bluuebunny/crossref_metadata_2025 huggingface dataset:
Endothelin-1 Gene Polymorphisms Influence Cerebrospinal Fluid Endothelin-1 Levels Following Aneurysmal Subarachnoid Hemorrhage
Authors: Gallek Matthew J. , Alexander Sheila A. , Crago Elizabeth , Sherwood Paula R. , Klamerus Megan , Horowitz Michael B. , Poloyac Samuel M. , Conley Yvette
Published: May 2014

Aneurysmal subarachnoid hemorrhage is a type of stroke with high morbidity and mortality. Increased endothelin-1 (ET-1) levels have been associated with increased risk of cerebral vasospasm, which is associated with increased morbidity. The purpose of this study was to investigate the relationships between ET-1 genotypes and ET-1 protein levels in cerebrospinal fluid (CSF) measured 72 hr before angiographic vasospasm measurement in subjects at high risk of cerebral vasospasm. Specifically, this study evaluated the differences between variant positive and variant negative groups of nine different ET-1 single-nucleotide polymorphisms (SNPs) in relationship with the ET-1 protein exposure rate. The CSF ET-1 protein levels were quantified using enzyme-linked immunosorbent assay. One functional SNP and eight ET-1 tagging SNPs were selected because they represent genetic variability in the entire ET-1 gene. The variant negative group of SNP rs2070699 was associated with a significantly higher ET-1 exposure rate than the variant positive group ( p = 0.004), while the variant positive group of the rs5370 group showed a trend toward association with a higher ET-1 exposure rate ( p = 0.051). Other SNPs were not informative. This is the first study to show differences in ET-1 exposure rate 72 hr before angiography in relation to ET-1 genotypes. These exploratory findings need to be replicated in a larger study; if replicated, these differences in genotypes may be a way to inform clinicians of those patients at a higher risk of increased ET-1 protein levels, which may lead to a higher risk of angiographic vasospasm.
Blood miRNA expression pattern is a possible risk marker for natalizumab-associated progressive multifocal leukoencephalopathy in multiple sclerosis patients
Authors: Muñoz-Culla M , Irizar H , Castillo-Triviño T , Sáenz-Cuesta M , Sepúlveda L , Lopetegi I , de Munain A López , Olascoaga J , Baranzini SE , Otaegui D
Published: May 2014

Background:

Natalizumab has shown its efficacy in reducing multiple sclerosis (MS) relapses and progression of disability; however, it has been associated with an increased risk of developing progressive multifocal leukoencephalopathy (PML). The differential expression of microRNA (miRNA), the small non-coding RNAs that regulate gene expression, in natalizumab-treated patients has been reported and miRNA have also been described as good candidates for disease biomarkers.

Objective:

To characterize the effect of natalizumab therapy on the miRNA expression pattern and to search for miRNAs that can predict PML on an individual basis.

Methods:

The expression of 754 microRNAs was measured in blood samples from 19 relapsing–remitting MS patients at three time points during natalizumab therapy, using TaqMan OpenArray panels. Two patients included in this study developed PML after more than 2 years of therapy.

Results:

We found that the expression level of three miRNAs (let-7c, miR-125a-5p and miR-642) was affected after 6 months of therapy (t6). Furthermore, we observed a differential expression of another three miRNAs (miR-320, miR-320b and miR-629) between the PML and non-PML groups after 12 months of treatment (t12); and a positive correlation was found between therapy time and the expression of miR-320.

Conclusions:

Natalizumab modified the expression levels of three miRNAs after a 6-month treatment. We suggest miR-320, miR-320b and miR-629 as possible biomarkers for individual PML risk assessment.
Multiple sclerosis, solitary sclerosis or something else?
Authors: Lattanzi Simona , Logullo Francesco , Di Bella Paolo , Silvestrini Mauro , Provinciali Leandro
Published: May 2014

Background:

Inflammatory demyelinating diseases of the central nervous system represent a wide spectrum of entities and their classification cannot currently be regarded complete.

Objective:

Our aim is to describe a series of patients presenting with progressive myelopathy associated to a single demyelinating lesion of the spinal cord.

Methods:

We identified the patients affected by chronic progressive spinal cord dysfunction related to a single spinal cord lesion not satisfying the diagnostic criteria for any of the currently defined diseases.

Results:

Seven females and one male were included. The median age at onset of symptoms was 53 years (range 42–68) and the median follow-up was 8 years (range 5–12). Brain and spinal magnetic resonance imaging (MRI) scans detected only one single, circumscribed, T2 hyperintense, non-longitudinally extensive lesion at level of cervico-medullary junction or cervical cord, in the absence of Gadolinium enhancement or swelling. Cerebrospinal fluid (CSF) examination displayed neither oligoclonal bands nor raised IgG index. A response to immunosuppressive agents was observed in some of the patients. Serial control brain and spinal MRI did not reveal accumulation of new lesions.

Conclusion:

New entities or variants should be included among the inflammatory demyelinating diseases of the central nervous system, and their characterization may have relevant prognostic and treatment implications.
An observational comparison of natalizumab vs. fingolimod using JCV serology to determine therapy
Authors: Carruthers Robert L , Rotstein Dalia L , Healy Brian C , Chitnis Tanuja , Weiner Howard L , Buckle Guy J
Published: May 2014

Background:

The lack of prospective trial data comparing certain multiple sclerosis (MS) therapies could be addressed with observational research.

