bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss of phosphatase and tensin homolog expression correlates with clinicopathological features of non‐small cell lung cancer patients and its impact on survival: A systematic review and meta‐analysis
Authors: Zhao Yongsheng , Zheng Renyan , Li Jian , Lin Feng , Liu Lunxu
Published: March 2017

Background

Phosphatase and tensin homolog (
PTEN
), regarded as a tumor suppressor gene, may act as a prognostic biomarker in human cancers.

Methods

All eligible studies from MEDLINE, Embase, CENTRAL, and the Chinese BioMedical Literature Database to October 2016 were incorporated. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, assessed the methodological quality of the included studies, and conducted meta‐analysis.

Results

A total of 2486 patients from 19 studies were included. PTEN expression was significantly correlated with gender, smoking history, histology (adenocarcinoma [ADC] vs. squamous cell carcinoma), tumor node metastasis stage (I–II vs. III–IV), N status (N0 vs. N1–N3), and distant metastasis (M0 vs. M1). Loss of PTEN expression was associated with poorer overall survival, but had no significant association with disease‐free survival. Subgroup analysis showed that negative PTEN expression was associated with a poorer outcome in Asian and ADC patients, but not in Western or squamous cell carcinoma patients.

Conclusion

Loss of PTEN might play an unfavorable prognostic role for overall survival of non‐small cell lung cancer patients, especially Asian or ADC patients.
Management of postoperative pain in Spain: a nationwide survey of practice
Authors: Montes A. , Aguilar J. L. , Benito M. C. , Caba F. , Margarit C. ,   Acute Pain Group of the Spanish Pain Society (SED)
Published: March 2017

Background

Although the need for structured assessment and management of acute postoperative pain has been recognized, practices and responsibilities vary between and within hospitals and countries. We sought to determine current pain management practices in Spanish hospitals with and without acute pain services (APSs) or acute pain management programmes (APMPs) and compare them to practices reported for 1997–1998.

Methods

Members of the Spanish Pain Society and APS/APMP heads were asked to respond to a survey. Responses were stratified by hospital size (< 200 or ≥ 200 beds) and APS/APMP presence or not. Categorical variables were described by percentages and the 95% confidence interval and continuous ones by the median and interquartile range.

Results

Responses were received from 42.4% of hospitals with ≥ 200 beds (vs. 9.6% of the smaller ones). We fully analysed only data for the larger hospitals, 57.7% of which had an APS or APMP. Full‐time pain physicians were on staff in 28.6% of large hospitals; 25% had full‐time nurses. Patients received written information about postoperative pain in 34.8% of APS/APMP hospitals, and 72% of them recorded pain assessments routinely. Protocols reflected interdepartmental consensus in 80.8%; training in postoperative pain was organised in 54%. Respondents thought pain was well or very well managed in 46.4%. In APS/APMP hospitals the following results had improved: provision of written information for patients (58.5% vs. 0%), the recording of pain assessments (93% vs. 43.8%), consensus on a pain scale (92.5% vs. 41.9%), use of protocols (99.7% vs. 55.2%), analysis of quality indicators (52.8% vs. 15.4%), training (73% vs. 26.9%), and respondents’ satisfaction with pain management in their hospital (68.6% vs. 9.5%).

Conclusions

The presence of an APS or APMP is associated with better results on indicators of quality of acute postoperative pain management.
Environmental and spatial drivers of spider diversity at contrasting microhabitats
Authors: Barton Philip S. , Evans Maldwyn J. , Foster Claire N. , Cunningham Saul A. , Manning Adrian D.
Published: March 2017

The relative importance of environmental and spatial drivers of animal diversity varies across scales, but identifying these scales can be difficult if a sampling design does not match the scale of the target organisms' interaction with their habitat. In this study, we quantify and compare the effects of environmental variation and spatial proximity on ground‐dwelling spider assemblages sampled from three distinct microhabitat types (open grassland, logs, trees) that recur across structurally heterogeneous grassy woodlands. We used model selection and multivariate procedures to compare the effects of different environmental attributes and spatial proximity on spider assemblages at each microhabitat type. We found that species richness and assemblage composition differed among microhabitat types. Bare ground cover had a negative effect on spider richness under trees, but a positive effect on spider richness in open grassland. Turnover in spider assemblages from open grassland was correlated with environmental distance, but not geographic distance. By contrast, turnover in spiders at logs and trees was correlated with geographic distance, but not environmental distance. Our study suggests that spider assemblages from widespread and connected open grassland habitat were more affected by environmental than spatial gradients, whereas spiders at log and tree habitats were more affected by spatial distance among these discrete but recurring microhabitats. Deliberate selection and sampling of small‐scale habitat features can provide robust information about the drivers of arthropod diversity and turnover in landscapes.
Influence of cognitive reserve on neuropsychological functioning in bipolar disorder: Findings from a 5‐year longitudinal study
Authors: Hinrichs Kristin H , Easter Rebecca E , Angers Kaley , Pester Bethany , Lai Zongshan , Marshall David F , Kamali Masoud , McInnis Melvin , Langenecker Scott A , Ryan Kelly A
Published: March 2017

Objectives

The present study examined the 5‐year longitudinal course of cognitive functioning in a large sample of well‐characterized patients with bipolar disorder (BP), compared to healthy controls (HCs), and the influence of cognitive reserve factors (e.g., education and IQ) on cognitive change over time.

