bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of in vitro inhibitory activity of hydrogen peroxide on the growth of Malassezia pachydermatis and to compare its efficacy with commercial ear cleaners
Authors: Marrero Edrei Javier , Silva Freddy Alejandro , Rosario Inmaculada , Déniz Soraya , Real Fernando , Padilla Daniel , Díaz Esther Licia , Acosta‐Hernández Begoña
Published: May 2017

Otitis caused by Malassezia pachydermatis is generally a common and recurrent disease in canine clinical pathology. The increased incidence of fungal resistant to antifungal in both humans and pets is a cause for concern and is associated with the indiscriminate use of antifungals. Finding the most effective disinfectants and antifungals has become essential. To evaluate the in vitro inhibitory activity of hydrogen peroxide on the growth of M. pachydermatis and compare its efficacy with commercial ear cleaners. The test for sensitivity to antimicrobials was carried out following the indications of the CLSI document M44‐A2. The comparative results demonstrated that hydrogen peroxide 1.5% showed excellent results for growth inhibition of M. pachydermatis, followed by Epiotic® and MalAcetic®, the lowest result was for Otoclean®.
The measure and mismeasure of reciprocity in heterostylous flowers
Authors: Armbruster W. Scott , Bolstad Geir H. , Hansen Thomas F. , Keller Barbara , Conti Elena , Pélabon Christophe
Published: May 2017

The goal of biological measurement is to capture underlying biological phenomena in numerical form. The reciprocity index applied to heterostylous flowers is meant to measure the degree of correspondence between fertile parts of opposite sex on complementary (inter‐compatible) morphs, reflecting the correspondence of locations of pollen placement on, and stigma contact with, pollinators. Pollen of typical heterostylous flowers can achieve unimpeded fertilization only on opposite‐morph flowers. Thus, the implicit goal of this measurement is to assess the likelihood of ‘legitimate’ pollinations between compatible morphs, and hence reproductive fitness.

Previous reciprocity metrics fall short of this goal on both empirical and theoretical grounds.

We propose a new measure of reciprocity based on theory that relates floral morphology to reproductive fitness. This method establishes a scale based on adaptive inaccuracy, a measure of the fitness cost of the deviation of phenotypes in a population from the optimal phenotype. Inaccuracy allows the estimation of independent contributions of maladaptive bias (mean departure from optimum) and imprecision (within‐population variance) to the phenotypic mismatch (inaccuracy) of heterostylous morphs on a common scale.

We illustrate this measure using data from three species of Primula (Primulaceae).
A microbially derived tyrosine‐sulfated peptide mimics a plant peptide hormone
Authors: Pruitt Rory N. , Joe Anna , Zhang Weiguo , Feng Wei , Stewart Valley , Schwessinger Benjamin , Dinneny José R. , Ronald Pamela C.
Published: May 2017

The biotrophic pathogen Xanthomonas oryzae pv. oryzae (Xoo) produces a sulfated peptide named RaxX, which shares similarity to peptides in the PSY (plant peptide containing sulfated tyrosine) family. We hypothesize that RaxX mimics the growth‐stimulating activity of PSY peptides.

Root length was measured in Arabidopsis and rice treated with synthetic RaxX peptides. We also used comparative genomic analyses and reactive oxygen species burst assays to evaluate the activity of RaxX and PSY peptides.

Here we found that a synthetic sulfated RaxX derivative comprising 13 residues (RaxX13‐sY), highly conserved between RaxX and PSY, induces root growth in Arabidopsis and rice in a manner similar to that triggered by PSY. We identified residues that are required for activation of immunity mediated by the rice XA21 receptor but that are not essential for root growth induced by PSY. Finally, we showed that a Xanthomonas strain lacking raxX is impaired in virulence.

These findings suggest that RaxX serves as a molecular mimic of PSY peptides to facilitate Xoo infection and that XA21 has evolved the ability to recognize and respond specifically to the microbial form of the peptide.
Three TOB1‐related YABBY genes are required to maintain proper function of the spikelet and branch meristems in rice
Authors: Tanaka Wakana , Toriba Taiyo , Hirano Hiro‐Yuki
Published: May 2017

YABBY genes play important roles in the development of lateral organs such as leaves and floral organs in Angiosperms. However, the function of YABBY genes is poorly understood in monocots.

We focused on three rice (Oryza sativa) YABBY genes, TONGARI‐BOUSHI (TOB1, TOB2, TOB3), which are closely related to Arabidopsis (Arabidopsis thaliana) FILAMENTOUS FLOWER (FIL). To elucidate the function of these YABBY genes, we employed a reverse genetic approach.

TOB genes were expressed in bract and lateral organ primordia, but not in meristems. RNAi knockdown of TOB2 or TOB3 in the tob1 mutant caused abnormal spikelet development. Furthermore, simultaneous knockdown of both TOB2 and TOB3 in tob1 affected not only spikelet, but also inflorescence development. In severe cases, the inflorescences comprised naked branches without spikelets. Analysis of inflorescence development at an early stage showed that the observed phenotypic defects were closely associated with a failure to initiate and maintain reproductive meristems.