Objective:

The objective of this paper is to investigate outcomes of natalizumab versus fingolimod treatment in an MS cohort using a novel method of patient selection.

Methods:

We reviewed entries from our clinic’s database for all relapsing–remitting MS patients started on fingolimod and natalizumab where JCV serology was used to determine treatment. We analyzed each group for time to first relapse and in a second analysis, time to first relapse or gadolinium-enhancing lesion.

Results:

Sixty-nine patients on natalizumab and 36 on fingolimod met our inclusion criteria and had adequate follow-up for analysis. The baseline clinical characteristics at the time of treatment switch were similar. With a mean follow-up of 1.5 years for both treatment groups, there was a trend favoring natalizumab in time to first relapse, although this was not statistically significant (2.20 (0.87, 5.55) p = 0.095). There was a significant difference in the secondary outcome, time to relapse or gadolinium-enhancing lesion (2.31 (1.03, 5.17) p = 0.041), favoring natalizumab. Adjusted analyses favored natalizumab for both outcomes ( p < 0.05).

Conclusion:

This work employed an observational study design where treatment allocation by JCV serology allowed for treatment groups with well-balanced characteristics.
Multiple deep white matter lesions mimic multiple sclerosis as an unusual complication of left atrial myxoma
Authors: Quan Chao , ZhangBao Jingzi , Luo Sushan , Fang Kun , Xi Jianying , Du Zunguo , Zhao Chongbo , Lu Jiahong
Published: May 2014

We report the case of a patient who developed right hemiparesis with an acute onset 2 weeks before being transferred to our hospital. The brain MRI revealed multiple lesions in deep white matter; some were ovoid and perpendicular to the lateral ventricle, typical of cerebral demyelinating disease such as multiple sclerosis. The patient reported no history of hypertension, diabetes, dyslipidemia or other conventional vascular risk factors. The initial diagnosis was clinically isolated syndrome. However, low fever and petechiae in the extremities developed during hospitalization, which reminded us of cardioembolism. Echocardiography finally revealed a left atrial myxoma. The patient’s symptom alleviated after resection of the tumor.
Effectiveness of psychologically focused group interventions for multiple sclerosis: A review of the experimental literature
Authors: Firth Nick
Published: May 2014

Psychologically focused group interventions for multiple sclerosis were reviewed. Studies reviewed (14) were quantitative, experimental and involved a comparison group (control or other intervention). Compared with controls, psychologically focused group interventions achieved considerable improvements in depression and moderate improvements in self-efficacy and quality of life but little change in anxiety. Psychologically focused group interventions compared well with other interventions, although evidence was limited. Psychologically focused group intervention was less effective short term for depression than individual cognitive behavioural therapy or medication but comparable long term. Intervention heterogeneity made comparisons difficult. Specificity of effect is unclear. Limited evidence suggests psychologically focused group intervention is effective in improving certain outcomes.
Social cognitive predictors of intention to test for variant Creutzfeldt-Jakob disease in those affected by haemophilia and other clotting disorders
Authors: Rowland Gemma , Robinson Georgina , Chilcot Joseph , Troop Nicholas A
Published: May 2014

Individuals with bleeding disorders are at increased risk of variant Creutzfeldt-Jakob disease. This study explored social cognitive predictors of screening intentions. Ninety men and women with bleeding disorders, recruited through the Haemophilia Society, completed an extended Theory of Planned Behaviour questionnaire to predict intention to screen for variant Creutzfeldt-Jakob disease. Extended Theory of Planned Behaviour variables accounted for 57 per cent of the variance in intention. Self-efficacy and anticipated affect predicted intention directly, while attitudes were mediated by anticipated affect. Simple interventions that already exist address relevant predictive components of intention to screen for variant Creutzfeldt-Jakob disease and could be used to aid decision-making.
Emotion recognition from congruent and incongruent emotional expressions and situational cues in children with autism spectrum disorder
Authors: Tell Dina , Davidson Denise
Published: May 2014

In this research, the emotion recognition abilities of children with autism spectrum disorder and typically developing children were compared. When facial expressions and situational cues of emotion were congruent, accuracy in recognizing emotions was good for both children with autism spectrum disorder and typically developing children. When presented with facial expressions incongruent with situational cues, children with autism spectrum disorder relied more on facial cues than situational cues, whereas typically developing children relied more on situational cues. The exception was fear. When presented with incongruent information (i.e. a smiling boy surrounded by a swarm of bees), most children based their response on the situation and indicated that the boy felt scared. While the majority of typically developing children commented on the disparity between facial expressions and situational cues, children with autism spectrum disorder did not mention the conflicting cues. Although typically developing children were more accurate in recognizing emotion with situational cues, children with autism spectrum disorder were still adequate at identifying emotion from situational cues alone. These findings suggest that children with autism spectrum disorder show an understanding of simple emotions in prototypical situations, but may prefer facial expressions when facial expressions and situational cues are incongruent. Reasons for these findings are discussed.
Transfusions and patient burden in chemotherapy-induced anaemia in France
Authors: Corey-Lisle Patricia K. , Desrosiers Marie-Pierre , Collins Helen , De La Orden Margarita , Payne Krista A. , Levaché Charles Briac , Dumont Patrick
Published: May 2014

Objectives:

To estimate the patient burden in terms of the time spent on outpatient red blood cell (RBC) transfusions indicated for chemotherapy induced-anaemia (CIA) in patients with cancer in France.

