bluuebunny/crossref_metadata_2025 huggingface dataset:
Enrichment of Black Ripe Olives in Bioactive Compounds Using a Single Alkali Treatment
Authors: Romero Concepción , García‐García Pedro , Brenes Manuel
Published: October 2016

The aim of this work was to develop a method for processing ripe olives with a single NaOH treatment (lye) instead of the well‐known 3 lye treatments. Olives of the Hojiblanca variety were processed according to the 2 processes and the color, firmness, flavor, and content in phenolic compounds of the final product were similar in both cases but concentration in triterpenic acids was highest in the olives from the single lye treatment. In this process the concentration of NaOH must range between 20 and 35 g/L, especially to obtain good texture when working at 20 °C. If temperature during the oxidation up to 27 °C the firmness of olives was significantly decreased. The concentration of the NaOH did not exert a high effect on the color of the final product, although firmness decreased as the strength of the lye increased. Higher contents in phenolic compounds and triterpenic acids were also found in the olives processed with the lowest NaOH concentration tested (20 g/L). This new process reduces the volume of wastewaters and energy consumption, and gives rise to a product which is richer in bioactive substances than the traditionally processed one.
Minimizing the Negative Flavor Attributes and Evaluating Consumer Acceptance of Chocolate Fortified with Peanut Skin Extracts
Authors: Dean L.L. , Klevorn C.M. , Hess B.J.
Published: October 2016

In recent years, there has been increased interest in antioxidant‐rich products by consumers wanting to enhance the health benefits of their diet. Chocolate has been identified as a natural source of antioxidant compounds, which resulted in the development of polyphenol‐enriched chocolate products that are now available commercially. This study investigated the use of phenolic compounds extracted from peanut skins as a novel antioxidant source for the enrichment of milk chocolate. The extracts were encapsulated with maltodextrin to lessen their bitterness. Antioxidant potential of the encapsulated peanut skin extracts was evaluated by the 2,2‐diphenyl‐1‐picrylhydrazl radical quenching assay. Encapsulated peanut skins were found to have a corrected Trolox equivalency of 31.1 μmol/g of chocolate up to 0.8% (w/w). To produce a product with an antioxidant content similar to that of dark chocolate yet which maintained the milder flavor of milk chocolate, the best estimate threshold of encapsulated peanut skin extract in chocolate was 0.9 % (w/w) based on the standard method (American Society of Testing Materials; ASTM E‐679). Consumer liking of milk chocolate enhanced by adding subthreshold (0.8 % (w/w)) inclusion levels of encapsulated peanut skin extract was found to be at parity with milk chocolate as a control.
Workforce Adaptation to the Cessation of Motor Vehicle Manufacturing in Australia
Authors: Dixon Janine
Published: October 2016

Over 2016 and 2017, the last of Australia's motor vehicle manufacturing plants will close their doors, retrenching several thousand workers. Agility, the solution to our economic woes, will be the key to recovery. Just how agile will workers need to be? This paper describes a scenario in which there is no “damage” in terms of increased unemployment, facilitated by flexibility in both occupation‐specific real wages and willingness of workers to transition to new occupations and new regions. The scenario identifies occupations and regions into which displaced workers may transition, based on an economy‐wide view of regional industry demands for labour and the skill profiles of the displaced workers.
Significance of Forecast Precision: The Importance of Investors’ Expectations
Authors: Rupar Kathy
Published: October 2016

I investigate whether the alignment between individual investors’ expectations about forecast precision and actual forecast precision affects their estimates of firm value, and whether this relationship is mediated by individual investors’ perceptions of management credibility and future firm growth. Experimental results confirm that when expected and actual forecast precision align, individual investors estimate higher firm stock prices than when expected and actual forecast precision do not align. I also provide evidence of a mediation path through which the misalignment between expected and actual forecast precision affects individual investors’ perceptions of management credibility, future firm growth, and estimates of firm stock price. My findings help reconcile inconsistencies in prior earnings forecast literature and inform managers and researchers about strategies that lead to higher perceptions of management credibility and firm value.
Are Increasing Volumes of Children and Young People Presenting to Emergency Departments Due to Increasing Severity of Illness?
Authors: Roland Damian , Jones Sam , Coats Tim , Davies Ffion
Published: October 2016

Background

Increasing utilization of emergency and acute care services by children and young people is a worldwide trend. This is thought to be a result of parent and carer desire for more “on‐demand” healthcare assessment and not a consequence of increasing severity of disease. A bespoke acuity assessment system in our department allowed us to test this hypothesis.

Methods

These data are based on the Paediatric Observation Priority Score, a previously published and validated assessment tool designed specifically for pediatric emergency care.1 It is scored from 0 to 16 and consists of physiologic, observational, and historical components with a unique “gut feeling” element. Data were available from November 2014 to March 2016.