Methods

Participants included 159 individuals diagnosed with BP and 54 HCs recruited as part of a longitudinal naturalistic study of BP who had completed neuropsychological testing at the time of their enrollment and again 5 years later.

Results

The overall relative rate of change did not differ between the BP and HC groups. In total, 46.5% of the BP group and 37% of the HC group showed evidence of decline on at least one measure over time. T‐test analyses did not find differences between BP ‘decliners’ and ‘non‐decliners’ in cognitive reserve variables. However, we found that higher baseline intellectual ability was associated with more stability in cognitive test scores over time for the BP group. Results of linear regression modeling revealed that lower verbal IQ and education were related to increased cognitive decline in specific domains in the BP group.

Conclusions

This study has explored the influence of cognitive reserve on preservation of specific cognitive abilities over time in BP. The BP group did not demonstrate accelerated cognitive decline over 5 years compared to the HC group. Although the trajectory of cognitive change over time was similar between BP patients and HCs, higher overall intellectual ability may be a protective factor against cognitive decline, particularly for BP patients.
Doing many things at a time: Lack of power decreases the ability to multitask
Authors: Cai Ran Alice , Guinote Ana
Published: March 2017

Three studies investigated the effects of power on the ability to pursue multiple, concomitant goals, also known as multitasking. It was predicted that powerless participants will show lower multitasking ability than control and powerful participants. Study 1 focused on self‐reported ability to multitask in a sample of executives and subordinate employees. Studies 2 and 3 investigated the ability to dual‐task and to switch between tasks, respectively, using dual‐task and task‐switching paradigms. Across the studies, powerless individuals were less able to effectively multitask compared with control and powerful participants, suggesting that the detrimental effects of lack of power extend beyond single‐task environments, shown in past research, into multitasking environments. Underlying mechanisms are discussed.
A randomized, placebo‐controlled trial of beloranib for the treatment of hypothalamic injury‐associated obesity
Authors: Shoemaker Ashley , Proietto Joseph , Abuzzahab M. Jennifer , Markovic Tania , Malloy Jaret , Kim Dennis D.
Published: March 2017

Aims

Hypothalamic injury‐associated obesity (HIAO) results from damage to the hypothalamus that often occurs with surgical removal/radiation therapy of tumours in the hypothalamic region, such as craniopharyngioma. There is currently no rigorously studied pharmaceutical treatment for the intractable weight gain and cardiometabolic consequences that occur in patients with HIAO. We aimed to assess efficacy, safety and tolerability of beloranib treatment for 4 to 8 weeks in patients with HIAO.

Materials and methods

This Phase 2a, double‐blind, placebo‐controlled study included 14 patients with HIAO, randomized to receive beloranib 1.8 mg or placebo subcutaneously twice weekly for 4 weeks with an optional 4‐week open‐label extension in which all patients received beloranib. The primary endpoint was change in weight from baseline to Week 4.

Results

Participants were 64% female, with a mean (SD) age of 32 (9) years, BMI of 43 (7) kg/m2 and weight of 126 (22) kg. Compared with placebo (N = 4), beloranib 1.8 mg (N = 8) resulted in a mean (95% CI) difference in weight of −3.2 (−5.4, −0.9) kg after 4 weeks. Weight loss continued through the 8 weeks in patients randomized to beloranib (mean −6.2 [−8.2, −4.1] kg). Beloranib treatment was associated with improvements in high‐sensitivity CRP. Adverse events were mild to moderate. No patients who received beloranib discontinued treatment.

Conclusion

Beloranib treatment resulted in progressive weight loss in patients with HIAO that was comparable to that observed with beloranib in patients with exogenous obesity. These findings indicate a novel mechanism for treating obesity in patients with HIAO.
Accompanied Self: Debating Pentecostal Individual and Japanese Relational Selves in Transnational Japan
Authors: Ikeuchi Suma
Published: March 2017

While the notion of the individual figures prominently in the debate about Christian personhood, the concept of relational selves has shaped the existing literature on Japanese selfhood. I take this seeming divergence between “individual Christian” and “interdependent Japanese” as the point of departure to probe how Japanese‐Brazilian Pentecostal migrants in contemporary Japan understand and experience their sense of self. The article is based on 14 months of fieldwork in Toyota, Japan, which consisted of participant observation, interviews, and surveys among Brazilian and Japanese residents there. The discourses about the category of religion serve as a major source of data to tease out cultural understandings about “the authentic self.” I will argue that Pentecostal personhood does not fit within either the “individual” or the “relational.” The concept of “accompanied self” will then be proposed to accurately capture the kind of self that many migrant converts strive to embody.
Climate change is predicted to alter the current pest status of Globodera pallida and G. rostochiensis in the United Kingdom
Authors: Jones Laura M. , Koehler Ann‐Kristin , Trnka Mirek , Balek Jan , Challinor Andrew J. , Atkinson Howard J. , Urwin Peter E.
Published: March 2017