Methods:

A retrospective chart review of patients with cancer receiving an outpatient RBC transfusion was conducted at seven treatment centres in France. Total treatment time for one transfusion visit per patient was measured as the elapsed time between pre- and post-transfusion vital sign assessment, including time from transfusion start to stop. Elapsed time from haemoglobin (Hb) level testing to transfusion start and from blood draw for compatibility testing to transfusion start were recorded. In addition, estimated travel time and distance to the transfusion centre, and clinical and demographic information were collected.

Results:

A total of 103 patients [63.1% men; mean age 66.2 years, standard deviation (SD) 11.9] were enrolled in the study (1 August 2010–31 October 2010). The four most frequent diagnoses were lung cancer (31.1%), urological cancer (15.5%), gynecological cancer (14.6%) and gastrointestinal/colorectal cancer (14.6%). Mean elapsed time between prevital and postvital sign assessment was 4.0 h [95% confidence interval (CI) 1.9–6.1], including a mean of 3.4 h (95% CI 2.5–4.2) for the transfusion itself. Hb level testing (mean pre-transfusion Hb level 8.0 g/dl, SD 0.8) and blood draw for compatibility testing were completed in a mean of 28.8 h (95% CI 1.3–56.2) and 9.4 h (95% CI 0–21.4) prior to transfusion respectively. Patients’ one-way mean travel time to the transfusion centre was 32.9 min (95% CI 28.5–37.4) and mean distance travelled was 25.4 km (95% CI 11.6–39.3).

Conclusion:

In France, CIA treatment with RBC transfusion is a time-consuming activity for patients that includes multiple trips to a medical facility, blood testing and the transfusion procedure itself. This burden is important to consider in the context of optimizing proactive monitoring and planning for supportive oncology care.
SIRT1 prevents genotoxic stress-induced p53 activation in acute myeloid leukemia
Authors: Sasca Daniel , Hähnel Patricia S. , Szybinski Jakub , Khawaja Kaml , Kriege Oliver , Pante Saskia V. , Bullinger Lars , Strand Susanne , Strand Dennis , Theobald Matthias , Kindler Thomas
Published: May 2014

Key Points

SIRT1 is highly expressed in subsets of patients with acute myeloid leukemia harboring activating mutations in signaling pathways and is regulated at the protein levels. Targeting SIRT1 sensitizes leukemic blast to tyrosine kinase inhibitor treatment or chemotherapy via restoration of p53 activity.
Non-Archimedean and random HUR-approximation of a Cauchy-Jensen additive mapping
Authors: Park Choonkil , Azadi Kenary Hassan , Sahami Najmeh
Published: May 2014

In this paper, using the fixed point and direct methods, we prove the Hyers-Ulam-Rassias approximation (briefly, HUR-approximation) of a Cauchy-Jensen additive (briefly, CJA) functional equation in various normed spaces.

MSC:39B52, 39B82, 47H10, 46S10.
Health-service performance of TB treatment for indigenous and non-indigenous populations in Brazil: a cross-sectional study
Authors: Lemos Everton Ferreira , Alves Aline Mara da Silva , Oliveira Giovana de Castro , Rodrigues Marcella Paranhos , Martins Natália Daiane Garoni , Croda Julio
Published: May 2014

Background

Health-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control.

Methods

Interviews with TB patients who underwent treatment between 2009 and 2011 were conducted using the Primary Care Assessment Tool adapted for TB care in Brazil.

Results

Primary healthcare (PHC) was the first treatment for most patients at symptom onset, and the diagnoses were typically performed by specialized services. Many patients experienced delayed TB diagnoses that required more than three medical appointments (51% and 47% for indigenous and non-indigenous populations, respectively). Indigenous people received social support, such as basic-needs grocery packages (2.19 ± 1.63 vs. 1.13 ± 0.49 for non-indigenous people, p < 0.01) and home visits from health professionals, with an emphasis on the performance of directly observed treatment strategies (DOT; 4.57 ± 0.89 vs. 1.68 ± 1.04 for non-indigenous people, p < 0.01).

Conclusions

Regardless of the differences between indigenous and non-indigenous populations, the time needed to receive a TB diagnosis was unsatisfactory for both groups. Furthermore, DOT must be performed with better coverage among non-indigenous patients.
Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial
Authors: Schulz Craig , Leininger Brent , Evans Roni , Vavrek Darcy , Peterson Dave , Haas Mitchell , Bronfort Gert
Published: May 2014

Background

Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.

Methods/design

This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment.

