bluuebunny/crossref_metadata_2025 huggingface dataset:
A Survey of Nutrition Practices for Patients With Cystic Fibrosis
Authors: O'Brien Catherine E. , Harden Heather , Com Gulnur
Published: December 2012

Background: Cystic fibrosis (CF) affects approximately 30,000 people in the United States and is characterized by pulmonary disease and poor nutrition. Optimal nutrition is associated with better pulmonary function, and aggressive nutrition interventions have played a major role in increased survival. Even though the CF Foundation (CFF) has published treatment guidelines for certain areas of nutrition care, there may still be variability in other areas. Thus, the purpose of this study was to survey current practices among CF dietitians. Materials and Methods: A 25‐item web‐based survey was developed and sent to nutrition professionals via the CFF nutrition listserv. Responses were anonymous. Areas of practice surveyed included nutrition care for infants, pancreatic enzyme replacement, vitamins and bone health, and miscellaneous practices. Descriptive statistics were used to report the results. Results: Among the 76 respondents (21% response rate), there was general agreement regarding nutrition practices for infants and pancreatic enzyme replacement. Responses varied regarding enzyme administration with gastrostomy tube feeds and in practices related to bone health. Of miscellaneous practices, there was agreement regarding zinc supplementation and appetite stimulants. However, opinions varied regarding concern for coronary artery disease with the CF high‐fat diet. Practices related to use of acid blockers also varied. Conclusion: The results of this survey demonstrate good agreement among nutrition professionals in some areas and variability in others for the nutrition management of patients with CF. Areas of variability point to the need for further research and continued additions to the guidelines and consensus statements.
Institutional Logics, Moral Frames, and Advocacy
Authors: Garrow Eve E. , Hasenfeld Yeheskel
Published: December 2012

Studies of advocacy by nonprofit human-service organizations generally fail to distinguish between two major types of advocacy—advocacy for social benefits versus organizational benefits. We show that different organizational factors explain the emphasis on each type of advocacy. We use an institutional logics perspective, with its emphasis on the moral frames organizations adopt, as our theoretical framework. We propose that two organizational mechanisms express these moral frames—selection of a practice frame and location decision—and shape the substance of advocacy. Analyzing a probability sample of these organizations, we find that a practice frame that places the clients’ problems on the environment rather than the individual is positively associated with advocacy for social benefits. Similarly, organizations that express their moral commitment to locate in high-poverty areas are more likely to advocate for social benefits. We conclude with some implications on the role of advocacy in a neoliberal regime.
Comparative machinability study on Ti54M titanium alloy in different heat treatment conditions
Authors: Khanna Navneet , Sangwan Kuldip S
Published: December 2012

In this study, the effect of microstructure on the machinability of Ti54M titanium alloy was investigated experimentally for the as-received (annealed), β-annealed and solution-treated plus aged conditions. Forces and temperature, that is, tool life, are mainly affected by variation in cutting speed and feed; therefore, the depth of cut was maintained constant while cutting speed and feed were varied. Ti54M alloy in annealed heat treatment condition showed the better machinability (in terms of specific forces, coefficient of friction and chip morphology) among all the analyzed alloys. This is due to the finer microstructure which enhanced the plastic deformability.
Trabecular architecture analysis in femur radiographic images using fractals
Authors: Udhayakumar G , Sujatha CM , Ramakrishnan S
Published: December 2012

Trabecular bone is a highly complex anisotropic material that exhibits varying magnitudes of strength in compression and tension. Analysis of the trabecular architectural alteration that manifest as loss of trabecular plates and connection has been shown to yield better estimation of bone strength. In this work, an attempt has been made toward the development of an automated system for investigation of trabecular femur bone architecture using fractal analysis. Conventional radiographic femur bone images recorded using standard protocols are used in this study. The compressive and tensile regions in the images are delineated using preprocessing procedures. The delineated images are analyzed using Higuchi’s fractal method to quantify pattern heterogeneity and anisotropy of trabecular bone structure. The results show that the extracted fractal features are distinct for compressive and tensile regions of normal and abnormal human femur bone. As the strength of the bone depends on architectural variation in addition to bone mass, this study seems to be clinically useful.
Wear of surface-engineered metal-on-metal bearings for hip prostheses under adverse conditions with the head loading on the rim of the cup
Authors: Leslie Ian , Williams Sophie , Isaac Graham , Hatto Peter , Ingham Eileen , Fisher John
Published: December 2012

Clinical studies have found high wear rates, elevated ion levels and high revision rates of large-diameter metal-on-metal surface replacement bearings in some patients, which have been associated with edge loading of the head on the rim of the cup. We have simulated increased wear and ion levels in metal-on-metal bearings in vitro by introducing variations in translational and rotational positioning of the components, which reproduces stripe wear on the femoral head, cup rim wear and clinically relevant large as well as small wear particles. There is interest in technologies such as surface engineering, which might reduce metal wear and the release of wear particles and ions. Reduced wear with surface-engineered surface replacements compared to metal-on-metal controls has been reported under standard walking conditions with correctly aligned and concentric components. In this in vitro study, the wear of chromium nitride surface-engineered metal-on-metal bearings under conditions of microseparation associated with translational and rotational malpositioning of the components was investigated and the results were compared with a previously reported study of metal-on-metal bearings under the same conditions. Simulations were conducted using our unique hip simulation microseparation methodologies, which reproduce accelerated wear in metal-on-metal bearings and have previously been clinically validated with ceramic-on-ceramic bearings.

