bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra-personal and extra-personal predictors of suicide attempts of South Korean adolescents
Authors: Lee Ji-Young , Bae Sung-Man
Published: July 2015

The purpose of this study was to explore significant variables predicting adolescent suicidal attempts. Socio-environmental variables such as gender, school record, school grade, school adaptation, and family intimacy together with intra-individual variables including depression, anxiety, delinquency, stress, and self-esteem were considered as candidates. Data from 1481 adolescents were collected from Korea National Youth Policy Institute. For statistical analyses, hierarchical logistic regression analysis was performed. Results of hierarchical logistic regression analysis showed that gender, school grade, depression, delinquent, stress, and family intimacy were significant predictors of suicidal attempts of adolescents. Among those, the most powerful predictor was depression, and the second was delinquency. Classification accuracy by the model of our study was 87.6%. Implications and limitations of present study and suggestions for future study were discussed.
Auditor’s Downward Switch, Governance, and Accounting Conservatism
Authors: Mitra Santanu , Jaggi Bikki , Al-Hayale Talal
Published: July 2015

This study demonstrates that the firms that switch from Big N auditors to non-Big N auditors use less accounting conservatism in the post-switch year relative to the year before switch. Our analyses further show that the decline in conservatism is mainly evident for the firms that switch to smaller non-Big N auditors, but not when the firms switch from Big N to second-tier national auditors, such as BDO Seidman and Grant Thornton (BDO/GT). In addition, we find that the firms experiencing switches from Big N to smaller non-Big N firms exhibit less accounting conservatism in the post-switch year when they have relatively weaker corporate governance. We also observe that both auditor resignation and auditor dismissal events lead to a significant decline in post-switch conservatism, especially among the firms with weaker governance mechanisms that experience switch to smaller non-Big N auditors. Furthermore, the smaller and younger firms with weaker governance adopt less conservatism in the post-switch period relative to the pre-switch period. Our findings complement prior research in this area and have policy implications that the quality of audits provided by smaller auditors may continue to remain a matter of concern in the post–Sarbanes–Oxley Act of 2002 (SOX) and post–Public Company Accounting Oversight Board (PCAOB) periods, especially when the firms have weaker governance.
Antidepressants with a high serotonin reuptake transporter affinity and serum lipid levels in a population-based study in older adults
Authors: Noordam Raymond , Aarts Nikkie , de Keyser Catherine E , Hofman Albert , Stricker Bruno H , Visser Loes E
Published: July 2015

Objective:

We aimed to investigate the association between antidepressants and serum lipid levels in a population-based study in older adults.

Methods:

We included participants from the prospective Rotterdam Study with data on lipid levels (total, low-density lipoprotein (LDL) and high-density lipoprotein cholesterol, and triglycerides). We classified antidepressants based on binding affinity to the serotonin transporter (low/intermediate- and high-affinity antidepressants). We compared lipid levels in users of these groups of antidepressants with lipid levels in non-users. Furthermore, we studied effect modification by the 102C>T polymorphism ( HTR2A gene), which is associated with antidepressant drug response and metabolic outcomes.

Results:

Compared with non-users ( N = 6438), LDL cholesterol level was higher (2.9 versus 3.1 mmol/L, respectively; p = 0.05) in users of high-affinity antidepressants ( N = 89). Similar levels of the other lipids were observed between the groups for the other lipids. The mean difference in serum LDL cholesterol level between non-users and users of high-affinity antidepressants was largest in participants with the CC genotype compared with the other genotypes (notably 0.47 mmol/L), indicative of effect modification ( p-value for interaction = 0.03).

Conclusion:

Antidepressants with a high serotonin reuptake transporter affinity were associated with higher LDL cholesterol levels, which were modified by a common genetic variation in the HTR2A gene.
Cohesion in Online Student Teams Versus Traditional Teams
Authors: Hansen David E.
Published: July 2015

Researchers have found that the electronic methods in use for online team communication today increase communication quality in project-based work situations. Because communication quality is known to influence group cohesion, the present research examined whether online student project teams are more cohesive than traditional teams. We tested this question using parallel online and traditional teams in introductory marketing courses. Compared with the traditional teams, online team members communicated more positively and participated more in team activities, both of which suggest a higher level of team cohesion. The online teams were more satisfied with their team experience and performed better on their projects than did the traditional teams. The importance and application of this research is discussed. Because the existing research in marketing education has focused on traditional teams, the study findings open a potentially important line of research.
Expression and clinicopathological significance of microRNA-21 and programmed cell death 4 in malignant melanoma
Authors: Jiao Jian , Fan Yu , Zhang Yan
Published: July 2015

Objective

To measure levels of microRNA (miR)-21 and its target gene, programmed cell death 4 ( PDCD4), in samples of human cutaneous malignant melanoma and normal non-malignant control skin.

Methods

Relative levels of miR-21 and PDCD4 mRNA were measured using a quantitative real-time reverse transcription–polymerase chain reaction. Correlations between the levels of the two molecules and the clinicopathological characteristics of malignant melanoma were analysed.