Discussion

This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

Trial registration

(ClinicalTrials.govNCT01096628).
Mitochondrial dysfunction in obesity: potential benefit and mechanism of Co-enzyme Q10 supplementation in metabolic syndrome
Authors: Alam Md Ashraful , Rahman Md Mahbubur
Published: May 2014

Co-enzyme Q10 (Co-Q10) is an essential component of the mitochondrial electron transport chain. Most cells are sensitive to co-enzyme Q10 (Co-Q10) deficiency. This deficiency has been implicated in several clinical disorders such as heart failure, hypertension, Parkinson’s disease and obesity. The lipid lowering drug statin inhibits conversion of HMG-CoA to mevalonate and lowers plasma Co-Q10 concentrations. However, supplementation with Co-Q10 improves the pathophysiological condition of statin therapy. Recent evidence suggests that Co-Q10 supplementation may be useful for the treatment of obesity, oxidative stress and the inflammatory process in metabolic syndrome. The anti-inflammatory response and lipid metabolizing effect of Co-Q10 is probably mediated by transcriptional regulation of inflammation and lipid metabolism. This paper reviews the evidence showing beneficial role of Co-Q10 supplementation and its potential mechanism of action on contributing factors of metabolic and cardiovascular complications.
Profile of metabolic abnormalities seen in patients with type 2 diabetes mellitus and their first degree relatives with metabolic syndrome seen in Benin City, Edo state Nigeria
Authors: Ogedengbe Stephen O , Ezeani Ignatius U
Published: May 2014

Background

To determine the profile of metabolic abnormalities in T2DM persons with metabolic syndrome and their non-diabetic first-degree relatives who also had metabolic syndrome in Benin City.

Methodology

This was a cross sectional case controlled study in which convenience sampling technique was used to recruit 106 persons with T2DM, 96 people who are first degree relatives of type 2 diabetic persons and 96 controls using a interviewer administered questionnaire technique. The following were assessed: anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar, proteinuria, and microalbuminuria. The data obtained were analyzed using the statistical software-Statistical package for social sciences [SPSS] version 16. A p-value of less than 0.05 was taken as statistically significant.

Results

The mean age (SD) of the study groups were: persons living with T2DM: 58.6 ± 11.2 years, control: 57.69 ± 60.8 years and FDR: 57.4 ± 10.6 years. No significant age and sex differences were observed in these groups. There were more females (59.7%) than males (40.3%) with T2DM. The prevalence of MS was 13.5%, 16.7%, and 87.1% in the control, FDR and T2DM patients respectively. For the T2DM group of subjects, impaired fasting glycaemia was the commonest metabolic abnormality followed by microalbuminuria, low HDL cholesterol, high LDL cholesterol, hypercholesterolaemia and hypertriglyceridaemia in decreasing frequency. For the FDR group, low HDL cholesterol was the commonest metabolic abnormality followed by hypertriglyceridaemia, impaired fasting glucose, high LDL cholesterol, hypertriglyceridaemia and microalbuminuria in decreasing frequency. Hypercholesterolemia and low HDL cholesterol were the commonest metabolic abnormalities in the control group.

Conclusion

The prevalence of the MS in persons with T2DM in Nigeria appears to be high. Secondly, there is a high prevalence of lipid abnormalities in all the study groups.
Relationship between HER2 expression and efficacy with first-line trastuzumab emtansine compared with trastuzumab plus docetaxel in TDM4450g: a randomized phase II study of patients with previously untreated HER2-positive metastatic breast cancer
Authors: Perez Edith A , Hurvitz Sara A , Amler Lukas C , Mundt Kirsten E , Ng Vivian , Guardino Ellie , Gianni Luca
Published: May 2014

Introduction

The purpose of this study was to retrospectively explore the relationship between human epidermal growth factor receptor 2 (HER2) messenger RNA (mRNA) expression and efficacy in patients receiving trastuzumab plus docetaxel (HT) or trastuzumab emtansine (T-DM1).

Methods

Patients with HER2-positive, locally advanced or metastatic breast cancer (MBC) were randomly assigned to HT (n = 70) or T-DM1 (n = 67). HER2 status was assessed locally using immunohistochemistry or fluorescence in situ hybridization and confirmed retrospectively by central testing. HER2 mRNA expression was assessed using quantitative reverse transcriptase polymerase chain reaction.

Results

HER2 mRNA levels were obtained for 116/137 patients (HT = 61; T-DM1 = 55). Median pretreatment HER2 mRNA was 8.9. The risk of disease progression in the overall population was lower with T-DM1 than with HT (hazard ratio (HR) = 0.59; 95% confidence interval (CI) 0.36 to 0.97). This effect was more pronounced in patients with HER2 mRNA ≥ median (HR = 0.39; 95% CI 0.18 to 0.85) versus < median (HR = 0.85; 95% CI 0.44 to 1.67). In the T-DM1 arm, median progression-free survival (PFS) was not reached in patients with HER2 mRNA ≥ median and was 10.6 months in patients with HER2 mRNA < median. In the HT arm, PFS was 8.8 versus 9.8 months in patients with HER2 mRNA ≥ median versus < median, respectively. The effect of HER2 mRNA expression on objective response rates was less pronounced.