Results

There has been a 32.6% increase in the number of children with a POPS > 4 (Figure 1, total number of children with POPS 0, 1–4, and >4) with a small (nonsignificant) increase in relative acuity.

Conclusion

In light of the overall total increase in attendances and relative increase in acuity it appears the general cohort of children presenting are more unwell. Given that a POPS > 4 is associated with an increased risk of admission for more than 24 hours2 it can also be concluded that a significant proportion of attendances to the department are appropriate.

Total number of children with POPS 0,1‐4 and >4.

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Convergence of accounting standards and financial reporting externality: evidence from mandatoryIFRSadoption
Authors: Gao Ru , Sidhu Baljit K.
Published: October 2016

Using mandatory adoption of International Financial Reporting Standards (IFRS) as a natural experiment, we examine whether reporting externalities can be magnified when financial disclosures are based on a common set of accounting standards. Specifically, we investigate and find that the changes in publicly available information of mandatoryIFRSadopters (due to the convergence of accounting standards) can impact the investment efficiency of prior voluntary adopters. While we document positive externalities of mandatoryIFRS, we also observe heterogeneity in these spillover effects at the firm and the country level, suggesting that externalities increase with improvements in the comparability of accounting information.
A momentary exposures analysis of proximity to alcohol outlets and risk for assault
Authors: Morrison Christopher N. , Dong Beidi , Branas Charles C. , Richmond Therese S. , Wiebe Douglas J.
Published: October 2016

Aims

This study estimated, with high spatial and temporal specificity, individuals’ risk of being assaulted relative to their momentary proximity to alcohol outlets during daily activities.

Design

Case–control study.

Setting

Philadelphia, PA, USA.

Participants

Cases were 194 non‐gun assault victims and 135 gun assault victims aged between 10 and 24 years. Age‐matched controls (n = 274) were selected using random‐digit dialing.

Measurements

Participants described minute‐by‐minute movements (i.e. activity paths) during the course of the day of the assault (cases) or a recent randomly selected day within 3 days of interview (controls). The dependent measure was being an assault case compared with a non‐assault control. The main independent measures were participants’ momentary proximity to alcohol outlets. The units of analysis were 10‐minute segments beginning at 4:00 a.m.

Findings

Proximity to bars and restaurants was associated with decreased odds of non‐gun assault before 1 p.m. [e.g. 7 a.m. to 9:59 a.m.: odds ratio (OR) = 0.78; 95% confidence interval (CI) = 0.64, 0.94; P = 0.008], and increased odds after 7 p.m. (e.g. 1 a.m. to 3:59 a.m.: OR = 1.96; 95% CI = 1.24, 3.09; P = 0.004). Proximity to beer stores was associated with increased odds before 1 p.m. (e.g. 7 a.m. to 9:59 a.m.: OR = 2.34; 95% CI = 1.58, 3.46; P < 0.001) and from 4 p.m. to 6:59 p.m. (OR = 1.50; 95% CI = 1.14, 1.96; P = 0.004), but decreased odds after 7 p.m. (e.g. 1 a.m. to 3:59 a.m.: OR = 0.28; 95% CI = 0.12, 0.63; P = 0.002). Proximity to alcohol outlets was mostly unrelated to risks for gun assault.

Conclusions

Individuals in areas with greater densities of bars and restaurants and beer stores appear to be at increased risk for non‐gun assault at times when these outlets are likely to be patronized most heavily.
Subcutaneous emphysema secondary to dental extraction: A case report
Authors: Tan S , Nikolarakos D
Published: October 2016

Although less frequently encountered in dental practices, subcutaneous emphysema of the face and neck has been reported in patients following dental extractions, particularly when lower molar teeth are extracted with the use of a high‐speed air‐turbine drill designed for restorative treatment, which forces air into the cervical fascial spaces. As facial swelling and pain are the most common presentations, subcutaneous emphysema can often be misdiagnosed as an allergic reaction or odontogenic infection. While usually a benign and self‐limiting condition, subcutaneous emphysema may have life‐threatening complications such as tension pneumothorax, cardiac tamponade, air embolism, tracheal compression and mediastinitis, which are important to recognize in an emergency setting. Dentists should be aware of the serious risks of inducing subcutaneous emphysema and avoid performing tooth extractions with high‐speed air‐turbine drills which are specifically designed for use for restorative treatments only.
Occupational diversification as an adaptation to rainfall variability in rural India
Authors: Skoufias Emmanuel , Bandyopadhyay Sushenjit , Olivieri Sergio
Published: October 2016

