bluuebunny/crossref_metadata_2025 huggingface dataset:
Willingness to communicate in english as a second language as a stable trait or context-influenced variable
Authors: Cameron Denise
Published: July 2016

Whether Willingness to Communicate (WTC) is a permanent trait or is modified by situational context has previously been investigated in various studies (e.g. Cao & Philp, 2006; Kang, 2005; MacIntyre & Legatto, 2011). However, most research into WTC has been quantitative or conducted in the English as a Foreign Language (EFL) or Study Abroad situation in countries such as Canada, Japan, Korea and China. This article reports on the qualitative component of an exploratory mixed methods study in a New Zealand (NZ) university with participants who are permanent migrants from Iran. These students completed a questionnaire and participated in further in-depth semi-structured interviews. The article provides an overview of previous research into WTC and motivation in Iran and NZ as the context for these three case studies. In this study, six factors, both trait and situational, were identified as having an effect on these students’ WTC in both countries: self-perceived competence; personality; anxiety; motivation and the importance of English; and the learning context. Finally, this article discusses the contribution of this study to the WTC field of research, identifying the implications of these results for teachers of English in the ESL (English as a Second Language or migrant) context and possible avenues for future research.
Advanced learners’ L1 (Swedish) versus L2 (English) inferencing
Authors: Karlsson Monica
Published: July 2016

Research shows that the most important skill to possess when learning a previously unknown word is to be able to interpret its meaning based on the context in which it is found (Nation, 2001). This is especially true for L1 learners, but regrettably, research shows, not as true for students learning a second language (Nation, 2001). The aim of the present study is therefore to investigate what differences, if any, there are between advanced learners’ inferencing skills in their first versus their second language. This is done by subjecting 15 first-term university students to two parallel inferencing tests in their L1 (Swedish) and L2 (English) respectively. Although the number of inferences and the success rate vary from student to student, the results of the present study show that the learners made extensive use of contextual clues, in their L1 as well as in their L2. Also, the success rate was comparatively high, indicating the great potential learners possess for inferencing. However, in order to improve the students’ results, it may be that the teaching syllabus needs to make room for instruction on how to make use of contextual clues so that the potential learners clearly possess is nurtured further.
Molecular dynamics simulations of fcc-to-bcc transformation in pure iron: A review
Authors: Ou X.
Published: July 2016

Molecular dynamics (MD) simulation has been used to study the martensitic transformation in iron at the atomic scale. The paper reviews the available interatomic interaction potentials for iron, which describe the properties of different phases present in that system. Cases on the fcc-to-bcc transformation in iron by MD simulations were included in the present paper. Factors affecting the fcc-to-bcc transformation in iron were analysed: (a) structural factors, such as grain/phase boundaries, grain sizes and stacking faults; (b) simulation conditions, such as the presence of free surfaces, external stress/strain and studied temperatures; (c) the interatomic interaction potential. The main emphasis of the present paper is on results giving insight on the mechanisms of the nucleation and growth of bcc phase in iron.

This review was submitted as part of the 2016 Materials Literature Review Prize of the Institute of Materials, Minerals and Mining run by the Editorial Board of MST. Sponsorship of the prize by TWI Ltd is gratefully acknowledged.
Information, capital, well-being
Authors: Engelbrecht Hans-Jürgen
Published: July 2016

Don Lamberton asked many questions about the nature and role of information, without expecting to be able to provide tidy or neat answers. The issues he raised have not gone away or been resolved. Some have re-appeared in modified or new form. This paper first focuses on the analysis of information at the macro-level, starting with the ill-fated ‘information sector’ studies and leading on to current attempts to use neoclassical economics to measure macro-level capital stocks in the context of the debate about sustainable development, also known as ‘wealth accounting’. Wealth accounting has no place for information-as-capital that goes beyond very primitive proxy measures for intangible capital other than human capital. Often, information-as-capital is neglected completely by denoting such capital stocks as ‘enabling assets’ that are assumed to be reflected in what turn out to be unmeasurable shadow prices. Next, an issue mostly neglected by Don Lamberton is discussed – the normative assessment of information and innovation. It is argued that neither mainstream economics nor evolutionary economics, information studies, innovation studies and so on currently has an appropriate normative theory of innovation. Increased output, innovation counts, productivity, competitiveness and consumption-related utility (what economists call ‘welfare’) are poor indicators of what really should be measured, which is the objective and subjective impacts of innovation on people’s well-being.
CD6 modulates thymocyte selection and peripheral T cell homeostasis
Authors: Orta-Mascaró Marc , Consuegra-Fernández Marta , Carreras Esther , Roncagalli Romain , Carreras-Sureda Amado , Alvarez Pilar , Girard Laura , Simões Inês , Martínez-Florensa Mario , Aranda Fernando , Merino Ramón , Martínez Vanesa-Gabriela , Vicente Rubén , Merino Jesús , Sarukhan Adelaida , Malissen Marie , Malissen Bernard , Lozano Francisco
Published: July 2016