Conclusions

This exploratory analysis suggests that while overall, patients with HER2-positive MBC show improved PFS with T-DM1 relative to HT, the effect is enhanced in patients with tumor HER2 mRNA ≥ median.

Trial registration

ClinicalTrials.gov NCT00679341
Metabolic suppression during protracted exposure to hypoxia in the jumbo squid,Dosidicus gigas, living in an oxygen minimum zone
Authors: Seibel Brad A. , Häfker N. Sören , Trübenbach Katja , Zhang J. , Tessier S. N. , Pörtner Hans-Otto , Rosa Rui , Storey Kenneth B.
Published: May 2014

The jumbo squid, Dosidicus gigas, can survive extended forays into the oxygen minimum zone (OMZ) of the Eastern Pacific Ocean. Previous studies have demonstrated reduced oxygen consumption and a limited anaerobic contribution to ATP production, suggesting the capacity for substantial metabolic suppression during hypoxic exposure. Here we provide a more complete description of energy metabolism and explore the expression of proteins indicative of transcriptional and translational arrest that may contribute to metabolic suppression. We demonstrate a suppression of total ATP demand under hypoxic conditions (1% oxygen, PO2 = 0.8 kPa) in both juveniles (52%) and adults (35%) of the jumbo squid. Oxygen consumption rates are reduced to 20% under hypoxia relative to air-saturated controls. Concentrations of Arg-P and ATP declined initially, reaching a new steady state (~30% of controls) after the first hour of hypoxic exposure. Octopine began accumulating after the first hour of hypoxic exposure, once Arg-P breakdown resulted in sufficient free arginine for substrate. Octopine reached levels near 30 mmoles g-1 after 3.4 h of hypoxic exposure. Succinate did increase through hypoxia but contributed minimally to total ATP production. Glycogenolysis in mantle muscle presumably serves to maintain muscle functionality and balance energetics during hypoxia. We provide evidence that post-translational modifications on histone proteins and translation factors serve as a primary means of energy conservation and that select components of the stress response are altered in hypoxic squids. Reduced ATP consumption under hypoxia serves to maintain ATP levels, prolong fuel store use and minimize the accumulation of acidic intermediates of anaerobic ATP generating pathways during prolonged diel forays into the OMZ. Metabolic suppression likely limits active, daytime foraging at depth in the core of the OMZ, but confers an energetic advantage over competitors that must remain in warm, oxygenated surface waters. Moreover, capacity for metabolic suppression provides habitat flexibility as oxygen minimum zones expand due to climate change.
Role of oleoylethanolamide as a feeding regulator in goldfish
Authors: Tinoco Ana B. , Armirotti Andrea , Isorna Esther , Delgado María J. , Piomelli Daniele , de Pedro Nuria
Published: May 2014

Oleoylethanolamide (OEA) is a bioactive lipid mediator, produced in the intestine and other tissues, which is involved in energy balance regulation in mammals, modulating feeding and lipid metabolism. The purpose of the present study was to investigate the presence and possible role of OEA on feeding regulation in goldfish (Carassius auratus Linnaeus 1758). We assessed whether goldfish peripheral tissues and brain contain OEA and their regulation by nutritional status. OEA was detected in all studied tissues (liver, intestinal bulb, proximal intestine, muscle, hypothalamus, telencephalon and brainstem). Food deprivation (48-h) reduced intestinal OEA levels and increased upon re-feeding, suggesting that this compound may be involved in the short-term regulation of food intake in goldfish, as a satiety factor. Next, the effects of acute intraperitoneal administration of OEA on feeding, swimming and plasma levels of glucose and triglycerides were analyzed. Food intake, swimming activity and circulating triglyceride levels were reduced by OEA 2 h post-injection. Finally, the possible interplay among OEA and other feeding regulators (leptin, cholecystokinin, ghrelin, neuropeptide Y, orexin and monoamines) was investigated. OEA actions on energy homeostasis in goldfish could be mediated, at least in part, through interactions with ghrelin and serotonergic system, since OEA treatment reduced ghrelin expression in the intestinal bulb, and increased serotonergic activity in the telencephalon. In summary, our results indicate for the first time in fish that OEA could be involved in the regulation of feeding, swimming and lipid metabolism, suggesting a high conservation of OEA actions in energy balance throughout vertebrate evolution.
The Impact of Advice on Women's and Men's Selection into Competition
Authors: Brandts Jordi , Groenert Valeska , Rott Christina
Published: May 2014

We conduct a laboratory experiment to study how advice by a more experienced and better-informed person affects an individual's entry into a real-effort tournament and the gender gap. Our experiment is motivated by the concerns raised by approaching the gender gap through affirmative action policies. Overall, advice improves the entry decision of subjects, in that forgone earnings due to wrong entry decisions go significantly down. The improvements are mainly driven by increased entry of strong-performing women, who also become more confident, and reduced entry of weak-performing men. We find that the overall gender gap persists even though it disappears among low and strong performers. The persistence is due to an emerging gender gap among intermediate performers driven by women (men) following more the advice to stay out of (enter) the tournament in this performance group.

