bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview of Cyanobacterial Exopolysaccharides: Features, Composition and Effects of Stress Exposure
Authors: Chakraborty Tania , Pal R.
Published: August 2014

Cyanobacterial polysaccharides have been topic of current research interests for quite some time. Most of the cyanobacteria are observed to secrete a somewhat slimy material which is either loosely bound to or released to the medium. These extracellular polysaccharidic materials are of high molecular weight and consist of either one or different sugar residues. The presence of more than one uronic acids and/or acetylated amino sugars, phosphate, lactate etc. are thought to be one of the main reasons of the structural complexity of these materials. The structural composition and productivity of cyanobacterial polysaccharides are usually changed during different stress exposure including aging. This unique property can play a vital role in the possible biotechnological exploitation in various fields. Though ample data are there, still there is a large gap between the information on hand and the technology needed to meet the demand of the industrial sectors on the other. In the current review article an attempt has been taken to compile the information available about the main features, structural composition, varied roles and to highlight the thrust areas in a detail approach.DOI: http://dx.doi.org/10.3126/ijls.v8i4.10891
Depression, Anxiety, Happiness and Satisfaction with life among Fertile and Infertile Women
Authors: Bakhtiari Mitra , Anamagh Alireza Nazari , Khayatan Tayebeh , Nouri Parichehr , Seyedi Asl Seyed Teymur
Published: August 2014

The present research was done for investigating the rate of depression, anxiety, happiness and satisfaction with life of infertile women and comparing with fertile women. The subjects of the study were all infertile women, who came to infertility section of Motazedi hospital in Kermanshah. Using the convenience sampling and with the participants’ consent, it was asked from them to answer 4 inventories. Also using the convenience sampling, it was asked from 80 fertile women to answer the inventories. The results showed that: differences between infertile and fertile woman in depression and anxiety variables was significant; but in happiness and satisfaction variables was not significant. Also, 66/2 percent of infertile women and 46/2 percent of fertile women suffered a degree of depression. The results also showed that 77/3 percent of infertile women and 67/5 percent of fertile women suffered a degree of anxiety.DOI: http://dx.doi.org/10.3126/ijls.v8i4.10892
The effect of vitamin C on bone mineral density of menopausal women with equilibrated regime: A randomized clinical trial study, 2012-2013
Authors: Azam Jokar , Farzaneh Farahi , Nasrin Asadi , Mosa Salehi , Sedeghe Foruhari , Mehrab Sayadi
Published: August 2014

The objective of the current study was to estimate the effect of vitamin C on BMD in menopausal women with balanced dietary. In the randomized controlled clinical trial, 150 menopausal women suffering from osteoporosis were chosen in purposive sampling method. In randomized block design, the individuals were placed in the received vitamin C (test) and placebo (control) groups. After integrating groups, the test group received 1000 mg of vitamin C in two divided doses for 6 months and the placebo control group received in the same method. There was a significant correlation between obstetric history with lumbar BMD (r= -295 and p<0.001) and femoral BMD (r= -0.226 and p=0.006). The average index changes of vertebral bone density did not indicate a statistically significant difference in the vitamin C group (0.02±0.05, P=0.001) and the placebo group (0.02±0.04, P<0.001) before and after treatment. With respect to the findings of the study about the effects of vitamin C on BMD, antioxidant is suggested to add to the current treatments.DOI: http://dx.doi.org/10.3126/ijls.v8i4.10930
Validity and Reliability of Sickle Cell Self-efficacy Scale
Authors: Javadipour Sheyda , Javadipour Shiva , Keikhaeidehdezi Bijan , Akbari Meymanat
Published: August 2014

Correction: On 20/08/2014 the spelling of the third author was changed from Bijan Keykhah DehdeziTO Bijan Keikhaeidehdezi.Correction: On 20/08/2014 the affiliation of the first author was changed fromMusculoskeletal Rehabilitation Research Center, Jundishapur University of Medical Sciences of Ahvaz, IranTO Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Abstract:Background: psychometric properties of a 9-item self-appraisal scale for studying self-efficacy in sickle cell disease was evaluated in order to survey people’s comprehension of their capabilities to be engaged in functional activities of daily living who were suffering from sickle cell disease and in order to manage syndromes.Methods: the participants of this study were aged between 11-19 years with sickle cell disease under treatment for at least one year.Result: reliability analysis showed the internal consistency and correlation coefficient of the scale to be acceptable values. Construct validity analysis showed moderate positive correlation between the scores obtained using Sickle Cell Self-Efficacy Scale and those obtained using Mental Components Scale of SF36. There is a weak correlation between the score obtained from SCSES and that of Physical Components Scale of SF36.Conclusion: this scale can be used in the future for future studies on self-efficacy and also to find the relationship between this component and other components.DOI: http://dx.doi.org/10.3126/ijls.v8i4.10931
Two logics of authority in modern law
Authors: Rosen Arie
Published: August 2014