The potato cyst nematodes Globodera pallida and G. rostochiensis are economically important plant pathogens causing losses to UK potato harvests estimated at £50 m/ year. Implications of climate change on their future pest status have not been fully considered. Here, we report growth of female G. pallida and G. rostochiensis over the range 15 to 25°C. Females per plant and their fecundity declined progressively with temperatures above 17.5°C for G. pallida, whilst females per plant were optimal between 17.5 and 22.5°C for G. rostochiensis. Relative reproductive success with temperature was confirmed on two potato cultivars infected with either species at 15, 22.5 and 25°C. The reduced reproductive success of G. pallida at 22.5°C relative to 15°C was also recorded for a further seven host cultivars studied. The differences in optimal temperatures for reproductive success may relate to known differences in the altitude of their regions of origin in the Andes. Exposure of G. pallida to a diurnal temperature stress for one week during female growth significantly suppressed subsequent growth for one week at 17.5°C but had no effect on G. rostochiensis. However, after two weeks of recovery, female size was not significantly different from that for the control treatment. Future soil temperatures were simulated for medium‐ and high‐emission scenarios and combined with nematode growth data to project future implications of climate change for the two species. Increased soil temperatures associated with climate change may reduce the pest status of G. pallida but benefit G. rostochiensis especially in the southern United Kingdom. We conclude that plant breeders may be able to exploit the thermal limits of G. pallida by developing potato cultivars able to grow under future warm summer conditions. Existing widely deployed resistance to G. rostochiensis is an important characteristic to retain for new potato cultivars.
Modelling native and alien vascular plant species richness: At which scales is geodiversity most relevant?
Authors: Bailey Joseph J. , Boyd Doreen S. , Hjort Jan , Lavers Chris P. , Field Richard
Published: March 2017

Aim

To explore the scale dependence of relationships between novel measures of geodiversity and species richness of both native and alien vascular plants.

Location

Great Britain.

Time period

Data collected 1995–2015.

Major taxa

Vascular plants.

Methods

We calculated the species richness of terrestrial native and alien vascular plants (6,932 species in total) across the island of Great Britain at grain sizes of 1 km2 (n = 219,964) and 100 km2 (n = 2,121) and regional extents of 25–250 km diameter, centred around each 100‐km2 cell. We compiled geodiversity data on landforms, soils, hydrological and geological features using existing national datasets, and used a newly developed geomorphometric method to extract landform coverage data (e.g., hollows, ridges, valleys, peaks). We used these as predictors of species richness alongside climate, commonly used topographic metrics, land‐cover variety and human population. We analysed species richness across scales using boosted regression tree (BRT) modelling and compared models with and without geodiversity data.

Results

Geodiversity significantly improved models over and above the widely used topographic metrics, particularly at smaller extents and the finer grain size, and slightly more so for native species richness. For each increase in extent, the contribution of climatic variables increased and that of geodiversity decreased. Of the geodiversity variables, automatically extracted landform data added the most explanatory power, but hydrology (rivers, lakes) and materials (soil, superficial deposits, geology) were also important.

Main conclusions

Geodiversity improves our understanding of, and our ability to model, the relationship between species richness and abiotic heterogeneity at multiple spatial scales by allowing us to get closer to the real‐world physical processes that affect patterns of life. The greatest benefit comes from measuring the constituent parts of geodiversity separately rather than one combined variable (as in most of the few studies to date). Automatically extracted landform data, the use of which is novel in ecology and biogeography, proved particularly valuable in our study.
Communication challenges experienced by migrants with cancer: A comparison of migrant and English‐speaking Australian‐born cancer patients
Authors: Hyatt Amelia , Lipson‐Smith Ruby , Schofield Penelope , Gough Karla , Sze Ming , Aldridge Lynley , Goldstein David , Jefford Michael , Bell Melanie L. , Butow Phyllis
Published: March 2017

Objectives

Understanding the difficulties faced by different migrant groups is vital to address disparities and inform targeted health‐care service delivery. Migrant oncology patients experience increased morbidity, mortality and psychological distress, with this tentatively linked to language and communication difficulties. The objective of this exploratory study was to investigate the communication barriers and challenges experienced by Arabic, Greek and Chinese (Mandarin and Cantonese) speaking oncology patients in Australia.

Methods

This study employed a cross‐sectional design using patient‐reported outcome survey data from migrant and English‐speaking Australian‐born patients with cancer. Patients were recruited through oncology clinics and Australian state cancer registries. Data were collected regarding patient clinical and demographic characteristics and health‐care and communication experiences. Data from the clinics and registries were combined for analysis.