Results

A total of 67 cases of human cutaneous malignant melanoma were analysed and compared with 67 samples of normal nonmalignant control skin. Compared with normal skin samples, the relative level of miR-21 was significantly higher and the relative level of PDCD4 mRNA was significantly lower in the melanoma specimens. A significant negative correlation between PDCD4 mRNA and miR-21 was demonstrated in malignant melanoma ( r = −0.602). Elevated miR-21 and reduced PDCD4 mRNA levels were both significantly correlated with increased tumour size, a higher Clark classification level and the presence of lymph node metastases in malignant melanoma.

Conclusions

These findings suggest that miR-21 and PDCD4 might be potential biomarkers for malignant melanoma and might provide treatment targets in the future.
Customary Law in One Area of 20th Century Africa: The Chagga of Kilimanjaro in Tanzania
Authors: Moore Sally Falk
Published: July 2015

The term ‘customary law’ has many layers of meaning when applied to the African experience. This article gives a vivid example of a practice of the Chagga people of Kilimanjaro which they regard as a matter of custom. But the paper also makes clear that the idea of customary law has had changing significance in the British colonial period, in the post-colonial present, and in anthropological theory. The article presents some of the concepts which the author has found useful in analyzing this complex topic.
Hiroshima and the responsibility of intellectuals
Authors: Giroux Henry A
Published: July 2015

This article addresses the relative silence of American intellectuals in the face of what can be termed the greatest act of terrorism ever committed by a nation-state, the bombing of Hiroshima and Nagasaki. I analyze this indifference by American intellectuals as partly due to their taming by a cultural apparatus that functions largely as a disimagination machine in conjunction with the neoliberal forces of commodification, privatization, and militarism. I argue that terror and violence are now addressed within a public pedagogy driven by a spectacle of violence that defines itself as entertainment but is actually a form of public pedagogy that thrives on an excess of representation and an attempt to produce a collective surrender to political cynicism and apocalyptic despair. In this instance, despair and cynicism, if not a retreat from any sense of moral responsibility, are deeply embedded in a mode of politics in which education is central to a flight from social responsibility and an embrace of modes of depoliticization. The article concludes by calling upon educators, intellectuals, artists and others to create the institutions, public spheres, and other sites necessary to develop a critical formative culture capable of reclaiming public memory while simultaneously producing critically engaged intellectuals and a vibrant democratic polity.
Aging Prisoners in Switzerland
Authors: Wangmo Tenzin , Meyer Andrea H. , Handtke Violet , Bretschneider Wiebke , Page Julie , Sommer Jens , Stuckelberger Astrid , Aebi Marcelo F. , Elger Bernice S.
Published: July 2015

Objective: This study assessed health care utilization of aging prisoners and compared it with that of younger prisoners. Method: Health care utilization comprised visits to general practitioners (GPs), nurses, and mental health professionals (MHPs) for a period of 6 months. Using retrospective study design, data were extracted from medical records of 190 older prisoners (50 years and older) and 190 younger inmates (18-49 years). Age group was a dichotomous predictor variable with type of sentencing and time spent in prison as covariates. Descriptive statistics and generalized linear mixed models (GLMMs) were performed. Results: For each of the three outcome variables, two GLMMs were constructed. The first model only included age group as the predictor variable (3 × Unadjusted models). The second included the two covariates in addition to the predictor variable (3 × Adjusted model). Results from the adjusted model indicate that visits to GPs significantly differed between the two age groups ( p = .022). Older prisoners visited GPs 1.43 times more often than younger prisoners over the 6-month period (adjusted risk ratio [RR] = 1.43, 95% confidence interval [CI] = [1.05, 1.94]). The finding for visits to nurses was not statistically significant ( p = .080). However, older prisoners visited nurses 1.36 times more frequently (adjusted RR = 1.36, 95% CI = [0.96, 1.91]). Finally, older prisoners visited MHPs 1.24 times more often than younger prisoners (adjusted RR = 1.24, 95% CI = [.95, 1.61]) and this finding was also not statistically significant ( p = .11). Discussion: Study findings underline that older prisoners utilized health care more often than younger prisoners although in most models the finding did not reach statistical significance. The prison system must develop solutions to address the needs of an aging population, particularly those with physical and mental health problems.
Is Intelligence in Early Adulthood Associated With Midlife Physical Performance Among Danish Males?
Authors: Meincke Rikke Hodal , Osler Merete , Mortensen Erik Lykke , Hansen Åse Marie
Published: July 2015

Objective: Insights into the causes of variances in physical performance are important to prevent mobility limitations in old age. We examined associations between intelligence in early adulthood and midlife physical performance. Method: Data from the Copenhagen Aging and Midlife Biobank were analyzed using linear regression. In total, 2,848 male cohort members had intelligence scores from conscription and physical performance measures from midlife. Results: In adjusted models, a 1 SD increase in intelligence resulted in 1.10 more chair-rises ( p < .001), a 1.03 cm higher jump ( p < .001), a 3.69% smaller balance area ( p < .001), a 0.71 kg increase in handgrip strength ( p < .001), and a 5.03 N increase in back force ( p < .001). Results for flexibility and abdominal force were not significant. Discussion: Public health interventions should focus on addressing people with different cognitive abilities and bear in mind that prevention of mobility limitations might need to start early in life.
Doing sociology in South East Asia
Authors: Alatas Syed Farid
Published: July 2015

