bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender-specific postnatal demethylation and establishment of epigenetic memory
Authors: Reizel Yitzhak , Spiro Adam , Sabag Ofra , Skversky Yael , Hecht Merav , Keshet Ilana , Berman Benjamin P. , Cedar Howard
Published: May 2015

DNA methylation patterns are set up in a relatively fixed programmed manner during normal embryonic development and are then stably maintained. Using genome-wide analysis, we discovered a postnatal pathway involving gender-specific demethylation that occurs exclusively in the male liver. This demodification is programmed to take place at tissue-specific enhancer sequences, and our data show that the methylation state at these loci is associated with and appears to play a role in the transcriptional regulation of nearby genes. This process is mediated by the secretion of testosterone at the time of sexual maturity, but the resulting methylation profile is stable and therefore can serve as an epigenetic memory even in the absence of this inducer. These findings add a new dimension to our understanding of the role of DNA methylation in vivo and provide the foundations for deciphering how environment can impact on the epigenetic regulation of genes in general.
The end of the message: multiple protein–RNA interactions define the mRNA polyadenylation site
Authors: Shi Yongsheng , Manley James L.
Published: May 2015

The key RNA sequence elements and protein factors necessary for 3′ processing of polyadenylated mRNA precursors are well known. Recent studies, however, have significantly reshaped current models for the protein–RNA interactions involved in poly(A) site recognition, painting a picture more complex than previously envisioned and also providing new insights into regulation of this important step in gene expression. Here we review the recent advances in this area and provide a perspective for future studies.
Assessing Ca2+-Removal Pathways in Cardiac Myocytes
Authors: Bito Virginie , Sipido Karin R. , Macquaide Niall
Published: May 2015

The decline of an intracellular calcium ([Ca2+]i) transient during a single excitation–contraction coupling (ECC) cycle reflects the combined activity of the sarcoplasmic reticulum Ca2+-ATPase (SERCA) pump and the sarcolemmal Na+–Ca2+ exchanger (NCX), along with minor contributions of the plasma membrane Ca2+-ATPase and mitochondrial Ca2+ uniporter, in removing Ca2+ from the cytosol. A traditional approach for assessing the individual components is to fit the decline of the [Ca2+]i transient evoked during electrical stimulation with an exponential. This reflects mostly the SERCA-dependent rate of uptake, which can be properly deduced after correcting for a component of NCX removal. As NCX function is an important determinant of the membrane potential as well as the Ca2+ balance, we present here several detailed protocols for assessing NCX function. As the reversal potential and the amplitudes of the current are highly dependent on the prevailing concentrations of Na+ and Ca2+, we show how NCX function can be assessed under highly controlled conditions, with Ca2+ and Na+ clamped, as well as under more physiological conditions, with freely changing Ca2+ and Na+.
Subcellular Fractionation of the Brain: Preparation of Synaptosomes and Synaptic Vesicles
Authors: Evans Gareth J.O.
Published: May 2015

The human brain is estimated to contain trillions of synaptic nerve terminals. These are the connections between neurons that are responsible for transmitting information and are modified as a result of learning. A valuable tool for studying synapses is the isolated nerve terminal, or synaptosome, which is obtained by homogenizing the brain in such a way that individual synapses pinch off to form metabolically active compartments that can recapitulate neurotransmitter release. This protocol describes the stepwise fractionation of rat brain tissue to yield synaptosomes and synaptic vesicles, which can be used in many different experimental approaches to study the structure and protein composition of the synapse and even dissect the molecular mechanisms of neurotransmission.
Detection of Bak/Bax Activating Conformation Change by Intracellular Flow Cytometry
Authors: Dewson Grant
Published: May 2015

Like the commonly used immunoprecipitation (IP) approach, this procedure for the detection of activated Bak or Bax by intracellular flow cytometry is based on the principle that Bak and Bax, during activation, expose occluded amino-terminal epitopes that can be recognized by conformation-specific antibodies. Flow cytometric analysis requires fewer cells and is less time-consuming than IP. Further, in contrast to IP, flow cytometry produces a quantifiable assessment of the percentage of cells containing activated Bak or Bax, which can be correlated with cell death.
The Yeast Two-Hybrid System: A Tool for Mapping Protein–Protein Interactions
Authors: Mehla Jitender , Caufield J. Harry , Uetz Peter
Published: May 2015

Virtually all processes in living cells are dependent on protein–protein interactions (PPIs). Understanding PPI networks is thus essential for molecular biology and disease research. One powerful genetic system for mapping PPIs both at a small scale and in a high-throughput manner is the yeast two-hybrid (Y2H) screen. In Y2H screening, PPIs are detected through the activation of reporter genes responding to a reconstituted transcription factor. In this introduction, we describe library- and array-based Y2H methods and explain their basic theory. We also include the rationale behind different Y2H approaches and strategies for optimizing results.
Design of interactive conjoint analysis Web-based system
Authors: Castel Dennis , Tsuji Hiroshi
Published: April 2015

Purpose

– The purpose of this paper is to presents an interactive conjoint analysis Web-based system that allows the problems of traditional conjoint analysis to be avoided.In the case of a product with lot of parameters, respondents’ tacit preferences may be difficult to understand for marketing analysis. To get a precise analysis, respondents must be allowed to reconsider and correct by themselves their evaluations with an adapted tool.