Authority is not of one kind, and authoritative directives may have different effects on the practical reasoning of their addressees. In this regard, we can distinguish between two types of authority – epistemic and decisionist. Although both are used to influence people’s actions, they diverge in the way in which they are respected and treated by those who follow them. This plurality of forms of authority is closely related to some of the questions that have been bothering legal philosophers for centuries, and particularly to questions concerning the relation between reason and fiat in law. Based on the distinction between epistemic and decisionist modes of reasoning with authoritative directives, we can distinguish two discrete logics governing the dynamics of positive law: an epistemic logic, which makes law aspire to correctness and reasonableness, and a decisionist logic, which leads to the identification of law with its positive particularity. In the final part of this article, I consider the practical and conceptual implications of this duality.
Clinical and Epidemiological Profile of Paediatric Encephalitis Patients in a Tertiary Care Hospital
Authors: Mahamud Nasir Uddin , Barua Sanat Kumar , Chowdhury Pranab Kumar , Karim Md Rezaul , Barua Prabad Chandra , Kamal Abu Hena Mostafa
Published: August 2014

Introduction: Acute encephalitis is potentially harmful central nervous system (CNS) inflammation usually caused by infections. The diagnosis is difficult to establish and the etiology often remain unclear. It is endemic throughout the year with occasional epidemics in various localities in our country. So this study was carried out to see the clinical and epidemiological background of hospitalized children with encephalitis. Methodology: A retrospective, observational study, conducted in the department of Paediatrics, Chittagong Medical College Hospital (CMCH). The study period was from January 2009 to December 2010. Children with all ages and sex with clinical case definition of encephalitis characterized by new onset of fever (tempareturee380C) or history of fever during present illness along with altered mental status (confusion, disorientation, coma) and/or neurological deficit (focal or diffuse neurological dysfunction or new onset of seizure) were included. Results: A total of 666 cases were analyzed during the study period. The mean age of the children was 3.77 years (SD± 2.9 years), most of the cases (48.5%) were between 12 months to 60 months age group. Urban cases were 144 (25%) & rural cases were 421 (75%).Year wise admissions in 2009 & 2010 were 312 & 354; deaths were 46% & 56%. Prominent clinical features of admitted encephalitis patients were fever (89%), convulsion (84%) and altered consciousness (75%). The trend of admission was high in the months of January, April and October. Significant number of death were observed under 5 years age group (P value <0.02%). Conclusion: It was observed from this study that clinical profiles among children with encephalitis can help to understand the course and epidemiological pattern of the disease. The spectrum of encephalitis can differ from rural to urban area and the months of January, April and October were the peak seasons for encephalitis in south-east region of Bangladesh; probably due to viral surge. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20020 Bangladesh J Child Health 2014; VOL 38 (1) : 5-10
Clinical Profile of Kerosene Poisoning in a Tertiary Level Hospital in Bangladesh
Authors: Anwar S , Rahman AKMN , Houqe SK A , Moshed AKMA , Yasmin L , Saleh ASM , Mohsin M
Published: August 2014

Background: Accidental ingestion of kerosene continues to remain a common medical emergency among children in developing countries. The importance of this poisoning makes it imperative that parents should be aware about this poisoning. Objective: To see clinical profile of Kerosene poisoning in Bangladesh. Methodology: This retrospective study analyzed 56 children with acute kerosene poisoning admitted in Dhaka Medical College Hospital from January 2010 to June 2010 Result: Fifty six kerosene poisoning cases were admitted within 6 months period. Among the cases boys 29(51.8%), aged less than three years 52(93%), from a rural background 36(64%) and belonging to lower economic class 51 (91%) were found. Inappropriate container of kerosene like soft drink bottle 40 (71%) & summer season 40 (71%) were found major risk factor for kerosene ingestion. Cough 52 (92%) and dyspnea 51(91%) were the commonest clinical findings. Conclusion: Respiratory complaints are predominant clinical features of Kerosene poisoning. Toddler age, children from rural area, summer season were found major risk factors for kerosene ingestion and is mostly due to faulty packing & storage of kerosene. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20021 Bangladesh J Child Health 2014; VOL 38 (1) : 11-14
Neonatal Seizures: Correlation between Clinico-Etiological Profile and EEG Findings
Authors: Parvin Ruma , Salim AFM , Rahman Mizanur , Chowdhury Kona , Sultana Azmeri , Ahmed Shafi , Rahman KM Ziaur
Published: August 2014

Introduction: Seizures are quite common in newborn babies. Among other investigations, EEG is used to show the type and location of the activity in the brain during a seizure. Correlation between clinico-etiological profile of neonatal seizures and EEG findings, so far, has not been studied in Bangladesh. Objective: The objective of the study was to correlate the clinical, etiological and EEG profile of neonatal seizures. Methodology: It was a cross-sectional study done at NICU of BSMMU and Central Hospital Ltd. All the neonates admitted with seizures during the study period were included in the study. Their clinico-etiological profiles were carefully recorded and EEG were done in all the cases. Chi-square test was done to find out the statistical difference. Results: Among total 51 cases of neonatal seizures, 29 (56.86%) cases had perinatal asphyxia, followed by septicemia in 8 (15.67%) and meningitis in 6 (11.76%). Hypoglycemia and hypocalcaemia was found in 10 (19.6%) & 8 (15.7%) cases respectively and 15 (29.4%) had acidosis. Thirty seven (72.5%) patients had seizure within 3rd day of life. Seizures were found tonic in nature in 23(45.1%) cases and subtle 18 (35.3%) cases. EEG findings were abnormal in 22 (43.1%) cases. EEG findings were analyzed with the etiology of seizures and it was found that there was a significant relationship between EEG changes and perinatal asphyxia (p<.0001), septicemia (p<.05), meningitis (p<.01) and neurometabolic disorder (p<.0001). However, no statistical significant relationship between type of discharges of EEG and type (p>.05) & pattern of seizures (p>.05) was found. Conclusion: This study suggests that there is a significant statistical relationship between EEG findings with perinatal asphyxia, septicemia and meningitis, but no relationship with types and pattern of seizures. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20023 Bangladesh J Child Health 2014; VOL 38 (1) : 19-23
Henoch-Schönlein Purpura Nephritis in Children: A Review
Authors: Uddin Golam Muin , Begum Afroza
Published: August 2014