These results indicate that the TOB genes regulate the maintenance and fate of all reproductive meristems. It is likely that the function of FIL/TOB clade YABBY genes has been conserved between Arabidopsis and rice to maintain the proper function of meristems, even though these genes are expressed in lateral organ primordia.
Effects of plant and pollinator traits on the maintenance of a food deceptive species within a plant community
Authors: Qu Hongchun , Seifan Tal , Seifan Merav
Published: May 2017

Model–mimic plant systems are well known. However, the conditions promoting the existence of such systems are still an enigma. We suggest that by focusing on floral similarity between model and mimic, reward levels offered by models, and pollinators’ ability to adjust foraging accordingly, the conditions can be better understood. Using spatially‐explicit modelling, we examined trait combinations that lead to the survival of deceptive species under a large range of mimic strategies, from Batesian mimicry to general food deception. Unlike previous models studying such systems, we examined model–mimic interactions in the presence of a third, dissimilar species, thus generating a more realistic scenario where pollinators may avoid the model–mimic system altogether. Results showed that overall survival and abundance of species in food deceptive systems depend on the relative reward provided by the participating species and the potential alternatives available. Specifically, the success of a mimic in a Batesian mimicry system depends on high levels of reward provided by its model species relative to potential alternatives in the flower community. On the other hand, the success of a mimic in a general food deception system was higher when the reward offered was lower. Our study suggests that the ability of pollinators to utilize their experience as part of decision‐making is highly relevant in promoting mimic survival, thus shedding light on the conditions under which food deception is expected.
Working memory load impairs the evaluation of behavioral errors in the medial frontal cortex
Authors: Maier Martin E. , Steinhauser Marco
Published: May 2017

Early error monitoring in the medial frontal cortex enables error detection and the evaluation of error significance, which helps prioritize adaptive control. This ability has been assumed to be independent from central capacity, a limited pool of resources assumed to be involved in cognitive control. The present study investigated whether error evaluation depends on central capacity by measuring the error‐related negativity (Ne/ERN) in a flanker paradigm while working memory load was varied on two levels. We used a four‐choice flanker paradigm in which participants had to classify targets while ignoring flankers. Errors could be due to responding either to the flankers (flanker errors) or to none of the stimulus elements (nonflanker errors). With low load, the Ne/ERN was larger for flanker errors than for nonflanker errors—an effect that has previously been interpreted as reflecting differential significance of these error types. With high load, no such effect of error type on the Ne/ERN was observable. Our findings suggest that working memory load does not impair the generation of an Ne/ERN per se but rather impairs the evaluation of error significance. They demonstrate that error monitoring is composed of capacity‐dependent and capacity‐independent mechanisms.
Exploring How Families Do Science Together: Adult‐Child Interactions at Community Science Events
Authors: Tuttle Nicole , Mentzer Gale A. , Strickler Lacey , Bloomquist Debra , Hapgood Susanna , Molitor Scott , Kaderavek Joan , Czerniak Charlene M.
Published: May 2017

Promoting family learning around science represents an important opportunity to reinforce science learning during out‐of‐school time. Evidence suggests that parent‐child discourse around science can promote inferential thinking by children and help solidify their understanding of science concepts. While teacher professional development that promotes the type of discourse that encourages student inquiry is trending, interventions that assist parents in developing the same types of learning talk skills are scarce. In this descriptive study, family discourse was observed at a series of events at community centers that promote science learning, such as the zoo and the library. These events were part of a large‐scale professional development program designed to transform teaching and learning around PK–3 science. Families were scored on their interaction, discourse, and use of “talk moves” using the Discourse, Interaction, and Inquiry in Family Science rubric. The results demonstrate that the events promoted family discourse and interaction in a manner dependent on the activity context. Implications for teachers and design of family science learning activities are discussed.
Toward Meaningful Interdisciplinary Education: High School Teachers’ Views of Mathematics and Science Integration
Authors: Weinberg Andrea Elizabeth , Sample McMeeking Laura Beth
Published: May 2017

Numerous national initiatives call for interdisciplinary mathematics and science education, but few empirical studies have examined practical considerations for integrated instruction in high school settings. The purpose of this qualitative study was twofold. First, the study sought to describe how and to what extent teachers integrate mathematics and science curricula in their classrooms after having participated in an intervention to promote and support mathematics and science integration. Second, the study was intended to expand our understanding of the barriers to and factors that enable integrated approaches in high school classrooms. The theoretical component of this study builds on and adapts previous models of science and mathematics integration to introduce the Intradisciplinary, Cross‐disciplinary, Mutlidisciplinary, Interdisciplinary (ICMI) framework for identifying and defining classroom integration strategies. Findings include a description of several distinct practices high school teachers related to integrated instruction as well as the trade‐offs teachers considered when making decisions related to integrated curricula. The implications of the findings for researchers and practitioners are discussed. Finally, we propose the conceptualization of “interdisciplinary pedagogical content knowledge” in mathematics and science as an area of focus that will enable teachers to successfully move toward interdisciplinary instruction.
A Fourier‐series‐based virtual fields method for the identification of three‐dimensional stiffness distributions and its application to incompressible materials
Authors: Nguyen T. T. , Huntley J. M. , Ashcroft I. A. , Ruiz P. D. , Pierron F.
Published: May 2017