Four of the six surface-engineered bearings had evidence of head contact on the rim of the cup, which produced stripe wear on the femoral head. Four of the six surface-engineered bearings (two without stripe and two with stripe wear) had lower wear than the previously reported high wearing metal-on-metal bearings. At 2 million cycles, two of the surface-engineered bearings had substantially increased wear rates, four times higher than the high wear rates previously reported for metal-on-metal bearings under the same conditions. There was wear through and cohesive failure of the thick atomic emission physical vapour deposition (AEPVD) chromium nitride (CrN) coating. At this point, the study was stopped to investigate the failure mode.

This study highlights the need to pre-clinically investigate the tribology of new bearings under a wide set of clinical conditions as demonstrated by our stratified approach for enhanced reliability (SAFER) simulation methods. In adopting this SAFER approach to pre-clinical simulation testing of new bearings, it is important to communicate the failures as well as successes of technologies arising from the research, in order that the wider community can benefit from the analysis of the pre-clinical failure modes.
Effect of storage methods on indentation-based material properties of abdominal organs
Authors: Lu Yuan-Chiao , Untaroiu Costin D
Published: December 2012

To investigate the possible changes in material properties of cadaveric abdominal organs due to the preservation methods, the indentation data obtained from porcine abdominal organs (kidney, liver, and spleen) preserved by cooling and freezing are analyzed statistically in this study. Indentation tests were first conducted on fresh specimens. One half of the specimens of each organ were then frozen (preserved at −12 °C), and the other half of the specimens were cooled (preserved at 4 °C). All preserved specimens were retested after 20 days. Force and displacement data recorded during indentation were analyzed using a quasi-linear viscoelastic model. The results show that both cooling and freezing storage increased the kidney stiffness. In contrast, both storage methods decreased the stiffness of the spleen specimens. While cooling increased the liver stiffness, no significant changes of the instantaneous elastic response were observed in the liver specimens preserved by freezing. The liver and spleen’s reduced relaxation responses and the liver’s instantaneous elastic response were significantly different when comparing between cooling and freezing effects after 20 days of preservation. This study showed that both cooling and freezing storage methods significantly changed the material properties of abdominal organs, especially the instantaneous elastic response. More research is needed in investigating the effect of preservation on failure properties and mechanical properties under large deformation.
Hydromechanical stimulator for chondrocyte-seeded constructs in articular cartilage tissue engineering applications
Authors: Pourmohammadali Homeyra , Chandrashekar Naveen , Medley John B
Published: December 2012

Mechanical stimulation is a key technique used for controlling the mechanical properties of tissue engineered articular cartilage constructs proposed for defect repair. The present study introduces a new technical method and device for ‘hydromechanical’ stimulation of tissue engineered articular cartilage constructs. The stimulation consists of simultaneous cyclic compression, frictional shear from a sliding indenter contact and direct pressurized fluid perfusion. Each of these modes of mechanical loading has been shown by other research groups to effectively stimulate tissue engineered constructs. A device for applying these conditions was designed, developed and tested. Two sets (high and low perfusion flow rates) of three experiments were performed, each with two samples subjected to hydromechanical stimulation conditions (compression and friction forces along with perfusion). Two other samples from each set were subjected to just compression and dynamic frictional shear forces, and two more were used as controls (not stimulated). The average amount of glycosaminoglycan retained in the constructs after 3 weeks ranked from low to high as follows: controls, hydromechanical conditions with the low-flow rate, hydromechanical conditions with the high-flow rate and just compression plus dynamic frictional shear. Statistically significant differences were not detected. However, future studies would focus on glycosaminoglycan production in the superficial zone, measuring the glycosaminoglycan released to the nutrient media, and address altering the hydromechanical stimulation parameters using the results of the present study as guidance, in attempts to achieve statistically significant increases in glycosaminoglycan production compared with the controls.
Decision-Making Deficits Among Maltreated Children
Authors: Weller Joshua A. , Fisher Philip A.
Published: December 2012

Although maltreated children involved with child welfare services are known to exhibit elevated levels of health-risking behaviors, little is known about their decision-making processes leading to such tendencies. Research findings suggest that maltreated children exhibit developmental delays in neurocognitive and emotional regulation systems that could adversely impact their abilities to make decisions under conditions of risk. Whereas prior researchers have examined risky decision making as a global construct, maltreated children’s decision making was examined in two contexts in the present study: potential gains and potential losses. Comparing maltreated children ( n = 25) and a nonmaltreated community group ( n = 112), it was found that the maltreated children showed decision-making impairments for both domains: This impairment was especially prominent in the loss domain. The maltreated children took excessive risks and were insensitive to changes in expected value. Follow-up analyses revealed that these differences were primarily associated with insensitivity to changes in outcome magnitude for the risky option. Finally, response latency analyses indicated that the maltreated children were slower to make choices, reinforcing underlying differences in decision processes between groups. These results have implications for basic and translational science.
A Regional Computable General Equilibrium Analysis of Property Tax Rate Caps and a Sales Tax Rate Increase in Indiana
Authors: Thaiprasert Nalitra , Faulk Dagney , Hicks Michael J.
Published: December 2012