The CD6 glycoprotein is a lymphocyte surface receptor putatively involved in T cell development and activation. CD6 facilitates adhesion between T cells and antigen-presenting cells through its interaction with CD166/ALCAM (activated leukocyte cell adhesion molecule), and physically associates with the T cell receptor (TCR) at the center of the immunological synapse. However, its precise role during thymocyte development and peripheral T cell immune responses remains to be defined. Here, we analyze the in vivo consequences of CD6 deficiency. CD6−/− thymi showed a reduction in both CD4+ and CD8+ single-positive subsets, and double-positive thymocytes exhibited increased Ca2+ mobilization to TCR cross-linking in vitro. Bone marrow chimera experiments revealed a T cell–autonomous selective disadvantage of CD6−/− T cells during development. The analysis of TCR-transgenic mice (OT-I and Marilyn) confirmed that abnormal T cell selection events occur in the absence of CD6. CD6−/− mice displayed increased frequencies of antigen-experienced peripheral T cells generated under certain levels of TCR signal strength or co-stimulation, such as effector/memory (CD4+TEM and CD8+TCM) and regulatory (T reg) T cells. The suppressive activity of CD6−/− T reg cells was diminished, and CD6−/− mice presented an exacerbated autoimmune response to collagen. Collectively, these data indicate that CD6 modulates the threshold for thymocyte selection and the generation and/or function of several peripheral T cell subpopulations, including T reg cells.
Two-year longitudinal assessment of physicians’ perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
Authors: Hanauer David A , Branford Greta L , Greenberg Grant , Kileny Sharon , Couper Mick P , Zheng Kai , Choi Sung W
Published: July 2016

This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.
Insights into the physician assistant profession in Canada
Authors: Fréchette Danielle , Shrichand Arun
Published: July 2016

Physician assistants (PAs) have been used for decades in the Canadian military. Now, PAs are being introduced in various clinical settings to provide patient care for the general population. This article reviews major developments in the PA profession across Canada over the last decade. Nearly 541 PAs are employed in Canada or work for a Canadian agency. Growing evidence demonstrates the positive effect of PAs; however, key issues challenge the extent to which the PA movement will continue to build momentum.
Which antidotes are available for the novel oral anticoagulants?
Authors: Thomas Rebekah , Gonzalez Renzo
Published: July 2016

Use of novel (or target-specific) oral anticoagulants continues to increase. This article reviews idarucizumab and andexanet alfa, two antidotes that can be used to reverse anticoagulation in patients needing emergency surgery or with life-threatening bleeding.
PA and NP productivity in the Veterans Health Administration
Authors: Moran Eileen A. , Basa Edesha , Gao Jian , Woodmansee Denni , Almenoff Peter L. , Hooker Roderick S.
Published: July 2016

This study assessed the 2014 clinical productivity of 5,959 physician assistants (PAs) and nurse practitioners (NPs) in the US Department of Veterans Affairs' Veterans Health Administration (VHA). Total work relative value units divided by the direct clinical full-time equivalent measured annual productivity, and correlated factors were examined using weighted analysis of variance. PAs and NPs in adult primary care roles were more productive than those in other specialties. Both providers were more productive in rural than in nonrural settings and less productive in teaching than nonteaching hospitals. Men were slightly more productive than women but age and years of VHA employment were not correlates of productivity. PAs were more productive when their scope of practice allowed significant autonomy; NP productivity was unaffected by supervisory requirements. PAs and NPs are an important component of the VHA provider workforce, and their productivity correlates with a number of factors. More organizational research is necessary to better understand the contributing roles PAs and NPs provide in a rapidly evolving, vertically integrated, national health delivery system.
Direct oral anticoagulants for venous thromboembolism treatment and prophylaxis
Authors: Yorkgitis Brian K.
Published: July 2016

Direct oral anticoagulants are a popular option for prevention and treatment of venous thromboembolism. However, they possess significantly different pharmacologic properties from warfarin. This article reviews approved direct oral anticoagulants, their indications, pharmacologic properties, monitoring, and reversal strategies.
EPIGENETIC INFLUENCES EARLY IN LIFE
Authors: Pot B.
Published: July 2016