Orientalism continues to manifest itself in the humanities and social sciences today in a way that is different from the 19th and early 20th century. This presents challenges of doing social theory. Orientalism defines the content of education in the schools and universities of the world in such a way that the origins of ideas and concepts and the question of alternative perspectives are not thematized. It is this lack of thematization that explains the neglect of non-European thinkers and ideas. They are rarely given the same attention as European and American social theorists such as Marx, Weber and Durkheim. Furthermore, it should be stressed that Orientalism is a thought-style that is not restricted to Europeans or Americans. The social sciences are taught in the Third World too in a Eurocentric manner, contributing to the alienation of social scientists there from local and regional scholarly traditions. At the same time, university education in these countries generally does not attempt to correct the Orientalist bias by introducing non-Western thinkers. It is as if no significant ideas emerged from outside of the Western areas during the formative period of the social sciences beginning in the 19th century. There is a need to universalize the canon. This is the topic of this article.
An evaluation of simplified CFD models applied to perimeter fans in air-cooled steam condensers
Authors: van der Spuy Sybrand J , von Backström Theodor W
Published: July 2015

Modelling air-cooled condensers (ACCs) incorporating hundreds of fans, necessitates the use of simplified fan models when performing a computational fluid dynamics (CFD) analysis of the condenser. The perimeter fans in these ACCs are subjected to distorted inlet flow conditions. This paper compares the accuracy of three different simplified fan models and proposes an improved model, based on numerical and experimental results from representative fan configurations. Three different fan configurations are tested as perimeter fans in a three-fan test facility, and their results compared to CFD results. The experimental evaluation by particle image velocimetry (PIV) reveals the shape of the velocity profiles immediately upstream of the perimeter fan. The accuracy of the CFD-predicted flow field directly upstream of the perimeter fan varies according to the model used to represent the fan as well as the configuration of the specific perimeter fan. The paper indicates a discrepancy of as much as 30% between experimental and simulated volumetric effectiveness values for a specific simulation model and fan configuration. The standard and extended actuator disc fan models perform better than the pressure jump model in predicting the volumetric effectiveness of the perimeter fans, and the extended actuator disc model performs best at predicting fan inlet velocity profiles.
Tartrate-Resistant Acid Phosphatase 5b in Young Patients With Sickle Cell Disease and Trait Siblings
Authors: Mokhtar Galila Mohamed , Tantawy Azza Abdel Gawad , Hamed Ahmed Al-Saeed , Adly Amira Abdel Moneam , Ismail Eman Abdel Rahman , Makkeyah Sara Mostafa
Published: July 2015

Bone involvement is a frequent cause of acute morbidity in sickle cell disease (SCD). Tartrate-resistant acid phosphatase 5b (TRACP 5b), a bone resorption marker, is produced specifically by activated osteoclasts. We assessed bone mineral density (BMD) in 30 young patients with SCD and 17 asymptomatic patients with sickle cell trait (SCT) compared with 32 healthy controls and determined TRACP 5b levels in relation to vascular complications. Serum ferritin, alkaline phosphatase (ALP), and TRACP 5b were measured. Echocardiography was performed with assessment of BMD using dual energy X-ray absorptiometry (DXA). The BMD was decreased in patients with SCD compared with SCT and controls ( P = .005), with no significant difference between the latter 2 groups. Patients with SCD had higher incidence of bone complications than SCT group and controls ( P = .03). The SCD group with abnormal DXA scan had higher ferritin and ALP than normal BMD. Serum TRACP 5b was significantly higher in patients with SCD than SCT and controls ( P = .003). The TRACP 5b levels were associated with severe vaso-occlusive crisis ( P = .022). Patients treated with hydroxyurea and those on chelation therapy had lower TRACP 5b levels than untreated patients. The TRACP 5b level was positively correlated with lactate dehydrogenase, while there was no relation with ferritin, ALP, or BMD. We suggest that bone complications frequently occur in SCD as reflected by low BMD and high ALP and TRACP 5b. Hemolysis and iron overload may be involved in the occurrence of these complications. The lack of correlation between abnormal DXA scan and high TRACP 5b suggests that bone disease in SCD is multifactorial.
Maximum velocity of self-propulsion for an active segment
Authors: Recho P , Truskinovsky L
Published: July 2015