We use a regional computable general equilibrium (CGE) model and Indiana data to examine both the short-run and the long-run effects of property tax rate limits and an increase in the sales tax rate. We find that the property tax caps and sales tax rate increase have a relatively small impact on aggregate economic measures in the short run and a positive effect in the long run. Higher-income households experience larger increases in income than lower-income households in terms of the dollar amount of the increase, but lower-income households experience larger gains as a percentage of labor income. The value of output (sales) increases in the long run with construction, certain manufacturing industries, and wholesale trade experiencing the largest increases.
Samples with high virus load cause a trend toward lower signal in feline coronavirus antibody tests
Authors: Meli Marina L , Burr Paul , Decaro Nicola , Graham Elizabeth , Jarrett Oswald , Lutz Hans , McDonald Michael , Addie Diane D
Published: December 2012

Measurement of feline coronavirus (FCoV) antibody titres is utilised mainly for diagnosing feline infectious peritonitis (FIP) and for quarantine purposes. However, occasional samples show a falsely low or negative FCoV antibody test. We tested the hypothesis that such results are due to virus in the sample binding antibody and rendering it unavailable to antigen in the test. Thirteen effusions, one plasma and three undefined samples from cats with FIP, which gave unexpectedly low FCoV antibody titres, were examined by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Increasing amounts of virus correlated with lower signals in indirect immunoflourescent, enzyme-linked immunosorbent asssay and rapid immunomigration antibody tests. However, five samples were negative by RT-PCR, so the presence of virus alone may not explain all cases of false-negative FCoV antibody tests, although it is a possible explanation in 71% of discordant samples. We conclude that falsely low or negative FCoV antibody tests can occur in samples rich in virus.
Health hopes and fears for the future in relation to health behavior and current health status
Authors: McGinty Heather L , Dark-Freudeman Alissa , West Robin L
Published: December 2012

We examined the relationships among age, health, beliefs, and possible-selves. Using a new approach based on health-related possible-selves, young-old and older individuals were separated into specific health types: (1) improvement or maintenance health hopes and (2) preventable or unpreventable health fears. The young-old perceived greater capability to achieve health hopes and reported more health activities than older individuals; the older group reported more maintenance than improvement. More unpreventable fears were related to experiencing higher pain and worse physical functioning. Health types provide useful information about individual differences in health behavior and beliefs and are sensitive to current health status.
Using the theory of planned behavior to predict self-medication with over-the-counter analgesics
Authors: Pineles Lisa L , Parente Rick
Published: December 2012

Millions of people worldwide use over-the-counter analgesics on a regular basis; yet little is known about how decisions to self-medicate are made. This study used the theory of planned behavior to explore the influence of beliefs about medicines (Beliefs about Medicines Questionnaire) and individual pain experience as predictors of intent to self-medicate. Both emerged as significant predictors of intent to self-medicate. Furthermore, intent to self-medicate significantly predicted reported use of analgesics. These findings indicate that use of over-the-counter pain medication is more likely when the value of the pain relief is greater than concerns about harm.
Communication online with fellow cancer patients: Writing to be remembered, gain strength, and find survivors
Authors: Chiu Yu-Chan , Hsieh Yu-Ling
Published: December 2012

This qualitative research explored how cancer patients’ writing and reading on the Internet play a role in their illness experience. Focus-group interviews were conducted, with 34 cancer patients participating. A grounded qualitative analysis method was applied to analyze the interview transcripts. The results show that by writing personal blogs, cancer patients reconstructed their life story, expressed their closure of life, and expected to be remembered after death. Reading fellow cancer patients’ stories online significantly influenced cancer patients’ perceptions and expectations of their own illness prognosis, and that influence was sometimes greater than that of the doctors’ influence.
How Black women make sense of ‘White’ and ‘Black’ fashion magazines: A qualitative think aloud study
Authors: Ogden Jane , Russell Sheriden
Published: December 2012

This qualitative think aloud study explored how Black women ( n = 32) processed information from a White or Black fashion magazine. Comments to the ‘White’ magazine were characterised by rejection, being critical of the media and ambivalence, whereas they responded to the ‘Black’ magazine with celebration, identification and a search for depth. Transcending these themes was their self-identity of being a Black woman that was brought to the fore either by a sense of exclusion (White magazine) or engagement (Black magazine). Such an identity provides resilience against the media’s thin ideals by minimising the processes of social comparison and internalisation.
The implications of the economic crisis for pensions and pension policy in Europe
Authors: Casey Bernard H
Published: December 2012