Henoch-Schönlein purpura (HSP) is a systemic disorder which involves multiple organs including kidney. The characteristic pathology is leukocytoclastic vasculitis of the capillaries with deposition of IgA immune complexes. The principal cause of morbidity and mortality in this disease is due to renal involvement. Approximately half of the children with HSP develop nephritis (HSPN) within 4-6 weeks of initial presentation and HSPN is a major cause of end stage renal disease (ESRD) in children. So, it is important to be updated about aetio-pathogensis, clinico-pathological aspects and prognostic factors of nephritis related to Henoch Schonlein purpura. The most important is to identify the appropriate treatment options for HSPN. So, herein review has been done on the different aspects of HSPN including treatment. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20024 Bangladesh J Child Health 2014; VOL 38 (1) : 24-31
Acute Post-Streptococcal Glomerulonephritis in Children  A Review
Authors: Roy Ranjit Ranjan , Laila Kamrul
Published: August 2014

Acute post-streptococcal glomerulonephritis (APSGN) is characterized by abrupt onset of hematuria, edema, hypertension, oliguria and impaired renal function following streptococcal group A â hemolytic streptococcal throat and skin infection. There is a declining incidence of APSGN worldwide, particularly in industrialized nations because of easier and earlier access to competent medical treatment of streptococcal infections and the widespread use of fluorination of water since virulence factors in streptococcus pyogens are reduced with fluoride exposure. But in the underdeveloped world, global burden of APSGN continues to be significant with lower estimate of 9.3 to 9.8 cases per 1,00,000 population per year to higher estimates as high as three times these values. Furthermore, clusters of cases are more frequently reported in poor communities in industrialized countries while epidemics of more than 100 cases are reported in the middle ranger countries with mean annual health expenditure per capita of about 550 US dollars. APSGN typically follows 1to2 weeks after pharyngeal infection and 2 to 4 weeks after skin infection by nephritogenic strains of group A â hemolytic streptococcus in a range of 5  15 years of age. Subclinical cases are 4  10 times higher than symptomatic patients. The acute phase generally resolves within 4-8 weeks but microscopic hematuria may persist for 1-2 yr after the initial presentation. Acute complications of symptomatic patients are hypertensive heart failure, encephalopathy and retinopathy. There can be acute renal failure and rarely rapidly progressive ( crescentic) glomerulonephritis, hyperkalemia, hyperphosphatemia, hypocalcemia and acidosis. Treatment is directed towards reduction of hypertension, but prompt address of complications are essential to avoid immediate mortality. Heart failure is treated with diuretic and anti-hypertensive, digoxin is ineffective. Hypertensive encephalopathy is treated by I.V phenobarbitone for convulsion, supportive measures for unconsciousness and blood pressure control. Acute renal failure is managed by supportive measures, rarely requires dialysis. Short and long term prognosis is excellent, with1% mortality during acute stage and 1% ending up with chronic kidney disease, but in higher age group abnormal urinalysis are present in higher number of patients. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20025 Bangladesh J Child Health 2014; VOL 38 (1) : 32-39
Xeroderma Pigmentosum  A Social Stigma Report in Two Siblings and Literature Review
Authors: Jagzape Tushar , Bagga Arunita , Gupta Amol , Balpande Damodhar
Published: August 2014

Xeroderma pigmentosum is an autosomal recessive, rare pigmentary atrophic disease of childhood that progresses to early development of senile changes in sun-exposed skin. Xeroderma pigmentosum (XP) was first described in 1874 by Hebra and Kaposi. In 1882, Kaposi coined the term xeroderma pigmentosum for the condition, referring to its characteristic dry, pigmented skin. Xeroderma pigmentosum is also known as DeSanctis- Cacchione syndrome. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20026 Bangladesh J Child Health 2014; VOL 38 (1) : 40-43
Carcinoma Colon of a Child presenting As Abdominal Pain
Authors: Begum Mamtaz , Khan Zohora Jameela , Hasan Md Kamrul , Karim Sabina
Published: August 2014

DOI: http://dx.doi.org/10.3329/bjch.v38i1.20027 Bangladesh J Child Health 2014; VOL 38 (1) : 44-47
Femoral hypoplasia- Unusual Facies Syndrome or Femoral Facial Syndrome with Radioulnar Synostosis
Authors: Naher Begum Sharifun
Published: August 2014

DOI: http://dx.doi.org/10.3329/bjch.v38i1.20028 Bangladesh J Child Health 2014; VOL 38 (1) : 48-50
Congenital Cytomegalovirus Infection As Lissencephaly - A Case Report
Authors: Kundu Gopen Kumar , Akhter Mohsina , Akhter Shaheen , Rahman Md Mizanur
Published: August 2014

