bluuebunny/crossref_metadata_2025 huggingface dataset:
Teachers’ pedagogical decision‐making and influences on this when teaching students with severe intellectual disabilities
Authors: Lawson Hazel , Jones Phyllis
Published: August 2017

This article focuses on teachers' pedagogical decision‐making and influences on this decision‐making when teaching students with severe intellectual disabilities. The research reported and discussed forms part of an international collaborative research project in the south west of England and Florida, US. The study is set within the broader socio‐political context of inclusion, contributing a pedagogical dimension to other aspects of inclusion, such as placement, curriculum and accountability. Houssaye's (2000) pedagogical interaction model is examined and adapted to situate and analyse teachers’ pedagogical decision‐making, and influences on this, when teaching students with severe intellectual disabilities. The study shows a prominence and privileging of pedagogical decisions and influences around teacher‐student pedagogical interactions over curriculum‐teacher or curriculum‐student pedagogical interactions. The implications of this emphasis are considered in the historical context of teaching and learning models and approaches for this group of learners.
Levocarnitine Decreases Intradialytic Hypotension Episodes: A Randomized Controlled Trial
Authors: Ibarra‐Sifuentes Héctor Raúl , Del Cueto‐Aguilera Ángel , Gallegos‐Arguijo Daniel Alberto , Castillo‐Torres Sergio Andres , Vera‐Pineda Raymundo , Martínez‐Granados Rolando Jacob , Atilano‐Díaz Alexandro , Cuellar‐Monterrubio Jesus Eduardo , Pezina‐Cantú Cesar Octaviano , Martínez‐Guevara Edgar de Jesús , Ortiz‐Treviño Juan Francisco , Delgado‐García Guillermo Rubén , Martínez‐Jiménez José Guadalupe , Cruz‐Valdez Jesús , Sánchez‐Martínez Concepción
Published: August 2017

Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo‐controlled quadruple‐blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively. During the trial, 33 patients received 1188 hemodialysis sessions. We identified 239 (21.3%) intradialytic hypotension episodes. The intradialytic hypotension episodes were less frequent in the levocarnitine group (9.3%, 60 IH events) (P < 0.001). Hemodialysis is frequently perplexed by intradialytic hypotension episodes. Levocarnitine supplementation before each hemodialysis session efficiently diminishes the intradialytic hypotension episodes. This is a new application method that must be considered and explored.
Factors moderating the relative effectiveness of varenicline and nicotine replacement therapy in clients using smoking cessation services
Authors: Walker Neil , Gainforth Heather , Kiparoglou Vasiliki , Robinson Hayley , van Woerden Hugo , West Robert
Published: August 2017

Aims

To assess how far the greater effectiveness of varenicline over nicotine replacement therapy (NRT) is moderated by characteristics of the smokers or setting in clinical practice.

Design

We used observational data from 22 472 treatment episodes between 2013 and 2016 from smoking cessation services in England to assess whether differences between varenicline and NRT were moderated by a set of smoker and setting characteristics: these included level of social deprivation, age, gender, ethnic group, nicotine dependence and treatment context. From the above, 15 640 episodes were analysed in relation to 4‐week quit and 14 273 episodes at 12 weeks. All two‐way interactions involving pharmacotherapy were fitted in addition to the main effects and a parsimonious model identified using a backwards stepwise selection procedure.

Setting

England

Participants

Clients of smoking cessation service (number of individuals in 4‐week quit analysis = 15 640).

Measurements

Four‐week carbon monoxide‐validated (primary outcome) and 12‐week self‐reported (secondary outcome) quit success/failure.

Findings

At both follow‐up points, varenicline was associated with higher success rates overall [P < 0.001 at both 4 and 12 weeks; adjusted odds ratio (OR) varenicline versus NRT = 1.82 (95% confidence interval (CI) = 1.61, 2.06) and 2.58 (95% CI = 2.26, 2.94) at 4 and 12 weeks, respectively]. At 12 weeks, the relative benefits of varenicline were found to be influenced by the setting in which advice was provided [P < 0.001 for interaction pharmacotherapy × setting; adjusted odds ratio for varenicline × pharmacy setting = 0.53 (95% CI = 0.42, 0.69) and for varenicline × general practice (GP) setting = 0.79 (95% CI = 0.64, 0.98) against a baseline of 1 for varenicline × community setting]. The same trends were evident at 4 weeks, but this did not translate to statistical significance. There was inconclusive evidence for moderating effects of other variables.