Design/methodology/approach

– This system also helps respondents to easily evaluate complex product profiles and to be involved in the evaluation process, which also leads to the creation of new knowledge for product design. As this system is designed for marketers and for respondents, this paper also presents the case of a product evaluation with attributes selectable by respondents.

Findings

– This paper is based on empirical experiment to obtain an efficient design of our system. The authors propose different evaluation scenario to usersto decide the design of our system. The authors want to include users in our evaluation process; however, we found that too much liberty for users can interfere with our objective.

Originality/value

– This paper present the design of our original system allowing to perform interactive conjoint analysis.
The effectiveness of fraud detection instruments in not-for-profit organizations
Authors: Kummer Tyge-F. , Singh Kishore , Best Peter
Published: April 2015

Purpose

– The purpose of this study is to investigate the effectiveness of fraud detection instruments in not-for-profit (NFP) organizations. Not-for-profit organizations rely on trust and volunteer support. They are often small in size and do not have relevant expertise to prevent fraud. Such organizations are more vulnerable to fraud and, consequently, require effective fraud detection instruments. The existing literature on fraud detection is primarily descriptive and does not measure instrument performance. The authors address this research gap and provide a detailed overview of the impact of nine common fraud detection instruments.

Design/methodology/approach

– Data were obtained from an NFP fraud survey conducted in Australia and New Zealand. A set of contingency tables is produced to explore the relationship between the existence of a specific fraud detection instrument and actual detection of fraud. We also investigate the relationship between organization size and fraud detection strategy.

Findings

– The findings provide valuable insights into understanding fraud detection mechanisms. Although most fraud detection measures may not lead to more fraud detection, three highly effective instruments emerge, namely, fraud control policies, whistle-blower policies and fraud risk registers. The results also reveal that commonly used fraud detection instruments are not necessarily the most effective. This is true in a significant number of small organizations that appear to be focusing on ineffective fraud detection instruments.

Practical implications

– Implementation of more effective fraud detection measures will reduce the damage caused to an organization and is highly relevant for practitioners.

Originality/value

– The results show that differences in the effectiveness of fraud detection instruments in the NFP sector exist. This knowledge is directly applicable by related organizations to reduce fraud damage.
MEMS SPDT microswitch with low actuation voltage for RF applications
Authors: Samaali Hatem , Najar Fehmi , Ouni Bouraoui , Choura Slim
Published: April 2015

Purpose

– This paper aims to propose a novel design of an ohmic contact single-pole double-throw (SPDT) microelectromechanical system (MEMS) microswitch for radio frequency applications.

Design/methodology/approach

– The proposed microswitch (SPDT design) shares antenna between transmitter and receiver in a wireless sensor. An electrical voltage is used to create an electrostatic force that controls the ON/OFF states of the microswitch. First, the authors develop a mathematical model of the proposed microswitch and propose a reduced-order model of the design, based on the differential quadrature method, which fully incorporates the electrostatic force nonlinearities. The authors solve the static, transient and dynamic behavior and compare the results with finite element solutions. Then, the authors examine the dynamic solution of the switch under different actuation waveforms.

Findings

– The obtained results showed a significant reduction in actuation voltage, pull-in bandwidth and switching time.

Originality/value

– In this paper, a new design of SPDT MEMS switch is proposed, the SPDT switch needs low voltage to be actuated and it can be easily integrated with integrated circuits.
Child maltreatment: how can friends contribute to safety?
Authors: Allnock Debra Sue
Published: May 2015

Purpose

– The purpose of this paper is to present the findings of a study of support received by 60 young adults who experienced sexual, physical or emotional abuse and neglect in childhood. It is focussed on the support provided by friends in particular, and draws out relevant learning for child sexual exploitation (CSE).

Design/methodology/approach

– In all, 60 young people completed a questionnaire, complemented by a two hour follow-up interview to explore experiences of formal and informal support in disclosing abuse. In total, 13 young people were recruited on the basis of their prior participation in a larger, associated study of child abuse and neglect, with the remainder recruited via open invitation.

Findings

– There is rich information in the interviews about the ways that friends provided support to participants. Friends provided practical, moral and emotional support. They intervened to keep their friends safe. They offered emotional “escape” and a conduit to adults who could help keep them safe. Importantly, friends recognised that participants were in distress even when they did not know the participants were being abused.

Practical implications

– The results highlight that friends have a crucial role to play in helping children to keep safe and to feel safe, provided that they are equipped with information and knowledge of how to respond and where to seek help.