DOI: http://dx.doi.org/10.3329/bjch.v38i1.20029 Bangladesh J Child Health 2014; VOL 38 (1) : 51-54
Abstracts from Current Literature Vol.38(1)
Authors: Editor The
Published: August 2014

DOI: http://dx.doi.org/10.3329/bjch.v38i1.20030 Bangladesh J Child Health 2014; VOL 38 (1) : 55-56
Inheritance and reproductive consequences of floral anthocyanin deficiency inSilene dioica (Caryophyllaceae)
Authors: Rahmé Joelle , Suter Léonie , Widmer Alex , Karrenberg Sophie
Published: August 2014

•Premise of the study:Flower color is one of the most important traits for pollinator attraction. However, natural plant populations often harbor rare flower color variants resulting from mutations in biochemical pathways for floral pigment production. It is unclear how such mutations can persist because they can affect not only pollinator visitation but also plant fertility and performance.

•Methods:We collected rare white‐flowered (anthocyanin‐deficient) and common pink‐flowered morphs ofSilene dioicafrom natural populations in Switzerland. First‐ and second‐generation hybrids between pink and white morphs, as well as backcrosses toward white morphs were produced, and the proportion of white‐flowered offspring was determined. We compared seed siring ability and seed production between morphs using hand pollination experiments. Moreover, we scored the transfer of pollen analogues (fluorescent dyes) in a 50:50 array of the two morphs.

•Key results:The proportions of white‐flowered plants in the offspring of our crosses were consistent with more than one recessive mutation as the cause of floral anthocyanin deficiency and further suggested a role of maternal effects for flower color. Seed siring ability and seed set did not differ significantly between pink and white morphs. Pollen transfer occurred preferentially within morphs.

•Conclusions:Overall, our results imply that the white morph ofS. dioicalikely is caused by recessive mutations that do not impair reproduction. However, as this flower color polymorphism led to assortative mating in our experiment, it may represent standing genetic variation with the potential to contribute to evolutionary divergence.
Genetic variation in horizontally transmitted fungal endophytes of pine needles reveals population structure in cryptic species
Authors: Oono Ryoko , Lutzoni François , Arnold A. Elizabeth , Kaye Laurel , U’Ren Jana M. , May Georgiana , Carbone Ignazio
Published: August 2014

• Premise of the study: Fungal endophytes comprise one of the most ubiquitous groups of plant symbionts, inhabiting healthy leaves and stems of all major lineages of plants. Together, they comprise immense species richness, but little is known about the fundamental processes that generate their diversity. Exploration of their population structure is needed, especially with regard to geographic distributions and host affiliations.

• Methods: We take a multilocus approach to examine genetic variation within and among populations of Lophodermium australe, an endophytic fungus commonly associated with healthy foliage of pines in the southeastern United States. Sampling focused on two pine species ranging from montane to coastal regions of North Carolina and Virginia.

• Key results: Our sampling revealed two genetically distinct groups within Lophodermium australe. Our analysis detected less than one migrant per generation between them, indicating that they are distinct species. The species comprising the majority of isolates (major species) demonstrated a panmictic structure, whereas the species comprising the minority of isolates (cryptic species) demonstrated isolation by distance. Distantly related pine species hosted the same Lophodermium species, and host species did not influence genetic structure.

• Conclusions: We present the first evidence for isolation by distance in a foliar fungal endophyte that is horizontally transmitted. Cryptic species may be common among microbial symbionts and are important to delimit when exploring their genetic structure and microevolutionary processes. The hyperdiversity of endophytic fungi may be explained in part by cryptic species without apparent ecological and morphological differences as well as genetic diversification within rare fungal species across large spatial scales.
Attracting mutualists and antagonists: Plant trait variation explains the distribution of specialist floral herbivores and pollinators on crops and wild gourds
Authors: Theis Nina , Barber Nicholas A. , Gillespie Sandra D. , Hazzard Ruth V. , Adler Lynn S.
Published: August 2014

•Premise of the study:Floral traits play important roles in pollinator attraction and defense against floral herbivory. However, plants may experience trade‐offs between conspicuousness to pollinators and herbivore attraction. Comparative studies provide an excellent framework to examine the role of multiple traits shaping mutualist and antagonist interactions.

•Methods:To assess whether putative defensive and attractive traits predict species interactions, we grew 20 different Cucurbitaceae species and varieties in the field to measure interactions with pollinators and herbivores and in the greenhouse to assess trait variation. Cucurbits are characterized by the production of cucurbitacins, bitter nonvolatile terpenoids that are effective against generalist herbivores but can attract specialist beetles. We determined whether plant traits such as cucurbitacins predict herbivore resistance and pollinator attraction using an information‐theoretic approach.

•Key results:Mutualists and floral antagonists were attracted to the same cucurbit varieties once they flowered. However, rather than cucurbitacin concentration, we found that the size of the flower and volatile emissions of floral sesquiterpenoids explained both pollinator and floral herbivore visitation preference across cucurbit taxa. This pattern held across cucurbit taxa and within theCucurbitagenus.