Occupational diversification among household members in rural India is investigated as an adaptation strategy against the risks arising from the variability of local rainfall. Nationally representative household‐level survey data are combined with the coefficient of variation of rainfall constructed based on historical rainfall data at the district level. The analysis finds that high rainfall variability has significant negative effects on the agricultural specialization of within‐household occupational choices. This result is reinforced by the finding that improved access to irrigation, education, credit, roads, and postal services, is associated with a lower occupational diversification within families and a greater specialization of household members in agricultural‐related employment.
Therapeutic experience of vincristine/cyclophosphamide/melphalan or mitoxantrone/prednisone combination therapy plus thalidomide as first‐line induction therapy for newly diagnosed multiple myeloma in a single institution of China
Authors: Wang Xiaoning , He Pengcheng , Guo Caili , Sun Chunhong , Zhang Mei
Published: October 2016

Introduction

To investigate the safety and efficacy of the combination regimen vincristine, cyclophosphamide, melphalan or mitoxantrone and prednisone (VCMP) plus thalidomide as first‐line induction therapy for newly diagnosed multiple myeloma (MM).

Methods

Three hundred and ninety‐six symptomatic, newly diagnosed MM patients were treated with VCMP plus thalidomide in our hospital for the past 11 years, and clinical data of these patients were retrospectively analyzed.

Results

Of the 396 patients enrolled, the total response rate was 77.3%. Forty‐three patients relapsed after sCR and CR. Mean cycles to first response were six cycles (range 1–16 cycles). A total of 53% of patients achieved at least a PR within the first cycle of therapy. The actuarial 1‐year, 3‐year and 5‐year overall survival of all patients were 89.4%, 29.5% and 10.6%, respectively. The probabilities of 1‐year, 3‐year and 5‐year progression‐free survival of all patients were 84.0%, 23.1% and 8.4%, respectively. The major adverse events were gastrointestinal symptoms, electrolytes and glucose metabolism disorders, hypertension, infection, peripheral nerve disease and hematological adverse events, which were mostly below grade 3 and could be alleviated by symptomatic treatment.

Conclusion

We concluded that VCMP plus thalidomide is an effective regimen with manageable side effects in the treatment of symptomatic, newly diagnosed MM including elderly patients and patients with renal failure.
The Strategic Shuffle: Ethnic Geography, the Internal Security Apparatus, and Elections in Kenya
Authors: Hassan Mai
Published: October 2016

For autocrats facing elections, officers in the internal security apparatus play a crucial role by engaging in coercion on behalf of the incumbent. Yet reliance on these officers introduces a principal‐agent problem: Officers can shirk from the autocrat's demands. To solve this problem, autocrats strategically post officers to different areas based on an area's importance to the election and the expected loyalty of an individual officer, which is a function of the officer's expected benefits from the president winning reelection. Using a data set of 8,000 local security appointments within Kenya in the 1990s, one of the first of its kind for any autocracy, I find that the president's coethnic officers were sent to, and the opposition's coethnic officers were kept away from, swing areas. This article demonstrates how state institutions from a country's previous authoritarian regime can persist despite the introduction of multi‐party elections and thus prevent full democratization.
Pregnancy outcome in joint hypermobility syndrome and Ehlers–Danlos syndrome
Authors: Sundelin Heléne E. K. , Stephansson Olof , Johansson Kari , Ludvigsson Jonas F.
Published: October 2016

Introduction

An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers–Danlos syndrome is suspected.

Material and methods

In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers–Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers–Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers–Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes.

Results

Maternal joint hypermobility syndrome/Ehlers–Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3–1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3–2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7–1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2–7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7–3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4–1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6–2.1). Examining only women with Ehlers–Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4–4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0–7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome.

Conclusion

Women with joint hypermobility syndrome/Ehlers–Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome.
B12 deficiency is common in infants and is accompanied by serious neurological symptoms
Authors: Irevall T , Axelsson I , Naumburg E
Published: October 2016

Aim

Adverse neurological symptoms have been linked to vitamin B12 deficiency in infants. This explorative study described the clinical presentation associated with vitamin B12 deficiency in this age group.

Methods

The study comprised infants who were born between 2004 and 2012 and were tested for vitamin B12 levels after they were admitted to a hospital with neurological symptoms at less than one year of age. Vitamin B12 deficiency was defined as low cobalamin in serum and/or increased homocysteine and/or increased methylmalonate. It was diagnosed according to the applicable International Classification of Diseases, 10th revision, and recorded as vitamin B12 deficiency in the medical records. All information was retrieved from medical records and compared to symptomatic infants with normal levels.

Results

Of the 121 infants tested, 35 had vitamin B12 deficiency and 86 had normal levels. Vitamin B12 deficiency was diagnosed at an average age of 1.7 months and was more common among boys. Seizures and apparent life‐threatening events were the most common symptoms among infants with B12 deficiency compared to infants with normal levels.