The financial crisis has affected European pensions in both the short and longer term. Members of funded pension systems nearing retirement experienced a sharp contraction in pension wealth as equity markets fell. Market turmoil has damaged public trust in such schemes and has caused employers to revise their pension obligations. Countries running funded schemes based on a share of mandatory contributions are faced with rising transition costs as unemployment rises and tax bases shrink. Pressure on public expenditure has caused some governments to raise pensionable ages and even cut pensions in payment, while reducing future public pension obligations. Thus the crisis has forced politicians to address the consequences of societal ageing while exposing the fallibility of funded schemes as a source of pension security. Fundamental questions about the prolongation of working lives remain to be resolved.
Averting the funding-gap crisis: East European pension reforms since 2008
Authors: Drahokoupil Jan , Domonkos Stefan
Published: December 2012

This article analyses pension reforms in Central and East European countries in the aftermath of the 2008 financial crisis. The crisis revealed unresolved problems in the implementation of previous reforms, namely the financing of the transition costs. In their attempts to solve the funding-gap issue, the reforms needed to address legacies of past choices as well as the exceptional circumstances of the crisis. The interaction of fiscal constraints and political conditions shaped the variety of these reform outcomes.
Squeezing social partners to embrace reforms: The case of private earnings-related pension schemes
Authors: Marier Patrik
Published: December 2012

How do changes to public schemes and ongoing economic difficulties impact private earnings-related pension schemes (PERPS) governed by social partners? The decreasing generosity of public schemes does put strong pressure onto social partners to improve their PERPS; however, PERPS face challenges of their own related to their integration within the pension system and their financing mechanisms. Based on a comparative analysis of Finland, France, the Netherlands and Sweden, this contribution demonstrates that PERPS have all enacted measures to reduce the generosity of their scheme. Yet, the emerging policy measures responding to these challenges are quite different and depend on the previous public/private mix and the financial structure behind their PERPS.
Mineralocorticoid receptor blockade inhibits accelerated atherosclerosis induced by a low sodium diet in apolipoprotein E-deficient mice
Authors: Raz-Pasteur Ayelet , Gamliel-Lazarovich Aviva , Gantman Anna , Coleman Raymond , Keidar Shlomo
Published: December 2012

Introduction:

A low-sodium diet (LSD) was shown to increase both angiotensin II (AngII) and aldosterone levels, and to accelerate atherosclerosis in apolipoprotein E-deficient (E0) mice. The aim of the present study was to examine whether accelerated atherosclerosis in E0 mice fed a LSD is mediated by aldosterone, using the mineralocorticoid receptor blocker, eplerenone (Epl).

Methods and Results:

Mice were divided into three groups: normal diet (ND), LSD and LSD treated with Epl at 100 mg/kg per day (LSD+Epl) for 10 weeks. LSD significantly enhanced plasma renin and aldosterone levels, which were further increased in mice fed LSD+Epl. The aortic lesion area increased three-fold with LSD, while LSD+Epl significantly reduced the lesion area to values similar to ND. Serum and peritoneal macrophages obtained from LSD-fed mice exhibited pro-atherogenic properties including increased inflammation, oxidation and cholesterol accumulation, which were inhibited in mice fed LSD+Epl. In a J774A.1 macrophage-like cell line stimulated with lipopolysaccharide, Epl was shown to have a direct anti-inflammatory effect.

Conclusion:

In E0 mice, Epl inhibited LSD-accelerated atherosclerosis, despite the elevation of renin and aldosterone levels. It is therefore suggested that the atherogenic action of LSD could be mediated, at least in part, by activation of the mineralocorticoid receptor. In addition, eplerenone may have direct anti-inflammatory actions.
Should we reclaim political utopianism?
Authors: Walzer Michael
Published: December 2012

Isaiah Berlin welcomed the decline of political utopianism and was eager to help it along. But there are reasons to think that occasional moments of utopian aspiration and enthusiasm are necessary to sustain even moderate liberal regimes. In all such regimes there are ‘natural’ tendencies towards authoritarianism and hierarchy, which have to be resisted. And it is hard to image a successful resistance that isn’t fuelled by something very like political utopianism.
Isaiah Berlin: The history of ideas as psychodrama
Authors: Ryan Alan
Published: December 2012

The essay is a ‘personal impression’ of Isaiah Berlin and his liberalism, beginning with some intellectual biography, and turning to the question of how the way Berlin wrote about political ideas illuminates the liberalism he espoused. The essay discounts Berlin’s self-description as a historian of ideas who had abandoned philosophy, and follows Bernard Williams in arguing that the historicity of our political values demands a dialogical approach to their analysis in which we engage with our forebears and contemporaries in an essentially conversational mode. The claim is illustrated with Berlin’s engagement with Alexander Herzen and Romanticism.
Can values be measured? Significant contributions from a small civil society organization through action research
Authors: Podger Dimity , Velasco Ismael , Luna Cardiela Amézcua , Burford Gemma , Harder Marie K
Published: December 2012

