne‐Caroline , Christophe Anne
Published: July 2018

Adults create and update predictions about what speakers will say next. This study asks whether prediction can drive language acquisition, by testing whether 3‐ to 4‐year‐old children (n = 45) adapt to recent information when learning novel words. The study used a syntactic context which can precede both nouns and verbs to manipulate children's predictions about what syntactic category will follow. Children for whom the syntactic context predicted verbs were more likely to infer that a novel word appearing in this context referred to an action, than children for whom it predicted nouns. This suggests that children make rapid changes to their predictions, and use this information to learn novel information, supporting the role of prediction in language acquisition.
Differential impact of socioeconomic position across life on oral cancer risk in Kerala, India: An investigation of life‐course models under a time‐varying framework
Authors: ThekkePurakkal Akhil Soman , Naimi Ashley I. , Madathil Sreenath A. , Kumamangalam Puthiyannal Shahul H. , Netuveli Gopalakrishnan , Sacker Amanda , Schlecht Nicolas F. , Nicolau Belinda
Published: July 2018

Objectives

The incidence of oral cancer has been rapidly increasing in India, calling for evidence contributing to a deeper understanding of its determinants. Although disadvantageous life‐course socioeconomic position (SEP) is independently associated with the risk of these cancers, the explanatory mechanisms remain unclear. Possible pathways may be better understood by testing which life‐course model most influences oral cancer risk. We estimated the association between life‐course SEP and oral cancer risk under three life‐course models: critical period, accumulation and social mobility.

Methods

We recruited incident oral cancer cases (N = 350) and controls (N = 371) frequency‐matched by age and sex from two main referral hospitals in Kozhikode, Kerala, India, between 2008 and 2012. We collected information on childhood (0‐16 years), early adulthood (17‐30 years) and late adulthood (above 30 years) SEP and behavioural factors along the life span using interviews and a life‐grid technique. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between life‐course SEP and oral cancer risk using inverse probability weighted marginal structural models.

Results

Relative to an advantageous SEP in childhood and early adulthood, a disadvantageous SEP was associated with oral cancer risk [(OR = 2.76, 95% CI: 1.99, 3.81) and (OR = 1.84, 95% CI: 1.21, 2.79), respectively]. In addition, participants who were in a disadvantageous (vs advantageous) SEP during all three periods of life had an increased oral cancer risk (OR = 4.86, 95% CI: 2.61, 9.06). The childhood to early adulthood social mobility model and overall life‐course trajectories indicated strong influence of exposure to disadvantageous SEP in childhood on the risk for oral cancer.

Conclusions

Using novel approaches to existing methods, our study provides empirical evidence that disadvantageous childhood SEP is critical for oral cancer risk in this population from Kerala, India.
Diagnostic accuracy of parathyroid hormone levels in washout samples of suspicious parathyroid adenomas: A single‐centre retrospective cohort study
Authors: Gökçay Canpolat Asena , Şahin Mustafa , Ediboğlu Elif , Erdoğan Murat Faik , Güllü Sevim , Demir Özgür , Emral Rıfat , Çorapçıoğlu Demet
Published: July 2018

Introduction

Minimally invasive surgery is an alternative surgical approach for primary hyperparathyroidism with less surgical trauma and anaesthesia complications. When combined with intraoperative measurement of parathyroid hormone (PTH), cure rates are exceeding 97%. Preoperative intact PTH determination in washout samples is really very useful when parathyroid lesions cannot be easily distinguished from thyroid lesions or sometimes lymph nodes. Herein, we aimed to report our institutional experience about parathyroid fine‐needle aspiration (FNA) method and suggest a cut‐off ratio for this purpose.

Methods

In our clinic, we performed ultrasonography (USG)‐guided parathyroid FNA procedure for 131 patients diagnosed with primary hyperparathyroidism between January 2005 and January 2016. Both cytologic evaluation and intact PTH determination were performed in washout samples. Eighty‐seven of the study group also had a parathyroid scintigraphy. Both demographic features and laboratory results were all recorded.

