bluuebunny/crossref_metadata_2025 huggingface dataset:
Family‐centred care for children and young people with cerebral palsy: results from an Italian multicenter observational study
Authors: Molinaro A. , Fedrizzi E. , Calza S. , Pagliano E. , Jessica G. , Fazzi E. ,   GIPCI Study Group
Published: March 2017

Background

Family‐centred care (FCC) is recognized as the model of best practice for the provision of services for children who have physical disabilities and their families.

Objective

To assess the overall perception of FCC provided in an Italian network of 17 rehabilitation services, as perceived by parents of children with cerebral palsy and professionals, and to explore whether children, families, service providers and service‐related characteristics influence parent satisfaction regarding service provision in an FCC practice.

Methods

The Measure of Processes of Care (MPOC‐20) for parents/caregivers and the Measure of Processes of Care for Service Providers (MPOC‐SP) for healthcare providers were used. For the purposes of the study, an ad hoc information form was developed to collect information concerning children, families, service providers and services.

Results

A total of 382 parents/caregivers and 269 healthcare providers completed the MPOC questionnaires. Parents and service providers both identified the domains for enabling partnerships and interpersonal sensitivity as a strength, while the domain relating to general information was always scored the lowest. An advanced maternal age, being a single parent, being unemployed and having lower socio‐economic status were factors identified as individually predictive of lower FCC scores on the MPOC‐20. Higher intensity treatment, inpatient services, primary healthcare settings and settings identified with limited financial resources and reduced space/time for each family were other variables significantly associated with less favourable MPOC‐20 ratings.

Conclusions

The perception of FCC provided was fairly positive, with some areas of improvement, such as the domain of provision of information. Professionals should, therefore, provide better communication and take more time in giving information and attention to parents. Potential sources of variation in parent perceptions of FCC based on family characteristics and the organization of services highlight the importance the need to support services through the provision of greater financial and human resources.
Peer Problems and Hyperactivity–Impulsivity Among Norwegian and American Children: The Role of 5‐HTTLPR
Authors: Stenseng Frode , Li Zhi , Belsky Jay , Hygen Beate W. , Skalicka Vera , Guzey Ismail C. , Wichstrøm Lars
Published: March 2017

Peer problems are linked to attention deficit hyperactivity disorder (ADHD) symptoms and the serotonin system is thought to be involved in ADHD‐related behavior. Hence, from a Gene × Environment perspective, the serotonin transporter 5‐HTTLPR may play a moderating role. In two large community samples, the moderating role of 5‐HTTLPR was examined related to more hyperactivity–impulsivity symptoms (HI symptoms) predicted by more peer problems. In Study 1, involving 642 Norwegian children, results indicated that for s‐allele carriers only, caregiver‐reported peer problems at age 4 predicted more parent‐reported HI symptoms at age 6. In Study 2, similar results emerged involving 482 American children. Discussion focuses on differential sensitivity to the adverse effects of poor peer relations.
Preschoolers’ Understanding of How Others Learn Through Action and Instruction
Authors: Sobel David M. , Letourneau Susan M.
Published: March 2017

It is widely believed that exploration is a mechanism for young children's learning. The present investigation examines preschoolers’ beliefs about how learning occurs. We asked 3‐ to 5‐year‐olds to articulate how characters in a set of stories learned about a new toy. Younger preschoolers were more likely to overemphasize the role of characters’ actions in learning than older children were (Experiment 1, N = 53). Overall performance improved when the stories explicitly stated that characters were originally ignorant and clarified the characters’ actions, but general developmental trends remained (Experiment 2, N = 48). These data suggest that explicit metacognitive understanding of the relation between actions and learning is developing during the preschool years, which might have implications for how children learn from exploration.
Naturalistic Language Recordings Reveal “Hypervocal” Infants at High Familial Risk for Autism
Authors: Swanson Meghan R. , Shen Mark D. , Wolff Jason J. , Boyd Brian , Clements Mark , Rehg James , Elison Jed T. , Paterson Sarah , Parish‐Morris Julia , Chappell J. Chad , Hazlett Heather C. , Emerson Robert W. , Botteron Kelly , Pandey Juhi , Schultz Robert T. , Dager Stephen R. , Zwaigenbaum Lonnie , Estes Annette M. , Piven Joseph ,   the IBIS Network
Published: March 2017

Children's early language environments are related to later development. Little is known about this association in siblings of children with autism spectrum disorder (ASD), who often experience language delays or have ASD. Fifty‐nine 9‐month‐old infants at high or low familial risk for ASD contributed full‐day in‐home language recordings. High‐risk infants produced more vocalizations than low‐risk peers; conversational turns and adult words did not differ by group. Vocalization differences were driven by a subgroup of “hypervocal” infants. Despite more vocalizations overall, these infants engaged in less social babbling during a standardized clinic assessment, and they experienced fewer conversational turns relative to their rate of vocalizations. Two ways in which these individual and environmental differences may relate to subsequent development are discussed.
Mother–Child Attachment From Infancy to the Preschool Years: Predicting Security and Stability
Authors: Meins Elizabeth , Bureau Jean‐François , Fernyhough Charles
Published: March 2017