We present an inverse method to identify the spatially varying stiffness distributions in 3 dimensions. The method is an extension of the classical Virtual Fields Method—a numerical technique that exploits information from full‐field deformation measurements to deduce unknown material properties—in the spatial frequency domain, which we name the Fourier‐series‐based virtual fields method (F‐VFM). Three‐dimensional stiffness distributions, parameterised by a Fourier series expansion, are recovered after a single matrix inversion. A numerically efficient version of the technique is developed, based on the Fast Fourier Transform. The proposed F‐VFM is also adapted to deal with the challenging situation of limited or even non‐existent knowledge of boundary conditions. The three‐dimensional F‐VFM is validated with both numerical and experimental data. The latter came from a phase contrast magnetic resonance imaging experiment containing material with Poisson's ratio close to 0.5; such a case requires a slightly different interpretation of the F‐VFM equations, to enable the application of the technique to incompressible materials.
Are top managers important for firm performance and idiosyncratic risk? Evidence from sharia vs non‐sharia‐compliant firms in theUKand Pakistan
Authors: Kutan Ali M. , Naz Iram , Shah Syed Muhammad Aamir
Published: May 2017

We examine the impact of top managers on performance and idiosyncratic risk of the sharia‐compliant firms in theUKand Pakistan by constructing a manager–firm matched panel data and then tracking the role of individual top managers across different firms. The results regarding the individual effects on performance by a particular firm show that there exists a significant difference for managers who move from a non‐sharia to a sharia‐compliant firm. However, this difference is not significant for managers who move from a sharia‐compliant firm to another sharia firm. Policy implications of the findings are discussed.
Una intervención en Aprendizaje Cooperativo sobre el perfil del Observador en la dinámica Bullying.
Authors: Polo del Río María Isabel
Published: May 2017

El acoso escolar contempla como protagonistas a un grupo de alumnos con papeles bien diferenciados: Agresor, víctima y observadores, estos últimos testigos del acoso, que pueden condicionar el curso del mismo. Con este estudio se pretende determinar que tras la aplicación en el aula de técnicas de Aprendizaje Cooperativo, los observadores detectan y confirman reducción de la frecuencia de conductas de acoso escolar dentro del aula. Con el fin de evaluar dichas conductas, se diseña un instrumento “Escala de frecuencias de acoso escolar entre iguales. Perspectiva Observador”. Nuestros resultados apoyan la hipótesis, de que tras la aplicación de técnicas de aprendizaje cooperativo en el aula, los observadores detectan una reducción de las conductas de acoso propias de la dinámica bullying.
La percepción de los estilos de crianza y su relación con las autopercepciones de los niños de Buenos Aires: Diferencias en función del género
Authors: Molina María Fernanda , Raimundi María Julia , Bugallo Lucía
Published: May 2017

El objetivo de este trabajo fue estudiar la influencia de la percepción de los estilos de crianza en las autopercepciones de los niños en función del género. Se administró el Perfil de Autopercepciones para Niños (SPPC) y la Escala Argentina de Percepción de la Relación con los Padres a una muestra de 98 niños de ambos sexos (varones 43.90%; edad media= 9.86; DE= 1.28) de Buenos Aires (Argentina). Se encontró que la percepción de la relación con los padres predice el nivel de las autopercepciones de las niñas en los todos los dominios evaluados (físico/social, académico/comportamental, y autoestima global) mientras que sólo la aceptación por parte de la madre predice las autopercepciones de los varones en el dominio físico/social.
El papel de las verbalizaciones en forma de regla: análisis topográfico del discurso del terapeuta
Authors: Vargas de la Cruz Ivette , Pardo Cebrian Rebeca , Martínez Héctor , Froján Parga María Xesús
Published: May 2017

Aunque se ha reconocido la importancia del uso de las reglas para el tratamiento de problemas psicológicos, aún se desconoce el papel que juega este tipo de verbalizaciones en el cambio clínico. Con el fin de contribuir al esclarecimiento del rol de las verbalizaciones en forma de regla, proponemos un análisis funcional de este tipo de verbalizaciones a lo largo del proceso clínico. En este estudio se analizaron las verbalizaciones en forma de regla emitidas por 9 terapeutas a lo largo de 19 casos clínicos (92 sesiones). Las verbalizaciones se codificaron de acuerdo a un Sistema de Categorización de las Reglas del Terapeuta (SISC-REGLAS-T). Los resultados mostraron diferencias entre el tipo de verbalizaciones en forma de regla y el objetivo que el terapeuta persigue alcanzar en los distintos momentos de la terapia. Estos resultados pueden ayudar a comprender cómo el terapeuta utiliza las verbalizaciones en forma de reglas, lo que contribuye al esclarecimiento del papel funcional de las reglas que emite el terapeuta para conseguir el cambio clínico.
Superharmonic Resonance of Cross-Ply Laminates by the Method of Multiple Scales
Authors: Youzera Hadj , Meftah Sid Ahmed , Daya El Mostafa
Published: May 2017