Originality/value

– The paper is original in considering the role of friends within a community safety framework. In addition, the study sample is larger than other studies of its kind, and considers a wider variety of child maltreatment experiences than previous studies, making clear links to CSE.
Understanding children’s non-disclosure of child sexual assault: implications for assisting parents and teachers to become effective guardians
Authors: Wager Nadia Marie
Published: May 2015

Purpose

– The purpose of this paper is to examine adult survivors’ of childhood sexual abuse (CSA) retrospective reflections on their motives for not disclosing their abuse. The aim was to identify factors that might facilitate early disclosure in order to both enhance the future safety of young people who have experienced sexual victimisation and to offer a means of reducing the numbers of future victims.

Design/methodology/approach

– This was a retrospective web-based, mixed-methods survey which was completed by 183 adult survivors of CSA. The data presented here is in relation to answers offered in response to an open-ended question which were thematically analysed.

Findings

– In all, 75 per cent of the survivors of CSA indicated that they had not told anyone of the abuse whilst they were a child. Analysis of the responses revealed five barriers to disclosure which included: a lack of opportunity, normality/ambiguity of the situation, embarrassment, concern for others and a sense of hopelessness. Additionally, some respondents highlighted implicit attempts to disclose and others reported later regret over non-disclosure.

Practical implications

– A timely disclosure of CSA, which is appropriately responded to, has the potential to reduce the risk for subsequent sexual exploitation/revictimisation, and to foreshorten the predations of offenders. To achieve this, responsible and trusted adults in the lives of children need to learn how to invite a genuine disclosure of CSA.

Originality/value

– This paper offers practical suggestions for parents and teachers on what signs indicate that an invitation might be warranted and for creating the right context for their invitation to be accepted.
Effect of topical vitamin D on chronic kidney disease‐associated pruritus: An open‐label pilot study
Authors: Jung Kyung Eun , Woo Yu Ri , Lee Joong Sun , Shin Jong Ho , Jeong Jin Uk , Koo Dae Won , Bang Ki Tae
Published: April 2015

Chronic kidney disease‐associated pruritus (CKD‐aP) is a troublesome symptom in patients with end‐stage renal disease (ESRD). Recently, vitamin D deficiency has been known to be one of the possible etiologic factors in CKD‐aP. However, limited data is available on whether topical vitamin D treatment is effective for relieving CKD‐aP. Therefore, the purpose of this study is to evaluate the effectiveness of topically vitamin D for CKD‐aP. Twenty‐three patients with CKD‐aP were enrolled in a single center, open‐label study. Patients were instructed to apply a topical vitamin D (calcipotriol) agent (Daivonex solution; LEO Pharma) or vehicle solution twice daily for a month. We assessed the efficacy and safety of topical vitamin D on CKD‐aP using clinical and dermoscopic photographs, and questionnaires including the validated modified pruritus assessment score (VMPAS) and visual analog scale (VAS) every 2 weeks. Dry dermoscopic findings showed significant improvement of scale (dryness) on the skin of topical vitamin D‐treated patients compared with those of the vehicle group. Both VMPAS and VAS were significantly decreased after 2 and 4 weeks of the topical vitamin D treatment compared with the vehicle, respectively (P < 0.05). No significant side‐effects were observed. Topical vitamin D may be one of the safe and effective therapeutic candidates for CKD‐aP.
The Adaptive Capacity of Markets and Convergence in Law: UK High Yield Issuers, US Investors and Insolvency Law
Authors: Paterson Sarah
Published: May 2015

This article examines the increasing access by UK issuers of high yield bonds to US investors notwithstanding substantive differences in the approach to valuation of the issuer in financial distress in US and UK restructuring law and, therefore, in anticipated return on default. It examines the development of the market in the context of existing theories on the relationship between law and finance and suggests that previous accounts have overlooked the adaptive capacity of the finance market to legal environment and the implications of such structural adaptation for the prospects of convergence in law. Three states are identified: where the market is poorly adapted to the legal environment and reinforces other pressure for change, where the market is adapted to the legal environment and is a neutral influence on, or even dampens, other pressure for change and where both legacy and adapted structures exist, potentially pulling in different directions at the same time.
Section 47 of theEnterprise andRegulatoryReformAct 2013: A FlawedReform of theUKCartel Offence
Authors: Whelan Peter
Published: May 2015

On 1April 2014, section 47 of theEnterprise andRegulatoryReformAct 2013 (ERRA) entered into force, ensuring significant changes to theUKcartel offence. The criminal offence, contained in section 188 of theEnterpriseAct 2002, was enacted to secure the deterrence of cartel activity affecting theUK. Following almost ten years of enforcement, the cartel offence had failed to live up to expectations. Consequently, following a public consultation, it was reformed in substance. Section 47ERRA, removed the (controversial) definitional element of ‘dishonesty’ from the offence, created a number of ‘carve outs’ from the offence, and created three additional defences. This article examines in detail the specific reforms of the cartel offence and argues that, although considerable improvement has been made, theUKoffence is fundamentally flawed and unworkable in practice. Further reform is therefore advised.
Monitoring Technology for Gamma‐Aminobutyric acid Production in Polished Mochi Barley Grains using a Carbon Dioxide Sensor
Authors: Watanabe Yasuo , Kawata Kohki , Watanabe Seiya
Published: April 2015