Relations between maternal mind‐mindedness (appropriate and nonattuned mind‐related comments), children's age‐2 perspective‐taking abilities, and attachment security at 44 (n = 165) and 51 (n = 128) months were investigated. Nonattuned comments predicted insecure preschool attachment, via insecure 15‐month attachment security (44‐month attachment) and poorer age‐2 perspective‐taking abilities (51‐month attachment). With regard to attachment stability, higher perspective‐taking abilities distinguished the stable secure groups from (a) the stable insecure groups and (b) children who changed from secure to insecure (at trend level). These effects were independent of child gender, stressful life events, and socioeconomic status (SES). The contribution of these findings to our understanding of stability and change in attachment security from infancy to the preschool years is discussed.
Chronic amastigote‐negative cutaneous leishmaniasis: A clinical, histopathologic and molecular study of 27 cases with emphasis on atypical and pseudolymphomatous presentations
Authors: Tomasini Carlo , Moneghini Laura , Barbui Anna M.
Published: March 2017

Background

Chronic amastigote‐negative cutaneous leishmaniasis (CL) is a diagnostic challenge, as the parasite load may be low, or absent in biopsy tissue sections.

Methods

A series of consecutive biopsy specimens, taken from 130 patients with a diagnosis of granulomatous dermatitis of unknown etiology, were reviewed. Polymerase chain reaction (PCR) was carried out for Leishmania‐specific DNA.

Results

A total of 27 of 130 samples were positive for Leishmania‐specific DNA. In only 3 patients was a clinical diagnosis CL made. The lesions were, single or multiple nodules or plaques of many months duration. Histopathologically, a tuberculoid granulomatous dermatitis was the least common denominator in every case, whilst in 5 cases a heavy lymphoid component was predominant. One patient had a concurrent cutaneous marginal zone lymphoma (MZL), the additional PCR study showed the presence of Leishmania DNA in tissue.

Conclusions

The results of this study expand on previous observations as to the deceptive clinicopathologic manifestations of chronic CL, confirming the diagnostic value of PCR analysis for Leishmania DNA in unspecified granulomatous dermatitides. We also suggest that, in countries where Leishmaniasis is endemic, PCR for Leishmania‐specific DNA be performed in any idiopathic pseudolymphomatous. More compelling evidence as to whether chronic Leishmania infection is implicated in the pathogenesis of some cutaneous MZL is warranted by further studies.
Effect of direct oral anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection
Authors: Yoshio Toshiyuki , Tomida Hideomi , Iwasaki Ryuichiro , Horiuchi Yusuke , Omae Masami , Ishiyama Akiyoshi , Hirasawa Toshiaki , Yamamoto Yorimasa , Tsuchida Tomohiro , Fujisaki Junko , Yamada Takuya , Mita Eiji , Ninomiya Tomoyuki , Michitaka Kojiro , Igarashi Masahiro
Published: March 2017

Background and Aim

Anticoagulants are used to prevent thromboembolic events. Direct oral anticoagulants (DOAC) are our new choice; however, their effect on bleeding risk for endoscopic treatment has not been reported. We aimed to assess the clinical effect of DOAC compared to warfarin for gastric endoscopic submucosal dissection (ESD).

Methods

We retrospectively studied 97 patients on anticoagulants and treated 108 gastric neoplasms with ESD in three referral institutes. Twenty‐four patients were taking DOAC, including dabigatran (12), rivaroxaban (11), and apixaban (one) and 73 were taking warfarin.

Results

In the DOAC group, delayed bleeding rate was significantly higher in patients on rivaroxaban than in patients on dabigatran (45% vs 0%, P < 0.05) without relation to heparin bridge therapy (HBT). In the warfarin group, 78% of patients underwent HBT, and delayed bleeding rate was significantly higher in patients with HBT than in those without (36% vs 0%, P < 0.05). Delayed bleeding rate increased as intake of antithrombotic agents increased (P < 0.05). HBT period was shorter (P < 0.05) in DOAC because DOAC achieve the maximum effect quicker, and hospitalization period was shorter (P < 0.05), compared with warfarin. Multivariate analysis showed that HBT (OR, 10.7), rivaroxaban (OR, 6.00) and multiple antithrombotic agents (OR, 4.35) were independent delayed bleeding risk factors.

Conclusions

The DOAC effect differs in each agent. Dabigatran is a feasible alternative to warfarin for shortening the hospitalization period and decreasing delayed bleeding rate, although rivaroxaban has a significantly higher delayed bleeding risk.
Diagnostic capability of colon capsule endoscopy for advanced colorectal cancer: A pilot study
Authors: Ota Yumiko , Yamada Atsuo , Kobayashi Yuka , Niikura Ryota , Shimpoh Takayuki , Narita Akiko , Yoshida Shuntaro , Suzuki Nobumi , Watabe Hirotsugu , Hirata Yoshihiro , Ishihara Soichiro , Sunami Eiji , Watanabe Toshiaki , Koike Kazuhiko
Published: March 2017

Background and Aim

Colon capsule endoscopy (CCE) is a safe and effective method for detecting lesions in the colon. However, the sensitivity of CCE in detecting advanced colorectal cancer (CRC) has not been sufficiently evaluated. Therefore, the aim of the present study was to assess the sensitivity of CCE in detecting advanced CRC.