General differential equations of motion in nonlinear forced vibration analysis of multilayered composite beams are derived by using the higher-order shear deformation theories (HSDT's). Viscoelastic properties of fiber-reinforced plastic composite materials are considered according to the Kelvin–Voigt viscoelastic model for transversely isotropic composite materials. The method of multiple scales is employed to perform analytical frequency amplitude relationships for superharmonic resonance. Parametric study is conducted by considering various geometrical and material parameters, employing HSDT's and first-order deformation theory (FSDT).
A Review of the Capabilities of Current Low-Cost Virtual Reality Technology and Its Potential to Enhance the Design Process
Authors: Coburn Joshua Q. , Freeman Ian , Salmon John L.
Published: May 2017

In the past few years, there have been some significant advances in consumer virtual reality (VR) devices. Devices such as the Oculus Rift, HTC Vive, Leap Motion™ Controller, and Microsoft Kinect® are bringing immersive VR experiences into the homes of consumers with much lower cost and space requirements than previous generations of VR hardware. These new devices are also lowering the barrier to entry for VR engineering applications. Past research has suggested that there are significant opportunities for using VR during design tasks to improve results and reduce development time. This work reviews the latest generation of VR hardware and reviews research studying VR in the design process. Additionally, this work extracts the major themes from the reviews and discusses how the latest technology and research may affect the engineering design process. We conclude that these new devices have the potential to significantly improve portions of the design process.
Influence of Graphite on Tribological Properties of Hexagonal Boron Nitride Hybrid/Polyimide Composites in Wide Temperature Range
Authors: Wang Yanming , Cai Peng , Wang Tingmei , Wang Qihua
Published: May 2017

Tribological and mechanical properties of aramid fiber (AF), graphite (Gr), and hexagonal boron nitride (h-BN) hybrid polyimide composites were investigated under room and high temperature. Results show that, Gr in composite reinforced with AF and h-BN can reduce coefficient of friction (COF) and improve antiwear property of composites under room temperature. Gr can accelerate the formation of transfer film under high temperature without sacrificing the wear resistant of composites. Transfer film of composites reinforced with Gr and h-BN simultaneously present more smooth and uniform compared with that of composites reinforced with only AF and h-BN. However, under higher temperature, composite reinforced with pure Gr present higher COFs and wear rates (WRs) compared with composites filled with h-BN and Gr simultaneously. Comprehensively, composite filled with 10% AF, 3% h-BN, and 4% Gr is the optimum composition.
Chain stretching and recoiling during startup and cessation of extensional flow of bidisperse polystyrene blends
Authors: López-Barrón Carlos R. , Zeng Yiming , Richards Jeffrey J.
Published: May 2017

Simultaneous measurements of stress and flow-induced chain alignment were collected on a series of bidisperse polystyrene blends during startup of uniaxial extension and after cessation of flow at 150 °C. Chain alignment was measured using a novel method that combines the use of a commercial Sentmanat extensional rheometer with time-resolved small-angle neutron scattering (SANS) measurements. The latter uses state of the art methods of neutron time stamping in the SANS detector and deconvolution protocols that yields scattering data with time resolutions of the order of seconds [M. A. Calabrese et al., Soft Matter 12, 2301–2308 (2016)]. Those measurements were used to confirm the direct correlation between strain hardening and chain stretching at strain rates corresponding to Rouse Weissenberg number WiR> 0.5. Furthermore, a linear relation between the alignment factor, Af, and the tensile stress, σE, was observed in the bidisperse blends for stress values below 65 kPa during flow startup. This result confirmed the validity of a simple stress-SANS rule (SSR), analogous to the stress-optic rule, which relates chain alignment to the extensional stress. For stresses below 65 kPa, the stress-SANS coefficient, CE=Af/σE, was found to have a value of 3.9 MPa−1. Failure of the SSR is observed at stresses greater than 65 kPa. Further confirmation of the SSR was provided by the linear relation between Af and σ during the late regime of relaxation after flow cessation, which yield CE values nearly identical to those obtained during flow startup.
In-Service Physical Educators’ Experiences of Online Adapted Physical Education Endorsement Courses
Authors: Sato Takahiro , Haegele Justin A. , Foot Rachel
Published: May 2017