Results

Significant differences were found between migrant groups in demographic characteristics, communication and health‐care experiences, and information and care preferences. Chinese patients cited problems with understanding medical information, the Australian health‐care system, and communicating with their health‐care team. Conversely, Arabic‐ and Greek‐speaking patients reported higher understanding of the health‐care system, and less communication difficulties.

Conclusions

Our study findings suggest that migrant groups differ from each other in their health communication expectations and requirements. Lower education and health literacy of some groups may play a role in poorer health outcomes. Public health interventions and assistance provided to migrants should be tailored to the specific needs and characteristics of that language or cultural group. Future research directions are discussed.
Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists’ language
Authors: Chou Wen‐ying Sylvia , Hamel Lauren M. , Thai Chan L. , Debono David , Chapman Robert A. , Albrecht Terrance L. , Penner Louis A. , Eggly Susan
Published: March 2017

Background

The National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information.

Objective

This qualitative study describes oncologists’ language during discussions of prognosis and treatment goals in clinical interactions with African American patients diagnosed with cancer.

Design

We analysed transcripts from video recordings of clinical interactions between patients with StageIIIorIVcancer (n=26) and their oncologists (n=9). In‐depth discourse analysis was conducted to describe and interpret oncologists’ communication behaviours and common linguistic features in the interactions.

Setting and participants

Data were from a larger study of patient‐provider communication between African Americans and oncologists at two cancer hospitals in Detroit.

Results

Prognosis was discussed in 73.1% (n=19) of the interactions; treatment goals were discussed in 92.3% (n=24). However, analysis revealed that oncologists’ description of prognosis was vague (e.g. “prognosis is a bit worse in your case”) and rarely included a survival estimate. Oncologists often used ambiguous terminology, including euphemisms and jargon, and emphasized uncertainty (e.g. “lesions are suspicious for the disease”). Conversation about prognosis was frequently brief, moving quickly to the urgency and details of treatment.

Discussion

This study demonstrates how oncologists’ language may obscure discussion of prognosis and treatment goals. The identified behaviours may lead to missed opportunities in eliciting and discussing patients’ knowledge about and preferences for their care. Patient‐, provider‐ and system‐oriented interventions are needed to improve clinical communication, especially among minority patients with advanced cancer.
Morphological and immunophenotypical features of hairy cell leukaemia involving lymph nodes and extranodal tissues
Authors: Cortazar Jacqueline M , DeAngelo Daniel J , Pinkus Geraldine S , Morgan Elizabeth A
Published: March 2017

Aims

Hairy cell leukaemia (HCL) is a rare B cell neoplasm that mainly affects bone marrow (BM), peripheral blood (PB) and spleen. Involvement of lymph nodes and extranodal structures is considered infrequent. Herein we describe our institutional experience of nodal (n = 10) and extranodal (n = 3) HCL during a 30‐year period.

Methods and results

Ten patients had prior evidence of HCL within the BM or PB at a median 35.8 months before nodal/extranodal diagnosis (range: <1–175 months), and HCL was diagnosed concurrently within the bone marrow of one additional patient. Nodal involvement showed distinct architectural patterns, including diffuse (62% of cases), sinusoidal (25%) and nodular (13%). Extranodal involvement was characterized as diffuse infiltration through underlying structures in all cases. Morphological features ranged from classic ‘fried‐egg’ cytology to a plasmacytoid appearance. Nodal/extranodal disease showed an overlapping immunophenotypical profile with other small B cell lymphomas, including expression of cyclin D1 (70%), CD43 (55%), CD10 (38%) and CD5 (8%). Rates of both CD43 and CD10 reactivity were higher than described previously in leukaemic HCL, suggesting that expression may be enriched in cases with extramedullary extension.

Conclusions

Although uncommon, HCL should be considered in the differential diagnosis of small B cell neoplasms involving nodal/extranodal sites, given the therapeutic implications. In particular, recent discoveries including detection of the BRAFV600E mutation in nearly all cases of HCL and the availability of an antibody to CD103 for use in paraffin‐embedded tissues will facilitate the distinction of HCL from other small B cell lymphomas in the nodal/extranodal setting.
Coagulation factors, anticoagulant proteins, and plasminogen in Mexican older adults
Authors: Hernández Zamora E. , González‐Espinosa L. O. , Zavala‐Hernández C. , Rosales‐Cruz E. , Reyes‐Maldonado E.
Published: March 2017

Introduction

Hemostasis protects upon the occurrence of vascular endothelial damage, with involving of different factors. The interaction of these factors in older adults is poorly known, and has been associated with different disorders. Therefore, we determined the activity of coagulation factors (CF), anticoagulant proteins (AP), and plasminogen (Plg), as well as the frequency of deficiencies of these proteins in a population of healthy Mexican older adults (OA).

Methods

CF (I, II, V, VII, VIII, IX, X, and XI y XII), AP [protein C (PC), protein S (PS), and antithrombin (AT)], and Plg were determined from 244 plasma samples of OA using commercial kits in a coagulometer ACL Elite Pro.