Methods

Patients previously diagnosed with advanced CRC by conventional colonoscopy underwent CCE. Primary outcome measure was the sensitivity of CCE in detecting advanced CRC per patient and per lesion. Secondary parameters measured were the sensitivity of CCE in detecting polyps ≥6 mm and ≥10 mm in size in a per‐lesion analysis and the safety of CCE.

Results

Of the 21 advanced CRC lesions in 20 patients, 17 were detected by CCE. The per‐patient and per‐lesion sensitivities of CCE for detecting advanced CRC lesions were 85% (95% confidence interval [CI]: 62–97%) and 81% (95% CI: 58–95%), respectively. All advanced CRC lesions were diagnosed in the accessible region by CCE while the capsule was still functional. A significant association was found between incomplete CCE and failure to diagnose advanced CRC. No severe adverse events occurred.

Conclusion

The diagnostic capability of CCE in detecting advanced CRC was limited in cases of procedure incompletion. Refining procedures to increase CCE procedure completion rates are required to enhance CRC detection.
Predictors of incident obesity phenotype in nonobese healthy adults
Authors: Eftekharzadeh Anita , Asghari Golaleh , Serahati Sara , Hosseinpanah Farhad , Azizi Ali , Barzin Maryam , Mirmiran Parvin , Azizi Fereidoun
Published: March 2017

Background

Despite their different cardiovascular consequences, little is known about predictors of metabolically healthy (MHO) and metabolically unhealthy obesity (MUHO). This cohort study was designed to address this question in participants of the Tehran Lipid and Glucose Study.

Materials and methods

Employing the Joint Interim Statement (JIS) metabolic syndrome criteria to define MHO/MUHO phenotypes, nonobese, otherwise healthy individuals, aged > 20 years (n = 3489) were recruited and followed up for a median of 13·4 years.

Results

At the follow‐up, MHO incidence rate in obese individuals was 36·6%. Comparing MHO vs. MUHO, female gender [odds ratio (OR) = 3·28, 95% confidence interval (CI) 1·27, 8·46)], increased body mass index (BMI; OR = 1·32, 95% CI: 1·12, 1·60) and elevated high‐density lipoprotein cholesterol (HDL‐C) levels (OR = 1·04, 95% CI: 1·02, 1·07) were related to higher odds of incident MHO, while older age (OR = 0·95, 95% CI: 0·92, 0·98), increased waist circumference (WC; OR = 0·86, 95% CI: 0·81, 0·91), higher WC gain (OR = 0·91, 95% CI: 0·87, 0·95) and increased diastolic blood pressure (DBP; OR = 0·94, 95% CI: 0·91, 0·98) prevented progression towards MHO.

Conclusions

While baseline BMI and WC were detrimental for developing MHO vs. MUHO, gender was the strongest predictor of incident obesity phenotype in healthy nonobese individuals.
The association between systemic lupus erythematosus and valvular heart disease: an extensive data analysis
Authors: Watad ‬‬‬‬Abdulla , Tiosano Shmuel , Grysman Noam , Comaneshter Doron , Cohen Arnon D. , Shoenfeld Yehuda , Amital Howard
Published: March 2017

Background

Association between antiphospholipid syndrome in systemic lupus erythematosus (SLE) and valvular heart disease (VHD) is well reported, but relatively few studies have been carried out to establish the linkage between VHD and SLE itself. We aimed to investigate link between VHD and SLE and to evaluate the association of diverse factors with VHD among these patients in a large‐scale population‐based study.

Materials and methods

We used the databases of the largest state‐mandated health service organization in Israel. All SLE patients were included (n = 5018) as well as their age and sex‐matched controls (n = 25 090), creating a cross‐sectional population‐based study. Medical records of all subjects were analysed for documented VHD and the presence of antiphospholipid antibodies (aPLs). A logistic regression model was carried out to evaluate the diverse factors including SLE and aPLs as independent risk factors for VHD.

Results

Valvular heart disease were found to be more frequent among SLE group when compared to controls (aortic stenosis, 1·08% vs. 0·35% respectively, P < 0·001; aortic insufficiency, 1·32% vs. 0·29% respectively, P < 0·001; mitral stenosis, 0·74% vs. 0·21% respectively, P < 0·001; mitral insufficiency, 1·91% vs. 0·39% respectively, P < 0·001). Male sex, hypertension, aPLs and SLE were found to be significant independent risk factors for VHD.

