bluuebunny/crossref_metadata_2025 huggingface dataset:
Avoiding the first cesarean section–results of structured organizational and cultural changes
Authors: Blomberg Marie
Published: February 2016

Introduction

In 2006 the overall rates of instrumental deliveries (10%) and cesarean sections (CS) (20%) were high in our unit. We decided to improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation.

Material and methods

Implementation of a “nine‐item list” of structured organizational and cultural change in Linköping 2006–15. The nine items include monitoring of obstetric results, recruitment of a midwife coordinator, risk classification of women, introduction of three different midwife competence levels, improved teamwork, obstetrical morning round, fetal monitoring skills, obstetrical skills training, and public promotion of the strategy.

Results

The CS rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall CS rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord pH <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience.

Conclusions

The CS rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce CS rates without increased risk of neonatal complications.
Likelihood of repeat abortion in a Swedish cohort according to the choice of post‐abortion contraception: a longitudinal study
Authors: Kilander Helena , Alehagen Siw , Svedlund Linnea , Westlund Karin , Thor Johan , Brynhildsen Jan
Published: February 2016

Introduction

Despite high access to contraceptive services, 42% of the women who seek an abortion in Sweden have a history of previous abortion(s). The reasons for this high repeat abortion rate remain obscure. The objective of this study was to study the choice of contraceptive method after abortion and related odds of repeat abortions within 3–4 years.

Material and methods

This is a retrospective cohort study based on a medical record review at three hospitals in Sweden. We included 987 women who had an abortion during 2009. We reviewed medical records from the date of the index abortion until the end of 2012 to establish the choice of contraception following the index abortion and the occurrence of repeat abortions. We calculated odds ratios (OR) with 95% CI.

Results

While 46% of the women chose oral contraceptives, 34% chose long‐acting reversible contraceptives (LARC). LARC was chosen more commonly by women with a previous pregnancy, childbirth and/or abortion. During the follow‐up period, 24% of the study population requested one or more repeat abortion(s). Choosing LARC at the time of the index abortion was associated with fewer repeat abortions compared with choosing oral contraceptives (13% vs. 26%, OR 0.36; 95% CI 0.24–0.52). Subdermal implant was as effective as intrauterine device in preventing repeat abortions beyond 3 years.

Conclusions

Choosing LARC was associated with fewer repeat abortions over more than 3 years of follow up.
Justice and Surgical Innovation: The Case of Robotic Prostatectomy
Authors: Hutchison Katrina , Johnson Jane , Carter Drew
Published: February 2016

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long‐term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations.
From Ethical Exceptionalism to Ethical Exceptions: The Rule and exception Model and the Changing Meaning of Ethics In German Bioregulation
Authors: Braun Kathrin
Published: February 2016

Germany is an interesting case with respect to the governance of reprogenetics. It has a strong profile in the technosciences and high aims regarding the global bioeconomy, yet her regulation of human genetics, reproductive medicine and embryo research has for a long time been rather restrictive. German biopolitical exceptionalism has often been explained by reference to Catholicism and the legacy of the Nazi past. The Germans, so goes the common story, have learnt the lessons of history and translated them into unconditional respect for human dignity, which in turn translates into unconditional protection of human life, including the human embryo, and the firm repudiation of any eugenic distinction between ‘life worth to live’ and ‘life not worth to live’. This, however, is not the whole story. Alongside deontological strictness we find another strand of governing body politics and reprogenetics in Germany, the rule‐and‐exception model, running from the mid‐1970s abortion law via the 2002 Stem Cell Act to the 2011 regulation of pre‐implantation genetic diagnosis. In contrast to the former, that strongly draws on Kant and his concept of human dignity, the latter bears resemblances to Carl Schmitt's concept of state of exception. The article will show that the rule‐and‐exception model builds the exception into the rule and transforms the meaning and mandate of ethics, namely from safeguarding ethical standards to deciding about the exception. Given that the exception has now tended to become the rule, the question is whether the lessons of history will govern German reprogenetics for much longer.
Incident Type 2 diabetes and the effect of early regression to normoglycaemia in a population with impaired glucose regulation
Authors: Bodicoat D. H. , Khunti K. , Srinivasan B. T. , Mostafa S. , Gray L. J. , Davies M. J. , Webb D. R.
Published: February 2016

Aims

To report contemporary regression rates from impaired glucose regulation to normal glucose tolerance, identify modifiable factors associated with early regression, and establish whether it affects subsequent diabetes risk in a population‐based cohort.

Methods

Participants with impaired glucose regulation (impaired fasting glucose and/or impaired glucose tolerance on a 75‐g oral glucose tolerance test) at baseline in the UK‐based ADDITION‐Leicester study had annual Type 2 diabetes re‐screens for 5 years or until diabetes diagnosis. Logistic regression models investigated modifiable risk factors for regression to normal glucose tolerance at 1 year (n = 817). Cox regression models estimated subsequent diabetes risk (n = 630).