Results

A total of 139 women and 105 men were under study. They were divided into age range groups (50–59, 60–69, 70–79, and ˃80 years). Activity of CF, AP, and Plg was determined. Frequencies of CF, AP, and Plg activity values were obtained for each age group according to gender. Differences were found between both frequencies for each protein.

Conclusion

Significant differences were found, so it is recommended to establish reference values (RV) for the activity of fibrinogen and FX by decade and gender, FVII and FXII by gender, FII, FV, FVIII, PC, PS, and Plg by decade, whereas for FIX, FXI, and AT, they are not modified by age or gender, so the RV described for adult Mexican population can be used. It is important to integrate these results into established diagnostic algorithms, which can be taken into account to provide an accurate diagnosis and treatment for patients with suspected hemorrhagic or thrombotic processes, as well as suggest those habits that improve their quality of life, to maintain optimal health and prevent thrombotic and hemorrhagic events.
A model for upscaling global partnerships and building nurse and midwifery capacity
Authors: Spies L.A. , Garner S. L. , Faucher M.A. , Hastings‐Tolsma M. , Riley C. , Millenbruch J. , Prater L. , Conroy S.F.
Published: March 2017

Aim

To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships.

Background and introduction

Nurses and midwives across nations need skills reaching beyond the bedside and unit level in today's complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed.

Discussion

This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents.

Conclusion and implications for nursing

Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long‐term goals for capacity building through strong and sustainable global partnerships.

Implication for nursing policy

Development of global skills can focus the nurse and midwife to influence policy‐level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value‐added component to the well‐rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy‐level discussions.
An overview of the therapeutic potential of regenerative medicine in cutaneous wound healing
Authors: Pang Calver , Ibrahim Amel , Bulstrode Neil W , Ferretti Patrizia
Published: March 2017

The global burden of disease associated with wounds is an increasingly significant public health concern. Current treatments are often expensive, time‐consuming and limited in their efficacy in chronic wounds. The challenge of overcoming current barriers associated with wound care requires innovative management techniques.

Regenerative medicine is an emerging field of research that focuses on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function. This article provides an overview of the pathophysiology of wound healing and reviews the latest evidence on the application of the principal components of regenerative medicine (growth factors, stem cell transplantation, biomaterials and tissue engineering) as therapeutic targets.

Improved knowledge and understanding of the pathophysiology of wound healing has pointed to new therapeutic targets. Regenerative medicine has the potential to underpin the design of specific target therapies in acute and chronic wound healing. This personalised approach could eventually reduce the burden of disease associated with wound healing. Further evidence is required in the form of large animal studies and clinical trials to assess long‐term efficacy and safety of these new treatments.
Mechanical and chemical plaque control in the simultaneous management of gingivitis and caries: a systematic review
Authors: Figuero Elena , Nóbrega Diego F. , García‐Gargallo María , Tenuta Livia M. A. , Herrera David , Carvalho Joana C.
Published: March 2017

Aim

To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries.

Material and Methods

A protocol was designed to identify randomized (RCTs) and controlled (CCTs) clinical trials, cohort studies and prospective case series (PCS), with at least 6 months of follow‐up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta‐analyses were performed whenever possible.

Results

After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self‐performed mechanical plaque control significantly reduces standardized plaque index [n = 4; weighted mean difference (WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis.

Conclusion

Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries.
Treatment considerations in actinic keratosis
Authors: Goldenberg G.
Published: March 2017

The chronic skin condition actinic keratosis (AK) is characterized by the formation of keratotic lesions of variable thickness that are poorly delimited. AK occurs on areas of the skin that have had long‐term exposure to the sun or UV radiation. Although AKs may regress, they usually persist and can progress to squamous cell carcinoma (SCC). Clinicians are unable to predict which AKs will progress; therefore, both clinically visible lesions and subclinical, non‐visible (i.e. the entire area affected by AK/field cancerization) should be treated. AK treatment options include lesion‐directed therapies that target specific AK lesions and field‐directed therapies that target multiple clinical lesions and the underlying field damage. This article reviews currently available treatment options in AK, with a focus on patient‐applied field therapies, and their suitability according to specific disease characteristics and patient needs. Choice of treatment in AK depends on lesion‐, patient‐ and treatment‐related factors and should be individualized. Considerations when choosing a therapy include site of application, treatment duration, surface area of application, tolerability profiles and implications on adherence. Field‐directed therapies treat clinical and subclinical damage (i.e. the entire area affected by AK), achieve high rates of sustained clearance of AKs and may reduce the risk of progression to SCC. There is a clear need for field therapies with short duration of treatment and predictable, short‐lived, mild local skin reactions that can be used over a large surface area. Therapies with shorter and simpler treatment courses are often associated with better adherence than treatments with longer courses. These may, therefore, represent more appropriate choices in patients for whom convenience and/or adherence are an issue.
Mapping an Experiment‐Based Assessment of Collaborative Behavior Onto Collaborative Problem Solving in PISA 2015: A Cluster Analysis Approach for Collaborator Profiles
Authors: Herborn Katharina , Mustafić Maida , Greiff Samuel
Published: March 2017