Conclusions

Varenicline use was associated with higher smoking cessation rates than nicotine replacement therapy in routine clinical practice, irrespective of a wide range of smoker characteristics, but the difference was less in certain intervention settings, most notably pharmacy but also GP practice, compared with community setting.
Complicated untreated apical periodontitis causing paraesthesia: A case report
Authors: Ricucci Domenico , Loghin Simona , Siqueira José F.
Published: August 2017

The purpose of this article was to report a case of untreated apical periodontitis resulting in severe late complications. A patient with an asymptomatic crowned root canal‐treated mandibular molar revealing a radiographic substandard endodontic treatment and a slight periapical radiolucency was made aware of the treatment options and opted for no treatment. The lesion slightly increased in size after 6 years, but the tooth remained asymptomatic and endodontic retreatment was again refused. After 4 more years, the patient presented with an abscess and severe pain, complicated by paraesthesia of the left chin and lip. Radiographic examination revealed that the lesion had increased considerably to involve the mandibular canal. The treatment protocol included long‐term intracanal medication with calcium hydroxide and follow‐ups revealed complete resolution of the periapical radiolucency and the paraesthesia had completely subsided.
Acculturation and Health: The Moderating Role of Sociocultural Context
Authors: Fox Molly , Thayer Zaneta M. , Wadhwa Pathik D.
Published: August 2017

Acculturation represents an important construct for elucidating the determinants and consequences of health disparities in minority populations. However, the processes and mechanisms underlying acculturation's effects on health are largely undetermined and warrant further study. We integrate concepts from anthropology and statistics to describe the role of sociocultural context as a putative modifier of the relationship between acculturation and health. Sociocultural context may influence the extent to which exposure to host culture leads to internalization of host cultural orientation and may influence the extent to which acculturation leads to stress and adoption of unhealthy behaviors. We focus on specific aspects of sociocultural context: (1) neighborhood ethno‐cultural composition; (2) discrimination; (3) discrepancy between origin and host environments; (4) discrepancy between heritage and host cultures; (5) origin group, host group, and individual attitudes toward assimilation; (6) variation in targets of assimilation within host community; (7) public policy and resources; and (8) migration selection bias. We review and synthesize evidence for these moderation effects among first‐ and later‐generation immigrants, refugees, and indigenous populations. Furthermore, we propose best‐practices data‐collection and statistical‐analysis methods for this purpose, in order to improve our understanding of the complex, multilevel aspects of the relationship between acculturation and health. [acculturation, minority health, health disparities, sociocultural context, effect moderation, statistical interaction]
Confronting the present: Migration in Sidney Mintz's journal forThe People of Puerto Rico
Authors: GARCÍA‐COLÓN ISMAEL
Published: August 2017

Sidney Mintz's field journal forThe People of Puerto Rico, published in 1956, is a valuable source for historical anthropological work. Until now, however, it has remained a hidden treasure for the anthropology of migration. By the late 1940s and 1950s, migration was central to the lives of Puerto Rican sugarcane workers and their families, and Mintz recorded important details of it. His journal shows how people maneuvered within fields of power that were full of opportunities and constraints for people seeking to make a living by migrating. Thanks to Mintz, anthropologists can learn about working‐class Puerto Ricans’ experiences, lives, and discussions about migration in the late 1940s. Mintz's legacy in its many forms will continue offering anthropologists an opportunity to confront the present. [Sidney Mintz,migration,farmworkers,field notes,political economy,historical anthropology,Puerto Rico]

El diario de campo de Sidney Mintz paraThe People of Puerto Rico, publicado en 1956, es una fuente valiosa para el trabajo antropológico histórico. Sin embargo, ha permanecido como un tesoro escondido para la antropología de la migración hasta el presente. En los finales de los años cuarenta y durante los años cincuenta, la migración fue central en la vida de los trabajadores puertorriqueños de la caña de azúcar y sus familias, y Mintz anotó detalles importantes de la misma. Su diario muestra cómo la gente maniobró dentro de campos de poder que estaban llenos de oportunidades y obstáculos para los que buscaban ganarse la vida migrando. Gracias a Mintz, los antropólogos pueden aprender acerca de las experiencias, vidas y debates que tuvieron los trabajadores puertorriqueños entorno a la migración de finales de los años cuarenta. El legado de Mintz en sus múltiples formas continuará ofreciendo a los antropólogos la oportunidad de confrontar el presente. [Sidney Mintz,migración,trabajadores agrícolas,notas de campo,economía política,antropología histórica,Puerto Rico]
Professional apartheid: The racialization of US law schools after the global economic crisis
Authors: TEJANI RIAZ
Published: August 2017

After the 2008 global financial crisis, US law schools suffered a steep drop in enrollment. In response, many professional law programs, especially so‐called fourth‐tier institutions, turned to ethnoracial minorities as a new market for student recruitment. They relaxed admissions standards, enabling more “diverse” students to finance their studies with guaranteed federal student loans. By raising diversity in a lower‐status “southern hemisphere” of legal education and services, however, this new approach replaced outright exclusion with a racialized professional dualism justified by the neoliberal ideology of market access. Some have called this an “apartheid model”—a freighted term with broad theoretical and ethical entanglements. This pairing of race and free‐market logics resembles wider, specious extensions of market citizenship into the global peripheries. [law, education, professions, neoliberalism, race, markets, United States]
Ultrasound assessment of gastric contents in children undergoing elective ear, nose and throat surgery: a prospective cohort study
Authors: Desgranges F.‐P. , Gagey Riegel A.‐C. , Aubergy C. , de Queiroz Siqueira M. , Chassard D. , Bouvet L.
Published: August 2017