Conclusion

All VHD are more prevalent among SLE patients when compared to controls. SLE and aPLs are independent risk factor for VHD (OR of 2·46 and 1·7, respectively). Physicians must be aware of such significant association, and routine echocardiography should be considered in SLE patients regardless of their aPL status.
Differential response to abiotic stress controls species distributions at biogeographic transition zones
Authors: Sommer Brigitte , Beger Maria , Harrison Peter L. , Babcock Russ C. , Pandolfi John M.
Published: March 2017

Understanding range limits is critical to predicting species responses to climate change. Subtropical environments, where many species overlap at their range margins, are cooler, more light‐limited and variable than tropical environments. It is thus likely that species respond variably to these multi‐stressor regimes and that factors other than mean climatic conditions drive biodiversity patterns. Here, we tested these hypotheses for scleractinian corals at their high‐latitude range limits in eastern Australia and investigated the role of mean climatic conditions and of parameters linked to abiotic stress in explaining the distribution and abundance of different groups of species. We found that environmental drivers varied among taxa and were predominantly linked to abiotic stress. The distribution and abundance of tropical species and gradients in species richness (alpha diversity) and turnover (beta diversity) were best explained by light limitation, whereas minimum temperatures and temperature fluctuations best explained gradients in subtropical species, species nestedness and functional diversity. Variation in community structure (considering species composition and abundance) was most closely linked to the combined thermal and light regime. Our study demonstrates the role of abiotic stress in controlling the distribution of species towards their high‐latitude range limits and suggests that, at biogeographic transition zones, robust predictions of the impacts of climate change require approaches that account for various aspects of physiological stress and for species abundances and characteristics. These findings support the hypothesis that abiotic stress controls high‐latitude range limits and caution that projections solely based on mean temperature could underestimate species’ vulnerabilities to climate change.
Dyadic and Triadic Family Interactions as Simultaneous Predictors of Children's Externalizing Behaviors
Authors: Murphy Sarah E. , Boyd‐Soisson Erin , Jacobvitz Deborah B. , Hazen Nancy L.
Published: March 2017

The purpose of this study was to investigate the relationship between dyadic and triadic family interactions and their association with the development of children's externalizing behaviors. Data were obtained from a longitudinal study of family interactions (N = 125), followed from before parents had their first child until children were 7 years old. Family interactions (marital, father–child, mother–child, and triadic mother–father–child) were observed in separate interaction tasks when children were 24 months old as predictors of children's externalizing behaviors at age 7 (n = 71 children). Results demonstrated that the triadic measure of competitive coparenting and the dyadic mother–child interaction characterized by negative emotional socialization related to children's later externalizing behavior, even after controlling for covariates and effects of all other family interaction variables. Results emphasize the importance of examining the family holistically and provided new information for designing more effective whole‐family interventions to reduce the development of children's externalizing behaviors.
Parachlorophenylalanine‐induced 5‐HT depletion alters behavioral and brain neurotransmitters levels in 6‐Hz psychomotor seizure model in mice
Authors: Jahan Kausar , Pillai Krishna K. , Vohora Divya
Published: March 2017

The present study was designed to investigate the role of serotonin and other neurotransmitters namely dopamine (DA), histamine, nor‐epinephrine (NE), glutamate, and γ‐aminobutyric acid (GABA) in the 6‐Hz‐induced psychomotor seizures in Swiss albino mice. Parachlorophenylalanine (PCPA, 300 mg/kg/day, i.p for 3 days)‐treated mice were given 6‐Hz stimulation. Sodium valproate (SVP) (200 mg/kg/day, p.o for 3 days) was used as a reference antiepileptic drug. The behavioral changes induced by 6 Hz including increased rearing and grooming, Straub's tail, behavioral arrest, stun position were amplified by PCPA. The 6‐Hz‐induced seizures were accompanied by reduced brain 5‐HT, DA, NE, histamine, GABA, and enhanced glutamate levels. PCPA facilitated further reduction of endogenous 5‐HT and DA levels but not NE, histamine, GABA, and glutamate levels. Pre‐ and post‐treatment with SVP protected the mice from 6‐Hz seizures and attenuated PCPA‐induced changes in the levels of 5‐HT and DA in the mice brain suggesting the protective effect of SVP in the pharmacoresistant model of epilepsy involving mainly serotonergic mechanism. However, the study also suggests modulation of other neurotransmitters both in 6‐Hz psychomotor seizures and in the action of SVP against such seizures.
Beyond histones – the expanding roles of protein lysine methylation
Authors: Wu Zhouran , Connolly Justin , Biggar Kyle K.
Published: March 2017

A robust signaling network is essential for cell survival. At the molecular level, this is often mediated by as many as 200 different types of post‐translational modifications (PTMs) that are made to proteins. These include well‐documented examples such as phosphorylation, ubiquitination, acetylation and methylation. Of these modifications, non‐histone protein lysine methylation has only recently emerged as a prevalent modification occurring on numerous proteins, thus extending its role well beyond the histone code. To date, this modification has been found to regulate protein activity, protein–protein interactions and interplay with other PTMs. As a result, lysine methylation is now known to be a coordinator of protein function and is a key driver in several cellular signaling events. Recent advances in mass spectrometry have also allowed the characterization of a growing number of lysine methylation events on an increasing number of proteins. As a result, we are now beginning to recognize lysine methylation as a dynamic event that is involved in a number of biological processes, including DNA damage repair, cell growth, metabolism and signal transduction among others. In light of current research advances, the stage is now set to study the extent of lysine methylation that exists within the entire proteome, its dynamics, and its association with physiological and pathological processes.
Oilseed rape (Brassica napus) as a resource for farmland insect pollinators: quantifying floral traits in conventional varieties and breeding systems
Authors: Carruthers Jonathan M. , Cook Samantha M. , Wright Geraldine A. , Osborne Juliet L. , Clark Suzanne J. , Swain Jennifer L. , Haughton Alison J.
Published: March 2017