A collaborative partnership is developing a values-based indicator framework for use by civil society organizations (CSOs). A key sub-study on the relevance and usability of such indicators was carried out through an action research process with a CSO and it was found that: 1) it was, indeed, possible to develop useful and relevant indicators for the presence of CSO values; 2) it was not useful to tie each indicator to only one value; 3) the indicators were more ‘universal’ than the values for which they had been derived; 4) these indicators were not considered valid by the user CSO without being ‘localized’; 5) the use of our values-based framework caused substantive transformational learning within this CSO. The importance of these findings to studies on values and to design issues central to formal values-based measurement work, such as face validity and catalytic validity, is drawn out. The principles of emancipatory action research used are shown to be key to the results, which themselves form foundational elements that led to key and significant understandings and modifications of the values-based framework.
Children’s participation and experiential reflections using co-operative inquiry for developing a learning programme for children with asthma
Authors: Trollvik Anne , Eriksson Bengt G , Ringsberg Karin C , Hummelvoll Jan Kåre
Published: December 2012

The aim of this article is to discuss methodological issues based on experiences involving the use of co-operative inquiry in a paediatric ward and to describe how the children’s own perspectives were taken into account. This project, which was conducted in Norway between 2004 and 2007, involved children, parents and health care professionals meeting in a mutual working process to apply a new pedagogic approach for children with asthma. Ninety individuals (children, parents, health care professionals, teachers and students) participated in the study that had a qualitative approach. The findings indicate that the adults considered the child perspectives throughout the project, while the children’s own perspectives were taken into account during the period of intervention. The children participated actively, which can support empowerment processes. Health care professionals and researchers responded to the children’s views using communication and research techniques adapted to the children’s age, development and sensitivity. Critical choices related to the project were made because of recruitment challenges involving children and families. Children between 7 and 10 years of age are competent actors who can be involved in research and thus represent activated sources of knowledge. Bringing about change requires endurance and a long-term perspective.
Endolumenal Rectal Resection and Transanal Natural Orifice Specimen Extraction (NOSE) Without Rectal Stump Opening
Authors: Kvasha Anton , Kvasha Vladimir , Hadary Amram , Willenz Udi , Szvalb Sergio , Waksman Igor
Published: December 2012

Minimally invasive surgery has been continuously evolving over the past 20 years. The use of natural orifice specimen extraction (NOSE) is one of the most recent contributions to minimally invasive methods. The anus has been widely used in NOSE procedures. However, an open rectal stump carries the highest risk of contamination compared with other translumenal approaches to the peritoneal cavity. In this study, the feasibility of a novel NOSE method was tested in a porcine model. This technique combined abdominal and transanal approaches. The abdominal approach was used in rectal mobilization; this was followed by a transanal recto-rectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. Once IPT was established, a second ligature was placed around the rectum, approximating the proximal and distal resection margins. The specimen was resected and extracted by making a full-thickness incision through 2 bowel walls distal to the previously placed ligatures. Anastomosis was achieved by applying the stapler. The technique was found to be feasible. A substantial length of bowel was resected in all experiments. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. Although more investigation is warranted, this procedure has the potential to limit surgical site infections by using aseptic bowel manipulation during colorectal resection and transanal specimen extraction.
Laparoscopic Resection for Submucosal Tumors Near the Esophagogastric Junction
Authors: Liao Yu-Tso , Yang Chin-Yao , Lai I-Ru , Chen Chiung-Nien , Lin Ming-Tsan
Published: December 2012

Background. Minimally invasive surgery has proved to be effective and efficient in the management of gastric submucosal tumors (SMT). However, confronting a SMT near the esophagogastric junction (EGJ) is still challenging because of the potentially devastating risks of stenosis or leakage. This study evaluated the safety, feasibility, and oncological efficacy of laparoscopic resection for SMTs located near the EGJ. Methods. From December 2008 to November 2011, we enrolled a total of 19 patients diagnosed with gastric SMTs located near the EGJ who underwent laparoscopic surgery. The clinicopathological characteristics and surgical outcomes of the 19 patients were recorded and reviewed retrospectively. Results. All 19 patients underwent laparoscopic resections of their gastric SMTs without complications during the study period. There were 9 men and 10 women, with a mean age of 63.3 ± 15.1 years (range 33-86 years). The operative duration was 187.8 ± 58.9 minutes (range 90-310 minutes). Intraoperative localization included endoscopy (n = 3), tattooing (n = 2), and combined modalities (n = 1). The exogastric (n = 12) and transgastric methods (n = 7) were used. The histopathology showed 10 gastrointestinal stromal tumors, 7 leiomyomas, 1 hyperplastic polyp, and 1 lipoma. The postoperative courses for all cases were uneventful. The mean follow-up period was 16.7 ± 9.4 months, with no recurrence noted. Conclusions: Laparoscopic resections for gastric SMTs near the EGJ are safe and feasible, with satisfactory oncological outcomes in the short term.
Clinical Research in the ICU
Authors: Turner Elizabeth E. , Rosen Mark A. , Hosseini Melika
Published: December 2012