Ultrasound examination of the gastric antrum allows reliable assessment of gastric contents and volume. Postoperative assessment of gastric contents before recovery from anaesthesia could help the physician to choose the most appropriate extubation technique after surgery in children. In this prospective observational study, we assessed whether significant changes occurred in gastric contents during the intra‐operative period in children undergoing elective ear, nose and throat (ENT) surgery. Children aged between six months and 16 years were recruited consecutively. Ultrasound examination of the antrum was performed before induction of anaesthesia and at the end of surgery before tracheal extubation, and included quantitative and qualitative assessment of gastric contents. The mean (SD) gastric volume was 0.28 (0.30) ml.kg−1 before surgery and 0.27 (0.30) ml.kg−1 after surgery, p = 0.82. No solid contents were identified in the antrum, and the gastric volume was < 1.5 ml.kg−1 in all patients during both ultrasound examinations. Our results suggest that, after elective ENT surgery, children are not at risk of a full stomach before tracheal extubation, and that pulmonary aspiration of blood that may occur after elective ENT surgery is probably not related to regurgitation of ingested blood from the stomach.
Letter: the definition of budesonide dependence in microscopic colitis
Authors: Fernández‐Bañares F. , Gisbert J. P.
Published: August 2017

Linked Content

This article is linked to Cotter et al papers. To view these articles visit https://doi.org/10.1111/apt.14133 and https://doi.org/10.1111/apt.14239.
Letter: complex interplay between obesity and Clostridium difficile infection
Authors: Kapur A. , Nagaraja V.
Published: August 2017

Linked Content

This article is linked to Mulki et al and Mulki and Katz papers. To view these articles visit https://doi.org/10.1111/apt.13832 and https://doi.org/10.1111/apt.14252.
Editorial: probiotics in inflammatory bowel disease—wrong organisms, wrong disease, or flawed concepts?
Authors: Shanahan F.
Published: August 2017

Linked Content

This article is linked to Derwa et al and Gracie et al papers. To view these articles visit https://doi.org/10.1111/apt.14203 and https://doi.org/10.1111/apt.14237.
Letter: the treatment of coronary artery disease in cirrhotics needs more thinking—author's reply
Authors: Feagins L. A.
Published: August 2017

Linked Content

This article is linked to Zhao et al and Krill et al papers. To view these articles visit https://doi.org/10.1111/apt.14225 and https://doi.org/10.1111/apt.14121.
Letter: the definition of budesonide dependence in microscopic colitis—authors’ reply
Authors: Cotter T. G. , Kamboj A. K. , Hicks S. B. , Tremaine W. J. , Loftus Jr E. V. , Pardi D. S.
Published: August 2017

Linked Content

This article is linked to Cotter et al and Fernández‐Bañares and Gisbert papers. To view these articles visit https://doi.org/10.1111/apt.14133 and https://doi.org/10.1111/apt.14220.
Impact of beta‐blockers on cardiopulmonary exercise testing in patients with advanced liver disease
Authors: Wallen M. P. , Hall A. , Dias K. A. , Ramos J. S. , Keating S. E. , Woodward A. J. , Skinner T. L. , Macdonald G. A. , Arena R. , Coombes J. S.
Published: August 2017

Background

Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. Beta‐blockers reduce portal pressure and minimise haemorrhage risk. These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing.

Aim

To determine the effect of beta‐blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease.

Methods

This was a cross‐sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation. All participants remained on their usual beta‐blocker dose and timing prior to the test. Variables measured during cardiopulmonary exercise testing included the ventilatory threshold, peak oxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and the ventilatory equivalents for carbon dioxide slope.

Results

Participants taking beta‐blockers (n = 28) had a lower ventilatory threshold (P <.01) and peak oxygen uptake (P = .02), compared to participants not taking beta‐blockers. After adjusting for age, the model of end‐stage liver‐disease score, liver‐disease aetiology, presence of refractory ascites and ventilatory threshold remained significantly lower in the beta‐blocker group (P = .04). The oxygen uptake efficiency slope was not impacted by beta‐blocker use.

Conclusions

Ventilatory threshold is reduced in patients with advanced liver disease taking beta‐blockers compared to those not taking the medication. This may incorrectly risk stratify patients on beta‐blockers and has implications for patient management before and after liver transplantation. The oxygen uptake efficiency slope was not influenced by beta‐blockers and may therefore be a better measure of cardiopulmonary performance in this patient population.
Proteomic analysis to unravel the effect of heat stress on gene expression and milk synthesis in bovine mammary epithelial cells
Authors: Li Lian , Wang Yiru , Li Chengmin , Wang Genlin
Published: August 2017