Oilseed rape (OSR; Brassica napus L.) is a major crop in temperate regions and provides an important source of nutrition to many of the yield‐enhancing insect flower visitors that consume floral nectar. The manipulation of mechanisms that control various crop plant traits for the benefit of pollinators has been suggested in the bid to increase food security, but little is known about inherent floral trait expression in contemporary OSR varieties or the breeding systems used in OSR breeding programmes. We studied a range of floral traits in glasshouse‐grown, certified conventional varieties of winter OSR to test for variation among and within breeding systems. We measured 24‐h nectar secretion rate, amount, concentration and ratio of nectar sugars per flower, and sizes and number of flowers produced per plant from 24 varieties of OSR representing open‐pollinated (OP), genic male sterility (GMS) hybrid and cytoplasmic male sterility (CMS) hybrid breeding systems. Sugar concentration was consistent among and within the breeding systems; however, GMS hybrids produced more nectar and more sugar per flower than CMS hybrid or OP varieties. With the exception of ratio of fructose/glucose in OP varieties, we found that nectar traits were consistent within all the breeding systems. When scaled, GMS hybrids produced 1.73 times more nectar resource per plant than OP varieties. Nectar production and amount of nectar sugar in OSR plants were independent of number and size of flowers. Our data show that floral traits of glasshouse‐grown OSR differed among breeding systems, suggesting that manipulation and enhancement of nectar rewards for insect flower visitors, including pollinators, could be included in future OSR breeding programmes.
Multitrait index based on factor analysis and ideotype‐design: proposal and application on elephant grass breeding for bioenergy
Authors: Rocha João Romero do Amaral Santos de Carvalho , Machado Juarez Campolina , Carneiro Pedro Crescêncio Souza
Published: March 2017

This study proposes a new multitrait index based on factor analysis and ideotype‐design (FAI‐BLUP index), and validates its potential on the selection of elephant grass genotypes for energy cogeneration. Factor analysis was carried out, and afterwards, factorial scores of each ideotype were designed according to the desirable and undesirable factors, and the spatial probability was estimated based on genotype‐ideotype distance, enabling genotype ranking. In order to quantify the potential of the FAI‐BLUP index, genetic gains were predicted and compared with the Smith‐Hazel classical index. The FAI‐BLUP index allows ranking the genotypes based on multitrait, free from multicollinearity, and it does not require assigning weights, as in the case of the Smith‐Hazel classical index and its derived indices. Furthermore, the genetic correlation ‐ positive or negative ‐ within each factor was taken into account, preserving their traits relationship, and giving biological meaning to the ideotypes. The FAI‐BLUP index indicated the 15 elephant grass with the highest performance for conversion to bioenergy via combustion, and predicted balanced and desirable genetic gains for all traits. In addition, the FAI‐BLUP index predicted gains of approximately 62% of direct selection, simultaneously for all traits that are desired to be increased, and approximately 33% for traits which are desired to be decreased. The genotypes selected by the FAI‐BLUP index have potential to improve all traits simultaneously, while the Smith‐Hazel classical index predicted gains of 66% for traits that are desired to be increased, and −32% for traits that are desired to be decreased, and it does not have potential to improve all traits simultaneously. The FAI‐BLUP index provides an undoubtable selection process and can be used in any breeding programme aiming at selection based on multitrait.
Training with a balance exercise assist robot is more effective than conventional training for frail older adults
Authors: Ozaki Kenichi , Kondo Izumi , Hirano Satoshi , Kagaya Hitoshi , Saitoh Eiichi , Osawa Aiko , Fujinori Yoichi
Published: March 2017

Aim

To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults.

Methods

The present study was designed as a cross‐over trial without a washout term. A total of 27 community‐dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65–85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle‐strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. Main outcome measures: preferred and maximal gait speeds, tandem gait speeds, timed up‐and‐go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program.

Results

Robotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up‐and‐go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001–0.030) compared with conventional exercise.

Conclusions

In frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; 17: 1982–1990.
Understanding advance care planning within the South Asian community
Authors: Biondo Patricia D. , Kalia Rashika , Khan Rooh‐Afza , Asghar Nadia , Banerjee Cyrene , Boulton Debbie , Marlett Nancy , Shklarov Svetlana , Simon Jessica E.
Published: March 2017

Background

Advance care planning (ACP) is a process of reflection on and communication of a person's future health‐care preferences. Evidence suggests visible minorities engage less in ACP. The South Asian ethnic group is the largest visible minority group in Canada, and information is needed to understand how ACP is perceived and how best to approach ACP within this diverse community.

Objective

To explore perspectives of South Asian community members towards ACP.