While recent research shows the importance of the microbiota in e.g. the development of the immune system, it also became evident that the very early phases in life, even before birth, may be crucial. Later in life the impact of microbiota interventions may be less effective. While we don't know at this stage how and where and when the microbiota can change the human DNA, we can learn from epigenetic observational studies linked to e.g. malnutrition (the Dutch famine study) or linked to other types of stress (the Canadian ice storm babies). Whether these observations can be extrapolated to, or even explained by ‘microbiota stresses’, remains to be clarified.
GUT‐BRAIN AXIS AND BEHAVIOUR
Authors: Rousseau G.
Published: July 2016

Evidences are accumulating to stress the importance of the gut‐brain axis in mood disorders. In the laboratory, we are interested in myocardial infarction and depression that occurs in more than 65% of patients following a heart attack. We have demonstrated that cells in certain brain areas die mainly during the first days following the ischemic episode which result in the apparition of clinical signs of depression. In order to reduce these effects, we have tested different interventions, including taking probiotics before and after a myocardial infarction to determine their effects in post‐myocardial depression. Our results show that probiotics can reduce this death, resulting in a significant decrease in depressive behaviours. Although the beneficial mechanisms of probiotics to reduce post‐infarction depression symptoms are hypothetical for now, we will explore different ways to explain these effects. Among these ways, we will focus on a better integrity of the intestinal barrier and the stimulation of the vagus nerve.
VERTICAL TRANSMISSION OF THE MICROBIOTA FROM THE MOTHER TO THE PROGENY
Authors: van de Wiele T.
Published: July 2016

The gut microbiome is an important determinant of human health. Human babies are born largely germfree and colonization begins immediately upon birth. While adults have a gut microbiome that is quite robust and stable over time, new‐borns experience a dynamic microbial colonization resulting in higher vulnerability and sensitivity to disturbances. The new‐born's microbiome composition is highly dependent on delivery mode (vaginal vs. caesarean) and feeding choices (breastfeeding vs. formula), which may directly impact child's health by modulating risks for developing diseases like asthma or allergy. Breast milk is now understood to be an additional source of microbes from the mother towards the infant, and intriguingly, latest research tells that the uterus is not completely sterile, although whether it contributes to colonization prior to birth is highly controversial. In particular, the role of labour or lack thereof, remains enigmatic. This presentation will provide an overview of the different transmission routes and highlight research on different cohorts of mother‐infant pairs according to different delivery modes. While many questions remain to be addressed, new insights from the scientific field may lead to new research opportunities for developing strategies that mitigate the negative effects from deviations in the early‐life microbial colonization.
MODE OF DELIVERY, ROUTE OF DELIVERY AND DIET ALL REGULATE INFANT MICROBIOTA AND METABOLOME
Authors: Tuohy Kieran M.
Published: July 2016

The intestinal microbiome is now recognised as playing an important role in human health and disease, impacting on many host physiological processes from metabolism and immune homeostasis to brain development and even cognitive function. Importantly, many of these physiological processes appear to be affected by early life events. Maternal health during pregnancy, term of birth, mode of delivery (Spontaneous Vaginally Delivered or Caesarean‐section), infant diet (breast feeding, infant formula feed, fortified infant formula) and exposure to microorganisms (both pathogenic and commensal) all impact on neonatal physiological development and later life health or disease risk. Many studies, using different microbiological approaches have characterised the successional development of the infant gut microbiota. Some have also correlated microbiota composition with concomitant changes in health status (e.g. incidence of infections) or physiological biomarkers. Studies in animals and using in vitro microbiota models have identified prebiotics capable of modulating the architecture of the infant gut microbiota and intervention studies in healthy infants have also confirmed that infant formula fortified with prebiotics can modulate the gut microbiota of formula fed infants towards that of breast‐fed infants. In this presentation we will assess the potential of fructans (inulin and oligofructuse in particular) as prebiotic ingredients capable of modulating the composition of the infant gut microbiota. We will discuss evidence of safety, tolerability and impact on microbiota metabolic output. Finally, we will discuss the need for wider application of whole systems metabolic profiling or metabolomics to study the metabolic consequences of microbiota modulation, using a specific example data‐set. In a collaborative study with University College Cork in Ireland, we have measured the metabolic implications of early life events in terms of urinary metabolite profiles using LC‐MS based metabolomics in 199 breast fed infants. Mode of delivery and term v pre‐term birth clearly impacted on urinary metabolite profiles, with 5000 statistically significant biomarkers separating infant groups. Remarkably, these shifts in metabolite profiles reflected closely differentiative clustering of faecal microbiota at the same time point, indicating that gut microbiota derived metabolites contribute significantly to the urinary metabolome in infants and more importantly, that changes within the intestinal microbiome brought on by early life events have clear and measurable consequences in terms of infant metabolism. These observations identify metabolomics as a powerfully informative tool for studying diet:microbiota interactions, especially in infants, and a technology likely to provide new mechanistic insight linking microbiota modulation with physiological response or health effects in babies.
QUALITY OF PROBIOTIC PRODUCTS
Authors: Szajewska H.
Published: July 2016