The motor part of a crawling eukaryotic cell can be represented schematically as an active continuum layer. The main active processes in this layer are protrusion, originating from non-equilibrium polymerization of actin fibers, contraction, induced by myosin molecular motors, and attachment due to active bonding of trans-membrane proteins to a substrate. All three active mechanisms are regulated by complex signaling pathways involving chemical and mechanical feedback loops whose microscopic functioning is still poorly understood. In this situation, it is instructive to consider the problem of finding the spatial organization of standard active elements inside a crawling layer ensuring an optimal cost-performance trade-off. If we assume that (in the range of interest) the energetic cost of self-propulsion is velocity independent, we obtain, as an optimality criterion, the maximization of the overall velocity. We choose a prototypical setting, formulate the corresponding variational problem and obtain a set of bounds suggesting that radically different spatial distributions of adhesive complexes would be optimal depending on the domineering active mechanism of self-propulsion. Thus, for contraction-dominated motility, adhesion has to cooperate with ‘pullers’ which localize at the trailing edge of the cell, while for protrusion-dominated motility it must conspire with ‘pushers’ concentrating at the leading edge of the cell. Both types of crawling mechanisms have been observed experimentally.
Unlocking the Potential of the “What Works” Approach to Policymaking and Practice
Authors: Granger Robert C. , Maynard Rebecca
Published: July 2015

Despite bipartisan support in Washington, DC, which dates back to the mid-1990s, the “what works” approach has yet to gain broad support among policymakers and practitioners. One way to build such support is to increase the usefulness of program impact evaluations for these groups. We describe three ways to make impact evaluations more useful to policy and practice: emphasize learning from all studies over sorting out winners and losers; collect better information on the conditions that shape an intervention's success or failure; and learn about the features of programs and policies that influence their effectiveness. We argue that measurement of the treatment contrast that exists between the intervention and comparison condition(s) is important for each of these changes. Measurement and analysis of the treatment contrast will increase cost and policymakers and practitioners already see evaluations as expensive. Therefore we offer suggestions for reducing costs in other areas of data collection.
Party placement in supranational elections
Authors: Garzia Diego , Trechsel Alexander , De Sio Lorenzo
Published: July 2015

Throughout the years, political scientists have devised a multitude of techniques to position political parties on various ideological and policy/issue dimensions. So far, however, none of these techniques was able to evolve into a “gold standard” in party positioning. Against this background, one could recently witness the appearance of a new methodology for party positioning tightly connected to the spread of Voting Advice Applications (VAAs), i.e. an iterative method that aims at improving existing techniques using a combination of party self-placement and expert judgement. Such a method, as pioneered by the Dutch Kieskompas, was first systematically employed on a large cross-national scale by the EU Profiler VAA in the context of the 2009 European Parliamentary elections. This article introduces the party placement datasets generated by euandi (reads: EU and I), a transnational VAA for the 2014 EP elections. The scientific relevance of the euandi endeavour lies primarily in its choice to stick to the iterative method of party positioning employed by the EU Profiler in 2009 as well as in the choice to keep as many as 17 policy statements in the 2014 questionnaire in order to allow for cross-national, longitudinal research on party competition in Europe across a five-year period. This article provides a brief review of traditional methods of party positioning and contrasts them to the iterative method employed by the euandi team. It then introduces the specifics of the project, facts and figures of the data collection procedure, and the details of the resulting dataset encompassing 242 parties from the whole EU28.
Aspects of the institutionalization of evaluation in Finland: Basic, agency, process and change
Authors: Ahonen Pertti
Published: July 2015

This article draws on neo-institutional theoretical ideas to empirically examine the institutionalization of evaluation in the national government of Finland. The results indicate ambiguity in the basic institutionalization of Finnish evaluation, and imprecision in the agency of the actors that carry out or commission evaluations or utilize the evaluation results. Some Finnish institutional practices of evaluation enhance formal rationality such as efficiency and effectiveness, some support legitimation, and others do both in combination. The strength of coupling of evaluation to decision-making varies greatly. For future research, the article suggests studies on the institutionalization of evaluation in other countries. For evaluation practice, the results highlight the position of evaluation along the rationality-legitimation axis, and the variable linkages of evaluation to decision-making.
Adolescents’ experiences and perceived (dis)advantages of the three main outlet types for alcohol purchases
Authors: Gosselt Jordy F , Strump Tanja , Van Hoof Joris
Published: July 2015

Based on the existing literature, relevant determinants of availability for on-premises locations, off-premises locations, and the Internet were qualitatively explored and categorized by “experts” consisting of underage alcohol purchasers. In total, 14 focus group discussions were conducted with 94 Dutch adolescents. For on-premises locations, the high prices were perceived as the biggest disadvantage, and the ease to circumvent legal age limits as the biggest advantage. For off-premises locations, the cheap pricing was perceived as the most positive aspect, and the legal age limit as the biggest disadvantage. For online purchases, the waiting time was perceived as the most negative aspect, and the proximity of online stores as the biggest advantage.
Building capacity for civic learning and engagement: An emerging infrastructure in the academic arts and humanities in the United States
Authors: Heiland Donna , Huber Mary Taylor
Published: July 2015

American higher education has always articulated a civic mission as part of its purpose: colleges and universities educate students for life in a democratic society and provide that society with citizens who ensure that it thrives in turn. This essay maps the development of a national infrastructure for civic learning and engagement in American higher education, with a focus on the mid-1980s onward, when—after a period of relative eclipse—this work gained new coherence and momentum. Beginning with that moment of eclipse, when an intensified and professionalized research mission threatened to overshadow higher education’s civic commitments, we adumbrate briefly the countermovements that allowed the civic mission of colleges and universities to reassert itself. We then discuss the civic engagement networks that have emerged over the past three decades, and more recent partnerships and projects that have expanded understanding of higher education’s civic commitment in the 21st century.
Rethinking dynamic capabilities from a creative action perspective
Authors: MacLean Donald , MacIntosh Robert , Seidl David
Published: July 2015