Design

Peer‐to‐peer inquiry. South Asian community members who graduated from the Patient and Community Engagement Research programme (PaCER) at the University of Calgary utilized the PaCER method (SET, COLLECT and REFLECT) to conduct a focus group, family interviews and a community forum.

Setting and participants

Fifty‐seven community‐dwelling men and women (22‐86 years) who self‐identified with the South Asian community in Calgary, Alberta, Canada.

Results

The concept of ACP was mostly foreign to this community and was often associated with other end‐of‐life issues such as organ donation and estate planning. Cultural aspects (e.g. trust in shared family decision making and taboos related to discussing death), religious beliefs (e.g. fatalism) and immigration challenges (e.g. essential priorities) emerged as barriers to participation in ACP. However, participants were eager to learn about ACP and recommended several engagement strategies (e.g. disseminate information through religious institutions and community centres, include families in ACP discussions, encourage family physicians to initiate discussions and translate materials).

Conclusions

Use of a patient engagement research model proved highly successful in understanding South Asian community members' participation in ACP.
Effectiveness of a decision aid for patients with depression: A randomized controlled trial
Authors: Perestelo‐Perez Lilisbeth , Rivero‐Santana Amado , Sanchez‐Afonso Juan Antonio , Perez‐Ramos Jeanette , Castellano‐Fuentes Carmen Luisa , Sepucha Karen , Serrano‐Aguilar Pedro
Published: March 2017

Background

Shared decision making is an important component of patient‐centred care and decision aids are tools designed to support patients' decision making and help patients with depression to make informed choices.

Objective

The study aim was to assess the effectiveness of a web‐based decision aid for patients with unipolar depression.

Design

Randomized controlled trial.

Setting and participants

Adults diagnosed with a major depressive disorder and recruited in primary care centres were included and randomized to the decision aid (n=68) or usual care (n=79).

Intervention

Patients in the decision aid group reviewed the decision aid accompanied by a researcher.

Outcome measures

Knowledge about treatment options, decisional conflict, treatment intention and preference for participation in decision making. We also developed a pilot measure of concordance between patients' goals and concerns about treatment options and their treatment intention.

Results

Intervention significantly improved knowledge (P<.001) and decisional conflict (P<.001), and no differences were observed in treatment intention, preferences for participation, or concordance. One of the scales developed to measure goals and concerns showed validity issues.

Conclusion

The decision aid “Decision making in depression” is effective improving knowledge of treatment options and reducing decisional conflict of patients with unipolar depression. More research is needed to establish a valid and reliable measure of concordance between patients' goals and concerns regarding pharmacological and psychological treatment, and the choice made.
The everyday politics of being a student in South Africa: A history
Authors: Healy‐Clancy Meghan
Published: March 2017

Over the past year, student protests under the banners #RhodesMustFall and #FeesMustFall have swept South Africa, demanding the “decolonization” of curricula and greater educational access. This article contextualizes these protests, drawing on a vibrant historiography on student politics under apartheid (1948–1994). In scholarship produced during the antiapartheid movement, it often seemed that the history of student protests was the history of education. The study of resistance has remained integral to the field. Yet, over the past decade, how historians look at student politics has been changing. First, we look at the spaces of politics differently. We move beyond familiar narratives of student resistance because we look beyond the campuses that played emblematic roles in the making of African nationalism and antiapartheid struggle. New vantage points enable us to see different political actors. These youth asked diverse questions about their lives and about the purpose and form of schooling in an unequal society, and they expressed these questions through strategies that included but were not limited to school strikes. Their questions arose out of daily struggles around issues of race, gender, sexuality, and class—struggles that resonate with the concerns of student activists today.
Effectiveness of platinum‐based adjuvant chemotherapy for muscle‐invasive bladder cancer: A weighted propensity score analysis
Authors: Shimizu Fumitaka , Muto Satoru , Taguri Masataka , Ieda Takeshi , Tsujimura Akira , Sakamoto Yoshiro , Fujita Kazuhiko , Okegawa Takatsugu , Yamaguchi Raizo , Horie Shigeo
Published: March 2017

Objectives

To evaluate the clinical benefit of adjuvant platinum‐based chemotherapy after radical cystectomy for muscle‐invasive bladder cancer in routine clinical practice.

Methods

The present observational study was carried out to compare the effectiveness of adjuvant chemotherapy versus observation post‐radical cystectomy in patients with clinically muscle‐invasive bladder cancer. Cancer‐specific survival and overall survival between the adjuvant chemotherapy group and radical cystectomy alone group were compared using Kaplan–Meier method and log–rank test. After adjusting for background factors using propensity score weighting, differences in cancer‐specific survival and overall survival between these two groups were compared. Subgroup analyses by the pathological characteristics were carried out.