The purpose of this study was to investigate in-service physical education (PE) teachers’ experiences during online adapted physical education (APE) graduate courses. Based on andragogy theory (adult learning theory) we employed a descriptive qualitative methodology using an explanatory case study design. The participants (6 female and 3 male) were in-service PE teachers enrolled in an online graduate APE endorsement program. Data collection included journal reflection reports and face-to-face interviews. A constant comparative method was used to interpret the data. Three interrelated themes emerged from the participants’ narratives. The first theme, instructor communication, exposes the advantages and disadvantages the participants perceived regarding communication while enrolled in the online APE graduate courses. The second theme, bulletin board discussion experiences, described participants’ perceptions of the use of the bulletin board discussion forum. Lastly, the final theme, assessment experiences, described how the participants learned knowledge and skills through online courses related to assessment and evaluation.
Twitter Power and Sport-Fan Loyalty: The Moderating Effects of Twitter
Authors: Yoon Sukjoon , Petrick James F. , Backman Sheila J.
Published: May 2017

Sport fans who have formed strong connections to their favorite team may be termed loyal fans. One popular communication tool for such fans is Twitter, which has been found to be an important medium for sharing news and events, yet few studies have examined the moderating of Twitter use in a sport context. Adopting the relational approach examining the determinants of sport-fan loyalty, this study examined how Twitter use moderates the building of fan loyalty. Findings revealed that team attraction, team trust, and team involvement are positively related to team attachment. While team attachment was found to positively influence fan loyalty, sport fans’ Twitter use was found to significantly reinforce their loyalty. Specific implications for both theory and practice are discussed.
Disabling Prejudice: A Case Study of Images of Paralympic Athletes and Attitudes Toward People With Disabilities
Authors: Suggs David Welch , Guthrie Jason Lee
Published: May 2017

Part of the goal of the International Paralympic Committee is to “touch the heart of all people for a more equitable society” by exposing people to adaptive sports, with the goal of improving public views toward people with disabilities. The authors hypothesized that exposure to parasocial contact with images of athletes with disabilities could lead to a change in attitude during the formation of social identity, disrupting the tendency to view the population of individuals with physical disabilities as “other. ” This case study found that viewing a documentary of a Paralympic sprinter produced in the same style as an Olympic feature appeared to affect the emotional components of attitude formation, especially when compared with respondents who viewed a comparable documentary about an able-bodied athlete. These findings are of interest to proponents of adaptive sports, producers of adaptive-sports media, and marketers who use athletes with disabilities in advertising campaigns.
A Review of Physical Activity Interventions Delivered via Facebook
Authors: Ferrer David A. , Ellis Rebecca
Published: May 2017

Background:

The use of social networking sites to deliver behavioral interventions is becoming more prevalent. The purpose of this review was to systematically evaluate the published research to determine the effectiveness of Facebook-delivered interventions for promoting physical activity behavior change.

Methods:

A search of interventions delivered via Facebook (as the primary delivery method or part of a multifaceted intervention) in which physical activity was the primary or secondary outcome resulted in 8 studies for review.

Results:

Overall, 87.5% of the Facebook interventions reported some type of significant physical activity behavior change (ie, interactions, main effects for time, differences between conditions); however, only 2 of these interventions found this change to be significantly better for the treatment group than the control group.

Conclusion:

Future researchers are encouraged to test the effectiveness of Facebook-delivered physical activity interventions with additional control groups that receive no aspects of the intervention within experimental study designs, more diverse samples, theory-based content with assessment of mediators of behavior change, direct observations of physical activity, and long-term follow-ups. Although based on a small sample of studies, Facebook appears to be a promising delivery method for physical activity interventions.
Bouts of Vigorous Physical Activity and Bone Strength Accrual During Adolescence
Authors: Gabel Leigh , Macdonald Heather M. , Nettlefold Lindsay , McKay Heather A.
Published: May 2017

Purpose: We examined the influence of vigorous physical activity (VPA) bout frequency on bone strength accrual across adolescence, independent of total volume of VPA. Methods: We measured VPA (6 metabolic equivalents; total volume and bout frequency <5 min in duration) annually using waist-worn accelerometers (ActiGraph GT1M) in 309 adolescents (9–20 y at baseline: 99, <13 y; 126, 13–18 y; 84, >18 y) over a maximum of 4 years. We applied finite element analysis to high-resolution peripheral quantitative computed tomography scans of the distal tibia (8% site) to estimate bone strength (failure load; F.Load, Newtons). We fit a mixed effects model with maturity offset (years from age at peak height velocity) as a random effect and sex, ethnicity, tibia length, lean body mass, and VPA (volume and bout frequency) as fixed effects. Results: VPA volume and bout frequency were positively associated with F.Load across adolescence; however, VPA volume did not predict F.Load once VPA bout frequency was included in the model. Participants in the upper quartile of VPA bout frequency (∼33 bouts per day) had 10% (500 N) greater F.Load across adolescence compared with participants in the lowest quartile (∼9 bouts per day; P = .012). Each additional daily bout of VPA was associated with 21 N greater F.Load, independent of total volume of VPA. Conclusion: Frequent VPA should be promoted for optimal bone strength accrual.
Beyond the Black/White Binary: A Multi-Institutional Study of Campus Climate and the Academic Success of College Athletes of Different Racial Backgrounds
Authors: Oseguera Leticia , Merson Dan , Harrison C. Keith , Rankin Sue
Published: May 2017