Dynamic capabilities research aims to explain how firms manage to change in order to sustain their competitive advantage. Yet, despite considerable progress, dynamic capabilities theorizing struggles to capture novelty, which lies at the heart of change. We argue that this is caused by inherent limitations of the ways in which human action has been conceptualized: dynamic capabilities theorizing to date is based on rational or normative notions of actions, neither of which account for novelty in action. Hence, we propose that to overcome this impasse dynamic capabilities research needs to incorporate a concept of creative action into its theoretical apparatus. We elaborate on the positioning of creative action relative to existing dynamic capabilities theorizing and outline its implications for future dynamic capabilities research.
Hypofractionated Helical Tomotherapy for Older Aged Patients With Prostate Cancer
Authors: Liu Hai-Xia , Du Lei , Yu Wei , Cai Bo-Ning , Xu Shou-Ping , Xie Chuan-Bin , Ma Lin
Published: July 2015

In our center, the feasibility and related acute toxicities of hypofractionated helical tomotherapy have been evaluated in older aged patients with prostate cancer . Between February 2009 and February 2014, 67 patients (older than 65 years) were enrolled in a prospective phase I-II study (registered number, ChiCTR-ONC-13004037). Patients in cohort 1 (n = 33) and cohort 2 (n = 34) received 76 Gy in 34 fractions (2.25 Gy/F) and 71.6 Gy in 28 fractions (2.65 Gy/F), respectively, to the prostate and seminal vesicles, while 25 patients in cohort 2 also received integrated elective lymph node irradiation (50.4 Gy). All patients were treated with helical tomotherapy, and daily image guidance was performed before each treatment. Acute toxicities were assessed with Radiation Therapy Oncology Group (RTOG)/European Organization for Research on Treatment of Cancer (EORTC) criteria. No significant difference was detected between the 2 cohorts in the incidence of acute toxicities. In cohort 1, the incidences of grade 1 and 2 genitourinary and gastrointestinal toxicities were 45.5% and 45.4%, respectively, and without grade 3 and 4 toxicities. In cohort 2, the incidences of acute grade 1 and 2 genitourinary and gastrointestinal toxicities were 47.1% and 55.9%, respectively, and grade 3 genitourinary toxicity (hematuria) was noted only in 1 patient. No significant difference was detected in the incidence of acute toxicities between the patients receiving integrated elective lymph node irradiation and those receiving irradiation to prostate and seminal vesicle in cohort 2. Univariate and multivariate analyses were performed with clinical parameters. Only the baseline weight was found negatively correlated with genitourinary toxicities at a weak level (relative risk = 0.946, 95% confidence interval 0.896-0.998], P = .043). This study shows that 2 hypofractionation regimens (76 Gy/34F and 71.6 Gy/28F) delivered with HT are well tolerated in older aged patients having prostate cancer without significant difference for acute toxicities between the 2 cohorts. Late toxicities and treatment outcomes for these patients are under investigation.
Characteristics of clinical trials that require participants to be fluent in English
Authors: Egleston Brian L , Pedraza Omar , Wong Yu-Ning , Dunbrack Roland L , Griffin Candace L , Ross Eric A , Beck J Robert
Published: July 2015

Background/Aims:

Diverse samples in clinical trials can make findings more generalizable. We sought to characterize the prevalence of clinical trials in the United States that required English fluency for participants to enroll in the trial.

Methods:

We randomly chose over 10,000 clinical trial protocols registered with ClinicalTrials.gov and examined the inclusion and exclusion criteria of the trials. We compared the relationship of clinical trial characteristics with English fluency inclusion requirements. We merged the ClinicalTrials.gov data with US Census and American Community Survey data to investigate the association of English-language restrictions with ZIP-code-level demographic characteristics of participating institutions. We used Chi-squared tests, t-tests, and logistic regression models for analyses.

Results:

English fluency requirements have been increasing over time, from 1.7% of trials having such requirements before 2000 to 9.0% after 2010 (p < 0.001 from Chi-squared test). Industry-sponsored trials had low rates of English fluency requirements (1.8%), while behavioral trials had high rates (28.4%). Trials opening in the Northeast of the United States had the highest regional English requirement rates (10.7%), while trials opening in more than one region had the lowest (3.3%, p < 0.001). Since 1995, trials opening in ZIP codes with larger Hispanic populations were less likely to have English fluency requirements (odds ratio = 0.92 for each 10% increase in proportion of Hispanics, 95% confidence interval = 0.86–0.98, p = 0.013). Trials opening in ZIP codes with more residents self-identifying as Black/African American (odds ratio = 1.87, 95% confidence interval = 1.36–2.58, p < 0.001 for restricted cubic spline term) or Asian (odds ratio = 1.16 for linear term, 95% confidence interval = 1.07–1.25, p < 0.001) were more likely to have English fluency requirements. ZIP codes with higher poverty rates had trials with more English-language restrictions (odds ratio = 1.06 for a 10% poverty rate increase, 95% confidence interval = 1.001–1.11, p = 0.045). There was a statistically significant interaction between year and intervention type, such that the increase in English fluency requirements was more common for some interventions than for others.