In times of shrinking departmental budgets, physician attrition, restricted house staff work hours, and reductions in grant funding, there has been a trend towards migration of physicians away from academic medicine. Creative solutions to maintain clinical research programs are frequently necessary. At the University of California Irvine Medical Center, a clinical research program has been created that has allowed research to both survive and thrive in challenging times. The MICU Research Associates Program (MICU-RAP) provides a longitudinal experience for select undergraduate students to facilitate research as part of the MICU team while receiving academic credit and valuable experience. The MICU-RAP student coordinator and faculty advisor work together to recruit research associates, organize weekly meetings, create and implement research protocols, and mentor students and future physician-scientists. Student research associates are trained to develop and maintain a secure database, assist in the authorship of IRB protocols, aid in statistical analyses, and co-author abstracts, posters, and papers. In addition to the research, the MICU-RAP students are exposed to experiences meant to educate and prepare them for a career in health care. A coordinated group of student researchers can provide a significant piece of the infrastructure that physicians wishing to build or sustain a research career need to carry out clinical research when resources are scarce.
Repeatability and bronchodilator reversibility of lung function in young children
Authors: Sonnappa Samatha , Bastardo Cristina M. , Wade Angie , Bush Andrew , Stocks Janet , Aurora Paul
Published: December 2012

Knowledge of short- and longer-term repeatability of lung function in health and disease is essential to determine bronchodilator reversibility thresholds and to recognise if changes in lung function represent disease progression, therapeutic intervention or normal variability.

Multiple-breath washout indices (lung clearance index, conductive ventilation inhomogeneity (Scond)) and specific airway resistance (sRaw) were measured in healthy children and stable wheezers. Measurements were performed at baseline and after 20 min without intervention to assess repeatability and determine bronchodilator reversibility thresholds. Bronchodilator reversibility was assessed by repeating baseline measurements 20 min after inhaled salbutamol.

28 healthy controls, mean±sdage 6.1±0.7 years and 62 wheezers 5.4±0.6 years were tested. Baseline variability in multiple-breath washout indices andsRawwas not significantly different between wheezers and healthy controls. Significant bronchodilator reversibility was only observed in wheezers forScond(16%), but in both wheezers (37%) and healthy controls (20%) for sRaw. Some wheezers and healthy controls demonstrated increases in multiple-breath washout indices post-bronchodilator.

Lung clearance index and sRawdemonstrate low baseline variability in healthy and diseased subjects. Neither multiple-breath washout indices nor sRaware ideal for assessing bronchodilator reversibility in young children with stable wheeze. These findings will help to interpret the effect of therapeutic interventions in children with respiratory diseases.
Auto-servoventilation in heart failure with sleep apnoea: a randomised controlled trial
Authors: Arzt Michael , Schroll Stephan , Series Frederic , Lewis Keir , Benjamin Amit , Escourrou Pierre , Luigart Ruth , Kehl Victoria , Pfeifer Michael
Published: December 2012

We tested the hypotheses that in patients with congestive heart failure (CHF) and sleep disordered breathing (SDB) auto-servoventilation (ASV) improves cardiac function and quality of life.

Between March 2007 and September 2009, patients with stable CHF (left ventricular ejection fraction (LVEF) ≤40%) and SDB (apnoea/hypopnoea index ≥20 events·h−1) were randomised to receive either ASV (BiPAP ASV (Philips Respironics, Murrysville, PA, USA), n=37) and optimal medical management, or optimal medical management alone (n=35). Outcomes were assessed at baseline and 12 weeks.

The apnoea/hypopnoea index assessed with polysomnography scored in one core laboratory was significantly more reduced in the ASV group (-39±16versus-1±13 events·h−1; p<0.001) with an average use of 4.5±3.0 h·day−1. Both groups showed similar improvements of the primary end-point LVEF (+3.4±5versus+3.5±6%; p=0.915) assessed with echocardiography. In the ASV group, reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) was significantly greater (-360±569versus+135±625 ng·mL−1; p=0.010). No differences were observed between the groups in subjective quality of life.

In patients with CHF and SDB, ASV reduced NT-proBNP levels, but improvement of LVEF or quality of life was not greater than in the control group. The data support that such patients can be randomised in large-scale, long-term trials of positive airway pressure therapyversuscontrol to determine effects on cardiovascular outcome.
Clinical phenotypes of Italian and Spanish patients with α1-antitrypsin deficiency
Authors: Piras Barbara , Ferrarotti Ilaria , Lara Beatriz , Martinez Maria Teresa , Bustamante Ana , Ottaviani Stefania , Pirina Pietro , Luisetti Maurizio , Miravitlles Marc
Published: December 2012

With the aim of providing better clinical characterisation of patients with α1-antitrypsin deficiency (AATD), we analysed the data of adult patients with severe AATD enrolled in the Spanish and Italian national registries.

We assessed 745 subjects, 416 of whom were enrolled in the Spanish registry and 329 in the Italian registry. 57.2% were male and 64.9% were smokers or former smokers with a mean±sdage of 49.9±13.8 years. Most (81.2%) were index cases, mainly having the PI*ZZ genotype (73.4%), and the mean±sddiagnostic delay was 9.0±12.1 years.