Collaborative problem solving (CPS) assessment is a new academic research field with a number of educational implications. In 2015, the Programme for International Student Assessment (PISA) assessed CPS with a computer‐simulated human‐agent (H‐A) approach that claimed to measure 12 individual CPS skills for the first time. After reviewing the approach, we conceptually embedded a computer‐based collaborative behavior assessment (COLBAS) into the overarching PISA 2015 CPS approach. COLBAS is an H‐A CPS assessment instrument that can be used to measure certain aspects of CPS. In addition, we applied a model‐based cluster analysis to the embedded COLBAS aspects. The analysis revealed three types of student collaborator profiles that differed in cognitive performance and motivation: (a) passive low‐performing (non‐)collaborators, (b) active high‐performing collaborators, and (c) compensating collaborators.
Falls and Frailty in Prostate Cancer Survivors: Current, Past, and Never Users of Androgen Deprivation Therapy
Authors: Winters‐Stone Kerri M. , Moe Esther , Graff Julie N. , Dieckmann Nathan F. , Stoyles Sydnee , Borsch Carolyn , Alumkal Joshi J. , Amling Christopher L. , Beer Tomasz M.
Published: March 2017

Objectives

To compare the prevalence of and association between falls and frailty of prostate cancer survivors (PCSs) who were current, past or never users of androgen deprivation therapy (ADT).

Design

Cross‐sectional.

Setting

Mail and electronic survey.

Participants

PCSs (N = 280; mean age 72 ± 8).

Measurements

Cancer history, falls, and frailty status (robust, prefrail, frail) using traditionally defined and obese phenotypes.

Results

Current (37%) or past (34%) ADT users were more than twice as likely to have fallen in the previous year as never users (15%) (P = .002). ADT users had twice as many recurrent falls (P < .001) and more fall‐related injuries than unexposed men (P = .01). Current (43%) or past (40%) ADT users were more likely to be classified as prefrail or frail than never users (15%) (P < .001), and the prevalence of combined obese frailty + prefrailty was even greater in current (59%) or past (62%) ADT users than never users (25%) (P < .001). Traditional and obese frailty significantly increased the likelihood of reporting falls in the previous year (odds ratio (OR) = 2.15, 95% CI = 1.18–3.94 and OR = 2.97, 95% CI = 1.62–5.58, respectively) and was also associated with greater risk of recurrent falls (OR = 3.10, 95% CI = 1.48–6.5 and OR = 3.99, 95% CI = 1.79–8.89, respectively).

Conclusions

Current and past exposure to ADT is linked to higher risk of falls and frailty than no treatment. PCSs should be appropriately counseled on fall prevention strategies, and approaches to reduce frailty should be considered.
Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6‐month Function and Cognition
Authors: Han Jin H. , Vasilevskis Eduard E. , Chandrasekhar Rameela , Liu Xulei , Schnelle John F. , Dittus Robert S. , Ely E. Wesley
Published: March 2017

Background

The natural course and clinical significance of delirium in the emergency department (ED) is unclear.

Objectives

We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6‐month functional status and cognition.

Design

Prospective cohort study.

Setting

Tertiary care, academic medical center.

Participants

ED patients ≥65 years old who were admitted to the hospital.

Measurements

The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6‐month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6‐month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6‐month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders.

Results

A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients’ delirium persisted into hospitalization. For every ED delirium duration day, the 6‐month OARS ADL decreased by 0.63 points (95% CI: −1.01 to −0.24), indicating poorer function. For every ED delirium duration day, the 6‐month IQCODE increased 0.06 points (95% CI: 0.01–0.10) indicating poorer cognition.

Conclusions

Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6‐month functional and cognitive outcomes.
Determinants of Dropout and Nonadherence in a Dementia Prevention Randomized Controlled Trial: The Prevention of Dementia by Intensive Vascular Care Trial
Authors: Beishuizen Cathrien R. L. , Coley Nicola , Moll van Charante Eric P. , van Gool Willem A. , Richard Edo , Andrieu Sandrine
Published: March 2017

Objectives

To explore and compare sociodemographic, clinical, and neuropsychiatric determinants of dropout and nonadherence in older people participating in an open‐label cluster‐randomized controlled trial—the Prevention of Dementia by Intensive Vascular care (preDIVA) trial—over 6 years.

Design

Secondary analysis.

Setting

One hundred sixteen general practices in the Netherlands.

Participants

Community‐dwelling individuals aged 70 to 78 (N = 2,994).

Intervention

Nurse‐led multidomain intervention targeting cardiovascular risk factors to prevent dementia.