Heat stress can play a negative effect on milk yield and composition of dairy cattle, leading to immeasurable economic loss. The basic components of the mammary gland are the alveoli; these alveolar mammary epithelial cells reflect the milk producing ability of dairy cows. In this study, we exposed bovine mammary epithelial cells to heat stress and compared them to a control group using isobaric tags for relative and absolute quantitation combined with liquid chromatography coupled with tandem mass spectrometry. Compared with a control group, 104 differentially elevated proteins (>1.3‐fold) and 167 decreased proteins (<0.77‐fold) were identified in the heat treatment group. Gene Ontology analysis identified a majority of the differentially expressed proteins are associated in cell‐substrate junction assembly, catabolic processes and metabolic processes. Some of these significantly regulated proteins were related to the synthesis and secretion of milk, such as milk protein and fat. This finding was further supported by the results obtained from the reduced β‐casein expression through the system of plasminogen activator – plasminogen – plasmin and decreased fatty acid synthase could partly explain why milk fat synthesis ability of dairy cows decreased under heat stress. Our results highlight the effects of heat stress on synthesis of milk protein and fat, thus providing additional clues for further studies of heat stress on dairy milk production.
Mechanistic Model for Blood Pressure and Heart Rate Changes Produced by Telmisartan in Human Beings
Authors: Chae Dongwoo , Son Mijeong , Kim Yukyung , Son Hankil , Park Kyungsoo
Published: August 2017

Telmisartan, an angiotensin receptor blocker (ARB), is indicated for the treatment of essential hypertension. This study aimed to develop a mechanistic model of telmisartan drug effect in human beings using non‐invasive markers. Data were acquired from a previous study where telmisartan 80 mg was given once daily for 6 days. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were measured before dosing for days 1–5 and serially after the last dose. Mean arterial pressure (MAP) and pulse pressure (PP) were calculated from SBP and DBP. Relationships between MAP, PP, HR and total peripheral resistance (TPR) were developed. Circadian variation was incorporated into PP and HR, and TPR was assumed to adjust itself in response to changes in PP and HR based on baroreflex mechanism. Drug effects were then described as lowering the set point of MAP through TPR with a physiological feedback effect stimulating HR and PP. Drug concentrations were described by a two‐compartment disposition model with first‐order absorption and lag time, and first‐order elimination. Circadian variation was described by cosine functions, having periods of 12 and 24 hr. A log‐linear model was used to describe drug effect, with estimated drug effect parameter of 0.051/hr. Estimated fractional turnover rate of PP, HR and TPR was 11.2 hr. The model successfully described the time courses of these cardiovascular variables. This work demonstrated the feasibility of using non‐invasive cardiovascular measurements to derive a mechanistic model for telmisartan in human beings. The model may be suitable for other ARBs.
Beauty in the blink of an eye: The time course of aesthetic experiences
Authors: Verhavert San , Wagemans Johan , Augustin M. Dorothee
Published: August 2017

Under normal circumstances, perception runs very fast and seemingly automatic. In just a few ms, we go from sensory features to perceiving objects. This fast time course does not only apply to general perceptual aspects but also to what we call higher‐level judgements. Inspired by the study on ‘very first impressions’ by Bar, Neta, and Linz (2006, Emotion, 6, 269) the current research examined the speed and time course of three aspects of the aesthetic experience, namely beauty, specialness, and impressiveness. Participants were presented with 54 reproductions of paintings that covered a wide variety of artistic styles and contents. Presentation times were 10, 50, 100 and 500 ms in Experiment 1 and 20, 30 and 40 ms in Experiment 2. Our results not only show that consistent aesthetic judgements can be formed based on very brief glances of information, but that this speed of aesthetic impression formation also differs between different aesthetic judgements. Apparently, impressiveness judgements require longer exposure times than impressions of beauty or specialness. The results provide important evidence for our understanding of the time course of aesthetic experiences.
Isometry‐Aware Preconditioning for Mesh Parameterization
Authors: Claici S. , Bessmeltsev M. , Schaefer S. , Solomon J.
Published: August 2017

This paper presents a new preconditioning technique for large‐scale geometric optimization problems, inspired by applications in mesh parameterization. Our positive (semi‐)definite preconditioner acts on the gradients of optimization problems whose variables are positions of the vertices of a triangle mesh in ℝ2 or of a tetrahedral mesh in ℝ3, converting localized distortion gradients into the velocity of a globally near‐rigid motion via a linear solve. We pose our preconditioning tool in terms of the Killing energy of a deformation field and provide new efficient formulas for constructing Killing operators on triangle and tetrahedral meshes. We demonstrate that our method is competitive with state‐of‐the‐art algorithms for locally injective parameterization using a variety of optimization objectives and show applications to two‐ and three‐dimensional mesh deformation.
A Parallel Approach to Compression and Decompression of Triangle Meshes using the GPU
Authors: Jakob Johannes , Buchenau Christoph , Guthe Michael
Published: August 2017

Most state‐of‐the‐art compression algorithms use complex connectivity traversal and prediction schemes, which are not efficient enough for online compression of large meshes. In this paper we propose a scalable massively parallel approach for compression and decompression of large triangle meshes using the GPU. Our method traverses the input mesh in a parallel breadth‐first manner and encodes the connectivity data similarly to the well known cut‐border machine. Geometry data is compressed using a local prediction strategy. In contrast to the original cut‐border machine, we can additionally handle triangle meshes with inconsistently oriented faces. Our approach is more than one order of magnitude faster than currently used methods and achieves competitive compression rates.
Histoplasmosis in transplant recipients
Authors: Gajurel Kiran , Dhakal Reshika , Deresinski Stan
Published: August 2017