Results

Median serum PTH level was 142 (113‐197), while mean PTH washout level was 1824 (0‐3953). When three of the localization techniques are compared with each other, FNA‐PTH washout group had a better diagnostic accuracy (90.8%) when compared to cytology (7.92%) and MIBI (67.8%) groups. Both MIBI and FNA‐PTH washout group had 100% positive predictive value (PPV) and 100% specificity. We found values greater than 436.5 pg/mL for FNA‐PTH washout with a sensitivity of 90.3% and specificity of 88.9% (P < 0.01 and AUC 94.3 (87.8‐100)) and a cut‐off for FNA/serum PTH greater than 3.05 with a sensitivity of 91.2% and specificity of 89% (P = 0.02 and AUC 94.5 (88.8‐100)) which implicate parathyroid lesions.

Conclusion

According to the literature, PTH determination in washout samples has a specificity of 75%‐100% and sensitivity of 70%‐100%. This approach has better results than both cytology and scintigraphy in case of concomitant multinodular thyroid disease in experienced hands. Although there is not a definite cut‐off for PTH levels in washout samples, we agree with the need of ratios rather than cut‐offs in this issue.
Limits of monetization in protecting ecosystem services
Authors: Temel Julia , Jones Aled , Jones Nikoleta , Balint Lenke
Published: July 2018

The monetary valuation of ecosystem services is gaining traction in policy and business communities. Several tools and decision‐making processes have been proposed, including criteria to assess the appropriateness of using monetary valuation for biodiversity conservation outcomes. These criteria include measures such as scale, uniqueness, and threat. We used case studies of monetization projects for which the outcomes were measured to explore the limitations and application of these criteria. There was limited evidence of the effectiveness of such schemes. The majority of the schemes were established in areas where the criteria specifically excluded their use in isolation. Thus, although some aspects of monetization may be beneficial for biodiversity conservation, these schemes were not being used appropriately and require some quantitative minimum (or maximum) measurements to be applied through additional policy or governance measures to ensure biodiversity conservation outcomes.
Incorporating biotic interactions reveals potential climate tolerance of giant pandas
Authors: Wang Fang , Zhao Qing , McShea William J. , Songer Melissa , Huang Qiongyu , Zhang Xiaofeng , Zhou Lingguo
Published: July 2018

Many studies have overestimated species’ range shifts under climate change because they treat climate as the only determinant while ignoring biotic factors. To assess the response of giant pandas to climate change, we incorporated spatial effects in modeling bamboo distributions, which in turn was incorporated to represent giant panda–bamboo biotic interactions in predicting giant panda distribution. Our study revealed potential tolerance of giant pandas to climate change. We found significant residual spatial correlation in the bamboo models. The biotic interactions with bamboo understories and anthropogenic activities had large effects on panda distribution, which lowered the relative importance of climatic variables. Our results are fundamentally different from previous studies that used climate‐only and nonspatial approaches, which may have overestimated the effects of climate change on panda and lead to inappropriate conservation recommendations. We strongly advocate that giant panda conservation planning continues to focus on protecting bamboo forest and reducing anthropogenic interferences.
Peace in Colombia is a critical moment for Neotropical connectivity and conservation: Save the northern Andes–Amazon biodiversity bridge
Authors: Clerici Nicola , Salazar Camilo , Pardo‐Díaz Carolina , Jiggins Chris D. , Richardson James E. , Linares Mauricio
Published: July 2018

Colombia is one of the most biodiverse countries in the world that has historically and is currently experiencing extensive deforestation and habitat fragmentation. Here we show how the most extensive region acting as a natural corridor between the Colombian Andes and Amazon biogeographical regions, the Picachos–Tinigua–Sierra de la Macarena–Chiribiquete megacorridor, is being eroded by large‐scale agricultural expansion endangering the maintenance and connection of gene flow and biodiversity exchange. Several phylogenetic studies indicate that the complex dynamics between the Andean highlands and the Amazonian lowlands have strongly influenced the origin and maintenance of Neotropical biodiversity. We appeal for the attention of international conservation and governmental organizations to direct resources and promote projects focused on the preservation and sustainable management of this strategic Andes–Amazon bridge in both protected and unprotected areas. In the current postconflict era, Colombia has a unique opportunity to create a new social and economic paradigm based on long‐term sustainably developed landscapes and more equitable sharing of wealth. We believe improved management and conservation efforts for the Picachos–Tinigua–Macarena–Chiribiquete megacorridor would demonstrate a collective will in helping to achieve this goal.
What is the significance of non‐specific pleuritis? A trick question
Authors: Janssen Julius , Maldonado Fabien , Metintas Muzaffer
Published: July 2018