Results

At 1 year, 54% of participants had regressed to normal glucose tolerance, and 6% had progressed to diabetes. Regression to normal glucose tolerance was associated with weight loss of 0.1–3% [adjusted odds ratio 1.81 (95% CI 1.08, 3.03) compared with maintaining or gaining weight] and a waist circumference reduction of > 3 cm [adjusted odds ratio 1.78 (95% CI 1.03, 3.06) compared with maintaining or increasing waist circumference]. Those with normal glucose tolerance at 1 year subsequently had lower diabetes risk than those who remained with impaired glucose regulation [adjusted hazard ratio 0.19 (95% CI 0.10, 0.37)].

Conclusions

Early regression to normal glucose tolerance was associated with reduced diabetes incidence, and might be induced by small reductions in weight or waist circumference. If confirmed in experimental research, this could be a clear and achievable target for individuals diagnosed with impaired glucose regulation.
Mechanisms of fatigue crack growth – a critical digest of theoretical developments
Authors: Chowdhury P. , Sehitoglu H.
Published: February 2016

Recent advances in the processing technology are permitting the manufacture of novel metallic materials with superior fatigue properties via microstructure tailoring. In the light of these promising developments, there is a rising need for establishing a synergy between state‐of‐the‐art experimental characterizations and physically based theoretical underpinnings. A revisit to the existing predictive literature is thus a timely requirement prior to furthering new design guidelines against cyclic damage. To that end, this paper recounts an overview of the key mechanistic and analytical theories on the fatigue crack growth mechanisms. Emphasis is placed on categorizing the proposed modelling endeavours based on their fundamental principles. In doing so, contributions and limitations thereof are carefully examined on the basis of most updated experimental revelations. The objective is to provide a perspective to the current generation of engineers and researchers alike. This concise yet critical narrative would essentially assist in formulating even more advanced microstructure–damage relationships in the modern context. A commentary is added at the end outlining the promising avenues for future research.
An experimental methodology for quantitative characterization of multi‐site fatigue crack nucleation in high‐strength Al alloys
Authors: Jin Y. , Cai P. , Tian Q. B. , Liang C. Y. , Ke D. J. , Wang G. , Zhai T.
Published: February 2016

An experimental method was developed to quantify the multi‐site fatigue crack initiation behaviour of engineering alloys in four‐point bend fatigue testing under stress control. In this method, fatigue crack initiation sites [fatigue weak‐links (FWLs)] were measured on the sample surface at different cyclic stress levels. The FWL density in an alloy could be best described using a three‐parameter Weibull function of stress, although other types of sigmoidal functions might also be used to quantify the relation between weak‐link density and stress. The strength distribution of the FWLs was derived from the Weibull function determined by fitting the weak‐link versus stress curve experimentally obtained. As material properties, FWL density and strength distribution could be used to characterize the fatigue crack nucleation behaviour of engineering alloys quantitatively and evaluate the alloy quality in terms of weak‐link density and strength distribution. In this work, the effects of environment, types of microstructural heterogeneities and loading direction on FWLs were all studied in detail in AA7075 T651, AA2026 T3511, A713 alloys, etc. It was also found that FWL should be quantified as a Weibull‐type function of strain instead of stress, when the applied maximum cyclic stress exceeded the yield strength of the tested alloy.
Students' Perspectives on Communities‐Oriented Goals
Authors: White Kelsey D.
Published: February 2016

Scholars and professional organizations have described participation in target language (TL) communities as one of the primary aims of language learning, but little work has been done to determine how students define those communities or envision their own involvement within them. This exploratory study drew on questionnaire and interview data to investigate the extent to which beginning‐level learners of German (n = 23) valued the goals that are outlined in the World‐Readiness Standards for Language Learning (National Standards Collaborative Board, 2015)—particularly the Communities‐oriented goals—and examined the ways in which these students delineated a TL community and conceived of participation in that community. Findings suggest that, relative to other goal areas, the items representing the Communities standard on the whole were rated as unimportant to these learners; however, there were some specific aspects of Communities that were rated much more favorably. Regardless of their alignment with those goals, learners' definition of what constituted a TL community focused on native speaker status and geographical location and excluded groups that met in local settings (e.g., German classes).
Comparing estimates of number of breeders Nb based on microsatellites and single nucleotide polymorphism of three groups of brown trout (Salmo trutta L.)
Authors: Linløkken A. N. , Haugen T. O. , Mathew P. K. , Johansen W. , Lien S.
Published: February 2016