Histoplasma capsulatum is a dimorphic fungus that most often causes asymptomatic infection in the immunocompetent population. In immunocompromised patients, including solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, however, it is likely to cause severe life‐threatening infection. Post‐transplant histoplasmosis (PTH) in SOT is uncommon with an incidence of ≤1% and is even rarer in HCT patients. The majority of PTH in SOT is diagnosed in the first 2 years following transplantation. Histoplasmosis may result from endogenous reactivation of latent infection, de novo post‐transplant acquisition, and donor‐derived infection. Disseminated infection is common. Fever is the most common symptom and clinical features are often nonspecific, but patients with disseminated infection may present with a septic picture. Other features, including pancytopenia and hepatosplenomegaly, may not be prominent early in the course of illness. Contemporary histoplasma antigen assays are the most sensitive tests but cross‐reactivity with antigens of other fungi, including with Aspergillus galactomannan, is not uncommon. Treatment should be continued for at least a year. Histoplasma antigen levels have prognostic value and can be used to monitor the response to therapy. The attributable mortality is approximately 10%. Routine screening of donors and recipients is not currently recommended.
Perceptions and Misperceptions of Regime Stability and Iran's Convoluted Rise to Regional Influence
Authors: Arsenault Joshua T. , Honig Or Arthur
Published: August 2017

This article seeks to explain revolutionary Iran's convoluted rise to regional prominence over the last three decades. We hold that perceptions and misperceptions of regime stability (both of one's self and of others) by the relevant actors have played a major role in Iran's recent. The main logic is that the success of many strategies employed by relevant regional actors to augment their regional influence (both Iran seeking more influence and others seeking to stem that influence) have crucially hinged on making correct assessments of regime stability. This study has both theoretical and empirical findings. Theoretically, we find that failures to accurately estimate regime stability stem from three main sources: (1)objective uncertaintiesregarding the target state's level of regime stability, given the high strength of societal forces shaping state‐society relations in the Middle East and given the distinct variation between autocrats in terms of their ability to develop effective counterrevolutionary/repressive tools; (2)ideological blinders, from which both the United States and regional actors frequently suffer, which have often led them to be falsely optimistic regarding the existence of either subversive opportunities or opportunities to stabilize regimes facing domestic pressures; and (3)incorrect theories regarding sources of regime stabilitywhich lead experts and policymakers to overlook factors which may destabilize a regime. This article has two major empirical findings. First, Iran's rise may be at least partly attributed to Iran demonstrating aslightlybetter learning curve at the tactical level (i.e., learning subversive skills from its Lebanese experience in the 1980s–1990s and applying them to Iraq in the 2000s–2010s) as well as at the strategic level (i.e., understanding the limits of its subversive capacities and correctly assessing when it can engage in successful stabilizing operations). Second, two errors committed by the United States have been far more consequential than those committed by Iran for the regional balance of power: First, the George W. Bush Administration myopically opened up subversive opportunities for Iran when it invaded Iraq in 2003 by thinking that it could stabilize a democratic regime and insulate it from outside influence; second, on two occasions Washington overestimated the transformative effect that its concessions to Iran would have in terms of sufficiently empowering reformists so as to bring about complete regime transformation from within.
Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study
Authors: Giulioni Marco , Marucci Gianluca , Pelliccia Veronica , Gozzo Francesca , Barba Carmen , Didato Giuseppe , Villani Flavio , Di Gennaro Giancarlo , Quarato Pier Paolo , Esposito Vincenzo , Consales Alessandro , Martinoni Matteo , Vornetti Gianfranco , Zenesini Corrado , Efisio Marras Carlo , Specchio Nicola , De Palma Luca , Rocchi Raffaele , Giordano Flavio , Tringali Giovanni , Nozza Paolo , Colicchio Gabriella , Rubboli Guido , Lo Russo Giorgio , Guerrini Renzo , Tinuper Paolo , Cardinale Francesco , Cossu Massimo ,   the Commission for Epilepsy Surgery of the Italian League Against Epilepsy
Published: August 2017

Objective

To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of “low grade epilepsy associated neuroepithelial tumors” (LEATs).

Methods

We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor‐associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis.

Results

Fifty‐five (98.2%) of 56 patients with medically controlled epilepsy were seizure‐free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug‐resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012).