This work contributes to an understanding of college athletes’ experiences with campus climate and its relationship to perceptions of their academic success. This work extends race work to include Latina/o and Asian and Pacific Islander college athlete populations across multiple divisions and sports as the literature is scarce on college athletes of color beyond the Black/White binary and high profile sports. The current paper fills a gap in the literature by applying the Student-Athlete Climate Conceptual Frame and quantitative research on college athletes of color, women college athletes and perceptions of campus climate and academic success. Our findings highlight a relationship between positive perceptions of campus climate and academic success. Participation in academic student organizations is also related to academic success.
Occult myeloproliferative neoplasms: not so occult any more
Authors: Karam Dhauna , Iyer Veena , Agrawal Bharat
Published: May 2017

Non-cirrhotic, non-malignant portal vein thrombosis (PVT) is commonly secondary to inherited or acquired prothrombotic states. However, even after extensive workup, 25% of patients with PVT have no apparent prothrombotic aetiology identified (idiopathic PVT). Inherited conditions include factor V Leiden, PT mutation and protein C/S/AT deficiency. Acquired conditions include APS, PNH and BCR-ABL 1-negative myeloproliferative neoplasms (MPN). BCR-ABL-1 negative MPNs are the most frequent underlying prothrombotic risk factor for PVT (15%–30%). However, peripheral blood counts often remain within normal ranges in these patients with MPN because of portal hypertension sequel. Despite suggestive features of MPN in bone marrow, these patients lack adequate diagnostic criteria and are classified as occult MPN. The discovery of recurrent molecular abnormalities such as CALR gene exon 9 mutation presented a crucial advance in the diagnosis of occult MPNs. In our patient, the diagnosis of MPN was made on this basis, despite lack of peripheral evidence of MPN.
Pioglitazone and risk of mortality in patients with type 2 diabetes: results from a European multidatabase cohort study
Authors: Strongman Helen , Korhonen Pasi , Williams Rachael , Bahmanyar Shahram , Hoti Fabian , Christopher Solomon , Majak Maila , Kool-Houweling Leanne , Linder Marie , Dolin Paul , Heintjes Edith M
Published: May 2017

Objectives

Estimate and compare the risk of mortality in patients whose antidiabetic therapy is modified to include pioglitazone compared with an alternative antidiabetic medication at the same stage of disease progression.

Design

Retrospective cohort study.

Setting

Pooled analysis of clinical data collected from primary and/or secondary care settings in four European countries: Finland, The Netherlands, Sweden and the UK .

Participants

56 337 patients with type 2 diabetes mellitus first prescribed pioglitazone between 2000 and 2011, and 56 337 patients never prescribed pioglitazone matched by treatment stage, history of diabetes, diabetes complications and cardiovascular disease, and year of cohort entry using exact and propensity score matching. Patients were followed-up for a mean of 2.90 (SD 2.21) and 2.83 (SD 2.37) years in the pioglitazone-exposed and non-pioglitazone-exposed groups, respectively.

Outcomes

All-cause mortality ascertained from clinical or registry data. Mortality was a planned secondary outcome in a study primarily studying the association of pioglitazone use with bladder cancer risk.

Results

The crude overall mortality rate per 10 000 patient years was 206 (95% CI 199 to 213) in the pioglitazone-exposed group and 448 (95% CI 438 to 458) in the non-pioglitazone-exposed group. The crude HR comparing pioglitazone to alternative antidiabetic exposure was 0.46 (95% CI 0.45 to 0.48). This reduced in magnitude to 0.67 (95% CI 0.64 to 0.70) following further adjustment for matching variables, propensity scores, age, gender and time-dependent variables representing use of alternative antidiabetic drugs.

Conclusions

In this large observational cohort study of patients with type 2 diabetes, pioglitazone exposure was associated with a statistically significant decrease in the risk of all-cause mortality across four European countries. Results should be interpreted with caution due to the potential for residual confounding.

Protocol registration

European Network of Centres for Pharmacoepidemiology and Pharmacovigilance.
Prevalence and types of rectal douches used for anal intercourse among men who have sex with men in Brazil
Authors: Lamblet Luiz Carlos Ribeiro , da Silva Roberto José Carvalho
Published: May 2017

Introduction

Rectal douching (RD) is practised among men who have sex with men (MSM), and various products and materials are used. There have been no studies in Brazil on this practice and its risks in the transmission of sexually transmitted infections and HIV.

Method

Between June and August 2015, 401 MSM over the age of 18 were interviewed about their sexual practices associated with RD over the last 3 months. RD was associated with the reported sexual behaviour, and descriptive statistical analyses were conducted on the same.