Microsatellites (10 MSs) and single nucleotide polymorphism (3871 SNPs) were analysed in three closely related, single‐cohort groups of brown trout, Salmo trutta L. Autumn (W/0+) and subsequent year (W/1+) samples of brown trout of the same stream were retrieved using electric fishing, and one sample of artificially reared brown trout (H/1+), bred from wild parents, was collected from a hatchery. The number of breeders, Nb, was estimated based on each total sample set and from subsets of loci by means of the software LDNe, and by means of Colony2, NeEstimator and ONeSAMP softwares. MS‐based estimates were consequently higher than those based on SNPs. ML‐Relate and Colony2 software was used to estimate putative full‐sib pairs, and there was considerable variation between methods. For monitoring species and populations, both methods are recommended, but to compare Nb across samples and years, the same markers of MSs or SNPs must be used as estimates varied across markers within sample.
Going against the flow: a case for upstream dispersal and detection of uncommon dispersal events
Authors: Wubs E. R. Jasper , Fraaije Rob G. A. , de Groot G. Arjen , Erkens Roy H. J. , Garssen Annemarie G. , Kleyheeg Erik , Raven Bart M. , Soons Merel B.
Published: February 2016

Dispersal and colonisation are key processes determining species survival, and their importance is increasing as a consequence of ongoing habitat fragmentation, land‐use change and climate change. Identification of long‐distance dispersal events, including upstream dispersal, and of the dispersal mechanisms and resulting spatial dispersal patterns involved provides much‐needed information for conservation in an era of rapid environmental change.

However, quantifying contemporary dispersal among populations is far from straightforward. We used the relatively well‐defined, typically linear, spatial structure of streams, rivers and their associated riparian and aquatic plant populations to illustrate this. We performed a literature review on studies where dispersal and its directionality (upstream versus downstream) were explicitly quantified.

Upstream dispersal was detected in the majority (75%) of examined stream and riparian plant species and mediated mainly by waterfowl, but also by other animals and wind. However, upstream movements are generally less frequent than downstream. Upstream dispersal can occur in excess of tens and sometimes even hundreds of kilometres.

Most of the reviewed studies suffer from important methodological limitations that generate difficulties in detecting uncommon dispersal events. Major limitations include use of molecular ecological analyses based on unrealistic assumptions, and the inability to separate seed from pollen flow. On the basis of these findings, we outline a flexible research design using DNA‐based assignment methods that allows quantification of contemporary dispersal in future studies. We suggest four key improvements: (i) assignment of propagules and/or seedlings; (ii) use of spatial models to inform sampling design; (iii) reducing the influence of unsampled populations and (iv) combined use of nuclear and uniparentally inherited DNA markers to separate gene flow (including pollen and sperm) in general from propagule‐mediated dispersal. In combination with direct measurements of seed dispersal these facilitate empirical quantification of dispersal and the detection of uncommon dispersal events, allowing more realistic assessment of spatial population dynamics, relevant for sedentary and relatively immobile organisms.
Biogeographical patterns of the genus Merodon Meigen, 1803 (Diptera: Syrphidae) in islands of the eastern Mediterranean and adjacent mainland
Authors: Vujić Ante , Petanidou Theodora , Tscheulin Thomas , Cardoso Pedro , Radenković Snežana , Ståhls Gunilla , Baturan Željana , Mijatović Gorana , Rojo Santos , Pérez‐Bañón Celeste , Devalez Jelle , Andrić Andrijana , Jovičić Snežana , Krašić Dušanka , Markov Zlata , Radišić Dimitrije , Tataris Giorgos
Published: February 2016

The objective of this study was to obtain a biogeographical perspective on the hoverfly genus Merodon (Diptera, Syrphidae) based on data from 32 islands in the Aegean and Ionian archipelagoes vis‐à‐vis the adjacent mainland. In this part of the world, the genus comprises 57 species, out of more than 160 species described worldwide.

The importance of eco‐geographical variables (area, elevation, distance to the nearest island and distance to the nearest mainland) and the species–area relationship (SAR) were studied in order to explain patterns of species richness. All tests supported the dynamic equilibrium concept.

The area and distance to closest island were found to be the most important drivers of species richness on the Aegean and Ionian archipelagoes. Out of three SAR models evaluated in this study, the exponential function fitted our data best. It was found that a power model with no intercept value (C = 1) performed even better by using symbolic regression for non‐linear equation optimisation.

The cluster and null‐model analyses performed to detect inter‐island similarities and origins of the insular Merodon fauna indicated a clear influence of colonisation history of the species on different islands.

The results imply that the current distributions of Merodon species in the study area exhibit the combined effects of historical and present‐day processes.
Efficacy of naringenin against permethrin‐induced testicular toxicity in rats
Authors: Mostafa Heba El‐Sayed , Abd El‐Baset Samia A. , Kattaia Asmaa A. A. , Zidan Rania A. , Al Sadek Mona M. A.
Published: February 2016