Significance

Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.
Extreme weather‐year sequences have nonadditive effects on environmental nitrogen losses
Authors: Iqbal Javed , Necpalova Magdalena , Archontoulis Sotirios V. , Anex Robert P. , Bourguignon Marie , Herzmann Daryl , Mitchell David C. , Sawyer John E. , Zhu Qing , Castellano Michael J.
Published: August 2017

The frequency and intensity of extreme weather years, characterized by abnormal precipitation and temperature, are increasing. In isolation, these years have disproportionately large effects on environmental N losses. However, the sequence of extreme weather years (e.g., wet–dry vs. dry–wet) may affect cumulative N losses. We calibrated and validated the DAYCENT ecosystem process model with a comprehensive set of biogeophysical measurements from a corn–soybean rotation managed at three N fertilizer inputs with and without a winter cover crop in Iowa, USA. Our objectives were to determine: (i) how 2‐year sequences of extreme weather affect 2‐year cumulative N losses across the crop rotation, and (ii) if N fertilizer management and the inclusion of a winter cover crop between corn and soybean mitigate the effect of extreme weather on N losses. Using historical weather (1951–2013), we created nine 2‐year scenarios with all possible combinations of the driest (“dry”), wettest (“wet”), and average (“normal”) weather years. We analyzed the effects of these scenarios following several consecutive years of relatively normal weather. Compared with the normal–normal 2‐year weather scenario, 2‐year extreme weather scenarios affected 2‐year cumulative NO3− leaching (range: −93 to +290%) more than N2O emissions (range: −49 to +18%). The 2‐year weather scenarios had nonadditive effects on N losses: compared with the normal–normal scenario, the dry–wet sequence decreased 2‐year cumulative N2O emissions while the wet–dry sequence increased 2‐year cumulative N2O emissions. Although dry weather decreased NO3− leaching and N2O emissions in isolation, 2‐year cumulative N losses from the wet–dry scenario were greater than the dry–wet scenario. Cover crops reduced the effects of extreme weather on NO3− leaching but had a lesser effect on N2O emissions. As the frequency of extreme weather is expected to increase, these data suggest that the sequence of interannual weather patterns can be used to develop short‐term mitigation strategies that manipulate N fertilizer and crop rotation to maximize crop N uptake while reducing environmental N losses.
Using the Washoe Language to Inform Hydrologic and Environmental Models
Authors: Fillmore Helen
Published: August 2017

Article impact statement: Listening to indigenous stakeholders, in their language, can improve the quality and impact of hydrologic and environmental models.
Patient, caregiver, and provider perceptions of pain and pain management in adolescents and young adults with bleeding disorders
Authors: Lambing Angela , Nichols Cynthia D. , Munn James E. , Anderson Terry L. , Tortella Bartholomew J. , Witkop Michelle L.
Published: August 2017

Introduction

Recurrent bleeding and associated pain are critical components in the management of bleeding disorders, yet scant data describe perceptions of pain in this patient population.

Objective

This study assessed perceptions of pain and pain management in adolescents and young adults (AYAs) with haemophilia or von Willebrand disease (VWD) to determine agreement/disagreement between patients, caregivers and health care providers.

Methods

Using an online questionnaire, AYA patients (N=89), their caregivers (N=77), and providers (N=54) reported on pain perception, pain treatment and pain control. Acute and chronic pain was measured in patients via the Faces Pain Scale–Revised (FPS‐R). Questionnaires queried about pharmacologic and non‐pharmacologic pain management methods and how well providers and caregivers helped to manage pain.

Results

Poor agreement existed between patients and caregivers across all pain levels, perception of pain control and effectiveness of pain management. Specifically for chronic pain, poor agreement was noted between patients and caregivers (kappa=0.04; 29% agreement) and patients and providers (kappa=−0.07; 21.4% agreement). Among patients reporting acute or chronic pain, only 67% and 43%, respectively, utilized medication for their specific pain. Patients used more opioid medications than expected by their providers. On average, AYAs reported initial use of pain medications for chronic pain at 11.5 years.

Conclusions

Ongoing research is needed in haemophilia and VWD pain management, and on the differences in pain perception between patients, caregivers and providers. As chronic pain often begins at an early age, optimal pain management should include acknowledging patient complaints, exploring pharmacologic and non‐pharmacologic options, and optimizing prophylaxis.
Willingness to pay for antiretroviral drugs among HIV and AIDS clients in south‐east Nigeria
Authors: Mbachu Chinyere , Okoli Chijioke , Onwujekwe Obinna , Enabulele Fabian
Published: August 2017

Background

The current trend of withdrawal of donor support for HIV/AIDS treatment in Nigeria may require that the cost of antiretroviral drugs be borne in part by infected people and their families.

Objective

This study was conducted to determine the economic value for free antiretroviral drugs (ARVs) expressed by clients receiving treatment for HIV/AIDS in a tertiary hospital.

Study method

The contingent valuation method was used to elicit the values attached to free ARVs from people living with HIV/AIDS that were receiving care in a public tertiary hospital in south‐east Nigeria. Exit poll using a pre‐tested questionnaire was undertaken with adult clients on treatment. The bidding game technique was used to elicit their willingness to pay (WTP) for ARVs for themselves and members of their households. Ordinary least squares (OLS) multiple regression analysis was used to test the construct validity of elicited WTP amounts.

Results

About a third of the respondents were willing to pay for a monthly supply of ARVs for themselves and household members. The mean WTP for monthly supply of ARVs for self was US$15.32 and for household member was US$15.26 (1US$=₦160). OLS regression analysis showed that employment status and higher socio‐economic status were positively associated with higher WTP. OLS showed that age and transport cost per clinic visit were negatively related to WTP. Knowing the risks of not adhering to treatment protocol was positively related to WTP.