Results

Among the respondents, 85.6% identified themselves as men and 14.4% as transgender; 255 declared themselves to be white (63.6%) and 104 to be mixed (25.9%). From among those who had performed anal sex within the last 3 months (n=369), 197 reported having used RD (53.4%). The most commonly used material was a shower hose (84.5%) and the main product used was water (93%). Of those interviewed, 94.5% never received guidelines from health professionals on this practice and its potential risks. Receptive anal intercourse and RD were found to be associated (p<0.001).

Conclusions

RD is a common practice among the MSM population. Health professionals must deepen their knowledge of this. We propose studies in Brazil on the practice of RD that—from that knowledge strategies for prevention and harm reduction—can be incorporated to the vulnerable populations.
Protocol for a single-centre, parallel-arm, randomised controlled superiority trial evaluating the effects of transcatheter arterial embolisation of abnormal knee neovasculature on pain, function and quality of life in people with knee osteoarthritis
Authors: Landers Steve , Hely Andrew , Harrison Benjamin , Maister Nick , Hely Rachael , Lane Stephen E , Gill Stephen D , Page Richard S
Published: May 2017

Introduction

Symptomatic knee osteoarthritis (OA) is common. Advanced knee OA is successfully treated with joint replacement surgery, but effectively managing mild to moderate knee OA can be difficult. Angiogenesis increases with OA and might contribute to pain and structural damage. Modifying angiogenesis is a potential treatment pathway for OA. The aim of the current study is to determine whether transcatheter arterial embolisation of abnormal neovasculature arising from the genicular arterial branches improves knee pain, physical function and quality of life in people with mild to moderate symptomatic knee OA.

Methods and analysis

The study is a single centre, parallel-arm, double-blinded (participant and assessor), randomised controlled superiority trial with 1:1 random block allocation. Eligible participants have mild to moderate symptomatic knee OA and will be randomly assigned to receive either embolisation of aberrant knee neovasculature of genicular arterial branches or a placebo intervention. Outcome measures will be collected prior to the intervention and again 1, 6 and 12 months postintervention. The primary outcome is change in knee pain between baseline and 12 month assessment as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include change in self-reported physical function (KOOS), self-reported quality of life (KOOS, EuroQol: EQ-5D-5L), self-reported knee joint stiffness (KOOS), self-reported global change, 6 min walk test performance, and 30 s chair-stand test performance. Intention-to-treat analysis will be performed including all participants as randomised. To detect a mean between group difference in change pain of 20% at the one year reassessment with a two-sided significance level of α=0.05 and power of 80% using a two-sample t-test, we require 29 participants per arm which allows for 20% of participants to drop out.

Ethics and dissemination

Barwon Health Human Research Ethics Committee, 30 May 2016, (ref:15/101). Study results will be disseminated via peer-reviewed publications and conference presentations.

Trial registration number

Universal trial number U1111-1183-8503, Australian New Zealand Clinical Trials Registry, ACTRN12616001184460, approved 29 August 2016.
A bespoke mobile application for the longitudinal assessment of depression and mood during pregnancy: protocol of a feasibility study
Authors: Marcano Belisario Jose Salvador , Doherty Kevin , O'Donoghue John , Ramchandani Paul , Majeed Azeem , Doherty Gavin , Morrison Cecily , Car Josip
Published: May 2017

Introduction

Depression is a common mental health disorder during pregnancy, with important consequences for mothers and their children. Despite this, it goes undiagnosed and untreated in many women attending antenatal care. Smartphones could help support the prompt identification of antenatal depression in this setting. In addition, these devices enable the implementation of ecological momentary assessment techniques, which could be used to assess how mood is experienced during pregnancy. With this study, we will assess the feasibility of using a bespoke mobile application (app) running on participants’ own handsets for the longitudinal (6 months) monitoring of antenatal mood and screening of depression.

Methods and analysis

We will use a randomised controlled study design to compare two types of assessment strategies: retrospective + momentary (consisting of the Edinburgh Postnatal Depression Scale plus five momentary and two contextual questions), and retrospective (consisting of the Edinburgh Postnatal Depression Scale only). We will assess the impact that these strategies have on participant adherence to a prespecified sampling protocol, dropout rates and timeliness of data completion. We will evaluate differences in acceptance of the technology through a short quantitative survey and open-ended questions. We will also assess the potential effect that momentary assessments could have on retrospective data. We will attempt to identify any patterns in app usage through the analysis of log data.

Ethics and dissemination

This study has been reviewed and approved by the National Research Ethics Service Committee South East Coast—Surrey on 15 April 2016 as a notice of substantial amendment to the original submission (9 July 2015) under the Research Ethics Committee (REC) reference 15/LO/0977. This study is being sponsored by Imperial College London under the reference number 15IC2687 and has been included in the UK Clinical Research Network Study Portfolio under the Central Portfolio Management System number 19280. The findings of this study will be disseminated through academic peer-reviewed publications, poster presentations and abstracts at academic and professional conferences, discussion with peers, and social media. The findings of this study will also inform the PhD theses of JSMB and KD.
Selection by a panel of clinicians and family representatives of important early morbidities associated with paediatric cardiac surgery suitable for routine monitoring using the nominal group technique and a robust voting process
Authors: Pagel Christina , Brown Katherine L , McLeod Isobel , Jepps Helen , Wray Jo , Chigaru Linda , McLean Andrew , Treasure Tom , Tsang Victor , Utley Martin
Published: May 2017

Objective

With survival following paediatric cardiac surgery improving, the attention of quality assurance and improvement initiatives is shifting to long-term outcomes and early surgical morbidities. We wanted to involve family representatives and a range of clinicians in selecting the morbidities to be measured in a major UK study.