This paper was accepted by Uri Gneezy, behavioral economics.
Aircraft Rescheduling with Cruise Speed Control
Authors: Aktürk M. Selim , Atamtürk Alper , Gürel Sinan
Published: May 2014

Airline operations are subject to frequent disruptions typically due to unexpected aircraft maintenance requirements and undesirable weather conditions. Recovery from a disruption often involves propagating delays in downstream flights and increasing cruise stage speed when possible in an effort to contain the delays. However, there is a critical trade-off between fuel consumption (and its adverse impact on air quality and greenhouse gas emissions) and cruise speed. Here we consider delays caused by such disruptions and propose a flight rescheduling model that includes adjusting cruise stage speed on a set of affected and unaffected flights as well as swapping aircraft optimally.

To the best of our knowledge, this is the first study in which the cruise speed is explicitly included as a decision variable into an airline recovery optimization model along with the environmental constraints and costs. The proposed model allows one to investigate the trade-off between flight delays and the cost of recovery. We show that the optimization approach leads to significant cost savings compared to the popular recovery method delay propagation.

Flight time controllability, nonlinear delay, fuel burn and CO2 emission cost functions, and binary aircraft swapping decisions complicate the aircraft recovery problem significantly. In order to mitigate the computational difficulty we utilize the recent advances in conic mixed integer programming and propose a strengthened formulation so that the nonlinear mixed integer recovery optimization model can be solved efficiently. Our computational tests on realistic cases indicate that the proposed model may be used by operations controllers to manage disruptions in real time in an optimal manner instead of relying on ad-hoc heuristic approaches.
Learning About Service Orientation in KIBS: Understanding the Customer as an Active Actor
Authors: Kallio Katri , Lappalainen Inka
Published: May 2014

Cocreation of value is a core phenomenon in service systems. It implies that provider companies should change their focus from goods to service and to interaction with customers. Moreover, it means that the customers' role becomes increasingly important in a business activity. This kind of renewal is a learning challenge, as it includes a profound change in the providers' orientation and concrete practices to enhance customer understanding and foster collaboration. This article aims to deepen our knowledge about the complex social reality in which interaction, collaboration, and change processes take place by connecting the service-dominant logic and learning literature. Concrete ways of collaboration and activity changes are examined empirically in a case study. This case study illustrates how and what an information technology company learned when it, together with its customer and end users, developed its offering for service orientation. The results indicate that a genuine change in orientation requires both collaborative experimenting and conceptual learning; i.e., practical experience and its broader reflection go hand in hand. From a theoretical viewpoint, the study provides new insights into the interfaces of service-dominant logic and learning theories in the examination of collaborative service development and service innovation.
Solving the Liner Shipping Fleet Repositioning Problem with Cargo Flows
Authors: Tierney Kevin , Áskelsdóttir Björg , Jensen Rune Møller , Pisinger David
Published: May 2014

We solve a central problem in the liner shipping industry called the liner shipping fleet repositioning problem (LSFRP). The LSFRP poses a large financial burden on liner shipping firms. During repositioning, vessels are moved between routes in a liner shipping network. Liner carriers wish to reposition vessels as cheaply as possible without disrupting cargo flows. The LSFRP is characterized by chains of interacting activities with a multicommodity flow over paths defined by the activities chosen. Despite its industrial importance, the LSFRP has received little attention in the literature. We introduce a novel mathematical model and a simulated annealing algorithm for the LSFRP with cargo flows that makes use of a carefully constructed graph; we evaluate these approaches using real-world data from our industrial collaborator. Additionally, we compare the performance of our approach against an actual repositioning scenario, one of many undertaken by our industrial collaborator in 2011. Our simulated annealing algorithm is able to increase the profit from $18.1 to $31.8 million using only a few minutes of CPU time. This shows that our algorithm could be used in a decision support system to solve the LSFRP.
EFFECTIVENES OF SPIRONOLACTON IN COMPLEX THERAPY OF RHEUMATOID ARTHRITIS
Authors: Komarova Elena , Rebrov Borys
Published: May 2014

Aldosterone blocker – Spironolactone has anti-inflammatory, anti-proliferative and anti-oxidative effects, that is why pathogenetically it is expedient to use it in complex therapy of rheumatoid arthritis.Material and methods: 46 patients with RA took 25-50 mg/day of Spironolactone during 12 months as an addition to standard therapy, the comparison group consisted of 47 patients that got only standard therapy, all the patients were fully examined prior and post the treatment.Results: complex RA therapy leads to improved VAS, HAQ, the antioxidative potential index F; decreased blood concentrations of TNF-α, ICAM-1, FGF and VEGF in contrast to standard therapy. Complex therapy made reduced the DAS 28 more > 0.6.Conclusions: applying of Spironolactone in complex therapy of rheumatoid arthritis contributes to more pronounced improvement in indices of articular syndrome and patient’s life quality, reduce of anti-inflammatory, anti-proliferative and angiogenic cytokines, and more effectively reduces the activity of the disease comparing to standard therapy.
ERYTHROCYTE BLOOD GROUP ANTIGENS AND ALTERATIONS OF THE HORMONAL STATUS AMONG THE REPRODUCTIVE AGE WOMEN WITH BREAST TUMORS
Authors: Nakashidze Irina , Kotrikadze Nanuli , Diasamidze Anzor , Nagervadze Marina , Alibegashvili Manana , Ramishvili Liana , Gordeziani Manana
Published: May 2014