Conclusion

The respondents positively valued the free ARVs. This calls for greater financial support for the sustainable provision of the treatment service. However, holistic financing mechanisms should be explored to ensure sustained funding in the event of complete withdrawal of donor support.
Avocados crossing borders: The problem of runaway objects and the solution of a shipping information pipeline for improving international trade
Authors: Jensen Thomas , Vatrapu Ravi , Bjørn‐Andersen Niels
Published: August 2017

This paper investigates the case of shipments of containers with avocados from farmers in Africa to grocery store shelves in the European Union. We find 3 predominant challenges to containerized shipping that effectively become trade barriers: international trade cost, lead time uncertainty, and security risks. We use activity theory to describe, understand, and analyze the shipping activity in the international trade ecosystem with focus on physical objects and their related information. We find that the shipment becomes problematic and can be characterized as a runaway object in the heterogeneous and multiple organizational setting of international trade. Our analysis of shipping reveals (1) inefficient collaboration across loosely coupled activity systems and (2) fragmented information infrastructures. We propose the solution of Shipping Information Pipeline, a shared information infrastructure, thus facilitating collaboration in containerized shipping and contributing to lowering trade barriers. Shipping Information Pipeline can significantly improve containerized shipping resulting in estimated potential benefits of up to 4.7% growth in global GDP.
A critical analysis of the “improved Clarke and Wright savings algorithm”
Authors: Sörensen Kenneth , Arnold Florian , Palhazi Cuervo Daniel
Published: August 2017

In their paper “An improved Clarke and Wright savings algorithm for the capacitated vehicle routing problem,” published in ScienceAsia (38, 3, 307–318, 2012), Pichpibul and Kawtummachai developed a simple stochastic extension of the well‐known Clarke and Wright savings heuristic for the capacitated vehicle routing problem. Notwithstanding the simplicity of the heuristic, which they call the “improved Clarke and Wright savings algorithm” (ICW), the reported results are among the best heuristics ever developed for this problem. Through a careful reimplementation, we demonstrate that the results published in the paper could not have been produced by the ICW heuristic. Studying the reasons how this paper could have passed the peer review process to be published in an ISI‐ranked journal, we have to conclude that the necessary conditions for a thorough examination of a typical paper in the field of optimization are generally lacking. We investigate how this can be improved and come to the conclusion that disclosing source code to reviewers should become a prerequisite for publication.
Periodontitis and Non‐alcoholic Fatty Liver Disease, a population‐based cohort investigation in the Study of Health in Pomerania
Authors: Akinkugbe Aderonke A. , Slade Gary D. , Barritt A. Sidney , Cole Stephen R. , Offenbacher Steven , Petersmann Astrid , Kocher Thomas , Lerch Markus M. , Mayerle Julia , Völzke Henry , Heiss Gerardo , Holtfreter Birte
Published: August 2017

Background

Non‐alcoholic fatty liver disease (NAFLD) affects 20%–30% of adults with risk factors like obesity and insulin resistance putatively acting through chronic low‐grade inflammation. Because periodontitis elicits low‐grade inflammation, we hypothesized that it could contribute to NAFLD occurrence.

Objective

To investigate epidemiologic associations between periodontitis and the incidence of NAFLD among 2,623 participants of the Study of Health in Pomerania.

Methods

Periodontitis at baseline was defined as the percentage of sites (0%, <30%, ≥30%) with (i) clinical attachment level (CAL) ≥3 mm; (ii) probing pocket depth (PD) ≥4 mm. Incident NAFLD was defined as a significant increase in liver echogenicity on ultrasound relative to the kidneys, with the diaphragm indistinct or the echogenic walls of the portal veins invisible.

Results

After a median 7.7 years of follow‐up, 605 incident NAFLD cases occurred at a rate of 32.5 cases per 1,000 person‐years. Relative to participants without CAL ≥3 mm, NAFLD incidence was elevated slightly in participants with <30% of sites affected and moderately in participants with ≥30% of sites affected (multivariable‐adjusted incidence rate ratio = 1.28, 95% CI, 0.84, 1.95 and 1.60, 95% CI, 1.05–2.43), respectively. A similar dose–response relationship was not observed for PD.

Conclusion

History of periodontitis may be a risk factor for NAFLD.
Actinic keratoses show variable histological basal growth patterns – a proposed classification adjustment
Authors: Schmitz L. , Gambichler T. , Gupta G. , Stücker M. , Stockfleth E. , Szeimies R.M. , Dirschka T.
Published: August 2017

Background

Common histological classification schemes of actinic keratoses (AK) do not evaluate growth patterns at basal epidermal aspects of AK. Until now, the importance of basal epidermal growth patterns of AK has not been studied.

Objective

To investigate the extent of atypical keratinocytes throughout the epidermis and variation in basal growth patterns of AK.