Conclusion

Vitamin B12 deficiency was more common in infants than we expected and presented with severe symptoms, such as seizures and apparent life‐threatening events.
Laparoscopy‐assisted distal gastrectomy in a case of gastric cancer with situs inversus totalis: a case report
Authors: Kigasawa Yu , Takeuchi Hiroya , Kawakubo Hirofumi , Fukuda Kazumasa , Nakamura Rieko , Takahashi Tsunehiro , Wada Norihito , Kitagawa Yuko
Published: October 2016

Situs inversus totalis (SIT) is a rare congenital condition in which abdominal and thoracic organs are transposed from normal positions. Laparoscopy‐assisted distal gastrectomy for situs inversus totalis is technically difficult and has rarely been reported. Here, we report the case of man in his 40s with situs inversus totalis and a preoperative diagnosis of stage IA gastric cancer (cT1b, cN0, cM0). We successfully performed laparoscopy‐assisted distal gastrectomy with D1+ lymph node dissection and Billroth I reconstruction. To ensure a safe procedure, we evaluated the vessels preoperatively with 3‐D CT angiography. Furthermore, we performed the surgery by reversing our surgical positions, using a two‐monitor method, and then reconstructing under direct vision through the incision. The surgery was performed with minimal blood loss, and no severe postoperative complications were observed. Histopathological examination revealed poorly to moderately differentiated stage IA (pT1b, pN0, pM0) adenocarcinoma. No recurrence has been observed as of 2 years postoperatively.
Impact of concomitant medications on obstructive sleep apnoea
Authors: Jullian‐Desayes Ingrid , Revol Bruno , Chareyre Elisa , Camus Philippe , Villier Céline , Borel Jean‐Christian , Pepin Jean‐Louis , Joyeux‐Faure Marie
Published: October 2016

Obstructive sleep apnoea (OSA) is characterized by repeated episodes of apnoea and hypopnoea during sleep. Little is known about the potential impact of therapy drugs on the underlying respiratory disorder. Any influence should be taken into account and appropriate action taken, including drug withdrawal if necessary. Here, we review drugs in terms of their possible impact on OSA; drugs which (1) may worsen OSA; (2) are unlikely to have an impact on OSA; (3) those for which data are scarce or contradictory; and (4) drugs with a potentially improving effect. The level of evidence is ranked according to three grades: A – randomized controlled trials (RCTs) with high statistical power; B – RCTs with lower power, non‐randomized comparative studies and observational studies; C – retrospective studies and case reports. Our review enabled us to propose clinical recommendations. Briefly, agents worsening OSA or inducing weight gain, that must be avoided, are clearly identified. Drugs such as ‘Z drugs’ and sodium oxybate should be used with caution as the literature contains conflicting results. Finally, larger trials are needed to clarify the potential positive impact of certain drugs on OSA. In the meantime, some, such as diuretics or other antihypertensive medications, are helpful in reducing OSA‐associated cardiovascular morbidity.
Metacognitive control: Shifting from habitual to agenda processes on item selection during study in elementary school children
Authors: Li Weijian , Ji Haojie , Li Fengying , Li Ping , Zhang Yuchi , Li Xinyu
Published: October 2016

Background

Like adults, children need to allocate study time and endeavour optimally in order to enhance learning effectiveness.

Aims

The aim of this study was to investigate the development of shifting from habitual to agenda‐based processes on study decisions.

Sample

The participants were 309 children in the second, fourth, and sixth grades.

Methods

We adopted the research paradigm proposed by Ariel and Dunlosky (2013, Mem. Cognit., 41, 416). In Experiment 1, the students selected items to study either with or without time constraint. In Experiment 2, the students were instructed to select all three items or one item to study per trial.

Results

The results of Experiment 1 showed that for sixth graders, the likelihood of selecting high‐value items under the restricted‐study‐time condition was higher than that under the restricted‐total‐time condition; second and fourth graders failed to construct an agenda of prioritizing high‐reward items for study in the restricted‐study‐time condition. In Experiment 2, when students were instructed to select one item to study per trial, high‐value items were prioritized over items on the left of the array for sixth graders; on the contrary, second and fourth graders seemed to choose item for study arbitrary, although they tend to choose high‐value items compared with their choice pattern in no‐choice‐limit condition.