•Conclusions:Surprisingly, floral sesquiterpenoid volatiles, which are associated with direct defense, indirect defense, and attraction, rather than defense traits such as cucurbitacins, appeared to drive interactions with both pollinators and floral herbivores across cucurbit taxa. Identifying the relevant plant traits for attraction and deterrence is important in this economically valuable crop, particularly if pollinators and floral herbivores use the same plant traits as cues.
Overview of Nine Computerized, Home-Based Auditory-Training Programs for Adult Cochlear Implant Recipients
Authors: Zhang Ming , Miller Aimee , Campbell Melanie McNutt
Published: August 2014

Background:Computerized, home-based auditory-training programs could be attractive to cochlear implant (CI) recipients who cannot obtain direct intensive training services and also to busy clinicians who would like to enable CI recipients to benefit from these programs. However,
it is difficult for either group to know which of the many programs available might best suit individual needs.Purpose:Selecting a computerized home-based program can be challenging because each offers different features. This article provides an overview of currently available programs
to help clinicians and recipients choose one that is most suitable.Data Collection and Analysis:A narrative literature review and an advanced Google search of Web sites linked to auditory-training programs were conducted. This overview builds on and updates information from previous
literature.Results:Nine computerized, home-based auditory-training programs were identified for overview. Twenty-nine information items and features for each of the nine programs are presented, categorized by general product and purchase information, design features of the training
paradigm, and auditory and communication targets.Conclusions:This article provides a descriptive overview of computerized, home-based auditory-training programs for the use of clinicians, CI recipients, researchers, and hearing aid users.
Aural Rehabilitation through Music Workshops for Cochlear Implant Users
Authors: van Besouw Rachel M. , Nicholls David R. , Oliver Benjamin R. , Hodkinson Sarah M. , Grasmeder Mary L.
Published: August 2014

Background:It has been reported that after speech perception, music appreciation is the second most commonly expressed requirement among cochlear implant (CI) recipients. Certain features of music are known to be more readily accessible; however, provision of music rehabilitation
for adult CI users is limited.Purpose:A series of music workshops were organized to (1) enable attendees to explore which aspects of music they are able to perceive and appreciate; (2) raise awareness of listening strategies, technology, and rehabilitation resources for music; and (3)
develop ideas, and prototype software, for inclusion in a music rehabilitation program. The therapeutic value of music workshops was concurrently investigated.Research Design:A qualitative, longitudinal study was used. Two consultation meetings were held before a series of nine music
workshops that occurred over a period of 5 mo.Study Sample:Five adult CI users participated in consultations before the workshops. Twenty-eight adult CI users from the South of England Cochlear Implant Centre attended at least one of the workshops.Intervention:Participants could
attend as many workshops as they wished. Each workshop lasted between 2 to 2.5 hr and included individual computer-based and group activities.Data Collection and Analysis:Responses to open-ended questions were transcribed in the consultation meetings and used to develop workshop activities.
A preworkshop survey was used to determine attendees’ aspirations and expectations. Postworkshop surveys were used to qualitatively and quantitatively evaluate attendees’ immediate reactions to the workshop content, software, and perceived benefits. A 2-month, postworkshop survey
evaluated the longer-term impact of the workshops.Results:Overall reaction to the workshops and prototype software was positive. All attendees indicated that they anticipated changing how they engaged with music as a result of the workshops, and data from the preworkshop and postworkshop
surveys suggest a positive change in listening habits.Conclusions:The workshops proved to be an effective means of simultaneously encouraging music exploration in a social and safe environment and obtaining feedback on prototype rehabilitation materials. Survey data suggested that through
group listening and practical activities, certain aspects of music can be accessible and rewarding through a CI, leading to positive changes in attitude and behavior toward music.
Normative Sweep Frequency Impedance Measures in Healthy Neonates
Authors: Aithal Venkatesh , Kei Joseph , Driscoll Carlie , Swanston Andrew , Roberts Katrina , Murakoshi Michio , Wada Hiroshi
Published: August 2014

Background:Diagnosing middle ear disorders in neonates is a challenging task for both audiologists and otolaryngologists. Although high-frequency (1000 Hz) tympanometry and acoustic stapedial reflex tests are useful in diagnosing middle ear problems in this age group, they do
not provide information about the dynamics of the middle ear in terms of its resonance frequency (RF) and mobility. The sweep frequency impedance (SFI) test can provide this information, which may assist in the diagnosis of middle ear dysfunction in neonates.Purpose:This study aimed
to investigate the feasibility of testing neonates using the SFI technique, establish normative SFI data for RF and mobility of the middle ear in terms of changes in sound pressure level (ΔSPL in dB), and describe the dynamics of the middle ear in healthy Australian neonates.Study
Sample:A prospective sample of 100 neonates (58 males, 42 females) with a mean gestational age of 39.3 wk (SD = 1.3 wk; range = 38‐42 wk), who passed all three tests, namely, automated auditory brainstem response, transient evoked otoacoustic emissions, and 1000 Hz tympanometry,
were included in this study.Data Collection and Analysis:A SFI research prototype was used to collect the data. First, the SPL in the ear canal was measured as a probe-tone frequency was swept from 100‐2000 Hz with the ear canal static pressure held constant at 200 daPa. Then,
this measurement was repeated with the static pressure reduced in 50 daPa steps to ‐200 daPa. Additional measurement was also performed at the static pressure, where the peak of the 1000 Hz tympanogram occurred. A graph showing the variation of SPL against frequency at all static pressures
was plotted. From this graph, the RF and ΔSPL at tympanometric peak pressure (TPP) were determined. Descriptive statistics and an analysis of variance (ANOVA) were applied to the RF and ΔSPL data with gender and ear as independent variables.Results:The results showed two
resonance regions of the outer/middle ear with the high RF (mean = 1236 Hz; 90% range: 830‐1518 Hz) being approximately equal to four times that of the low RF (mean = 287 Hz; 90% range = 209‐420 Hz). The low RF was more easily identifiable than the high RF. The ΔSPL at
the low RF (mean = 8.2 dB; 90% range = 3.4‐13 dB) was greater than that at the high RF (mean = 5.0 dB; 90% range = 1.5‐8.1 dB). There were no significant differences or interactions between genders and ears.Conclusion:The study showed that the SFI is a feasible test of
middle ear function in neonates. The SFI results revealed two regions of resonance with the lower resonance (287 Hz) possibly related to the movements of the outer ear canal wall and higher resonance (1236 Hz) related to the resonance of the middle ear. The normative data developed in this
study will be useful in evaluating outer and middle ear function in neonates.
Pediatric Hearing Aid Use: How Can Audiologists Support Parents to Increase Consistency?
Authors: Muñoz Karen , Preston Elizabeth , Hicken Sydney
Published: August 2014