Patients with chronic bronchitis were younger, had better preserved lung function and lower tobacco consumption. Overlap patients (chronic obstructive pulmonary disease with asthma) were mainly females, more frequently never-smokers and received respiratory medications more often. 48% of emphysema, 27.5% of chronic bronchitis and 44.8% of overlap subjects were receiving augmentation therapy. Compared with PI*ZZ patients (n=547), the PI*SZ (n=124) subjects were older at diagnosis and had more preserved lung function, despite a higher mean smoking consumption.

Early diagnosis of AATD is still an unmet need. Augmentation therapy is administered to similar proportions of patients with different clinical phenotypes. PI*ZZ patients in both registries had more severe respiratory disease than those with PI*SZ, despite lower smoking levels.
Periodontitis is related to lung volumes and airflow limitation: a cross-sectional study
Authors: Holtfreter Birte , Richter Stefanie , Kocher Thomas , Dörr Marcus , Völzke Henry , Ittermann Till , Obst Anne , Schäper Christoph , John Ulrich , Meisel Peter , Grotevendt Anne , Felix Stephan B. , Ewert Ralf , Gläser Sven
Published: December 2012

This study aimed to assess the potential association of periodontal diseases with lung volumes and airflow limitation in a general adult population.

Based on a representative population sample of the Study of Health in Pomerania (SHIP), 1463 subjects aged 25–86 years were included. Periodontal status was assessed by clinical attachment loss (CAL), probing depth and number of missing teeth. Lung function was measured using spirometry, body plethysmography and diffusing capacity of the lung for carbon monoxide. Linear regression models using fractional polynomials were used to assess associations between periodontal disease and lung function. Fibrinogen and high-sensitivity C-reactive protein (hs-CRP) were evaluated as potential intermediate factors.

After full adjustment for potential confounders mean CAL was significantly associated with variables of mobile dynamic and static lung volumes, airflow limitation and hyperinflation (p<0.05). Including fibrinogen and hs-CRP did not change coefficients of mean CAL; associations remained statistically significant. Mean CAL was not associated with total lung capacity and diffusing capacity of the lung for carbon monoxide. Associations were confirmed for mean probing depth, extent measures of CAL/probing depth and number of missing teeth.

Periodontal disease was significantly associated with reduced lung volumes and airflow limitation in this general adult population sample. Systemic inflammation did not provide a mechanism linking both diseases.
A cutting hyperplane method for solving pseudomonotone non-Lipschitzian equilibrium problems
Authors: Anh Pham N , Kim Jong K , Hien Nguyen D
Published: December 2012

We present a new method for solving equilibrium problems, where the underlying function is continuous and satisfies a pseudomonotone assumption. First, we construct an appropriate hyperplane which separates the current iterative point from the solution set. Then the next iterate is obtained as the projection of the current iterate onto the intersection of the feasible set with the half-space containing the solution set. We also analyze the global convergence of the method under minimal assumptions.

MSC: 65K10, 90C25.
Proteomic characterization and evolutionary analyses of zona pellucida domain-containing proteins in the egg coat of the cephalochordate, Branchiostoma belcheri
Authors: Xu Qianghua , Li Guang , Cao Lixue , Wang Zhongjun , Ye Hua , Chen Xiaoyin , Yang Xi , Wang Yiquan , Chen Liangbiao
Published: December 2012

Background

Zona pellucida domain-containing proteins (ZP proteins) have been identified as the principle constituents of the egg coat (EC) of diverse metazoan taxa, including jawed vertebrates, urochordates and molluscs that span hundreds of millions of years of evolutionary divergence. Although ZP proteins generally contain the zona pellucida (ZP) structural modules to fulfill sperm recognition and EC polymerization functions during fertilization, the primary sequences of the ZP proteins from the above-mentioned animal classes are drastically different, which makes it difficult to assess the evolutionary relationships of ZP proteins. To understand the origin of vertebrate ZP proteins, we characterized the egg coat components of Branchiostoma belcheri, an invertebrate species that belongs to the chordate subphylum Cephalochordata.

Results

Five ZP proteins (BbZP1-5) were identified by mass spectrometry analyses using the egg coat extracts from both unfertilized and fertilized eggs. In addition to the C-terminal ZP module in each of the BbZPs, the majority contain a low-density lipoprotein receptor domain and a von Willebrand factor type A (vWFA) domain, but none possess an EGF-like domain that is frequently observed in the ZP proteins of urochordates. Fluorescence in situ hybridization and immuno-histochemical analyses of B. belcheri ovaries showed that the five BbZPs are synthesized predominantly in developing eggs and deposited around the extracellular space of the egg, which indicates that they are bona fide egg coat ZP proteins. BbZP1, BbZP3 and BbZP4 are significantly more abundant than BbZP2 and BbZP5 in terms of gene expression levels and the amount of mature proteins present on the egg coats. The major ZP proteins showed high polymorphism because multiple variants are present with different molecular weights. Sequence comparison and phylogenetic analysis between the ZP proteins from cephalochordates, urochordates and vertebrates showed that BbZP1-5 form a monophyletic group and share no significant sequence similarities with the ZP proteins of urochordates and the ZP3 subtype of jawed vertebrates. By contrast, small regions of homology were identifiable between the BbZP and ZP proteins of the non-jawed vertebrate, the sea lamprey Petromyzon marinus. The lamprey ZP proteins were highly similar to the ZP1 and ZP2 subtypes of the jawed vertebrates, which suggests that the ZP proteins of basal chordates most likely shared a recent common ancestor with vertebrate ZP1/2 subtypes and lamprey ZP proteins.