Results

In total, 322 patients were included in the present study. Of these, 23% received adjuvant chemotherapy post‐radical cystectomy. Clinicopathological characteristics showed that patients in the adjuvant chemotherapy group were pathologically more advanced and were at higher risk than the radical cystectomy alone group. In the unadjusted population, although it is not significant, the adjuvant chemotherapy group had lower overall survival (3‐year overall survival; 61.5% vs 73.6%, HR 1.33, P = 0.243, log–rank test, adjuvant chemotherapy vs radical cystectomy alone). In the weighted propensity score analysis, although it is not significant, the adjuvant chemotherapy group were superior to radical cystectomy alone groups (overall survival: HR 0.65, 95% CI 0.39–1.09, P = 0.099, log–rank test, adjuvant chemotherapy vs radical cystectomy alone). Subgroup analyses showed that adjuvant chemotherapy significantly reduced the hazard ratio of overall survival and cancer‐specific survival in the ≥pT3, pN+, ly+ and v+ subgroups.

Conclusions

Platinum‐based adjuvant chemotherapy might be associated with increased cancer‐specific survival and overall survival in patients with high‐risk invasive bladder cancer.
Environmental correlates of biome‐level floristic turnover in South Africa
Authors: Power Simon C. , Anthony Verboom G. , Bond William J. , Cramer Michael D.
Published: March 2017

Aim

Biomes are defined according to the growth forms of their dominant species but also contrast in floristic composition. Biome boundaries thus represent areas of taxonomic turnover. The degree of turnover is dependent on the difference in environmental conditions between biomes and the ability of lineages to evolve adaptive traits. Open‐ and closed‐canopy biomes differ in structure, disturbance and resource availability. We aimed to determine whether these boundaries impose greater adaptive challenges to the movement of floristic lineages than do structurally similar ones.

Location

South Africa.

Methods

We determined genus‐ and family‐level dissimilarity between neighbouring biomes, and tested their correlations with differences in climate and soil properties, fire frequency and leaf area index (LAI: a measure of canopy cover used as a proxy for understorey light availability).

Results

Genus‐ and family‐level dissimilarities between biomes were positively correlated with differences in LAI. High taxonomic turnover was also associated with differences in fire frequency and soil organic carbon. LAI was strongly predicted by differences in precipitation in the driest quarter. Although environmental correlates with floristic turnover varied, the taxonomically dissimilar Fynbos boundaries were linked to differences in cation exchange capacity.

Main conclusions

Biome boundaries with edaphic contrasts or emergent differences in vegetation structure caused by plant–water–fire interactions present possibly the hardest boundaries for floristic transitions. The infrequency of transitions across these boundaries is probably a consequence of environments contrasting in light and moisture availability, fire frequency and soil properties, requiring co‐adaptation across multiple traits. Variation in floristic turnover between boundaries, however, implies that adaptive challenges and the ease with which they overcome vary with biome.
The pathogenicity of T cell epitopes on human Goodpasture antigen and its critical amino acid motif
Authors: Hu Shui‐yi , Gu Qiu‐hua , Wang Jia , Wang Miao , Jia Xiao‐yu , Cui Zhao , Zhao Ming‐hui
Published: March 2017

Goodpasture antigen, the non‐collagenous domain of α3 chain of type IV collagen [α3(IV)NC1], is the target antigen of anti‐glomerular basement membrane (GBM) antibodies. The pathogenicity of T cell epitopes is not elucidated clearly. In this study, we aim to define the nephritogenic T cell epitopes and its critical amino acid residues. Twenty‐four overlapping linear peptides were synthesized covering the whole sequence of human α3(IV)NC1. Wistar–Kyoto rats were immunized with linear peptides, and experimental autoimmune glomerulonephritis was evaluated. Critical amino acid was identified by the loss of nephritogenic function after each amino acid substitution by alanine. Of the 24 peptides, P14 (α3127‐148) could induce 90.5% (19/21) of WKY rats developing anti‐GBM glomerulonephritis with proteinuria, elevated serum urea and creatinine, IgG linear deposit on GBM and substantial (in average 82.4 ± 5.6%) crescent formation in glomeruli. Lymphocytes of immunized rats proliferated in response to α3127‐148 and α3(IV)NC1 in vitro. Sera of these rats recognized α3127‐148 and later on together with intact human α3(IV)NC1. Antibodies towards α3127‐148 and intact α3(IV)NC1 could also be detected from the kidney elutes. These antibodies showed no cross‐reaction with each other, which implies intramolecular epitope spreading during disease progress. After sequential amino acid substitution, the α3127‐148 with substitution of tryptophan136, isoleucine137, leucine139 or tryptophan140 lost its nephritogenicity. Human α3127‐148 is a nephritogenic T cell epitope in WKY rats, with the critical amino acids as W136I137xL139W140. These findings might facilitate future investigation on microbial aetiology and potential specific immunotherapy of anti‐GBM disease.
Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression
Authors: Swanson James M. , Arnold L. Eugene , Molina Brooke S.G. , Sibley Margaret H. , Hechtman Lily T. , Hinshaw Stephen P. , Abikoff Howard B. , Stehli Annamarie , Owens Elizabeth B. , Mitchell John T. , Nichols Quyen , Howard Andrea , Greenhill Laurence L. , Hoza Betsy , Newcorn Jeffrey H. , Jensen Peter S. , Vitiello Benedetto , Wigal Timothy , Epstein Jeffery N. , Tamm Leanne , Lakes Kimberly D. , Waxmonsky James , Lerner Marc , Etcovitch Joy , Murray Desiree W. , Muenke Maximilian , Acosta Maria T. , Arcos‐Burgos Mauricio , Pelham William E. , Kraemer Helena C. ,   the MTA Cooperative Group
Published: March 2017

Background

The Multimodal Treatment Study (MTA) began as a 14‐month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7–10 years of age) diagnosed with attention‐deficit/hyperactivity disorder (ADHD)‐combined type. It transitioned into an observational long‐term follow‐up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2–16 years after baseline.