Background:Children need consistent access to the full range of speech sounds for spoken language development, making daily hearing aid management a fundamental component of effective intervention. In addition to receiving services from professionals with expertise in childhood
hearing loss, parents play a central role in the intervention process. However, parents can experience an array of barriers and challenges in learning to cope with the demands of daily management. Feedback about hearing aid use time might offer parents insight into challenges and lead to the
identification of strategies to increase use, optimizing child outcomes.Purpose:This exploratory study had 2 primary purposes: (1) to examine hearing aid use time for a cohort of children 7 mo to 6 yr of age and (2) to examine whether hearing aid use time increased when parents were
given periodic objective feedback (i.e., data-logging results) about average daily use time.Research Design:A retrospective chart review was used to collect data on eligible participants.Results: Findings for 29 children (7 mo to 6 yr of age) revealed variability in hours of
hearing aid use and an increase in hours of use with age and severity of hearing loss. Reports of typical hearing aid use from seven parents revealed that parents overestimated use by an average of 3.36 hr. Review of challenges reported revealed issues with retention, awareness of the effect
of nonuse on average daily access to sound, and lack of perceived benefit of hearing aid use. Hearing aid use increased with communication about data logging for some, but not all, parents.Conclusions:For effective integration of essential hearing aid management skills into the daily
lives of primary caregivers, audiologists must consider caregiver needs in the overall child management and monitoring plan. The ability to optimize child outcomes might depend in part on the extent audiologists embrace family-centered services, engage in collaborative problem solving, and
support parents in applying individualized strategies.
Responsiveness of Magnetic Resonance Imaging-derived Measures Over 2.7 Years
Authors: Aitken Dawn , Ding Changhai , Pelletier Jean-Pierre , Martel-Pelletier Johanne , Cicuttini Flavia , Jones Grame
Published: August 2014

Objective.

To compare the responsiveness of magnetic resonance imaging (MRI)-derived measures of knee osteoarthritis over 2.7 years.

Methods.

There were 430 community-based participants (mean age 63.0 yrs, range 51–79 yrs; 51% female) measured at baseline and 2.7 years later. MRI of the right knee at both timepoints was performed to assess cartilage volume, cartilage defects, bone marrow lesions (BML), meniscal pathology, and tibial bone area. Global measurements were calculated as the sum of tibial and femoral measures. Standardized response mean (SRM) was calculated as the mean of change divided by the SD of change.

Results.

Global tibiofemoral cartilage volume and cartilage defects had the best SRM of −0.80 and 0.62, respectively. Site-specific measurements were lower (SRM range for cartilage volume −0.48 to −0.54 and cartilage defects 0.33 to 0.49). The SRM for BML was 0.12, meniscal pathology 0.39, and tibial bone area −0.09. Cartilage volume and/or defects tended to be more responsive in those with knee pain, those who were obese, those who were older, and those with radiographic osteoarthritis.

Conclusion.

Global cartilage volume demonstrated the best sensitivity to change, suggesting that if we relied solely on SRM to optimize clinical trial design, then cartilage volume would be the best outcome measure. However, clinical trials have shown that cartilage volume may be less responsive to treatment compared to other measures that have lower SRM (such as BML). Therefore, although one can optimize trial efficiency by finding more responsive endpoints, both sensitivity to change and magnitude of benefit should be considered.
When to Adjust Therapy in Patients with Rheumatoid Arthritis After Initiation of Etanercept plus Methotrexate or Methotrexate Alone: Findings from a Randomized Study (COMET)
Authors: Dougados Maxime R. , van der Heijde Désirée M. , Brault Yves , Koenig Andrew S. , Logeart Isabelle S.
Published: August 2014

Objective.

The objective of these posthoc analyses was to evaluate short-term clinical outcomes as predictors of poor response after 1 year of treatment with combination etanercept/methotrexate (ETN/MTX) therapy versus MTX monotherapy in patients with early rheumatoid arthritis (RA).

Methods.