Gamma‐aminobutyric acid (GABA) has many biological functions, including the inhibition of blood pressure increases and acceleration of growth hormone secretion. In this study, we discovered the utility of measuring the concentration of carbon dioxide (CO2) dissolved in the reaction solution, for development of a real‐time and convenient technique to estimate GABA production. In addition to mochi barley bran, we examined the polished grains of three species: mochi barley (a variant of hulless barley), barley, and Japanese millet, all soaked in l‐glutamic acid (l‐Glu) solution at pH 4.5. We found a positive correlation between GABA and CO2 concentrations, and the production of CO2 was suppressed in the absence of l‐Glu at pH 4.5. These results suggest that GABA content can be easily predicted by measuring the aqueous CO2 content using a CO2 sensor, during the process of GABA production in polished mochi barley grains and bran.
A safer alternative: Cannabis substitution as harm reduction
Authors: Lau Nicholas , Sales Paloma , Averill Sheigla , Murphy Fiona , Sato Sye‐Ok , Murphy Sheigla
Published: April 2015

Introduction and Aims

Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework.

Design and Methods

We present selected findings from our qualitative study of Baby Boomer (born 1946–1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio‐recorded, semi‐structured in‐depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices.

Results

Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low‐risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain.

Discussion and Conclusions

Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative. [Lau N, Sales P, Averill S, Murphy F, Sato S, Murphy S. A safer alternative: Cannabis substitution as harm reduction. Drug Alcohol Rev 2015;34:654–659]
Does Europe Matter? A Comparative Study of Young People's Identifications with Europe at a State School and a European School in England
Authors: Savvides Nicola , Faas Daniel
Published: April 2015

This article explores the extent to which young people in predominantly middle‐class environments identify with Europe and considers the influence of European education policy, school ethos and curricula. We compare data drawn from individual and focus group interviews with students aged 15–17 at a state school and a European School in England. The empirical analysis was informed by post‐structuralism and found that young people at both schools developed multidimensional, multifaceted identities. Students at the European School, which has an ethos of developing both national and European identities, identified themselves more as European than their peers at the state school, which integrated students on the basis of a common British citizenship. The findings suggest that the policy on the European dimension in education contributes towards developing students’ identification with Europe and to their knowledge of Europe, though not at the expense of their ethnic and national identities, which were stronger than their European identities. Lack of a European dimension in education (both in and out of school) seems to result in a lack of identification with and knowledge about Europe.
Initial preference for plant species and state during oviposition site selection by an odonate
Authors: Lambret Philippe , Besnard Aurélien , Matushkina Natalia
Published: May 2015

Endophytic egg‐laying odonates use an ovipositor to insert their eggs inside plant tissues. Before egg deposition, oviposition site selection consists of two crucial steps: (i) the initial choice, typically decided in species that oviposit in tandem within vertical substrates by the male when landing and then by the female by staying on the substrate or flying to another; and (ii) the insertion site choice, made by the female who uses her ovipositor to palpate the substrate. Some odonates prefer to deposit their eggs within specific plant species. Some are able to discriminate between living and dead substrates during the initial choice. However, the extent to which odonates discriminate among distinct plant species during the initial choice is unknown. We studied the initial site preference in Lestes macrostigma (Odonata: Lestidae) to determine whether the males and/or females show a distinct preference among five types of shoots when landing on or when palpating the substrate, respectively. Male L. macrostigma preferred to land on Bolboschoenus maritimus and dead Juncus spp. When focusing on J. maritimus, females preferentially palpated the substrate when the male landed on dead shoots. We suggest that the male preference for these substrates is consistent with that of the female during insertion site choice but also during egg deposition. Such behavior should reduce the duration of oviposition, with benefits of reducing the predation risk and increasing available time for foraging. The advantage in preferring these substrates should be linked to a selection pressure acting on egg development and/or survival.
Out‐of‐pocket health expenditure for poor and non‐poor older adults inColombia: composition and trends
Authors: Prada Sergio I. , Duarte Jorge L. , Guerrero Ramiro
Published: April 2015

Colombia is a middle income country with a growing older adult population and the only country in Central and South America with Universal Health coverage insurance. The purpose of this article is twofold. First, it describes a simple methodology to estimate Out‐of‐Pocket (OOP) health spending by line items using the Colombian Living Standard Measurement Survey (LSMS). Second, it describes the composition of such spending and shows recent trends in OOP health expenditures between poor and non‐poor older adults using three waves of the same survey. Annual OOP on health spending, as percentage of Gross Domestic Product (GDP), was 2.87, 2.59 and 2.33% for those years respectively. Personal hygiene represents the largest line item, followed by over‐the‐counter (OTC) drugs, dentistry services and transportation to the point of care. At the per‐capita level, OOP spending on health care for older adults is also low, representing 3% of the legal monthly minimum wage for poor older adults and 9% for non‐poor older adults. Nonetheless, a look at the composition of the OOP reveals that older adults are at a disadvantage due to the fact that OTC drugs represent the biggest share of their spending, 44% for the poor and 31% for the non‐poor.
Frequency of squamous cell carcinoma (SCC) invasion in transected SCC in situ referred for Mohs surgery: the Dartmouth−Hitchcock experience
Authors: Knackstedt Thomas J. , Brennick Jeoffry B. , Perry Ann E. , Li Zhongze , Quatrano Nicola A. , Samie Faramarz H.
Published: April 2015

Background

Squamous cell carcinoma (SCC) in situ may be transected in a superficial biopsy, which makes it difficult to distinguish between in situ and invasive carcinoma. This study investigated the frequency of invasive SCC in transected SCC in situ referred for Mohs surgery.