The significance of ABO blood system groups antigens in development of some malignant tumors is already established. The alteration of  hormonal homeostasis must also be taken into account. Hence the aim  of   the investigation was to study ABO  and Rh blood system antigens and hormonal status among  reproductive age  women with benign and malignant breast   tumors. Methods: The determination of  hormones was made by the enzymatic analysis method (ELAIZA), provided by proper ELAIZA kits. For the study of ABO and Rh-Hr system antigens, internationally recognized immunoserology methods were used.Results: High index of  the breast gland tumors  were  revealed  in  patients with A(II) phenotypic group,  according to the  ABO  system.  The frequency distribution of O(I) phenotypic group was low  among women with breast tumors. Among  D, C, E, c and e antigens of  the Rh system, the frequency of D and E antigens were increased in benign and malignant breast tumors patients. The study of hormonal balance revealed thyroid gland hypofunction and increased level of estradiol on the background of  increased testosterone and decreased progesterone levels. Such hormonal imbalance and  excess  production of estradiol creates conditions for malignant tumor formation in reproductive age women.Conclusion: The highest frequency of breast cancer in reproductive age was revealed in A(II) group patients. The wide spectrum of hormonal disorders were revealed in breast tumor patients of the reproductive age, which was especially clear in cases of malignant tumor.
Nursing in the media: some lessons for sub-Saharan Africa
Authors: Watiti James
Published: May 2014

Nursing and midwifery as a profession in Africa has borne the brunt, scant and often stereotyped media attention. An active engagement of the media by the midwifery and nursing community in Africa will serve to raise the profile of the discipline within the public realm.
Reproductive health problems in Sri Lankan adolescents
Authors: Mirkuzie Alemnesh H. , Olsson Pia
Published: May 2014

This qualitative interview study explores twelve adolescent reproductive health (ARH) care providers’ perceptions of ARH problems in Colombo, Sri Lanka. Several minor ARH projects have been running in Colombo and the experience of the providers working in those projects may contribute to the improvement of ARH. Adolescents are challenged by conflicting paradigms regarding sexuality represented by traditional cultural norms recommending sexual abstinence and the modern values with acceptance of love affairs. A variety of ARH problems and reflections over different strategies to improve knowledge, awareness and services were revealed. The need for collaboration between the health, education, social, cultural and legal sectors to diminish ARH problems is clear. The active participation of adolescents in development of programmes and services is needed and the possibility of midwives to contribute to ARH promotion should be considered.
Transmitting infection: testing disinfectants used in maternity units
Authors: Muchina Waithaka Peter , Muchina Emily Njeri
Published: May 2014

The practice of infection control is important in every health care institution since it ensures safety of the patient, health care providers and visitors to the facility and community at large. Instruments and equipment that are re-used from one patient to another should be thoroughly disinfected to minimize, if not eliminate, the possibility of transmitting infections. It is sad that health care providers who are entrusted by an unsuspecting patient should spread infections including such blood-born diseases as HIV, hepatitis and haemorrhagic fevers.

The objective of this study was to establish how effective are the solutions used for disinfecting instruments in health facilities. A ‘disinfectant-in-use’ test was applied to samples collected from five public institutions. In addition the hospital acquired sepsis was analysed from the same institutions to establish a correlation. Forty per cent failed the test by supporting growth of micro-organisms. The duration of disinfectant in use significantly contributed to the failure rate: the higher the duration above that recommended the higher the growth of micro-organism in the sample. Failure to clean the disinfectant container also contributed to failure rate. The facilities that had high disinfectant failure rate also had high prevalence of sepsis. It is recommended that adherence to manufacturer instructions and professional ethics is paramount. Close supervision and regular surveillance on use of disinfectants should be done in all institutions to minimize likelihood of contamination.
Polypharmacy and the QT interval
Authors: Khan Ehsan
Published: May 2014

A mini-systematic review was carried out to examine the evidence base of the effect of multiple drug administration (polypharmacy) on the QT interval in healthy humans. Prolongation of the electrocardiograph QT interval may lead to fatal cardiac arrhythmias and this may be induced by multiple drug administration. Many medications prolong the QT interval and when one of these medications is co-administered with another drug that shares the same pharmacokinetic mechanisms, there is potential for a drug interaction to occur that may prolong the QT interval past normal limits.