Non‐specific pleuritis (NSP) is defined as fibrinous or inflammatory pleuritis which cannot be attributed to a specific benign or malignant etiology. It can be diagnosed in biopsies in up to 30% of cases of exudative pleuritis after thoracoscopy, with a mean of 19.2%. In 66 out of 469 (14.2%) patients in combined series, a malignant pleural disease (mostly mesothelioma) was found during a follow‐up of at least 21 months. Most likely, a follow‐up time of 12 months is sufficient, although the current routine is a follow‐up of 2 years. Because of a benign course in 85% of patients with NSP, a repeated invasive procedure after thoracoscopy is only indicated in a limited group of patients. The most important indications for a repeated pleural biopsy are persistent chest pain, recurrent pleural effusion, radiologic findings suggestive for malignant pleural disease.
Migration strategies of brown trout (Salmo trutta) in a subarctic river system as revealed by stable isotope analysis
Authors: Ruokonen Timo J. , Kiljunen Mikko , Erkinaro Jaakko , Orell Panu , Sivonen Olli , Vestola Eero , Jones Roger I.
Published: July 2018

We estimated the proportions of anadromous and freshwater‐resident brown trout (Salmo trutta) in different parts of the subarctic River Näätämöjoki/Neidenelva system (Finland and Norway) using carbon, nitrogen and hydrogen stable isotope analyses of archived scales as identifiers of migration strategy. Our results showed that carbon stable isotope values were the best predictor of migration strategy. Most individuals fell into two clearly distinct groups representing anadromous (47%) or freshwater‐resident (42%) individuals, but some fish had intermediate carbon values suggesting repeated movement between freshwater and the sea. The proportion of anadromous individuals decreased steadily with distance from the sea forming a spatial continuum in migration strategies which is probably maintained by the combination of several factors such as divergent availability of food resources, variable migration costs and genetic differences. These within‐catchment differences in migration strategies should be taken into account in fisheries management practices.
Feeling nothing: Numbness and emotional absence
Authors: Roberts Tom
Published: July 2018

I argue that it is possible for a subject to undergo experiences of emotional absence, during which she becomes aware of her own failure to be moved by the world around her. Just as a part of one's body feels numb when it manifestly fails to incur the ordinary sensory consequences of transactions at the surface of the skin, so an individual feels emotional absence when her affective condition manifestly fails to vary in predictable ways as she navigates her surroundings. Experiences of emotional absence, such as feeling numb with shock or grief, feeling unamused, or feeling fearless, are not simply flat or neutral states of awareness, but can bear psychological and epistemic significance for the agent.
Serial evaluation of resting and exercising overground endoscopic examination results in young Thoroughbreds with no treatment intervention
Authors: McGivney C. L. , Sweeney J. , Gough K. F. , Hill E. W. , Katz L. M.
Published: July 2018

Background

We hypothesised that grade/appearance for upper respiratory tract (URT) disorders identified at the first overground endoscopy (OGE) examination would vary at subsequent examinations.

Objectives

To compare OGE examinations from horses evaluated on at least two occasions under similar exercise conditions without treatment intervention.

Study design

Retrospective cohort.

Methods

Pre‐exercise and exercising OGE recordings from Thoroughbred horses undergoing multiple examinations under similar exercise conditions were reviewed, with the first two recordings for each horse statistically evaluated. Paired Wilcoxon signed‐rank tests were used to assess differences in exercise and physiological parameters between examinations. Z‐tests were used to assess the proportion of changes in URT disorder grade/appearance between examinations. A McNemar's test was used to compare the proportion of horses with each disorder at each examination. Test–retest reliability across examinations was assessed using Spearman's ρ, and ordered logistic regression used to explore temporal effects on repeatability. Lattice plots were constructed to view variability in disorders over time.