Conclusion:

The proportion of clinical trials registered with ClinicalTrials.gov that have English fluency requirements for study inclusion has been increasing over time. English-language restrictions are associated with a number of characteristics, including the demographic characteristics of communities in which the sponsoring institutions are located.
Capacity value of offshore wind in Great Britain
Authors: Harrison Gareth P , Hawkins Samuel L , Eager Dan , Cradden Lucy C
Published: July 2015

The extent to which large volumes of offshore wind can contribute to a secure and reliable electricity supply is the subject of much debate. Central to providing credible answers is a detailed understanding of the wind resource and its variability in time and space. Here, a mesoscale atmospheric model was employed to create a 10 year hindcast of British onshore and offshore wind speeds and simulate the output of a British offshore wind fleet. This enabled estimation of the capacity value of British wind fleets both on- and offshore during periods of high winter demand. It provides a credible estimate of the distinct long-term contribution of production from a future British offshore wind fleet and indicates substantial improvement over onshore wind. Furthermore, a first level analysis demonstrated that the availability of offshore wind farms had a modest negative impact on the capacity value of wind but that conventional generation and demand levels played a more significant role.
The Arab Economic Integration
Authors: El-Ghattis Nedal
Published: July 2015

This article addresses the economic integration among Arab States and its role in the evolution of Islamic Banking. I proceed by attempting to answer two fundamental questions, what are the future scenarios for economic integration in light of the Arab revolutions and what is their possible impact on Islamic Banking? By taking into the account social, political, and historical background, I analyze the best-case, worst-case, and business-as-usual scenarios for economic integration among the Arab states. These scenarios take into account the particularity of the Gulf Cooperation Council’s region to find a common ground of dialogue for futuristic vision.
Liver Function Tests (LFTs)
Authors: Yap Clementine YF , Aw Tar Choon
Published: July 2015

Each liver function test by itself is neither highly sensitive nor specific but when interpreted together may provide the clinician with useful information about the patient's liver, and may also indicate other health issues such as malnutrition and bone disease.
Clinical and Laboratory Barriers to the Timely Diagnosis of Sulphite Oxidase Deficiency
Authors: Choong Chew Thye , Hart Claire , Tan Ee Shien , Goh Denise Li Meng
Published: July 2015

Isolated sulphite oxidase deficiency (SOD) is a rare genetic neurometabolic disorder characterised by intractable seizures and progressive severe neurological dysfunction. Affected children commonly present at or soon after birth with seizures and neurological deficits. In the newborn period, diagnosis may be missed as clinical features may mimic perinatal hypoxia-ischaemia, a more common entity. We report an infant with SOD whose clinical presentation of seizures and lethargy on the 4th day of life had suggested hypoxic-ischaemic encephalopathy, and discuss the challenges in the diagnostic process. The infant's progressive severe neurological deterioration suggested a metabolic disorder. His brain magnetic resonance imaging at 10 weeks showed severe cerebral atrophy and cystic changes. Biochemical findings of a very low plasma cystine concentration (<5μmol/L, reference range 24–100) and elevated urinary sulphocysteine in the presence of a normal plasma uric acid pointed towards SOD. The diagnosis was confirmed by mutational analysis. Isolated SOD can be difficult to diagnose on the basis of clinical features and routine metabolic tests. Nonetheless heightened awareness of the SOD entity coupled with selective biochemical testing will help towards a more accurate diagnosis. The disorder should be considered in all infants with unexplained hypoxic-ischaemic encephalopathy or progressive neurological dysfunction.
The Clinical Effects of Fermented Papaya Preparation® (FPP®) on Oxidative Stress in Patients with HbE/ β -Thalassaemia
Authors: Jamuar Saumya Shekhar , Tan Ee Shien , Sun Li , Law Hai Yang , Lai Angeline HM , Ng Ivy SL
Published: July 2015

Background:

Red blood cells (RBC) of patients with thalassaemia are under continuous oxidative stress. Fermented papaya preparation® (FPP®) has been shown to have an antioxidative effect and is postulated to reduce the oxidative stress on RBC.

Objective:

To study the clinical effects of FPP® treatment in patients with HbE/β-thalassaemia on RBC indices, oxidative stress and quality of life scores.

Method:

Patients with HbE/β-thalassaemia who do not receive regular blood transfusion were included in the study and were given FPP® daily (3gm 2 times a day) for 12 weeks. Peripheral blood samples were obtained at the initiation of the study and at 4-weekly intervals thereafter for a period of 12 weeks. The following parameters were measured: Haemoglobin (Hb), mean corpuscular volume (MCV), reticulocyte count; Oxidation studies: production of reactive oxygen species (ROS) and intracellular glutathione content (GSH), spontaneously and in response to oxidative stress; Quality of life (QoL) at the start and at the end of 12 weeks using health survey questionnaires.