Many clinicians have concerns regarding the reliability of some of the products currently on the market. Indeed, a number of studies have questioned the microbiological quality and labeling of many commercial probiotic products. Only some of them met the definition of probiotics, i.e., contain viable, well‐defined microorganisms in sufficient numbers. A substantial percentage of products contained other species of organisms. Products sold for medicinal purposes tend to be of better quality than probiotics used in dairy foods or probiotic supplements. This may be due to the fact that in most countries, probiotics are not regulated as drugs but are marketed as dietary supplements. This means that they are not standardized. However, even top quality probiotic products may suffer from some degree of product variability. Probiotics are live microorganisms that survive in the anaerobic environment. Factors such as oxygen, temperature, and humidity may have an impact on the maintaining the viability of the probiotic strains at sufficiently high levels to ensure their therapeutic activity throughout their shelf life. Additionally, variations in manufacturing processes, quality between batches, and packaging material may have an impact on the final products. Accurate labeling is essential for proper use of probiotics. Healthcare professionals and consumers should be aware of possible variations. Until issues are regulated, the only sound approach seems to be to choose probiotic products from a recognized manufacturer who has a regulated quality control of factors including the composition and content of the probiotic bacteria and adheres to good manufacturing practice.
INFANT GUT MICROBIOTA, HUMAN MILK OLIGOSACCHARIDES AND PREBIOTICS – WHAT'S NEW?
Authors: Venema K.
Published: July 2016

Over the past two decades it has become clear that the gut microbiota is heavily involved in health and disease, not only for the gut itself, but also for the rest of the body. Correlations have been found between the presence/absence of certain bugs and many diseases and disorders. One of the major activities of the gut microbiota is the fermentation of carbohydrates. In breast‐fed infants these are the human milk‐oligosaccharides (HMO). Breast‐feeding is considered the ‘golden standard’ for infants, and hence companies are trying to mimic the composition of HMO with prebiotics. Prebiotics are defined as non‐digestible carbohydrates that specifically stimulate one or a few members of the gut microbiota, leading to improved health. However, it is the phrase 'specifically’ in that definition that usually is not met. Although previously e.g., inulin and fructooligosaccharides were thought to specifically increase bifidobacteria, with the advent of new and better molecular tools to study the gut microbiota, this bifidogenic concept has been challenged. Besides, other members of the microbiota have been identified as beneficial, such as Faecalibacterium prausnitzii and Akkermansia muciniphila. Moreover, even other bugs may need to be stimulated when dysbiosis occurs, such as in inflammatory bowel disease, obesity, etc. In addition, every individual has his/her own microbiota composition, and hence other species and strains, each with their own (carbohydrate degrading) enzyme machinery. Due to next generation sequencing methods we have access to a tremendous amount of information, either from single strain sequencing, or from metagenomic samples. Genes encoding glycosylhydrolases and other carbohydrate active enzymes (CAZy) can be identified in these sequences. Attempts and challenges to use this information for the development of strain‐specific prebiotics will be highlighted. This will pave the way for the concept of personalized prebiotics.
MICROBIOME MANIPULATION AND IMMUNE REGULATION
Authors: Garssen J.
Published: July 2016

Our body is attacked continuously by many different danger signals. An effective immune system is essential in order to protect. Unbalanced immune reactivity seems to play a key role in non‐communicable diseases (NCDs) such as for example chronic pulmonary disease (COPD), allergies, asthma, diabetes, cancer and even cardiovascular diseases and obesity. According to the WHO NCDs are not only relevant for high income countries but even for middle and low income areas. It is essential to develop new avenues to prevent the enormous increase in incidence and severity of NCDs. Early life programming including proper education of our immune system (a.o. inflammation management) has been recognized as one of the most promising approaches.

The awareness of the importance of a diverse microbiome in immune‐regulation/inflammation management and as a consequence impact on NCDs is growing exponentially. After birth, the development of a “healthy” gut microbiome is considered to play an important role in immune development and as a consequence inflammation management. The relevance of our microbiome in susceptibility for a.o. immune related diseases including NCDs is very well recognized nowadays. Non‐digestible prebiotic oligosaccharides and even some unique microbes are transferred by the mother through the breastmilk to the child. Some of these affect the composition and/or activity of the gastrointestinal microbiome leading to health benefits (prebiotic function). As an example it has been shown that specific non‐digestible oligosaccharides (GOS/FOS) induces a gut microbiome comparable at least in part to breastfed infants. In addition to indirect effects on the immune system via microbiome changes prebiotic oligosaccharides can affect immune cells in a direct fashion as well. Many research groups are currently in search for the unique receptors such as lectins/galectins that are responsible for these direct immune effects.