Permethrin (PM), a synthetic pyrethroid insecticide, has broad toxicity spectra. We aimed to investigate the effects of PM on the testes of adult albino rats, examine the recovery response and evaluate the efficacy of naringenin (NG) supplementation. Adult male albino rats were randomly assigned to five groups of six each: control, NG (50 mg/kg), PM (70 mg/kg), recovery (after subsequent withdrawal of PM) and NG‐PM group. All treatments were given by oral gavage for 6 weeks and another 3 weeks for the recovery group. At the time of sacrifice, each testis was weighed. Biochemical analysis of epididymal sperm count and serum testosterone level was performed. Testes were processed for histological, ultrastructural and c‐Kit immunohistochemical study. PM toxicity was evidenced by a highly significant decrease in testicular weight, epididymal sperm count and serum testosterone level compared to control. Furthermore, testicular structure abnormalities and reduced c‐Kit immunoreactions were observed. Stoppage of PM in the recovery group partially reversed PM‐induced changes. There was a mild decrease in testicular weight and biochemical parameters compared to control. The structure of seminiferous tubules was partially retained. The NG‐PM group showed an overall improvement in testicular weight and biochemical alterations which were confirmed by light and electron microscopic examination. In conclusion, PM induced testicular toxicity, which was ameliorated by NG co‐administration. However, stoppage of PM exposure was associated with partial recovery.
Prescribing or dispensing medication represents the best opportunity for GPs and pharmacists to engage older people in alcohol-related clinical conversations
Authors: Wilkinson Celia , Dare Julie , French Michelle , McDermott Marie- Louise , Lo Johnny , Allsop Steve
Published: February 2016

Objectives

This research aimed to identify older Australian drinkers’ knowledge about Australian Alcohol Guidelines and their beliefs about the risks and benefits of alcohol; their recall of alcohol-related issues being raised with them by their community pharmacist and General Practitioner (GP); and their receptiveness to alcohol-related information being provided by either health professional.

Methods

This research was conducted in Perth, Western Australia. Flyers calling for participants were placed in local health and service centres, and advertisements were placed in local media. Participants who met eligibility requirements were posted a survey pack (n = 190) including an information letter, consent form, quantitative survey, and return addressed, postage paid envelope. 188 people aged over 60 years returned completed questionnaires.

Key findings

Women were more familiar with national alcohol guidelines, and were more conservative about the potential health benefits of alcohol. While 90% of participants were receptive to their GP asking about their alcohol use, only 30% of men and 20% of women recalled their GP raising this issue with them in the prior 12 months. Of these, high-risk drinkers were six times more likely than low-risk drinkers to have been asked by their GP. Likewise, 50% of men and 65% of women were receptive to having alcohol-related health conversations with their community pharmacist, but less than 4% recalled their pharmacist raising this issue. Participants were most receptive to receiving information about alcohol-medication interactions.

Conclusions

This research highlights that prescribing and dispensing medication represents the ideal opportunity for health professionals to deliver alcohol-related information to older people.
Analysis of bacterial community profiles of endodontically infected primary teeth using pyrosequencing
Authors: Yun Kwan Hee , Lee Hyo‐Seol , Nam Ok Hyung , Moon Chan Yang , Lee Jae‐Hyung , Choi Sung Chul
Published: February 2016

Objective

The purpose of this study was to identify the endodontic microbiome in primary teeth with dental caries using high‐throughput pyrosequencing and to establish data on the oral microbiome of primary teeth with endodontic infection.

Methods

Ten primary teeth with dental caries and endodontic infection were included. Samples were collected from root canals using sterilized paper points and analyzed by pyrosequencing, based on the V1‐V3 hypervariable region of the 16S rRNA gene. The data were analyzed using the CLcommunity software.

Results

Analysis of the 10 samples yielded a total of 64,291 16S rRNA gene sequences. In total, 1586 OTUs (range, 91–235), six bacterial phyla, including unclassified, and 187 genera were assigned. At the genus level, Neisseria (group A), Acinetobacter (group B), and Fusobacterium (group C) were prominent. These predominant microorganisms were associated with the clinical condition and reflected the progression of endodontic infection in primary teeth.

Conclusions

This study revealed a relationship between the oral microbiome and endodontic infection in primary teeth. Additionally, anaerobic bacteria such as Fusobacterium species were dominant in the teeth with apical abscesses.
Zr‐Substituted (Na0.5Bi0.5)1‐xBax TiO3‐Based Solid Solutions
Authors: Ishchuk Valeriy M. , Gusakova Lyudmila G. , Kisel' Nikolai G. , Spiridonov Nikolai A. , Sobolev Vladimir L.
Published: February 2016

This study investigates the phase formation of Zr‐substituted [(Na0.5Bi0.5)0.80Ba0.20](Ti1−yZry)O3 system during its solid‐state synthesis. The synthesis was found to be a multistep process accompanied by the formation of a number of intermediate phases which depend on the solid solution's composition and sintering temperatures. Single‐phase solid solutions were obtained when the sintering temperature was increased to 1000°C–1100°C. Increase in content of substituting Zr‐ions tends to linearly increase in the size of the crystal cell leading to reduction in the tolerance factor which results in the increase in stability of the antiferroelectric phase relative to the ferroelectric phase.
Enhancing Self‐Determination in Health: Results of an RCT of the Ask Project, a School‐Based Intervention for Adolescents with Intellectual Disability
Authors: McPherson Lyn , Ware Robert S. , Carrington Suzanne , Lennox Nicholas
Published: February 2016

Background

Adolescents with intellectual disability have high levels of unrecognized disease and inadequate health screening/promotion which might be addressed by improving health advocacy skills.