Results

Seventy‐eight horses (median age 2.4 years) with 195 resting endoscopic examinations including 72/78 horses with 179 pre‐exercise and exercising OGE examinations were evaluated. Median time between examinations was 226.5 days with no differences between exercise and physiological parameters. Grades significantly varied between examinations for all disorders, and in particular for palatal instability (PI) and epiglottic grade at rest. A temporal link between examination interval and disorder grade change was identified for PI and resting arytenoid asymmetry.

Main limitations

OGE re‐examinations within a shorter, more consistent time‐frame would allow determination of intrahorse variability. The sample size was inadequate to conclusively establish temporal links between disorders and time between examinations.

Conclusions

Variability for most URT abnormalities identified with OGE should be considered when making therapeutic decisions based on a single examination and may partially explain development of additional URT conditions after surgical intervention.

The Summary is available in Portuguese ‐ see Supporting Information
Pharmacological effects of the isomeric mixture of alpha and beta amyrin from Protium heptaphyllum: a literature review
Authors: Nogueira Amaurilio O. , Oliveira Yasmin Ingrid S. , Adjafre Beatriz L. , de Moraes Maria E. Amaral , Aragão Gislei F.
Published: July 2018

Protium heptaphyllum Aubl. belongs to the Burseraceae family. It is commonly called ‘almecegueira’ and is known to produce an amorphous resin which has constituents such as α‐ and β‐amyrin, taraxastan‐3‐oxo‐20‐ol and sitostenonein. The α‐ and β‐amyrin from P. heptaphyllum have pharmacological activities in several systems, such as central and peripheral nervous system, gastrointestinal tract and immunological system. In this study, our objective was to review pharmacological activities and to gather more information on the mixture of α‐ and β‐amyrin obtained from P. heptaphyllum to guide future preclinical and clinical studies using this compound. This review consisted of searches performed using scientific databases such as PubMed, SciELO, LILACS, SciFinder and Science Direct. Some uses of α‐ and β‐amyrin have been partially confirmed by previous studies demonstrating analgesic, anti‐inflammatory, anticonvulsant, antidepressive, gastroprotective, hepatoprotective, antipancreatitic, anticholytic, antihyperglycemic and hypolipidemic effects. It is noteworthy that there are no α‐ and β‐amirin toxicity tests described in the literature as recommended in the international guidelines, and such tests are one of the research stages to proceed in clinical and preclinical trials if this compound was to be used.
Characterization of Miscanthus cell wall polymers
Authors: Schäfer Judith , Sattler Melinda , Iqbal Yasir , Lewandowski Iris , Bunzel Mirko
Published: July 2018

Efficient utilization of lignocellulosic Miscanthus biomass for the production of biochemicals, such as ethanol, is challenging due to its recalcitrance, which is influenced by the individual plant cell wall polymers and their interactions. Lignocellulosic biomass composition differs depending on several factors, such as plant age, harvest date, organ type, and genotype. Here, four selected Miscanthus genotypes (Miscanthus sinensis, Miscanthus sacchariflorus, Miscanthus × giganteus, Miscanthus sinensis × Miscanthus sacchariflorus hybrid) were grown and harvested, separated into stems and leaves, and characterized for their non‐starch polysaccharide composition and structures, lignin contents and structures, and hydroxycinnamate profiles (monomers and ferulic acid dehydrodimers). Polysaccharides of all genotypes are mainly composed of cellulose and low‐substituted arabinoxylans. Ratios of hemicelluloses to cellulose were comparable, with the exception of Miscanthus sinensis that showed a higher hemicellulose/cellulose ratio. Lignin contents of Miscanthus stems were higher than those of Miscanthus leaves. Considering the same organs, the four genotypes did not differ in their Klason lignin contents, but Miscanthus × giganteus showed the highest acetylbromide soluble lignin content. Lignin polymers isolated from stems varied in their S/G ratios and linkage type distributions across genotypes. p‐Coumaric acid was the most abundant ester‐bound hydroxycinnamte monomer in all samples. Ferulic acid dehydrodimers were analyzed as cell wall cross‐links, with 8‐5‐coupled diferulic acid being the main dimer, followed by 8‐O‐4‐, and 5‐5‐diferulic acid. Contents of p‐coumaric acid, ferulic acid, and ferulic acid dimers varied depending on genotype and organ type. The largest amount of cell wall cross‐links was analyzed for Miscanthus sinensis.
Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care
Authors: Jablonski Rita A. , Kolanowski Ann M. , Azuero Andres , Winstead Vicki , Jones‐Townsend Corteza , Geisinger Maria L.
Published: July 2018