Conclusions

The results indicate that children can shift towards agenda‐based process when habitual responding cannot maximize reward, and there is an age‐related improvement in shifting between grade 4 and grade 6.
Xenobiotic‐metabolizing enzymes in Bacillus anthracis: molecular and functional analysis of a truncated arylamine N‐acetyltransferase isozyme
Authors: Kubiak Xavier , Duval Romain , Pluvinage Benjamin , Chaffotte Alain F , Dupret Jean‐Marie , Rodrigues‐Lima Fernando
Published: October 2016

Background and Purpose

The arylamine N‐acetyltransferases (NATs) are xenobiotic‐metabolizing enzymes that play an important role in the detoxification and/or bioactivation of arylamine drugs and xenobiotics. In bacteria, NATs may contribute to the resistance against antibiotics such as isoniazid or sulfamides through their acetylation, which makes this enzyme family a possible drug target. Bacillus anthracis, a bacterial species of clinical significance, expresses three NAT isozymes with distinct structural and enzymatic properties, including an inactive isozyme ((BACAN)NAT3). (BACAN)NAT3 features both a non‐canonical Glu residue in its catalytic triad and a truncated C‐terminus domain. However, the role these unusual characteristics play in the lack of activity of the (BACAN)NAT3 isozyme remains unclear.

Experimental Approach

Protein engineering, recombinant expression, enzymatic analyses with aromatic amine substrates and phylogenetic analysis approaches were conducted.

Key Results

The deletion of guanine 580 (G580) in the nat3 gene was shown to be responsible for the expression of a truncated (BACAN)NAT3 isozyme. Artificial re‐introduction of G580 in the nat3 gene led to a functional enzyme able to acetylate several arylamine drugs displaying structural characteristics comparable with its functional Bacillus cereus homologue ((BACCR)NAT3). Phylogenetic analysis of the nat3 gene in the B. cereus group further indicated that nat3 may constitute a pseudogene of the B. anthracis species.

Conclusion and Implications

The existence of NATs with distinct properties and evolution in Bacillus species may account for their adaptation to their diverse chemical environments. A better understanding of these isozymes is of importance for their possible use as drug targets.

LINKED ARTICLES

This article is part of a themed section on Drug Metabolism and Antibiotic Resistance in Micro‐organisms. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.14/issuetoc
Who's the Boss? Concepts of Social Power Across Development
Authors: Gülgöz Selin , Gelman Susan A.
Published: October 2016

Power differences are observed in children's early relationships, yet little is known about how children conceptualize social power. Study 1 recruited adults (n = 35) to assess the validity of a series of vignettes to measure five dimensions of social power. Using these vignettes, Study 2 (149 three‐ to nine‐year‐olds, 42 adults) and Study 3 (86 three‐ to nine‐year‐olds, 22 adults) showed that children visiting a science museum at a middle class university town are sensitive to several dimensions of social power from a young age; however, an adult‐like breadth of power concepts does not develop until 7–9 years. Children understand social power whether the powerful character is malevolent or benevolent, though malevolent power is easier to detect for children and adults.
DUSP23 is over-expressed and linked to the expression of DNMTs in CD4+ T cells from systemic lupus erythematosus patients
Authors: Balada E , Felip L , Ordi-Ros J , Vilardell-Tarrés M
Published: October 2016

We evaluated the transcriptional expression of dual-specificity protein phosphatase 23 (DUSP23) in CD4+ T cells from 30 systemic lupus erythematosus (SLE) patients and 30 healthy controls. DUSP23 mRNA levels were considerably higher in the patient group: 1490 ± 1713 versus 294·1 ± 204·2. No association was found between DUSP23 mRNA expression and the presence of typical serological and clinical parameters associated with SLE. Meaningful statistical values were obtained in the patient group between the levels of DUSP23 and integrin subunit alpha L (ITGAL), perforin 1 (PRF1) and CD40L. Similarly, transcript levels of different DNA methylation-related enzymes [DNA methylation-related enzymes (DNMT1, DNMT3A, DNMT3B, MBD2, and MBD4)] were also correlated positively with the expression of DUSP23. In an attempt to counteract the hypomethylation status of the promoters of certain genes known to be over-expressed in SLE, it is possible that DUSP23 acts as a negative regulatory mechanism which ultimately silences the transcription of these epigenetically regulated genes by triggering an increase in the expression of different DNMTs.
The effect of growth hormone (GH) replacement on blood glucose homeostasis in adult nondiabetic patients with GH deficiency: real‐life data from the NordiNet® International Outcome Study
Authors: Weber Matthias M. , Biller Beverly M.K. , Pedersen Birgitte Tønnes , Pournara Effie , Christiansen Jens Sandahl , Höybye Charlotte
Published: October 2016

Objective

To assess the effect of 4 years’ growth hormone (GH) replacement on glucose homeostasis and evaluate factors affecting glycosylated haemoglobin (HbA1c) in adults with growth hormone deficiency (GHD).

Design

NordiNet® International Outcome Study, a noninterventional study, monitors long‐term effectiveness and safety of GH replacement [Norditropin® (somatropin), Novo Nordisk A/S] in real‐life clinical practice.

Patients

Nondiabetic patients (n = 245) with adult‐onset GHD (age ≥20 years at GH start), ≥4 years’ GH replacement and HbA1c values at baseline and 4 years were included in the analysis.