Participants with moderate to severe RA [28-joint Disease Activity Score-Erythrocyte Sedimentation Rate (DAS28-ESR) ≥ 3.2] of 3–24 months’ duration received ETN 50 mg weekly plus MTX or MTX monotherapy for 52 weeks. Regression analyses were performed to evaluate the likelihood of remission (DAS28-ESR < 2.6) after 1 year despite poor clinical short-term treatment effects (e.g., absolute or changes from baseline in DAS28-ESR after 4, 8, 12, 20, and 24 weeks of therapy).

Results.

The magnitude of disease activity and its improvement and timing influenced remission probability in both treatment groups; remission rate was diminished with higher disease activity levels and lower response levels over time from weeks 4 to 24. The rate of DAS28-ESR remission at 1 year was generally greater with ETN/MTX than with MTX alone at most timepoints from weeks 4 to 24. Despite persistent high disease activity (DAS28-ESR > 5.1) after 4, 8, 12, and 24 weeks of therapy, 35%, 27%, 25%, and 22% of patients, respectively, in the ETN/MTX group achieved DAS28-ESR remission after 1 year of continuous treatment; the respective proportions were 33%, 27%, 8%, and 13% in the MTX group.

Conclusion.

High disease activity and less improvement with treatment over time in the initial 24 weeks of treatment, particularly after 12 weeks, were predictive of a lower remission rate after 1 year.
The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study
Authors: Durcan Laura , Wilson Fiona , Cunnane Gaye
Published: August 2014

Objective.

Sleep disturbance and chronic fatigue are common in rheumatoid arthritis (RA) and contribute to disability, symptomatology, and healthcare use. It has long been recognized in other populations that exercise can improve sleep and diminish fatigue. The effect of exercise on sleep quality and fatigue in RA has not been evaluated.

Methods.

Ours is a randomized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue. These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale. Patients were randomized to either a 12-week, home-based exercise intervention or usual care. The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Questionnaire (HAQ) with cardiovascular work as per the guidelines. The intervention group was evaluated on a 3-week basis. Full evaluation was carried out at baseline and at 12 weeks.

Results.

Forty patients were randomized to the intervention with 38 controls. In the exercise intervention group, there was a statistically significant improvement in HAQ (p = 0.00), pain (p = 0.05), stiffness (p = 0.05), sleep quality (p = 0.04), and fatigue (p = 0.04). In our control group, there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise, but none of the other variables.

Conclusion.

Our study demonstrates that an exercise program resulted in significant improvement in sleep quality and fatigue. This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population.
Reduced Ovarian Reserve in Patients with Takayasu Arteritis
Authors: Mont’Alverne Andrea Rocha S. , Pereira Rosa Maria R. , Yamakami Lucas Yugo S. , Viana Vilma Santos T. , Baracat Edmund Chada , Bonfá Eloisa , Silva Clovis Artur
Published: August 2014

Objective.

To assess ovarian reserve markers in patients with Takayasu arteritis (TA).

Methods.

Twenty patients with TA and 24 healthy controls were evaluated for ovarian reserve by follicle-stimulating hormone, luteinizing hormone, and estradiol, and antral follicle count (AFC). Anti-Müllerian hormone (AMH) was measured by ELISA using 2 different kits. Demographical data, menstrual abnormalities, disease variables, and treatment were also analyzed.

Results.

The median current age was similar in patients with TA and controls (31.2 ± 6.1 vs 30.4 ± 6.9 yrs, p = 0.69). The frequencies of decreased levels of AMH in patients with TA were identical using both kits and higher when compared to controls (50% vs 17%, p = 0.02; 50% vs 19%, p = 0.048). A positive correlation was observed between the 2 kits in patients with TA (r = +0.93, p < 0.0001) and in healthy controls (r = +0.93, p < 0.0001). The apparent lower AFC (11 vs 16, p = 0.13) and the higher frequency of low AFC (41% vs 22%, p = 0.29) in TA compared to controls did not reach statistical significance. Other hormones were similar in both groups (p > 0.05). Further evaluation of patients with TA with low AMH levels (< 1.0 ng/ml) versus normal AMH levels (> 1.0 ng/ml) revealed that the frequency of current disease activity (p = 1.0) and the median of erythrocyte sedimentation rate (p = 0.6), C-reactive protein (p = 0.4), prednisone cumulative dose (p = 0.8), and methotrexate cumulative dose (p = 0.8) were comparable in both groups. Cyclophosphamide use was reported in only 1 patient with reduced ovarian reserve, whereas none of the remaining patients received gonadotoxic drugs.

Conclusion.

To the best of our knowledge, our present study was the first to suggest that patients with TA may have diminished ovarian reserve.
A Multibiomarker Disease Activity Score for Rheumatoid Arthritis Predicts Radiographic Joint Damage in the BeSt Study
Authors: Markusse Iris M. , Dirven Linda , van den Broek Marianne , Bijkerk Casper , Han K. Huub , Ronday H. Karel , Bolce Rebecca , Sasso Eric H. , Kerstens Pit J.S.M. , Lems Willem F. , Huizinga Tom W.J. , Allaart Cornelia F.
Published: August 2014

Objective.

To determine whether a multibiomarker disease activity (MBDA) score predicts radiographic damage progression in the subsequent year in patients with early rheumatoid arthritis.

Methods.