Methods

AK lesions occurring on the head/face from patients seen in routine practice were assessed histologically. We determined histological grade (AK I‐III), basal growth patterns of atypical keratinocytes (crowding, budding and papillary sprouting) and accompanying parameters.

Results

Of the 246 lesions included, 28.0% were histologically classified as AK I, 46.7% as AK II and 25.2% as AK III. Approximately 26.4% of the basal growth patterns were classified as crowding (pro I), 49.6% as budding (pro II), 17.9% as papillary sprouting (pro III) and 6.1% without basal directed growth. No significant correlation of the histological AK I‐III grading and underlying growth patterns was observed (P = 0.4666). However, adnexal structure involvement (OR = 2.37; 95% CI 1.21–4.65), infiltration (OR = 2.53; 95% CI 1.31–4.90) and increased number of vessels (OR = 2.56; 95% CI 1.42–4.65) were independent positive predictive markers for pro II and pro III basal growth patterns.

Conclusions

Basal growth patterns (pro I‐III) in AK do not correlate with the established AK I‐III histological grading system. Besides the degree of upward extension, varying degrees of downward extension exist. Histological classification should consider both, upwards and downward growth patterns when assessing AK.
Recommendations for the management of comorbidity in hidradenitis suppurativa
Authors: Dauden E. , Lazaro P. , Aguilar M.D. , Blasco A.J. , Suarez C. , Marin I. , Queiro R. , Bassas‐Vila J. , Martorell A. , García‐Campayo J.
Published: August 2017

Background

The association between hidradenitis suppurativa (HS) and some diseases is becoming relevant in recent years. Providing appropriate management of HS from an early stage requires to include prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat HS potentially related to the onset of a comorbidity.

Objective

To provide the dermatologist with an accurate, easily used tool that will inform the diagnosis of HS comorbidity, and to facilitate decision‐making regarding the referral and treatment of patient with HS‐associated comorbidity.

Methods

These recommendations have been developed by a working group composed of seven experts (three dermatologists, a cardiovascular specialist internist, a rheumatologist expert in spondyloarthritis, a gastroenterologist and a psychiatrist) and a team of three methodologist researchers. The expert group selected the HS comorbidities considered in these recommendations through a literature review. The recommendations on diagnostic criteria are based on the relevant clinical practice guidelines for each of the comorbidities and on the recommendations of the experts. The information regarding the repercussion of HS medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug.

Results

The comorbidities considered in this guide are as follows: cardiovascular risk factors (diabetes, dyslipidaemia, obesity, hypertension and metabolic syndrome), inflammatory bowel disease, inflammatory joint disorders and psychological disorders (anxiety and depression). In addition, the association between HS and the consumption of alcohol and tobacco is included. The tables and figures are a precise, easy‐to‐use tool to systematize the diagnosis of comorbidity in patients with HS and facilitate the decision‐making process regarding referral and treatment of patients with an associated disease.

Conclusion

The application of these recommendations will facilitate the dermatologist practice and benefit HS patients’ health and quality of life.
Limited uptake of ulcerative colitis “treat‐to‐target” recommendations in real‐world practice
Authors: Bryant Robert V , Costello Samuel P , Schoeman Scott , Sathananthan Dharshan , Knight Emma , Lau Su‐Yin , Schoeman Mark N , Mountifield Reme , Tee Derrick , Travis Simon P L , Andrews Jane M
Published: August 2017

Background and Aims

A “treat‐to‐target” approach has been proposed for ulcerative colitis (UC), with a target of combined clinical and endoscopic remission. The aim of the study was to evaluate the extent to which proposed targets are achieved in real‐world care, along with clinician perceptions and potential challenges.

Methods

A multicentre, retrospective, cross‐sectional review of patients with UC attending outpatient services in South Australia was conducted. Clinical and objective assessment of disease activity (endoscopy, histology, and/or biomarkers) was recorded. A survey evaluated gastroenterologists' perceptions of treat to target in UC. Statistical analysis included logistic regression and Fisher's exact tests.

Results

Of 246 patients with UC, 61% were in clinical remission (normal bowel habit and no rectal bleeding), 35% in clinical and endoscopic remission (Mayo endoscopic sub‐score ≤ 1), and 16% in concordant clinical, endoscopic, and histological (Truelove and Richards' Index) remission. Rather than disease‐related factors (extent/activity), clinician‐related factors dominated outcome. Hospital location and the choice of therapy predicted combined clinical and endoscopic remission (OR 3.6, 95% CI 1.6–8.7, P < 0.001; OR 3.3, 95% CI 1.1–12.5, P = 0.04, respectively). Clinicians used C‐reactive protein more often than endoscopy as a biomarker for disease activity (75% vs 47%, P < 0.001). In the survey, 45/61 gastroenterologists responded, with significant disparity between clinician estimates of targets achieved in practice and real‐world data (P < 0.001 for clinical and endoscopic remission).

Conclusions

Most patients with UC do not achieve composite clinical and endoscopic remission in “real‐world” practice. Clinician uptake of proposed treat‐to‐target guidelines is a challenge to their implementation.