Results:

Seven patients (5 females and 2 males) were recruited to the study from January 2006 to April 2006. Median age of the study population was 19 years (range 4 to 27yrs). In vitro analyses showed production of significantly less ROS and more GSH following treatment. There was no significant difference in the Hb, MCV, reticulocyte count, clinical parameters or QoL scores. FPP® was well tolerated by all the patients.

Conclusion:

Although oxidative stress parameters were decreased, FPP® did not have any significant effect on the Hb levels or QoL. Longer studies on larger sample size are required to study the long-term clinical effect of FPP® on clinical parameters in patients with Hb E/β-thalassaemia.
Integrated Perinatal Care and beyond
Authors: Tan Kok Hian , Agarwal Pratibha , Hoon Siew Jong , Sia Alex , Kwek Kenneth
Published: July 2015

The concept of Integrated Perinatal Care was initiated with the formation of the KKH Perinatal Team in 1993 to further improve the maternal and perinatal care. All staff in the team are committed to providing labouring women and women with high-risk pregnancies with the highest possible standards of care to allow the best outcomes and birthing experience for mothers, babies and families. Teamwork as well as national and worldwide collaborations are the hallmarks of this team.
Smoking Cessation: Barriers, Motivators and the Role of Physicians — A Survey of Physicians and Patients
Authors: Joshi Veena , Suchin Viranak , Lim Jeremy
Published: July 2015

Objective:

To identify the motivators of and barriers to smoking cessation and to evaluate the dynamics of the patient-physician visit.

Methods:

A total of 175 physicians and 347 patient-smokers completed a written questionnaire about their attitudes and behaviours toward smoking cessation. Physicians were additionally queried on their level of involvement in the smoking cessation efforts of their patients.

Results:

Patient smokers had an average age of 42 years and had been smoking for 15 years. Males and females smoked 17 and 8 cigarettes a day respectively. About 50% of the subjects had made 2–5 attempts to quit smoking in the past and one-third of the subjects had tried to quit once. The top 2 motivators to quit smoking citied by both smokers and physicians were concern about their own health and concern about the health of family members and friends. The third reason given by patient-smokers was the cost of cigarettes. Physicians felt it was their advice that had persuaded/convinced patient-smokers to quit. Both physicians and patient-smokers agreed that the key barriers to smoking cessation were craving/physical addiction and smokers' concern of withdrawal symptoms if they attempted quitting. While both physicians and patients identified similar barriers to smoking cessation, there was a difference in perception about the role physicians play: 55% of physicians said that they discussed smoking cessation with their patients, but only 15% of the patients agreed with this statement. In addition, 78% of physicians said they started the initial discussion while 63% of patient-smokers said they themselves started the initial discussion.

Conclusion:

Smokers and physicians identified similar motivators of and barriers to smoking cessation. However, there were differences in perception over the roles physicians play.
Hypoxic Ischaemic Injury in an Immature Brain on MRI
Authors: Chotai Niketa , Tang Phua Hwee , Agarwal Pratibha
Published: July 2015

The appearance of the child's brain on magnetic resonance imaging (MRI) differs with age. The manifestations of hypoxic ischaemic injury in the neonate on MRI also depend on the whether the child is premature or term and the duration/severity of injury. This case illustrates the typical MRI brain findings of a neonate who had experienced severe hypoxic ischaemic injury.
Spinal Cord Stimulation for the Treatment of Intractable Pain from Failed Back Surgery Syndrome
Authors: Pasutharnchat Koravee , Ho Kok-Yuen
Published: July 2015

Introduction:

Failed back surgery syndrome (FBSS) is a debilitating chronic neuropathic pain condition, affecting approximately 10–40% of patients after lumbosacral spine surgery. Treatment of FBSS is challenging as conservative therapies and repeat surgery often fail in providing adequate pain relief. Spinal cord stimulation (SCS) has been proven to be a successful therapeutic option in FBSS patients.

Case Report:

A 23 year-old male presented with persistent low back pain and bilateral radicular pain after spinal surgery. He was also wheelchair-bound because of his severe pain. Conservative treatment with oral analgesics and interventional pain procedures were unsuccessful in improving his pain. Subsequently, we performed a permanent implantation of epidural leads for SCS after a successful trial of SCS. He reported good coverage of pain without complications after the procedure. Three months after surgery, and after intensive physiotherapy and rehabilitation, he could walk and return to work.

Conclusion:

We describe our first successful case of treating intractable pain from FBSS in a patient after implantation of SCS leads in our institution.
Bone Turnover Markers
Authors: Yap Clementine YF , Aw Tar Choon
Published: July 2015

Bone turnover markers (BTM) provide useful data to titrate the optimal dosing regimes for patients within 3–6 months as compared to 1–2 years using bone mineral density (BMD). Serum obtained under standardised conditions (fasting, early morning) should be tested using a precise automated immunoassay for a panel of bone markers that includes a resorption marker — C-terminal cross-linked telopeptide of bone collagen (CTX) — and formation markers — Procollagen Type 1 N-terminal Propeptide (P1NP) and Osteocalcin (OC).
Health-Related Quality of Life of Caregivers of People with Parkinson's Disease in Singapore
Authors: Tan Siok Bee , Williams Allison F , Morris Meg E , Tan Eng King
Published: July 2015

Introduction:

To investigate the health-related quality of life (HRQoL) of caregivers for people with Parkinson's disease (PD) living in Singapore.