There were 180 serum samples available in the BeSt study (trial numbers NTR262, NTR 265): 91 at baseline (84 with radiographs available) and 89 at 1-year followup (81 with radiographs available). Radiographs were assessed using the Sharp/van der Heijde Score (SvdH). Twelve serum biomarkers were measured to determine MBDA scores using a validated algorithm. Receiver-operating curves and Poisson regression analyses were performed, with Disease Activity Score (DAS) and MBDA score as independent variables, and radiographic progression as dependent variable.

Results.

At baseline, MBDA scores discriminated more between patients who developed radiographic progression (increase in SvdH ≥ 5 points) and patients who did not [area under the curve (AUC) 0.767, 95% CI 0.639–0.896] than did DAS (AUC 0.521, 95% CI 0.358–0.684). At 1 year, MBDA score had an AUC of 0.691 (95% CI 0.453–0.929) and DAS had an AUC of 0.649 (95% CI 0.417–0.880). Adjusted for anticitrullinated protein antibody status and DAS, higher MBDA scores were associated with an increased risk for SvdH progression [relative risk (RR) 1.039, 95% CI 1.018–1.059 for baseline MBDA score; 1.037, 95% CI 1.009–1.065 for Year 1 MBDA score]. Categorized high MBDA scores were also correlated with SvdH progression (RR for high MBDA score at baseline 3.7; low or moderate MBDA score as reference). At 1 year, high MBDA score gave a RR of 4.6 compared to low MBDA score.

Conclusion.

MBDA scores predict radiographic damage progression at baseline and during disease course.
Serum 14-3-3η is a Novel Marker that Complements Current Serological Measurements to Enhance Detection of Patients with Rheumatoid Arthritis
Authors: Maksymowych Walter P. , Naides Stanley J. , Bykerk Vivian , Siminovitch Katherine A. , van Schaardenburg Dirkjan , Boers Maarten , Landewé Robert , van der Heijde Désirée , Tak Paul-P. , Genovese Mark C. , Weinblatt Michael E. , Keystone Edward C. , Zhukov Olga S. , Abolhosn Rania W. , Popov Joanna M. , Britsemmer Karin , van Kuijk Arno W. , Marotta Anthony
Published: August 2014

Objective.

Serum 14-3-3η is a novel joint-derived proinflammatory mediator implicated in the pathogenesis of rheumatoid arthritis (RA). In our study, we assessed the diagnostic utility of 14-3-3η and its association with standard clinical and serological measures.

Methods.

A quantitative ELISA was used to assess 14-3-3η levels. Early (n = 99) and established patients with RA (n = 135) were compared to all controls (n = 385), including healthy subjects (n = 189). The sensitivity, specificity, positive and negative predictive values of 14-3-3η, and the likelihood ratios (LR) for RA were determined through receiver-operator curve analysis. The incremental value of adding 14-3-3η to anticitrullinated protein antibody (ACPA) and rheumatoid factor (RF) in diagnosing early and established RA was assessed.

Results.

Serum 14-3-3η differentiated established patients with RA from healthy individuals and all controls (p < 0.0001). A serum 14-3-3η cutoff of ≥ 0.19 ng/ml delivered a sensitivity and specificity of 77% and 93%, respectively, with corresponding LR positivity of 10.4. At this cutoff in early RA, 64% of patients with early RA were positive for 14-3-3η, with a corresponding specificity of 93% (LR+ of 8.6), while 59% and 57% were positive for ACPA or RF, respectively. When ACPA, RF, and 14-3-3η positivity were used in combination, 77 of the 99 patients (78%) with early RA were positive for any 1 of the 3 markers. Serum 14-3-3η did not correlate with C-reactive protein, erythrocyte sedimentation rate, or Disease Activity Score, but patients who were 14-3-3η-positive had significantly worse disease.

Conclusion.

Serum 14-3-3η is a novel RA mechanistic marker that is highly specific, associated with worse disease, and complements current markers, enabling a more accurate diagnosis of RA.
Predictors of Incident Depression in Systemic Lupus Erythematosus
Authors: Huang Xiangyang , Magder Laurence S. , Petri Michelle
Published: August 2014

Objective.

Findings from previous studies of predictors of depression among patients with systemic lupus erythematosus (SLE) have been inconsistent. The aim of our study was to identify risk factors that preceded incident depression based on a large, closely followed longitudinal cohort.

Methods.

Data regarding 1609 patients with SLE in the Hopkins Lupus Cohort who had no history of depression prior to cohort entry were analyzed. Demographic variables, SLE manifestations, laboratory tests, physician’s global assessment, Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), cumulative organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), and onset of depression were recorded at enrollment and each quarterly visit. Rates of incident depression were calculated overall, and in subgroups defined by demographic and clinical variables. Adjusted estimates of association were derived using pooled logistic regression.

Results.

The incidence of depression was 29.7 episodes per 1000 person-years. In the multivariable analysis, these variables remained as independent predictors of incident depression: recent SLE diagnosis, non-Asian ethnicity, disability, cutaneous activity, longitudinal myelitis, and current prednisone use of 20 mg/day or higher. Global disease activity (SELENA-SLEDAI) was not a significant predictor after controlling for prednisone use.

Conclusion.

Depression in SLE is multifactorial. Higher-dose prednisone (≥ 20 mg daily) is 1 important independent risk factor. Global disease activity is not a risk factor, but cutaneous activity and certain types of neurologic activity (myelitis) are predictive of depression. The independent effect of prednisone provides clinicians with an additional incentive to avoid and reduce high-dose prednisone exposure in SLE.