Methods

Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long‐term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow‐up, hypothesis‐generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD‐LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication.

Results

For ratings of symptom severity, the ADHD‐LNCG comparison was statistically significant for the parent/self‐report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self‐report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38).

Conclusions

In the MTA follow‐up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.
Satisfaction of switching to combination therapy with lixisenatide and basal insulin in patients with type 2 diabetes receiving multiple daily insulin injection therapy: A randomized controlled trial
Authors: Miya Aika , Nakamura Akinobu , Miyoshi Hideaki , Cho Kyu Yong , Nagai So , Kurihara Yoshio , Aoki Shin , Taguri Masataka , Terauchi Yasuo , Atsumi Tatsuya
Published: March 2017

Aims/Introduction

We compared the satisfaction levels of patients with type 2 diabetes undergoing combination therapy with lixisenatide (LIX) and basal insulin with that of patients undergoing multiple daily insulin injection (MDI) therapy.

Materials and Methods

The study was a 12‐week open‐label, randomized, multicenter, controlled trial. Participants were Japanese patients with type 2 diabetes receiving MDI for >3 months. Patients were randomly assigned to each treatment cohort: (i) a group that continued MDI (MDI group); and (ii) a group that switched from MDI to combination therapy with LIX and basal insulin (LIX group). The primary outcome was change in Diabetes Treatment Satisfaction Questionnaire scores from baseline to 12 weeks between these two groups. Key secondary outcomes were glycated hemoglobin and body weight changes.

Results

A total of 31 patients were initially enrolled in the study, and 26 of them completed the study. The change in Diabetes Treatment Satisfaction Questionnaire scores in the LIX group was significantly greater compared with that in the MDI group. Mean changes in glycated hemoglobin levels were −0.05 ± 0.37% in the MDI group and 0.04 ± 0.38% in the LIX group (P = 0.36). Mean changes in body weight were +0.6 ± 1.8 kg in the MDI group and −2.5 ± 1.8 kg in the LIX group (P < 0.01).

Conclusions

Switching from MDI to combination therapy with LIX and basal insulin improved satisfaction levels while maintaining glycemic control in Japanese patients with type 2 diabetes.
Rapid improvements in health‐related quality of life and itch with ixekizumab treatment in randomized phase 3 trials: results from UNCOVER‐2 and UNCOVER‐3
Authors: Leonardi C.L. , Blauvelt A. , Sofen H.L. , Gooderham M. , Augustin M. , Burge R. , Zhu B. , Reich K.
Published: March 2017

Background

Patients with moderate‐to‐severe psoriasis report impaired health‐related quality of life (HRQoL).

Objective

To assess speed of onset of ixekizumab‐induced clinically relevant improvement in HRQoL.

Methods

This post hoc analysis used pooled data from patients randomized in UNCOVER‐2 and UNCOVER‐3, and treated with 80 mg ixekizumab every 2 weeks (IXEQ2W), 80 mg ixekizumab every 4 weeks (IXEQ4W), 50 mg etanercept (ETN) twice weekly or placebo (PBO) for 12 weeks. HRQoL and pruritus were assessed using the Dermatology Life Quality Index (DLQI) and Itch Numeric Rating Scale (NRS), respectively. Minimally clinical important differences (MCID) in DLQI and Itch NRS were defined as ≥5‐point and ≥4‐point improvements from baseline, respectively. Time to response from randomization was estimated using Kaplan–Meier methodology and the log‐rank test. Hazard ratios between treatments were calculated using a Cox proportional hazards regression model adjusting for studies.

Results

A total of 2570 patients were included: 361 PBO; 740 ETN; 733 IXEQ4W and 736 IXEQ2W. Significantly greater differences in time to DLQI ≥5 point or Itch NRS ≥4 point improvement for IXEQ2W or IXEQ4W compared with ETN and PBO (P < 0.001) were observed. The median time when 50% of patients reached a ≥5‐point reduction in DLQI was shorter for ixekizumab‐treated patients (2 weeks, both schedules) compared with ETN‐ (4 weeks) or PBO‐treated (>12 weeks) patients. Likewise, the median time when 50% of patients reached a ≥4‐point reduction in Itch NRS was shorter for ixekizumab‐treated patients (2 weeks, both schedules) compared with ETN‐ (8 weeks) or PBO‐treated (>12 weeks) patients. Significantly more ixekizumab‐treated patients were likely to achieve MCIDs in DLQI or itch reduction compared with ETN or PBO after 12 weeks of treatment.

Conclusion

Ixekizumab‐treated patients achieved more rapid improvements both in HRQoL and itch compared with patients treated with ETN and PBO.