Recent clinical trials indicated that unique prebiotic fibers can impair the incidence and severity of allergic disorders. The majority of the studies sofar indicated immune effects in individuals still having an immature immune system (infants and toddlers). However very recent data indicated significant impact on other immune related diseases in other life stages as well. Recent publications indicate significant effects on the immune system during HIV infections, cancer and asthma.

Both pharma as well as specialized–nutrition companies do see the highly relevance of microbiome manupilation for both prevention as well as treatment of some immune related disorders linked to NCDs. However more research, multicenter trials, and longterm followup studies are needed in order to validate the uniqueness of a.o. non‐digestible oligosaccharides and microbiome management in both classical pharma approaches as well as specialised and medical nutrition aimed at NCD management.
MICROBIOTA AND OBESITY
Authors: Vanderhoof J.
Published: July 2016

Today the world is faced with an epidemic of obesity, most prominent in the industrialized world. A number of factors are thought to play a role including lifestyle changes and dietary habits. Recently the role of the microbiome has become a topic of intense investigation. Differences in microbial colonization between obese and nonobese individuals have been demonstrated in numerous studies. Animal studies have demonstrated that obese animals can be made nonobese by transplantation of microbiota from nonobese animals and the converse also appears to be true. The microbiota appeared to be able to influence the development of obesity through multiple mechanisms. One possible mechanism is increasing energy harvest through the production of short chain fatty acids and other compounds incompletely absorbed in the gastrointestinal tract. Other possible explanations include direct regulation of metabolic pathways either through epigenetic programming of important regulatory genes or through production of various metabolites which can influence metabolic pathways. Our ability to measure not only the microbiome, but also the metabolome and the transcriptome at present exceeds our ability to understand the entire process, although bits and pieces appear to be coming together. Unfortunately, it is often difficult to determine causal relationships between observed phenomenon and outcomes, as dietary changes may result in almost immediate alterations in gut microbiota and their metabolic products. Further investigation over the next several years will likely bring a much greater understanding of the role of the microbiota in obesity and the possibility of therapeutic interventions targeted at the microbiome.
MICROBIOTICA AND PROBIOTICS IN PEDIATRIC IRRITABLE BOWEL SYNDROME
Authors: Staiano A.
Published: July 2016

Irritable bowel syndrome (IBS), as described by the Rome criteria, includes abdominal pain (AP) or discomfort associated with changes in bowel patterns.

Despite a still incomplete pathophysiologic understanding of this condition, IBS is generally considered a disorder of the brain‐gut axis. This bidirectional connection between the central and the enteric nervous systems links emotional and cognitive centers of the brain with intestinal motility and entero‐endocrine and immune functions, likely determining the clinical expression of most functional gastrointestinal disorders (FGIDs).

Probiotics are emerging as new therapeutic tools in FGIDs, due to the recognition of the importance of gut microbiota in influencing brain‐gut interactions, and of the role played by intestinal infections in the genesis of AP‐FGIDs. Preclinical data suggest that changes in the gut microbiota can affect brain signaling systems related to pain and associated emotional behavior. Therefore, probiotics likely play a relevant role in the management of FGIDs, by affecting the gut microbiota or by altering brain function and pain perception centrally.

Few randomized clinical trials (RCTs) are available in children. A meta‐analysis including 9 trials which tested different probiotics as a treatment for FGIDs in children and adolescents concluded that Lactobacillus GG, Lactobacillus reuteri DSM 17938 and VSL#3 significantly increased treatment success, particularly in children with associated bowel changes.

We recently showed that, in children with IBS, a mixture of Bifidobacterium infantis M‐63®, breve M‐16V® and longum BB536® is safe and is associated with better AP control and improved QoL when compared to placebo.
PRE‐, PROBIOTICS AND SYNBIOTICS IN CONSTIPATION
Authors: Benninga M.A.
Published: July 2016

Prevalence of childhood constipation has been estimated at 0.7% to 29.6% in the general population worldwide; most children have no obvious etiological factors. The management of constipation is essentially multifactorial and, along with medical treatment, should address the social and psychological issues that may be associated with it.

This presentation focuses on the evidence of treatment with pre‐ pro‐ and synbiotics in one of the most prevalent gastrointestinal disorders in children of all ages. Namely, functional constipation.