Objectives

The purpose of this study was to test the efficacy ofMOUTh (Managing Oral Hygiene Using Threat Reduction), a nonpharmacologic, relationship‐based intervention vs. control on 2 primary outcomes for nursing home (NH) residents with dementia who resisted mouth care: (i) reduction in the occurrence and intensity of care‐resistant behaviours (CRBs) and (ii) improvement in oral health. Two secondary outcomes were also examined: (i) the duration of mouth care and (ii) the completion of oral hygiene activities.

Background

Persons with dementia who exhibitCRBs are at risk for inadequate mouth care and subsequent systemic illnesses.

Materials and methods

The study used a randomised repeated measures design. Recruitment occurred in 9 nursing homes that varied in size, ownership, reimbursement patterns and location. One hundred and one nursing home residents with dementia were randomised at the individual level to experimental (n = 55) or control groups (n = 46). One hundred participants provided data for the analyses.

Results

Compared to the control group, persons in the experimental group had twice the odds of allowing mouth care and completing oral hygiene activities; they also allowed longer duration of mouth care (d = 0.56), but showed only small reductions in the intensity ofCRBs (d = 0.16) and small differential improvements in oral health (d = 0.18).

Conclusion

The data suggest that this intervention facilitates mouth care among persons with dementia. The management of refusal behaviour may be a clinically more realistic approach than reducing or eradicating refusals.
Less than one‐third of hip fracture patients return to their prefracture level of instrumental activities of daily living in a prospective cohort study of 480 patients
Authors: Moerman Sophie , Mathijssen Nina MC , Tuinebreijer Wim E , Nelissen Rob GHH , Vochteloo Anne JH
Published: July 2018

Aim

A significant loss of instrumental activities of daily living (IADL) after a hip fracture has been reported. The aim of the present study was to identify specific predictors for low IADL after a hip fracture, in order to target better postoperative care for these patients.

Methods

A prospective observational cohort study of 480 hip fracture patients was carried out. IADL was measured at baseline, and after 3 and 12 months using the Groningen Activity Restriction Scale. Multivariable logistic regression analysis was carried out using age, sex, American Society of Anesthesiologists classification, prefracture living with a partner, prefracture living situation, prefracture use of walking aids, type of fracture, type of anesthesia, length of hospital stay, postoperative complications and prefracture IADL as potential predictors for low IADL after a hip fracture. The correlation between IADL, mobility and living situation, both at admission, and 3 and 12 months postoperatively, were measured.

Results

Three months after hip fracture treatment, 24% of patients returned to their baseline IADL level, at 12 months postoperative this was 29%. Factors associated with a larger loss in IADL after a hip fracture were older age, prefracture living with a partner, prefracture living at home, prefracture use of walking aids and longer length of hospital stay. The correlation between IADL and living situation was 0.69, and between IADL and use of walking aids was 0.80.

Conclusions

A return to prefracture IADL level was low. Healthier patients have a steeper decline in postoperative IADL. Geriatr Gerontol Int 2018; 18: 1244–1248.
Long‐term outcomes from prophylactic or episodic treatment of haemophilia A: A systematic review
Authors: O'Hara J. , Sima C. S. , Frimpter J. , Paliargues F. , Chu P. , Presch I.
Published: July 2018

Introduction

Evaluating treatment success in patients with haemophilia A (HA) remains a vigorous debate, especially concerning the interpretation of results from clinical and observational research. The benefits of short‐term prophylaxis are well established, but long‐term outcomes, particularly related to humanistic and economic burden, are not as well understood.

Aim

We conducted a systematic literature review to evaluate the association of episodic or prophylactic bleed control with long‐term clinical, humanistic and economic outcomes.