Methods

A parallel‐group cluster randomized controlled trial was conducted to investigate whether a health intervention package, consisting of classroom‐based health education, a hand‐held health record and a health check, increased carer‐reported health advocacy in adolescents with intellectual disabilities.

Results

Carers of 388 adolescents responded. Adolescents allocated to receive the health intervention package were significantly more likely to go to the doctor on their own, ask questions and explain their health problems to the doctor without help. Carers reported their adolescent had benefited, gaining increased knowledge and responsibility for their own health. They themselves reported an increase in knowledge and better ability to support the young person.

Conclusions

An educational initiative based on the Ask Health Diary led to improved healthcare autonomy for adolescents with intellectual disabilities.
Proprotein convertase 7 rs236918 associated with liver fibrosis in Italian patients with HFE‐related hemochromatosis
Authors: Pelucchi Sara , Galimberti Stefania , Greni Federico , Rametta Raffaela , Mariani Raffaella , Pelloni Irene , Girelli Domenico , Busti Fabiana , Ravasi Giulia , Valsecchi Maria Grazia , Valenti Luca , Piperno Alberto
Published: February 2016

Background and Aim

p.Cys282Tyr homozygosity is the prevalent genotype in (HFE)‐related Hereditary Hemochromatosis with low penetrance and variable expression. However, liver cirrhosis and hepatocellular carcinoma remain the main causes of mortality in these patients. Detection of genetic modifiers identifying patients at risk for liver damage would be relevant for their clinical management. We evaluated proprotein convertase 7 (PCSK7) rs236918 as genetic marker of risk of liver fibrosis in an Italian cohort of p.Cys282Tyr homozygotes.

Methods

Liver fibrosis was histologically assessed by Ishak score. We evaluated PCSK7 alleles and genotypes frequencies according to single or grouped staging scores: absent/mild fibrosis (stage: 0–2), moderate (stage: 3–4), and severe fibrosis/cirrhosis (stage: 5–6). Single nucleotide polymorphism genotyping was performed by restriction fragment length polymorphism or Taqman 5′‐nuclease assays.

Results

The rs236918 allele C frequency increased from stages 0–2 to 5–6 (7.1% vs 13.6%, vs 21.9%, P = 0.003). The wild‐type genotype was significantly more frequent in the absent/mild fibrosis group (54.2%) compared with only 17% in patients with severe fibrosis/cirrhosis. At univariate proportional odds model, patients with GC + CC genotypes were 2.77 times (P = 0.0018) more likely to have worse liver staging scores than wild‐type patients. In the adjusted analysis, odds ratio was 2.37 (P = 0.0218), and 2.56 (P = 0.0233) when the analysis was restricted to males. An exploratory mediation analysis suggested a direct effect of genotype on severe fibrosis/cirrhosis (odds ratio = 3.11, P = 0.0157), and a mild non‐significant indirect effect mediated through iron accounting for 28%.

Conclusions

These findings confirm that PCSK7 rs236918 C allele is a risk factor for cirrhosis development in Italian patients with HFE‐Hemochromatosis.
Effects of Home‐Based Tai Chi and Lower Extremity Training and Self‐Practice on Falls and Functional Outcomes in Older Fallers from the Emergency Department—A Randomized Controlled Trial
Authors: Hwang Hei‐Fen , Chen Sy‐Jou , Lee‐Hsieh Jane , Chien Ding‐Kuo , Chen Chih‐Yi , Lin Mau‐Roung
Published: February 2016

Objectives

To compare the effects of guided home‐based tai chi chuan (TCC) and lower extremity training (LET) and of levels of self‐practice on falls and functional outcomes in older fallers.

Design

Randomized controlled trial.

Setting

Taipei, Taiwan.

Participants

Individuals aged 60 and older who had fall‐related emergency department visits at least 6 months before participating in the study and ambulated independently at baseline (N = 456).

Intervention

Six months of TCC or LET.

Measurements

Four types of fall measures (falls, time to first fall, fallers, recurrent fallers) and six functional measures (handgrip strength, balance, mobility, fear of falling, depression, cognitive function).

Results

The TCC group was significantly less likely than the LET group to experience any falls during the 6‐month intervention (incidence rate ratio (IRR) = 0.30, 95% confidence interval (CI) = 0.15–0.60), and the effects remained significant after 12 months of follow‐up (IRR = 0.32, 95% CI = 0.14–0.71). These effects remained significant for injurious falls during the 6‐month intervention (IRR = 0.33, 95% CI = 0.16–0.68) and the entire 18‐month study (IRR = 0.39, 95% CI = 0.18–0.83). Similar results were obtained when another two fall measures (time to first fall, number of fallers) were used. Moreover, participants who independently practiced TCC or LET seven times per week or more were significantly less likely to experience injurious falls during the 6‐month intervention (IRR = 0.41, 95% CI = 0.20–0.83) and the 18‐month study (IRR = 0.43, 95% CI = 0.21–0.87) than their counterparts, had a significantly longer time to first injurious fall, and were significantly less likely to have an injurious fall during the 6‐month intervention. Cognitive function improved to a greater extent in the TCC group than in the LET group over the 18‐month study.