Low fiber intake is associated with constipation and, therefore, every child with or without constipation needs a normal daily fiber intake. The role of extra fiber on constipation requires further evaluation. Clinical guidelines recommend the use of polyethylene glycol (PEG) with or without electrolytes as first‐line maintenance pharmacological treatment for the functional constipation in children rather than dietary interventions alone.

There are many different prebiotics and probiotic microorganisms with different effects. Currently, evidence is lacking to support use of any pre‐ or pro‐ or synbiotic strain in the treatment of constipation in children.
APPLICATION OF GAS CHROMATOGRAPHY‐MASS SPECTROMETRY FOR ASSESSMENT OF THE INTESTINAL MICROFLORA CONDITION IN CHILDREN WITH CHRONIC GASTRITIS
Authors: Gurova M. , Novikova V.
Published: July 2016

Objectives:

This study is aimed at assessing condition of intestinal microflora in children with chronic gastritis in different phases of the disease and after a course of probiotic treatment using of gas chromatography ‐ mass spectrometry (GC‐MS).

Methods:

This longitudinal study was conducted among 90 children aged 11–15 years with Helicobacter pylori positive morphologically proven chronic gastritis (CG). 22 healthy children matched by age and gender with the children of the main group were taken as comparison group. Children with CG have been investigated repeatedly in the period of exacerbation, 6 months after the successful eradication of Helicobacter pylori infection and after a one‐month course of probiotic medicine. As the probiotic medicine, a complex probiotic Bifiform containing at least 107 Bifidobacteriun longum and at least 107 Enterococcus faecium was used. To assess the state of intestinal microbiota we use GC‐MS – detecting species‐specific fatty acids as genetically determined structural components of the cell wall.

Results:

In children with chronic gastritis both in acute and remission phases in 100% of cases were revealed changes in composition of the intestinal microflora affecting not only intraluminal but parietal microflora. In phase of exacerbation, microbiota disorders were expressed by decreased number of obligate bacteria (bifidobacteria, lactobacilli). In phase of remission the revealed changes saved and characterized by decreased number not only bifidobacteria, lactobacilli but propionobacterium and increased number of such opportunistic bacteria as clostridia (Clostridium histolyticum, Clostridium propionicum, and Clostridium ramosum), streptococci, Candida fungi. Excessive proliferation of Candida albicans were found in 16.5% (95% CI 12 – 21.2) children in exacerbation phase and in 30% (95% CI 22.2 – 38.8) in phase of remission (р = 0.0412). Intensity of violations of parietal microflora were significantly associated (р < 0.05) with morphological changes of gastric mucous. After a course of probiotic treatment were found positive changes in composition of the gut microbiota characterizing by increasing number of bifidobacteria and enrecocci, and decreased number of clostridia and Candida fungi.

Conclusion:

Chronic gastritis in children is commonly associated with negative changes in parietal microflora in acute phase and in 6 months. Using of gas chromatography ‐ mass spectrometry for studying and evaluating the intestinal microflora in children with chronic gastritis can significantly extend the range of the defined microbiota and its possible changes in different phases in diseases.
ARE SYNBIOTICS (BIFIDOBACTERIUM LACTIS B94, INULIN) BETTER THAN PROBIOTICS (BIFIDOBACTERIUM LACTIS B94) AND PREBIOTICS (INULIN) FOR IRRITABLE BOWEL SYNDROME IN CHILDREN?
Authors: Artan R , Basturk A , Yilmaz A
Published: July 2016

Background:

The etiology of irritable bowel syndrome (IBS) has not been fully elucidated. Therefore, multi‐centered studies examining the efficacy and safety of different probiotics and synbiotics for the treatment of IBS in different age groups are necessary.

Aims:

Our current study aimed to investigate the efficacy of synbiotics (Bifidobacterium lactis B94, Inulin), probiotics (Bifidobacterium lactis B94) and prebiotics (Inulin) for the treatment of IBS in a pediatric age group. This study was randomized, double‐blind, controlled and prospective in design.

Materials and Methods:

This study included 71 children between the ages of 2–18 years old who were diagnosed with IBS according to Roma III diagnostic criteria. The patients were randomly divided into three groups. The first group received synbiotic treatment [5 × 109 colony forming unit (CFU) Bifidobacterium lactis B94 (B. Lactis B94) and 900 mg inulin], the second group received probiotic treatment (5 × 109 CFU B. Lactis B94) and the third group received prebiotic treatment (900 mg inulin). The treatments for each group were administered twice daily in a double‐blind setting. All patients were evaluated at the end of a four week treatment period. Those who did not have any complaints at the end of four weeks were considered as having a full recovery. Those who had improvements in one or more of their initial complaints were considered as having improvement of their initial complaints.