Methods

Studies published in English between 1 January 2006 and 15 December 2016 were included. Participants had HA (with or without inhibitors), received prophylactic or episodic treatment and had at least 4 years of treatment or follow‐up. Results were analysed qualitatively with descriptive findings.

Results

A total of 2091 records were screened, resulting in 19 studies from 20 publications for inclusion. Most studies included children (84%), were limited to patients with severe disease (74%) and were conducted in Europe or North America (89%). Ten studies (53%) included patients with inhibitors. Median study follow‐up ranged from 5 to 19 years. Long‐term bleeding and haemarthrosis outcomes were consistently better for patients receiving prophylaxis, who also required fewer hospitalizations or surgeries. Health‐related quality of life, functionality and productivity were generally more favourable in patients receiving prophylaxis. Quantitative comparisons were not feasible due to the lack of consistency in endpoint collection and reporting among studies.

Conclusion

This systematic review confirmed that the benefits of prophylactic treatment on short‐term outcomes translate to broader long‐term clinical, humanistic and economic benefits. Better harmonization of data collection and outcome assessments across both registries and clinical studies is needed to allow for effective comparisons across studies and across data sources.
The immunogenicity of ReFacto AF (moroctocog alfa AF‐CC) in previously untreated patients with haemophilia A in the United Kingdom
Authors: Mathias M. C. , Collins P. W. , Palmer B. P. , Chalmers E. , Alamelu J. , Richards M. , Will A. , Hay C. R. M. ,   the United Kingdom Haemophilia Centre Doctors’ Organisation Inhibitor Working Party
Published: July 2018

Introduction

Factor VIII inhibitor development is currently the most serious complication of the treatment of haemophilia A. Differences in manufacturing and the molecular structure of brands of recombinant factor VIII have led to speculation that concentrates may differ in immunogenicity. This has led to a regulatory focus on the immunogenicity of factor VIII concentrates both before and after licensure.

Aim

To investigate the immunogenicity of ReFacto AF post licensure in a real‐world setting in previously untreated patients (PUPs) treated exclusively with this product until at least 50 exposure days (EDs).

Methods

The United Kingdom Haemophilia Centre Doctors’ Organisation (UKHCDO) National Haemophilia Database (NHD) identified a consecutive cohort of patients with severe haemophilia A (<0.01 IU/L) whose first treatment was with ReFacto AF, monitored time to inhibitor development and described associated risk factors.

Results

One hundred and three boys reached 50 EDs within the study period, of whom 35 developed an inhibitor (P(t ≤ 50) = 0.33, [95% CI: 0.25‐0.43]), of which 15 (P(t ≤ 50) = 0.16, [95% CI: 0.10‐0.25]) were high titre. Inhibitors arose after a median (interquartile range) 11 (7‐16) EDs. Inhibitors were significantly associated with high‐risk mutations and non‐significantly associated with non‐white ethnicity. Inhibitors were negatively associated with a family history of haemophilia A. High‐titre inhibitors were significantly associated with a family history of inhibitors.

Conclusion

Inhibitor incidence in a single country population of ReFacto AF PUPs was similar to that previously described. Low‐ and high‐titre inhibitors were detected after a similar number of EDs, contrasting with previous data, probably reflecting standardized inhibitor monitoring within the United Kingdom.
Risk factors for cardiovascular disease in children and young adults with haemophilia
Authors: Limjoco Jacqueline , Thornburg Courtney D.
Published: July 2018

Introduction

The origins of cardiovascular disease (CVD) begin in childhood. The primary objective of this cross‐sectional cohort study was to determine the prevalence of cardiovascular risk factors in patients with congenital haemophilia A or B followed at Rady Children's Hospital San Diego Hemophilia and Thrombosis Treatment Center (HTC). We hypothesized that cardiovascular risk factors could be identified as part of a comprehensive clinic visit.

Materials and Methods

Standardized measurement of weight, height, waist circumference and blood pressure plus non‐fasting glucose and lipid panel were performed. Participants and/or caregivers completed questionnaires about family history, medical history and lifestyle. Clinical data were abstracted from the medical record. Descriptive statistics, Student's t test, correlation, Mann‐Whitney U test and chi‐square test were performed to analyse the data.