Conclusion

Home‐based TCC may reduce the incidence of falls and injurious falls more than conventional LET in older fallers, and the effects may last for at least 1 year.
Enhanced ubiquitination and proteasomal degradation of catalytically deficient human choline acetyltransferase mutants
Authors: Morey Trevor M. , Albers Shawn , Shilton Brian H. , Rylett R. Jane
Published: February 2016

Choline acetyltransferase (ChAT) is essential for cholinergic neuron function as it mediates synthesis of the neurotransmitter acetylcholine. ChAT mutations have been linked to the neuromuscular disorder congenital myasthenic syndrome (CMS). One CMS‐related ChAT mutation, V18M, reduces enzyme activity and cellular protein levels, and is positioned within a highly conserved proline‐rich motif with the sequence 14PKLPVPP20. We demonstrate that N‐terminal truncation that includes this proline‐rich motif, as well as mutation of prolines‐17/19 together to alanine (P17A/P19A), dramatically reduces ChAT steady‐state protein levels and cellular activity when expressed in cholinergic SN56 neural cells. The in vitro activity of bacterially expressed recombinant P17A/P19A‐ChAT is also reduced, although this is not caused by changes in protein secondary structure or thermal stability. Treatment of SN56 cells with the proteasome inhibitor MG132 increases cellular P17A/P19A‐ChAT steady‐state protein levels, and by immunoprecipitation we found that ChAT is ubiquitinated and that polyubiquitination of P17A/P19A‐ChAT is increased compared to wild‐type (WT) ChAT. Using a novel fluorescent‐biorthogonal pulse‐chase protocol in SN56 cells, we determined that the protein half‐life of P17A/P19A‐ChAT (2.2 h) is substantially reduced compared to WT‐ChAT (19.7 h). Lastly, we show that two CMS‐related ChAT mutants (V18M and A513T) have enhanced ubiquitination, and that treatment with MG132 can partially restore both the steady‐state protein levels as well as cellular activity of some CMS‐mutant ChAT. These results identify a novel mechanism for regulation of ChAT through the ubiquitin–proteasome system that is influenced by the conserved N‐terminal proline‐rich motif of ChAT and may be implicated in CMS pathology.

image

Choline acetyltransferase (ChAT) synthesizes acetylcholine in cholinergic neurons. In this study we find that steady‐state protein levels of human 69‐kDa ChAT are regulated by the ubiquitin–proteasome system. Mutation of a highly conserved N‐terminal proline‐rich motif in human 69‐kDa ChAT reduces both cellular ChAT protein levels, through enhanced ubiquitination and proteasomal degradation, and enzyme activity. Ubiquitination of catalytically deficient congenital myasthenic syndrome (CMS)‐mutant ChAT is increased in cells, and importantly proteasome inhibition partially restores steady‐state protein levels as well as cellular activity of some CMS‐mutant ChAT proteins.
A family matter – when a parent is diagnosed with multiple sclerosis. A qualitative study
Authors: Boström Katrin , Nilsagård Ylva
Published: February 2016

Aims and objectives

The aim was to explore and describe from a triple perspective – that of the ill parent, the healthy parent and the children – experienced issues that are important to acknowledge and act upon to make it easier for a child to cope when a parent is diagnosed with multiple sclerosis.

Background

A chronic disease affects the whole family and has a substantial impact on the children. Traditionally, the focus is on the patient, and communication with other family members is not generally integrated into health care. Health care professionals need to be aware of a child's needs when a parent is diagnosed with multiple sclerosis.

Design

A qualitative design using content analysis with an inductive approach was used.

Methods

Nine focus group interviews were conducted with the ill parents, the healthy parents and the children separately.

Results

Participants jointly indicated that family members need to be recognised, both initially and onwards in their everyday lives. Seven categories were defined: Prerequisites within the families, Initial reactions, Trying to adapt and manage, Developing strategies, Everyday life, Thoughts about the future and Support from health care providers. Together they constituted the theme that multiple sclerosis is a family matter. Both ill and healthy parents wished for support from health care professionals in addressing their children's needs.

Conclusions

Health care professionals need to pay attention to children as a parent's illness affects them. Not only the children would benefit, but so would their parents, as their worries for their children would be reduced.