Methods:

A face-to-face survey was conducted with a cross-section of caregivers for people with PD. The caregivers were recruited from a PD clinic at an acute tertiary hospital in Singapore and from the members of the Singapore Parkinson's Disease Society. HRQoL was quantified using the SF-36v2® Health Survey, an internationally validated multi-purpose short-form health survey.

Results:

Ninety-four caregivers completed the survey (a response rate of 57.3%). The respondents were all above 21 years old, with most falling in the 51 and >61 years age range. Seventy-four of the respondents (78.7%) were female. As a whole, the caregivers scored lower in all 6 health domains compared to the general population (adjusted for age, gender and ethnic group) in Singapore. The were significant differences for the “Role Physical” and the “Role Emotional” domains, at 3.9 and 3.3 respectively. Caregivers had a much lower mental component summary (-2.4) when compared to the physical component summary (-1.6).

Conclusion:

It is important to identify the factors that influence the HRQoL of caregivers so that policies can be developed to lower the burden of PD on caregivers. Assessing the well-being of caregivers may help to identify individuals at risk. The well-being of caregivers has the potential to influence quality of life of people with PD.
An Overview of Surgical Therapy for Movement Disorders
Authors: Prakash Kumar M
Published: July 2015

Surgical treatments are an important consideration in the management of many movement disorders, particularly for patients refractory to medications. Increasing number of published reports have demonstrated an overall improvement in motor function, activities of daily living and quality of life particularly with deep brain stimulation. In addition the procedure is also relatively safe. In this article, we review the various types of movement disorders that may benefit from surgical intervention.
Genetic and Genomic Aspects of Alzheimer's Disease
Authors: Chua Sze-Ming , Ng Beng-Yeong , Lee Tih-Shih
Published: July 2015

Alzheimer's disease (AD) is the most common chronic neurodegenerative disease today, afflicting 35 million people worldwide. Age is the major risk factor. The heritability of AD is estimated to be around 60%. Less than 5% of AD cases are familial with early-onset of disease caused by specific gene mutations. Genetic studies over the past 2 decades have provided invaluable insights into this complex disease. Here we review AD from the latest genome-wide association studies (GWAS), and a brief review of the transcriptomics, proteomics, metabolomics and epigenetics. Ultimately, a system-wide approach is essential to integrating the diverse and complicated findings into a meaningful understanding of AD.
Prognostic Variables in 1814 Sporadic Colon Cancers: A Review of Experience from a Single Institution from 1999–2005
Authors: Chew Min-Hoe , Yeo Eugene Shen-Ann , Tang Choong-Leong
Published: July 2015

Introduction:

Singapore has one of the highest age-standardized incidence rates for colorectal cancer (CRC) at 35.1% in men and 29.9% in women which is almost double that of our neighboring Southeast Asian countries. Surgery is presently the mainstay in treatment of this cancer. This present study evaluates the clinical and prognostic characteristics of sporadic cancers treated by surgical resection in a single institution in an Asian population.

Methods:

1814 consecutive patients with CRC from 1999–2005 treated in the Department of Colorectal Surgery in Singapore General Hospital were reviewed. The clinciopathological characteristics of these patients were collected from a prospectively collected database maintained in the department since 1987. Univariate analysis was performed, and survival curves were constructed using the Kaplan-Meier method. Multivariate analysis was carried out on independent prognostic factors that were positive on univariate analysis.

Results:

All patients had a minimum follow up duration of 5 years unless they were lost to follow up. There were 921 (50.8%) males and 893 (49.2%) females with a median age of 67 years (interquartile range 22–99). The predominant location of the tumour was left-sided ie distal to (and including) the splenic flexure (n=1272, 70%), and the majority presented at an advanced AJCC stage III and IV (n=1018, 56%). The most common site for solitary metastasis is in the liver (n=194, 49%) followed by the lungs (6%). Locoregional recurrence is low at 2.6% (n=46) and distant recurrence is noted at 16.8% (n=297). Disease recurrence are 5.7%, 18.1%, and 27.5% for Stages I, II and III respectively. The median five-year Cancer Specific Survival (CSS) is 58.7 % (95% CI 56.2%–61.2%). On multivariate analysis, a high pre-operative CEA, poorly-differentiated tumour grade, signet ring cell tumours, high tumour stage (T3/T4), nodal disease (N1/N2), presence of both perineural invasion and vascular emboli were all significant factors that worsened CSS.

Conclusion:

Our dataset confirms the current favourable survival of colonic cancers in our country which is comparable to data from the West. Future challenges in management of patients involve improving staging, selection of high risk of recurrence of patients for closer monitoring and further adjuvant treatment to improve survival and reduce locoregional recurrence.