Measurements

Changes from baseline (∆) to 4 years in HbA1c, fasting plasma glucose (FPG), IGF‐I, lipids (high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, total cholesterol, triglycerides), waist circumference, glycaemic (HbA1c <5·7%; HbA1c, 5·7–6·5%; HbA1c, ≥6·5%) and metabolic health status were evaluated. Effects of baseline HbA1c, gender, baseline age, average GH dose and baseline body mass index (BMI) on ΔHbA1c were investigated. The models were adjusted for concomitant medication use.

Results

Mean (standard deviation) baseline HbA1c was 5·13 (0·65)% and remained at the same level at 4 years. Age at treatment start (P = 0·0094) and BMI (P = 0·0008) had a significant impact on ∆HbA1c. At 4 years, 85% of patients with HbA1c <5·7% (normal levels) at baseline and 55% of patients with HbA1c 5·7–6·5% (impaired glucose tolerance) at baseline remained in the same glycaemic health category. Nineteen patients improved from impaired glucose tolerance to normal HbA1c. Seven patients developed diabetes.

Conclusions

These data demonstrate that 4 years’ GH replacement therapy did not adversely affect glucose homeostasis in the majority of adults with GHD.
Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care
Authors: Frederico Margarita , Long Maureen , McNamara Patricia , McPherson Lynne , Rose Richard
Published: October 2016

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.
CHARGE syndrome gastrointestinal involvement: from mouth to anus
Authors: Hudson A. , Macdonald M. , Friedman J.N. , Blake K.
Published: October 2016

CHARGE syndrome is an autosomal dominant disorder that occurs as a result of a heterozygous loss‐of‐function mutation in the chromodomain helicase DNA‐binding (CHD7) gene, which is important for neural crest cell formation. Gastrointestinal (GI) symptoms and feeding difficulties are highly prevalent but are often a neglected area of diagnosis, treatment, and research. Cranial nerve dysfunction, craniofacial abnormalities, and other physical manifestations of this syndrome lead to gut dysmotility, sensory impairment, and oral–motor function abnormalities. Over 90% of children need tube feeding early in their life and many experience weak sucking/chewing, gastroesophageal reflux disease (GERD), and aspiration. The mainstay of treatment thus far has consisted of feeding therapy, GERD medications, Nissen fundoplication, gastrostomy/jejunostomy, and food texture limitation. Owing to the multitude of severe medical issues associated with this genetic disorder, GI involvement is often overlooked. Here, we report on five patients with CHARGE syndrome who manifested a range of severe GI and feeding difficulties.
INCOME AND WEALTH INEQUALITY: EVIDENCE AND POLICY IMPLICATIONS
Authors: Saez Emmanuel
Published: October 2016

(with an introduction by David Card)
Variability in the reporting of renal function endpoints in immunosuppression trials in renal transplantation: time for consensus?
Authors: Knight Simon R. , Hussain Samia
Published: October 2016

Early measures of graft function are increasingly used to assess efficacy in clinical trials of kidney transplant immunosuppression. This study aimed to assess the variability and quality of reporting of these endpoints in contemporary trials. Data regarding renal function endpoints were extracted from 213 reports from randomized controlled trials comparing immunosuppressive interventions in renal transplant recipients published between 2010 and 2014. A total of 174 (81.7%) reports included a measure of renal function; in 44 (20.7%), this was the primary endpoint. A total of 103 manuscripts (48.4%) reported serum creatinine, 142 (66.6%) reported estimated glomerular filtration rate (eGFR), and 26 (12.2%) reported measured GFR. Formulas used for GFR estimation were modification of diet in renal disease (42.3%), Cockroft‐Gault (23.5%), Nankivell (15.0%), and CKD‐EPI (0.9%). Six studies (2.8%) did not report the formula used to estimate GFR. A total of 13.9% of endpoints had missing data. In 10 studies, disagreement was found in the significance of findings using different measures of renal function. There is a great deal of variability in the reporting of renal function endpoints, with a significant proportion of studies using underperforming or inappropriate estimates. There is a need for consensus as to the best tool for monitoring and reporting renal function post‐transplant, and in particular for use in clinical trials and registries.
Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension
Authors: Gabrielli Luigi , Ocaranza María Paz , Sitges Marta , Kanacri Andrés , Saavedra Rodrigo , Sepulveda Pablo , Sepulveda Luis , Rossel Victor , Zagolin Monica , Verdejo Hugo E. , Baraona Fernando , Zalaquett Ricardo , Chiong Mario , Lavandero Sergio , Castro Pablo F.
Published: October 2016

Background

Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated.

Methods

Cross‐sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre‐ and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients.

Results

Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, P<.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002).