Results

Forty‐three males (mean 12 years, range 5‐20 years) enrolled. High rates of overweight and obesity, (pre)hypertension and abnormal lipids were identified. Subjects with normal weight had more days of >60 minutes of physical activity compared with those with overweight or obesity (5.2 ± 2.4 vs. 3.8 ± 2.5 day; P = 0.07). Higher weight was correlated with higher factor consumption (cor = 0.88; P < 0.001). There was no difference in target joints based on weight category (30% in normal weight vs. 25% in overweight or obese, χ2= 0.11, P = 0.74), which may be attributed to high rates of prophylaxis.

Conclusions

Modifiable risk factors for CVD were identified as part of the study during comprehensive clinic visits. The HTC team may develop behavioural interventions to target cardiovascular risk reduction as part of the comprehensive care model.
Desmopressin in non‐severe haemophilia A: Test‐response and clinical outcomes in a single Canadian centre review
Authors: Hews‐Girard Julia , Rydz Natalia , Lee Adrienne , Goodyear Marilyn Dawn , Poon Man‐Chiu
Published: July 2018

Introduction

Desmopressin is an effective haemostatic agent for patients with non‐severe haemophilia A; however, response may differ between patients of similar severity. Responsiveness is classified based on various cut‐off values for plasma levels of FVIII post‐desmopressin administration. Patients may be classified differently depending on the values chosen.

Aim

To classify desmopressin response in non‐severe haemophilia A patients with respect to current test‐response definitions. Also, to characterize relationships between test response and clinical outcome of desmopressin use.

Methods

Current desmopressin test‐response definitions were obtained from the literature. We adopted peak FVIII level (at 1 hour post‐administration) ≥50 IU/dL and <20 IU/dL as complete and no response, respectively, thereby satisfying most reported definitions. Test‐responses and clinical outcomes of use between 2007 and 2017 for adult mild/moderate haemophilia A patients were reviewed and correlated.

Results

All patients classified as complete responders (n = 31; peak FVIII ≥50 IU/dL) and the majority of partial responders (n = 11; peak FVIII ≥20 to <50 IU/dL) had good clinical outcomes after desmopressin use for a variety of bleeding episodes and procedures. Two non‐responders (peak FVIII <20 IU/dL) given desmopressin for minor bleeding/procedures also had good clinical outcomes. One patient with a partial test‐response (peak FVIII 23 IU/dL) required additional factor concentrate to achieve haemostasis.

Conclusions

Based on our review, we suggest that the determination of desmopressin responsiveness should consider both the change in plasma FVIII levels as well as clinical outcomes associated with prior therapeutic use.
Cross‐over study in hyperammonemia patients for efficacy, safety, and acceptability of a new lactulose preparation (SK‐1202) compared to approved drug
Authors: Yoshiji Hitoshi , Karino Yoshiyasu , Suzuki Yoshiyuki , Suzuki Fumitaka , Uejima Masakazu , Aikata Hiroshi , Chayama Kazuaki , Iwai Hisakazu , Suzuki Eiji , Kumada Hiromitsu
Published: July 2018

Aim

A novel jelly lactulose preparation (SK‐1202) has been developed to improve compliance and reduce the elevation of blood glucose levels in diabetic patients. To compare the equivalence in the efficacy and safety of SK‐1202 and an approved commercially available syrup preparation, we undertook a randomized multicenter cross‐over study in hyperammonemia patients with liver cirrhosis who were taking lactulose.

Methods

Forty‐four patients were enrolled and took each preparation for 2 weeks. Efficacy was evaluated using the Number Connection Test, blood ammonia concentration, coma grade, and the flapping tremor grade. Safety was evaluated by the number of adverse events observed, vital signs, and laboratory tests. We also examined the acceptability of each preparation using questionnaires evaluating sweetness, aftertaste, ease of use, and preference of the preparations.

Results

There were no differences in efficacy or safety between SK‐1202 and the approved syrup preparation. With regard to the acceptability evaluation, given over 80% of the participants chose the SK‐1202 preparation, it appears to be preferred by patients.