Methods

A retrospective chart review was performed to identify subjects with biopsy‐proven, transected SCC in situ referred for Mohs surgery. The incidence of invasion, histologic variables, preoperative and intraoperative correlations, and clinical factors were determined and recorded.

Results

Of 51 cases identified, five (9.8%) were found to harbor invasive SCC, 15 (29.4%) showed SCC in situ, and 28 (54.9%) showed evidence of scarring, inflammation, or actinic keratosis at the prior biopsy site. Invasive lesions required significantly more stages of Mohs surgery to obtain tumor clearance but were similar with regard to patient age, symptoms, and family and personal histories of skin cancer. Preoperative lesion size and duration were greater in invasive cases, but these differences did not reach statistical significance.

Conclusions

A small number of transected SCCs in situ, to which the caveat “invasion cannot be ruled out” can be applied, have an invasive component that is identified during Mohs surgery. Definitive treatment choices should depend on the physician's impression, the clinical characteristics of the lesion, tumor location, patient comorbidities, and patient desires.
Prediction of Intracerebral Haemorrhage Expansion with Clinical, Laboratory, Pharmacologic, and Noncontrast Radiographic Variables
Authors: Chan Sheila , Conell Carol , Veerina Kaivalya T. , Rao Vivek A. , Flint Alexander C.
Published: April 2015

Background

Hematoma expansion confers excess mortality in intracerebral haemorrhage, and is potentially preventable if at-risk patients can be identified. Contrast extravasation on initial computed tomographic angiography strongly predicts hematoma expansion but is not very sensitive, and most centers have not yet integrated computed tomographic angiography into acute intracerebral haemorrhage management. We therefore asked whether other presentation variables can predict hematoma expansion.

Methods

We searched the electronic medical records of a large integrated healthcare delivery system to identify patients with a hospitalization discharge diagnosis of intracerebral haemorrhage between the years 2008 and 2010. Hematoma expansion was defined as radiographic increase by 1/3 or by 12·5 ml within 48 h of presentation. Pre-specified patient demographic and clinical presentation variables were extracted. Stepwise multivariable logistic regression was performed to model hematoma expansion. Because some patients may have died from hematoma expansion without a second head computed tomography, we constructed a separate model including patients that died without a second head computed tomography in 48 h, hematoma expansion or death.

Results

Ninety-one of 257 patients (35%) had hematoma expansion. Antithrombotic use (odds ratio = 1·9, P = 0·04) and initial mNIHSS (modified National Institutes of Health Stroke Scale; odds ratio = 1·06, P = 0·001) were significant predictors in the hematoma expansion model (area under the Receiver–Operator Characteristics curve, AUROC = 0·6712, pseudo- r2 = 0·0641). 163 of 343 patients (48%) had hematoma expansion or death. Age (odds ratio = 1·02, P = 0·02), initial mNIHSS (odds ratio = 1·07, P < 0·001), and initial hematoma volume (odds ratio = 1·01, P = 0·03) were significant predictors of hematoma expansion or death (AUROC = 0·7579, pseudo- r2 = 0·1722).

Conclusion

Clinical and noncontrast radiographic variables only weakly predict hematoma expansion. Examination of other indicators, such as computed tomographic angiography contrast extravasation (the ‘spot sign’), may prove more valuable in acute intracerebral haemorrhage care.
The Ratio of Mesial to Neocortical Temporal Lobe Blood Flow as a Predictor of Dementia
Authors: Cohen Robert M. , Andreason Paul J. , Sunderland Trey
Published: April 2015

OBJECTIVE: The hypothesis tested was that an increased ratio of cerebral blood flow (rCBF) in the mesocortical temporal lobe to that of the neocortical temporal lobe (MES/ NEO ratio) would be related to clinical measures of dementia severity and would help distinguish Alzheimer's patients from normal controls.