Conclusions

The results document the spectra of zona pellucida domain-containing proteins of the egg coat of basal chordates. Particularly, the study provides solid evidence for an invertebrate origin of vertebrate ZP proteins and indicates that there are diverse domain architectures in ZP proteins of various metazoan groups.
Dyspeptic symptoms and delayed gastric emptying of solids in patients with inactive Crohn’s disease
Authors: Nóbrega Ana Carolina Mello , Ferreira Bruno Roberto Silva , Oliveira Graciela Josué , Sales Kamila Maria Oliveira , Santos Armênio Aguiar , Nobre e Souza Miguel Ângelo , Braga Lúcia Libanês Bessa Campelo , de Almeida Troncon Luizde Almeida Ernesto , Souza Marcellus Henrique Loiola Ponte
Published: December 2012

Background

Patients with Crohn’s disease (CD) have been shown to present dyspeptic symptoms more frequently than the general population. Some of these symptoms could be related to motility disorders to some degree. Then, we propose to investigate whether gastric emptying of solids in patients with inactive CD is delayed and to determine the relationships between gastric emptying and dyspeptic symptoms in inactive CD.

Methods

Twenty-six patients with inactive Crohn’s disease, as defined by a Crohn’s Disease Activity Index (CDAI) < 150, underwent a gastric emptying test by breath test using 13C octanoic acid coupled to a solid meal and answered a validated questionnaire (The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms. Patients with scores ≥ 6 were considered to have dyspepsia. The control group was composed by 19 age- and sex-matched healthy volunteers.

Results

Patients with CD had a significantly longer t 1/2 and t lag (p<0.05) than the controls. CD patients with dyspepsia had significantly (p<0.05) prolonged gastric emptying when compared to patients without dyspeptic symptoms. When the individual symptom patterns were analyzed, only vomiting was significantly associated with delayed gastric emptying (p<0.05). There was no difference between the subgroups of patients with respect to gender, CDAI scores, disease location, clinical behavior (obstructive/obstructive) or previous gastrointestinal surgery.

Conclusion

Delayed gastric emptying in inactive Crohn’s disease patients seems to be associated with dyspeptic symptoms, particularly vomiting, even without any evidence of gastrointestinal obstruction.
Sleep hygiene intervention for youth aged 10 to 18 years with problematic sleep: a before-after pilot study
Authors: Tan Evan , Healey Dione , Gray Andrew R , Galland Barbara C
Published: December 2012

Background

The current study aimed to examine the changes following a sleep hygiene intervention on sleep hygiene practices, sleep quality, and daytime symptoms in youth.

Methods

Participants aged 10–18 years with self-identified sleep problems completed our age-appropriate F.E.R.R.E.T (an acronym for the categories of Food, Emotions, Routine, Restrict, Environment and Timing) sleep hygiene programme; each category has three simple rules to encourage good sleep. Participants (and parents as appropriate) completed the Adolescent Sleep Hygiene Scale (ASHS), Pittsburgh Sleep Quality Index (PSQI), Sleep Disturbance Scale for Children (SDSC), Pediatric Daytime Sleepiness Scale (PDSS), and wore Actical® monitors twice before (1 and 2 weeks) and three times after (6, 12 and 20 weeks) the intervention. Anthropometric data were collected two weeks before and 20 weeks post-intervention.

Results

Thirty-three youths (mean age 12.9 years; M/F = 0.8) enrolled, and retention was 100%. ASHS scores significantly improved (p = 0.005) from a baseline mean (SD) of 4.70 (0.41) to 4.95 (0.31) post-intervention, as did PSQI scores [7.47 (2.43) to 4.47 (2.37); p < 0.001] and SDSC scores [53.4 (9.0) to 39.2 (9.2); p < 0.001]. PDSS scores improved from a baseline of 16.5 (6.0) to 11.3 (6.0) post- intervention (p < 0.001). BMI z-scores with a baseline of 0.79 (1.18) decreased significantly (p = 0.001) post-intervention to 0.66 (1.19). Despite these improvements, sleep duration as estimated by Actical accelerometry did not change. There was however a significant decrease in daytime sedentary/light energy expenditure.

Conclusions

Our findings suggest the F.E.R.R.E.T sleep hygiene education programme might be effective in improving sleep in children and adolescents. However because this was a before and after study and a pilot study with several limitations, the findings need to be addressed with caution, and would need to be replicated within a randomised controlled trial to prove efficacy.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12612000649819