Relevance to clinical practice

Staff can be advised to pay attention to the parenting role, how the parenting role and parent–child relationship may change as a result of a chronic disease. Parents may need reassurance and benefit from advice about how to talk to their children about their condition and its impact.
Transcatheter Aortic Valve Replacement: 2015 in Review
Authors: Harjai Kishore J. , Grines Cindy L. , Leon Martin B.
Published: February 2016

Transcatheter aortic valve replacement (TAVR) has emerged as an attractive option for patients with severe symptomatic aortic stenosis (AS) who are either at high risk or extreme risk for surgical aortic valve replacement (SAVR). This article summarizes the major advances in TAVR that were published or reported in 2015. (J Interven Cardiol 2016;29:27–46)
Liver innate immune cells and insulin resistance: the multiple facets of Kupffer cells
Authors: Jager J. , Aparicio‐Vergara M. , Aouadi M.
Published: February 2016

Obesity, which affects 600 million adults worldwide, is a major risk factor for type 2 diabetes (T2D) and insulin resistance. Current therapies for these metabolic disorders include weight management by lifestyle intervention or bariatric surgery and pharmacological treatment with the aim of regulating blood glucose. Probably because of their short‐term effectiveness, these therapies have not been able to stop the rapidly rising prevalence of T2D over the past decades, highlighting an urgent need to develop new therapeutic strategies. The role of immune cells, such as macrophages, in insulin resistance has been extensively studied. Major advances have been made to elucidate the role of adipose tissue macrophages in these pathogeneses. Recently, anti‐inflammatory drugs have been suggested as an alternative treatment for T2D, and clinical trials of these agents are currently ongoing. In addition, results of previous clinical trials using antibodies against inflammatory cytokines, which showed modest effects, are now being rigorously re‐evaluated. However, it is still unclear how liver macrophages [termed Kupffer cells (KCs)], which constitute the major source of macrophages in the body, contribute to the development of insulin resistance. In this review, we will discuss the present understanding of the role of liver immune cells in the development of insulin resistance. We will particularly focus on KCs, which could represent an attractive target for the treatment of metabolic diseases.
The Progression of Sexual Relationships
Authors: Sassler Sharon , Michelmore Katherine , Holland Jennifer A.
Published: February 2016

The authors examine factors associated with the advancement or dissolution of newly formed sexual relationships. Data from the 2006–2010 National Survey of Family Growth (NSFG) was used to examine women and men aged 18–39 (n = 2,774) whose most recent sexual relationship began within the 12 months before their interview. Results indicate that newly formed sexual relationships are often transitory. By 12 months, only 23% of respondents remained in nonresidential sexual relationships, another 27% were cohabiting with that partner, and half had ended their relationships. Sexual relationships formed before age 25 are significantly more likely to break up than to transition into cohabitation. Indicators of social class disadvantage, such as living with a stepparent, expedited cohabitation, whereas measures of advantage, such as having a college‐educated mother, deterred transitions into shared living. Racial differences also emerge: Blacks were less likely than Whites to transition rapidly into shared living.
WNT‐activated medulloblastoma with melanotic and myogenic differentiation: Report of a rare case
Authors: Rajeshwari Madhu , Kakkar Aanchal , Nalwa Aasma , Suri Vaishali , Sarkar Chitra , Satyarthee Guru Dutta , Garg Ajay , Sharma Mehar Chand
Published: February 2016

Medulloblastoma (MB) with melanotic and myogenic differentiation, previously known as melanotic medullomyoblastoma, is an extremely rare histological variant of MB showing melanocytic as well as skeletal muscle differentiation. Only 10 cases of this rare tumor have been reported in the literature to date. We report this case of a 2‐year‐old male child who presented with a midline cerebellar mass, which on histopathological examination showed classic MB intermixed with cells containing melanin pigment, along with rhabdomyoblasts, spindle cells and occasional strap cells, which corresponded to WNT subgroup on molecular classification. The cell of origin of this MB variant is likely to be neural crest‐derived stem cells which are capable of multilineage differentiation. Significant findings from previous reports and important differential diagnoses are discussed. Documentation of these tumors is important to characterize the clinical behaviour and to identify distinct genetic features, if any.
Herbivores control effects of algal species richness on community biomass and stability in a laboratory microcosm experiment
Authors: Rakowski Chase , Cardinale Bradley J.
Published: February 2016

Hundreds of studies that have explored how biodiversity affects the productivity and stability of ecosystems have produced a consensus that communities composed of more species tend to have higher biomass that is more stable through time. However, the majority of this work stems from studies performed using highly simplified food webs, often composed of just primary producers competing for inorganic resources in the absence of trophic interactions. When studies have incorporated trophic interactions, diversity‐function relationships have been more variable, leaving open the question of how biodiversity affects the functioning of ecosystems with more trophic levels. Here we report the results of a laboratory experiment that used freshwater microcosms to test for effects of algal diversity (one or four species) on community biomass and temporal variability in the presence and absence of two different herbivore species (cladocerans Ceriodaphnia dubia and Daphnia pulex). When no herbivores were present, we found the classic pattern observed in hundreds of other studies – as species richness of algae increased, algal biomass increased, and the temporal variation in biomass decreased. This pattern was retained when one of the herbivores (C. dubia) was present. Ceriodaphnia dubia exhibited weak and non‐selective grazing on the focal algae, leaving the effect of diversity on biomass and variability essentially intact. In contrast, D. pulex exhibited strong and selective grazing in algal polycultures that qualitatively altered both diversity–function relationships. As algal richness increased, total algal biomass decreased and variation through time increased. These changes were coupled with larger and less variable populations of D. pulex. Our results show that herbivory leads to a richer array of diversity–function relationships than often observed in studies focused on just one trophic level, and suggests trophic interactions should be given more attention in work that seeks to determine how biodiversity impacts the functioning of ecosystems.
Differential heart rate responses to social and monetary reinforcement in women with obesity
Authors: Kube Jana , Schrimpf Anne , García‐García Isabel , Villringer Arno , Neumann Jane , Horstmann Annette
Published: February 2016