Conclusions

It is expected that SK‐1202 could represent a useful agent for patients with hepatic encephalopathy.
International and transnational education for whose interests? A study on the career development of Chinese students
Authors: Mok Ka Ho , Han Xiao , Jiang Jin , Zhang Xiaojun
Published: July 2018

A significant increase in internationally mobile students has been observed in the past decades. With the strong intention of enhancing their competitiveness in the global labour market, a growing number of students have embarked on their learning journeys through studying abroad or enrolling in transnational Higher Education programmes. These students expect the international learning experience will enhance their future job prospects and career advancement. However, whether or not this learning experience enables students to secure promising positions in the global labour market and make their investments in Higher Education worthwhile remains debatable. Drawing on both student surveys and in‐depth interviews, this study explores how international or transnational Higher Education affects job prospects and career development, with particular reference to the perspective of employable skills and contextual influences. The respondents of the present research rate their learning experiences highly for hard knowledge, soft skills and cross‐cultural understanding. The majority of respondents suggest that the international and transnational learning experience will positively contribute to their career development. Such findings are supported by similar studies related to the job prospects of returning Chinese students after studying overseas. This article contributes to a better understanding of how students assess their studying abroad affected their personal development, job prospects and career development.
Does internationalisation of Higher Education still matter? Critical reflections on student learning, graduate employment and faculty development in Asia
Authors: Mok Ka Ho
Published: July 2018

In the last few years, there has been a growing trend of anti‐globalism and the rise of nationalism spreading across different parts of the world. Promoting internationalisation of Higher Education has brought with it the globally connected phenomenon with regard to inter‐university collaboration and student mobility across national borders but also the locally divided phenomenon when people question the value of international education. Recent elections not only in Europe and the United Kingdom but also in the United States show the rise of popularism and nationalism. Against such a wider sociopolitical context an increasing number of people believe the call for internationalisation of education has indeed favoured the elite and the rich but marginalised the poor. The major objective of this article is to set out the wider policy context for the present special issue with a theme of ‘Transnationalisation of Higher Education and Student/Faculty Mobility’. More specifically, this article identifies and discusses key issues confronting the growing tides of transnationalisation and internationalisation of Higher Education, highlighting the major arguments presented by the selected articles in this issue. This article concludes by critically examining the implications of internationalisation/transnationalisation of Higher Education for education policy and university governance.
MYB rearrangement and immunohistochemical expression in adenomyoepithelioma of the breast: a comparison with adenoid cystic carcinoma
Authors: Baraban Ezra , Zhang Paul J , Jaffer Shabnam , Lubin Daniel , Feldman Michael , Bleiweiss Ira J , Nayak Anupma
Published: July 2018

Aims

Adenomyoepithelioma (AME) and adenoid cystic carcinoma (ACC) of the breast have been noted to occur simultaneously, raising the possibility that AME may represent a related or precursor lesion to ACC. ACC frequently harbours genetic rearrangement of the MYB gene. We sought to clarify the relationship between AME and ACC by comparing their rates of MYB expression by IHC and MYB rearrangement by FISH.

Methods and results

IHC and FISH for MYB rearrangement were performed on paraffin‐embedded sections of 11 breast ACCs, 11 non‐breast ACCs and 11 breast‐AMEs. Using FISH, five of eight (63%) interpretable breast ACCs demonstrated MYB gene rearrangement. Nine of 11 (81%) breast ACCs demonstrated MYB expression (range = 20–95%). Of the three FISH‐negative breast ACCs, two were solid variant and demonstrated strong MYB expression by IHC. Of the 10 interpretable non‐breast ACCs, six showed MYB rearrangement, all of which were conventional type. Nine of these 11 (81%) cases showed MYB immunoexpression (range = 10–90%), including three solid‐variant cases which were negative by FISH. No MYB rearrangements were detected by FISH in 10 interpretable AMEs. However, three of 11 cases (27%) showed weak to moderate MYB expression by IHC (range = 10–40%).

Conclusions

Our results indicate that AMEs do not harbour MYB gene rearrangement. IHC for MYB may be helpful in diagnosing FISH‐negative cases of ACC, particularly the diagnostically more difficult solid variants. However, weak to moderate MYB expression in a subset of AMEs highlights not only a potential diagnostic pitfall, but also shared pathophysiology with ACC worth investigating further at the genomic level.