DESIGN: The rCBF of nine Alzheimer's patients (5 males and 4 females; age = 65.9 ± 6.0 years, range 55–71; Folstein Mini‐Mental Status Examination = 18.6 ± 7.4, range 9–28) and 10 age‐matched normal controls (7 males, 3 females; age = 66.0 ± 5.7 years, range 58–75) was determined by positron emission tomography (PET) using H2150 and the method of Alpert et al.25

RESULTS: Alzheimer's disease patients had a significantly higher MES/NEO ratio (1.19 ± .17) than the age‐matched normal controls (.854 ± .14; t = .‐4.74, df= 17, P = .0002). Using a MES/NEO ratio of 1 as the cutoff point for discrimination between Alzheimer's patients and normal controls, the ratio demonstrated 100% sensitivity (no. of correctly identified Alzheimer's patients/no. of Alzheimer's patients) and 90% specificity (no. of correctly identified unaffected subjects/no. of unaffected subjects). Further, those patients with the highest MES/NEO ratios had the lowest overall measures of cognitive function (Folstein Mini‐Mental Status Examination: r = ‐.75, P < .02, 1‐tail; Mattis Dementia Rating Scale: r = −0.655, P = .028, 1‐tail) scores.

CONCLUSIONS: The findings are consistent with other in vivo and postmortem studies, suggesting that functional and structural changes of the lateral temporal lobe in Alzheimer's disease occur relatively early in the disease process and appear to be distinguishable from those changes accompanying normal aging. In contrast, the memory loss and pathology of the mesial temporal lobe that is characteristic of the early stages of Alzheimer's patients do not appear to be associated with a reduction in cerebral blood flow in the resting Alzheimer's patient. Nevertheless, the clinical significance of the results must await findings of longitudinal studies of larger numbers of Alzheimer's patients and controls.
Preventive Medicine and Screening in Older Adults
Authors: Goldberg Todd H. , Chavin Stephen I.
Published: April 2015

PURPOSE: To review important current issues, studies, recommendations and controversies relating to preventive medicine and screening in older people.

STUDY SELECTION/DATA ABSTRACTION: MEDLINE searches for literature on prevention and screening with regard to older adults as well as each individual condition reviewed; bibliographical reviews of textbooks, journal articles, government and advocacy organization task force reports, and recommendations. Important information synthesized and discussed qualitatively.

DATA SYNTHESIS: Data and recommendations are presented for most common preventive services, including primary prevention and screening for cardiovascular diseases and risk factors, common malignancies, endocrine and infectious diseases, osteoporosis, sensory deficits, and dementia.

CONCLUSIONS: The goal of preventive medicine in older people should be not only reduction of premature morbidity and mortality but preservation of function and quality of life. Attempts to prevent diseases of old age should start in youth; the older the patient, the less likely the possibility or value of primary and secondary prevention, and the greater the stress must be on tertiary prevention. Age 85 is proposed as a general cutoff range beyond which conventional screening tests are unlikely to be of continued benefit; however, care must always be individualized. Emphasis should be on offering the best proven and most effective interventions to the individuals at highest risk of important problems such as cardiovascular diseases, malignancies, infectious and endocrine diseases, and other important threats to function in older people. Breast cancer screening, smoking cessation, hypertension treatment, and vaccination for infectious diseases are thus far among the most firmly proven and well accepted specific preventive measures, with physical exercise also being particularly promising. Although more research is needed, a current working approach is necessary and possible. A summary table of recommendations and information tools such as reminders or flowsheets may be valuable in helping the physician carry out prevention and screening programs.
Transitions in Health Care Use and Expenditures Among Frail Older Adults by Payor/Provider Type
Authors: Pearlman Deborah N. , Branch Laurence G. , Ozminkowski Ronald J. , Experton Bettina , Li Zili
Published: April 2015

OBJECTIVES: To assess whether transitions in health care expenditures differed over time by payor/provider type: Medicare fee‐for‐service (FFS), Medicaid‐Medicare, and Medicare HMO.

DESIGN: Longitudinal study.

SETTING: A large, nonprofit healthcare system in San Diego, California.

PARTICIPANTS: A total of 450 frail older people who responded to the baseline and follow‐up surveys and who survived the 18‐month study period.

MEASUREMENTS: Measures included three total expenditure categories for each 6‐month period: low users (<$4000); medium users ($4000–$19,999); or high users ($20,000+). Seven conceptually meaningful expenditure trajectories over time were identified: (1) consistently low expenditures, (2) consistently medium expenditures, (3) consistently high expenditures, (4) decreasing expenditures, (5) increasing expenditures, (6) U‐shaped expenditures, and (7) inverted U‐shaped expenditures.

MAIN RESULTS: Logistic regression analyses showed that HMO enrollees were about twice as likely as Medicaid‐Medicare beneficiaries to have consistently low expenditures, but no differences were found between the FFS and HMO groups on this trajectory. Other expenditure patterns showed no significant differences by payor/provider group. Significant interactions among payor/provider type, low/medium/high expenditure status, and time were observed for inpatient hospital care, skilled nursing/rehabilitation care, and home health care.