Conclusions

Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.
β‐blockers are associated with decreased leucocyte–platelet aggregate formation and lower residual platelet reactivity to adenosine diphosphate after angioplasty and stenting
Authors: Lee Silvia , Durstberger Markus , Eichelberger Beate , Kopp Christoph W. , Koppensteiner Renate , Panzer Simon , Gremmel Thomas
Published: October 2016

Background

The beneficial effects of β‐blockers on the long‐term prognosis of patients with cardiovascular disease may in part be attributable to decreased platelet activation. In this prospective cohort study, we sought to investigate the impact of concomitant β‐blocker therapy on sensitive markers of platelet activation and aggregation.

Materials and methods

Monocyte–platelet (MPA) and neutrophil–platelet aggregate (NPA) formation in vivo and in response to the platelet agonist adenosine diphosphate (ADP) were determined by flow cytometry in 258 patients undergoing angioplasty and stenting. On‐treatment residual platelet reactivity to ADP was assessed by multiple electrode aggregometry (MEA).

Results

One hundred seventy‐five patients of the study population (67·8%) received β‐blockers. Treatment with β‐blockers was associated with significantly lower MPA and NPA formation in vivo and in response to ADP compared to patients without β‐blockers (all P ≤ 0·01). The inverse associations of MPA and NPA formation with β‐blocker therapy remained statistically significant after adjustment for differences in patient characteristics by multivariate linear regression analyses (all P < 0·05). Moreover, high levels of MPA in response to ADP as well as high levels of NPAin vivo and in response to ADP were significantly less frequent in patients with β‐blocker treatment (all P < 0·05). Finally, on‐treatment residual platelet reactivity to ADP by MEA was significantly lower in patients receiving β‐blockers (P = 0·005).

Conclusion

β‐Blockers are associated with decreased leucocyte–platelet aggregate formation and lower on‐treatment residual platelet reactivity to ADP in patients with dual antiplatelet therapy following angioplasty and stenting.
Body mass index and response to abatacept in rheumatoid arthritis
Authors: Gardette Anais , Ottaviani Sébastien , Sellam Jérémie , Berenbaum Francis , Lioté Frédéric , Fautrel Bruno , Palazzo Elisabeth , Meyer Alain , Sibilia Jean , Dieudé Philippe
Published: October 2016

Background

Previous studies suggested that obesity could negatively affect the response to antitumour necrosis factor‐α (TNFα) agents in rheumatoid arthritis (RA). However, data are lacking on whether obesity affects the response to abatacept (ABA). We aimed to determine whether body mass index (BMI) affects the response to ABA in RA.

Materials and methods

In this multicenter retrospective study, we included RA patients who received ABA. BMI was calculated at the initiation of treatment. After 6 months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C‐reactive protein level, tender and swollen joint count were analysed. The primary endpoint was decrease in DAS28 ≥ 1·2. Secondary outcomes were good response and remission by EULAR criteria.

Results

At baseline, among 141 RA patients included, the median [interquartile range] BMI was 26·0 [22·9–30·8] kg/m². The number of patients with normal weight, overweight and obesity was 64 (45·4%), 38 (27%) and 39 (27·6%), respectively. Baseline characteristics did not differ among the three BMI subgroups. Univariate analysis revealed no difference in BMI between responders and nonresponders: DAS28 decrease ≥ 1·2 (25·0 [23·4–31·3] vs. 26·3 [22·9–30·2], P = 0·95), EULAR good response (26·4 [23·5–30·9] vs. 26·0 [22·9–30·6], P = 0·96) and remission (26·7 [21·7–30·3] vs. 26·0 [23·0–30·1], P = 0·83).

Conclusion

In our real‐life study, BMI did not affect the response to ABA in RA. If confirmed, these results suggest that obesity is not a limitation of ABA use in RA.
Reformist Distractions and Educational Labor: Two Perspectives on Paying for Grades
Authors: Warnick Bryan R.
Published: October 2016

In this essay Bryan Warnick examines two recent analyses of the practice of paying students for grades, with a focus on educational justice. Philosopher Derrick Darby argues against cash‐for‐grades programs on the grounds that such programs leave educational inequality intact. Warnick contends that Darby's arguments are incomplete. Increasing levels of educational “adequacy” is morally desirable, Warnick argues, even if inequality remains unchanged. There is also an obligation to engage in “localized practice reforms” that benefit small groups of disadvantaged students, even if such reforms do not change the structural problems that lead to inequality. At the same time, engaging in a close analysis of “cash” as an incentive does reveal specific reasons why the inequality that persists under cash‐for‐grades might be particularly troublesome. In contrast to Darby, Alexander Sidorkin argues that paying students for learning is not only allowed, but ethically obligatory. Schooling, for Sidorkin, is a form of labor and labor demands fair compensation. Warnick challenges the idea that schooling is a form of exploited labor by looking across a range of issues, including the nonpecuniary benefits of schooling. At the same time, it seems that schooling could become a form of exploited labor, given current trends. Overall, the justice of cash incentive programs remains an open question. The essay concludes with a discussion about how we can move forward with a philosophical analysis of cash‐for‐grades programs.
Absurdities, Contradictions, and Paradoxes in Miguel de Unamuno's Amor y pedagogía
Authors: Boyles Deron
Published: October 2016