Results:

At the end of treatment, the prebiotic group had significant improvements in belching‐abdominal fullness (p = 0.008), the probiotic group had significant improvements in abdominal fullness (p = 0.016), bloating after meals (p = 0.016) and constipation (p = 0.031), and the synbiotic group had significant improvements in belching‐abdominal fullness (p = <0.001), bloating after meals (p = 0.004), constipation (p = 0.021) and mucus in the feces (p = 0.021). The synbiotic group had a significantly higher ratio of full recovery with treatment than did the prebiotic group (39% vs. 12.5%, p = 0.036).

Conclusion:

In conclusion, the twice‐a‐day administration of synbiotics, probiotics and prebiotics is safe for the treatment of children with IBS. When compared to prebiotics, the administration of synbiotics and probiotics provides significant improvements in initial complaints. Furthermore, the ratio of those with full recovery in IBS symptoms was significantly higher in the synbiotic group than in the prebiotic group; the probiotic group was not significantly different.
Effects of Probiotics on Some Blood Parameters and Serum IgG in Broilers
Authors: Yalçin Sakine , Eser Handan , Yalçin Suzan , Yalçin S. Songül
Published: July 2016

Introduction:

Probiotics as a live microbial feed supplement affects the host by improving its gut microbial balance. Probiotics may have positive effects on broiler performance, improve microbial balance, synthesize vitamins of B complex, decrease pH in the intestine, stimulate of intestinal mucosa immunity, reduce blood cholesterol and increase protection against toxins produced by pathogenic microorganisms. Blood serum parameters may provide useful information about the evaluation of the health status of broilers. This study was aimed to determine the effects of dietary probiotics on some blood parameters and serum IgG in broilers.

Methods:

A total of 300 Ross 308 broiler male chicks aged one day were divided into one control group and two treatment groups each group containing 100 chicks. Each group was divided into 5 replicates, as subgroups, each comprising 20 chicks. The experimental period lasted 39 days. Basal diet was supplemented with the probiotics (Nafoil forte, Bacillus subtilis, Lactobacillus plantarum, Saccharomyces cerevisiae, Biotem Ltd Company). Probiotics were added at 0.1 and 0.2% to the first and second treatment groups, respectively. At the end of the experiment (d 39) blood samples were collected from 10 fed broilers randomly chosen from each group (2 from each replicate) and centrifuged. Serum was separated. Levels of ALT, AST, ALP and total protein, uric acid, cholesterol and triglyceride were determined by an autoanalyser using their accompanying commercial kits. Serum IgG levels were determined by ELISA.

Results:

Dietary supplementation of probiotics containing Bacillus subtilis, Lactobacillus plantarum, Saccharomyces cerevisiae didn't affect blood serum protein, uric acid, triglyceride and the levels of ALT, AST and ALP. Probiotics supplementation decreased serum cholesterol concentration linearly (P = 0.001). Serum IgG concentration linearly increased (P = 0.014) with dietary probiotics supplementation.

Discussion:

Dietary probiotics supplementation decreased serum cholesterol and increased serum IgG concentration in broilers. Therefore this probiotics seems to be the perfect feed additive for lowering cholesterol in the gastrointestinal tract and enhancing humoral immune response.
A Framework for Understanding Lapses in Professionalism Among Medical Students: Applying the Theory of Planned Behavior to Fitness to Practice Cases
Authors: Jha Vikram , Brockbank Susannah , Roberts Trudie
Published: July 2016

Fitness to practice decisions are often based on a student’s digression from the regulations, with limited exploration of the reasoning behind the student’s behavior. However, behavior is underpinned by complex, “hidden” variables, including an individual’s attitudes and social norms. Examining hidden determinants of professionalism, such as context, interpersonal relationships, social norms, and local cultures, then allows medical educators to develop a richer understanding of unprofessional behavior.

In this article, the authors propose the use of the theory of planned behavior (TPB) as a framework to help evaluate unprofessional behavior in students. The TPB is a deliberative processing model that explains how an individual’s behavior is underpinned by his or her cognitions, with behavior being primarily dependent on the intention to perform the behavior (behavioral intention). Intention, in turn, is determined by three variables: attitude, subjective norm, and perceived behavioral control.

To understand the practical use of the TPB, the authors present four complex, anonymized case studies in which they employed the TPB to help deal with serious professionalism lapses among medical students. The outcomes of these cases as well as the student and program director perspectives, all explained via the TPB variables, are presented. The strengths and limitations of the TPB are discussed.
Modifying the Primary Care Exception Rule to Require Competency-Based Assessment
Authors: Tobin Daniel G. , Doolittle Benjamin R. , Ellman Matthew S. , Ruser Christopher B. , Brienza Rebecca S. , Genao Inginia
Published: July 2016

Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training. However, CMS does not mandate that programs assess or attest to residents’ clinical competence before using this rule. By requiring this six-month probationary period, the implication is that residents are adequately prepared for indirectly supervised practice by this time. As residents’ skill development varies, this may or may not be true. The PCER makes no attempt to delineate how residents’ competence should be assessed, nor does the GME community have a standard for how and when to make this assessment specifically for the purpose of determining residents’ readiness for indirectly supervised primary care practice.