Setting

Paediatric cardiac surgery services in the UK.

Participants

We convened a panel comprising family representatives, paediatricians from referring centres, and surgeons and other clinicians from surgical centres.

Primary and secondary outcome measures

Using the nominal group technique augmented by a robust voting process to identify group preferences, suggestions for candidate morbidities were elicited, discussed, ranked and then shortlisted. The shortlist was passed to a clinical group that provided a view on the feasibility of monitoring each shortlisted morbidity in routine practice. The panel then met again to select a prioritised list of morbidities for further study, with the list finalised by the clinical group and chief investigators.

Results

At the first panel meeting, 66 initial suggestions were made, with this reduced to a shortlist of 24 after two rounds of discussion, consolidation and voting. At the second meeting, this shortlist was reduced to 10 candidate morbidities. Two were dropped on grounds of feasibility and replaced by another the panel considered important. The final list of nine morbidities included indicators of organ damage, acute events and feeding problems. Family representatives and clinicians from outside tertiary centres brought some issues to greater prominence than if the panel had consisted solely of tertiary clinicians or study investigators.

Conclusion

The inclusion of patient and family perspectives in identifying metrics for use in monitoring a specialised clinical service is challenging but feasible and can broaden notions of quality and how to measure it.
Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials
Authors: Ahmed Haroon , Davies Freya , Francis Nick , Farewell Daniel , Butler Christoper , Paranjothy Shantini
Published: May 2017

Objective

To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults.

Design

Systematic review andmeta-analysis of randomised trials.

Method

We searched Medline, Embase, TheCumulative Index to Nursing and Allied Health Literature(CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs.

Results

We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecalEscherichia coliisolates were resistant to trimethoprim–sulfamethoxazole after 1 month of prophylaxis.

Conclusions

Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance.
Systemic glucocorticoid use in Denmark: a population-based prevalence study
Authors: Laugesen Kristina , Jørgensen Jens Otto Lunde , Sørensen Henrik Toft , Petersen Irene
Published: May 2017

Objectives

Glucocorticoid (GC) use is widespread and associated with many adverse effects. Thus, it is important to ascertain GC utilisation patterns. In this study, we examined the annual prevalence of prescription users and amount of use of systemic GCs.

Design

Population-wide prevalence study.

Setting

The primary healthcare and hospital sectors in Denmark from 1999 to 2015.

Results

Approximately 3% of the Danish population redeemed at least one prescription for a systemic GC annually between 1999 and 2015, with annual prevalence remaining constant over the period. However, after adjusting for age and sex, we observed a decrease in annual prevalence from 1999 to 2015, with a prevalence ratio of 0.92 (95% CI 0.91 to 0.92). Annual prevalence was highest among the elderly (7.0%–8.2% among persons 65–79 years of age and 8.4%–10% among persons 80+ years of age). Prednisolone was the most frequently redeemed systemic GC, with annual prevalence increasing from 1.4% to 2.1% during the 1999–2015 period. The amount of systemic GCs provided to the hospital sector increased from 2.3 defined daily doses (DDD)/1000 inhabitants/day in 1999 to 3.5 DDD/1000 inhabitants/day in 2015, while the amount provided to the primary healthcare sector remained constant in the range of 10–11 DDD/1000 inhabitants/day.

Conclusion

We found a high prevalence of systemic GC use of 3% with a remarkably high prevalence in elderly of up to 10%, wherefore continued awareness of its effects is mandated.
Developing a core outcome set for infant colic for primary, secondary and tertiary care settings: a prospective study
Authors: Steutel Nina F , Benninga Marc A , Langendam Miranda W , Korterink Judith J , Indrio Flavia , Szajewska Hania , Tabbers Merit M
Published: May 2017

Objective

Infant colic (IC) is defined as recurrent and prolonged crying without an obvious cause or evidence of failure to thrive or illness. It is a common problem with a prevalence of 5%–25%. The unknown aetiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis.

Design and setting

Prospective study design; primary, secondary and tertiary care.

Methods

The COS was developed using a modified Delphi technique. First, healthcare professionals (HCPs) and parents of infants with IC were asked to list up to five outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritised. The final COS was defined in a face-to-face expert meeting of paediatricians.

Results

F of invited stakeholders (133 HCPs and 55 parents of infants with IC) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS.

Conclusions

The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial in primary, secondary and/or tertiary care or performing a systematic review on IC.