This essay reconsiders Miguel de Unamuno's contribution to philosophy and education by focusing on his Amor y pedagogía (Love and Pedagogy [1902]) — a piece of fiction considered by many to be the transition point in his work from the documentary realism of the nineteenth century to what Unamuno called “viviparous” narrative for the twentieth century. Deron Boyles examines four central characters in Love and Pedagogy — Avito Carrascal, Marina Carrascal, Fulgencio Entrambosmares, and Apolodoro Carrascal — as symbolic representations of enduring conflicts in school and society.
Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey
Authors: Hazar Bodrumlu E. , Avşar A. , Arslan S.
Published: October 2016

Introduction

Child abuse is a serious public problem. Signs of abuse are often present in the oro‐facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students’ knowledge about and attitudes towards child abuse.

Material and methods

This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self‐report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students’ experience and requests made by students were evaluated by the students’ response to questions put in the questionnaire. Descriptive statistics and chi‐square tests were performed to analyse the questionnaire data.

Results

The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third‐, fourth‐ and fifth‐year students’ answers. Fifth‐year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic.

Conclusion

Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse.
Dopamine and noradrenaline, but not serotonin, in the human claustrum are greatly reduced in patients with Parkinson's disease: possible functional implications
Authors: Sitte Harald H. , Pifl Christian , Rajput Ali H. , Hörtnagl Heide , Tong Junchao , Lloyd George K. , Kish Stephen J. , Hornykiewicz Oleh
Published: October 2016

In the human brain, the claustrum is a small subcortical telencephalic nucleus, situated between the insular cortex and the putamen. A plethora of neuroanatomical studies have shown the existence of dense, widespread, bidirectional and bilateral monosynaptic interconnections between the claustrum and most cortical areas. A rapidly growing body of experimental evidence points to the integrative role of claustrum in complex brain functions, from motor to cognitive. Here, we examined for the first time, the behaviour of the classical monoamine neurotransmitters dopamine, noradrenaline and serotonin in the claustrum of the normal autopsied human brain and of patients who died with idiopathic Parkinson's disease (PD). We found in the normal claustrum substantial amounts of all three monoamine neurotransmitters, substantiating the existence of the respective brain stem afferents to the claustrum. In PD, the levels of dopamine and noradrenaline were greatly reduced by 93 and 81%, respectively. Serotonin levels remained unchanged. We propose that by virtue of their projections to the claustrum, the brain stem dopamine, noradrenaline and serotonin systems interact directly with the cortico‐claustro‐cortical information processing mechanisms, by‐passing their (parallel) routes via the basal ganglia‐thalamo‐cortical circuits. We suggest that loss of dopamine and noradrenaline in the PD claustrum is critical in the aetiology of both the motor and the non‐motor symptoms of PD.
Early exposure to Aroclor 1254 in vivo disrupts the functional synaptic development of newborn hippocampal granule cells
Authors: Parent A. S. , Pinson A. , Woods N. , Chatzi C. , Vaaga C. E. , Bensen A. , Gérard A. , Thome J. P. , Bourguignon J. P. , Westbrook G. L.
Published: October 2016

Neurogenesis in the dentate gyrus is sensitive to endogenous and exogenous factors that influence hippocampal function. Ongoing neurogenesis and the integration of these new neurons throughout life thus may provide a sensitive indicator of environmental stress. We examined the effects of Aroclor 1254 (A1254), a mixture of polychlorinated biphenyls (PCBs), on the development and function of newly generated dentate granule cells. Early exposure to A1254 has been associated with learning impairment in children, suggesting potential impact on the development of hippocampus and/or cortical circuits. Oral A1254 (from the 6th day of gestation to postnatal day 21) produced the expected increase in PCB levels in brain at postnatal day 21, which persisted at lower levels into adulthood. A1254 did not affect the proliferation or survival of newborn neurons in immature animals nor did it cause overt changes in neuronal morphology. However, A1254 occluded the normal developmental increase in sEPSC frequency in the third post‐mitotic week without altering the average sEPSC amplitude. Our results suggest that early exposure to PCBs can disrupt excitatory synaptic function during a period of active synaptogenesis, and thus could contribute to the cognitive effects noted in children exposed to PCBs.