Measurements

The associations between participant baseline sociodemographic (age, sex, education), clinical (medical history, disability, cardiovascular risk), neuropsychiatric (depressive symptoms (Geriatric Depression Scale‐15), and cognitive (Mini‐Mental State Examination)) characteristics and dropout from the trial and nonadherence to the trial intervention were explored using multilevel logistic regression models.

Results

Older age, poorer cognitive function, more symptoms of depression, and greater disability were the most important determinants of dropout of older people. The presence of cardiovascular risk factors was not associated with dropout but was associated with nonadherence. Being overweight was a risk factor for nonadherence, whereas people with high blood pressure or a low level of physical exercise adhered better to the intervention. The association between poorer cognitive function and symptoms of depression and dropout was stronger in the control group than in the intervention group, and vice versa for increased disability.

Conclusion

In a large dementia prevention trial with 6‐year follow‐up, dropout was associated with older age, poorer cognitive function, symptoms of depression, and disability at baseline. These findings can help to guide the design of future dementia prevention trials in older adults. The associations found between cardiovascular risk factors and nonadherence need to be confirmed in other older populations receiving cardiovascular prevention interventions.
Characterizing Clinical and MRI Dissociation in Patients with Multiple Sclerosis
Authors: Healy Brian C. , Buckle Guy J. , Ali Eman N. , Egorova Svetlana , Khalid Fariha , Tauhid Shahamat , Glanz Bonnie I. , Chitnis Tanuja , Guttmann Charles R.G. , Weiner Howard L. , Bakshi Rohit
Published: March 2017

BACKGROUND AND PURPOSE

Two common approaches for measuring disease severity in multiple sclerosis (MS) are the clinical exam and brain magnetic resonance imaging (MRI) scan. Although most patients show similar disease severity on both measures, some patients have clinical/MRI dissociation.

METHODS

Subjects from a comprehensive care MS center who had a concurrent brain MRI, spinal cord MRI, clinical examination, and patient reported outcomes were classified into three groups based on the Expanded Disability Status Scale (EDSS) and cerebral T2 hyperintense lesion volume (T2LV). The first group was the low lesion load/high disability group (LL/HD) with T2LV < 2 ml and EDSS ≥ 3. The second group was the high lesion load/low disability group (HL/LD) with T2LV > 6 ml and EDSS ≤ 1.5. All remaining subjects were classified as not dissociated. The three groups were compared using regression techniques for unadjusted analyses and to adjust for age, disease duration, and gender.

RESULTS

Twenty‐two subjects were classified as LL/HD (4.1%; 95% CI: 2.6%, 6.2%), and 50 subjects were classified as HL/LD (9.4%; 95% CI: 7.0%, 12.2%). Subjects in the LL/HD group were more likely to have a progressive form of MS and had significantly lower physical quality of life in adjusted and unadjusted analysis. Subjects in HL/LD had significantly more gadolinium‐enhancing lesions, and subjects in the LL/HD group had significantly more cervical spinal cord lesions.

CONCLUSIONS

Our results indicate that dissociation may occur between physical disability and cerebral lesion volume in either direction in patients with MS. Type of MS, brain atrophy, and spinal cord lesions may help to bridge this dissociation.
Arginine for gestating sows and foetal development: A systematic review
Authors: Palencia J. Y. P. , Lemes M. A. G. , Garbossa C. A. P. , Abreu M. L. T. , Pereira L. J. , Zangeronimo M. G.
Published: March 2017

The use of functional amino acids during pregnancy has been linked to improved reproduction in mammals. In this context, arginine is a precursor in the synthesis of numerous molecules, such as nitric oxide and polyamines, which play an important role during reproduction. However, contradictory studies are found in the literature, particularly regarding the amount of supplementation and the period of pregnancy in which it is used. The objective of this study was to evaluate the effects of dietary arginine supplementation for pregnant sows on foetal development via a systematic review. The search for papers was performed during the month of December 2015, in the databases ISI Web of Science, Science Direct, Scopus, and SciELO. From a total of 5675 returned studies, only 13 papers were selected after applying selection criteria. Most (47%) of the studies that evaluated the effects of dietary arginine supplementation on foetal development in pigs used 1% arginine. Supplementation was initiated in the first third of pregnancy in 47% of tests, including in both primiparous and multiparous sows. These studies showed positive results for embryo survival and foetal development, evidenced by the increase in placental weight and the number and weight of piglets born alive. Of all evaluated studies, 53% showed benefits on foetal development. It is concluded that supplementing dietary arginine in gestating sows can benefit embryo survival and foetal development. However, to establish a supplementation plan with this amino acid, aspects related to the period of pregnancy, supplementation levels, and source of arginine must be well defined.
Effects of restricted vs. step up dietary adaptation for 6 or 9 days on feedlot performance, feeding behaviour, ruminal and blood variables of Nellore cattle
Authors: Perdigão A. , Millen D. D. , Brichi A. L. C. , Vicari D. V. F. , Franzói M. C. S. , Barducci R. S. , Martins C. L. , Estevam D. D. , Cesar M. T. , Arrigoni M. D. B.
Published: March 2017