Obesity is often accompanied by weight stigmatization; subsequently, individuals with obesity frequently face social rejection. It has been shown that recurrent negative social experiences can alter the perception of social cues. However, the way individuals with obesity process social stimuli is not well understood. This study aims to investigate obesity‐related alterations in social compared to nonsocial information processing. Women with obesity (n = 14) and without obesity (n = 14) participated in a social and a monetary incentive delay task in which they anticipated and received positive, negative, and neutral outcomes in the form of faces or money. During the experiment, phasic heart rate changes and reaction times were measured. Women with obesity, compared to lean women, exhibited a stronger differentiation during the anticipation of monetary and social reinforcement, showing slower reaction times to social cues compared to monetary cues. During the outcome processing phase, women with obesity relative to controls demonstrated diminished heart rate responses particularly to negative social outcomes. Interestingly, differences in cardiac responses in participants with obesity were moderated by weight‐related teasing experiences. In women with obesity, a higher BMI was associated with blunted cardiac responses to social cues relative to monetary cues only if they reported more emotional pain after weight‐related teasing. Our results contribute to a better understanding of social information processing in obesity and give first evidence for the role of negative social experiences in reinforcement processing.
Improving the effectiveness of nondisclosure agreements by strengthening concept learning
Authors: Wetter Olive E. , Hofer Franziska , Schmutz Philipp , Jonas Klaus
Published: February 2016

Intellectual property infringements rank among the top economic crimes, even though there are mechanisms in place to prevent their occurrence. One such mechanism are nondisclosure agreements, which, however, have been reported to fail in practice. This article argues that this may be overcome by strengthening employees’ concept learning. In an experiment, we investigated whether extended nondisclosure agreements, which provide the employee with detailed explanations and examples, lead to better recognition of trade secrets as compared to a standard nondisclosure agreement or no agreement at all. It was found that the extended nondisclosure agreement indeed increased participants’ ability to judge what falls under the trade secret law, whereas the standard nondisclosure agreement showed no such effect. Furthermore, the effects of the factors ‘Involvement’, ‘Specificity’, ‘Publicity’, and ‘Purpose’ on the identification of trade secrets could be proven experimentally. Employees’ judgments of whether an information represents a trade secret seem to rely on general cognitive processes. From this follows that concept learning could be integrated into systematic approaches for protecting intellectual property.
Height differences in two eucalypt provenances with contrasting levels of aridity
Authors: Breed Martin F. , Gellie Nicholas J. C. , Lowe Andrew J.
Published: February 2016

Huge investments are fed into repairing the world's degraded land, placing unparalleled pressure on delivering large quantities of quality seed. One of the most pressing issues is to identify which region to collect seed from and specifically whether local seed has a home‐site advantage, particularly given the pressures of climate change. Recent theoretical recommendations have supported supplementing local seed with seed transferred in an arid‐to‐mesic direction to improve climate resilience of plantings. We tested this recommendation by establishing a reciprocal transplant trial in June 2010 of two seed provenances with contrasting aridity of Eucalyptus socialis, a tree widely used for restoration in Southern Australia. We recorded survival and height over 5 years. The years 2010 and 2011 were particularly wet years at both sites (>1.8 times historical rainfall), but the years 2012–2015 were consistent with long‐term rainfall trends, with the arid site receiving 12–48% less annual rainfall than the mesic site. Only the arid provenance showed a home‐site advantage, and only for height after the two wet years followed by the three drier years. Provenances had similar levels of survival at both sites and did equally well at the mesic site. These results only provide initial evidence to support the recommendation that restoration plantings aiming to incorporate climate resilience should include arid‐to‐mesic transferred seed. Further work is needed to fully explore potential confounding site‐specific effects. Supplementing locally collected seeds with arid‐to‐mesic transferred seed could be important to increase climate resilience of plantings and demands further studies to explore its costs versus benefits.
A Reply to Theodori, Luloff, Brennan, and Bridger
Authors: Flaherty Jeremy , Cope Michael R.
Published: February 2016

Theodori et al. (2016) take issue with our presentation of the interactional field theory of community, asserting that, according to interactional field theory, (1) community does not equate with community field; (2) community does not emerge out of the community‐oriented actions of individuals; as well as making various other charges. In our reply, we refute their points, and demonstrate how Theodori et al., themselves, often provide the best evidence against their own arguments.