In this Perspective, the authors review the history and current requirements of the PCER, explore its limitations, and offer suggestions for how to modify the teaching physician billing requirements to mandate the evaluation of residents’ competence using the existing milestones framework. They also recommend strategies to standardize this process of evaluation and to develop benchmarks across training programs.
Methodologic Considerations for Collecting Patient-reported Outcomes from Unselected Surgical Patients
Authors: Helsten Daniel L. , Ben Abdallah Arbi , Avidan Michael S. , Wildes Troy S. , Winter Anke , McKinnon Sherry , Bollini Mara , Candelario Penny , Burnside Beth A. , Sharma Anshuman
Published: July 2016

Background

The impact of surgery on health is only appreciated long after hospital discharge. Furthermore, patients’ perceptions of postoperative health are not routinely ascertained. The authors instituted the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) registry to evaluate patients’ postoperative health based on patient-reported outcomes (PROs).

Methods

This article describes the methods of establishing the SATISFY-SOS registry from an unselected surgical population, combining perioperative PROs with information from electronic medical records. Patients enrolled during their preoperative visit were surveyed at enrollment, 30 days, and 1-yr postoperatively. Information on PROs, including quality of life, return to work, pain, functional status, medical complications, and cognition, was obtained from online, mail, or telephone surveys.

Results

Using structured query language, 44,081 patients were identified in the electronic medical records as having visited the Center for Preoperative Assessment and Planning for preoperative assessment between July 16, 2012, and June 15, 2014, and 20,719 patients (47%) consented to participate in SATISFY-SOS. Baseline characteristics and health status were similar between enrolled and not enrolled patients. The response rate for the 30-day survey was 62% (8% e-mail, 73% mail, and 19% telephone) and for the 1-yr survey was 71% (13% e-mail, 78% mail, and 8% telephone).

Conclusions

SATISFY-SOS demonstrates the feasibility of establishing a PRO registry reflective of a busy preoperative assessment center population, without disrupting clinical workflow. Our experience suggests that patient engagement, including informed consent and multiple survey modalities, enhances PROs collection from a large cohort of unselected surgical patients. Initiatives like SATISFY-SOS could promote quality improvement, enable efficient perioperative research, and facilitate outcomes that matter to surgical patients.
Effort and Displeasure in People Who Are Hard of Hearing
Authors: Matthen Mohan
Published: July 2016

Listening effort helps explain why people who are hard of hearing are prone to fatigue and social withdrawal. However, a one-factor model that cites only effort due to hardness of hearing is insufficient as there are many who lead happy lives despite their disability. This article explores other contributory factors, in particular motivational arousal and pleasure. The theory of rational motivational arousal predicts that some people forego listening comprehension because they believe it to be impossible and hence worth no effort at all. This is problematic. Why should the listening task be rated this way, given the availability of aids that reduce its difficulty? Two additional factors narrow the explanatory gap. First, we separate the listening task from the benefit derived as a consequence. The latter is temporally more distant, and is discounted as a result. The second factor is displeasure attributed to the listening task, which increases listening cost. Many who are hard of hearing enjoy social interaction. In such cases, the actual activity of listening is a benefit, not a cost. These people also reap the benefits of listening, but do not have to balance these against the displeasure of the task. It is suggested that if motivational harmony can be induced by training in somebody who is hard of hearing, then the obstacle to motivational arousal would be removed. This suggests a modified goal for health care professionals. Do not just teach those who are hard of hearing how to use hearing assistance devices. Teach them how to do so with pleasure and enjoyment.
Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL)
Authors: Pichora-Fuller M. Kathleen , Kramer Sophia E. , Eckert Mark A. , Edwards Brent , Hornsby Benjamin W.Y. , Humes Larry E. , Lemke Ulrike , Lunner Thomas , Matthen Mohan , Mackersie Carol L. , Naylor Graham , Phillips Natalie A. , Richter Michael , Rudner Mary , Sommers Mitchell S. , Tremblay Kelly L. , Wingfield Arthur
Published: July 2016

The Fifth Eriksholm Workshop on “Hearing Impairment and Cognitive Energy” was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to Titchener (1908) who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman’s seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener’s motivation to expend mental effort in the challenging situations of everyday life.