This study was designed to determine effects of quantitatively restricted intake of the final finishing diet as a means of dietary adaptation compared with diets increasing in concentrate (step up) over periods of 6 and 9 days on feedlot performance, carcass characteristics, feeding behaviour, blood gas profile and rumen morphometrics of Nellore cattle. One hundred twenty 22‐month‐old Nellore bulls (352 ± 20 kg) were randomly allocated in 24 pens and fed for 84 days. The experimental design was a completely randomized block with 2 × 2 factorial arrangement of treatments: adaptation using either step up protocol for 6 days or 9 days or restriction protocol for 6 days or 9 days, where the pen (five bullocks/pen; six pens/treatment) was considered the experimental unit. Cattle adapted by step up protocol had significantly greater average daily gain throughout the study when compared to those adapted by restriction protocol, regardless of adaptation length. During the adaptation period, a greater dry matter intake fluctuation was observed for animals maintained on restriction programme when compared to those adapted to the finishing diets using step up protocol. In addition, a protocol × length interaction for rumenitis scores was observed, where the level of injuries to the ruminal wall was significantly higher for the cattle adapted by restriction protocol for 9 days and lower for animals submitted for 9 days to the step up programme. Likewise, a protocol × length interaction for mitotic index was observed, in which cattle adapted by step up protocol for 9 days had lower numbers of cells in mitosis. Thus, the step up protocol led to better feedlot performance, and based on this fact, the length of 9 days promoted better rumen epithelium adaptation of Nellore cattle to high‐concentrate diets.
Dietary effects of soy and citrus flavonoid on antioxidation and microbial quality of meat in broilers
Authors: Kamboh A. A. , Memon A. M. , Mughal M. J. , Memon J. , Bakhetgul M.
Published: March 2017

The current study investigated dietary effects of soy genistein (SG) and citrus hesperidin (CH) on microbial spoilage and antioxidant quality of chicken meat. Broilers were divided to six treatment groups: control (C), SG and CH, supplemented with 5 mg of SG and 20 mg of CH per kg of feed, respectively, and SGCH1, SGCH2 and SGCH3, supplemented with 5, 10 or 20 mg of SG + CH (1:4) per kg of feed respectively. Both SG and CH reduced (p < .01) the microbial load of spoilage organisms in breast meat at 0 and 15 days of refrigeration. Hepatic and muscle total antioxidant and superoxide dismutase activities, and crude protein contents were generally improved (p < .05), whereas hepatic malondialdehyde concentration and muscle fat was decreased (p < .01) by the dietary treatments. In conclusion, soy genistein and CH supplementation could improve meat composition, antioxidant and microbial quality of broilers meat.
Relationships between body temperatures and inflammation indicators under physiological and pathophysiological conditions in pigs exposed to systemic lipopolysaccharide and dietary deoxynivalenol
Authors: Tesch T. , Bannert E. , Kluess J. , Frahm J. , Hüther L. , Kersten S. , Breves G. , Renner L. , Kahlert S. , Rothkötter H.‐J. , Dänicke S.
Published: March 2017

We studied the constancy of the relationship between rectal and intraabdominal temperature as well as their linkage to inflammatory markers (leucocyte counts, kynurenine‐to‐tryptophan ratio (Kyn–Trp ratio), tumour necrosis factor alpha (TNF‐α) in healthy and in pigs exposed to lipopolysaccharide (LPS) and/or deoxynivalenol (DON). Barrows (n = 44) were fed 4 weeks either a DON‐contaminated (4.59 mg DON/kg feed) or a control (CON) diet and equipped with an intraabdominal temperature logger and a multicatheter system (V.portae hepatis, V.lienalis, Vv.jugulares) facilitating infusion of 0.9% NaCl (CON) or LPS (7.5 μg/kg BW) and simultaneous blood sampling. Body temperatures were measured and blood samples taken every 15 min for leucocyte counts, TNF‐α and Kyn–Trp ratio. Combination of diet and infusion created six groups: CON_CONjug.‐CONpor., CON_CONjug.‐LPSpor., CON_LPSjug.‐CONpor., DON_CONjug.‐CONpor., DON_CONjug.‐LPSpor., DON_LPSjug.‐CONpor.. The relationship between both temperatures was not uniform for all conditions. Linear regression revealed that an intraabdominal increase per 1°C increase in rectal temperature was ~25% higher in all LPS‐infused pigs compared to NaCl‐infusion, albeit diet and site of LPS infusion modified the magnitude of this difference. Inflammatory markers were only strongly present under LPS influence and showed a significant relationship with body temperatures. For example, leucocyte counts in clinically inconspicuous animals were only significantly correlated to core temperature in DON‐fed pigs, but in all LPS‐infused groups, irrespective of diet and temperature method. In conclusion, the gradient between body core and rectal temperature is constant in clinically inconspicuous pigs, but not under various pathophysiological conditions. In the latter, measurement of inflammatory markers seems to be a useful completion.