CONCLUSION: This study illustrates the complexity of frail older people with respect to their health care expenditures and service use. Expanded efforts to control health care expenditures for frail older people should focus first on those who are dually‐enrolled. In addition, because mean medical expenditures for high users enrolled in different payor/provider groups were surprisingly similar, the data suggest that containing expenditures for individuals in the highest usage group ($20,000+) presents challenges for physicians practicing in an era of healthcare reform, regardless of payor/provider setting.
Frontotemporal Dementia Versus Vascular Dementia: Differential Features on Mental Status Examination
Authors: Cherrier Monique M. , Mendez Mario F. , Ferryman Kent M. , Pachana Nancy A. , Miller Bruce L. , Cummings Jeffrey L.
Published: April 2015

OBJECTIVE: After Alzheimer's disease, vascular dementia (VaD) and frontotemporal dementia (FTD) are among the most common dementing illnesses. FTD may have a neuropsychological profile similar to that of VaD, and patients with these dementias may be difficult to distinguish on clinical examination. The purpose of this study was to elucidate distinct cognitive profiles of a large group of FTD and VaD patients on a brief, clinical mental status examination.

DESIGN: A comparison of 39 FTD patients and 39 VaD patients on a brief, clinical mental status examination.

SETTING: A Dementia Research Center and affiliated, university hospitals.

METHODS: The FTD patients were diagnosed by noncognitive clinical and neuroimaging criteria, and the VaD patients met NINDS‐AIREN criteria for vascular dementia. The two dementia groups were comparable on three dementia assessment scales.

MEASUREMENTS: The mental status measures included the neuropsychological battery from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), plus supplementation from the Neurobehavioral Cognitive Status Examination (NCSE) for cognitive areas not assessed by the CERAD.

RESULTS: The FTD and VaD groups differed significantly on the mental status examination measures. FTD patients performed significantly better than the VaD patients on digit span and constructions, despite comparable performance by both groups on calculations. Although not statistically significant, the FTD group performed worse than the VaD group on verbal fluency and abstractions. These differences were not explained by group differences in age and education.

CONCLUSION: These results suggest that cognitive differences between FTD and VaD groups reflect greater frontal pathology in contrast to relative sparing of posterior cortex and subcortical white matter in FTD. These cognitive differences as measured by a mental status examination may help distinguish between these two dementia syndromes.
Oral Staphylococcus in Older Subjects with Rheumatoid Arthritis
Authors: Jacobson Jed J. , Patel Bonnie , Asher Gillian , Woolliscroft James O. , Schaberg Dennis
Published: April 2015

OBJECTIVE: To determine if Staphylococcus aureus and Staphylococcus epidermidis, etiologic bacterial agents to late prosthetic joint infections (LPJI), are more prevalent in the oral flora of older individuals with rheumatoid arthritis (RA) than in an age and gender‐matched nonarthritic control population (NA).

DESIGN: Cultures were obtained from the nares, oropharynx, saliva, tongue, and gingival crevice, and the results were compared between older patients with RA and controls.

SETTING: University of Michigan Medical Center, Ann Arbor, VA Medical Center, and University of Michigan School of Dentistry.

PARTICIPANTS: A total of 111 community‐dwelling subjects with a diagnosis of RA and 83 gender‐matched control subjects.

MEASUREMENTS: Colistin nalidixic acid agar plates with 5% sheep's blood were inoculated and incubated. Isolates were speciated using the API Staph Trac® micro method and catalase and coagulase tests.

MAIN RESULTS: Individuals with RA had a higher prevalence of S. aureus isolated from the oral cavity. However, only the oropharynx and tongue revealed higher rates; all other sites were insignificant. The presence of oral S. aureus was associated with xerostomia. Staphylococcus epidermidis was not detected from any of the oral sites sampled. Sixty‐two percent (10/16) of the S. aureus isolates from the RA subjects were resistant to penicillin and ampicillin, whereas none were resistant to a cephalosporin.

CONCLUSIONS: These findings suggest that rheumatoid arthritis may be a risk factor for LPJI in older prosthetic joint patients undergoing invasive dental procedures in the posterior oral cavity. This increased risk is caused, in part, by a higher prevalence of S. aureus in the posterior oral cavity. The prevalence and the antibiotic resistance of S. aureus must be considered when determining the need for chemoprophy‐laxis.
Cerebral White Matter Changes (Leukoaraiosis), Stroke, and Gait Disturbance
Authors: Briley Dennis P. , Wasay Mohammad , Sergent Susan , Thomas Stuart
Published: April 2015

OBJECTIVES: Leukoaraiosis, a radiological change of cerebral white matter thought to be caused by ischemia, is associated with gait disturbance. However, because of concomitant stroke and cerebral atrophy, the clinical relevance of leukoaraiosis is uncertain. We, therefore, sought to determine if leukoaraiosis is a predictor of gait disturbance after accounting for cerebral atrophy and stroke in patients with a high prevalence of cerebrovascular disease.

DESIGN: Cross‐sectional observational study.

SETTING: Neurology service (inpatient and outpatient) of a Department of Veterans Affairs Hospital.

PARTICIPANTS: Consecutive sample of 130 patients, 127 men and three women.

MEASUREMENTS: The findings of a gait scale were correlated to vascular risk factors, neurological examination as quantified by the NIH stroke scale and supplemental motor scale, and to brain CT findings. Brain CT scans were rated for leukoaraiosis, cerebral infarction, and cerebral atrophy.