Four clinical trials were obtained that examined different drug combinations. The drug combinations used were clinically relevant and are frequently found both in community and hospital-based care. All the studies found increases in circulating drug levels when medications were administered concomitantly. This increase in drug plasma level resulted in QT prolongation in two studies. Thus, depending on the drug combinations used, concomitant dual medication therapies in healthy adults may increase the risk of QT prolongation. This highlights the potential risk of polypharmacy, particularly when patients are pharmacokinetically impaired, as may be the case in many chronic diseases and older age.
The role of complementary therapies in cardiac care: Where are we now?
Authors: Suen Lorna , Thompson David R
Published: May 2014

Complementary medicine is expanding rapidly, with therapies that focus on the holistic care of the individual. Evidence is accumulating to demonstrate that complementary therapies have a promising effect on many cardiovascular conditions. Selected therapies that have demonstrated clinical effectiveness in the promotion of cardiac health are classified under the following categories: energy therapies, alternative medical systems, biologically-based therapies, mind-body interventions and manipulative and body-based methods. It is suggested that each individual therapy should establish clear guidelines regarding the achievement of either self-regulation or statutory regulation. In addition, more rigorously and carefully designed studies should be conducted in order to support the effectiveness of these therapies. Nurses and other health professionals should also develop a basic knowledge of complementary therapies to enable them to educate the patients and evaluate their therapeutic effects more efficiently.
The epidemiology of the metabolic syndrome
Authors: Wild Sarah
Published: May 2014

The metabolic syndrome refers to a clustering of: central obesity, dyslipidaemia, hyper tension and dysglycaemia which is associated with an increased risk of diabetes, cardiovascular disease, liver disease, polycystic ovary syndrome and some cancers. This article reviews the definitions of metabolic syndrome, its prevalence and variations by age, sex, ethnicity and over time. The consequences of the metabolic syndrome are summarized and the value of identifying people with the metabolic syndrome is reviewed.
Consent and the role of the cardiovascular nurse
Authors: J Haxby Elizabeth , Shuldham Caroline
Published: May 2014

Consent is a fundamental part of any interaction between healthcare staff and patients and it is important to ensure that the consent process is appropriately carried out and correctly recorded. In the setting of cardiovascular medicine nurses may have a number of roles pertinent to the consent process including assessing a patient’s competence and understanding as well as ensuring clinical staff provide appropriate and relevant information about potential risks and intended benefits of any procedures. Where competence is lacking the nurse has a duty, as part of the multi-disciplinary team, to ensure that whatever care is provided is done in the patient’s ‘best interests’. Nursing staff need to be familiar with their own trust’s policy on consent to examination and treatment, how different circumstances may impact on the consent process e.g. emergency situations and how to access additional advice when necessary.
Rationale for a rapid access blackouts triage clinic
Authors: Petkar Sanjiv , Bell Winifred , Rice Nicola , Iddon Pamela , Cooper Paul , Fitzpatrick Adam
Published: May 2014

Patients with ‘Clapse?cause’ are common in emergency care in the UK. ‘Collapse’ refers to patients who have suffered an abrupt loss of postural control. Collapse is not synonymous with loss of consciousness, though loss of consciousness commonly results in collapse. Collapse due to transient loss of consciousness (T-LOC) is referred to by patients as a ‘blackout’. The three common causes of blackouts/T-LOC are syncope, epilepsy or psychogenic blackouts. Among these, syncope is much the most prevalent. Problems have been identified in the care of patients with T-LOC/blackouts. The Manchester Rapid Access Blackouts Triage Clinic aims to address these. This article deals with the rationale behind this clinic.
Understanding and interpreting a chest X-ray
Authors: Ash-Miles Janice , Callaway Mark
Published: May 2014

This article explains the procedure for taking and interpreting a chest X-ray (CXR), The CXR contains a vast amount of information about many important body structures and systems. By setting out how the images are obtained and how a radiologist’s report is put together it is intended to inform cardiovascular nurses, who may be required to request an X-ray for a patient or asked to comment on the significance of a film.
Consent and lack of capacity
Authors: Haxby Elizabeth J , Shuldham Caroline
Published: May 2014

In order to ensure consent is valid the patient must have capacity to make the decision in question. Where capacity is lacking the code of practice of the Mental Capacity Act (2005) must be followed and a number of options exist in relation to consent for medical treatment. The Act sets out the statutory obligations of healthcare staff in relation to the care management of patients who lack capacity. It makes provision for others to consent on behalf of an individual who lacks capacity either through donation of lasting power of attorney or through the appointment of court of protection deputies. In addition advance decisions, verbal or in writing, made by a patient in anticipation of a time when they lose capacity to make decisions for themselves are now formally recognised and binding on healthcare staff providing they are valid and relate to the circumstances in question. Where such a decision pertains to withdrawal or withholding life-sustaining treatment the decision must be witnessed and in writing and include the statement ‘even if life is at risk’. Nursing staff should be familiar with the processes which must be followed when caring for patients who lack capacity since they impact on the provision of day to day care as well as more major interventions such as surgery.
Eisenmenger’s syndrome:A review of the pathophysiology and therapeutic options
Authors: Bradford Rebecca , Tulloh Robert
Published: May 2014

The number of children with congenital heart disease graduating to adult care is increasing rapidly as treatment becomes more successful. A significant proportion has pulmonary hypertension, which will lead to Eisenmenger’s syndrome, having an associated high morbidity and mortality rate. This article discusses the pathophysiology of Eisenmenger’s syndrome, its clinical course and management. Medical management of these complex patients is evolving quickly and rapidly changing. We discuss each of the therapies available for the treatment of this disease, use of phosphodiesterase inhibitors, endothelin receptor antagonists and prostanoids. Transplantation is now less likely with these new medications. We also discuss the important role of the nurse in Eisenmenger’s syndrome and administration of various therapies.