RESULTS: Gait disturbance was more frequent and more severe in subjects with leukoaraiosis, of whom 31% had mild and 49% moderate/severe gait disturbance compared with 27% with mild and 12% with moderate/severe gait disturbance in subjects without leukoaraiosis (P < .001). Leukoaraiosis, cerebral atrophy, a history of multiple strokes, and weakness and ataxia of the legs were independent predictors of gait disturbance. The proportion and severity of leukoaraiosis increased with increasing gait disturbance in subgroups without leg deficit (P < .001) and without multiple strokes (P < .001), but no association with leukoaraiosis was shown in patients with leg deficit or a history of multiple strokes (P = .037 and P = .186, respectively). Gait disturbance was more severe when both leukoaraiosis and cerebral atrophy were present (P = .019).

CONCLUSION: In our Veteran population, leukoaraiosis is an independent predictor of gait disturbance after accounting for stroke and cerebral atrophy. Although leukoaraiosis is a form of cerebrovascular disease, it appears to be most closely associated to gait disturbance in the absence of symptomatic stroke or leg deficit. J Am Geriatr Soc 45:1434–1438, 1997.
The Synergy of Low Lung Function and Low Body Mass Index Predicting All‐Cause Mortality Among Older Japanese‐American Men
Authors: Sharp Dan S. , Burchfiel Cecil M. , Curb J. David , Rodriguez Beatriz L. , Enright Paul L.
Published: April 2015

OBJECTIVE: To assess the joint characteristics of low standardized weight and compromised pulmonary function in predicting all‐cause mortality.

DESIGN: A population‐based, prospective cohort study.

SETTING: Oahu Island, Hawaii.

PARTICIPANTS: Surviving Japanese‐American men of the Honolulu Heart Program cohort, 71 to 93 years of age (N = 3059).

MEASUREMENTS: Body mass index (BMI ‐ weight in kilograms/square of height in meters) and 1‐second forced expiratory volume (FEV1) as a percentage of age‐and height‐predicted FEV1 from the 1991 to 1993 examination of the cohort. Mortality data derived from the ongoing tracking of deaths of the cohort. Relations of selected risk factors among joint levels of BMI (≤ 21, >21 to <25, ≥ 25 kg/m2) and percent predicted FEV1 (≤ 70%, >70%) were determined. The impact of these covariates on relations between joint BMI/percent predicted FEV1 levels and subsequent all‐cause mortality was assessed.

RESULTS: The highest age‐adjusted mortality rate (91.9 deaths per 1000 person‐years) was noted among men characterized by the joint conditions of percent predicted FEV1 ≤ 70% and BMI ≤ 21 kg/m.2 This rate was 4.0 times the mortality rate of a “healthy” reference group characterized by percent predicted FEV1 > 70% and 21 < BMI < 25 kg/m2. This rate ratio is attenuated to 3.2 upon statistical control for measures of current and past smoking behavior. Among the three strata of BMI, statistical interaction is reflected in a heterogeneity of mortality rate differences (49.7, 21.8, − 9.6 deaths/person‐year, respectively) and rate ratios (2.18, 1.98, .66, respectively) comparing men with percent predicted FEV1 ≤ 70% to > 70%.

CONCLUSION: Joint loss of pulmonary function and relative weight is predictive of subsequent all‐cause mortality in excess of additive or multiplicative effects of each condition separately. Smoking behavior may contribute to this observation. J Am Geriatr Soc 45:1464–1471, 1997.
Older Women and Hormone Replacement Therapy: Factors Influencing Late Life Initiation
Authors: Leveille Suzanne G. , LaCroix Andrea Z. , Newton Katherine M. , Keenan Nora L.
Published: April 2015

OBJECTIVE: To describe factors associated with initiation of hormone replacement therapy (HRT) by older women.

DESIGN: A cross‐sectional study of 671 randomly selected women aged 65 to 80 who participated in a larger telephone survey on preventive health behaviors.

SETTING: A large health maintenance organization (HMO) in Seattle, Washington.

PARTICIPANTS: Of the 521 women who responded (78%), 51 had begun taking HRT at age 60 or older and were identified as initiators. Women who had never used HRT or past users who had begun HRT before age 60 were classified as noninitiators (n = 362). Current users who started HRT before age 60 (n = 108) were excluded.

MEASUREMENTS: Sources included the telephone survey, automated HMO pharmacy data, and HMO utilization and provider databases.

RESULTS: Initiators were similar to noninitiators with respect to age, marital status, education, and health status. Initiators were more likely to have had a hysterectomy at age 60 or later than noninitiators. Sixty‐two percent of the non‐initiators said they had received no information about the benefits of HRT from their providers compared with 18% of initiators. HRT initiation was associated with belief in prevention benefits of HRT for fractures and cardiovascular disease and with reported encouragement from the physician to use HRT.

CONCLUSIONS: Other than hysterectomy status, there were few sociodemographic or health characteristics that markedly distinguished older initiators from noninitiators. Our findings show the importance of physician counseling in an older woman's decision to initiate HRT. J Am Geriatr Soc 45:1496–1500, 1997.